化學療法

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化學療法英語:Chemotherapy),簡稱化療Chemo),是用特殊的藥物來治療疾病,為目前治療腫瘤及某些自身免疫性疾病的主要手段之一,不過在治療中,普遍會為患者帶來明顯的噁心嘔吐副作用,為患者帶來不適感。化療是指應用藥物治療癌症。這些可殺滅腫瘤細胞,有時稱為細胞毒藥物。許多化療藥物來源於自然,如:植物,其他是人工合成。目前已超過50種化療藥物,常用的有:表阿黴素英語Epirubicin阿黴素柔紅黴素絲裂黴素氟脲嘧啶脫氧核苷酸等。這些藥物經常以不同的強度聯合應用。

化療是一種全身性治療手段對原發灶、轉移灶和亞臨床轉移灶均有治療作用,但是化療治療腫瘤在殺傷腫瘤細胞的同時,也可能將正常細胞和免疫(抵抗)細胞一同殺滅,所以化療是一種「兩害相權取其輕」的治療手段。

醫療機制[編輯]

由於癌細胞的增殖比正常細胞快,抗癌藥物的作用原理通常是阻斷細胞分裂以抑制癌細胞生長,如一些藥物可以抑制脫氧核醣核酸進行複製。化療藥物一般也同時殺死正常細胞,因而傷害了需要進行分裂以維持正常功能的健康組織,例如毛髮基部細胞和腸黏膜細胞,使病人常伴有脫髮及噁心嘔吐等症狀。一般情況下,化療藥物是毒性強的先打,時間短的先打,化療藥物換的時候一般用生理鹽水沖洗,以減少藥物過敏。例如長春瑞濱毒性較強,一般先打,打之前推地塞米松抗過敏,打的時候速度要快,使其儘快通過血管;多西他賽這種藥物乃是紫杉醇的衍生物,這種藥物毒性小,效果好,打的時候要給病人上心電監護,隨時觀察。不過在打格拉司瓊的時候後面可以直接打化療藥物。如果發生化療藥物外滲,則立即停止注入,儘快吸收針頭內的殘留液體,拔出針頭,局部冷敷濕敷,用硫酸鎂溶液局部濕敷[來源請求],並抬高患肢24小時。

當然,也有用於非腫瘤治療,如指抗生素(抗菌化療)。從這個意義上講,首先應用化療劑的是保羅·埃利希,他於1909年用含砷化合物治療梅毒。其他化學療法的用法可以是用於治療自身免疫性疾病,如多發性硬化症類風濕性關節炎和抑制器官移植後的排斥反應等。

圖片[編輯]


治療策略[編輯]

常用的化療方案英語chemotherapy regimen組合[1]
癌症類型 藥物 縮寫
乳癌 環磷醯胺(Cyclophosphamide)、氨甲蝶呤(|methotrexate)、5-氟尿嘧啶(5-fluorouracil) CMF
阿黴素(Doxorubicin)、環磷醯胺(cyclophosphamide) AC
霍奇金淋巴瘤 Mustine, 長春新鹼(vincristine), procarbazine英語procarbazine, 潑尼松龍(prednisolone) MOPP
阿黴素(Doxorubicin), 博來黴素(bleomycin), 硫酸長春鹼(vinblastine), dacarbazine英語dacarbazine ABVD
非霍奇金氏淋巴瘤 Cyclophosphamide、doxorubicin、vincristine、prednisolone CHOP
生殖細胞瘤 Bleomycin、依託泊苷(etoposide)、順鉑(cisplatin) BEP
胃癌 Epirubicin英語Epirubicin, cisplatin, 5-fluorouracil ECF
Epirubicin, cisplatin, capecitabine英語capecitabine ECX
膀胱癌 氨甲蝶呤(Methotrexate)、vincristine、阿黴素(doxorubicin)、順鉑(cisplatin) MVAC
肺癌 環磷醯胺(Cyclophosphamide)、阿黴素(doxorubicin)、長春新鹼(vincristine) CAV
大腸癌 5-氟尿嘧啶(5-fluorouracil), folinic acid英語folinic acid, 奧沙利鉑(oxaliplatin) FOLFOX

There are a number of strategies in the administration of chemotherapeutic drugs used today. Chemotherapy may be given with a curative英語cure intent or it may aim to prolong life or to palliate symptoms.

  • Induction chemotherapy is the first line treatment of cancer with a chemotherapeutic drug. This type of chemotherapy is used for curative intent.[2]
  • Combined modality chemotherapy is the use of drugs with other cancer treatments, such as surgery, radiation therapy, and/or hyperthermia therapy英語hyperthermia therapy.
  • Consolidation chemotherapy is given after remission in order to prolong the overall disease-free time and improve overall survival. The drug that is administered is the same as the drug that achieved remission.[2]
  • Intensification chemotherapy is identical to consolidation chemotherapy but a different drug than the induction chemotherapy is used.[2]
  • Combination chemotherapy英語Combination chemotherapy involves treating a patient with a number of different drugs simultaneously. The drugs differ in their mechanism and side-effects. The biggest advantage is minimising the chances of resistance developing to any one agent. Also, the drugs can often be used at lower doses, reducing toxicity.[2][3]
  • Neoadjuvant英語Neoadjuvant chemotherapy is given prior to a local treatment such as surgery, and is designed to shrink the primary tumor.[2] It is also given to cancers with a high risk of micrometastatic disease.[4]
  • Adjuvant chemotherapy英語Adjuvant chemotherapy is given after a local treatment (radiotherapy or surgery). It can be used when there is little evidence of cancer present, but there is risk of recurrence.[2] It is also useful in killing any cancerous cells that have spread to other parts of the body. These micrometastases英語micrometastases can be treated with adjuvant chemotherapy and can reduce relapse rates caused by these disseminated cells.[5]
  • Maintenance chemotherapy is a repeated low-dose treatment to prolong remission.[2]
  • Salvage chemotherapy or palliative chemotherapy is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, in general, a better toxicity profile is expected.[2]

All chemotherapy regimen英語chemotherapy regimens require that the patient be capable of undergoing the treatment. Performance status英語Performance status is often used as a measure to determine whether a patient can receive chemotherapy, or whether dose reduction is required. Because only a fraction of the cells in a tumor die with each treatment (fractional kill英語fractional kill), repeated doses must be administered to continue to reduce the size of the tumor.[6] Current chemotherapy regimens apply drug treatment in cycles, with the frequency and duration of treatments limited by toxicity to the patient.[7]

參見[編輯]

參考文獻[編輯]

  1. ^ Corrie PG, Pippa G. Cytotoxic chemotherapy: clinical aspects. Medicine. 2008, 36 (1): 24–28. doi:10.1016/j.mpmed.2007.10.012. 
  2. ^ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Airley, pp. 55-59
  3. ^ Wood, pp. 17-18
  4. ^ Perry, p. 42
  5. ^ Epstein RJ. Maintenance therapy to suppress micrometastasis: the new challenge for adjuvant cancer treatment. Clinical Cancer Research. Aug 2005, 11 (15): 5337–41. doi:10.1158/1078-0432.CCR-05-0437. PMID 16061845. 
  6. ^ Skeel RT. Handbook of Cancer Chemotherapy (paperback) 6th. Lippincott Williams & Wilkins. 2003. ISBN 0-7817-3629-3. 
  7. ^ Chabner B, Longo DL. Cancer Chemotherapy and Biotherapy: Principles and Practice 4th. Philadelphia: Lippincott Willians & Wilkins. 2005. ISBN 0-7817-5628-6. 

外部連結[編輯]