Læknablaðið - 15.03.2013, Blaðsíða 30

Y F I R L I T
lungum en í íslenskri rannsókn voru 21,6% sjúklinga með mein-
vörp við greiningu og voru 13,4% með meinvörp í aftanskinueitl-
um og 7,3% með fjarmeinvörp.60 Eistnakrabbamein svarar mjög vel
krabbameinslyfjum jafnvel þótt fjarmeinvörp séu til staðar.61 Horf-
ur þessara sjúklinga eru því yfirleitt ágætar en hér á landi læknast
yfir 95% sjúklinga af sjúkdómnum.60
Meðferð eistnakrabbameins felst í blöndu krabbameinslyfja
sem innihalda meðal annars cisplatín en í allt að 30% tilfella næst
ekki að lækna meinið með þeim. Ef lungnameinvörp sjást á TS
eftir lyfjameðferð getur skurðaðgerð komið til greina.61 í íslenskri
rannsókn reyndust 8 af 97 sjúklingum vera með lungnameinvörp
við greiningu og voru þeir allir með eistnakrabbamein önnur
en sáðfrumukrabbamein.60 Aðeins einn þessara sjúklinga gekkst
undir lungnaaðgerð og læknaðist hann af sjúkdómnum.6 í nýlegri
samantekt á 6 rannsóknum sem tóku til 407 sjúklinga sem gengist
höfðu undir brottnám á lungnameinvörpum frá einstnakrabba-
meini öðru en sáðfrumukrabbameini var dánarhlutfall innan 30
daga undir 4% og 5 ára lifun á bilinu 73-94%.61 Rannsóknir hafa
einnig sýnt betri lifun þegar fjöldi meinvarpa er undir fjórum62 og
þegar hækkun á æxlisvísunum alfa fetoprotein og beta human chorio-
nic gonadotropin (b-HCG ) er lítil.61
Lokaorð
Þegar meinvörp eru bundin við lungu getur brottnám með skurð-
aðgerð komið til greina. Þetta á sérstaklega við um sjúklinga með
stök/fá meinvörp frá sarkmeini, ristil- og endaþarmskrabbameini
og nýrnafrumukrabbameini. Ekki eru til framskyggnar, slembaðar
rannsóknir á árangri þessara aðgerða en fjöldi afturskyggnra rann-
sókna hefur sýnt að lifun þeirra sem gangast undir aðgerð er betri
en eftir aðra meðferð. Þó er mikilvægt að hafa í huga að sjúklingar
sem gangast undir aðgerð eru valinn hópur og valskekkja getur því
haft áhrif á niðurstöður samanburðarrannsókna, skurðaðgerðum í
hag. Engu að síður er ljóst að brottnám lungnameinvarpa er örugg
aðgerð þar sem tíðni fylgikvilla er lág og innan við 1% sjúklinga
lifa ekki af aðgerðina. Mikih'ægt er að vanda val á sjúklingum í
aðgerð en til þess eru sameiginlegir krabbameinsfundir tilvaldir.
í dag eru slíkir fundir haldnir innan flestra sérgreina hér á landi.
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