thin ve tinh thin, sinh hogt van hda de gdy cdng thing thin kinh, tdm ly cho ngudi lao dpng. ^
2. Thyc trang si>c khoe vd dpc diem than kinh tam ly cOa ngirdi lao dpng fren phuvng tipn thuy
- Phdn logi sire khoP: Logi II ehllm 58,1%; Loai I chiem 22,6%; Logi III chilm 17,9%; Logi IV chiem 1.3%; Khdng cd tm'dng hgp ndo sO'c khoe logi V. ^
- Bpnh rdng hdm mpt 41,9%; Bpnh mdt ehlem 40,9%; Bpnh tuan hodn 21,3%; Bpnh tiSu hda 20,9%;
Bpnh tilt nipu, sinh dye 11,3%.
- Ngudi lao dpng Idm vipc trSn phuang tipn thiiy cd ti Ip mac bpnh cao han ngudi Idm cdng vipc phy trg trSn bd. Sg khdc bipt ndy ed if nghTa thdng kS vdi P<0,05.
- Cde ylu t l anh hudng d i n cdng thing thin kinh tdm ly cOa ngudi lao dpng: mong dugc tin tO'C cua gia dinh (91,4%), nhd nhd khi dl tdu (89,4%), lo cho tinh mang eOa minh khi Idm viSc trin tdu (72,2%), lo sg gpp hda hogn tren tdu (72,2%), khd chju khi phai Idm vipc trang mli trudng khac nghipt: filng dn. mng, ndng... (64,9%), cdm gidc cd dan khi di tdu (50,3%), cdm gidc tdch bipt khi di tau (35,8%). lo ling gdnh npng v l kinh t l (43%).
- TJ ip ngudi lao dpng tren phuang tipn thuy ed bilu hipn cdng thing thin kinh d muc tmng binh Id 38,4%-45,7%, rlt cdng thing 19.2%-22.5% vd cang thing qud muc 1,3%-2,0%.
TAI LI$U THAM K H A O
1. Trin Thj Qujnnh Chi, Nguyin Tnrdvig So>n, Trin Thj Chinh (2003), "SwSc i^u nghiin ciiu rr^tsd die ffiki tim shh ty da thuyin van V^( Nam". Tap ehi Y hi^ttvc hdnh, Bp Y te xuat bdn, Hd Npi, sd 444, tr. 71-73.
2. BOI Thj Hd, Nguyen Trud'ng Son (2003), Qjc diim sQc khde vi ca du b$nh t$t cua thuyin viin congt^
vin tii Xing diu dw&ng thiiy I Hii Phmg, Tgp chi Y hjc thgc hanh, so444, tr. 177-184.
3. NguySn Thj Hdi Hd (2014), Diiu kiin lao d$ng, siic khde vi b$nh tit cOa thuyen viin tiu viin duang hSrn 2011-2012. Vipn Vp sinh djch te 7W.
4. Nguyin Lung (1995), "iWpt sd vin di sOc khoi, binh tytvi tai nan sTquan, thu^tiiH VietNanf. TgpdilY hpc Vipt Nam, Tong hpi Y Dugc hpc Vipt Nam, so 12, Ir 2-8.
5. Nguyin Bao Nam, Nguyin Hai Hd (2012). Ttiifl:
tryng sue khoe vi ca ciu binh tit cOa thuyin viSn W!|
Warn lim viyc tren dc tiu v$n ^1 viin duong, Kj ySu cing trinh nghien ciru khoa hpe Y hpe biln, NXB Y hpc
6. Nguyin Trvdng Son, Tran Thj Qu^ti Chi (2003), E>ic diem mdi tmung lao dyng bin biin, kih huong cOa nd din st)c khoe vi ca cau b$r}h tit c6a thuyen viin Viyt Nam. Tap chl Y hoc thgc hdnh s6 444/2003 (YHTH).
7. Le Tmng (1994), Binh nghi nghiip, NXB Y hpc, Ha Npi, tr. 47-78.
8. International Maritime Health Association (2012), Newsletter. January 2012:14.
NGHIEN CU'U K^T QUA DI^U TRI UNG THU' PHdl T^ BAO N H C BANG HOA - XA TRI P H O I HOP TAI BENH VIEN DA KHOA T I N H THANH HOA
T 6 M TAT
Ung thw phdi ti bio nhd (UTP-TBN) chiim tiiy 15- 20%, niu khdng diiu bi kip th&i, khoing 60-70%
chuyin giai dOyn lan tiin [7]. Hdi cOv md tS, theo doi sdng thim 84 bynh nhin nhim dinh gii kit qua diiu tri (Etoposide, Cisplatin) + xy tii phdi hgp vi phwang phip xy tii UTP-TBN tyi tmng tim Ung Bw&u binh viin Da Khoa tinh Thanh Hda tir 1/1/2010 din 31/12^015.
Kit qui: T]? li nam/nO- li 2.5/1; tudi tmng binh li 56; ung thw biiu md ti bio nhd chiim 98,8%,; giai doan khu tni 82,1 %; chi sd KPS > 80% chiim 66,7%; ti ii dip img toan bd li 97,6%; giim bach ciu xa ddng th&i dd 3-4 li 5.4%; thiiu miu xy tri <Jdng dg 3-4 li 3,6%; sdng thim xy tq ddng thin 5 nam li 8.5%,, xa tri bd trg 5 nim 4% v&i p>0.05. Xy tn dw phdng nao.sdng thim 5 nim 21%,, khdng xa trj dy phdng nio 5 nim 0%, v&ip=0,001. Chisd KPS >80 sdngtiiim 5 Chiu trich nhiym: Li Vin Giao
Email: [email protected] Ngiy nh$n: 14/11/2017 Ngiypbin biin: 11/12/2017 Ngay duy$t bai: 26/12/2017 Ngiy xuit bin: 20/1/2018
LE VAN GIAO, L £ XUAN S A N H , L ^ DUY HUTiG Bynh viyn 71 Trung uong nam 10,7%,, KPS < 80 sdng thim 5 nim 0%.
Kit luin: Diiu tri, hda-xy tri phdi hgp vin phuur^
phip xy tri UTP-TBN cho tiiay tic dung dip Ong WiS tdt, giim nhe tri$u chiing vi kio dai thdi gian song thim cho ngw&i binh. Cic tic dung khdng mong mudn & mire an toin.
Twkh6a: Ung tiiwphdi ti bio nhd.
SUMMARY
Small ceil lung cancer accounts for 15-20%, ifiif^
treated pmmptiy about 60-70% of which move to fte spread period [7j. A refrospectfve sfudy of 84 pa^eris was conducted to assess the outixme of treabneri (Etoposide, Cisplatin) + concun^nt radiothempy. small cell lung cancer at the Center of Oncology of Ttianti Hda General Hospital from 1/1/2010 to 31/12/2015.
Results: The ratio of male to female is 2,5.1;
average age is 56; small cell eaminoma lung cancer accounts for 98.8%,; focal period is 82.1; KPS irvlmis
> 80% that acxounts for 66,7%>; The overall mspoim rate is 97.6%; Neutropenia at the scale of 3-4 is 5.4%
Radiotiierapy anemia at 3-4 is 3.6%; Live em J years is 8.5%, Complementary radiation iherapjf = yeare is 4% with p>0.05. Radiotherapy tor cersm prophylaxis, live extra 5 years is 21%, vwffw
Y HQC THV'C HANH (1066) - S6 iM^
radiotherapy is 0% with p = 0.001. KPS index > 80 lived for 5 more years is 10.7%. KPS <80 v^ich is 0%.
Conclusion: Chemo-radiationtherapy combined with radiation therapy for treating small cell lung cancer showed good response effects, reduced symptoms and prolonged life time for patients. Unwanted effects are sate.
Keywords: Small cell lung cancer.
DATVAND^
Ung thu phdi (UTP) Id bpnh 1;^ dc tinh thudng gap nhlt trSn the gidi cung nhu d Vipt Nam. UTP-TBN chilm 8 Ip 15-20% ting s l UTP. Ld mpt bpnh khdc bipt vdi edc khdi u trang ling nggc vi tiln triln nhanh, ti> vong nhanh, nlu khdng dugc chin dodn, dilu trj kip thdi, khodng 60-70% sd bpnh nhan chuyin giai doan lan trdn p^. Hda xg trj Id mgt vO khi ea bdn tnsng di4u trj UTP-TBN. keo ddi thdi gian sdng thim cho ngudi bpnh. Giai doan khu tnJ, khdng dilu trj, sdng them 12- 15 tuin vd giai dogn lan trdn sdng thSm ehi 6-9 tuin [1], [2]. Cde cdng trinh nghien eiru tir ndm 1980 trd Igi ddy eho rang hod-xg trj phli hgp vdi phuang phdp xa tri se kdo ddi thdi gian sing them, hgn chd tdi phdt sdm, gidm dugc lilu lugng vd d i e tinh.
Tgi tmng tdm Ung Budu bpnh vipn €)a Khoa tinh Thanh Hda. tir nam 2005 da dp dung phli hgp xa trj UTP-TBN. Song, chua cd nghien cO'u ndo danh gid diy dii tdc dyng phdc dd ndy. VI vgy, nghiSn cO'u ndy nham. Dinh gia kit qui diiu tri ung thw phdi te bio nhd bing phic dd (Etoposide. Cisfdatin) + Xa tri ddng th&i vi phwong phip xy tri.
3. Cdc tdc dung khdng mong mudn trong dieu trj Bdng S.BIeu hipn dpc tinh lien quan vdi phuang phdp xa tri
ediTutmc vA PHUONG PHAP NGHIEN CLTU 1. Doi tiFQ^g nghien cu>u
Gdm 84 BN UTP- TBN dugc ^ l u trj phdc dd (Etoposide, Cisplatin) + xg trj ddng thdi.
2. PhuoTig phdp nghiSn c i n i
- Phuang phdp nghiSn cipu hdi cO'u md td ca bpnh;
- Theo m l u thupn tipn tieh IQy;
-Thu thpp thdng tin v l bpnh nhdn theo mau bpnh dn thing nhat;
- Xir II theo phin mIm SPSS 20.0;
- Ddnh gia dgc tfnh theo WHO 2000;
- Danh gid ddp O'ng theo tieu chuin RECIST;
- Ddnh gid thdi gian sdng theo phuang phdp Kaplan-Meier.
K^T QUA NGHIEN CLTU 1. Theo nhdm tudi, gi6i va KPS Bang 1. Theo nhdm tuoi, gidi vd KPS
Nh6m tuoi, glfri vd KPS n/84
< 65 tu6i 72
> 6 5 t u 6 i 12 Nam 60 N a 24 KPS < 80 28 KPS i 80 56 TI le %
85,7 14,3 71,4 28,6 33.3 66,7 2 . D d p u-ng s a u d i l u tri
Bdnq 2. Danh gid ddp irng sau dilu trj Ddp ling EP + XT n/a4 Ddp Cpng hodn todn 60 Ddp gng mOt p h i n 22 KhSng ddp Cpng 2
Bpnh t i ^ t h i n 0 Ti> vong trong d i l u tri 0
T [ l p % 71,4 26,2 2,4 0 0
BiSu hipn dgc tinh (Theo 2000) Giam b^ch cdu Giam t i l u cdu Gidm HST(Hb)
W H O X T D T n D 0 1 vd 2 18(33.0%) 3^5,4%) 34(61,8%)
=55 DO 3 vd 4
3 (5,4%) 1 (1,8%) 2 {3,6%)
X T B T r DO 1 vd 2 16(55,1%) 2 (6.9%) 18 (62.0%)
1=29 Op 3 vd 4
0 0 0
4. Thd'i gian sdng them
4.1. Thai gian song thim theo phwong phip xy
tn
- Thdi gian sdng thSm XT ddng thdi 2 ndm, 3 nam.
5 ndm Id 32.2%, 22,0%, 8,5%.
- XT bd trg sdng them 2 nam, 3 ndm Id 20,0%, 12.0%. 5 nam chlcd4% (p>0.05).
+ Xg tri dg phdng ndo Sing thSm 2 ndm. 3 nam, 5 ndm la 35,7%, 21,4%, 21,5%.
+ Khdng xa tri ndo, sdng thSm 2 ndm, 3 ndm Id 25,0%, 17,9%, 5 nam 0% (p=0,001).
4.2. Thm gian sdng thim liin quan vdi chi s6 KPS
- KPS £ 80% sing thSm 2 nam, 3 ndm vd 5 nam Id 30,4%, 26,8% v d i 0,7%.
- KPS < 80% sing thSm 2 nam, 3 ndm Id 25.0%, 3,6%, 5 ndm la 0% (p<0.001).
B A N LUAN
1. Dgc diem tudi vd gidi
Nghien eiru ciia ehiing tdi, t u l i tmng binh 56, t' Ip nam/nO 2,5/1. Theo nghiin cO'u: Hipp hpi Ung thu Hoa Ky [4], t u l i tnjng binh 70, ti Ip nam/nO- 116.000/108.210; Dpng Thanh Hdng [2] tmng binh 58,5 tudi, nhdm tudi < 65, ty Ip 78,2%; Vd VSn Xuan [3]
tudi tmng binh 56.4, ti Ip nam/nu-14,5/1, 2. Dap Ong dieu trj
TT Ip ddp irng todn bp Id 97,6%, ddp dng hodn todn Id 71,4%, dap ung mpt phin Id 26.2% vd khdng ddp irng 2,4%. Theo Vd Vdn Xudn [3] ddp O'ng hodn todn Id 66.7% va ddp ung todn bp 95,7%.
3. Cdc tac dMng khdng mong mudn trong dieu trj
K i t qua nghien ciru ciia chiing toi v l tdc dyng phy Id r l t nhd vd hodn todn chip nhpn dugc. Trong dd gidm bgch cau xg ding thdi do 3-4 Id 5.4%; thilu mdu
YBOCTHVC HANH (1066) - SO 1/2018"
xg tn ding thdi dp 3-4 Id 3,6%; giam tllu c i u xa trj ddng thdi 1,8%. Nghien cO'u ciia: Vd Van Xudn [3]
giam bgch elu xa trj ddng thdi dp 3-4 Id 4.8%;
Okamoto H vd cpng sg [8] gidm bach elu xg tri dong thdi d l 1-2 Id 24,2%, gidm huylt sic td xa trj ding thdi dp 3-4 Id 5,3%.
4. Thdi gian sdng thdm
4.1. Thiri gian song thim theo phwomg phap xy tri
Xa trj ding thdi sing them 2 ndm 32,2%, 3 nam 22,0%, 5 nam Id 8,5%, cao han so vdi xg trj b l trg sau khi kit thiic 6 chu kl hod fri vdi ti IS tuang O'ng la 20,0%, 12,0% va 4.0%.
Nghien cO'u, cdc tdc gia nude ngodi eOng dua ra nhgn xdt, xg tn ding thdi mang lgi hipu qud eao han xa tli b l trg: Okamoto H vd cpng sg [8], so sdnh xa tn ding thai vdi xa tri b l tra phdc d l EP, sdng thim 2. 3 nam vd 5 ndm xg trj b l trg la 35,1%, 20,2% vd 18,3%, thIp han xg tri dong thdi la 54,5%, 29.8% vd 23,7%.
Tuy nhien dpc tinh trpn he tao mdu cao ban d nhdm hod-xg trj ding thdi vd ti Ip viem thuc quan cao ban (9% so vdi 4%) a nhdm xg trj bd trg.
4.2. Thai gian sdng them lien quan v&ixy trf dip phong nao
Sdng thSm xg trj dg phdng ndo 2 nam 35,7%, 3 nam 21,4% va 5 nam Id 21,5%, cao han khdng xg tri ndo 2 ndm, 3 nam Id 25.0%, 17,9% 5 nam 0,% vdi p = 0,001. Trong nghien eiru ndy phii hgp vdi cdc tac gid trong ngodi nude: Vd Vdn Xudn [3] xa tri ndo, 2. 3, 5 ndm 56.9%, 43,5%, 28,9%, khdng xg trj nao 29,3%, 4.7% vd 5 ndm 0% vdi p = 0,0002; Cao, Huang vd Tu [6] theo d5i sau 3 ndm, nhdm xg trj du phdng di can nao thIp han khdng xg tri ti IS 3,8% so vdi 28% (p <
0,05). Tuy nhidn, sg khdc bipt v l thai gian sdng thdm Id khdng cd 'y nghTa (3 ndm Id 42% va 32%, p > 0,05).
Nhu vpy, xa tri dg phdng nao tuy khong cai thipn dugc thdi gian sing thSm nhung giam duge ti Ip dl can ndo md khdng Inh hudng tdi chO'c nSng cua nao. Chl djnh xa trj dg phdng ndo cho cdc tm'dng hgp ddp O'ng hodn Id dn thilt vd theo ddi di cdn nao sdm kjp thdi.
4.3. Thdi gian sdng them lien quan vdi chi sd KPS
Nghien cO-u nay, ehi sd KPS > 80%. sing them 2, 3^5 nam Id 30,4%, 26,8%, 10,7%. Nhung KPS < 80%, song thSm 2, 3 ndm Id 25.0%. 3.6%, 5 nam 0% Nhu vpy, cht sd KPS cdng cao k i t qud dilu tri cdng hipu qud ban. So vdi nghiSn ciru tdc g i i trong ngodi nude:
Vo Van Xudn [3] sdng them 2, 3, 5 nam 49,8%, 34%, 22,9%. nhung KPS < 80%. sing them 2 ndm 28.3%
vd 3 nam Id 0%; Albain [5\ tdc gid cOng dua ra KPS >
70% sdng tmng binh 19 thdng vdi so vdi 12.5 thdng d nhdm KPS < 70% vd sdng 2 nam Id 40% vd 20%.
NghiSn ehi ra ring KPS cdng cao. thdi gian song them cdng eao. c l n chin dodn sdm d l dilu tq npi khoa. ndng eao t h i trgng trude hda xy trj, de nang eao chit lugng vd kit qud dieu trj cho nqudi bpnh
K^T LUAN
Qua nghiSn cu'u theo ddi 84 bpnh nhdn UTPTBN duge dilu tn bang phdc d l (Etoposide, Cisplatin) +Xg
trj dong thdi vd phuang phdp xg trj, nhIm ddnh gg hipu q u i Idm sdng vd tinh an todn. ChOng tSI nM ra c^c k i t lupn sau:
- Dgc diem Idm sdng. cgn Idm sang:
Tudi tmng binh Id 56. Ti Ip Nam/NQ' 2,5/1. Phan I6n bpnh nhdn cd ehi s l KPS > 80% chilm 66,7% va giai doan khu tnJ 82,1%.
- Ket qua dieu tr]:
+ Tf Ip ddp ling hodn todn Id 71,4,5%, ddp O'ng mgi phan 26,2%, khdng ddp Ong 2,4% theo tidu chu^n RECIST.
+ Tinh an todn: Cdc d i e tinh huyet hpc thudng g|ip d dd 1-2; XTDT gidm bach c i u dp 3 Id 5,4% , XTBT thilu mdu dp 3 Id 3,6% trong khi XTBT dp 3 Id 0%, h?
tllu cau dp 3 chl cd 1,8% do XTDT. Cde dpc tinh ^ ngoai ca quan tgo mdu cung chil y l u gpp d dp 1-2.
+ Thdi gian sdng cdn: Vdi thdi gian sing thgiti 5 nam id 8,5%, XT bo trg sdng thdm 5 nam ehi co 4%
(p>0.05). Cde y l u t l tlSn lugng song cdn c6 y nghla khi ehi s l hoat ddng ea the vd giai dogn lan tran trucrc
dilu tri.
+ Xg trj ding thdi vd phuang phap xg trj cho iif tic dyng giam nhg tripu chung vd keo ddi thdt gian sdng cdn ciing vdi tinh an todn eOa nd Id hodn todn chip nhpn dugc. H l u h i t cac tardng hgp dlu c6 thi khac phyc hope dg phdng dugc ma khdng d n giam lilu hda chit bode ngirng xa trj.
TAI LI$U THAM K H A O
1. Nguyin Ba DOc, Trin Van ThuIn, Nguy^ Tuy^
Mai (2010), " Ung thw phdi" Diiu tq ndi khoa b^nh ung thw, Nhd xult ban Y hpc, Hd Npi, trang 81- 98.
2. Dpng Thanh Hdng va 08 (2004). Chin do^n va diiu tri ung thw phdi ti bio nhd tyi Benh win Ung bmi TP H6 Chl Minh. Tgp chl Y hpc thgc hanh sd 489 B6 Y tl xult ban, tr 125-129
3. ve Van Xuan (2009). Nghiin ciru phic d6 kM'h(fp hda - xy tri UTP- TBN vi danh gii kit qua diiu tri. Lu^n an tiln sT Y hpc. Bai hpe Y Ha Npi.
4. American Cancer Society (2014). Cancer Facts&
Figures 2014.
5. Albain KS, Crovi4ey JJ, L^BIanc M, Livingston RB (1990). Detemninanls of improved outcome in smat cell lung cancer an analysis of tiie 2,580 - patient Southwest Oncology Group data base. J Clin Oncol 8:1563-1574.
6. Cao K, Huang H, Tu M (2010). Olnicai study prophylatie CTanial inadiation for small cell lung cancer.
Zhonghua Zhong Liu Za Zhi, 22(4) 336 - 338.
7. IWIasters GA (2007). Clinical presentation of st^
cell carcinoma of the lung. Lung cancer, Principles ffld' practice. Thirs edition, Lipplncott Williams & Wiildns, 304- 314.
8. Okamoto H. Watanabe K, Kunikane K, Yokoyama A Kudoh S, IshizukaN, Fukuda H (2005).
Randomized phase III trial of earboplatin(C) plus etoposide (E) vs. split doses of cisplatin (P) plus etoposide (E) in elderly or poor - risk patients with extensive disease small cell lung cancer (ED-SCLC): JCOG9702. J Clifi Oncol. Vol 23, No. 16S, Part I of II (June 1 Supplement}:
7010.
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