:

:

 

 

 

14 2012 . N 188

 

( )

 

10.08.2005 . N 1506- " , 50- " , 27.02.2006 . N 279-, 09.06.2007 . N 1172-, 05.09.2008 . N 2028-, 04.09.2009 . N 2326-, 25.01.2010 . N 90- , :

1. ( ) ( - ), .

2. , "" :

2.1. , ;

2.2. , , .

3. ...

 

..

 

 

 

 

 

14 2012 . N 188

 

( )

 

N/N

10

1.


50

2.


53, 54, 56

3.


61, 62, 64, 67

4.


49

5.


41

6.


71

7.


,

43, 44

8.


00-14

9.


00-14

10.


34

11.


-

15, 16, 19

12.


,

22, 23, 25

13.

 

14.

 

 

( - )

(50)

 





:

20 /.
1

1


,

,

:

25 /.
1

1


,

,

,

:

75-100 /.
1


3


,


:

80 /.
1

1


,


:

90 /.
1, 8, 15


4
1-


,


+

90 /.
1, 8, 15
10 /
1 15


4
1-


,


AD -
+

50 /. /
75 /. /

1


3


,
(
300 /. )

,


-
+

60 /. /
600 /. /

1


3






-
+

50 /. /
175 /.


3


,
(
300 /. )

,


FAC -
5- +
+

500 /. /
50 /. /
500 /. /

1


3





FEC -
5- +
+

500 /. /
75-80 /. /
500 /. /

1


3





ED -
+

75 /. /
75 /. /

1


3


,
(
300 /. )

,


CMF -
+
+
5-

100 /. per os
1-14
40 /. /
600 /. /

1


4




DX -
+

75 /.
1000-1250 /.
per os 1-14


3



DV -
+

75 /.
25 /. /
1 8


3


(

IV )

DDP -
D +

75 /. /

75 /. /


1


3


,

PLDD -
+

40 /. /
75 /. /

1


4


,

G-CSF

CD -
+

AUC-5 75
/.

1


3


,

-
+

AUC-5
175 /.

1


3


,

-
+

50 /. /
175 /.

1


3


,
CMF

-
+

75 /. /
135 /.

1


3


,
CMF

-
+

825-1000 /.
per s 1-14
175 /.

1


3


,

-
+

1000-1250 /.
per os 1-14
20-25 /.


1 8


3





:

1000-1250 /.
per os 1-14


3





GC -
+

1000-1200 /.
1 8 /
60-75 /.
1 /


3


,

,
,

GCarbo -
+

1000-1200 /.
1 8 /
AUC 4-5 1 /


3


,

,
,

+

1000-1200 /.
1 8 /
20-25 /.
1 8 /


3


,

,
,

+
+

8 /.
1 /
40 /.
1 /
12 /.
1 /


3 4


,

,
,


:
+

2,5 2
2
(. .
)
50



,

,
,
,




:
+

500 3

50



,

,
,


 

HER/2

 




TD -
+


4 /,
2 /


35 /.
1, 8 15

1


,
3

-
+


80 /.



6 / 1
3
(1-
8 /)

-

-
3

,
,
3

-
+


90 /.
1, 8 15


4 /,
2 /


,

22-

,
,
3

TD -
+


6 /
(1-
8 / )

75-100 /.


1

3


,
3-

-
+

175
/.

6 / (1-
8 /
)

1

3


,
3

+

1000-1250 /.
per os
1-14
1250

3
,


,
3

+

1000-1250 /.
per os
1-14
6 / (1-
8 /
)

3


,
3

+
-

Her/2


1 .
+
6 /
(1-
8 / )

,




,

,

+
-

Her/2


1 .
+
1250

,




,

,

 

 

- - 4 4 6 FAC FEC.

: 4 AC (, FAC, FEC) 4 , 4 75 /. + 600 /. + 50 /. 1 1 3 .

, - 6 ( 75 /. + 50 /. + 500 /. ) 1 3 .

Her/2 , N+, / 3 : 4 , 4 . , . : 75 /. + AUC 5 1 6 , ( ).

: 6 / 1 3 (1- 8 / ) 4- .

 

 

:

- ( () ):

, :

1. 20 , , 5 , . , .

2. , :

- , 20 ;

- - , 3,6 10,8 1 3 2-3- ( 40 , ), 20 .

5- . 20 5 2-3 , (2-3 ). , 5 .

, , . , .

, , Her/2 , .

:

- , ( /, 5 ) 20 . ( /, 5 ) ( ). "" 2-3 , , - 2-3 .

, Her/2- :

, . , , . .

, , , . - .

:

- - .

- - .

- , .

- - .

.

 

 

,

(56)

 




-
+

175 /.
AUC 5-6

1


3


PDDP -
+

135 /.
1
75 /.
2


3


DC -
+

75 /.
AUC - 5

1


3


DP -
+

75 /.
75 /.

1


3


-

AUC 7 1


3




-
+

AUC - 5
600 /.

1


3




PDRC -

() +

30 /.
AUC - 5

1


4


- +

1 /. 1-3
AUC - 5

1


4


+

AUC - 5
1
1000 /.
1 8


3


PG - +

60 /.
1
1 /.
1, 8


3


DOXA -
+

75 /. ,
100 /.

1


3


-

80 /. 1

1


,
-

50 /. 1

1
4


,

-

1 /. 1-5

1 3-4


,
-

1 /.
1, 8, 15

1
4


,
-

50






130 /. /,
2
1-
1 /. per os 2
/.
1-14


3


,


 

() ,

(56)

 




-
+ +

15 / /
1, 3, 5
100 /. /
1-5
20 /.
1 -5


3


- +

100 /. /
1-5
20 /.
1-5


3


 

( N 62)

 

 




-
-

50 /.
1
60 /.
1


3


-
+

50 /.
1
AUC 5 1


3


-
+

175 /.
AUC 5
1


3


,
-


 

: - .

- III , - 6 (. ).

- - - , + (. ).

 

 




GP -
+

1 /.
1, 8
60 /.
1


3


GC -
+

1 /.
1, 8
AUC 5 1


3


-
+

175 /.
AUC 5

1


3


DP -
+

75 /.
75 /.

1


3


 

 

(64)

 




-

-
3 . / 3

 


,


<**>

50 1 /
28 ,
2 .

37,5

28 ,

2


,


<**>

-
+

-
3 . / 3
+
10 / 1
2
15 / 1
3

1
2



1
3


,


<**>

800 1


,


<**>

<*>

25
30-60 . 1 /.

1




<**>

400 2 /



<*>

10 1 /


 

:

<*> : .

<**> :

MSKCC - Motzer - :

Karnofsky (< 80%).

(> 1,5 X ).

(< ).

(> 10 / (2,5 /)).

.

2 (: + + ..).

0 - .

1-2 - .

3 - .

 

(67)

 






(
)

75 /. /
1-
AUC 5-6

)
1 /. / 1, 8


3






AUC 6

175 /. /
3-
1-
AUC 6 /
1-


3


,


(
1 )

 

( "")

 




40-50

1

6

 

50

1

6

 

 

(61)

 




/
-
(,
,
)
+

3,6 1
10,8 1
3 3,75
7,5

50
250

1 28
, 1
3 .,
1
6 .


150



75 /. / 1
5 per os 2
21


3


-

1


12 /. 1
5 per os 2
21


3


-


2
1-
(



)

 

(62)

( N 62, N 57, N 1)

 




-
+ +

15 / /
1, 3, 5
100 /. /
1-5
20 /.
1-5


3 ,
1-


- +

100 /. /
1-5
20 /.
1-5


3 ,
1-


 

(49)

(M N 62, N 57, N 1)

 









900 /.
90
1 8
100 /.
8
300 / 5


3




2 /
50 /. /
500 /. /
1


3-4




60 /. /
600 /. /
25 /. /
1


3




60 /. /
1
60 /. 1 8


3








600 /. /
6
30 /. /
2 3
100 /.
1
1,5 /. /
5


4



50 /. 1 7

10 /. 1 7
/

5-6


 

(41)

N 62

 

(71)

 




200 /. per os
5


3-4






75 /.
8-21
130 /.
1
1,4 /. /
8

8


10 / /


2


+

10 / /
125 /. /


2


 

( ) (44)

 




40 /.



 

(43)

 




250 /. /
1-5
850 /. /
1


3





1 /. / 1
200 /. /
2-5
30 / 1


3






80 /. per os
1-
25 /. /
1-3-
220 /. /
1-3-


4


 

: - 3-5 . . / 3 1 .

 

(00-14)

 

 






(
AUC 6


)

1 /. / 1 8
75 /. /
1-


3


40 /.

 




 

(73)

 





60 /. / 1
40 /. /
1


3






 

 

( ) (34)

 







175-200 /. /
3-
1-
AUC 6 /
1-


3







175-200 /. /
3-
1-
AUC 6 /
1-
7,5 /
/ 1


3


,

,





(
)

1 /. / 1 8
75 /. /
1-
AUC 6


3






(
)

25 /. /,
1, 8
75 /. 1

AUC 6


3






(
)

75 /. /
1-
75 /. /
1-
AUC 6


3





(
)

500 /. /,
1
75 /. /
1-
AUC 6


3








(
)

100 /. /
1-3
75 /. /
1-
AUC 6


3


75 /. . / 1


3


500 /. . /
1


3




175 /.
3
1 /. / 1, 8


3




1 /. . 1 8
/
25 /. . 1 8
/


3


( ,



)

250 per os

-




EGFR

150 per os

-




EGFR

 

(34)

 








(
)

100 /. /
1-3
75 /. /
1-
AUC 6


3





1/. / 1-
50 /. /
1-
1,4 /. /
1


3


 

-

 

(15)

 

( )

 

(16)

 






-

5-

120 /. /
1-3
300 /. /
1-3
500 /. /
1-3


3




,

1000 /.
2 /. per os
1 14


3


(

)

,







-

5-

30 /. / .
1 5
30 /. /
1 5
100 /. /
2-4
300 /. /
2-4


3





130 /. /,
2
1-
1 /. per os
2 /.
1-14


3








130 /. /,
2
1-
625 /. per os x
2 p/.
1-14
50 /. / 1


3



(
)

75 /. 1
(130 /. /,
2
1- )
1 /. per os
2 /.
1-14


3


,
Her/2
-




8-12 /. ,
1 - 1
6
1000 /.
2 /. per os
1 14 -
3


3




180 /. ,
1 /
60 /. ,
1 /


2


 

: 5- .

 

(19)

 

5- , .

 




-

5-
( )

20 /. /
1 5
425 /. /
1 5


4










+/-

130 /. /,
2
1-
1 /. per os
2 /.
1-14
7,5 / /,
1-


3




,

-




+/-


100 /. /
1- 8-

800-1000 /.
per os x 2 /.
1-14
7,5 / /,
1-


3




(
-

)

1000 /.
2 /. per os
1 14


3









(
""
KRAS)

125 /. /
1, 8, 15,
22
250 /. /
(1-
400 /. )

-



36-
-



" " KRAS

-

125 /. /
1, 8, 15,
22




36-



80 - 1200 per os

3

2


3 /.


3


-
5-

500 /. /
500 /. /

-

6
(

)




,


FOLFOX6


-




5-

80-85 /. /
2
1
200-400 /. /

2 1 ,


400 /.
1- ,
,
5- 2400
/.

46 ,
(

5-)


2 ,

1-


,



-





5-

FOLFIRI


-




5-

180 /. /
1 1

200-400 /. /
2 1
,


400 /.
1- ,
,
5- 2400
/.

46 ,
(

5-)


2 ,

1-

,
,



-





5-

 

: FOLFOX6 FOLFIRI 5 / 2 , 1- 2- . "" KRAS ( BRAF) 1- 2- .

 

(25)

 




1 /. /
1, 8, 15


4 ,

1-




1 /. / 1, 8
15-
1 /. per os
2 /.
1-14


3 ,

1-



1 /. / 1
85 /. /,
2
1


2


 

 




150-250 /. /
3 .

-



.

-

20-30 1

-






(
)

100 /. /
1-3
75 /. /
1-
AUC 6


3


,



 

- GIST

 




400 1 /.

 

: , , : , , , , , , , 12- , , , , - . , .

 

 

 


24-32 30-60 .
XT 1

1-3 2 30-60 .
XT 1

5 30-60 . XT
1

 

: 8-12 .

 

 


16-24 30-60 .
XT 1

2 1 30-60 .
XT 1

5 30-60 . XT
1

 

: 8 .

 

 


30-60 . XT

10-40 30-60 .
XT

 

/

 


0

2 .
,
. 24 .
, ,
. .

1

2 . ( 6 .)
,
3-4 .
.
, .
.

2

.
. 10% -
.

3

.
.

2 . 4 . .

4

2 .
. , .
.

 

 


1

.
.

2

.
( ).
4 , 2
2 . .

3

, .
. . .

4

, .
. , .

 

 



<= 10
/:





1.) 10000 .
1, 3, 5


2.) 40000 .
1

Hb > 12 /,
,
Hb < 12 /,
25% .
Hb
12 / -.

 

 



24

XT



-

5 /

1












.




9
1 x 10 /


28




XT






 

,

 


( )


4 / 15 . , 4


: 3200-2400 / 3-4
; 3-5 / / 3 . 3-7
3-4 ;
: 2400-1600 / 3-4


2-4 / 2 . . 4


90 / 2 . . 4

 

 

:

- 1-2 . 2-3 30 ;

- 400-800 (/, /, ) 30 .

:

- 10-15 / .

 

 

(, )
/ /

,

,

,

 

 

- 3
, , - 5% -
, .

- . -
, .


600-800 /., ,

 

 

(
, )

,


 

 



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