{"id":28235,"date":"2023-04-25T10:27:55","date_gmt":"2023-04-25T03:27:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28235"},"modified":"2023-04-25T10:28:11","modified_gmt":"2023-04-25T03:28:11","slug":"ung-thu-co-tu-cung-huong-dan-dieu-tri-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/ung-thu-co-tu-cung-huong-dan-dieu-tri-theo-bo-y-te\/","title":{"rendered":"Ung th\u01b0 c\u1ed5 t\u1eed cung: H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf"},"content":{"rendered":"<p><strong>Ung th\u01b0 c\u1ed5 t\u1eed cung l\u00e0 b\u1ec7nh ung th\u01b0 ph\u1ed5 bi\u1ebfn \u1edf ph\u1ee5 n\u1eef nhi\u1ec1u n\u01b0\u1edbc tr\u00ean th\u1ec3 gi\u1edbi. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung gi\u00fap t\u0103ng c\u01a1 h\u1ed9i ch\u1eefa kh\u1ecfi b\u1ec7nh v\u00e0 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. B\u00e0i vi\u1ebft s\u1ebd gi\u1edbi thi\u1ec7u v\u1ec1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung theo b\u1ed9 Y t\u1ebf.<\/strong><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 ung th\u01b0 c\u1ed5 t\u1eed cung<\/h2>\n<p>Ung th\u01b0 c\u1ed5 t\u1eed cung l\u00e0 b\u1ec7nh ung th\u01b0 ph\u1ed5 bi\u1ebfn \u1edf ph\u1ee5 n\u1eef nhi\u1ec1u n\u01b0\u1edbc tr\u00ean th\u1ec3 gi\u1edbi.Theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) n\u0103m 2020, tr\u00ean th\u1ebf gi\u1edbi c\u00f3 h\u01a1n 600.000 ng\u01b0\u1eddi m\u1edbi m\u1eafc v\u00e0 x\u1ea5p x\u1ec9 342.000 ng\u01b0\u1eddi v\u1eed vong v\u00ec ung th\u01b0 c\u1ed5 t\u1eed cung. T\u1ea1i Vi\u1ec7t Nam, m\u1ed7i n\u0103m c\u00f3 h\u01a1n 5.100 ca m\u1eafc m\u1edbi v\u00e0 kho\u1ea3ng 2.400 ca t\u1eed vong v\u00ec c\u0103n b\u1ec7nh n\u00e0y. Trong 30 n\u0103m qua, nh\u1edd c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh s\u00e0ng l\u1ecdc ph\u00e1t hi\u1ec7n s\u1edbm ung th\u01b0 c\u1ed5 t\u1eed cung b\u1eb1ng x\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o h\u1ecdc c\u1ed5 t\u1eed cung &#8211; \u00e2m \u0111\u1ea1o, \u0111\u00e3 gi\u00fap gi\u1ea3m 70% t\u1ef7 l\u1ec7 t\u1eed vong do ung th\u01b0 c\u1ed5 t\u1eed cung.<\/p>\n<figure id=\"attachment_28231\" aria-describedby=\"caption-attachment-28231\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-28231\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20201220_132120_290098_57.max-1800x1800-1-300x178.jpg\" alt=\"minh-hoa-ung-thu-co-tu-cung-pho-bien\" width=\"300\" height=\"178\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20201220_132120_290098_57.max-1800x1800-1-300x178.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20201220_132120_290098_57.max-1800x1800-1-768x455.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20201220_132120_290098_57.max-1800x1800-1.jpg 800w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-28231\" class=\"wp-caption-text\">Ung th\u01b0 c\u1ed5 t\u1eed cung l\u00e0 b\u1ec7nh ung th\u01b0 ph\u1ed5 bi\u1ebfn \u1edf ph\u1ee5 n\u1eef nhi\u1ec1u n\u01b0\u1edbc tr\u00ean th\u1ebf gi\u1edbi<\/figcaption><\/figure>\n<h2>2. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung<\/h2>\n<p>T\u00f9y theo giai \u0111o\u1ea1n b\u1ec7nh, th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc, t\u00ecnh tr\u1ea1ng c\u1ee5 th\u1ec3 \u0111\u1ec3 \u0111\u01b0a ra c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p. C\u1ee5 th\u1ec3:<\/p>\n<h3>2.1. Giai \u0111o\u1ea1n ti\u1ec1n x\u00e2m nh\u1eadp<\/h3>\n<p>Lo\u1ea1n s\u1ea3n, ung th\u01b0 t\u1ea1i ch\u1ed7. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb: \u0111\u1ed1t l\u1ea1nh, \u0111\u1ed1t laser, c\u1eaft v\u00f2ng (LEEP), kho\u00e9t ch\u00f3p c\u1ed5 t\u1eed cung, c\u1eaft t\u1eed cung to\u00e0n b\u1ed9.<\/p>\n<h3>2.2. Giai \u0111o\u1ea1n x\u00e2m nh\u1eadp<\/h3>\n<h4>2.2.1. Ph\u1eabu thu\u1eadt<\/h4>\n<p><strong>2.2.1.1. Kho\u00e9t ch\u00f3p t\u1eed cung<\/strong><\/p>\n<p>Ch\u1ec9 \u0111\u1ecbnh: giai \u0111o\u1ea1n IA1, ph\u1ee5 n\u1eef tr\u1ebb, mong mu\u1ed1n sinh con.<\/p>\n<p><strong>2.2.1.2. Ph\u1eabu thu\u1eadt Wertheim Meigs<\/strong><\/p>\n<p>C\u1eaft t\u1eed cung to\u00e0n b\u1ed9 + 2 ph\u1ea7n ph\u1ee5 + v\u00e9t h\u1ea1ch ch\u1eadu hai b\u00ean. Ch\u1ec9 \u0111\u1ecbnh: giai \u0111o\u1ea1n I, IIa.<\/p>\n<h4>2.2.2. X\u1ea1 tr\u1ecb<\/h4>\n<p>C\u00f3 th\u1ec3 \u0111\u01a1n thu\u1ea7n, k\u1ebft h\u1ee3p v\u1edbi ph\u1eabu thu\u1eadt, h\u00f3a ch\u1ea5t.<\/p>\n<h5><strong>2.2.2.1. X\u1ea1 tr\u1ecb tri\u1ec7t c\u0103n \u0111\u01a1n thu\u1ea7n<\/strong><\/h5>\n<ul>\n<li>Ch\u1ec9 \u0111\u1ecbnh: giai \u0111o\u1ea1n O, I, II<sub>A<\/sub>, II<sub>B<\/sub>.<\/li>\n<\/ul>\n<p>Ph\u01b0\u01a1ng ph\u00e1p: k\u1ebft h\u1ee3p <a href=\"https:\/\/vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/xa-tri-ung-thu-co-tu-cung-nhung-dieu-can-biet\/\">x\u1ea1 tr\u1ecb<\/a> ngo\u00e0i v\u00e0 x\u1ea1 tr\u1ecb \u00e1p s\u00e1t. C\u00f3 th\u1ec3 x\u1ea1 tr\u1ecb b\u1eb1ng m\u00e1y <sup>60<\/sup>Co ho\u1eb7c m\u00e1y gia t\u1ed1c theo ph\u01b0\u01a1ng ph\u00e1p 3D conformal ho\u1eb7c x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u, \u0111i\u1ec1u bi\u1ebfn th\u1ec3 t\u00edch, x\u1ea1 tr\u1ecb proton. Ch\u1ee5p m\u00f4 ph\u1ecfng b\u1eb1ng CT, MRI ho\u1eb7c PET\/CT, PET\/MRI.<\/p>\n<ul>\n<li>X\u1ea1 tr\u1ecb \u00e1p s\u00e1t \u0111\u01a1n thu\u1ea7n: giai \u0111o\u1ea1n O, I<sub>A1<\/sub>, I<sub>A2<\/sub>.<\/li>\n<\/ul>\n<p>+ X\u1ea1 tr\u1ecb t\u1eeb ngo\u00e0i k\u1ebft h\u1ee3p x\u1ea1 tr\u1ecb \u00e1p s\u00e1t: giai \u0111o\u1ea1n II<sub>A<\/sub>, II<sub>B<\/sub>.<\/p>\n<p>+ Th\u1ec3 t\u00edch chi\u1ebfu x\u1ea1 bao g\u1ed3m c\u1ed5 t\u1eed cung, t\u1eed cung, hai ph\u1ea7n ph\u1ee5, h\u1ea1ch ch\u1eadu ngo\u00e0i, ch\u1eadu trong, ch\u1eadu g\u1ed1c.<\/p>\n<p>+ Li\u1ec1u l\u01b0\u1ee3ng: t\u00f9y thu\u1ed9c th\u1ec3 t\u00edch kh\u1ed1i u v\u00e0 s\u1ef1 ph\u1ed1i h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb \u00e1p s\u00e1t. T\u1ed5ng li\u1ec1u: x\u1ea1 tr\u1ecb t\u1eeb ngo\u00e0i 50Gy v\u00e0o ti\u1ec3u khung, x\u1ea1 tr\u1ecb \u00e1p s\u00e1t v\u00e0o t\u1eed cung &#8211; \u00e2m \u0111\u1ea1o 20Gy.<\/p>\n<h5>2.2.2.2. X\u1ea1 tr\u1ecb ti\u1ec1n ph\u1eabu<\/h5>\n<ul>\n<li>Ch\u1ec9 \u0111\u1ecbnh: giai \u0111o\u1ea1n I<sub>B<\/sub>, II<sub>A<\/sub>.<\/li>\n<li>Ph\u00e1c \u0111\u1ed3:<\/li>\n<\/ul>\n<p>+ N\u1ebfu t\u1ed5n th\u01b0\u01a1ng &lt;4cm: x\u1ea1 tr\u1ecb \u00e1p s\u00e1t v\u00e0o t\u1eed cung, \u00e2m \u0111\u1ea1o li\u1ec1u 60Gy t\u1ea1i \u0111i\u1ec3m A; ph\u1eabu thu\u1eadt Wertheim sau 6 tu\u1ea7n.<\/p>\n<p>+ N\u1ebfu t\u1ed5n th\u01b0\u01a1ng &gt;4cm: x\u1ea1 tr\u1ecb t\u1eeb ngo\u00e0i v\u00e0o v\u00f9ng ch\u1eadu 20-30Gy; x\u1ea1 tr\u1ecb \u00e1p s\u00e1t v\u00e0o t\u1eed cung, \u00e2m \u0111\u1ea1o li\u1ec1u 65-70Gy t\u1ea1i \u0111i\u1ec3m A; ph\u1eabu thu\u1eadt Wertheim sau 6 tu\u1ea7n.<\/p>\n<h5>2.2.2.3. X\u1ea1 tr\u1ecb h\u1eadu ph\u1eabu<\/h5>\n<ul>\n<li>Ch\u1ec9 \u0111\u1ecbnh: sau ph\u1eabu thu\u1eadt, k\u1ebft qu\u1ea3 m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a h\u1ea1ch, di\u1ec7n c\u1eaft d\u00e2y ch\u1eb1ng r\u1ed9ng, \u00e2m \u0111\u1ea1o d\u01b0\u01a1ng t\u00ednh.<\/li>\n<li>Bi\u1ec7n ph\u00e1p: x\u1ea1 tr\u1ecb \u00e1p s\u00e1t m\u1ecfm c\u1ee5t \u00e2m \u0111\u1ea1o li\u1ec1u 25-30Gy ho\u1eb7c x\u1ea1 tr\u1ecb t\u1eeb ngo\u00e0i v\u00e0o ti\u1ec3u khung li\u1ec1u 30-50Gy v\u00e0 c\u00f3 th\u1ec3 n\u00e2ng li\u1ec1u v\u00e0o v\u00f9ng h\u1ea1ch ch\u1eadu \u0111\u1ebfn 50-55Gy t\u00f9y theo \u0111\u00e3 x\u1ea1 ngo\u00e0i tr\u01b0\u1edbc \u0111\u00f3 hay ch\u01b0a.<\/li>\n<\/ul>\n<h5>2.2.2.4. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p x\u1ea1 tr\u1ecb<\/h5>\n<p>X\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i (EBRT: External Beam Radiation Therapy):<\/p>\n<ul>\n<li>S\u1eed d\u1ee5ng h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh ho\u1eb7c PET\/CT \u0111\u1ec3 m\u00f4 ph\u1ecfng l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb. PET\/CT gi\u00fap \u0111\u00e1nh gi\u00e1 di c\u0103n h\u1ea1ch t\u1ed1t h\u01a1n CT. Tuy nhi\u00ean, c\u1ed9ng h\u01b0\u1edfng t\u1eeb l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 x\u00e2m l\u1ea5n c\u1ee7a kh\u1ed1i u v\u00e0o t\u1eed cung, \u00e2m \u0111\u1ea1o v\u00e0 t\u1ed5 ch\u1ee9c xung quanh.<\/li>\n<\/ul>\n<p>Th\u1ec3 t\u00edch x\u1ea1 tr\u1ecb bao g\u1ed3m to\u00e0n b\u1ed9 kh\u1ed1i u, d\u00e2y ch\u1eb1ng t\u1eed cung-c\u00f9ng, \u00e2m \u0111\u1ea1o (d\u01b0\u1edbi 3cm di\u1ec7n u x\u00e2m l\u1ea5n t\u1edbi \u00e2m \u0111\u1ea1o), h\u1ea1ch tr\u01b0\u1edbc x\u01b0\u01a1ng c\u00f9ng v\u00e0 c\u00e1c h\u1ea1ch v\u00f9ng t\u1ea1i v\u1ecb tr\u00ed kh\u00e1c c\u00f3 nguy c\u01a1 b\u1ecb di c\u0103n<\/p>\n<ul>\n<li>\u0110\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 di c\u0103n h\u1ea1ch sau ph\u1eabu thu\u1eadt ho\u1eb7c kh\u00f4ng r\u00f5 di c\u0103n h\u1ea1ch tr\u00ean c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u00ec th\u1ec3 t\u00edch x\u1ea1 tr\u1ecb c\u1ea7n bao to\u00e0n b\u1ed9 h\u1ea1ch ch\u1eadu ngo\u00e0i, ch\u1eadu trong v\u00e0 h\u1ed1 b\u1ecbt.<\/li>\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 di c\u0103n h\u1ea1ch nhi\u1ec1u (kh\u1ed1i u k\u00edch th\u01b0\u1edbc l\u1edbn, kh\u1ed1i u, nghi ng\u1edd ho\u1eb7c c\u00f3 di c\u0103n h\u1ea1ch ch\u1eadu) th\u00ec th\u1ec3 t\u00edch x\u1ea1 tr\u1ecb c\u1ea7n bao c\u1ea3 h\u1ea1ch ch\u1eadu chung.<\/li>\n<li>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 di c\u0103n h\u1ea1ch ch\u1eadu chung v\u00e0\/ho\u1eb7c h\u1ea1ch c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 th\u00ec tr\u01b0\u1eddng chi\u1ebfu c\u1ea7n m\u1edf r\u1ed9ng \u0111\u1ebfn h\u1ea1ch c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ngang m\u1ee9c \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/li>\n<li>Li\u1ec1u x\u1ea1 tr\u1ecb ngo\u00e0i d\u1ef1 ph\u00f2ng h\u1ea1ch l\u00e0 45Gy (ph\u00e2n li\u1ec1u 1,8-2,0Gy m\u1ed7i ng\u00e0y) v\u00e0 n\u1ebfu c\u00f3 h\u1ea1ch di c\u0103n m\u00e0 kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 t\u0103ng th\u00eam 10-15Gy v\u00e0o h\u1ea1ch n\u00e0y.<\/li>\n<li>\u0110\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c n\u00ean \u0111i\u1ec1u tr\u1ecb h\u00f3a-x\u1ea1 tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi cisplatin 40mg\/m<sup>2<\/sup>\/h\u00e0ng tu\u1ea7n trong 5 tu\u1ea7n ho\u1eb7c cisplatin+ 5-fluorouracil (5-FU 750mg\/m<sup>2 <\/sup>da\/ng\u00e0y 1-5 v\u00e0 cisplatin 75mg\/m<sup>2<\/sup> da ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y).<\/li>\n<li>X\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u (IMRT), x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn th\u1ec3 t\u00edch (VMAT) l\u00e0 c\u00e1c k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111\u1ea1t li\u1ec1u x\u1ea1 tr\u1ecb v\u00e0o kh\u1ed1i u v\u00e0 h\u1ea1ch l\u00e0 cao nh\u1ea5t m\u00e0 gi\u1ea3m thi\u1ec3u li\u1ec1u b\u1ee9c x\u1ea1 \u0111\u1ebfn ru\u1ed9t non, tr\u1ef1c tr\u00e0ng v\u00e0 c\u00e1c c\u1ea5u tr\u00fac kh\u00e1c (\u0111\u1eb7c bi\u1ec7t c\u00f3 \u00edch khi x\u1ea1 tr\u1ecb li\u1ec1u cao v\u00e0o kh\u1ed1i u, h\u1ea1ch v\u00f9ng v\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n sau khi c\u1eaft b\u1ecf t\u1eed cung, khi x\u1ea1 tr\u1ecb v\u00e0o h\u1ea1ch c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7).<\/li>\n<\/ul>\n<p>Khi x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u, c\u1ea7n ph\u1ea3i xem x\u00e9t li\u1ec1u x\u1ea1 tr\u1ecb \u0111\u1ebfn t\u1ed5 ch\u1ee9c ung th\u01b0 v\u00e0 m\u00f4 l\u00e0nh b\u1eb1ng c\u00e1ch ki\u1ec3m tra \u0111\u1ea3m b\u1ea3o ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a qu\u00e1 tr\u00ecnh x\u1ea1 tr\u1ecb.<\/p>\n<p>Tuy nhi\u00ean, IMRT kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ec3 thay th\u1ebf x\u1ea1 tr\u1ecb \u00e1p s\u00e1t trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung.<\/p>\n<h5>2.2.2.5. X\u1ea1 tr\u1ecb \u00e1p s\u00e1t (Brachytherapy)<\/h5>\n<p>X\u1ea1 tr\u1ecb \u00e1p s\u00e1t li\u1ec1u cao ph\u1ed1i h\u1ee3p v\u1edbi x\u1ea1 ngo\u00e0i c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung. X\u1ea1 tr\u1ecb \u00e1p s\u00e1t nh\u1eb1m m\u1ee5c \u0111\u00edch n\u00e2ng li\u1ec1u cao t\u1ea1i v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng c\u1ed5 t\u1eed cung, eo c\u1ed5 t\u1eed cung, th\u00e2n t\u1eed cung v\u00e0 v\u00f9ng c\u1eadn k\u1ec1. Li\u1ec1u x\u1ea1 suy gi\u1ea3m nhanh t\u1ef7 l\u1ec7 ngh\u1ecbch v\u1edbi kho\u1ea3ng c\u00e1ch, v\u1eeba \u0111\u1ea1t m\u1ee5c \u0111\u00edch \u0111\u01b0a li\u1ec1u cao t\u1ea1i v\u1ecb tr\u00ed u, gi\u1ea3m li\u1ec1u t\u1ea1i b\u00e0ng quang, tr\u1ef1c tr\u00e0ng.<\/p>\n<h5>2.2.2.6. X\u1ea1 tr\u1ecb trong m\u1ed5 (Intraoperative Radiation Therapy: IORT)<\/h5>\n<ul>\n<li>IORT l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 cung c\u1ea5p m\u1ed9t li\u1ec1u x\u1ea1 tr\u1ecb duy nh\u1ea5t, t\u1eadp trung cao li\u1ec1u b\u1ee9c x\u1ea1 t\u1ea1i n\u1ec1n kh\u1ed1i u sau ph\u1eabu thu\u1eadt ho\u1eb7c c\u00e1c kh\u1ed1i u kh\u00f4ng th\u1ec3 c\u1eaft b\u1ecf h\u1ebft \u0111\u01b0\u1ee3c, c\u00e1c kh\u1ed1i u t\u00e1i ph\u00e1t.<\/li>\n<li>Trong IORT, c\u00e1c m\u00f4 b\u00ecnh th\u01b0\u1eddng (nh\u01b0 ru\u1ed9t ho\u1eb7c c\u00e1c t\u1ea1ng kh\u00e1c) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1eb7t tr\u00e1nh xa v\u00f9ng x\u1ea1 tr\u1ecb n\u00ean r\u1ea5t \u00edt t\u00e1c d\u1ee5ng ph\u1ee5.<\/li>\n<li>IORT c\u00f3 nhi\u1ec1u lo\u1ea1i k\u00edch th\u01b0\u1edbc c\u1ee7a \u0111\u1ea7u ph\u00e1t tia b\u1ee9c x\u1ea1 (applicator) kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o di\u1ec7n c\u1eaft v\u00e0 h\u00ecnh d\u1ea1ng kh\u1ed1i u, h\u01a1n n\u1eefa di\u1ec7n t\u00edch x\u1ea1 tr\u1ecb h\u1ea1n ch\u1ebf n\u00ean b\u1ea3o v\u1ec7 c\u00e1c c\u1ea5u tr\u00fac b\u00ecnh th\u01b0\u1eddng xung quanh v\u00f9ng chi\u1ebfu x\u1ea1.<\/li>\n<\/ul>\n<h4>2.2.3. H\u00f3a tr\u1ecb<\/h4>\n<h5>2.2.3.1. Ch\u1ec9 \u0111\u1ecbnh:<\/h5>\n<p>Giai \u0111o\u1ea1n II<sub>B<\/sub>, III, IV. B\u1ec7nh nh\u00e2n t\u1eeb ch\u1ed1i ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb.<\/p>\n<h5>2.2.3.2. Ph\u01b0\u01a1ng th\u1ee9c<\/h5>\n<ul>\n<li>H\u00f3a ch\u1ea5t \u0111\u01a1n thu\u1ea7n: giai \u0111o\u1ea1n IV<sub>B<\/sub>.<\/li>\n<li>H\u00f3a ch\u1ea5t ti\u1ec1n ph\u1eabu: giai \u0111o\u1ea1n II<sub>B<\/sub>.<\/li>\n<li>H\u00f3a ch\u1ea5t h\u1eadu ph\u1eabu: sau ph\u1eabu thu\u1eadt, k\u1ebft qu\u1ea3 m\u00f4 b\u1ec7nh h\u1ecdc \u1edf h\u1ea1ch, di\u1ec7n c\u1eaft d\u00e2y ch\u1eb1ng r\u1ed9ng, \u00e2m \u0111\u1ea1o d\u01b0\u01a1ng t\u00ednh (k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb).<\/li>\n<li>H\u00f3a ch\u1ea5t k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb: giai \u0111o\u1ea1n II<sub>B<\/sub>, III, IV.<\/li>\n<\/ul>\n<p>Tr\u01b0\u1eddng h\u1ee3p giai \u0111o\u1ea1n I<sub>B2<\/sub>, II<sub>A<\/sub> n\u1ebfu b\u1ec7nh nh\u00e2n t\u1eeb ch\u1ed1i ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc h\u00f3a ch\u1ea5t k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb.<\/p>\n<h5>2.2.3.3. C\u00e1c ph\u00e1c \u0111\u1ed3<\/h5>\n<p><strong>Ph\u00e1c \u0111\u1ed3 cisplatin \u0111\u01a1n thu\u1ea7n<\/strong><\/p>\n<p>Cisplatin: 50mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p>Ho\u1eb7c<\/p>\n<p>Cisplatin: 40mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch h\u00e0ng tu\u1ea7n, k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 capecitabine<\/strong><\/p>\n<p>Capecitabine 1.000-1.250mg\/m<sup>2<\/sup>\/l\u1ea7n, u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y, ng\u00e0y 1-14, chu k\u1ef3 21 ng\u00e0y<\/p>\n<p>Ho\u1eb7c<\/p>\n<p>Capecitabine 825mg\/m<sup>2<\/sup>\/l\u1ea7n, u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y, ng\u00e0y 1-5, chu k\u1ef3 21 ng\u00e0y k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 UFT<\/strong><\/p>\n<p>UFT (Tegafur+Uracil): 100-125mg\/m<sup>2<\/sup>, u\u1ed1ng x 3 l\u1ea7n\/ng\u00e0y, ng\u00e0y 1-14, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 docetaxel \u0111\u01a1n thu\u1ea7n\u00a0<\/strong><\/p>\n<p>Docetaxel 100mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 paclitaxel \u0111\u01a1n thu\u1ea7n<\/strong><\/p>\n<p>Paclitaxel 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 vinorelbine<\/strong><\/p>\n<p>Vinorelbine 30mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 8 ho\u1eb7c vinorelbin 60-80mg\/m<sup>2<\/sup> da, u\u1ed1ng ng\u00e0y 1, 8. Chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 topotecan<\/strong><\/p>\n<p>Topotecan 1,5mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch, chu k\u1ef3 3-4 tu\u1ea7n.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 Irinotecan<\/strong><\/p>\n<p>Irinotecan 125mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 8, 15, 28. Chu k\u1ef3 42 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 pemetrexed<\/strong><\/p>\n<p>Pemetrexed 900mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 gemcitabine\u00a0<\/strong><\/p>\n<p>Gemcitabine 800mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 8, 15. Chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 5 FU<\/strong><\/p>\n<p>5-FU 370mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch bolus<\/p>\n<p>Leucovorin 200mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch bolus, m\u1ed7i 4 tu\u1ea7n.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 gemcitabine &#8211; cisplatin<\/strong><\/p>\n<p>Cisplatin 30mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 8<\/p>\n<p>Gemcitabine 800mg\/m<sup>2<\/sup> da, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 8. Chu k\u1ef3 28 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 PF<\/strong><\/p>\n<p>Cisplatin: 50 -75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>5 FU: 750mg-1.000mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1-4; chu k\u1ef3 21-28 ng\u00e0y, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 PC<\/strong><\/p>\n<p>Paclitaxel 135mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch 24 gi\u1edd ng\u00e0y 1<\/p>\n<p>Cisplatin: 50mg-75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 2, chu k\u1ef3 21 ng\u00e0y<\/p>\n<p>Ho\u1eb7c<\/p>\n<p>Paclitaxel 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Cisplatin: 75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y<\/p>\n<p>Ho\u1eb7c<\/p>\n<p>Paclitaxel 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Carboplatin: 300mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 topotecan &#8211; cisplatin<\/strong><\/p>\n<p>Topotecan 0,75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat, ng\u00e0y 1-3 Cisplatin: 50mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 topotecan &#8211; paclitaxel<\/strong><\/p>\n<p>Topotecan 0,75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat, ng\u00e0y 1-3 Paclitaxel: 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 vinorelbine &#8211; cisplatin<\/strong><\/p>\n<p>Vinorelbine 30mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch trong 6-10 ph\u00fat, ho\u1eb7c 60-80mg\/m<sup>2<\/sup> u\u1ed1ng, h\u00e0ng tu\u1ea7n.<\/p>\n<p>Cisplatin: 75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch trong 4 gi\u1edd ng\u00e0y 1, chu k\u1ef3 28 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 EP<\/strong><\/p>\n<p>Etoposide: 40mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1-5 Cisplatin: 25mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1-5 Chu k\u1ef3 2 tu\u1ea7n, c\u00f3 th\u1ebf k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 IP<\/strong><\/p>\n<p>Ifosfamide: 5.000mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch 24 gi\u1edd ng\u00e0y 1<\/p>\n<p>Cisplatin: 50mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y<\/p>\n<p>Ho\u1eb7c<\/p>\n<p>Cisplatin: 20mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1-5<\/p>\n<p>Ifosfamide: 1.200mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1-5, chu k\u1ef3 21 ng\u00e0y<\/p>\n<p>Ho\u1eb7c<\/p>\n<p>Ifosfamide: 5.000mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch 24 gi\u1edd ng\u00e0y 1<\/p>\n<p>Carboplatin: 300mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 28 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 TIP<\/strong><\/p>\n<p>Paclitaxel: 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Cisplatin: 50mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Ifosfamide: 5.000mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch 24 gi\u1edd ng\u00e0y 2, chu k\u1ef3 28 ng\u00e0y.<\/p>\n<p><em><strong>L\u01b0u \u00fd:<\/strong><\/em> Trong c\u00e1c ph\u00e1c \u0111\u1ed3 khi truy\u1ec1n ifosfamide c\u1ea7n ph\u1ed1i h\u1ee3p truy\u1ec1n mesna li\u1ec1u t\u1eeb 50% \u0111\u1ebfn 100% li\u1ec1u ifosfamide, truy\u1ec1n tr\u01b0\u1edbc v\u00e0 sau ifosfamide \u0111\u1ec3 h\u1ea1n ch\u1ebf t\u00e1c d\u1ee5ng ph\u1ee5.<\/p>\n<h5>2.2.3.4. \u0110i\u1ec1u tr\u1ecb \u0111\u00edch Bevacizumab:<\/h5>\n<ul>\n<li>Thu\u1ed1c kh\u00e1ng sinh m\u1ea1ch l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng t\u00e1i t\u1ed5 h\u1ee3p (monoclonal antibody), t\u00e1c \u0111\u1ed9ng \u0111\u1eb7c hi\u1ec7u l\u00ean th\u1ee5 th\u1ec3 t\u0103ng sinh n\u1ed9i m\u1ea1c m\u1ea1ch m\u00e1u (Vascular endothelial growth factor &#8211; VEGF) tr\u00ean t\u1ebf b\u00e0o ung th\u01b0. Bevacizumab ph\u00e1t huy t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m t\u0103ng sinh m\u1ea1ch, gi\u1ea3m nu\u00f4i d\u01b0\u1ee1ng t\u1ebf b\u00e0o u, gi\u1ea3m kh\u1ea3 n\u0103ng di chuy\u1ec3n x\u00e2m nh\u1eadp di c\u0103n c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0, \u0111\u01b0a t\u1ebf b\u00e0o ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh, l\u00e0m t\u0103ng nh\u1ea1y c\u1ea3m c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0 v\u1edbi h\u00f3a tr\u1ecb li\u1ec7u.<\/li>\n<li>Bevacizumab \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho ung th\u01b0 bi\u1ec3u m\u00f4 c\u1ed5 t\u1eed cung dai d\u1eb3ng, t\u00e1i ph\u00e1t ho\u1eb7c di c\u0103n.<\/li>\n<li>Li\u1ec1u d\u00f9ng: 15mg\/kg, truy\u1ec1n t\u0129nh m\u1ea1ch m\u1ed7i 3 tu\u1ea7n ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c ph\u00e1c \u0111\u1ed3 h\u00f3a ch\u1ea5t cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n ho\u1eb7c xu\u1ea5t hi\u1ec7n \u0111\u1ed9c t\u00ednh kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c.<\/li>\n<\/ul>\n<p><strong>Ph\u00e1c \u0111\u1ed3 BPC<\/strong><\/p>\n<p>Bevacizumab 15mg\/kg, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Paclitaxel 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Cisplatin: 50mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p><strong>Ph\u00e1c \u0111\u1ed3 BTP<\/strong><\/p>\n<p>Bevacizumab 15mg\/kg, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1<\/p>\n<p>Topotecan 0,75mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat, ng\u00e0y 1-3 Paclitaxel: 175mg\/m<sup>2<\/sup>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y.<\/p>\n<p>C\u00e1c thu\u1ed1c ph\u00e2n t\u1eed nh\u1ecf: Sunitinib, Erlotinib, Lapatinib, Pazopanib \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung h\u1ee9a h\u1eb9n k\u1ebft qu\u1ea3 kh\u1ea3 quan.<\/p>\n<p><strong>2.2.3.5. \u0110i\u1ec1u tr\u1ecb mi\u1ec5n d\u1ecbch<\/strong><\/p>\n<p>Th\u00e1ng 6 n\u0103m 2018, pembrolizumab \u0111\u00e3 \u0111\u01b0\u1ee3c FDA ph\u00ea duy\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n ung th\u01b0 c\u1ed5 t\u1eed cung c\u00f3 b\u1ed9c l\u1ed9 PD-L1 t\u00e1i ph\u00e1t, di c\u0103n ho\u1eb7c ti\u1ebfn tri\u1ec3n b\u1ec7nh trong ho\u1eb7c sau khi h\u00f3a tr\u1ecb.<\/p>\n<p>Li\u1ec1u pembrolizumab 200mg\/m<sup>2<\/sup> t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y, \u0111\u1ebfn 2 n\u0103m ho\u1eb7c khi b\u1ec7nh ti\u1ebfn tri\u1ec3n ho\u1eb7c kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c.<\/p>\n<h3>2.3. \u0110i\u1ec1u tr\u1ecb trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p u x\u00e2m l\u1ea5n r\u1ed9ng, di c\u0103n xa<\/h3>\n<ul>\n<li>U x\u00e2m l\u1ea5n b\u00e0ng quang, tr\u1ef1c tr\u00e0ng: n\u1ebfu c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt th\u00ec ph\u1eabu thu\u1eadt v\u00e9t \u0111\u00e1y ch\u1eadu tr\u01b0\u1edbc, sau, to\u00e0n b\u1ed9 + \u0111i\u1ec1u tr\u1ecb h\u00f3a x\u1ea1 tr\u1ecb; n\u1ebfu kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt th\u00ec \u0111i\u1ec1u tr\u1ecb h\u00f3a x\u1ea1 tr\u1ecb.<\/li>\n<li>Kh\u1ed1i u lan r\u1ed9ng ch\u00e8n \u00e9p g\u00e2y suy th\u1eadn, ch\u1ea3y m\u00e1u: x\u1ea1 tr\u1ecb tri\u1ec7u ch\u1ee9ng li\u1ec1u 30-50Gy; n\u1ebfu h\u1ebft suy th\u1eadn v\u00e0 ch\u1ea3y m\u00e1u th\u00ec xem x\u00e9t kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb <a href=\"https:\/\/vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/hoa-tri-trong-dieu-tri-ung-thu-co-tu-cung\/\">h\u00f3a tr\u1ecb<\/a>.<\/li>\n<li>Kh\u1ed1i u x\u00e2m l\u1ea5n di c\u0103n x\u01b0\u01a1ng: d\u00f9ng thu\u1ed1c ch\u1ed1ng h\u1ee7y x\u01b0\u01a1ng: zoledronic acid, pamidronat\u2026 k\u1ebft h\u1ee3p x\u1ea1 tr\u1ecb gi\u1ea3m \u0111au (x\u1ea1 ngo\u00e0i: 8Gy\/1 l\u1ea7n ho\u1eb7c 4,25Gy x 4 bu\u1ed5i ho\u1eb7c 3Gy x 10 bu\u1ed5i ho\u1eb7c 2Gy x 20 bu\u1ed5i) v\u00e0o v\u00f9ng t\u1ed5n th\u01b0\u01a1ng di c\u0103n x\u01b0\u01a1ng g\u00e2y \u0111au ho\u1eb7c x\u1ea1 trong gi\u1ea3m \u0111au b\u1eb1ng <sup>32<\/sup><\/li>\n<li>Kh\u1ed1i u di c\u0103n n\u00e3o: x\u1ea1 ph\u1eabu (b\u1eb1ng dao gamma, Cyberknife\u2026) c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb gia t\u1ed1c to\u00e0n n\u00e3o.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ung th\u01b0 c\u1ed5 t\u1eed cung l\u00e0 b\u1ec7nh ung th\u01b0 ph\u1ed5 bi\u1ebfn \u1edf ph\u1ee5 n\u1eef nhi\u1ec1u n\u01b0\u1edbc tr\u00ean th\u1ec3 gi\u1edbi. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung gi\u00fap t\u0103ng c\u01a1 h\u1ed9i ch\u1eefa kh\u1ecfi b\u1ec7nh v\u00e0 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. B\u00e0i vi\u1ebft s\u1ebd gi\u1edbi thi\u1ec7u v\u1ec1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 [&hellip;]<\/p>\n","protected":false},"author":43,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ung th\u01b0 c\u1ed5 t\u1eed cung: H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft s\u1ebd gi\u1edbi thi\u1ec7u v\u1ec1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 c\u1ed5 t\u1eed cung theo b\u1ed9 Y t\u1ebf, bao g\u1ed3m c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb v\u00e0 h\u00f3a tr\u1ecb.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ung th\u01b0 c\u1ed5 t\u1eed cung: H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - 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