Cutar ciwon kwakwalwa na farko sun bunkasa a cikin kwakwalwa, maimakon yada daga wani asali kamar cutar kanjamau. Mafi yawan nau'in ciwon kwakwalwa na kwakwalwa na yau da kullum yana fitowa ne daga kwayoyin da ba su da kullun wanda ke taimakawa wajen kula da kwayar halitta. A lokacin da kwayoyin da ke cikin jiki suka zama masu ciwo, an kira su glioma .
Akwai nau'o'i iri-iri masu yawa, ciki har da astrocytes, oligodendrocytes, microglia, da kwayoyin ependymal.
Astrocytomas sune mafi yawan yawan glioma. Ana kuma rarraba Gliomas a cikin maki huɗu ta hanyar alamun tantancewar kwayar halitta a ƙarƙashin microscope. Matsayi na III da na IV sune maki mafi girma, tare da mafi munin ganewa da kuma mafi girma ga mahimmancin magani idan ya yiwu. Grade IV glioma, wanda ake kira glioblastoma multiforme ko GBM, yana da matsala maras kyau.
Mataki na farko a lura da glioma mai zurfi shine ƙwayar cutar ne don cire yawancin ƙwayar cuta kamar yadda zai yiwu. Wasu lokuta, duk da haka, wannan ba zai yiwu ba - mai haƙuri na iya zama lafiya sosai don jure wa tiyata, alal misali, ko ƙwayar cuta na iya kasancewa a wani yanki kamar kwakwalwar kwakwalwa inda inda aikin tiyata zai zama mai hatsarin gaske. Ko da an yi aikin tiyata, gliomas m suna da matukar damuwa cewa kusan dukkanin marasa lafiya zasu sake dawowa bayan tiyata. Abin farin ciki, wasu zaɓuɓɓuka suna samuwa don ƙarin yaduwar cutar da kuma maye gurbin shi idan aikin ba zai yiwu ba.
Radiation
Amfanin radiationrapy (RT) a cikin marasa lafiya tare da m glioma da aka farko nuna a cikin 1970s. A wannan lokaci, an cire kwakwalwa gaba daya, hanyar da ake kira wutan kwakwalwa gaba ɗaya (WBRT). Matsakaicin iyakar radiation shine kusan 50 zuwa 60 Grey (Gy), ba tare da ƙarin amfani ba amma ƙara yawan halayen illa a sama da wannan kashi.
Wadannan cututtukan da zasu iya haifar da sunadaran necrosis-mutuwar adadin kwakwalwa ta jiki saboda radiation. Sauran rikitarwa sun haɗa da raguwa na jini, da gashin gashi, ciwon kai da sauransu.
Don rage girman lalacewar, lalacewar yanzu an fi mayar da hankali a kan ƙwayar cuta, tare da gefe 1 zuwa 3, ta amfani da ma'ana da ake kira farfadowa ta hanyar radiation (IFRT). Rashin gefe yana dogara ne da kimanin kashi 90 na raguwa wanda ke faruwa tsakanin 2 cm na ainihin shafin ƙwararrun bayan radiation.
Sauran wasu fasahohi sun haɗa da rediyon rediyon 3D (3D-CRT), wanda ke amfani da software na musamman don yin magungunan kulawa don rage rashawa na kwakwalwar kwakwalwa. RT (Intanit-modulated RT) (IRRT) ya bambanta radiation a fadin filayen magani, wanda yake da amfani a lokacin da kututture yake kan yankunan ƙwaƙwalwa. Ganin cewa ana amfani da hanyoyin da aka saba amfani dasu don sadar da ƙananan rassan radiation a yayin jerin lokuta, radiosurgery na stereotactic (SRS) ya ba da cikakkiyar radiation zuwa kananan ƙira a cikin kwakwalwa. Amfanin SRS ya kasance a ɓoye mara kyau lokacin amfani da shi tare da chemotherapy, ko da yake ana amfani dashi a wasu lokuta don magance ciwace-ciwacen da ba za a iya amfani dasu ba.
Za'a iya samun radiation ta hanyar sanya shirye-shiryen radioisotope a cikin tashar tasirin ko tsangon kansa, wanda zai haifar da ci gaba da ba da izini.
Gwaje-gwaje na asibiti da aka ƙaddara sun nuna alamar muni mafi kyawun wannan ƙira. Hanyar kulawa na yau da kullum shine kulawa tare da RT mai sauƙi-ƙaddamarwa a mafi yawan lokuta m glioma.
Chemotherapy
Temozolomide, wanda ake kira Temodar, shine maganin likita a cikin marasa lafiya tare da GBM. Lokacin da aka gwada mutanen da suka yi ko basu karbi temozolomide bayan maganin radiation, akwai wata babbar rayuwa (kashi 27 da 11 a shekara daya). Methylation na methyl guanine methyltransferase (MGMT) promoter wani kwayoyin factor da yake tsinkaya na amfana da chemotherapy, ƙara yawan rayuwa rayuwa fiye da uku a shekaru biyu.
Chemotherapy tare da temozolomide yawanci ana bawa yau da kullum na kwana biyar a kowane kwana 28, wanda yake tare da kwanaki 23 bayan kwana biyar na gwamnati. Anyi wannan don 6 zuwa goma sha biyu. Temozolomide yana ƙara haɗarin matsalolin hematologic kamar thrombocytopenia, don haka ana buƙatar gwaje-gwaje na jini tsawon kwanaki 21 da 28 a kowane juyi na magani. Sauran cututtukan da suka shafi illa sun hada da motsa jiki, gajiya, da kuma rage ci.
Haɗuwa da chemotherapeutics da ake kira procarbazine, lomustine, da vincristine (PCV) wani zaɓi ne a jiyya na ciwon kwakwalwa. Yawan adadin jini wanda ke fama da kamuwa da cuta zai iya ragewa ta wannan magani, kamar yadda kwayoyin da ke hana raguwa da zub da jini. Rashin wuya, tashin zuciya, damuwa, da tingling iya faruwa.
Wafers na miyagun ƙwayoyi carmustine (Gliadel) wasu lokuta an dasa su ne a lokacin da ake yin bincike. Duk da haka, ana rasa bayanai game da inganci da aminci na wannan hanyar ta hanyar sabon glioblastoma bincikar lafiya tare da sauran hanyoyin kwantar da hankali. Da miyagun ƙwayoyi ya fi tasiri sosai a matakin III glioma, amma har yanzu ana amfani da fasahar gwaji. Hanyoyi masu illa mai yiwuwa sun hada da kamuwa da cuta da kuma kullun kwakwalwa.
Bevacizumab (Avastin) wani ɓangare ne wanda ke daura ga matakan ci gaba na ƙananan ciwon ƙananan ƙwayar cuta (VEGF). Wannan miyagun ƙwayoyi yana ƙoƙarin tsangwama tare da samar da sababbin jini wanda ke samar da kayan gina jiki ga ƙwayar ƙwayar cuta. Duk da haka, babu wani amfani da aka tabbatar don zamawacizumab a hade tare da temozolomide da RT. Anyi amfani da miyagun ƙwayoyi tare da neutropenia, hauhawar jini, da kuma thromboembolism. Ƙarin karatu yana bincika tasiri mai amfani a cikin rukuni na marasa lafiya.
Marasa tsofaffi
Shawarar maganin sau da yawa yakan bambanta ga marasa lafiya da suka kamu da cutar. Za'a iya ba da shawarar ƙarar radiyo don waɗanda ba'a dace ba don magani tare da radiation da chemotherapy. Ga wadanda ke tare da MGMT-methylated ciwon sukari, temozolomide kadai zai iya zama wata hanya madaidaiciya.
Rushewa
Kula da mummunar glioma wanda ya sake komawa baya bayan jiyya yana da rikici kuma ya dogara da magunguna da likitoci. Maimaita maganin radiation yana kara haɗarin ƙwayar cutar necrosis, ko da yake wasu bincike sun nuna amfani da rayuwa a cikin tauraron astrocytoma, amma ba a cikin GBM ba. Jiyya tare da bevacizumab zai iya zama mafi dacewa a cikin irin wannan jiyya. Duk lokacin da ya yiwu, marasa lafiya suyi la'akari da shiga cikin gwaji na asibiti.
Sources:
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Paulino AC, Mai WY, Chintagumpala M, et al. Gliomas masu ciwo da radiation: suna da wani tasiri don sake farfadowa? Int J Radiat Oncol Biol Phys 2008; 71: 1381.
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