Neoadjuvant chemotherapy da tiyata na gaba don ciwon daji na pancreatic

CHICAGO-Neoadjuvant chemotherapy ba zai iya daidaita aikin tiyata na gaba don rayuwa don ciwon daji na pancreatic wanda za a iya sake sakewa ba, ƙaramin gwaji ya nuna.
Ba zato ba tsammani, marasa lafiya da aka yi wa tiyata a karon farko sun rayu fiye da shekara guda fiye da waɗanda suka sami ɗan gajeren hanya na FOLFIRINOX chemotherapy kafin tiyata.Wannan sakamakon yana da ban mamaki musamman ganin cewa an haɗa maganin neoadjuvant tare da mafi girma na ƙananan ƙwayar tiyata (R0) da kuma cewa ƙarin marasa lafiya a cikin ƙungiyar kulawa sun sami matsayi mara kyau.
"Ƙarin bin diddigin na iya yin bayanin tasirin dogon lokaci na ingantawa a cikin R0 da N0 a cikin ƙungiyar neoadjuvant," in ji Knut Jorgen Laborie, MD, Jami'ar Oslo, Norway, Ƙungiyar Jama'ar Amirka ta Clinical Oncology.ASCO) taro."Sakamakon baya goyan bayan amfani da neoadjuvant FOLFIRINOX a matsayin daidaitaccen jiyya don ciwon daji na pancreatic.
Wannan sakamakon ya ba Andrew H. Ko, MD, na Jami'ar California, San Francisco, mamaki, wanda aka gayyace shi zuwa tattaunawar, kuma ya yarda cewa ba sa goyon bayan neoadjuvant FOLFIRINOX a matsayin madadin tiyata na gaba.Amma kuma ba su keɓe wannan yiwuwar ba.Saboda wasu sha'awar binciken, ba zai yiwu a yi takamaiman bayani game da matsayi na gaba na FOLFIRINOX neoadjuvant ba.
Ko ya lura cewa rabin majiyyatan ne kawai suka kammala zagaye hudu na neoadjuvant chemotherapy, “wanda ya yi ƙasa da abin da na sa rai ga wannan rukunin marasa lafiya, waɗanda tsarin zagayowar jiyya gabaɗaya ba shi da wahala sosai…...Na biyu, me yasa ƙarin ingantattun sakamakon tiyata da cututtukan cututtuka [R0, N0 matsayi] ke haifar da haɓaka zuwa sakamako mafi muni a cikin ƙungiyar neoadjuvant?fahimtar dalilin kuma a ƙarshe canza zuwa tsarin tushen gemcitabine."
"Saboda haka, da gaske ba za mu iya cimma matsaya mai ƙarfi daga wannan binciken ba game da takamaiman tasirin FOLFIRINOX a kan sakamakon rayuwa… FOLFIRINOX ya kasance yana nan, kuma binciken da yawa da ke gudana da fatan za su ba da haske kan yuwuwar sa a tiyatar da za a iya gyarawa."Cututtuka.”
Laborie ya lura cewa tiyata haɗe tare da ingantacciyar hanyar magani tana ba da sakamako mafi kyau ga ciwon daji na pancreatic.A al'adance, ma'auni na kulawa ya haɗa da tiyata na gaba da maganin chemotherapy.Duk da haka, maganin neoadjuvant wanda ke biye da tiyata da kuma maganin chemotherapy ya fara samun shahara a tsakanin yawancin masu ilimin oncologists.
Maganin Neoadjuvant yana ba da fa'idodi masu yawa: kulawa da wuri na cututtukan tsarin jiki, ingantaccen isar da maganin chemotherapy, da ingantaccen sakamakon histopathological (R0, N0), Laborie ya ci gaba.Koyaya, har zuwa yau, babu wani gwaji da aka yi bazuwar da ya nuna a fili fa'idar rayuwa ta chemotherapy neoadjuvant.
Don magance rashin bayanai a cikin gwaje-gwajen da bazuwar, masu bincike daga cibiyoyi 12 a Norway, Sweden, Denmark da Finland sun dauki marasa lafiya da ciwon daji na pancreatic.Marasa lafiya da aka bazu zuwa aikin tiyata na gaba sun sami 12 hawan keke na FOLFIRINOX (mFOLFIRINOX) da aka gyara adjuvant.Marasa lafiya da ke karɓar maganin neoadjuvant sun karɓi kewayon 4 na FOLFIRINOX wanda ya biyo baya ta maimaita tsari da tiyata, sannan 8 hawan keke na adjuvant mFOLFIRINOX.Babban ƙarshen ƙarshen shine rayuwa gabaɗaya (OS), kuma an ƙarfafa binciken don nuna haɓakawa a cikin rayuwar watanni 18 daga 50% tare da tiyata gaba zuwa 70% tare da neoadjuvant FOLFIRINOX.
Bayanai sun haɗa da marasa lafiya na 140 bazuwar tare da matsayi na ECOG 0 ko 1. A cikin rukunin farko na tiyata, 56 na marasa lafiya na 63 (89%) sun yi aikin tiyata kuma 47 (75%) sun fara maganin chemotherapy adjuvant.Daga cikin marasa lafiya na 77 da aka ba da maganin neoadjuvant, 64 (83%) fara farfadowa, 40 (52%) sun kammala farfadowa, 63 (82%) sun shiga resection, kuma 51 (66%) sun fara farfadowa na adjuvant.
Grade ≥3 m events (AEs) aka lura a cikin 55.6% na marasa lafiya samun neoadjuvant chemotherapy, yafi zawo, tashin zuciya da amai, da neutropenia.A lokacin chemotherapy adjuvant, kusan 40% na marasa lafiya a kowace rukunin jiyya sun sami digiri na ≥3 AEs.
A cikin nazarin niyya-da-biyya, matsakaiciyar rayuwa gaba ɗaya tare da maganin neoadjuvant shine watanni 25.1 idan aka kwatanta da watanni 38.5 tare da tiyata a gaba, kuma neoadjuvant chemotherapy ya ƙara haɗarin rayuwa ta 52% (95% CI 0.94-2.46, P=0.06).Adadin rayuwa na watanni 18 shine 60% tare da neoadjuvant FOLFIRINOX da 73% tare da tiyata a gaba.Ƙididdigar ƙa'idodin ƙa'idodi sun ba da sakamako iri ɗaya.
Sakamakon histopathologic yana ba da ilimin chemotherapy neoadjuvant kamar yadda 56% na marasa lafiya sun sami matsayin R0 idan aka kwatanta da 39% na marasa lafiya na gaba (P = 0.076) da 29% sun sami matsayin N0 idan aka kwatanta da 14% na marasa lafiya (P = 0.060).Binciken ka'idoji guda ɗaya ya nuna bambance-bambance masu mahimmanci tare da neoadjuvant FOLFIRINOX a matsayin R0 (59% vs. 33%, P=0.011) da matsayi na N0 (37% vs. 10%, P=0.002).
Charles Bankhead babban editan oncology ne kuma ya shafi urology, dermatology da kuma ido.Ya shiga MedPage A Yau a cikin 2007.
Binciken ya sami goyan bayan ƙungiyar Cancer Society na Norwegian, Hukumar Lafiya ta Yanki na Kudu-maso-Gabas Norway, Cibiyar Sjoberg ta Sweden da Asibitin Jami'ar Helsinki.
Ko 披露了与 Clinical Care Options, Gerson Lehrman Group, Medscape, MJH Life Sciences, Research to Practice,AADi, FibroGen, Genentech, GRAIL, Ipsen, Merus, Roxiics, Roxiics Binciken OMed Valley "Bristol Myers Squibb" .Celgene, CrystalGenomics, Leap Therapeutics da sauran kamfanoni.
Tushen Magana: Labori KJ et al."Gajeren hanya neoadjuvant FOLFIRINOX tare da aikin tiyata na gaba don ciwon kansa na pancreatic: gwaji na lokaci na II mai bazuwar multicenter (NORPACT-1)," ASCO 2023;Saukewa: LBA4005.
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