Y HOC VIET NAM THANG 3 - SO 2/2012 XUPng , 2 BN ( 3,6%) di can gan, 1 BN di can
phoi, 1 BN di can nao. Ket qua ve di can xa trong nghien cifu cija chung tdi thap hPn mdt s d nghien ciru trong va ngoai nUdc.Theo Leung va CS (2005) khi nghien ciru 1070 BN UTVH dieu tri lai Hongkong tU nam 1990-1998 : di can xa xay ra tren 191 benh nhan (18%). Ngd Thanh Tiing nghien cUu 367 benh nhan UTVH dupc dieu trj tU nSm 1993-1995 cho thay t^ le di can xa chiem 17,4% sau thdi gian theo ddi 36 thang, xuong bj di can nhieu nhat (25%) sau dd la gan (19,4%), phoi (13,9%). Thdi gian di can chil ye'u dien ra trong 2 nam dau sau dieu trj (63,9%). T ^ le tai phat va di can sau dieu trj trong nghien ciru nay thap hon hau he't cac nghien ciru trong va ngoai nUdc trudc day chimg td vai trd quan trpng ciia phac do hda xa tri dong thdi giup giam t^ le tai phat va di can.
IV. KET LU/kN 1. Dap umg dieu trj:
T9 le dap img hoan toan lai u 9 1 , 1 % , mot phan tai u la 8,9%.
T9 le dap Cmg hoan l o a n tai hach la 92,8%, mpt phan tai hach 7,2%.
T^ le dap img hoan toan chung la 89,3%, dap umg mdt phan la 10,7%.
2. Ket qua song t h e m ;
T9 le sd'ng them 3 nSm loan bd la 8 5 , 1 % ,
4 nam toan bd la 72,2%. Thdi gian sd'ng them trung binh la 46,6 thang.
T^ le sd'ng them 3 nam khdng benh la 81,3%, 4 nam khdng t>enh la 65,2%.
Dap irng va tinh trang siit can sau dieu tri la hai ye'u t d tien lupng cd ^ nghTa thd'ng ke dd'i vdi thdi gian sd'ng them qua phan tich hdi qui da bie'n Cox.
3. Tai phat di c a n :
T9 le tai phat la 10,7% trong do lai phat tai vdm la 7 , 1 % , tai phat lai hach 3,6%.
Ty le di can la 16,1%, di can gan 8,9%, di can gan 3,6%, di can phoi 1,8%
TAI UEU THAM KHAO
1. Lee AW, Foo W, Law SC et al (1997),
"Reirradiation for recurrent nasopharyngeal carcinoma' factors affecting the therapeutic ratio and ways for improvement./nf-J-Rad/a(- Oncol-Biol-Phys. Apr 1; 38(1), pp 43- 2. Leung TW, Tung SY, Wong FC et al (2005)."
Treatment results of 1070 patients with nasopharyngeal carcinoma' an analysis of survival and failure patterns". Head and Neck 27:555-565.
3. Ngo Thanh Tiing (2001): Nghien cOu d$c diem lam sang va ket qua xa tn ung thu bi4u md khong biet hoa vom hgng tai BVK giai doan 93-95. Luan van thac sy y hoc, Tmdng Bai hoc Y Ha Npi.
NGHIEN Cl)U KET QUA DIEU TRj BENH U LYMPHO AC TINH KHONG HODGKIN TAI BENH VIEN TRUNG irCTNG QUAN DO1108
N g u y i n Trung Chinh*
TOM T A T
Qua nghien ciiU 80 benh nhan dieu tn phac do Chop va DHAP Chiing tdi nhan thay Dac diem lam sang, xet nghiem 2 nhom nghien cifu khac biet khdng cd y nghTa thong ke. Dap irng dieu tri hoan loan va dap ifng chung phac do DHAP cao hdn phac do Chop. Thdi gian song them toan bd 2 phac dd khdng c6 •) nghTa thdng ke, Thdi gian sd'ng them khong benh khong c6 •H nghTa thdng ke, Ty le rung tdc phac dd Chop cao hon phac do DHAP,
* Benh vien TWQD 108
Phan bien khoa hgc: PGS.TS. Le Van Don
SUMMARY
ASSESSMENT ON RESULT OF MALIGNANT LYMPHO ADENOMA NON - HODGKIN TREATMENT BY CHOP AND DHAP DIAGRAM
Through the study of 80 patients treated under CHOP and DHAP diagram. We found that: the clinical charactenstics in examination of 2 distinctive study groups have no significant result. To meet the complete treatment and commonly meet, the DHAP diagram is higher than that of CHOP one.
Y HOC VIET NAM THANG 3 • SO 2/2012 The time of further live of the whole 2 diagram has
no statistical significance. The time of further live non - disease has no statistical significance. The hair lost rate of CHOP diagram is higher than that of DHAP one
I. O A T V A N OE
U lympho ac tinh khdng hodgkin la benh ac tinh phat sinh lii te bao lympho. Benh phat sinh, phat trien chi^ ye'u 6 cac hach lympho nhung cung cd the phat trien d ngoai he thd'ng hach. U lympho ac tinh khdng hodgkin la mdt trong mudi benh ac tinh hay gap nha't. Theo udc tinh nam 2001 nudc ta cd 1420 benh nhan nam mdi mac, chie'm ty le 4,9/100.000 dan cao thir 6 trong tong so cac loai benh ung thU. Cd 828 benh nhan nii" mdi mac, chie'm t^ le 2,4/100.000 dan, cao thif 11 trong long s d cac benh ung IhU.
Hien nay phac do CHOP (Cyclophosphaniide, Doxorubicin, Vincristine, Prednisolone) van dupc coi la phac dd dieu tri chuan cho ULAKH dp ac tinh trung gian va dp ac tinh cao. Phac do DHAP (Dexamethasone, Cisplatin, Cytosar) la phac do dUdc ap dung tuong ddi cd hieu qua cho ULAKH dp ac tinh trung gian va dp ac tinh cao khang thud'c, lai phaL Nhung thij" nghiem ban dau ap dung phac do DHAP cho ULAKH dp ac tinh trung gian va dp ac tinh cao mdi chan doan, chua dieu tri cfio thay cd the tao ra dap irng hoan toan va thdi gian sd'ng them keo dai. Chung tdi tie'n hanh nghien culi de tai: Danh gia kei qua dieu trj benh u lympho ac tinh khong Hodgkin bang phac dd CHOP va phac dd DHAP tai Benh vien TUOD 108 nham danh gia t9 le dap timg, lac dung ngoai y, thdi gianidng them cCia phac do DHAP ap dung dieu tri cho ULAKH dp ac tinh trung gian va dp ac linh cao mdi chan doan, chua dieu tri.
tl. DOI TUONG VA PHL/ONG P H A P NGHIEN COU 2.1 Ddi tupng nghien ciiu: La cac benh nhan dupc chan doan xac dinh ULAKH dp ac tinh trung gian va do ac tinh cao dUPc dieu trj tai Benh vien T a O D 108 tir thang 1-2000 den thang 10-2007. Chi chpn cac benh nhan mdi chan doan, cd the dieu tri hoa ciia't, tU nguyen tham gia vao nghien cifu.
2.2 Phuang phap nghien cuu: Tien ciru, md ta cat ngang, theo ddi dpc, cd kiem soat.
2.3 Ngi dung nghien cuu: Cac chi lieu nghien ciTu chinh bao g o m :
- Tac dung ngoai y: danh gia tac dung ngoai ^ theo phan dp cija To chuc Y te The gidi.
- Dap Ung vdi dieu trj: Danh gia dap img vdi dieu tri theo tieu chuan cOa To chUc Y te The gidi. Cu the:
+ Dap img hoan toan (DUHT): hach, u tan hoan loan.
+ Dap Cmg mot phan (DUMP): hach, u giam > 5 0 % kich thudc.
-I- Dap Ung chung (DUC): Gop dap img hoan loan va dap Cmg mdt phan.
-I- Benh giu nguyen (BGN): hach, u giam
< 5 0 % kich thudc nhUng khdng xua't hien them tdn thuong mdi.
+ Benh lien trien/tai p h a t : Hach, u to len hoac xuat hien tdn thuong mdi.
Thdi gian sd'ng them: danh gia thdi gian sdng them loan bd, thdi gian sdng them khdng benh, thdi gian sd'ng them khdng sU kien va thdi gian sd'ng them khdng tie'n trien.
2.4 Xu" / y sd lieu: S d lieu dUpc xif l>/ tren phan men thd'ng ke y hpc SSPP 1 i .5, So sanh cac t^ le bang test A N O V A R . Thdi gian sd'ng them dupc Udc lupng bang phUdng phap Kaplan Meier. So sanh thdi gian sd'ng them bang Log Rank lest.
III. KET QUA NGHIEN COU
3.1 Dac diem lam s^ng, xet nghiem
TCrthang 1-2000 de'n thang 10-2007 co 80 benh nhan dUdc dUa vao nghien cOij. Dac diem lam sang, xet nghiem cOa cac benh nhan nghien ciTu tdm tat 6 bang 3.1
Bang 3.1: So sanh dac diem lam sang, xet nghiem cua 2 nhdm Dac diem
Gidi Nam
CHOP DHAP
Y HOC VIET NAM THANG 3 - SO 2/2012
< = 60
> 6 0 Hoi chLTng B
Khong Co
Tinh (rang toan than
< 2 diem
> = 2 diem So VI tri ngoai hach
< = 1 VI tri
> 1 VI tri Loai te bao
Te bao B Te bao T Tham nhilm tuy xuong
Khong Co Mile LDH
Binh thadng Tang
Giai doan Ann Arbor Giai doan 1, II Giai doan III, IV MCrc tienluong
Thap Trung binh thap Trung binh cao Cao
24 16 26 14 17 23 33 7 32 8 30 10 21 19 18 22 14 8 7 8
25 15 19 21 20 20 31 9 30 10 30 10 25 15 18 22 14 12 10 7
0,721
0.088
0.910
0,820
0.395
0,50
0.256
0,971
0,706
Nhan xet: Dac diem lam sang, xet nghiem, phi:n bd mirc lien lupng Qud'c te cija 2 nhdm nghien cinj khac biet khdng cd y nghTa thdng ke.
3.2 Dap utig vdi diSu tri
- Nhdm dieu tri phac dd CHOP cd 40 benh nhan. Trong dd 36 benh nhan dieu trj du 6-8 dpt hoa chat. 01 benh nhan dieu trj 5 dot dat DUHT nhUng toan trang yeu nen dirng dieu trj, 02 benh nhan chi dieu tri 4 ddt do benh tien
then. 01 benh nhan sau 4 dpi benh giCr nguyen nen doi phac do.
- Nhdm dieu tri phac do DHAP cd 40 benh nhan. Trong dd 36 benh nhan dieu trj du 6-8 dpt hoa chat. 01 benh nhan dieu trj 4 dpi benh giiJ nguyen nen doi phac do. 03 benh nhan benh dieu trj 3 dot benh tien then nen ddi phac do, 01 benh nhan ban dau cd dap img nhung dieu tri he't 6 dpt benh tie'n trien trd lai.
- bap Cfng vdi dieu trj ciia 2 phac do the hien torn tat d bang 3.2
Banq 3.2: B a p Cmg Daptjmg
B U H T BLfMP DUC Benh ON Tien trien
v6i dieu tri CHOP n 28 6 36 2 4
(%)
7015 85 5 10
DHAP n 30 5 35 1 4
(%)
7512.5 87.5 2,5
10 P
0,623
Nhan xe'f; Dap Crng hoan loan va dap Cmg chung cua phac (36 DHAP hoi cao hon cua phac
a6 CHOP. Tuy nhien dap Cmg cia 2 phac do khac biet I<h6ng c6 j nghra thong ke (p= 0.623).
Y HOC VIET HAr^ THANG 3 - SO 2/2012
3.3 Thcii gian song them.
- Thai gian theo doi trung binh cOa nhom CHOP la 43,1 thang. ngan nhat la 7 thang, dai nhat la 94 thang. Thdi gian theo doi trung binh cua nhom DHAP la 31,2 thang, ngan nhat la 4 thang, dai nha't la 91 thang. Ty le song them Udc tinh tai thdi diem 5 nam cua 2 phac do the hien d bang 3.3 va cac hinh 3.1, 3.2; 3.3 va 3.4
3.3.1 Thcfi gian song them toan bg (ir&c tinh theo Kaplan-IVIeier) Banq 3.3: Thai qian sonq them toan bo
Phac do CHOP DHAP
n 40 40
TV 25 14.
3 nam 56.57 66.53
5 nam 50.59 42.69
ioqrank 0.35
P 0,5517
Phac do CHOP cd 40 benh nhan. Den thdi diem ket thiic nghien cUu cd 25 benh nhan TV, udc tinh sdng 3 nam la 56,57%. song 5 nam la 50,59%, Phac do DHAP cd 40 benh nhan, De'n thdi diem ket thuc nghien cifu cd 14 benh nhan TV. Udc tinh sdng 3 nam la 66,53%, sd'ng 5 nam la 42,69%. Logrank test = 0,35. P = 0,5517.
Nhan xet: Sd'ngthem toan bd ciia 2phac do khacbiet khdng cd^ nghTa thd'ngke ( p = 0,5517).
3.3.2 Thdi gian song them khong benh.
Banq 3.4: Thdi qian song them khonq benh CHOP
DHAP n 28 30
Tat phat 16 8
3 nam 72.26 75.29
5 nam 39.74 59.16
Loq rank 0.28
P 0.5945 Whan xet: Sd'ng them khong benh ciia 2 phac do CHOP va DHAP khac biet khong cd y
nghTa thd'ng ke.
3.3.3 Thdi gian sdng them khong sukien.
Bang 3.5: Thdi gian sd'ng them khdng su kien
CHOPDHAP n 40 40
Sukien 28 15
3 nam 57.12 63,58
5 nam 33.90 46,36
Log rank 1,23
P 0,2680
Nhan xet: Song them khdng su kien ciia 2 phac do CHOP va DHAP khac biet khdng cd •j nghTa thdng ke.
3.3.4 Thdi gian sdng them khong tien trien Bang 3.6: Thdi gian sd'ng them khdng lien trien
CHOP DHAP
n 40 40
Tien trien 24 16
3 nam 63,76 61,53
5 nam 38,97 42,73
Log rank 0,1
P 0,7006
Nhan xet: Sd'ng them khdng tie'n Irien ciia 2 phac do CHOP va DiHAP khac biet khdng cd:?
nghTa thd'ng ke.
Survival Functions Survival Functions
Bleu do 3.1: Thai gian song toan the Bieu do 3.2: Thdi gian song them khong benh
Y HOC VIET NAM THANG 3 • SO 2/2012
Survival Functions Survival Functions
Bleu do 3.3: Thdi gian sd'ng them khdng su" kien
Bieu dd3.4: Thdi gian sd'ng them khdng lien trien 3.4 Tac dung khong mong mudn
- Tong cdng cd 241 lUPt truyen hoa chat phac do CHOP va 235 luot truyen hoa chat phac do DHAP. Tac dung khdng mong mud'n dp 3, 4 n h u sau:
Trieu chijmg
Buon non l^lon Di long Viem loet mienq Rung toe
CHOF l+ll 1 LKOt
60 102
20 19 18;40'
TL%
25 42 8 8 45
(n=241) lll+IV Lirol
10 31 2 3 22/40*
TL%
4 13 1 1 55
DHAP(
l+ll Lirat
65 100 30 33 25/40*
TL%
28 43 13 14 63
n=235) 1 lll+IV Ltrat
9 25 4 4 4/40*
TL%
4 11 2 2 10 Nhan xet: T^ le rung tdc phac dd CHOP cao hdn phac do DHAP
IV. BAN LU^N
4.1 dac diem lam sang
Bang 3.1 cho thay cac dac diem ve tuoi, gidi, hpi chiTng B, tinh trang toan than, s d vj tri ngoai hach, loai te bao, tham nhiemtu^ xUPng, mirc LDH, giai doan lam sang cija 2 nhdm benh nhan khac biet khdng cd j? nghTa thd'ng k^. PhSn bo mirc tien lUdng giu"a 2 nhdm cung khac biet khong cd y nghTa thd'ng ke.
4.2 Dap ung vdi dieu tri, thdi gian sdng them: Bang 3.2, bang 3.3, bang 3.4, bang 3.5, bang 3.6 va cac hinh 3 . 1 , hinh 3.2, hmh 3.3, hinh 3.4 cho thay dap img vdi dieu trj, sd'ng thdm toan bd, sd'ng them khdng benh, sd'ng them khdng sU kien va sdng t h e m khdng tie'n trien giCra 2 phac do khac biet khdng cd y nghTa thdng ke giufa 2 phac do C H O P va DHAP.
V. KET LUAN
D a p Cmg vdi dieu trj, thdi gian sd'ng them glD'a phac do C H O P va phac 66 DHAP khac
biet khdng cd y nghTa thdng ke. Ty le benh nhan rung tdc dp III,IV d phac do CHOP cao hon phac do DHAP.
TAI UEU THAM K H A O
1. Nguyin Trung Chinh (2004), "Ket qCia dieu tri benh u Lympho ac tmh khong Hodgkin bang 2 phac do GOP va CHOP", Tap chi y hpc Viet Nam. 302, trang, 195- 171
2. Nguyen Ba Oufc (195). Nghien c i ^ chuan doan va dieu tn benh u Lympho ac ti'nh khdng Hodgkin tai benh vien K Ha Noi, Luan an tien sTY khoa, Trudng dai hoc Y khoa Ha Noi. Ha Noi
3. Aboutablet F.M., Ibrahim I.A et al (2000), evaluation of P53 in relapsed and refradoiy aggressiveNHL and response to DHAP protocol".
Journal of the Egyptian Nat., {12),pp 51- 57 4. Amiitage J.O., (2005), " Staging Non-Hodgkin
Lymphoma" CA Cancer J, Clin,, {55), pp, 368- 376, 5. Ansell S.M., Armitage J.O. (2005), Non-
Hodkin Lymphoma Diagnosis and treatment, Liloprint( Goenoa Italy)
