bavSvTa asakis avTvisebiani limfomebis · PDF filefollowing cytotoxic chemotherapy on bone...

hojkinis limfoma (HD)

saqarTvelos pediatr-hematologTada

onko hematologTa kavSiri

Tbilisi2007

gaidlainis aucilebloba BbavSvTa asakSi avTvisebiani limfomebis

maRaldozirebuli qimiTerapiuli programebis gamoyeneba mniSvnelovani

win gadadgmuli nabijia mosalodneli mogvianebiTi garTulebebis Tavidan

acilebisa da daavadebis optimaluri gamosavlis misaRwevad vinaidan

programuli Terapia iTvaliswinebs qimiopreparatebis dozirebisa da

Seyvanis zustad gansazRvrul reJims mizanmimarTul kvlevebs

garTulebebis marTvis algoriTmebs xangrZliv monitorings amitom

simsivnuri daavadebebis swori menejmentis gansaxorcieleblad

gaidlainis Seqmna umniSvnelovaniesi pirobaa

hojkinis limfoma (HD)(Hodgkinlsquos Disease)

1 daavadebis definicia

hojkinis limfomalimfogranulematozi aris simsivnuri daavadeba

romelis drosac xdeba limfoiduri qsovilis neoplaziuri

transformacia limfoiduri qsovili aris mTel organizmSi ris gamoc

simsivnuri procesi SeiZleba aRmocendes sxeulis nebismier nawilSi da

gavrceldes organizmis nebismier qsovilSi

sinonimebi hojkinis limfoma HD limfogranulematozi LG

2 epidemiologia

statistikuri monacemebiT hojkinis lmfomis sixSire bavSvTa asakSi

Seadgens 36 SemTxvevas erT milion bavSvTa mosaxleobaze

2

0

20

40

60 Hhojkinis daavadebis ganawileba asakis gaTvaliswinebiT

Ppac

inti

S

asaki

0-4 5-9 10-14 15-19 20-24 25-29 35-39 30-39

daavadebis piki aRiniSneba 5-dan 8 wlamde asakis bavSvebSi da biWebi

avadoben ufro xSirad bavSvTa asakis simsivnuri daavadebebis

struqturaSi hojkinis limfoma Seadgens 12-15 -s

0

20

40

60

80

100

gogobiWi lt7 8- dan 11 weli gt12

Hohojkinis limfomebis SemTxvevebi asakisa da sqesis mixedviT

Series2

hojkinis daavadebis ganawu

saqarTveloSi bavSvTa sakSi hojkinis limfomis SemTxvevebis sarwmuno

statistikuri monacemebi ar arsebos ukanasknel wlebSi SeiniSneba

bavSvTa onko-hematologiur centrSi hojkinis limfomiT daavadebuli

pirveladi pacientebis momarTvianobis Semcireba da meoradi pacientebis

(daavadebis recidivi) momarTvianobis momateba rac aixsneba imiT rom

hojkinis limfomiT daavadebuli bavSvebi mkurnalobas itareben

sxvadasxva klinikebSi

3 etiopatogenezi daavadebis substrats warmoadgens rid-Sternbergis

avTvisebiani ujredi daavadebis gamomwvevi mizezi ucnobia Tumca

arsebobs monacemebi hojkinis limfomis virusuli etiologiis (EBV)

virusis sasargeblod (Levine Stein 19900

4 daavadebis zogadi simptomebi

bull limfuri kvanZebis umtkiveulo hiperplazia

bull ucnobi genezis gaxangrZlivebuli cxeleba

bull Ramis Zlieri oflianoba

bull qavili

3

5 klasifikacia -

hojkinis limfomis tipebi (histolgiuri diagnozi)

klasikuri hojkinis daavadeba

bull nodularuli sklerozi

bull Sereulujredovan

bull limfocitebis siWarbiT

bull limfoiduri ganvleviT

6 gamokvlevis sqema

6 1 inicialuri diagnozis dadgena (mtkicebuleba 1 rekomendaciis

xarisxi A)

bull pacientis fizikaluri gamokvleva da anamnezis Segroveba

bull gulmkerdis rentgenografia

bull muclis Rrus organoebis eqoskopia

bull limfuri kvanZis biofsia ndashhistologiuri diagnozi

bull sisxlis saerTo analizi

bull eriTrocitebis daleqvis siCqare

bull RviZlisa da Tirkmlis funqciebis Seswavla (albuminis CaTvliT)

6 2 inicialuri stadirebis gansazrvrisTvis saWiro radiologiuri

kvlevebi (mtkicebuleba 1 rekomendaciis xarisxi A)

bull valdeieris rgolis kisris subklavikularuli aqsilaruli

mediastinaluri paratraqealuri abdominaluri da sazardulis

limfuri kvanZebis kompiuteruli tomografia (CT) an magnitur

rezonansuli tomografia (MRI)

bull gulmkerdis kompiuteruli tomografia (CT)

bull ConCxis scintigrafia (saWiroebis SemTxvevaSi)

bull Zvlis tvinis aspiracia da biofsia (Cveneba ndash daavadebis II stadia)

bull seleqtiuri laparaskopia (iSviaT SemTxvevaSi)

4

7 daavadebis stadiebi

stadia I

bull simsivnuri dazianeba aRiniSneba mxolod erTi regionis limfour

kvanZSi

bull simsivnuri dazianeba aRiniSneba mxolod erTi regionis organoSi

eqstranodalurad (IE)

stadia II

bull simsivnuri dazianeba aRiniSneba 2 an met regionalur limfuri

kvanZSi diafragmis mxolod erT mxares (zmoT an qvemoT)

bull simsivne nanaxia regionaluri limfuri kvanZebSi da mimdebare

qsovilSi (IIE )

stadia III

bull simsivnuri dazianeba aRiniSneba limfur kvanZebSi diafragmis orive

mxres

bull simsivnuri dazianeba aRiniSneba rogorc limfur kvanZebSi aseve

elenTaSi (IIIS) da an eqstranodalur regionSi an organoSi (IIIS) an

oriveSi erTadroulad(IIISE)

stadiaIV

bull adgili aqvs eqstranodalurad mxolod erTi organos

diseminirebul dazianebas simsivnuri ujredebi SeiZeleba

arsebobdes an ar asebobdes limfur kvanZebSi

bull adgili aqvs eqstranodalurad mxolod erTi organos simsivnur

dazianebas rasac Tan axlavs araregionaluri limfuri kvanZebis

procesSi CarTva

yoveli stadia A da B kategoriad aris dayofili

bull stadia A - zogadi simptomebis ar arseboba

bull stadia B - araumcires erT-erTi zemoT moyvanili zogadi

simptomebidan

5

8 hojkinis limfomis mkurnaloba (mtkicebuleba I rekomendaciis xarisxi A)

M81 bavSvTa asakSi hojkinis limfomis mkurnalobis ZiriTadi principebi

bull simsivniT daavadebuli yvela bavSvi unda mkurnalobdes bavSvTa

specializirebul samkurnalo centrSi

bull mkurnaloba unda emyarebodes daavadebis stadirebas

bull mkurnalobis ori ZiriTadi samkurnalo meTodia qimioTerapia

da sxivuri Terapia

82 mkurnalobis koncefcia

6

inicialuri diagnozis procedurebi

diagnizi

warmosaxviTi kvlevbi stadireba mkurnaloba gankurneba

qimioTerapia radiaciuli Terapi

83 bavSvTa asakis hojkinis limfomebis optimalur mkurnalobis Sedegebis misaRebad rekomendirebulia - GPOH_HD 2002 programa 831 mkurnalobis programa gogonebisTvis(mtkicebuleba I rekomendaciis xarisxi A)

TG 1IABIIA

TG 2IEABIIEA

IIBIIIA

TG 3IIEBIIIEABIIIBIVAB

2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP

sruli remisia - dasxiveba ara

Aarasruli remisia -dasxiveba

Ppirveladi velebisdasxiveba

832 mkurnalobis programa biWebisTvis(mtkicebuleba I rekomendaciis xarisxi A)

TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7

9 daavadebis gamosavali -gadarCenis sixSire stadiebis mixedviT

stadia 5 wliani gadarCenis sixSire1 90 - 9511 90 - 95111 80 - 851V daaxloebiT ndash 75

91 pacientTa garkveul raodenobas aReniSneba daavadebis progresi

911 parcialuri remisia - qimiTerapiis fonze adgili aqvs

simsivnuri substratis arasrul iradikacias rac qimioTerapiisa

da sxivuri Terapiis gaZlierebas saWiroebs Tumca pacientebis am

jgufisTvis blokebis raodenoba winaswar ar aris mkacrad

gansaxRvruli da damokidebulia pasuxze

912 daavadebis recidivi

- Zalian adreuli - Terapiis dasrulebidan sam TveSi ganviTarebuli

- adreuli - Terapiis dasrulebidan sami Tvidan Tormet Tvemde

ganviTarebuli

- mogvinebiTi - Terapiis dasrulebidan Tormet Tvis Semdeg

ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3

Terapiuli jgufebiSi (TG) ganawileba

bull pirveli Terapiuli jgufi (TG1) I AB da IIA

bull meore Terapiuli jgufi(TG2) I EAB II EA IIB an IIIA

bull mesme Terapiuli jgufi(TG3) II EB III EAB an IVAB

pacientTa ganawileba Terapiul jgufebSi

recidivis mkurnalobisTvis rekomendirebulia Sesabamisi kursebi

IEPABVD kursebi COPP da ChICEP reJimebTan erTad am SemTxvevaSi

blokebis raodenoba winaswar ar aris mkacrad gansaxRvruli da

damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel

IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi

pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT

(mtkicebuleba I rekomendaciis xarisxi A) (ixprotokoli)

913 hojkinis limfomiT daavadebul pacientTa 90 - s aReniSnebaT sruli

remisia (CR ndash cmplite remission) da aqvs gankurnebis Sansi Tumca mkurnalobis

dasrulebis Semdeg saWiroeben xuTi wlis ganmavlobaSi konkretul

kliniko-laboratoriul kvlevebsa da meTvalyureobas (ix protokoli)

10 eTikur-samarTlebrivi rekomendaciebi

hojkinis limfomebiT daavadebuli bavSvebis ojaxebi uzrunvelyofilni

unda iyvnen damakmayofilebeli socialuri pirobebiT ris gamoc maT

esWiroebaT materialuri daxmareba pensiis saxiT rac xels Seuwyobs

gankurnebuli bavSvebis socialur garemoSi adaptaciis sakiTxis

mogvarebasa da Sesabamisad maTi cxovrebis xarisxis gaumjobesebas

11 praqtikaSi adaptaciis da protokolebis SemuSavebis rekomendaciebi

m iaSvilis sax bavSvTa centraluri saavadmyofos onko-hematologiuri

centris aTwliani muSaobis Sedegebis Sefasebis safuZvelze

rekomendirebulia bavSvTa asakSi hojkinis limfomebis mkurnaloba

Catardes mkurnalobis optimizirebuli oqmebiT mogvianebiTi

garTulebebis Sesamcireblad rogoricaa hormonaluri ukmarisoba

farisebri jirkvlisa da mkerdis simsivneebi limfomiT daavadebuli

yvela bavSvis (0-dan 18 wlamde) mkurnaloba unda Catardes pediatriuli

protokolis mixedviT mesame donis bavsvTa saavadmyofoSi

rekomendacia efuZneba damoukidebeli eqspertis qfraiburgis

sauniversiteto klinikis pediatriuli onkologiisa da hematologiuri

ganyofilebis xelmZRvanelis prof Nnimaieris Sefasebas (Tbilisi 2003w

13-20 ianvari)

9

12 gaidlainis gadasinjvis da ganaxlebis vada

GPOH-HD 2002 ndash programa (mtkicebuleba I rekomendaciis xarisxi A)ndash

iTvaliswinebs hojkinis limfomis mkurnalobas optimizirebuli oqmebiT

romlis mizania qimioTerapiis toqsiurobisa da mogvianebiTi

garTulebebis Semcireba gadarCenis sixSiris gazrda aRniSnulidan

gamomdinare gaidlinis gadasinjvis vada rekomendirebulia ganisazRvros

5 wliT

13 gaidlainis miRebis xerxiwyaro

GPOH-HD 2002 ndash programa romelic Targmnilia qarTul enaze da

adaptirebulia saqarTveloSi gamoyenebisaTvis aRniSnuli programis

gamoyeneba saqarTveloSi m iaSvilis sax bavSvTa centraluri

saavadmyofondashs onko-hematologiur ganyofilebaSi da eqspertirdeba q

fraiburgis sauniversiteto klinikis profesor nimaieris mier

10

14 literatuara

Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure

in chemoradiotherapy Blood 9 93 -116

Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission

tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-

60

Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V

Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg cells

Int J Cancer 97 205-210

Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos

GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-

stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108

Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease

Critical appraisal of curative potential Am J Med 83 523ndash532

Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA

Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of the

hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting Airlie

House Virginia November 1997Ann Oncol 101419-1432

Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP

chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203

268-272

Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana M

(1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The Institute

Gustave-Roussy experience Rec Results canser Res 117 270-283

Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME

(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl

Med 38 343-348

11

Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell dysfunction

following cytotoxic chemotherapy on bone mineral density (BMD) and body composition Clin

Endocrinol 52 609-616

Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of

Hodgkins lymphoma Ann Oncol 13 11-18

Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell

lymphomas N Engl J Med 3411520ndash1529

Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC

Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the

evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7

1630-1636

Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A

Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary

leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and

anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin

Oncol 21 1074-1081

Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES Urba

WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in patients

relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability for cure J

Clin Oncol 10 210 -218

Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-

fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkins

disease influence on patient management in a single institution Ann Oncol 111273-1279

Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M

Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin

Pathol 55 162-176

12

Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T

Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin

lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a

phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424

Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L

Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease

an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51

1209-1218

Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J

(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-

glucose Eur J Nucl Med 231641

Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D

salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163

Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G Rath

B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High Cure

rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian

Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744

Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge

B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy im

Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein

Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263

13

bavSvTa asakSi hojkinis limfomis (HD)

mkurnalobis klinikuri praqtikis nacionaluri

rekomendacia

(protokoli)

programa - GPOH_HD 2002

14

1 hojkinis limfoma (HD- Hodgkinlsquos Disease) daavadebis definicia

hojkinis limfomahojkinis daavadeba aris ujredebis simsivnuri zrda

limfoidur sistemaSi limfoiduri qsovili aris mTel organizmSi ris

gamoc simsivnuri procesi SeiZleba aRmocendes sxeulis nebismier

nawilSi da gavrceldes organizmis nebismier qsovilSisinonimebi

hojkinis limfoma (HD) limfogranulematozi (LG)

2 daavadebis simptomebi

bull limfuri kvanZebis umtkiveulo SeSupeba



bull qavili

3 diagnostikur-laboratoriuli kvlevebi

31 inicialuri diagnozis dadgena






bull eriTrocitebis daleqvis reaqcia


32 inicialuri stadirebis gansazrvrisTvissaWiro radiologiuri

kvlevebi

bull valdeieris rgolis kisris subklavikularuli axsilaruli


limfuri kvanZebis kompiuteruli tomografia (CT) an

magniturrezonansuli tomografia (MRI)



bull Zvlis tvinis aspiracia da biofsia (Cveneba ndash daavadebis 11 stadia)


15

4 bavSvTa asakis hojkinis limfomebis optimalur mkurnalobis gaidlaini

GPOH_HD 2002 programa 41 mkurnalobis programa gogonebisTvis

TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP




42 mkurnalobis programa biWebisTvi

TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




43 Terapiuli jgufebiSi ganawileba

bull pirveli Terapiuli jgufi I AB da IIA

bull meore Terapiuli jgufi I EAB II EA IIB an IIIA

16

bull mesme Terapiuli jgufi II EB III EAB an IVAB

5 qimioTerapiis gverdiTi movlenebi

qimioTerapiis zogadi gverdiTi movlenebia gulisreva Rebineba wonaSi

kleba Tmis cvena da meoradi simsivnis ganviTarebis riski

damxmare Terapia romelic moicavs infeqciebis profilaqtikas

neitropeniul cxelebas dadasturebuli infeqciebis marTvas Rebinebisa

da tkivilis menejments identuria mwvave limfoiduri leikemiis damxmare

Terapiisa ixileT mwvave limfoiduri leikemiis samkurnalo protokoli

6 sxivuri Terapia

61 sxivuri Terapiis dawyeba

bolo qimioTerapiuli reJimis damTavrebidan 3 kviris Semdeg

62 Cvenebebi da dozireba

1 pacientebi romlenic ganekuTvnebian pirvel Terapiul jgufs sruli

remisiis SemTxvevaSi ar sxivdebian

2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs

arasruli remisiis SemTxvevaSi sxivdebian doziT 20 grei

3 pacientebi romlenic ganekuTvnebian meore da mesame Terapiul

jgufs sruli remisiis SemTxvevaSi sxivdebian doziT 20 grei

4 yvela pacientebi romelTa narCeni masa sawyisTan SedarebiT 25

metia anu 75 isev rCeba sxivdebian doziT 30 grei

5 yvela pacienti romelTa narCeni masa gt75-ze sxivdebian doziT 35

grei

6 dazianebuli eqstralimfoiduri organoebi (Zvlis tvinis

gamoklebiT) eqvemdebarebian sxivur Terapias doziT 12 ndash 15 grei

7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18

grei gamonakliss warmoadgens filtvebi da am SemTxvevaSi dRiuri

doza ar unda aRematebodes 1-12 greis

8 recidivis SemTxvevaSi sayuradReboa pirveladi doza ganmeorebiTi

Terapiis sumaruli doza ar unda aRematebodes 40 greis

17

63 sxivuri Terapiis principebi

aucilebelia sxivuri Terapia Catardes pirveladi dagegmarebiT da

sxivuri aqseleratoris gamoyenebiT rac miznad isaxavs janmrTeli

qsovilebis maqsimalur dacvas sxivebis mavne moqmedebisgan da samizne

qsovilebis efeqtur dasxivebas

teqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti

64 velebi

mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad

moicavs mxolod inicialurad dazianebul limfur kvanZebs da

eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis

Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi

gadawyvetilebiT

7 mkurnalobis progresi da regresi

71 mkurnalobis progresi

71sruli remisia (CR)

bull daavadebis yvela simptomi alagebulia

bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli

bull gnadgurebulia pirveladi simsivnuri masis 95-ze gt narCeni masa lt 2 sm

-ze

71 2 daudasturebuli sruli remisia



- ganadgurebulia pirveladi simsivnuri masis 75-ze gt magram lt 95

narCeni masa lt 2sm-ze

71 3 parcialuri remisia

bull ar aris sruli remisia an sruli remisiis dadastureba ver xerxdeba

bull ar SeiniSneba daavadebis progresi

SeniSvna- anti-recidiuli Terapiis Catareba naCvenebia mxolod im

SemTxvevaSi roca dadasturebulia daavadebis progresi an recidivi

18

72 mkurnalobis regresi 721 recidivi



ganviTarebuli


ganviTarebuli

722 Terapia im pacientebisTvis visTanac standartuli mkarnaloba iyo araefeqturi - gamoixata daavadebis progresireba mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi

COPP da ChICEP reJimebTan erTad pacientebis am jgufisTvis blokebis

raodenoba winaswar ar aris mkacrad gansaxRvruli da damokidebulia

pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze

qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis

SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT

723 recidivis sawinaaRmdego sqemebi

1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe

2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe

3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe

1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe

2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe

3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe

4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe

19

bull ABVD=AdriamicynDacarbazinBleomycinVinblastin

bull IEP=IfosfamidEtoposidPrednison

1CCNU 80mgm2 po 1 dRe

2Etoposid 100mgm2 po 1-5 dRe

3Prednison 40mgm2 po 1-5 dRe

4Chlorambuzil 6mgm2 po 1-5 dRe

724 recidivis mkurnalobis taqtikis SerCevisas gaTvaliswinebulia

inicialuri diagnozis dros Terapiuli jgufebi

recidivis sawinaaRmdego Terapia pacientebSi romlebic

1 miekuTvnebodnen pirvel Terapiul jgufs

bull pacientebi romelTac inicialurad ar CautardaT sxivuri Terapia

unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba

doziT 25-30 grei

bull Pacientebi romelbmac inicialurad miiRes dazianebuli velebis

radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli

an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25

grei dasxivebuli da 25-30 axali velebisaTvis

bull Pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT

dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD-

COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve

dasxivebuli da 25-30 greiT dausxivebeli velebis

2 miekuTvnebodnen meore da mesame Terapiul jgufebs

bull pacientebi romelTac ganuviTardad recidivi axali dausxivebel

regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia

doziT 25-30grei

bull Pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an

dausxivebeli regionebSi utrdebaT IEP- ABVD- IEP- ABVD - IEP +

sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT

dausxivebeli velebis


dasxivebul an dausxivebel regionebSi utrdebaT IEP- ABVD- -IEP ndash

20

bull ChICEP=CCNUEtoposidPrednisonChlorambuzil

ABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30

greiT dausxivebeli velebis

pacientebs romlebsac antirecidiul Terapiaze aReniSnebaT simsivnis

neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri

Terapiis doza Tu es SesaZlebelia (sxivuri Terapiis sumaruli doza ar

unda iyos 45 Gr- ze gt)da damatebiT utardeba qimioTerapiuli kursi

ChICEP

21

helliphelliphelliphellip

22

valdeieris rgoli

kisris laviwzeda

laviwqveSaaqsilarulipeqtoruli

mediastinaluri

paraaortalurielenTis kariRviZlis kari

iliakaluri

sazardulisbarZayis

elenTa

8 sxivuri Terapiis sqemalimfuri kvanZebis regionebi

karis

mezenterialuri

9 samkurnalo sqemebi

91 kursi OPPA

prednizoloni prokarbazini

vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe

10 pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg

kvlevebi Mmkurnalobis damtavrebidan1-2 weli 3-4 weli 5-10 weli

1 sisixlissaerTo analizi2 gulmkeris rentgenograma3 mucli Rruseqoskopia

yovel 3 TveSi

yovel 6TveSi yovelwliurad

gulmkerdis Rrus kompiuteruli tomografiaekgeqokardiografia

yovel 6TveSi yovelwliurad gansakuTrebulSemTxvevebSi

TBG TSHT4 yovelwliurad

testosteroni

estradioli

maluTinizirebeli hormoniLH-RH-Test

biWebSi 16-20 wlis asakSi weliwadSi erTxel

gogonebSi amenoreis drosara ugvianes 15 wlis asakisa

26

gaidlainis aucilebloba BbavSvTa asakSi avTvisebiani limfomebis

maRaldozirebuli qimiTerapiuli programebis gamoyeneba mniSvnelovani

win gadadgmuli nabijia mosalodneli mogvianebiTi garTulebebis Tavidan

acilebisa da daavadebis optimaluri gamosavlis misaRwevad vinaidan

programuli Terapia iTvaliswinebs qimiopreparatebis dozirebisa da

Seyvanis zustad gansazRvrul reJims mizanmimarTul kvlevebs

garTulebebis marTvis algoriTmebs xangrZliv monitorings amitom

simsivnuri daavadebebis swori menejmentis gansaxorcieleblad

gaidlainis Seqmna umniSvnelovaniesi pirobaa

hojkinis limfoma (HD)(Hodgkinlsquos Disease)

1 daavadebis definicia

hojkinis limfomalimfogranulematozi aris simsivnuri daavadeba

romelis drosac xdeba limfoiduri qsovilis neoplaziuri

transformacia limfoiduri qsovili aris mTel organizmSi ris gamoc

simsivnuri procesi SeiZleba aRmocendes sxeulis nebismier nawilSi da

gavrceldes organizmis nebismier qsovilSi

sinonimebi hojkinis limfoma HD limfogranulematozi LG

2 epidemiologia

statistikuri monacemebiT hojkinis lmfomis sixSire bavSvTa asakSi

Seadgens 36 SemTxvevas erT milion bavSvTa mosaxleobaze

2

0

20

40

60 Hhojkinis daavadebis ganawileba asakis gaTvaliswinebiT

Ppac

inti

S

asaki

0-4 5-9 10-14 15-19 20-24 25-29 35-39 30-39




0

20

40

60

80

100



Series2

















bull qavili

3

5 klasifikacia -







6 gamokvlevis sqema


xarisxi A)


















4


stadia I


kvanZSi



stadia II




qsovilSi (IIE )

stadia III


mxres




stadiaIV






procesSi CarTva




simptomebidan

5







da sxivuri Terapia


6


diagnizi




TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26




0

20

40

60

80

100



Series2

















bull qavili

3

5 klasifikacia -







6 gamokvlevis sqema


xarisxi A)


















4


stadia I


kvanZSi



stadia II




qsovilSi (IIE )

stadia III


mxres




stadiaIV






procesSi CarTva




simptomebidan

5







da sxivuri Terapia


6


diagnizi




TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26

5 klasifikacia -







6 gamokvlevis sqema


xarisxi A)


















4


stadia I


kvanZSi



stadia II




qsovilSi (IIE )

stadia III


mxres




stadiaIV






procesSi CarTva




simptomebidan

5







da sxivuri Terapia


6


diagnizi




TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26


stadia I


kvanZSi



stadia II




qsovilSi (IIE )

stadia III


mxres




stadiaIV






procesSi CarTva




simptomebidan

5







da sxivuri Terapia


6


diagnizi




TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26







da sxivuri Terapia


6


diagnizi




TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26


TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC




7












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26












ganviTarebuli


ganviTarebuli

8

40

34

26 TG 1 TG 2

TG 3



































13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26






























13-20 ianvari)

9







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26







5 wliT







10

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26

14 literatuara





60















268-272






Med 38 343-348

11











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26











1630-1636





Oncol 21 1074-1081










Pathol 55 162-176

12








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26








1209-1218














13



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26



rekomendacia

(protokoli)


14











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26











bull qavili











kvlevebi









15



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26



TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOPPA

2xOPPA 2xCOPP

2xOPPA 4 x COPP





TG 1IABIIA

TG 2IEABIIEA

IIBIIIA


2xOEPA

2xOEPA 2xCOPDIC

2xOEPA 4 x COPDIC







16









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26









6 sxivuri Terapia













grei








17







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26







64 velebi





gadawyvetilebiT







-ze











18




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26




ganviTarebuli


ganviTarebuli















19













doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26











doziT 25-30 grei












doziT 25-30grei







20








ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26







ChICEP

21


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26


22

valdeieris rgoli

kisris laviwzeda


mediastinaluri


iliakaluri

sazardulisbarZayis

elenTa


karis

mezenterialuri


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26


91 kursi OPPA


vinkristini

adriamicini

92 kursi OEPA

prednizoloni

vinkristini

adriamicini

etopozidi

23

1 2 3 4 5 8 15 dRe

1 8 15 dRe

M

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26

93 kursi COPP

prednizoloni

prokarbazini

vinkristini

ciclofosfa midi

mesna + +

94 kursi COPDIC

prednizoloni

dakarbazin

vinkristini

ciclofosfamidi

mesna + +

24

1 8 15 dRe

1 8 15 MdRe

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26

95 kursi IEP

prednizoloni

ifosfamidi

messna

etopozidi

96 kursi ABVD

adriamicini

dakarbazini

bleomicini

vinblastini

97 kursi ChICEP

ccnu

etapozidi

prednizoloni

qlorambucili

25

1 2 3 4 5 6 7 dRe

1 15MdRe

M1 15 dRe




yovel 3 TveSi





testosteroni

estradioli




26




yovel 3 TveSi





testosteroni

estradioli




26

Date post:	05-Mar-2018
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