NGHIEN CUU MOT SO OQC TENH CUA HOA CHAT TRiSOC PHAU THUAT VA/HOAC XA TRI BANG PHAC DO CISPLATIN - 5 FLUOROURACIL TRONG DIEU TRI UNG
T H U L U O IPHAN DI DONG GIAI DOAN I I I , IV (MO)
Le Van Quang*, Nguyin Tuyet Mai**, Le Dinh Roanh***
TOM T A T
Mue tieu.' nghiin cim mpt sd ddc tinh ciia hda chdt trude phdu thuat vd/hogc xa tii (tdn bd tra) bdng phac dd Cisplatin- 5 fluorouracll (CF) trong diiu tri ung thu luoi phdn dl ddng giai doan III. IV (MO).
Ddi tuong va phuong phap nghien ciru: nghien ciru tien cim, gdm 65 binh nhan (BN) ung thu ludi phdn di ddng giai doan III, IV (Mo) dupe diiu tri hda chdt phdc do CF tai Benh viin K tic 2002 din 2007. Cdc ddc tinh trin hi huyet hpc, gan, than vd mdt sd tdc dung phu khac duoc phdn tich bao gdm: hg bach edu, bach cau hat, huyit sac td, tiiu cau, ddc tinh tren gan than, budn ndn, ndn, rung tdc, viim mieng. Ket qua: ddc tinh hg bgch edu Id 22,5%), hg bgch edu hgt 29,7%o, ti li hg tiiu cau la 13,3%, ti li hg sde td la cao nhdt 43,6%, ddc tinh trin gan la 17,8%, tren than chiim ti li 3,4%. Budn ndn 30,2%, ndn 29,7%, viem mieng 17,9%, tieu chdy 22,6% vd rung tdc 76,9%. Ket luan: qua phdn tich cdc yiu td ddc tinh ciia thude trin hi tgo huyit, gan, than chiing tdi thdy hg chiim ti li cao, ti li hg BC Id 22,5yo, trong dd chu yiu la bgch edu hgt. Dpc tinh trin gan Id 17,6%), ddc tinh trin than chiem ti li thap.
I. DAT VAN DE
Ung thu ludi la ung thu thudng gap nhat trong cac ung thu viing khoang mieng, benh hay gap d nam gidi. Dieu tri ung thu ludi phan di dpng chii yeu la phau thuat va xa trj. 6 giai doan I, II dieu tri bang phau thuat don thuan hoac phau thuat ket hpp vdi xa tri. Giai doan III, IV dieu tri bang xa tri don thuan hoac phdi hgp phau thuat vdi xa tri va hoa chat dpng mach ludi. Dieu trj boa chat tan bd trg ddi vdi ung thu luoi giai doan 111, IV (MO) bang phac do gdm Cisplatin- 5 fluorouracil (CF) nham ha thap giai doan benh de nang cao hieu qua dieu
*Bd mdn Un^i ll'ii: Dai hgcY Ha Noi
**Khoa Nui I. Benh vien K
***Khoa Giai phau henh - le bao. Benh vien K
tri, nhung ban than nd eiing gay ddc vdi cac te bao binh thudng ciia co the, dac biet la nhung te bao cd tdc dp phan chia nhanh. 0 Viet Nam, cho den nay chua cd nghien ciru ve ddc tinh cua boa chat tan bd trg phac dd CF trong ung thu luoi giai doan 111, IV (MO). Do vay, ehiing tdi tien hanh nghien ciru de tai nham mye tieu: nghien cim mdt sd ddc tinh cua hda chdt tdn bd tra phdc dd Cisplatln-5 fluorouracll trong diiu tri ung thu ludi phdn di ddng giai doan III, IV (MO).
n. DOI TUgfNG VA PHUONG PHAP NGHIEN CUU 1. Doi tuong nghien ciiu
Gdm 65 BN ung thu ludi phan di dpng giai doan 111, IV (MO) dupe dieu tri hda chat phae dd CF tai benh vien K rii 2002 ddn 2007.
So 59 (Thang 12/2010) Y HOC LAM SANG | 29
DIEN
D A N YHOC
Nghien CLPU khoa hpc
* Tieu chuan chgn BN
- Cac BN ung thu luoi phan di ddng giai doan III, IV (MO) chua dugc dieu tri tru'dc do.
- Thd trang chung cdn tdt: Chi sd Kamofsky >
60%.
- Cd chan doan md benh hoe tai u la ung thu bieu md vay.
- Dugc didu tri hoa chat tan bd trg phae dd Cisplatin- 5 fluorouracil.
* Loai trir nhimg BN khong dii deu chudn tren
2. Phuong phap nghien cii-u
* Thiit ki nghiin ciru: nghien ciiu tien ciiu
* Cdc bu&c tien hdnh
- Thu thap thdng rin vao cac thdi diem khi BN mdi vao vien, sau mpt, sau hai dot va sau ba dpt hoa chat.
- Dde tinh cua boa chat:
+ Phan dp ddc tinh dua vao tieu chuan phan dp dde tinh thude chdng ung thu cua vien ung thu qudc gia My:
> Vdi te bao mau: bach eau, bach cau hat, huyet sac td, tieu eau.
> Vdi cac CO quan: gan, than.
+ Mpt sd tac dyng khdng mong mudn khae (theo tieu chuan cua td chirc Y te The gidi):
- Budn ndn, ndn Ryng tdc.
Viem mieng - Tieu chay -
3. Xii- li so lieu
Ma boa va xir li sd lieu bang phan mem SPSS 15.0. Sir dyng phuong phap thdng ke y hpc thdng thudng frong xu li va phan tich ket qua.
HI. KET QUA NGHIEN CUU
1. Doc tinh tren he huyet hoc, gan, than trong ca 3 chu ki hoa chat
Bdng 1. Dpc tinh tren hi huyet hoc, gan, than trong cd 3 chu ki hoa chdt
Ha huyet sac td Ha bach cau Ha bach eau hat Ha tieu cau Tang SCOT Tang Creatinin
Sd lan/tong chu ki 85/195 44/195 58/195 26/195 26/195 5/195
Ti le (%) 43,6 22,5 29,7 13,3 17,8 3,4 Nhan xet: ri le ha huyet sac td chiem ri le cao nhat 43,6%; ha bach cau hat 29,7%); ba tidu eSu chiem ti le 13,3%. Dpc rinh tren gan, than: tang SCOT la 17,8% va 3,4 % tang Crearinin.
2. Doc tinh tren he huyet hoc theo tiing chu ki dieu trj
Bdng 2. Dpc tinh trin hi huyit hpc theo timg chu ki diiu tri
Huyet sac td
Bach eau
Bach cau bat
Tieu eau
Dat 1 Dot 2 Dat 3 Dat 1 Dot 2 Dot 3 Dot 1 Dpi 2 Dot 3 Dot 1 Dpt 2 Dpt 3
D6 0 42 34 34 45 44 46 41 40 37 55 52 50
D6 1 18 20 18 12 15 13 10 16 15 7 12 15
Do 2 4 10 12 7 5 6 8 5 10
2 1 0
Do 3
0 6 4 3 1 0 0
Do 4 0 0 0 0 0 0 0 0 0 0 0 0
Tdng 65 65 65 65 65 65 65 65 65 65 65 65
30 I Y HOC LAM SANG 56 59 (Thang 12/2010)
Nhan xet: ha huydt sic td dp 3 la 1,5%, khdng cd BN nao ha huyet sac td dp 4. Ha bach cau do 3 la 1%, khdng cd BN nao ha dp 4. Ha bach chu hat la 6,6%, khdng cd BN nao ba bach eau hat dp 4. Ti le ha tieu cau thap.
3. So lan ha bach cau d mau ngoai vi
Bdng 3. So ldn ha bgch edu & mdu ngoai vi So lan ha bach cau
0 1 2 3 Tdng
SdBN 34 14 11 6 65
Ti le (%) 52,3 21,5 16.9 9,3 100
Nhan xet: ha bach eau xay ra d 31 BN chiem 47,7%), trong dd d chu ki mdt la 21,5%, 16,9% d chu ki 2 v a 9 , 3 % d c h u k i 3 .
4. Phan bo doc tinh tren gan, than theo tung chu ki
Bdng 4. Phdn bo dpc tinh trin gan, than theo timg chu ki
SCOT
Creatinin
Dot 1 Dat 2 Dat 3 Dot 1 Dot 2 Dot 3
D6 0 46 49 36 65 59 37
D6 1 16 14 7 0 6 6
Do 2 3 2 0 0 0 0
Do 3 0 0 0 0 0 0
Do 4 0 0 0 0 0 0
Tdng 65 65 43 65 65 43 Nhan xet: ti le tang SCOT dp 1 la 21,4%; dp 2 la 2,9%; khdng ed BN nao d dp 3 va 4. Ti le tang Crearinin d dp 1 la 6,9%.
5. Phan bo cac tac dung khac trong ca 3 chu ki
Bdng 5. Phdn bo cdc tdc dung khde trong cd 3 chu ki
Budn ndn Ndn
Viem mieng Tieu chay Ryng tdc
Sd lan/tong chu ki
59/195 58/195 35/195 44/195 50/65
Ti le (%) 30,3 29,7 17,6 22,6 76.9
Nhdn .xet: ti le BN budn ndn va ndn la 60°/b; lieu chay la 22,6%. Ti le ryng tdc sau 3 dgt didu tn la 76,9%.
So 59 (Thang 12/2010) Y HOC LAM SANG |31
DIEN DANY HOC
Nghien CLPU khoa hpc
IV. BAN LUAN
Hda chat cd tac dyng giam the tich khdi u, ngan chan sy phat trien eua te bao ung thu, nhung ban than nd eiing gay dpc \ di eac te bao binh thudng eiia eo the, dac biet la nhiing te bao cd tdc dp phan chia nhanh nhu te bao niem mac dudng tieu hda, tdc, hdng cau, bach cau. Dpc tinh ciia hda chat trong qua frinh dieu tri la van de ma cac thay thude npi khoa ung thu phai quan tam. mpt trong nhirng bien chimg dang lo ngai nhat la bien chung ha bach eau hat lam giam sire de khang ciia co the gay ra tinh trang nhiem khuan. Trong nghien cim cua chiing tdi.
trude dieu tri eac BN deu cd sd lugng bach cau va bach cau hat trong gidi ban binh thudng nhung trong qua trinh dieu tri thude hda chat Cisplatin va 5FU cd 22,5% sd BN bi ha bach eSu va 29,7% bi ha bach cau hat. Tinh chung ca 3 chu ki cd 1% sd BN bi ha bach eau dp 3, khdng cd BN nao ha bach eau dp 4;
6,6% sd BN hai bach cau hat dp 3.
Ha tieu eau cung la yeu td can quan tam, tinh chung ea 3 ehu ki ed 13,3% sd BN ha tieu ciu dp 1, 2; khdng cd BN nao ha rieu cau dp 3, 4. Ti le ba tieu cau tang dan qua cac chu ki dieu tri. tuy nhien khdng cd sy khae biet giiia ti le ha tieu cau giiia cac chu ki cd y nghTa thdng ke. Ndi den ddc tinh tren ha huydt bpc khdng the khdng ndi tdi yeu td huydt sic td, frong nghien cuu cua chiing tdi ti le BN bi ha huydt sac td chiem ri le eao nhat 43.6% trong dd ha dp 1, 2 la 42%, ha dp 3 la 1,5%. Nhung li do cd thd din
tdi rinh frang ba buydt sic td frong qua trinh dieu tri nhu su tieh luy lidu sau mdi ehu ki, dinh dudng bi anh hudng hoac do chay mau ri ra tai u.
Ddc tinh fren gan \ a than cdng la mdt trong cac yeu td anh hudng ddn lieu trinh didu tri. cae hda chat dupe diing frong nghien cim ehuyen hda chu yeu o gan va thai trir qua than nen ed kba nang gay ddc cho cac eo quan nay. Trong nghien ciin, ti le tang SCOT dp 1 la 21,4%, dp 2 la 2,9%, khdng ed BN nao d dp 4. Ti le tang creatinin d dp 1 la 0,9%; khdng ed BN nao d dp 2, 3, 4.
Hau het cac hda chat deu ed tac dyng khdng mong mudn nen khi dieu tri cho BN cae thay thude lam sang thudng diing thude de dy phdng va kiem soat cac tac dyng phy nay, vdi viec sir dyng thude hgp li se giam thieu met mdi, suy syp ve the chat, tinh than ciia BN hoac cac bien chiing nguy hiem khac.
Trong nghien cim ciia ehiing tdi tac dyng phu hay gap nhat la ryng tdc chiem 76,9%, budn ndn 30,3%, ndn 29,7%, tieu chay 22,6% va viem mieng 17,6%.
V. KET LUAN
Qua nghien cim eac yeu td ddc tinh eua thuoc tren he tao huyet, gan, than ehiing tdi thay ha huyet sac td chiem ti le cao, ti le ha bach cau la 22,5%, trong do chu yeu la bach cau bat. Ddc tinh fren gan la 17,6%, dpc tinh tren than chiem ti le thap.
Tac dyng phy khdng mong mudn la ndn, budn ndn, rung tdc \ a d mire dp nhe it anh hudng tdi chat lugng sdng cua BN.
TAI LIEU THAM KHAO
1. Nguyin Qudc Bdo (2001), "Ung thu biiu md khoang mling ", Hudng ddn thuc hdnh chdn dodn diiu tri ling thu, Nhd .xuat ban y hpc, 92-113.
2. Nguyin Dice Lai (2002), "Nghiin cim dde diim Idm sdng vd mpt sd yeu td tien luong binh ung thu heal diiu tri tgi binh viin K", Ludn vdn tot nghiep bdc si ndi tn'i cdc binh viin, Tncdng Dgi hpc YHdNdl
3. Phgm Tuan (1987), "Diiu tri ung thu ludi giai doan mudn bdng hod chdt ddng mgch kit hap vol tia xg ", Tdm tdt cdng trinh nghiin cim khoa hpc ung thu, Bd Y ti, 135-136.
4. Vu Vdn Vii vd cdng su (2004), "Hod tri mig thu ddu cd ", Ung budu hpc ndi khoa, Nhd xudt bdn V hoe, 207-223.
32 I Y HOC L A M S A N G S6 59 (Thang 12/2010)
5. American Cancer Society (2004), "Countiy- specifie prevalence and incidence statistics for Tongue Cancer using extrapolations to estimated populations and diagnosis rates ", Cancer Facts and Figures, American Cancer Society.
6. Grau J, Jopsep Domingo et al (2002),
"Neoadjuvant chemotherapy as organ presel'\^ation strategy in cancer of the oral cavity ", ASCO .Annual Meeting.
7. Decroix Y, Ghossein A.N (1987). "Experience of the Curie institute in treament of cancer of the mobile tongue ", Cancer, 496-502.
SUMMARY
THE TOXICITY OF THE NEOADJUVANT CHEMOTHERAPHY WITH CISPLATFN - 5 FLOUROURACIL (CF) IN PATIENTS WITH STAGE III, IV (MO) MOBILE TONGUE CANCER AT K HOSPITAL FROM 2002 TO 2007
Objective: to study the hematological toxicity and other toxicities In neoadjuvant regimen chemotherapy with CF of the patients with stage III, IV (MO) mobile tongue cancer
Patients andmethod:65/7q//e/7?.yw/?/7i'/(3ge///./F (MO) mobile tongue cancerwere Included in analyzing the hematological toxicity and other toxicities after 3 cycle of the chemotherapy. Common acute toxicities include the following: leucopenia, neutropenia, anemia, thrombocytopenia, liver toxic, kidney toxic, nausea, vomitting, mucous membrane ulceration.
other gastrointestinal effects and alopenia. Results:
the hematological toxicity' with leucopenia is 22.6%o, neuropenia is 29.7%o. Thrombocytopenia Is 13.3%.
Hemoglobin decrease Is 43.6%, liver toxic is 17.8%.
Kidney toxic Is low. Other toxicities as nausea, vomitting, mueuos membrane ulceration. Alopecia Is 76,9%. Conclusion: the common toxicities were leucopenia, neuropenia, anemia, alopecia but these toxicities were acceptable and could be recovered after applying medical treatment.
So 59 (Thang 12/2010) Y HOC LAM SANG | 33
