Y HOC VIET NAM THANG 6 - SO 2/2014
DOC TINH C O A P H A C DO XELOX DIEU TRI BO TRO UNG THU* DAI T R A N G GIAI DOAN III
T O M TAT
MMC tieu: Nhan xet mot so dpc tinh ciia phac dd XELOX trong dieu tr| bd trd ung thu dai trang giai doan I I I . Doi tu'dng va phu'dng phap: 70 benh nhan du'dc chan doan xac dinh UTBMDT giai doan I I I dirpc dieu tri phau thuat, hoa chat bo trp phac do XELOX tai Benh vien K va Benh vien Oai hpc Y Ha Npi tCr 2010 den 8/2013. Suf dung phu'dng phap nghien cifu mo ta hoi ciiu. K i t qua: doc tfnh giam HST chiem 19,64%, ti-ong do dp 1 la 15%, dp 2 va dp 3 tu'dng uhg 3,57%
va 1,07%, khong cd tru'dng hdp nao bi ha HST dp 4.
Ty le ha bach cau chiem 46,8%, trong do ha bach cau dp i , 2 eh lu'dt la 21,5% va 15%, ha bach clu dp 3 clilem 9,2% va ft nhat la dp 4 chi chiem 1,1%. Ha bach cau hay gap nhat vao ciiu ky thir 2, 3, 4 ciia lieu trinh dieu tri, cao nhat d chu ky thir 4. Dpc tfnh tren ddng tieu cau chiem ty Ie thap va chi d mirc do 1 va 2. Doc tfnh tren gan d mite thifp, 14,3% tang SGOT d dd 1, 2. Cd 16,1% tSng SGPT d dp 1, 2, khong gap tru'dng hdp nao tang dp 3-4. Ogc tinh tren than d dp 1, 2 la 10%, khong cd dp 3,4. Tieu chay gap 10% cac tru'dng hdp, non va buon non 13,3%. Hpi chiTng tay chan gSp d 15%, rung toe chi chiem chu5 den 10% do 1. Ooc ti'nh tren than kinh cam giac gap chiem 52,5%
trong do 40% dp 1,10% dp 2 va 2,5% dp 3.
Ket luan: Phac do XELOX tu'dng ddi an toan, cac dpc ti'nh tren he thong tao mau, gan than chiem ty le thSp,v^ chil yeii d dp 1 va dp 2, khong gap d dp 4.
Tieu chay gap 20%. Hpi chuhg tay chan 15%. Ooc tfnh thSn kinh ngoai bien 52,5%. Dau thu'dng vi -viem da day, viem mieng, rung toe, buon non- non ciiiem ty le thap.
710'khoa: 6QC tinh, phac dd Xelox, ung thu dai trang
S U M M A R Y
TO STUDY THE T O X I C I T Y OF THE ADJUVANT CHEMOTHERAPY W I T H XELOX
FOR COLON CANCER PATIENTS Objective: Evaluate toxicity of the adjuvant chemotherapy with Xelox for colon cancer patients.
Patients and method: 70 patients with stage I I I colon cancer were treated by surgery and adjuvant chemotherapy with Xelox at the K hospital and Ha Noi medical university hospital from 2010 to 2013. The restrospective descriptive study. Results: The hematological toxicity with anemia is 19,64%, grade 1(15%), grade 2 (3,57%), grade 3(1,07%).
Neutropenia grade 1, 2 is 21,5% and 15%; grade 3(9,2%) and grade 4 is very low. Neutropenia is 15%.
Neutropenia is most seen in cycle 2, 3, 4. The highest
* Khoa ngi *? - Bgnh vlgn K
** Khoa Ung budu va ChSm soc giam nhe -BVOHY HN Phin bi$n khoa hgc: PGS.TS Tran VSn Thuan
Nguyin Thi Thiiy H5ng*, Le Van Quang**
in cycle 4. Thrombocytopenia is low, usually grade 1-2.
Enzymes SGOT increase is 14,3% and Enzymes SGPT increase is 16,1%. Nephrotoxicity is not comment, grade 1-2(10%). Other toxicities as diarrhea 10%, nausea and vomiting 13,3%, hand-foot syndrome 15%, alopecia 10%. Neurologic sensitive toxicity is 52,5%. Conclusion: The common toxicities were anemia, neutropenia, thrombocytopenia, diarrhea, nausea and vomiting, hand-foot syndrome, alopecia, but these toxicities were acceptable and coud be recovered after applying medical treatment
Keywords: toxicity, colon cancer, chemotherapy
I.
OAT V X N OEUng thu* dai trang la mpt trong nhiJng benh ung thu' thu'dng gap d cac nu'dc phat^trien. Theo Globocan 2008, u'dc tfnh nam moi nam cd khoang 1,230.000 tru'dng hdp ung thu' dai trang mdi mac trong do 608.000 tru'dng hdp tii" vong.
Tai Viet Nam, UTOTT la 1 trong benh's benh ung thu" thu'dng gap nhat, va cd xu hu'dng gia tang, u'dc tfnh nam 2010 tren ca nu'dc cd khoang 7300 ngu'di mdi mac [ 1 ] .
Hau het cac benh nhan den vien khi benh 6 giai doan mupn gay khd khan cho qua trinli dieu trj cung nhu' tien lu'dng benh. Phau thuat la phu'dng phap dieu trj cd ban trong ung thu" dai trang. Oieu t n bo t r d ung thu' dai trang giai doan I I I cd rat nhieu phac d o du'dc ap dung d i f t tren nen tang cd ban la sil dung thuoc 5FU. Sy" phoi hdp hoa chat Capecitabine (Xeloda) va Oxaliplatin (phac d o XELOX hay CapeOx) trong dieu trj bo t r d ung thu" dai trang giai doan I I I da du'dc nhieu nghien culi tren the gidi chiihg minh tinh hieu qua cua nd va da du'dc ap dung rpng rai.
Ben canh tinh tien dung va nhieu ldi i'ch ro rang ma phac do mang lai, nd cung di kem nhu'ng dpc tinh ma cac nha lam sang phai quan tam.
Tai Viet Nam, dieu tri bo t r d ung thu' dai trang giai doan I I I bang phac do XELOX da du"*
ap dung trong may nam t r d lai day. Tai Benh vien K trung u'dng va Benh v i | n Dai hoc Y Ha Npi, XELOX da t r d thanh m p t trong nhOhg phac do hang dau du'dc cac thay thuoc lam sang LAJ tien lya chpn trong dieu t n bo t r d ung thi/ dai tru'c trang, tuy nhien hien nay chVa co nghi§n ciru nao danh gia ve dpc tinh cita phac do nay mpt each day d u , Vi vay chimg toi tien hanh nghien ciTu nay nham muc tieu: "iVhinxetm^t
sddpc tinh cua phic dd XELOX dieu tr! W
trd ung thWdai tring giai doan III"
¥ HOC Vl|T NAM THANG 6 - SO 2/2014
II. D 6 I TUpNG VA PHl/ONG PHAP NGHIEN CLTU
2.1. Doi tu'ang: 70 benh nhan du'dc chan doan xac djnh LITBMDT giai doan III du'dc dieu tri phau thuat, hda chat bo trd phac do XELOX tai B^h vien K va Benh vien Oai hoc Y Ha Noi tu"
2010 den 8/2013.
2.1.1. Tieujchuan chpn benh nhin + Du'dc chan doan xac dmh UTOT nguyen phat giai doan III sau phau thuat theo phan loai ciia UICC
+ Mo benh hpc la ung thu'^bieu mo tuyen + Sau rno du'dc dieu tri bo trd hda chat phac do XELOX
+ 03 ho sd benh an ghi chep day du.
+ Chu'c nang he tao mau, gan, than cdn tot.
III. K E T Q U A V A B A N LUAN
3.1. Doc tinh trgn h$ tao huyet
Bing 1: Ppc ti'nh tren dong hong cau
+ Khong cd benh ung thu' khac kem theo.
+ Khong mac cac benh cap va man tinh tram trpng co nguy cd gay tiT vong gan.
2.1.2. Tieu chuan loai trvt
+ NhiJng benh nhan UTDT tai phat hoac di can tir ndi khac den.
•I- Nhij'ng benh nhan khong phu hdp vdi mot trong cac tieu chuan lu'a chon d tren, bd dieu tn, ho sd lu'u tru' khong d^y dii.
2.2. Phu'dng phap nghien cihi: mo ta hoi cull
2.3. Thu thap va xuT ly so lieu - Thu thap so lieu theo mau benh an nghien ciilj in san
- Xu' ly so lieu bang phan mem SPSS 16,0.
So benh nhan (%) MtjfcdddSctinh
06 0 I Giam huyet sac to I 80,36% . HhSn xet: Ty le giam HST chiem 19, 3,57% va 1,07%.
b d l l l
06 IV Tong 15% I 3,57% I 1,07% [ 0% I 100%^
i%, trong do dp 1 chiem 15%, do 2 va dp 3 tu'dng img la Bing2:0dc ti'nh tren ddng bach cau
Mtirctf$d$ct{nh
Giam bach cau 06 0
Do ITy le (O/o)
D p n
P p mTtfng
21,5 15 9,2
Nhin xet: t y le ha bach cau d cac mCTc dd chiem ty le 42.8%. Ha bach cau do 1, dd 2 lan lu'dt la 21,5% va 15%, ha bach cau dp 3 chiem 9,2% va ft nhat la dp 4 chi ' •" ' " "
ll chiem 1,1%.71: Uen quan giu'a so lan ha bach cau va chu ky hda chat
Nh$n xit! Hg b?ch cau hay gap nhat vao chu ky thii" 2, 3, 4 cua lieu trinh dieu tri trong do cao nhat d chu ky thu" 4. 6 chu ky 1 ha bach cau d mirc trung binh. Cac chu ky thu" 5, 6, 7, 8 ty Ie ha bach cau thSp hdn va thap nhat d chu ky 8,
Mi^cd^d^ctlnh Glim bach cau
Ty le (»/o) 09 0
94,3 C o l
5,2 09 I I
1,5
C 9 I I I 0
09 IV 0
Tong
100
Nhfn xit: Ha tieu cau chi d mu'c do 1 va 2 vdi ty le thap tu'dng ung la 5,2% va 1,5 %.
Y HOC VlfT NAM THANG 6 • SO 2/2014 3.2. Doc tinh tren gan - than
Bi'ng 4; Doc tinh tren gan Mu'c do doc tinh
SGOT SGPT Mu'c do doc tinh
Creatinin Ure
TV le (%) eoO
85,7 83,9
0 6 1 10,7 13,4 0 6 0
79,8 89,6 Nhinxet:Ty le tang SGOT la 14,3%,
0 6 I 17,2 8,2
06 I I
3,6 2,7Do I I I 0 0
Do IV 0 0 ry le ("/o)
0611 3 2,2
Do I I I 0 0 trong do d do 1, do 2 la 10,/ va J,b"/
0 6 IV 0 0
Tong 100 100 Tong
100 100 .Tang SGPT la 16,1%, d o i , 2 tu'dng irng la 13,4 va 2,7%. , . , , . , , . , .
• Bpc tinh tren than chiem ty le thap, trong do dp 1 va dp 2 la 10%. Khong co benh nhan nao gap doc t'rih dp 3,4.
3.3. Ooc tinh tren da, niem mac, he tieu hoa Biiu do 2. Bpc tinh tren da, niem mac,he tieu hoa
25%
20%
15%
10%
5%
0%
20% I Z ;;•:: 8%_^ 5% 15%
Tieu chay Dau thugng Buon non Non 4%
Viem HC tay mieng chan
Nliinxit:T\eu chay chiem 20%, non va buon non chiem ty le 8,1% va 5,2%. Tieu chay dp 1 gSpda so chiem 12,5%, dp 2 chiem 6%, dp 3 la 1,5%. Dau thu'dng v| chiem ty le rat thap 2,i %, vilm mieng gSp 4%, hpi chiJng tay chan gap d 15%, rung toe chiem chu'a den 10% .
3.4. Ooc tinh than kinh
BingSiOoc tinh len than kinh cam giac nqoal bien Ty le °/o
0 6 1
40%
Do 2 10%
0 6 3 2,5%
06 4
0%Tong 52,5%
Nhin xet: Bxtnh tren than kinh cam giac chiem 52,5%, b'ong do 40% dp 1,10% dp 2 va 2,5% dp 3.
IV. B A N L U A N
4.1.09c tinh tren dong hong au Trong tat ca cac chu ky hoa chat, ty le khong lam giam huyet sSc to chiem 80,36%, giam HST chiem 19,64%, trong do giam HST do 1 chiem 15%, dp 2 va dp 3 tu'dng utig la 3,57% va 1,07%, khonq co tru'dnq hdp nao bi ha HST do 4.
Theo Soon II Lee (2011), thieu mau d moi mu'c do ciJa phac do XELOX la 14%. Nhu" vay mii'c do thieu mau qay ra bdi hda chat cd the chap nhan du'dc. Tronq nqhien ciJu cua chunq toi so benh nhan thieu mau nanq phai truyen mau la rat it (3 benh nhan), hau het cac benh nhan thieu mau mu'c dp nhe va silr dijng cac thuoc hp trd nhu' sat,
kich thich dong hong cau erythropoietin mang l?l hieu qua.
4.2. Ooc tinh tren dong b^cli cau Ha bach cau la mot trong nhiilig dpc tinh nguy hiem ciia hoa chat, co the de dpa tinh mang benh nhan. Trong nghien ciJu ciJa chung toi, t / le ha bach cau dp 1, 2 lan lu'dt la 21,5%
va 15%, ha bach cau dp 3 chiem 9,2% va it nhat la dp 4 chi chiem 1,1%. Ty le ha bach rau d cac mCrc do chiem ty le 42,8%. Tai cliau A, Lu GC (2010) cho biet tv le ha bach cau do 3-4 IS 14,3%, ciia Soon II Lee (2011) la 14%. 0 chSu Au, Schmoll H (2007), tv le ha bach cau moi mOt do la 35% trpnq dd do 3-4 chiem 15%. Cac benh nhan ha bach cau dp 1, khong can phai xii tn,
Y Hpc VIET NAM THANG 6 • SO 2/2014
chi can nanq cao the tranq va nqhi nqdi. Neu ha
bach cau til' do 2 se du'dc diinq cac thuoc kich thich dong bach cau hat nhu'i^Igrastim.
4.3. Lien quan ha bach cau va chu kV hda chat
Ha bach cau hay gap nhat vao chu ky thir 2, 3, 4 ciia lieu trinh dieu trj trong dd cao nhat d chu ky thuf 4, chu Iq^ 1 ha bach cau d mirc trung binh, cac chu ky thir 5, 6, 7, 8 ty le ha bach cau thap hdn va thap nhat d chu ky 8. Cd the giai thich do chu ky dau cd the mdi bat dau tiep xiic vdi hda chat tri lieu va nhihig chat nay chu^ gay anh hu'dng nhieu Ien tiiy xu'dng, cac chu ky tiep tiieo dpc tinh tfch luy dan va gay ha bach^cau nSng nhat vao chu ky thiT 4, sau dd cd the belt diu thfch nphi. Lu GC (2010), Diao C(2008) cung cho ket qua tu'dng tu* vdi ty le ha bach cau hay gSp nhat vao chu ky 3,4 sau dd giam dan.
4.4. D$c tinh tren dpng^tieu cau Doc tinh tren ddng tieu cau chiem ty le thap, ha tieu cau chi d mirc dp 1 va 2 vdi ty le tu'dng lihg la 5,2% va 1,5 %, khong cd tru'dnq hdp nao ha tieu cau d dd 3 va 4. Theo Soon II Lee (2011), ha bach a u dp 3-4 la 4%. Ha tieu cau dp 1, 2 thirdng ti/ hoi phuc, ha bach cau do 3-4 ho3c tc^m theo cac dau hieu xuat huyet (Sn phai du'dc ho trd bSng cac che pham giau tieu cau nhu* khdi U^u cau may.
4.5.0$c tfnh trSn gan
Dpc tfnh len gan cua hda chat d mu'c thap, c6 14,3% gay tang men gan SGOT d dp 1, 2 vdi ty l§ 10,7 va 3,6%. Chi cd 15,1% gay tang men gan SGPT d dp 1, 2 vdi ty- le 13,4 va 2,7%.
Khdng ghp tru'dng hdp nao t3ng men gan dp 3-4.
MOfc dp tac dpng ciia hda chat len^SGOT va SGPT Id tu'dng ty nhau. Theo hu'dng dan ciia nha san xulit khi diing oxaliplatin ddn trj lieu vdi lieu 130mg/m2 thi dpc tfnh tren gan d mpi mifc dp la 46% trong dd chu yeu dp 1-2 , dp 3 -4 tu'dng uhgja 10% va 2%, cao hdn rat nhieu so vdi nghien ciru cua chung toi, dieu nay cd the giai thich do c9 mau nghien culi rat Idn va thu'c hien tr§n nhlSu nhdm doi tu'dng benh nhan d nhieu qu6c gia khde nhau.
4.6. D$c tinh tren than
Ddc h'nh len than cua hda chat d mu'c thap, dp 1, 2 g$p khoang 10%, khong cd benh nhan nio g3p doc tfnh dp 3,4. Theo nha san xuat dpc tfnh len th?n dp 3-4 chiem 3%. Oxallplabn ciing nhim muoi platinum vdi cisplatin va carboplatin, thu§c_th€ h? thii" 2. Cisplatin gay dpc b'nh manh l&i ttian vS ty le suy than cap da duWC ghi nhan, do d6 khi dung phai kem theo ldi tieu manh. Den thS h§ 2 oxaliplatin da du'dc cai t^ien ro, dpc h'nh I6n th^n giam di dang ke, hau nhu' d mute thap va kWng c3n dirng kdm ldi tieu. Doi v&i capecitabine
dung dOn trj khdng gay dpc d'nh tren tiian. Phac do XELOX it gay ra dpc tinh tren than.
4.7. Dpc tinh tren da, niSm mac, he tieu hoa
fllon va buon non: chiem ty le 8,1% va 5,2%. Theo nghien ciTu NOi6966 (2011), ty le non va buon non moi mii'c do la 71% trong dd do 3,4 la 8%. Schm'oli (2011), nghien cu'u tren 938 benh nhan dieu tri phac do XELOX, 38% cd non va buon non mpl mu'c dp. Non va buon non chiu anh hu'dng nhieu yeu to trong do cd yeu td tam ly chi phoi. Thong thu'dng khi sii' dung cac thuoc chong non 5HT3 benh nhan dap iing tot, trong mpt sd tru'dng hdp Cortisol va cac thuoc an than cd hieu qua.
Bau ^uVlig vl: chiem ty le rat thap 2,1 % va khdng anh hu'dng nhieu den su'c khde benh nhan.Theo nghien cuU N016966 (2011), ty le dau thu'dng vi, viem da day moi mifc do la 21%
trong dd dp 3,4 la 1%! Thif nghiem XELOXA thu du'dc ty le viem da day do 3-4 d nhdm dung XELOX la 2%.
Viem mieng: viem mieng gap 4% cac tru'dng hdp nhu'ng gay khd chiu, dau ddn va anh hu'dng den sif ngon ml&ng cua benh nhan, vi v$y nen dir phdng dpc tinh nay tru'dc khi xay ra bing viec giao due benh nhan ve sinh hpng mieng dung each.
Rgng tdc: khdng thu'dng gap d cdc benh nhan nhd cac phac dd hda chat khac, chi chiem chuti den 10% dp 1. Thif nghiem X-ACT thi ty le rung tdc chu'a den 5%. Rung tdc gay anh hudng rat nhieu den tam ly benh nhan d3c bi^t la nCi' gidi, trong nghien cifu nay chiing tdi g3p ty le rung tdc thap. Rung tdc d nhChig benh nhan nay cung mifc dp nhe va khong gay anh hu'dng nhieu den tham my va tam ly.
Ty IS tiSu chiy cic mu'c di: la dpc tfnh hay gap nhat tren du'dng tieu hda, cd 20% cac tru'dng hdp gap tac dung phu tieu chay, dp 1 gap da sd chiem 12,5%, dp 2 chiem 6%, dd 3 ehi gap 1,5% cac tru'dng hdp, khong gap dp 4. Theo nghien CLTU N016966 (2011), gip d cac mifc do la 66% trong dd dp 3,4 la 20%. X-ACT (2011) nghien ciru tren 993 benh nhan sif dung capecitabine cd ket qua tieu chay moi mifc dp 43%. Lu GC (2010) gap 35% tieu chay moi mii'c dp, dp 3-4 la 10%.
TV le gip hdi chuhg tay chin d dc md'c
dd: hdi chiihg tay chan gap 15% cac tru'dng
hdp, dd 1 chiem 8%, dp 2 la 4,5%, thap nhat Id
dp 3 chiem 2,5%, khong gap hdi chiihg tay chan
dd 4. X-ACT (2011) cho ket qiia hdi chiihg tay
chan mpi mifc dp 60%. Nghien cifu N016966
(2011) thi g3p mpi mifc dp la 33% trong dd dp
3,4 la 6%. Khdng cd stf thong nhat glij^ cic
nghien ciiU ve ty le va miJc dp gSp hpi chifng tay
Y HOC Vl|T NAM THANG 6 • S6 2/2014 chan, cd nhu'ng nghien cihj cho thay t y !e nay rat
cao, mot sd tac gia lai cho ket qua thap. Hpi chuhg tay chan gay rat nhieu phien toai cho benh nhan va rat khd du" phdng. Ngu'di benh nen chu y tranh tiep xuc vdi nu'dc q u a j a n h , ndng, che chan tay chan khi ra nang, cd t h e xoa bdp va ngam tay nu'dc a m , dung kem duSng am cho da tay. Mpt so tac_;gia cho rang dimg cac thuoc dc che COX cd the lam giam cac mu'c dp ciia hdi chirng tay chan tuy nhien chu^ cd nghien ciiij nao cu the du'dc cdng bd.
Boc tinh Wan kinh cim giac ngoai biin:
doc tfnh tren than kinh cam giac gap chiem 52,5% trong dd 4 0 % dp Ij, 1 0 % dp 2 v a 2 , 5 % dp 3. Dpc tinh nay bad gom cac benh ly than kinh cam' giac ngoai bien nhU loan cani va/hay dj cam dau ehi cd kem hay khdng cam giac vop bej thu'dng khdi phat do lanh, kho thi/c fiien cac cac cif ddng tinh te^ mdt hpi chCfng cap tinh do rdi loan cam giac vung hau hpng da du'dc ghi nhan khi dieu tri vdi oxaliplatin. Theo Argyriou A (2012) ty le gap ddc tinh nay ciia nhom dung XELOX fa '44/73 benh nhan chiem 60,2%.
N016966 (2011) cho ket qua d moi mifc do la 82%, dp 3-4 la 17%.
V. K i t LUiSiN
Dpc tfnh tren ddng hong cau 19,64%, trong do chil yeu dp 1, dp 3-4 la 1,07%. Ha bach cau chiem 42,8%, dp 3-4 la 11,3%, hay gap nhat vao ehu ky thif 2, 3, 4 trong dd cao nhat d chu ky thir 4, so lan ha BC t r u n ^ binh 3 lan/benh nhan. 15%
ha bach cau cd nhiem khuan lam sang, hay gap
he hd hap va tieu hda, ha bach cau^cang nang thi ktia nang cang cao tim thay 6 nhiem khuan. Hci tieu cau ty le rat thap 6 , 7 % , khdng gap dp 3-4. ' Ddc tinh len gan, than gap d mifc thap chii yeu d d 1,2. Tieu chay gap 2 0 % , do 3-4 la 1,5%.
Hdi chifng tay chan 1 5 % , dp 3-4 la 2,5%. Dpc tfnh than kinh ngoai bien 5 2 , 5 % trong do dp 1 la 40%. Dau thu'dng vi -viem da day, viem mieng, rung tdc, buon ndn- ndn chiem t / le thap.
T A I L l | U T H A M K H A O
1. Nguyen Ba Dure (2010), Bao cao sd bp ket qui thu'c hien du' an quoc gia ve phong chmg ung thir giai doan 2008-2010, Tap chi un^ thd hgc Vilt Nam, Hot thao quoc gia phong chong ung thir lan thirXV,tr.21-26.
2. Soon I I Lee (2011A A Retrospective Study of First-Line Combination Chemotheraov in Advanced Colorectal Cancer: A Korean Sinale-Center Experience. Cancer Res and Treat 2011 June,42(2),pp 96-101.
3. T Shiroiwa (2009), Cost-effectiveness analysis of XELOX for metastatic colorectal cancer based on the N016966 and N016967 trials", Br J Qin Cancer. 2009 June 7,101(1), ppl2-18.
4. Lu GC (2010) , Efficacy and toxicity analysis of XELOX and F0LF0X4 regimens as adjuvant chemotherapy for stage I I I colorectalcancer , Chinese journal of oncology, 2010 Feb,pp 152-5.
5. DIao C (2008), Clinical observation of XELOX (Capecitabine puis Oxaliplatin): an adjuvant chemotherapy regimen used in stage III colorectal cancer, Chinese journal of oncology ItM Feb, pp 147-50.
V THU'C TRANG CG S(X VAT CHAT vA NGUON NHAN LITC CHAM SOC SU'C K H 6 E TAM THAN CAC TINH PHIA NAM
T6M TAT
Nghien ciru mo ta thUc trang cd sd vat chat va nguon lu'c he thdng chim soc sire khoe tam than cac tinh, thanh phd tn/c thupc tmng Udng thupc Khu vi/c phfa Nam dUdc tien hanh bang phu'dng phap dich t l hpc mo ta c3t ngang, tai tat cacac tinh, thanh pho thu6c khu vu'c phfa Nam tir Da Ning den Ca Mau. Ket qua nghien ciJfu cho ttiay so cd sd kham ch&a benh tam than d Khu vu'c phfa Nam la kha mdng vdi tdng so la 13 b?nh vien t i m than va 13 khoa tam than trong benh vien da khoa ti'nh; tong so giu'dng benh tam tfian
* Binh vien Tam than Trung udng 2
** Cue Quan ly Kham, diQti benh -BoYte Phin bign khoa hgc:lS. Vu'dng Anh Du'dng
Bui Thd Khanh*, Triin Quy Tirfrng**
tuong dUdng vdi ty le 6,4/100.000 dan, 6/32 tinii khong cd giu'dng benh tam than; Trang tiiiet bj thieu dong bp, con thieu ca nhiJng thiet bj chuyen khoa tfi thieu CO 8/32 tinh dii 3 loai may ghi dien nao d^, miy do lull huyet nao, may soc dien tam than; So cdn bg y te chim sdc sife khde tam than la 13,18/100.000 diln va ty le bac si tam than la 0,42/100.000 dSn thSp hfln so vdi cac nu'dc trong khu vUc va the gidi. Vl?c t3ng cu'dng dau tu" nang cap cd sd vat chat va tSng cudng dpi ngu can bp chuyen mdn chSm sdc sife kh6e tam than cho cac tinh khu vi/c phfa Nam la can thiet v i cSp bach, dac biet uu tien cho cac tinh thupc Viing TSy Nguyen va Ddng BSng Sdng Ciitj Long.
Tu'khda: ChSm sdc sife khde tam thSn, cic tinh phia nam.
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