{"id":29740,"date":"2023-05-04T17:25:18","date_gmt":"2023-05-04T10:25:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29740"},"modified":"2023-05-04T17:25:18","modified_gmt":"2023-05-04T10:25:18","slug":"ky-thuat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/ky-thuat\/","title":{"rendered":"K\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn"},"content":{"rendered":"

X\u1ea1 tr\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn th\u00f4ng qua s\u1eed d\u1ee5ng tia ph\u00f3ng x\u1ea1 \u0111\u1ec3 ti\u00eau di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0 v\u00e0 ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ch\u00fang. \u0110i\u1ec1u tr\u1ecb x\u1ea1 tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua c\u00e1c k\u1ef9 thu\u1eadt\u00a0 \u0111\u1ed9c l\u1eadp ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t trong vi\u1ec7c ki\u1ec3m so\u00e1t v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn.<\/strong><\/p>\n

1. Nguy\u00ean t\u1eafc x\u1ea1 tr\u1ecb<\/strong><\/h1>\n

Ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o<\/strong><\/p>\n

– Nguy c\u01a1 t\u00e1i ph\u00e1t.<\/p>\n

– Th\u1eddi gian k\u1ef3 v\u1ecdng s\u1ed1ng th\u00eam.<\/p>\n

– M\u1ee5c \u0111\u00edch l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n hay \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9<\/p>\n

– Kh\u00f4ng \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n s\u1ee9c kh\u1ecfe \u0111\u1ec3 ph\u1eabu thu\u1eadt<\/p>\n

– Nguy\u1ec7n v\u1ecdng c\u1ee7a ng\u01a3\u1eddi b\u1ec7nh.<\/p>\n

2. K\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb<\/strong><\/h2>\n

– K\u1ef9 thu\u1eadt: 3 D-CRT, IMRT (Intensity Modulated Radiation Therapy- x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u), VMAT (x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn th\u1ec3 t\u00edch), IGRT (x\u1ea1 tr\u1ecb d\u01a3\u1edbi h\u01a3\u1edbng d\u1eabn h\u00ecnh \u1ea3nh)<\/p>\n

– Thi\u1ebft b\u1ecb: m\u00e1y gia t\u1ed1c tuy\u1ebfn t\u00ednh<\/p>\n

– Li\u1ec1u l\u01b0\u1ee3ng:<\/p>\n

+ Nguy c\u01a1 th\u1ea5p<\/strong>: 70Gy-75Gy trong 36-41 bu\u1ed5i v\u00e0o tuy\u1ebfn ti\u1ec1n li\u1ec7t \u00b1 t\u00fai tinh. Kh\u00f4ng x\u1ea1 tr\u1ecb ti\u1ec3u khung<\/p>\n

+ Nguy c\u01a1 trung b\u00ecnh<\/strong>: 75- 80Gy. Ph\u00e2n li\u1ec1u 1,8-2,0Gy\/l\u1ea7n, c\u00f3 th\u1ec3 x\u1ea1 tr\u1ecb h\u1ea1ch ch\u1eadu.<\/p>\n

+ Nguy c\u01a1 cao<\/strong>: x\u1ea1 tr\u1ecb h\u1ea1ch ch\u1eadu – C\u00f3 th\u1ec3 k\u1ebft h\u1ee3p x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i v\u1edbi x\u1ea1 tr\u1ecb \u00e1p s\u00e1t su\u1ea5t li\u1ec1u cao n\u1ea1p ngu\u1ed3n sau.<\/p>\n

\"\"
Ngu\u1ed3n: Nicholas G. Zaorsky, Amy S. Harrison, Edouard J. Trabulsi, Leonard G. Gomella, Timothy N. Showalter, Mark D. Hurwitz, Adam P. Dicker & Robert B. Den<\/strong>, \u201cEvolution of advanced technologies in prostate cancer radiotherapy<\/em>\u201d, Nature Reviews Urology, p565\u2013579 (2013).<\/strong><\/figcaption><\/figure>\n

2.1. K\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i v\u00e0o v\u00f9ng ch\u1eadu <\/strong><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n

– U giai \u0111o\u1ea1n T4.<\/p>\n

– Di c\u0103n h\u1ea1ch ch\u1eadu.<\/p>\n

– T\u00fai tinh b\u1ecb x\u00e2m l\u1ea5n.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh thu\u1ed9c nh\u00f3m nguy c\u01a1 cao.<\/p>\n

– Nguy c\u01a1 di c\u0103n h\u1ea1ch > 15%, t\u00ednh theo c\u00f4ng th\u1ee9c Roach: Nguy c\u01a1 di c\u0103n h\u1ea1ch = (2\/3) \u00d7 PSA + [(GS \u2013 6) \u00d7 10]<\/p>\n

2.2. Hai tr\u01b0\u1eddng chi\u1ebfu tr\u01b0\u1edbc-sau v\u00e0 sau-tr\u01b0\u1edbc<\/strong><\/h3>\n

– Gi\u1edbi h\u1ea1n tr\u00ean: khe gi\u1eefa L5-S1.<\/p>\n

– N\u1ebfu h\u1ea1ch ch\u1eadu (+): khe gi\u1eefa L4-L5.<\/p>\n

– Gi\u1edbi h\u1ea1n d\u01b0\u1edbi: d\u01b0\u1edbi hai \u1ee5 ng\u1ed3i.<\/p>\n

– Gi\u1edbi h\u1ea1n hai b\u00ean: 1-1,5 cm ph\u00eda ngo\u00e0i c\u1ee7a khung ch\u1eadu b\u00e9 (che ch\u1eafn \u0111\u1ea7u x\u01a3\u01a1ng \u0111\u00f9i v\u00e0 c\u00e1nh ch\u1eadu). Tr\u01b0\u1eddng chi\u1ebfu hai b\u00ean:<\/p>\n

– Gi\u1edbi h\u1ea1n tr\u00ean v\u00e0 d\u01b0\u1edbi: gi\u1ed1ng nh\u01b0 c\u1ee7a tr\u01b0\u1eddng chi\u1ebfu tr\u01b0\u1edbc-sau.<\/p>\n

– Gi\u1edbi h\u1ea1n tr\u01b0\u1edbc: ph\u00eda tr\u01b0\u1edbc c\u1ee7a kh\u1edbp mu.<\/p>\n

– Gi\u1edbi h\u1ea1n sau: \u0111i qua khe S2-S3.<\/p>\n

2.3. K\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb khu tr\u00fa v\u00e0o tuy\u1ebfn ti\u1ec1n li\u1ec7t <\/strong><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh<\/strong>:<\/p>\n

– U giai \u0111o\u1ea1n s\u1edbm (T1, T2).<\/p>\n

– H\u1ea1ch ch\u1eadu (-).<\/p>\n

– T\u00fai tinh kh\u00f4ng b\u1ecb x\u00e2m l\u1ea5n.<\/p>\n

– Nguy c\u01a1 di c\u0103n h\u1ea1ch < 15%, t\u00ednh theo c\u00f4ng th\u1ee9c Roach.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh thu\u1ed9c nh\u00f3m nguy c\u01a1 th\u1ea5p \u0111\u1ebfn trung b\u00ecnh.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh thu\u1ed9c nh\u00f3m nguy c\u01a1 cao, k\u00e8m \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft d\u00e0i h\u1ea1n.<\/p>\n

– Ph\u1ed1i h\u1ee3p li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf androgen (ADT) \u1edf ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n c\u00f2n nh\u1ea1y n\u1ed9i ti\u1ebft nh\u00f3m nguy c\u01a1 th\u1ea5p (di c\u0103n x\u01b0\u01a1ng d\u01b0\u1edbi 4 t\u1ed5n th\u01b0\u01a1ng, kh\u00f4ng di c\u0103n t\u1ea1ng)<\/p>\n

\u0110\u1ec3 x\u1ea1 tr\u1ecb khu tr\u00fa v\u00e0o tuy\u1ebfn ti\u1ec1n li\u1ec7t, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb ph\u00f9 h\u1ee3p:<\/p>\n

+ X\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i (EBRT): k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb 3D CRT (3D Conformal Radiotherapy); X\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u (IMRT), X\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u th\u1ec3 t\u00edch (VMAT), x\u1ea1 d\u01a3\u1edbi h\u01a3\u1edbng d\u1eabn h\u00ecnh \u1ea3nh (IGRT).<\/p>\n

+ X\u1ea1 tr\u1ecb m\u00f4 ph\u1ecfng PET\/CT ho\u1eb7c CT<\/p>\n

+ X\u1ea1 tr\u1ecb \u00e1p s\u00e1t li\u1ec1u cao (HDR), c\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 v\u00e0o m\u00f4 tuy\u1ebfn ti\u1ec1n li\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n UTTTL giai \u0111o\u1ea1n khu tr\u00fa ho\u1eb7c \u0111\u1ec3 n\u00e2ng li\u1ec1u x\u1ea1 sau x\u1ea1 tr\u1ecb t\u1eeb ngo\u00e0i (x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i).<\/p>\n

2.4. T\u01b0 th\u1ebf n\u1eb1m c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh khi th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt m\u00f4 ph\u1ecfng v\u00e0 x\u1ea1 tr\u1ecb<\/strong><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng n\u1eb1m ng\u1eeda, k\u00ea g\u1ed1i d\u01b0\u1edbi khoeo ch\u00e2n. \u0110\u00e2y l\u00e0 t\u01b0 th\u1ebf n\u1eb1m tho\u1ea3i m\u00e1i nh\u1ea5t.<\/p>\n

– C\u0169ng c\u00f3 th\u1ec3 cho ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m s\u1ea5p \u0111\u1ec3 ru\u1ed9t non \u0111\u01b0\u1ee3c \u0111\u1ea9y l\u00ean tr\u00ean, ra ngo\u00e0i v\u00f9ng chi\u1ebfu x\u1ea1.<\/p>\n

– N\u00ean cho ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng n\u01b0\u1edbc nhi\u1ec1u tr\u01b0\u1edbc khi m\u00f4 ph\u1ecfng v\u00e0 x\u1ea1 tr\u1ecb \u0111\u1ec3 l\u00e0m c\u0103ng b\u00e0ng quang.<\/p>\n

– Khi m\u00f4 ph\u1ecfng n\u00ean ti\u00eam t\u0129nh m\u1ea1ch m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf ch\u1ea5t c\u1ea3n quang (40-50ml) \u0111\u1ec3 th\u1ea5y r\u00f5 b\u00e0ng quang v\u00e0 d\u1ec5 ph\u00e2n bi\u1ec7t \u0111\u00e1y tuy\u1ebfn ti\u1ec1n li\u1ec7t v\u1edbi c\u1ed5 b\u00e0ng quang.<\/p>\n

2.5. X\u00e1c \u0111\u1ecbnh c\u00e1c th\u1ec3 t\u00edch x\u1ea1 khi d\u00f9ng k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb ph\u00f9 h\u1ee3p m\u00f4 \u0111\u00edch<\/strong><\/h3>\n

GTV (Gross tumor volume \u2013 Th\u1ec3 t\u00edch u th\u00f4): th\u01b0\u1eddng kh\u00f4ng s\u1eed d\u1ee5ng trong x\u1ea1 tr\u1ecb UTTTL, v\u00ec kh\u00f3 nh\u00ecn th\u1ea5y nh\u00e2n ung th\u01b0 trong m\u00f4 tuy\u1ebfn tr\u00ean CLVT. Th\u1ec3 t\u00edch th\u01b0\u1eddng d\u00f9ng l\u00e0 CTV.<\/p>\n

– CTV (Clinical target volume \u2013 Th\u1ec3 t\u00edch \u0111\u00edch l\u00e2m s\u00e0ng): to\u00e0n b\u1ed9 tuy\u1ebfn ti\u1ec1n li\u1ec7t (th\u01a3\u1eddng bao g\u1ed3m 1\/3 th\u1ec3 t\u00edch t\u00fai tinh) \u00b1 t\u00fai tinh (n\u1ebfu t\u00fai tinh b\u1ecb x\u00e2m l\u1ea5n).<\/p>\n

– BTV (biologic target volume) l\u00e0 th\u1ec3 t\u00edch \u0111\u00edch sinh h\u1ecdc \u1ea3nh thu \u0111\u01b0\u1ee3c t\u1eeb ch\u1ee5p PET\/CT m\u00f4 ph\u1ecfng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh th\u1ec3 t\u00edch.<\/p>\n

– PTV (Planning target volume \u2013 Th\u1ec3 t\u00edch \u0111\u00edch theo k\u1ebf ho\u1ea1ch): CTV + 1cm v\u1ec1 m\u1ecdi h\u01b0\u1edbng ngo\u1ea1i tr\u1eeb h\u01b0\u1edbng ra ph\u00eda sau ch\u1ec9 l\u00e0 8 mm.<\/p>\n

2.6. Li\u1ec1u x\u1ea1 t\u1ed1i \u0111a tr\u00ean c\u00e1c c\u01a1 quan quan tr\u1ecdng<\/strong><\/h3>\n

Tr\u1ef1c tr\u00e0ng<\/strong>: D\u01b0\u1edbi 5-10% x\u1ea3y ra \u0111\u1ed9c t\u00ednh \u0111\u1ed9 III-IV tr\u00ean tr\u1ef1c tr\u00e0ng n\u1ebfu<\/p>\n

– V50 (th\u1ec3 t\u00edch tr\u1ef1c tr\u00e0ng nh\u1eadn li\u1ec1u > 50 Gy) l\u00e0 60-65%<\/p>\n

– V60 (th\u1ec3 t\u00edch tr\u1ef1c tr\u00e0ng nh\u1eadn li\u1ec1u > 60 Gy) l\u00e0 45-50%<\/p>\n

– V70 (th\u1ec3 t\u00edch tr\u1ef1c tr\u00e0ng nh\u1eadn li\u1ec1u > 70 Gy) l\u00e0 25-30%<\/p>\n

B\u00e0ng quang<\/strong>:<\/p>\n

– To\u00e0n b\u1ed9 b\u00e0ng quang: < 65 Gy.<\/p>\n

– M\u1ed9t ph\u1ea7n nh\u1ecf b\u00e0ng quang: 75-80 Gy. Kh\u00f4ng qu\u00e1 3% th\u1ec3 t\u00edch b\u00e0ng quang nh\u1eadn li\u1ec1u > 78 Gy.<\/p>\n

– \u0110\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i: li\u1ec1u trung b\u00ecnh < 50 Gy.<\/p>\n

2.7. Li\u1ec1u x\u1ea1 v\u00e0 m\u1ee9c n\u0103ng l\u01b0\u1ee3ng ch\u00f9m tia <\/strong><\/h3>\n

– Ph\u00e2n li\u1ec1u m\u1ed7i ng\u00e0y: 1,8 \u2013 2Gy.<\/p>\n

– Ch\u1ecdn n\u0103ng l\u01b0\u1ee3ng ch\u00f9m tia t\u00f9y v\u00e0o \u0111\u1ed9 d\u00e0y c\u1ee7a b\u1ee5ng ng\u01b0\u1eddi b\u1ec7nh. Th\u01b0\u1eddng d\u00f9ng tia X m\u1ee9c n\u0103ng l\u01b0\u1ee3ng 6-18 MV c\u1ee7a m\u00e1y x\u1ea1 tr\u1ecb gia t\u1ed1c th\u1eb3ng.<\/p>\n

– X\u1ea1 v\u00e0o v\u00f9ng ch\u1eadu (khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh): 45-50 Gy.<\/p>\n

– Sau \u0111\u00f3 x\u1ea1 khu tr\u00fa v\u00e0o tuy\u1ebfn ti\u1ec1n li\u1ec7t (\u00b1 t\u00fai tinh) cho \u0111\u1ebfn 70-76Gy.<\/p>\n

– X\u1ea1 tri\u1ec7t \u0111\u1ec3 khu tr\u00fa v\u00e0o tuy\u1ebfn ti\u1ec1n li\u1ec7t: 70-76 Gy.<\/p>\n

– X\u1ea1 v\u00e0o n\u1ec1n tuy\u1ebfn ti\u1ec1n li\u1ec7t sau ph\u1eabu thu\u1eadt c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t t\u1eadn g\u1ed1c:<\/p>\n

+ 64-66 Gy n\u1ebfu c\u00f2n s\u00f3t u vi th\u1ec3.<\/p>\n

+ \u2265 70 Gy n\u1ebfu c\u00f2n s\u00f3t u \u0111\u1ea1i th\u1ec3. V\u1edbi c\u00e1c k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb m\u1edbi nh\u01a3 IMRT (Intensity modulated radiotherapy – X\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u), IGRT (Image guided radiotherapy \u2013 X\u1ea1 tr\u1ecb d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn h\u00ecnh \u1ea3nh) c\u00f3 th\u1ec3 cho ph\u00e9p n\u00e2ng li\u1ec1u x\u1ea1 t\u1ea1i tuy\u1ebfn ti\u1ec1n li\u1ec7t l\u00ean \u0111\u1ebfn 80 Gy.<\/p>\n

X\u1ea1 tr\u1ecb \u00e1p s\u00e1t: c\u00f3 th\u1ec3 d\u00f9ng k\u1ef9 thu\u1eadt n\u1ea1p ngu\u1ed3n sau su\u1ea5t li\u1ec1u cao (High dose rate afterloading brachytherapy) ho\u1eb7c k\u1ef9 thu\u1eadt c\u1ea5y l\u01b0u c\u00e1c h\u1ea1t iod ph\u00f3ng x\u1ea1 (Iodine 125) v\u00e0o tuy\u1ebfn ti\u1ec1n li\u1ec7t.<\/p>\n

2.8. C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 \u0111i\u1ec1u tr\u1ecb \u00e1p s\u00e1t<\/strong><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh<\/p>\n

+ Nguy c\u01a1 th\u1ea5p: c\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 \u0111i\u1ec1u tr\u1ecb \u00e1p s\u00e1t \u0111\u01a1n thu\u1ea7n<\/p>\n

+ Nguy c\u01a1 trung b\u00ecnh: c\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 \u0111i\u1ec1u tr\u1ecb \u00e1p s\u00e1t + x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i (40-50Gy) \u00b1 n\u1ed9i ti\u1ebft (4-6 th\u00e1ng).<\/p>\n

– Li\u1ec1u x\u1ea1 tr\u1ecb:<\/p>\n

+ C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 v\u1edbi I-125 li\u1ec1u 145Gy n\u1ebfu v\u1edbi Pd-103 li\u1ec1u 125Gy.<\/p>\n

+ C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 sau khi x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i 40-50Gy: v\u1edbi I-125 li\u1ec1u 110Gy v\u00e0 Pd-103 li\u1ec1u 100Gy.<\/p>\n

– K\u1ef9 thu\u1eadt c\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 v\u00e0o kh\u1ed1i u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t, l\u00e0 s\u1ef1 c\u1ea3i ti\u1ebfn c\u1ee7a x\u1ea1 tr\u1ecb \u00e1p s\u00e1t k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb chi\u1ebfu trong \u0111\u00e3 \u0111\u01a3\u1ee3c nhi\u1ec1u n\u01b0\u1edbc tr\u00ean th\u1ebf gi\u1edbi nghi\u00ean c\u1ee9u \u00e1p d\u1ee5ng v\u00e0 \u0111em l\u1ea1i nhi\u1ec1u l\u1ee3i \u00edch to l\u1edbn cho b\u1ec7nh nh\u00e2n. Hi\u1ec7n nay t\u1ea1i c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n nh\u01a3 Hoa K\u1ef3, \u0110\u1ee9c, Nh\u1eadt B\u1ea3n, \u00e1p d\u1ee5ng cho ung th\u01a3 tuy\u1ebfn ti\u1ec1n li\u1ec7t giai \u0111o\u1ea1n s\u1edbm, khu tr\u00fa.<\/p>\n

– C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 \u0111i\u1ec1u tr\u1ecb UTTTL l\u00e0 ph\u01b0\u01a1ng ph\u00e1p x\u1ea1 tr\u1ecb \u0111\u01b0a c\u00e1c h\u1ea1t ph\u00f3ng x\u1ea1 I125 k\u00edch th\u01b0\u1edbc nh\u1ecf 4,5×0,8 mm ph\u00e1t tia gamma n\u0103ng l\u01b0\u1ee3ng th\u1ea5p (35 keV), v\u00e0o trong t\u1ed5 ch\u1ee9c kh\u1ed1i u, c\u00f3 t\u00e1c d\u1ee5ng ti\u00eau di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0 t\u1ea1i ch\u1ed7 m\u00e0 kh\u00f4ng ho\u1eb7c \u1ea3nh h\u01a3\u1edfng r\u1ea5t \u00edt t\u1edbi m\u00f4 l\u00e0nh xung quanh. B\u1ee9c x\u1ea1 gamma m\u1ec1m c\u1ee7a I-125 ch\u1ec9 ph\u00e1t huy hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb trong ph\u1ea1m vi v\u00e0i milimet (mm) c\u1ee7a c\u00e1c m\u00f4 b\u1ec7nh v\u00e0 kh\u00f4ng ho\u1eb7c r\u1ea5t \u00edt g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u00f4 l\u00e0nh xung quanh.<\/p>\n

\u01afu \u0111i\u1ec3m n\u1ed5i b\u1eadt c\u1ee7a k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 t\u1ea1o ra li\u1ec1u h\u1ea5p th\u1ee5 b\u1ee9c x\u1ea1 cao t\u1ea1i kh\u1ed1i u, trong khi c\u01a1 quan v\u00e0 t\u1ebf b\u00e0o l\u00e0nh ch\u1ec9 ph\u1ea3i ch\u1ecbu li\u1ec1u b\u1ee9c x\u1ea1 r\u1ea5t th\u1ea5p. C\u00e1c h\u1ea1t ph\u00f3ng x\u1ea1 c\u00f3 th\u1eddi gian b\u00e1n r\u00e3 kh\u00f4ng qu\u00e1 ng\u1eafn v\u00e0 kh\u00f4ng qu\u00e1 d\u00e0i (ch\u1eb3ng h\u1ea1n v\u1edbi I-125 l\u00e0 60 ng\u00e0y) n\u00ean c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i c\u00e1c h\u1ea1t ph\u00f3ng x\u1ea1 trong l\u00f2ng tuy\u1ebfn ti\u1ec1n li\u1ec7t m\u00e0 kh\u00f4ng c\u1ea7n l\u1ea5y ra sau khi c\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 v\u00e0o. D\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a h\u00ecnh \u1ea3nh si\u00eau \u00e2m, c\u00e1c kim ch\u1ee9a h\u1ea1t ph\u00f3ng x\u1ea1 n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00e2m xuy\u00ean qua da \u1edf v\u00f9ng t\u1ea7ng sinh m\u00f4n \u0111\u1ec3 \u0111\u01b0a th\u1eb3ng v\u00e0o trong l\u00f2ng c\u1ee7a tuy\u1ebfn ti\u1ec1n li\u1ec7t. C\u00e1c h\u1ea1t I-125 s\u1ebd \u0111\u01b0\u1ee3c l\u01b0u l\u1ea1i trong l\u00f2ng tuy\u1ebfn ti\u1ec1n li\u1ec7t sau khi kim \u0111\u01a3\u1ee3c r\u00fat ra.<\/p>\n

– \u01afu \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p c\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 l\u00e0 ki\u1ec3m so\u00e1t u t\u1ea1i ch\u1ed7 cao, th\u1eddi gian v\u00e0 li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ng\u1eafn, \u00edt bi\u1ebfn ch\u1ee9ng, ch\u1ee9c n\u0103ng sinh l\u00fd c\u1ee7a nam gi\u1edbi (li\u1ec7t d\u01a3\u01a1ng) \u00edt ho\u1eb7c kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng, t\u0103ng ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng<\/p>\n

– C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb an to\u00e0n, hi\u1ec7u qu\u1ea3, t\u0103ng th\u1eddi gian s\u1ed1ng th\u00eam, t\u0103ng ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho b\u1ec7nh nh\u00e2n ung th\u01a3 tuy\u1ebfn ti\u1ec1n li\u1ec7t giai \u0111o\u1ea1n s\u1edbm<\/p>\n

2.9. \u0110i\u1ec1u tr\u1ecb thu\u1ed1c ph\u00f3ng x\u1ea1 177Lu-PSMA<\/strong><\/h3>\n

PSMA (prostate-specific membrane antigen) l\u00e0 protein xuy\u00ean m\u00e0ng, hay g\u1eb7p \u1edf m\u00e0ng t\u1ebf b\u00e0o ung th\u01a3 tuy\u1ebfn ti\u1ec1n li\u1ec7t. \u0110\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 Lutetium-177 g\u1eafn v\u1edbi PSMA ph\u00e1t tia beta (E=490keV) v\u00e0 qu\u00e3ng ch\u1ea1y trong m\u00f4 tuy\u1ebfn <2mm, th\u1eddi gian b\u00e1n r\u00e3 6,73 ng\u00e0y. Thu\u1ed1c ph\u00f3ng x\u1ea1 177Lu-PSMA sau khi \u0111\u01b0a v\u00e0o c\u01a1 th\u1ec3 s\u1ebd t\u1eadp trung t\u1ea1i c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t v\u00e0 ph\u00e1t tia b\u1ee9c x\u1ea1 ti\u00eau di\u1ec7t kh\u1ed1i u. Tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb ng\u01a3\u1eddi b\u1ec7nh \u0111\u01a3\u1ee3c ch\u1ee5p 68Ga-PSMA PET\/CT \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c t\u1ed5n th\u01a3\u01a1ng di c\u0103n v\u00e0 d\u1ef1 b\u00e1o \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. Li\u1ec1u thu\u1ed1c 177Lu-PSMA: 3,5-8GBq, ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm, 4-6 chu k\u1ef3, m\u1ed7i chu k\u1ef3 6 tu\u1ea7n.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t c\u1ee7a B\u1ed9 Y t\u1ebf 2020<\/p>\n","protected":false},"excerpt":{"rendered":"

X\u1ea1 tr\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn th\u00f4ng qua s\u1eed d\u1ee5ng tia ph\u00f3ng x\u1ea1 \u0111\u1ec3 ti\u00eau di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0 v\u00e0 ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ch\u00fang. \u0110i\u1ec1u tr\u1ecb x\u1ea1 tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua c\u00e1c k\u1ef9 thu\u1eadt\u00a0 \u0111\u1ed9c l\u1eadp ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[],"yoast_head":"\nK\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn<\/title>\n<meta name=\"description\" content=\"X\u1ea1 tr\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn th\u00f4ng qua s\u1eed d\u1ee5ng tia ph\u00f3ng x\u1ea1, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua c\u00e1c k\u1ef9 thu\u1eadt\" \/>\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=\"K\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn\" \/>\n<meta property=\"og:description\" content=\"X\u1ea1 tr\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn th\u00f4ng qua s\u1eed d\u1ee5ng tia ph\u00f3ng x\u1ea1, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua c\u00e1c k\u1ef9 thu\u1eadt\" \/>\n<meta property=\"og:url\" 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