Malignity žlučových cest

English version

Autoři: Š. Tuček ^1,2; J. Tomášek ^1,2; J. Halámková ¹; I. Kiss ^1,2; T. Andrašina ³ ; B. Hemmelová ⁴; D. Adámková‑ krákorová ²; R. Vyzula ^1,2
Působiště autorů: Department of Clinical Oncology, Faculty Hospital Brno ¹; Masaryk Memorial Cancer Institute, Brno ²; Department of Radiology, Faculty Hospital Brno ³; Department of Surgery, Faculty Hospital Brno ⁴
Vyšlo v časopise: Klin Onkol 2010; 23(4): 231-241
Kategorie: Přehledy

Souhrn

Malignity žlučových cest zahrnují intra‑ a extrahepatální cholangiokarcinomy, karcinom žlučníku a karcinom Vaterské papily. Jsou to vzácné nádory s celkově špatnou prognózou. Incidence dosahuje 12,5/ 100 tis. obyvatel a mortalita 9,5/ 100 tis. obyvatel, obojí byly v posledních 30 letech pozoruhodně stabilní. Celkové přežití pacientů s těmito nádory je žalostné, většinou do 12 měsíců. Diagnostika má různá úskalí a velmi často přichází pozdě. Většina případů je při diagnóze neoperabilních, proto je zde hlavní modalitou paliativní léčba. Ta je však stále problematická, nové postupy mnoho nepřinesly. Chybí standardy paliativní péče a hodnocení kvality života je překvapivě velmi málo časté. I z nečetných dat se zdá být zřejmý pozitivní efekt multimodální individualizované léčby na přežití a kvalitu života pacientů. Ve specializovaných centrech zahrnují léčebné možnosti metody chirurgické, intervenční radiologii, klinickou onkologii a metody kvalitní podpůrné péče. Tyto metody jsou rozebírány v článku podrobněji. Zlepšení lze očekávat od nových diagnostických metod a nových postupů v chirurgii a intervenční radiologii. Také lepší poznání biologie nádorů na molekulární úrovni snad přinese více vyléčených pacientů. V paliativní léčbě lze zlepšení očekávat v nalezení nových cílových struktur a vývoji nových léčiv. Malé počty pacientů jsou limitující pro jakýkoli pokrok v tomto odvětví. Lze doufat, že nový volnější design mezinárodních randomizovaných multicentrických studií s pružným sdílením dat tento hlavní problém překlene. Nezbytným dalším krokem je definice standardů paliativní péče a hodnocení kvality života přinese pohled na skutečný přínos paliativní léčby pro pacienty.

Klíčová slova:
nádory žlučových cest – cholangiokarcinom – nádory žlučníku – paliativní terapie

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