{"id":3300,"date":"2024-02-08T13:22:29","date_gmt":"2024-02-08T12:22:29","guid":{"rendered":"https:\/\/www.ptc.cz\/co-liecime\/lymfomy\/o-malignich-lymfomech\/"},"modified":"2024-06-11T15:53:32","modified_gmt":"2024-06-11T13:53:32","slug":"rakovina-malignych-lymfomov","status":"publish","type":"page","link":"https:\/\/www.ptc.cz\/sk\/co-liecime\/lymfomy\/rakovina-malignych-lymfomov\/","title":{"rendered":"Rakovina mal\u00edgnych lymf\u00f3mov"},"content":{"rendered":"<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p>Mal\u00edgny lymf\u00f3m je v\u0161eobecn\u00e9 ozna\u010denie pre n\u00e1dorov\u00e9 ochorenie lymfatick\u00e9ho syst\u00e9mu. Mal\u00edgnymi lymf\u00f3mami sa ozna\u010duj\u00fa n\u00e1dory, ktor\u00e9 poch\u00e1dzaj\u00fa z&nbsp;jedn\u00e9ho typu bielych krviniek \u2013 lymfocytov. Prejavuj\u00fa sa najm\u00e4 zv\u00e4\u010d\u0161en\u00edm lymfatick\u00fdch uzl\u00edn. Z\u00e1kladn\u00e9 rozdelenie mal\u00edgnych lymf\u00f3mov tvoria dve skupiny: Hodgkinov lymf\u00f3m (HL) a&nbsp;Non-Hodgkinov lymf\u00f3m (NHL), ktor\u00fd tvor\u00ed podstatne r\u00f4znorodej\u0161iu podskupinu. Mal\u00edgne lymf\u00f3my s\u00fa ochorenie, ktor\u00e9 ve\u013emi \u010dasto postihuje osoby v&nbsp;mladom veku. V&nbsp;\u010ceskej republike je zisten\u00fdch zhruba 1800 nov\u00fdch pr\u00edpadov za rok. Progn\u00f3za ochorenia je \u010dasto ve\u013emi dobr\u00e1.<\/p>\n<p>Lie\u010debn\u00fd postup stanovuje \u0161pecialista &#8211; hematoonkol\u00f3g. Nosnou lie\u010dbou mal\u00edgnych lymf\u00f3mov je v&nbsp;s\u00fa\u010dasnej dobe lie\u010dba syst\u00e9mov\u00e1 (celotelov\u00e1), predstavovan\u00e1 chemoterapiou \u010di biologickou lie\u010dbou, event. kombin\u00e1ciou oboch t\u00fdchto met\u00f3d. R\u00e1dioterapia potom sl\u00fa\u017ei predov\u0161etk\u00fdm ako lie\u010dba doplnkov\u00e1, ktor\u00e1 m\u00e1 za \u00falohu zn\u00ed\u017ei\u0165 riziko n\u00e1vratu ochorenia v&nbsp;p\u00f4vodne postihnut\u00fdch oblastiach, alebo ako kurat\u00edvna lie\u010dba pred \u010fal\u0161ou pl\u00e1novanou syst\u00e9movou lie\u010dbou, napr\u00edklad v&nbsp;pr\u00edpade relabuj\u00facich lymf\u00f3mov. Ide o&nbsp;lok\u00e1lnu lie\u010dbu, teda obmedzen\u00fa na&nbsp;ur\u010dit\u00e9 miesto alebo oblas\u0165 tela. V&nbsp;tejto indik\u00e1cii sa r\u00e1dioterapia pou\u017e\u00edva pri skor\u00fdch a&nbsp;stredne pokro\u010dil\u00fdch \u0161t\u00e1di\u00e1ch Hodgkinovho lymf\u00f3mu, rizikov\u00e9ho Non-Hodgkinovho lymf\u00f3mu (postihnutie s&nbsp;objemn\u00fdm vstupn\u00fdm n\u00e1lezom, postihnut\u00edm kost\u00ed alebo mimouzlinov\u00fdm n\u00e1lezom) a&nbsp;u&nbsp;pacientov s&nbsp;nedostato\u010dnou lie\u010debnou odpove\u010fou na&nbsp;predch\u00e1dzaj\u00facu syst\u00e9mov\u00fa terapiu.<\/p>\n<p>Kombinovan\u00e1 lie\u010dba (syst\u00e9mov\u00e1 lie\u010dba + r\u00e1dioterapia) \u010dasto znamen\u00e1 vy\u0161\u0161ie \u0161ance na&nbsp;vylie\u010denie lymf\u00f3mu. Vzh\u013eadom na&nbsp;v\u00fdborn\u00fa \u00fa\u010dinnos\u0165 r\u00e1dioterapie nie je v\u00e4\u010d\u0161inou nutn\u00e9 pou\u017eitie d\u00e1vok \u017eiarenia, ktor\u00e9 prekra\u010duj\u00fa toleran\u010dn\u00e9 limity okolit\u00fdch zdrav\u00fdch tkan\u00edv. Av\u0161ak aj ni\u017e\u0161ie d\u00e1vky \u017eiarenia m\u00f4\u017eu by\u0165 potenci\u00e1lne \u0161kodliv\u00e9, a&nbsp;to predov\u0161etk\u00fdm v&nbsp;\u010dasovom horizonte desa\u0165 aj viac rokov po onkologickej terapii. \u010casto sa objav\u00ed bez nadv\u00e4znosti na&nbsp;ak\u00fatnu toxicitu r\u00e1dioterapie. S&nbsp;dlh\u0161\u00edm \u010dasov\u00fdm odstupom od ukon\u010denej onkologickej lie\u010dby st\u00fapa riziko v\u00fdvoja tejto neskorej toxicity.<\/p>\n<p>Tieto rizik\u00e1 by sa mali zv\u00e1\u017ei\u0165 predov\u0161etk\u00fdm u&nbsp;pacientov s&nbsp;ve\u013emi dobrou dlhodobou progn\u00f3zou. Patria sem najm\u00e4 mlad\u00ed pacienti s&nbsp;Hodgkinov\u00fdm lymf\u00f3mom a&nbsp;prognosticky priazniv\u00fdm B-non Hodgkinov\u00fdm lymf\u00f3mom (predov\u0161etk\u00fdm podtypy ako dif\u00fazny ve\u013ekobunkov\u00fd B-lymf\u00f3m, prim\u00e1rny mediastin\u00e1lny B-lymf\u00f3m). T\u00edto pacienti by mali by\u0165 lie\u010den\u00ed v\u017edy s&nbsp;vedom\u00edm dlhodob\u00fdch riz\u00edk onkologickej terapie.<\/p>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h3><strong>Ne\u017eiaduce \u00fa\u010dinky spojen\u00e9 s&nbsp;o\u017earovan\u00edm<\/strong><\/h3>\n<p>Pri o\u017earovan\u00ed sa m\u00f4\u017eeme stretn\u00fa\u0165 s&nbsp;bezprostredn\u00fdmi ne\u017eiaducimi \u00fa\u010dinkami \u017eiarenia. Objavuj\u00fa sa po\u010das RT a&nbsp;maxim\u00e1lne do 6 t\u00fd\u017ed\u0148ov po jej ukon\u010den\u00ed. Mo\u017en\u00e9 prejavy ak\u00fatnej radia\u010dnej toxicity (s\u00favisiace s&nbsp;miestom o\u017eiarenia) s\u00fa:<\/p>\n<ul>\n<li>slizni\u010dn\u00e9: afty, preh\u013atanie \u0165a\u017ekosti (pri o\u017earovan\u00ed oblasti hlavy a&nbsp;krku),<\/li>\n<li>slinn\u00e9 \u017e\u013eazy: suchos\u0165 v&nbsp;\u00fastach (pri o\u017earovan\u00ed v&nbsp;oblasti hlavy a&nbsp;krku),<\/li>\n<li>ko\u017en\u00e9: za\u010dervenanie a\u017e olupovanie poko\u017eky v&nbsp;o\u017earovacom poli,<\/li>\n<li>p\u013e\u00facna: poradia\u010dn\u00fd z\u00e1pal p\u013e\u00fac (pri o\u017earovan\u00ed oblasti medzihrudia-mediastina).<\/li>\n<\/ul>\n<p>\u010ealej sa v&nbsp;s\u00favislosti s&nbsp;RT m\u00f4\u017eeme stretn\u00fa\u0165 s&nbsp;neskor\u00fdmi n\u00e1sledkami \u017eiarenia, ktor\u00e9 sa m\u00f4\u017eu prejavi\u0165 aj bez predch\u00e1dzaj\u00facich \u0165a\u017ekost\u00ed s&nbsp;odstupom a\u017e nieko\u013eko desa\u0165ro\u010d\u00ed po RT (naj\u010dastej\u0161ie po 10 rokoch a&nbsp;viac). Pri lie\u010dbe lymf\u00f3mov s\u00fa z\u00e1sadn\u00e9 predov\u0161etk\u00fdm neskor\u00e9 n\u00e1sledky a&nbsp;snahou lek\u00e1rov je minimalizova\u0165 predov\u0161etk\u00fdm rizik\u00e1 v\u00fdskytu t\u00fdchto komplik\u00e1ci\u00ed.<\/p>\n<h3>Mo\u017en\u00e9 prejavy neskorej toxicity v&nbsp;z\u00e1vislosti od ulo\u017eenia o\u017earovanej oblasti:<\/h3>\n<ul>\n<li>ochorenie srdca+ciev (infarkt myokardu, chlop\u0148ov\u00e9 chyby),<\/li>\n<li>in\u00e9 zhubn\u00e9 n\u00e1dory (karcin\u00f3m prsn\u00edka, p\u013e\u00fac, non-Hodgkinov lymf\u00f3m, leuk\u00e9mia),<\/li>\n<li>poruchy funkcie \u0161t\u00edtnej \u017e\u013eazy (zn\u00ed\u017een\u00e1 \u010dinnos\u0165),<\/li>\n<li>postihnutie miechy (Lhermittov syndr\u00f3m-\u0161\u013eahav\u00e1 boles\u0165 \u0161\u00edriaca sa do horn\u00fdch a&nbsp;doln\u00fdch kon\u010dat\u00edn pri predklone hlavy),<\/li>\n<li>postihnutie muskuloskelet\u00e1lneho syst\u00e9mu,<\/li>\n<li>postihnutie kostnej drene (myelofibr\u00f3za).<\/li>\n<\/ul>\n<p><span style=\"font-size: 16px;\">Z\u00e1sadn\u00e9 je starostliv\u00e9 zv\u00e1\u017eenie indik\u00e1cie o\u017eiarenia. Nutnos\u0165 zaradenia RT do lie\u010debnej sch\u00e9my je potvrdzovan\u00e1 klinick\u00fdmi \u0161t\u00fadiami. V&nbsp;SR vych\u00e1dzame z&nbsp;odpor\u00fa\u010dan\u00ed Kooperat\u00edvnej lymf\u00f3movej skupiny (KLS), ktor\u00e9 reflektuj\u00fa najnov\u0161ie v\u00fdsledky t\u00fdchto klinick\u00fdch \u0161t\u00fadi\u00ed a&nbsp;s\u00fa pravidelne aktualizovan\u00e9. Pri vlastnom preveden\u00ed RT vych\u00e1dzame aj z&nbsp;odpor\u00fa\u010dan\u00ed ILROG (International Lymphoma Radiation Oncology Group).<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3>Prot\u00f3nov\u00e1 RT predstavuje ve\u013emi s\u013eubn\u00fa a&nbsp;\u0161etrn\u00fa techniku RT pre v\u00fdznamn\u00fa \u010das\u0165 pacientov s&nbsp;lymf\u00f3mami (predov\u0161etk\u00fdm mediastin\u00e1lne ulo\u017eenie o\u017earovan\u00e9ho objemu).<\/h3>\n<h3>Pacientsk\u00e9 pr\u00edbehy, 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>Prot\u00f3nov\u00e1 RT predstavuje ve\u013emi s\u013eubn\u00fa a&nbsp;\u0161etrn\u00fa techniku RT pre v\u00fdznamn\u00fa \u010das\u0165 pacientov s&nbsp;lymf\u00f3mami (predov\u0161etk\u00fdm mediastin\u00e1lne ulo\u017eenie o\u017earovan\u00e9ho objemu). Pacientsk\u00e9 pr\u00edbehy, 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":3293,"menu_order":385,"comment_status":"closed","ping_status":"closed","template":"template-service-detail-with-sidebar.php","meta":{"footnotes":""},"class_list":["post-3300","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/pages\/3300","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/comments?post=3300"}],"version-history":[{"count":4,"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/pages\/3300\/revisions"}],"predecessor-version":[{"id":3485,"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/pages\/3300\/revisions\/3485"}],"up":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/pages\/3293"}],"wp:attachment":[{"href":"https:\/\/www.ptc.cz\/sk\/wp-json\/wp\/v2\/media?parent=3300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}