{"id":29749,"date":"2023-05-04T17:24:57","date_gmt":"2023-05-04T10:24:57","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29749"},"modified":"2023-05-10T19:19:54","modified_gmt":"2023-05-10T12:19:54","slug":"phuong-phap-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/phuong-phap-dieu-tri\/","title":{"rendered":"Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chung cho ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn"},"content":{"rendered":"

Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn (UTTLT) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u1ebf b\u00e0o ung th\u01b0 ph\u00e1t tri\u1ec3n trong tuy\u1ebfn ti\u1ec1n li\u1ec7t (Prostate). Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 tu\u1ed5i, t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe chung, v\u00e0 m\u1ee9c \u0111\u1ed9 lan r\u1ed9ng c\u1ee7a b\u1ec7nh. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh cho ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf 2020.<\/strong><\/p>\n

1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/strong><\/h1>\n

\u0110i\u1ec1u tr\u1ecb UTTTL c\u1ea7n d\u1ef1a tr\u00ean nh\u1eefng y\u1ebfu t\u1ed1 sau:<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n, \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb<\/p>\n

– \u01af\u1edbc t\u00ednh th\u1eddi gian s\u1ed1ng th\u00eam<\/p>\n

– Ph\u00e2n nh\u00f3m nguy c\u01a1<\/p>\n

– X\u00e1c \u0111\u1ecbnh m\u1ee5c ti\u00eau, k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb<\/p>\n

2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

2.1. Ph\u1eabu thu\u1eadt <\/strong><\/h3>\n

2.1.1. Nguy\u00ean t\u1eafc ph\u1eabu thu\u1eadt trong ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t <\/strong><\/p>\n

– C\u1eaft to\u00e0n b\u1ed9 tuy\u1ebfn ti\u1ec1n li\u1ec7t, t\u00fai tinh v\u00e0 b\u00f3ng c\u1ee7a \u1ed1ng d\u1eabn tinh<\/p>\n

– N\u1ea1o h\u1ea1ch ch\u1eadu t\u1eeb h\u1ea1ch ch\u1eadu b\u1ecbt \u0111\u1ebfn v\u00f9ng chia \u0111\u00f4i \u0111\u1ed9ng m\u1ea1ch ch\u1eadu chung.<\/p>\n

– N\u1ea1o h\u1ea1ch m\u1edf r\u1ed9ng: \u0111\u1ebfn ch\u1ed7 chia \u0111\u00f4i \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng.<\/p>\n

– B\u1ea3o t\u1ed3n b\u00f3 m\u1ea1ch<\/p>\n

– Th\u1ea7n kinh c\u01b0\u01a1ng t\u1ed1i \u0111a c\u00f3 th\u1ec3.<\/p>\n

2.1.2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt <\/strong><\/p>\n

T\u00ean ph\u1eabu thu\u1eadt: c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t tri\u1ec7t c\u0103n. Ph\u1eabu thu\u1eadt n\u00e0y c\u00f3 nhi\u1ec1u lo\u1ea1i v\u00e0 t\u00ean g\u1ecdi: theo m\u1ed5 m\u1edf hay m\u1ed5 n\u1ed9i soi; theo \u0111\u01a3\u1eddng ti\u1ebfp c\u1eadn tuy\u1ebfn ti\u1ec1n li\u1ec7t qua ph\u00fac m\u1ea1c, sau ph\u00fac m\u1ea1c hay qua \u0111\u01b0\u1eddng \u0111\u00e1y ch\u1eadu l\u00e0:<\/p>\n

– Ph\u1eabu thu\u1eadt (m\u1edf) c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t tri\u1ec7t c\u0103n (Radical prostatectomy – RP).<\/p>\n

– Ph\u1eabu thu\u1eadt c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t tri\u1ec7t c\u0103n qua \u0111\u01a3\u1eddng \u0111\u00e1y ch\u1eadu (Perineal radical prostatectomy – PRP).<\/p>\n

-Ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t tri\u1ec7t c\u0103n qua ph\u00fac m\u1ea1c (Transperitoneal laparoscopicradical prostatectomy – TLRP).<\/p>\n

– Ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t tri\u1ec7t c\u0103n qua \u0111\u01a3\u1eddng sau ph\u00fac m\u1ea1c (Retroperitoneal laparoscopicradical prostatectomy – RLRP).<\/p>\n

– Ph\u1eabu thu\u1eadt c\u1eaft tuy\u1ebfn ti\u1ec1n li\u1ec7t tri\u1ec7t c\u0103n c\u00f3 h\u1ed7 tr\u1ee3 c\u1ee7a r\u00f4\u2013b\u1ed1t (Robotic Radical Prostatectomy – RRP).<\/p>\n

2.1.3. Ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p ph\u1eabu thu\u1eadt <\/strong><\/p>\n

* Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt theo lo\u1ea1i k\u1ef9 thu\u1eadt v\u00e0 \u0111\u01b0\u1eddng ti\u1ebfp c\u1eadn tuy\u1ebfn ti\u1ec1n li\u1ec7t <\/strong><\/p>\n

– Ph\u1eabu thu\u1eadt m\u1edf hay n\u1ed9i soi c\u00f3 c\u00f9ng ch\u1ec9 \u0111\u1ecbnh nh\u01b0 nhau, vi\u1ec7c quy\u1ebft \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p n\u00e0o l\u00e0 t\u00f9y thu\u1ed9c s\u1ef1 l\u1ef1a ch\u1ecdn v\u00e0 kinh nghi\u1ec7m c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean.<\/p>\n

– Ri\u00eang v\u1edbi \u0111\u01b0\u1eddng m\u1ed5 qua v\u00f9ng \u0111\u00e1y ch\u1eadu n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch cho ung th\u01b0 giai \u0111o\u1ea1n khu tr\u00fa, v\u00ec cho k\u1ebft qu\u1ea3 t\u1ed1t v\u00e0 \u0111\u1ea3m b\u1ea3o th\u1ea9m m\u1ef9. Tuy nhi\u00ean, khi l\u1ef1a ch\u1ecdn \u0111\u01a3\u1eddng m\u1ed5 n\u00e0y c\u1ea7n ph\u1ea3i x\u00e1c \u0111\u1ecbnh l\u00e0: kh\u00f4ng c\u00f3 di c\u0103n h\u1ea1ch, v\u1edbi c\u00e1c ti\u00eau chu\u1ea9n k\u00e8m theo l\u00e0 PSA <10ng\/ml, Gleason<7, t\u1ed1t nh\u1ea5t l\u00e0 c\u00f3 sinh thi\u1ebft h\u1ea1ch ch\u1eadu \u00e2m t\u00ednh.<\/p>\n

* Ch\u1ec9 \u0111\u1ecbnh theo b\u1ec7nh l\u00fd <\/strong><\/p>\n

– C\u0103n c\u1ee9 v\u00e0o giai \u0111o\u1ea1n b\u1ec7nh<\/p>\n

– Theo \u0111\u1ed9 m\u00f4 b\u1ec7nh h\u1ecdc.<\/p>\n

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

– Theo t\u00ecnh tr\u1ea1ng c\u1ee7a c\u00e1c b\u1ec7nh k\u00e8m theo c\u1ee7a ng\u01a3\u1eddi cao tu\u1ed5i nh\u01b0: b\u1ec7nh tim m\u1ea1ch, b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, di ch\u1ee9ng tai bi\u1ebfn m\u1ea1ch m\u00e1u, b\u1ec7nh c\u1ee7a h\u1ec7 th\u1ea7n kinh…<\/p>\n

2.2. X\u1ea1 tr\u1ecb (g\u1eafn link sau khi b\u00e0i c\u00f3 link)<\/strong><\/h3>\n

2.3. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft kh\u00e1c <\/strong><\/h3>\n

2.3.1. Kh\u00e1ng androgen <\/strong><\/p>\n

Kh\u00e1ng Androgen lo\u1ea1i Steroid<\/strong>: Cyproterone acetate, Megesterone acetate, Medroxyprogesterone acetate. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ea7n ch\u00fa \u00fd tr\u00ean h\u1ec7 tim m\u1ea1ch v\u00e0 ch\u1ee9c n\u0103ng gan. Ng\u00e0y nay \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng do v\u00ec kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 khi \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u1edbi li\u1ec7u ph\u00e1p c\u1eaft tinh ho\u00e0n.<\/p>\n

Kh\u00e1ng Androgen kh\u00f4ng steroid<\/strong>:<\/p>\n

– Bicalutamide<\/strong>: 1 l\u1ea7n trong ng\u00e0y, 50 mg\/ng\u00e0y<\/p>\n

– C\u00e1c thu\u1ed1c kh\u00e1ng androgen kh\u00e1c nh\u01b0: Flutamide, nilutamide.<\/p>\n

2.3.2. \u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p n\u1ed9i ti\u1ebft nam <\/strong><\/p>\n

    \n
  • Aminoglutethimide<\/strong>: li\u1ec1u 1000mg\/ng\u00e0y; \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p testosterone qua \u1ee9c ch\u1ebf chuy\u1ec3n h\u00f3a cholesterol th\u00e0nh pregnenolone; hi\u1ec7n ch\u1ec9 \u0111\u01a3\u1ee3c s\u1eed d\u1ee5ng trong ung th\u01b0 giai \u0111o\u1ea1n kh\u00e1ng c\u1eaft tinh ho\u00e0n, ch\u1ec9 \u0111\u1ecbnh ng\u00e0y c\u00e0ng h\u1ea1n ch\u1ebf.<\/li>\n
  • Ketoconazol:<\/strong> li\u1ec1u 300 mg, 3 l\u1ea7n m\u1ed7i ng\u00e0y; \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p testosterone v\u00e0 c\u1ea3 steroid th\u01a3\u1ee3ng th\u1eadn; t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u1ed1i v\u1edbi aminoglutethimide, hi\u1ec7n ch\u1ec9 \u0111\u01a3\u1ee3c s\u1eed d\u1ee5ng trong ung th\u01b0 giai \u0111o\u1ea1n kh\u00e1ng c\u1eaft tinh ho\u00e0n.<\/li>\n<\/ul>\n

    2.3.3. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft m\u1edbi <\/strong><\/p>\n

      \n
    • Abiraterone Acetate<\/strong>: Thu\u1ed1c \u1ee9c ch\u1ebf kh\u00f4ng \u0111\u1ea3o ng\u01b0\u1ee3c protein t\u1ed5ng h\u1ee3p b\u1edfi gen CYP17 (bao g\u1ed3m 17, 20- lyase v\u00e0 17-alpha-hydroxylase) qua \u0111\u00f3 ng\u0103n c\u1ea3n s\u1ef1 t\u1ed5ng h\u1ee3p androgen t\u1ea1i ch\u00ednh t\u1ebf b\u00e0o ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t, tinh ho\u00e0n v\u00e0 th\u01b0\u1ee3ng th\u1eadn. Thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng k\u1ebft h\u1ee3p v\u1edbi prednisone\/prednisolone \u0111\u1ec3 gi\u1ea3m t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n. Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu \u1edf giai \u0111o\u1ea1n kh\u00e1ng c\u1eaft tinh ho\u00e0n, li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 u\u1ed1ng 4 vi\u00ean k\u1ebft h\u1ee3p v\u1edbi prednisolone 10mg\/ng\u00e0y v\u00e0 ADT. Hai nghi\u00ean c\u1ee9u pha III cho th\u1ea5y ph\u1ed1i h\u1ee3p abiraterone\/prednisone c\u00f3 hi\u1ec7u qu\u1ea3 t\u0103ng th\u1eddi gian s\u1ed1ng c\u00f2n v\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 ho\u1eb7c ch\u01b0a h\u00f3a tr\u1ecb tr\u01b0\u1edbc v\u1edbi docetaxel.<\/li>\n
    • Enzalutamide<\/strong>: T\u00e1c \u0111\u1ed9ng tr\u00ean nhi\u1ec1u v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng t\u1ed5ng h\u1ee3p androgen: ng\u0103n c\u1ea3n k\u1ebft h\u1ee3p androgen v\u00e0 th\u1ee5 th\u1ec3, \u1ee9c ch\u1ebf chuy\u1ec3n v\u1ecb v\u00e0 ng\u0103n k\u1ebft h\u1ee3p v\u1edbi DNA c\u1ee7a th\u1ee5 th\u1ec3 androgen t\u1ea1i nh\u00e2n t\u1ebf b\u00e0o. Thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf UTTTL kh\u00e1ng c\u1eaft tinh ho\u00e0n \u0111\u00e3 ho\u1eb7c ch\u01b0a h\u00f3a tr\u1ecb v\u00e0\/ho\u1eb7c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi ADT trong ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n c\u00f2n nh\u1ea1y v\u1edbi c\u1eaft tinh ho\u00e0n. Thu\u1ed1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n c\u0103n co gi\u1eadt d\u00f9 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y r\u1ea5t hi\u1ec3m x\u1ea3y ra (0,6%). Li\u1ec1u l\u01b0\u1ee3ng enzalutamide 40mg x 4 vi\u00ean\/ng\u00e0y.<\/li>\n<\/ul>\n

      C\u00e1c thu\u1ed1c kh\u00e1c nh\u01b0 apalutamide, darolutamide \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 v\u1edbi ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t kh\u00e1ng c\u1eaft tinh ho\u00e0n.<\/p>\n

      2.4. Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ho\u00e1 tr\u1ecb <\/strong><\/h3>\n
        \n
      • Docetaxel<\/strong>: Nghi\u00ean c\u1ee9u pha III TAX 327 ghi nh\u1eadn docetaxel 75mg\/m2 m\u1ed7i 3 tu\u1ea7n ph\u1ed1i h\u1ee3p v\u1edbi prednisone 10mg\/ng\u00e0y c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng c\u00f2n h\u01a1n so v\u1edbi mitoxantrone\/prednisone. Theo k\u1ebft qu\u1ea3 n\u00e0y, docetaxel\/prednisone \u0111\u00e3 tr\u1edf th\u00e0nh ph\u1ed1i h\u1ee3p ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t UTTTL kh\u00e1ng c\u1eaft tinh ho\u00e0n.<\/li>\n
      • Mitoxantrone<\/strong>: Thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn cho UTTTL di c\u0103n v\u1edbi hi\u1ec7u qu\u1ea3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng. Hi\u1ec7n ch\u1ec9 \u0111\u1ecbnh thu h\u1eb9p cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ec9 \u0111\u1ecbnh h\u00f3a tr\u1ecb nh\u01b0ng kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c taxane ho\u1eb7c ti\u1ebfn tri\u1ec3n sau taxan.<\/li>\n
      • Cabazitaxel<\/strong>: M\u1ed9t d\u1eabn xu\u1ea5t taxane t\u1ed5ng h\u1ee3p m\u1edbi cho th\u1ea5y c\u00f3 hi\u1ec7u qu\u1ea3 t\u0103ng th\u1eddi gian s\u1ed1ng c\u00f2n khi ph\u1ed1i h\u1ee3p v\u1edbi prednisone \u0111i\u1ec1u tr\u1ecb ng\u01b0\u1eddi b\u1ec7nh ti\u1ebfn tri\u1ec3n sau docetaxel. Trong m\u1ed9t nghi\u00ean c\u1ee9u pha III, ph\u1ed1i h\u1ee3p cabazitaxel 25mg\/m2 v\u00e0 prednisone c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng c\u00f2n to\u00e0n b\u1ed9 h\u01a1n 2,4 th\u00e1ng so v\u1edbi mitoxantrone\/prednisone. T\u00e1c d\u1ee5ng ph\u1ee5 ch\u00ednh l\u00e0 ph\u1ea3n \u1ee9ng ti\u00eam truy\u1ec1n v\u00e0 \u0111\u1ed9c t\u00ednh t\u1ee7y.<\/li>\n<\/ul>\n

        2.5. Thu\u1ed1c ch\u1ed1ng h\u1ee7y x\u01b0\u01a1ng <\/strong><\/h3>\n

        Thu\u1ed1c thu\u1ed9c nh\u00f3m bisphosphonate, pamidronate, zoledrome acid c\u00f3 hi\u1ec7u qu\u1ea3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 t\u1ea7n su\u1ea5t c\u00e1c bi\u1ebfn c\u1ed1 li\u00ean quan di c\u0103n x\u01b0\u01a1ng.<\/p>\n

        Denosumab<\/strong>: m\u1ed9t kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ng\u01b0\u1eddi c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ch\u1ea5t k\u1ebft n\u1ed1i RANK, qua \u0111\u00f3 \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng h\u1ee7y c\u1ed1t b\u00e0o.<\/p>\n

        2.6. \u0110i\u1ec1u tr\u1ecb mi\u1ec5n d\u1ecbch <\/strong><\/h3>\n

        Thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ed1t ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch PD-1 nh\u01b0 Pembrolizumab<\/strong> c\u0169ng b\u01b0\u1edbc \u0111\u1ea7u cho th\u1ea5y c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf m\u1ed9t nh\u00f3m ng\u01a3\u1eddi b\u1ec7nh UTTTL di c\u0103n kh\u00e1ng c\u1eaft tinh ho\u00e0n v\u00e0 th\u1ea5t b\u1ea1i sau \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p v\u00e0 \u0111\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn \u0111i\u1ec1u tr\u1ecb tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n MSI-H ho\u1eb7c dMMR sau khi th\u1ea5t b\u1ea1i v\u1edbi \u00edt nh\u1ea5t m\u1ed9t li\u1ec7u ph\u00e1p to\u00e0n th\u00e2n tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

        Sipuleucel-T<\/strong> l\u00e0 vaccin c\u1ea5u t\u1ea1o b\u1edfi c\u00e1c t\u1ebf b\u00e0o c\u00f3 nh\u00e1nh t\u1ea1o ra t\u1eeb c\u00e1c b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n chi\u1ebft xu\u1ea5t t\u1eeb m\u00e1u ngo\u1ea1i bi\u00ean \u0111\u01b0\u1ee3c g\u00e2y \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch v\u1edbi PAP (prostatic acid phosphatase) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 \u1edf b\u1ec7nh nh\u00e2n UTTTL kh\u00e1ng c\u1eaft tinh ho\u00e0n sau \u0111i\u1ec1u tr\u1ecb Docetaxel.<\/p>\n

        2.7. <\/strong>Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c<\/strong>\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf PARP (Poly ADP ribose polymerase)<\/strong><\/h3>\n

        Olaparib<\/strong>: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n ung th\u01a3 tuy\u1ebfn ti\u1ec1n li\u1ec7t kh\u00e1ng c\u1eaft tinh ho\u00e0n di c\u0103n c\u00f3 \u0111\u1ed9t bi\u1ebfn gen s\u1eeda ch\u1eefa t\u00e1i t\u1ed5 h\u1ee3p t\u01b0\u01a1ng \u0111\u1ed3ng d\u1ea1ng g\u00e2y b\u1ec7nh ho\u1eb7c nghi ng\u1edd g\u00e2y b\u1ec7nh ti\u1ebfn tri\u1ec3n sau \u0111i\u1ec1u tr\u1ecb abiraterone acetate ho\u1eb7c enzalutamide.<\/p>\n

        2.8. Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng d\u01b0\u1ee3c ch\u1ea5t ph\u00f3ng x\u1ea1<\/strong><\/h3>\n

        Radium-223<\/strong> l\u00e0 m\u1ed9t d\u01b0\u1ee3c ch\u1ea5t ph\u00f3ng x\u1ea1 ph\u00e1t ra b\u1ee9c x\u1ea1 alpha. Radium c\u00f3 \u00e1i l\u1ef1c m\u1ea1nh v\u1edbi m\u00f4 x\u01b0\u01a1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng. T\u1ea1i \u0111\u00e2y hi\u1ec7n t\u01b0\u1ee3ng ph\u00e2n r\u00e3 ph\u00f3ng x\u1ea1 t\u1ea1o ra c\u00e1c b\u1ee9c x\u1ea1 n\u0103ng l\u01b0\u1ee3ng cao trong ph\u1ea1m vi ng\u1eafn h\u01a1n r\u1ea5t nhi\u1ec1u so v\u1edbi c\u00e1c \u0111\u1ed3ng v\u1ecb ph\u00e1t b\u1ee9c x\u1ea1 beta. \u0110i\u1ec1u n\u00e0y gi\u00fap tr\u00e1nh \u0111\u1ed9c t\u00ednh tr\u00ean t\u1ee7y x\u01b0\u01a1ng v\u00e0 c\u00e1c c\u01a1 quan l\u00e2n c\u1eadn. M\u1ed9t nghi\u00ean c\u1ee9u pha III cho th\u1ea5y radium 223 c\u00f3 t\u00ednh dung n\u1ea1p cao, c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng c\u00f2n to\u00e0n b\u1ed9 v\u00e0 l\u00e0m ch\u1eadm th\u1eddi gian xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan di c\u0103n x\u01b0\u01a1ng (nhu c\u1ea7u x\u1ea1 tr\u1ecb gi\u1ea3m \u0111au, g\u1eaby x\u01b0\u01a1ng b\u1ec7nh l\u00fd, ch\u00e8n \u00e9p t\u1ee7y, ph\u1eabu thu\u1eadt 20 ch\u1ec9nh h\u00ecnh\u2026). Ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng cho ng\u01b0\u1eddi b\u1ec7nh UTTTL di c\u0103n x\u01b0\u01a1ng kh\u00f4ng c\u00f3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u1ed9i t\u1ea1ng quan tr\u1ecdng.<\/p>\n

        2.9. Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 <\/strong><\/h3>\n

        Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 cho UTTTL giai \u0111o\u1ea1n ti\u1ebfn xa l\u00e0 ph\u1ed1i h\u1ee3p \u0111a m\u00f4 th\u1ee9c g\u1ed3m ph\u1eabu thu\u1eadt gi\u1ea3i ph\u00f3ng ch\u00e8n \u00e9p, x\u1ea1 tr\u1ecb gi\u1ea3m \u0111au, x\u1ea1 tr\u1ecb ch\u1ed1ng ch\u00e8n \u00e9p, \u0111i\u1ec1u tr\u1ecb di c\u0103n, \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au, ch\u0103m s\u00f3c t\u00e2m l\u00fd\u2026<\/p>\n

        2.9.1. Ph\u1eabu thu\u1eadt<\/strong><\/p>\n

        Ph\u1eabu thu\u1eadt gi\u1ea3i ph\u00f3ng ch\u00e8n \u00e9p do kh\u1ed1i u, ho\u1eb7c do t\u1ed5n th\u01b0\u01a1ng di c\u0103n xa; ph\u1eabu thu\u1eadt \u0111\u01b0a ni\u1ec7u qu\u1ea3n qua da, ph\u1eabu thu\u1eadt d\u1eabn l\u01b0u b\u00e0ng quang.<\/p>\n

        2.9.2. X\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i (EBRT) <\/strong><\/p>\n

        – Thi\u1ebft b\u1ecb: m\u00e1y x\u1ea1 tr\u1ecb gia t\u1ed1c ho\u1eb7c m\u00e1y Cobalt-60.<\/p>\n

        – Li\u1ec1u x\u1ea1 tr\u1ecb: t\u00f9y theo v\u1ecb tr\u00ed di c\u0103n.<\/p>\n

        + Di c\u0103n x\u01b0\u01a1ng: x\u1ea1 tr\u1ecb v\u00e0o v\u1ecb tr\u00ed x\u01a3\u01a1ng b\u1ecb di c\u0103n li\u1ec1u 40Gy\/20 bu\u1ed5i ho\u1eb7c 30Gy\/10 bu\u1ed5i ho\u1eb7c 20Gy\/5 bu\u1ed5i m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p x\u1ea1 1 li\u1ec1u 8Gy\/1 bu\u1ed5i.<\/p>\n

        + Di c\u0103n ch\u00e8n \u00e9p t\u1ee7y s\u1ed1ng: x\u1ea1 tr\u1ecb li\u1ec1u 30Gy\/10 bu\u1ed5i.<\/p>\n

        + Di c\u0103n g\u00e2y ch\u1ea3y m\u00e1u: x\u1ea1 tr\u1ecb c\u1ea7m m\u00e1u khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i khoa kh\u00f4ng hi\u1ec7u qu\u1ea3 li\u1ec1u 30Gy\/10 bu\u1ed5i.<\/p>\n

        + Di c\u0103n n\u00e3o: x\u1ea1 to\u00e0n n\u00e3o ho\u1eb7c x\u1ea1 ph\u1eabu t\u00f9y tr\u01b0\u1eddng h\u1ee3p.<\/p>\n

        2.9.3. \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa ung th\u01b0 nh\u1eb1m gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng <\/strong><\/p>\n

        – \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa ung th\u01b0 gi\u00fap k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng th\u00eam v\u00e0 gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

        – L\u1ef1a ch\u1ecdn \u0111\u1eb7c hi\u1ec7u bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft ho\u1eb7c h\u00f3a tr\u1ecb.<\/p>\n

        – Gi\u1ea3m \u0111au: theo b\u1eadc thang c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf th\u1ebf gi\u1edbi<\/p>\n

        2.9.4. Ch\u0103m s\u00f3c t\u00e2m l\u00fd <\/strong><\/p>\n

        Ng\u01b0\u1eddi b\u1ec7nh UTTTL giai \u0111o\u1ea1n cu\u1ed1i c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh ung th\u01b0 kh\u00e1c c\u1ea7n \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c n\u00e2ng \u0111\u1ee1 t\u00e2m l\u00fd ph\u00f9 h\u1ee3p. H\u1ea7u h\u1ebft c\u00e1c ng\u01b0\u1eddi b\u1ec7nh \u00fd th\u1ee9c \u0111\u01b0\u1ee3c ti\u1ebfn tr\u00ecnh b\u1ea5t kh\u1ea3 kh\u00e1ng c\u1ee7a b\u1ec7nh t\u1eadt \u1edf giai \u0111o\u1ea1n cu\u1ed1i, d\u00f9 c\u00f3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch hay kh\u00f4ng. V\u00ec v\u1eady vi\u1ec7c h\u1ed7 tr\u1ee3 v\u00e0 \u0111\u1ed9ng vi\u00ean tinh th\u1ea7n cho ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 gi\u1ea3m gi\u00e1c nh\u1eb9 nh\u00e0ng h\u01a1n, gi\u00fap ng\u01b0\u1eddi b\u1ec7nh v\u01b0\u1ee3t qua c\u00e1c lo l\u1eafng s\u1ee3 h\u00e3i. N\u1ebfu c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 ph\u1ea3i g\u1eedi kh\u00e1m t\u00e2m th\u1ea7n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e2m th\u1ea7n h\u1ed7 tr\u1ee3.<\/p>\n

        2.10. Kh\u00e1ng c\u1eaft tinh ho\u00e0n <\/strong><\/h3>\n

        \u0110\u1ecbnh ngh\u0129a kh\u00e1ng c\u1eaft tinh ho\u00e0n: Testosterone huy\u1ebft thanh \u1edf ng\u01b0\u1ee1ng c\u1eaft tinh ho\u00e0n: d\u01b0\u1edbi 50ng\/dL ho\u1eb7c d\u01b0\u1edbi 1,7 nmol\/L v\u00e0 k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong hai ti\u00eau chu\u1ea9n:<\/p>\n

          \n
        • Ti\u1ebfn tri\u1ec3n sinh h\u1ecdc<\/strong>: PSA t\u0103ng \u1edf 3 l\u1ea7n th\u1eed li\u00ean ti\u1ebfp c\u00e1ch nhau m\u1ed7i tu\u1ea7n, \u00edt nh\u1ea5t hai l\u1ea7n t\u0103ng tr\u00ean 50% so v\u1edbi m\u1ee9c th\u1ea5p nh\u1ea5t (nadir), v\u00e0 m\u1ed9t l\u1ea7n PSA t\u0103ng tr\u00ean 2ng\/mL.<\/li>\n
        • Ti\u1ebfn tri\u1ec3n h\u00ecnh \u1ea3nh<\/strong>: Xu\u1ea5t hi\u1ec7n t\u1eeb hai t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng m\u1edbi tr\u00ean x\u1ea1 h\u00ecnh tr\u1edf l\u00ean ho\u1eb7c ti\u1ebfn tri\u1ec3n c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ph\u1ea3i x\u01b0\u01a1ng theo ti\u00eau chu\u1ea9n RECIST.<\/li>\n<\/ul>\n
          \"\"
          S\u01a1 \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb UTTTL kh\u00e1ng c\u1eaft tinh ho\u00e0n. Ngu\u1ed3n<\/strong>: B\u1ed9 Y t\u1ebf 2020<\/em><\/figcaption><\/figure>\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":"

          Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn (UTTLT) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u1ebf b\u00e0o ung th\u01b0 ph\u00e1t tri\u1ec3n trong tuy\u1ebfn ti\u1ec1n li\u1ec7t (Prostate). Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 tu\u1ed5i, t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe chung, v\u00e0 m\u1ee9c \u0111\u1ed9 lan r\u1ed9ng c\u1ee7a b\u1ec7nh. […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nPh\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chung cho ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn<\/title>\n<meta name=\"description\" content=\"Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn (UTTLT) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u1ebf b\u00e0o ung th\u01b0 ph\u00e1t tri\u1ec3n. 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