{"id":4996,"date":"2024-02-08T13:22:29","date_gmt":"2024-02-08T12:22:29","guid":{"rendered":"https:\/\/www.ptc.cz\/sto-lijecimo\/lymfomy\/o-malignich-lymfomech\/"},"modified":"2024-06-21T14:37:55","modified_gmt":"2024-06-21T12:37:55","slug":"rak-malignih-limfoma","status":"publish","type":"page","link":"https:\/\/www.ptc.cz\/hr\/sto-lijecimo\/limfomi\/rak-malignih-limfoma\/","title":{"rendered":"Rak malignih limfoma"},"content":{"rendered":"<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p><strong>Malign\u00ed lymfom\u00a0je obecn\u00e9 ozna\u010den\u00ed pro n\u00e1dorov\u00e9 onemocn\u011bn\u00ed lymfatick\u00e9ho syst\u00e9mu.<\/strong>\u00a0<strong>Malign\u00edmi lymfomy se ozna\u010duj\u00ed n\u00e1dory, kter\u00e9 poch\u00e1zej\u00ed z&nbsp;jednoho typu b\u00edl\u00fdch krvinek \u2013 lymfocyt\u016f.<\/strong>\u00a0Projevuj\u00ed se zejm\u00e9na zv\u011bt\u0161en\u00edm m\u00edzn\u00edch (lymfatick\u00fdch) uzlin. Z\u00e1kladn\u00ed rozd\u011blen\u00ed malign\u00edch lymfom\u016f tvo\u0159\u00ed dv\u011b skupiny: Hodgkin\u016fv lymfom (HL) a&nbsp;Non-Hodgkin\u016fv lymfom (NHL), kter\u00fd tvo\u0159\u00ed podstatn\u011b r\u016fznorod\u011bj\u0161\u00ed podskupinu.<\/p>\n<p>Malign\u00ed lymfomy jsou onemocn\u011bn\u00ed, kter\u00e9 velmi \u010dasto postihuje osoby v\u00a0mlad\u00e9m v\u011bku.\u00a0V \u010cesk\u00e9 republice je zji\u0161t\u011bno zhruba 1800 nov\u00fdch p\u0159\u00edpad\u016f za rok. Progn\u00f3za onemocn\u011bn\u00ed je \u010dasto velmi dobr\u00e1.<\/p>\n<p><strong>L\u00e9\u010debn\u00fd postup stanovuje specialista &#8211; hematoonkolog.\u00a0<\/strong>Nosnou l\u00e9\u010dbou malign\u00edch lymfom\u016f je v\u00a0sou\u010dasn\u00e9 dob\u011b l\u00e9\u010dba syst\u00e9mov\u00e1 (celot\u011blov\u00e1), p\u0159edstavovan\u00e1\u00a0<strong>chemoterapi\u00ed \u010di biologickou l\u00e9\u010dbou<\/strong>, event. kombinac\u00ed obou t\u011bchto metod.\u00a0<strong>Radioterapie<\/strong>\u00a0pak slou\u017e\u00ed p\u0159edev\u0161\u00edm jako l\u00e9\u010dba dopl\u0148kov\u00e1, kter\u00e1 m\u00e1 za \u00fakol sn\u00ed\u017eit riziko n\u00e1vratu onemocn\u011bn\u00ed v&nbsp;p\u016fvodn\u011b posti\u017een\u00fdch oblastech anebo jako l\u00e9\u010dba kurativn\u00ed p\u0159ed dal\u0161\u00ed pl\u00e1novanou syst\u00e9movou l\u00e9\u010dbou, nap\u0159\u00edklad v\u00a0p\u0159\u00edpad\u011b relabuj\u00edc\u00edch lymfom\u016f. Jedn\u00e1 se o&nbsp;l\u00e9\u010dbu lok\u00e1ln\u00ed, tedy omezenou na&nbsp;ur\u010dit\u00e9 m\u00edsto nebo oblast t\u011bla.<\/p>\n<p>V&nbsp;t\u00e9to indikaci je radioterapie pou\u017e\u00edv\u00e1na u\u00a0<strong>\u010dasn\u00fdch a&nbsp;st\u0159edn\u011b pokro\u010dil\u00fdch stadi\u00ed Hodgkinova lymfomu, rizikov\u00e9ho Non-Hodgkinova lymfomu<\/strong>\u00a0(posti\u017een\u00ed s&nbsp;objemn\u00fdm vstupn\u00edm n\u00e1lezem, posti\u017een\u00edm kost\u00ed \u010di mimouzlinov\u00fdm n\u00e1lezem)\u00a0<strong>a u&nbsp;pacient\u016f s&nbsp;nedostate\u010dnou l\u00e9\u010debnou odpov\u011bd\u00ed\u00a0<\/strong>na p\u0159edch\u00e1zej\u00edc\u00ed syst\u00e9movou terapii. Kombinovan\u00e1 l\u00e9\u010dba (syst\u00e9mov\u00e1 l\u00e9\u010dba + radioterapie) \u010dasto znamen\u00e1 vy\u0161\u0161\u00ed \u0161ance na&nbsp;vyl\u00e9\u010den\u00ed lymfomu.<\/p>\n<p><strong>Vzhledem k\u00a0v\u00fdborn\u00e9 \u00fa\u010dinnosti radioterapie<\/strong>\u00a0nen\u00ed v\u011bt\u0161inou nutn\u00e9 u\u017eit\u00ed d\u00e1vek z\u00e1\u0159en\u00ed, kter\u00e9 p\u0159ekra\u010duj\u00ed toleran\u010dn\u00ed limity okoln\u00edch zdrav\u00fdch tk\u00e1n\u00ed. Ov\u0161em i&nbsp;ni\u017e\u0161\u00ed d\u00e1vky z\u00e1\u0159en\u00ed mohou b\u00fdt potenci\u00e1ln\u011b \u0161kodliv\u00e9, a&nbsp;to p\u0159edev\u0161\u00edm v\u00a0\u010dasov\u00e9m horizontu deset i&nbsp;v\u00edce let po onkologick\u00e9 terapii. \u010casto se objev\u00ed bez n\u00e1vaznosti na&nbsp;akutn\u00ed toxicitu radioterapie. S\u00a0del\u0161\u00edm \u010dasov\u00fdm odstupem od ukon\u010den\u00e9 onkologick\u00e9 l\u00e9\u010dby stoup\u00e1 riziko v\u00fdvoje t\u00e9to pozdn\u00ed toxicity. Tato rizika by m\u011bla b\u00fdt zv\u00e1\u017eena p\u0159edev\u0161\u00edm u&nbsp;pacient\u016f s\u00a0velmi dobrou dlouhodobou progn\u00f3zou. Pat\u0159\u00ed sem zejm\u00e9na mlad\u00ed pacienti s\u00a0Hodgkinov\u00fdm lymfomem a\u00a0prognosticky p\u0159\u00edzniv\u00fdm B-non Hodgkinov\u00fdm lymfomem (p\u0159edev\u0161\u00edm podtypy jako dif\u00fazn\u00ed velkobun\u011b\u010dn\u00fd B-lymfom, prim\u00e1rn\u00ed mediastin\u00e1ln\u00ed B-lymfom). Tito pacienti by m\u011bli b\u00fdt l\u00e9\u010deni v\u017edy s\u00a0v\u011bdom\u00edm dlouhodob\u00fdch rizik onkologick\u00e9 terapie.<\/p>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h3>Ne\u017e\u00e1douc\u00ed \u00fa\u010dinky spojen\u00e9 s&nbsp;oza\u0159ov\u00e1n\u00edm<\/h3>\n<p>P\u0159i oza\u0159ov\u00e1n\u00ed se m\u016f\u017eeme setkat s\u00a0bezprost\u0159edn\u00edmi ne\u017e\u00e1douc\u00edmi \u00fa\u010dinky z\u00e1\u0159en\u00ed.\u00a0<strong>Objevuj\u00ed se b\u011bhem RT a&nbsp;maxim\u00e1ln\u011b do 6 t\u00fddn\u016f po jej\u00edm ukon\u010den\u00ed.<\/strong><\/p>\n<p><strong>Mo\u017en\u00e9 projevy akutn\u00ed radia\u010dn\u00ed toxicity<\/strong>\u00a0(souvisej\u00edc\u00ed s\u00a0m\u00edstem oz\u00e1\u0159en\u00ed) jsou:<\/p>\n<ul>\n<li><strong>slizni\u010dn\u00ed:<\/strong>\u00a0afty, polykac\u00ed obt\u00ed\u017ee (p\u0159i oza\u0159ov\u00e1n\u00ed oblasti hlavy a&nbsp;krku),<\/li>\n<li><strong>slinn\u00e9 \u017el\u00e1zy:<\/strong>\u00a0suchost v\u00a0\u00fastech (p\u0159i oza\u0159ov\u00e1n\u00ed v\u00a0oblasti hlavy a&nbsp;krku),<\/li>\n<li><strong>ko\u017en\u00ed:<\/strong>\u00a0zarudnut\u00ed a\u017e olupov\u00e1n\u00ed poko\u017eky v\u00a0oza\u0159ovac\u00edm poli,<\/li>\n<li><strong>plicn\u00ed:<\/strong>\u00a0poradia\u010dn\u00ed z\u00e1n\u011bt plic (p\u0159i oza\u0159ov\u00e1n\u00ed oblasti mezihrud\u00ed-mediastina).<\/li>\n<\/ul>\n<p>D\u00e1le se v\u00a0souvislosti s\u00a0RT m\u016f\u017eeme setkat s\u00a0<strong>pozdn\u00edmi n\u00e1sledky z\u00e1\u0159en\u00ed<\/strong>, kter\u00e9 se mohou projevit i&nbsp;bez p\u0159edch\u00e1zej\u00edc\u00edch obt\u00ed\u017e\u00ed s\u00a0odstupem a\u017e n\u011bkolika desetilet\u00ed po RT (nej\u010dast\u011bji po 10 letech a&nbsp;v\u00edce). P\u0159i l\u00e9\u010db\u011b lymfom\u016f jsou z\u00e1sadn\u00ed p\u0159edev\u0161\u00edm pozdn\u00ed n\u00e1sledky a\u00a0<strong>snahou l\u00e9ka\u0159\u016f je minimalizovat<\/strong>\u00a0p\u0159edev\u0161\u00edm rizika v\u00fdskytu t\u011bchto komplikac\u00ed. Mo\u017en\u00e9 projevy pozdn\u00ed toxicity v&nbsp;z\u00e1vislosti na&nbsp;ulo\u017een\u00ed oza\u0159ovan\u00e9 oblasti:<\/p>\n<ul>\n<li>onemocn\u011bn\u00ed srdce+c\u00e9v (infarkt myokardu, chlopenn\u00ed vady),<\/li>\n<li>jin\u00e9 zhoubn\u00e9 n\u00e1dory (karcinom prsu, plic, non-Hodgkin\u016fv lymfom, leukemie),<\/li>\n<li>poruchy funkce \u0161t\u00edtn\u00e9 \u017el\u00e1zy (sn\u00ed\u017een\u00e1 \u010dinnost),<\/li>\n<li>posti\u017een\u00ed m\u00edchy (Lhermitt\u016fv syndrom-\u0161lehav\u00e1 bolest \u0161\u00ed\u0159\u00edc\u00ed se do horn\u00edch a&nbsp;doln\u00edch kon\u010detin p\u0159i p\u0159edklonu hlavy),<\/li>\n<li>posti\u017een\u00ed muskuloskelet\u00e1ln\u00edho syst\u00e9mu,<\/li>\n<li>posti\u017een\u00ed kostn\u00ed d\u0159en\u011b (myelofibr\u00f3za).<\/li>\n<\/ul>\n<p><strong>Z\u00e1sadn\u00ed je pe\u010dliv\u00e9 zv\u00e1\u017een\u00ed indikace oz\u00e1\u0159en\u00ed.<\/strong>\u00a0Nutnost za\u0159azen\u00ed RT do l\u00e9\u010debn\u00e9ho sch\u00e9matu je potvrzov\u00e1na klinick\u00fdmi studiemi. V\u00a0\u010cR vych\u00e1z\u00edme z&nbsp;doporu\u010den\u00ed Kooperativn\u00ed lymfomov\u00e9 skupiny (KLS), kter\u00e1 reflektuj\u00ed nejnov\u011bj\u0161\u00ed v\u00fdsledky t\u011bchto klinick\u00fdch studi\u00ed a&nbsp;jsou pravideln\u011b aktualizov\u00e1na. P\u0159i vlastn\u00edm proveden\u00ed RT vych\u00e1z\u00edme tak\u00e9 z\u00a0doporu\u010den\u00ed ILROG (International Lymphoma Radiation Oncology Group).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3>Protonov\u00e1 RT p\u0159edstavuje velmi slibnou a&nbsp;\u0161etrnou techniku RT pro v\u00fdznamnou \u010d\u00e1st pacient\u016f s\u00a0lymfomy (p\u0159edev\u0161\u00edm mediastin\u00e1ln\u00ed ulo\u017een\u00ed oza\u0159ovan\u00e9ho objemu).<\/h3>\n<h3><\/h3>\n<h3>Pacientsk\u00e9 p\u0159\u00edb\u011bhy, blogy:<\/h3>\n<p><a href=\"https:\/\/www.lymfomhelp.cz\/projekty\/pribehy-pacientu\/karolina-o\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.lymfomhelp.cz\/projekty\/pribehy-pacientu\/karolina-o\/<\/a><br \/>\n<a href=\"https:\/\/nas-zivot-s-hodgkinem.webnode.cz\/blog\/\" target=\"_blank\" rel=\"noopener\">https:\/\/nas-zivot-s-hodgkinem.webnode.cz\/blog\/<\/a><br \/>\n<a href=\"https:\/\/pisujakoozivot.blogspot.com\/\" target=\"_blank\" rel=\"noopener\">https:\/\/pisujakoozivot.blogspot.com\/<\/a><br \/>\n<a href=\"http:\/\/www.hlavuvzhuru.cz\/blog\/diagnoza-Hodgkinuv-lymfom\" target=\"_blank\" rel=\"noopener\">http:\/\/www.hlavuvzhuru.cz\/blog\/diagnoza-Hodgkinuv-lymfom<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Protonov\u00e1 RT p\u0159edstavuje velmi slibnou a&nbsp;\u0161etrnou techniku RT pro v\u00fdznamnou \u010d\u00e1st pacient\u016f s\u00a0lymfomy (p\u0159edev\u0161\u00edm mediastin\u00e1ln\u00ed ulo\u017een\u00ed oza\u0159ovan\u00e9ho objemu). Pacientsk\u00e9 p\u0159\u00edb\u011bhy, blogy: https:\/\/www.lymfomhelp.cz\/projekty\/pribehy-pacientu\/karolina-o\/ https:\/\/nas-zivot-s-hodgkinem.webnode.cz\/blog\/ https:\/\/pisujakoozivot.blogspot.com\/ http:\/\/www.hlavuvzhuru.cz\/blog\/diagnoza-Hodgkinuv-lymfom<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":4983,"menu_order":387,"comment_status":"closed","ping_status":"closed","template":"template-service-detail-with-sidebar.php","meta":{"footnotes":""},"class_list":["post-4996","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4996","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/comments?post=4996"}],"version-history":[{"count":1,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4996\/revisions"}],"predecessor-version":[{"id":5014,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4996\/revisions\/5014"}],"up":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4983"}],"wp:attachment":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/media?parent=4996"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}