今天Cincia馬不停蹄帶著光碟片趕往榮總和長庚放腫科來徵詢第二、第三意見。

【榮總諮詢】

榮總我是諮詢顏上惠主任,同時跟診的有吳元宏醫師。

治療建議:全腦放療(用TomoTherapy螺旋刀),可避開海馬迴,但其實Cincia有幾顆腫瘤的位置就很靠近海馬迴,避開的話以後該區腫瘤再長出來的機率較高,屆時可能就必須用伽瑪刀來處理。

(吳醫師有幫我數了一下,腦部的腫瘤超過30顆了啊~吳醫師還立即打電話去腦神經外科確認有無機會以伽瑪刀來處理,結果當然是辦不到=_=)

執行方式:200cGy*15次=3,000cGY=30Gy(總劑量和台大建議相同,但打法不同)

費用:螺旋刀為自費項目,12萬元/療程

Q:全腦放療真的只能做一次嗎?(這問題雖然Cincia也問過許醫師,不過實在好多版友都留言說只能做一次,讓Cincia太疑惑了,決定再問一次看看)

A:沒有這樣的限制,顏主任說他也有病人做了2次,只是當然對腦部的傷害就會比較大。

【長庚諮詢】

下午立刻轉往林口長庚諮詢,Cincia找的是王俊傑醫師,王醫師為公司主管的弟弟,Cincia先前有電話諮詢過王醫師幾次。

治療建議:全腦放療(用RapidArc銳速刀),也可以避開海馬迴,並且會針對有腫瘤的地方局部進行加強。

執行方式:250cGY*12次=3,000cGY,但局部可能會提高50%劑量加強,總劑量會到4,500cGY。

費用:1,400元/次,總計為16,800元

Q:照射總劑量一樣效果就一樣嗎?

A:當然不一樣。300cGY*10次和200cGY*15次雖然總量都是3,000cGY,但其實300cGY*10次的效果約莫200cGY要做20次,算起來就會是4,000cGY。

至於銳速刀和螺旋刀有什麼差異?當下王醫師有解釋是不同家廠商生產的儀器,螺旋刀先出來,後來有廠商才推出銳速刀抗衡。

不過我想大家心裡一定都跟Cincia有著相同的疑惑,這價格也未免差太多了吧???

剛剛查了一下資訊,看到長庚2009年引進銳速刀的新聞稿-->點我

不過Cincia相信這兩種(螺旋刀&銳速刀)一定是各有優缺點,不然怎麼可能同時被教學醫院所採用的?絕不可能是一方完勝的!

好吧!再多查點資料比較看看~一時也很難決定啊!


看完了長庚,再去竹林觀音寺拜拜求籤:

 0602竹林寺  

耶!疾病"漸安"!接下來的療癒之路應該會愈走愈順吧!突然覺得心裡很平靜~Cincia一定可以度過這次考驗的。

接下來要開始物色假髮了,一頂美麗的假髮絕對是必需品,就算是生病還是要美美的,這樣心情才會好啊!Y^O^Y

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留言列表 (95)

發表留言
  • Lin
  • 加油
  • Cincia會繼續努力的~謝謝鼓勵!

    Cincia 於 2015/06/04 10:13 回覆

  • Kim
  • 加油!
  • 謝謝Kim姊,你比Cincia勇敢啦!
    我很怕變傻拼命想辦法,你就直接衝了~強者!!

    Cincia 於 2015/06/04 10:12 回覆

  • 悄悄話
  • 梁以薰
  • 要繼續保持好心情
    期待妳越來越順利過關
    今天在來帶給妳滿滿的能量

    要加油加油哦!!
  • 謝謝漂亮妹妹,Cincia會繼續加油的。

    Cincia 於 2015/06/04 10:14 回覆

  • angel
  • 給妳打氣
  • Cincia會繼續努力的~謝謝鼓勵!

    Cincia 於 2015/06/04 10:14 回覆

  • ccfax
  • 今天辛苦了, 加油! 加油!
  • Cincia會繼續努力的~謝謝鼓勵!

    Cincia 於 2015/06/04 10:14 回覆

  • 笨狗
  • 加油!
  • 笨狗好久不見阿!尊夫人一切都好吧~
    Cincia會繼續努力的~謝謝鼓勵!

    Cincia 於 2015/06/04 10:15 回覆

  • Ming
  • 加油!...
  • Cincia會繼續努力的~謝謝鼓勵!

    Cincia 於 2015/06/04 10:15 回覆

  • 訪客
  • 妳這麼努力
    又與人為善
    老天當然幫妳
    專業的評估就交給醫師
    妳就放寬心帶著勇氣邁向挑戰吧
    每天都為妳祝福....
  • 謝謝你~我已經準備好了~^^Y
    繼續加油...為了生存而努力!

    Cincia 於 2015/06/04 17:03 回覆

  • wengee
  • 之前家人做全腦放療是在林口長庚,掉髮的狀況是在做完療程的一個禮拜後左右掉髮.買頂漂亮的假髮是很必要的!聽家人說療程中沒有什麼特別的感覺,所以不用擔心疼痛的問題.確定治療後,會依據妳的頭型去做一個模,是幫助定位用的.
    如果求籤的結果是好的,就放心去做吧!
    也希望星後續能找到控制腦部復發的好方法~
    我會跟眾版友一起持續為妳祈求平安的,加油! : )
  • 謝謝你的分享,Cincia也希望腦部腫瘤在放療後可以控制住。
    繼續加油~^^

    Cincia 於 2015/06/07 20:06 回覆

  • 每天
  • 加油! 放寬心吧!

    【一切皆是我們心造作的結果,心即一切】 -佛陀

    祝妳心想事成,圓滿平安~

    每天健康,每天開心,每天多愛自己一點點! ^^
  • Cincia會繼續努力的~謝謝鼓勵!

    Cincia 於 2015/06/04 10:15 回覆

  • 悄悄話
  • CY
  • 加油!籤詩是好兆頭,你一定會有貴人相助
  • 謝謝CY,Cincia會繼續努力的。為了活下去要盡大的努力~

    Cincia 於 2015/06/04 10:18 回覆

  • 悄悄話
  • Susan
  • 大略看了一下網路資訊, 好像真的是一方完勝!銳速刀不但在治療方面幾乎沒有輸於螺旋刀的點,最奇特的是價格也低太多了。照理說, 比較理想的技術應該要更高才是吧?!!
    Anyway, 妳真的很棒! 為你祈禱, 加油!!
  • 我會再去找台大許醫師諮詢看看的,這一定得諮詢專家意見啦!
    Cincia看資料看得霧煞煞~XD
    btw,謝謝你的鼓勵喔!

    Cincia 於 2015/06/04 10:46 回覆

  • Gary YC LIN
  • 如果最後選的是螺旋刀,那不是在台大做即可,不用轉院了???
    (就像Andrew上週幫妳找到的日本網站一樣,螺旋刀可避開海馬迴。)

    螺旋刀跟銳速刀,我爸爸都有做過。
    第一次術後輔助放療,是照螺旋刀,副作用真的比較少。

    我當時也像妳這樣,做功課做了很久。
    但因堂弟剛好是放射師,是負責執行照射的工作人員。
    他建議家父,別省這些錢,因好的設備真的還是有差。

    於是我們選用螺旋刀,事後看來,這決定是對的。
    有病友為了省錢,只用健保的放療,但副作用就一直跟著他,很辛苦。

    後來爸爸頸椎有骨轉移,要用放療打掉。
    這次醫生說,情況比較單純,用銳速刀就夠了。

    說實話,妳腦部的腫瘤這麼多,腦部又是這麼精密的器官,
    要是我,我會選用螺旋刀的。

    記得去年此時,我在台大開刀,妳在歐洲 Happy。
    出國玩的大錢都花了,螺旋刀的錢,妳還是不要省啦!

    趕快台大榮總確定一間,就馬上做,不要拖了。
    從定位到正式做,也還有一段前置時間,得加緊進度才行。

    妳一直不決定,關心妳的人,心就一直懸著,放不下來。
    (沒辦法,Jane的前車之鑑,我一直記得。)

    .
  • Gary兄,謝謝你分享這麼多的資訊給我。
    Cincia該花的錢不會省啦~我超怕自己變笨的,腦袋可能是我唯一的優勢,得想辦法保住阿!
    台大我再找回去諮詢看看~當然最好在台大治療比較方便就是。

    Cincia 於 2015/06/04 10:42 回覆

  • Gary YC LIN
  • 再貼一次日本網站的介紹,不知妳有無仔細讀過? http://www.hokuto7.or.jp/chinese/c-treat/c-medical-2.php 其中有一段話:图2显示

    根据螺旋断层放疗(Tomotherapy)的全颅照射的线量分布图。
    可以均匀地照射到脑脊液腔和靶区的脑组织,
    骨头及皮肤的照射量是很少。
    对于大多数女性来说头发还是很重要的。

    說不定,運氣好的話,假髮就不用買啦! 加油喔~~ ^_^
  • 感謝Gary兄提供的資料,Cincia不擔心頭髮掉啦!再長就有了~^^

    Cincia 於 2015/06/07 19:50 回覆

  • 原點
  • Y.C Lin 你們都好用心,相較之下我就遜多了,相信星西亞有你們這些可愛的戰友,一定很感動。
    星西亞妳說是不是咩。
  • 真的很謝謝原點大哥還有各位戰友、版友的關心,Cincia會繼續努力下去的。^_^

    Cincia 於 2015/06/04 10:47 回覆

  • 訪客
  • Cincia 你一定会战胜病魔!
    每天都為妳祝福....
  • 謝謝你的祝福~Cincia會繼續加油的。

    Cincia 於 2015/06/04 10:49 回覆

  • 流蘇
  • Gary YC LIN 意見→同意+1!
  • 露西
  • 為你祈禱,加油!
    一切都會順利、平安!!
  • 謝謝露西。Cincia會加油的~

    Cincia 於 2015/06/04 13:35 回覆

  • Katie
  • 加油 !!!
  • 謝謝Katie姊~Cincia會努力的!

    Cincia 於 2015/06/04 13:33 回覆

  • Lynn
  • 星真是辛苦了!
    我們一起加油!

    等著相約出遊呢!
  • Lynn姊骨頭螺旋刀也要加油喔!等我們都結束療程再來約出遊~

    Cincia 於 2015/06/04 13:33 回覆

  • 風清揚
  • 星希亞應該快作好決定了,總覺得這些「刀」有如七傷拳,傷己後傷敵,所以要趕快在施作前盡全力加強調養身體,運動,睡眠,食物都充足營養,強化全身修補及免疫能力,好應付接下來的挑戰。只要增強內力,那妳就會與木靈子一樣活到91歲。

    你知道我是不使「刀」的,我是用獨孤九劍。
  • 謝謝風清揚兄的鼓勵,Cincia已經決定好全腦放療了,就還沒有選定醫院而已。
    放心~這次我會跟公司請個長假好好休養的,畢竟身體還是最重要的,沒有健康什麼都只是空談。^^

    Cincia 於 2015/06/05 09:03 回覆

  • MeiTu
  • 抽籤的結果是好的,那麼就快快下定決心囉,一定「刀」到病除的,加油 ^^
  • 會的,已經做好全腦放療的準備了,現在只是要決定醫院而已。

    Cincia 於 2015/06/04 13:32 回覆

  • 小P
  • 請問是跟原先的醫院申請光碟去諮詢其它醫院嗎?
  • 對的,申請影像光碟很快,1hr就可以搞定,我是copy了兩次腦部MRI和兩次胸部CT。

    Cincia 於 2015/06/04 13:31 回覆

  • azucena
  • 勇敢的星希亞,配服妳永不放棄的精神,我只能幫妳加油,癌友們都是命中注定的修行者,他們因為生命巨變,,不得不誠實面對自己,並且腳踏實地去走人生的每一步路,
    疾病是靈魂的一種挑戰,為的是讓生命更加深刻、寬廣,能培養更多慈悲心與同理心,且更能體會他人的苦難,妳的部落格鼓舞與幫助很多人,我相信老天爺一定會厚待妳,妳一定可以過這關
  • 謝謝你的鼓勵,Cincia會繼續加油的。^^

    Cincia 於 2015/06/07 19:04 回覆

  • Jason
  • 顏榮郎博士曾經也是放射科醫生,可以請他提供客觀意見。另外,每家醫院螺旋刀一個療程費用大約介於8萬至15萬間,如果有相同設備,不考慮費用,在原醫院治療較好。
  • 沒錯,廖醫師也是比較希望我在台大治療,Cincia會再去台大諮詢看看的。
    gogogo~為了生存而努力。

    Cincia 於 2015/06/04 18:09 回覆

  • Catherine Chao
  • 美麗、可愛、善良的Cincia,既然已經有了初步的打算,就盡快決定,開始治療吧!祝福你的治療一切順利、平安,能把那些腦部的惱人小點消除殆盡!加油!!
    我也會幫你禱告的,加油!
  • 美麗溫柔的Catherine, 我們要一起加油!等你的新藥來的就可以好好平躺睡覺了,再撐一下下就好了。

    Cincia 於 2015/06/04 11:57 回覆

  • Bill
  • 我每次也都是去林口竹林觀音寺,讓神明加持過,心裡比較安定
    現在加入的戰友會以及follow星西亞的blog,跟拜神明的效果一樣,具有撫慰人心的效用

    祝妳病況順利!

    谷婷說,關關難過關關過
    就算眼前看似無路可走,但堅持信心保持樂觀,總是會在絕望前發現一條會被忽略的小徑,而走進去後卻柳暗花明
  • 謝謝Bill的鼓勵,Cincia會繼續加油的,希望有一天可以和谷婷一樣停止治療,只要追蹤就可以。^__^

    Cincia 於 2015/06/04 11:55 回覆

  • 樂樂
  • 非常認同15樓Gary的說法
    星希亞辛苦了
    當你已盡了全力為自己美麗的生命在奔跑拼鬥
    就相信自己吧
    贏得後面的勝利才是最重要的
    把握先機 速戰速決
    期盼妳的努力與眾多為你祈禱加油的力量
    能讓你"疾病漸安"
    可愛的籤詩的加持
    不要再猶豫了
    許多天使會引領妳走正確的方向的
    加油 秀秀 抱抱
  • 感謝你的關心和鼓勵,Cincia已經做好準備迎接接下來的挑戰了。
    繼續加油~為了生存而戰。

    Cincia 於 2015/06/04 18:07 回覆

  • 逆轉勝
  • 下定決心就去做吧 時間很重要 越早做可爭取越多的時間
    新的療法不斷推出 相信不久後醫學對癌症一定會有重大突破
    我相信妳可以逆轉勝
  • 感謝你的鼓勵,Cincia這週就會決定好了。繼續加油~為生存而努力!!

    Cincia 於 2015/06/04 11:54 回覆

  • cecilia188
  • 星,粉紅可可的假髮價格不高,款式很多,妳可以參考看看。

    絕對沒問題,一定順順利利的!fighing!gogogo*^0^*
  • 謝謝阿姊的推薦,粉紅可可真的很便宜耶!
    不過太便宜不知道品質好不好,周末來挑一頂先買買看。^^

    Cincia 於 2015/06/04 11:53 回覆

  • Mimi792
  • 三十幾顆,真的要快一點決定啊!每個醫院「等待」的時間長短也不同,治療團隊經驗也不一樣,的確傷腦筋,相信妳會做出明確的決定!加油!
  • 謝謝鼓勵,Cincia會加油的。
    這兩天會再回去台大做最後諮詢。^^

    Cincia 於 2015/06/04 11:32 回覆

  • rackeva
  • 加油 美麗版主!
  • 謝謝鼓勵,Cincia會加油的。

    Cincia 於 2015/06/04 11:31 回覆

  • totoma
  • 耶!好籤一枚!有觀音菩薩加持,沒問題的啦!
  • 謝謝totoma,祝你後續的治療一切順利,我們一起努力。

    Cincia 於 2015/06/04 11:31 回覆

  • 二寶爸:
  • 妳OK的!加油!
  • 謝謝二寶爸,我們一起加油~

    Cincia 於 2015/06/04 11:30 回覆

  • Sandy
  • 加油
  • 謝謝Sandy,Cincia會努力的。^_^

    Cincia 於 2015/06/04 11:30 回覆

  • 悄悄話
  • April
  • 加油~祝福cincia一切順利!!
  • 感謝鼓勵~Cincia會繼續加油的。

    Cincia 於 2015/06/04 13:24 回覆

  • Sker Coka
  • 拜託喔,一定要康復~
  • 會的~我會好好的啦!放心^_^

    Cincia 於 2015/06/04 13:23 回覆

  • 橘子
  • 小星,要抓紧时间,如果经济上有困难,我们大家可以帮你。祈福
  • 謝謝橘子的熱心,目前的費用Cincia還負擔的起啦!不用擔心~

    Cincia 於 2015/06/04 13:26 回覆

  • 橘子
  • 我个人经验,戴假发很闷,尤其是夏天。所以上班戴假发,回到家里就戴帽子比较透气。
  • 沒關係,我先買頂來試戴看看。^^

    Cincia 於 2015/06/04 13:26 回覆

  • 悄悄話
  • ayhsieh0206
  • 加油,為妳祈求平安,治療順利!
  • 感謝鼓勵~Cincia會繼續加油的。

    Cincia 於 2015/06/04 13:22 回覆

  • nick
  • 加油!
  • 感謝鼓勵~Cincia會繼續加油的。

    Cincia 於 2015/06/04 13:22 回覆

  • 梁以薰
  • 星西亞早安~
    我今天又來給你加油打氣哦
    記得今天也要微笑的度過一天哦

    加油加油!!
    祝一切順利
  • 謝謝漂亮妹妹今天也來給我鼓勵~
    放心的,Cincia會開心過每一天的。

    Cincia 於 2015/06/04 13:29 回覆

  • Hans:
  • 為勇敢善良的您加油,祈福您順利!!
  • 謝謝你的加油,Cincia會趕快恢復的。

    Cincia 於 2015/06/04 13:27 回覆

  • jw15
  • 個人的經驗(2014 3/19 開始服標靶 3/25 全腦放療 長庚)
    頭髮反應:全部掉光換新 新髪量減少髮質柔軟 掉髮是一搓一搓慢慢掉 還出現膿胞
    由於外科不建議開刀 放射線醫師門診說若有空當天就可以開始座放療
    結果未剪髮 造成日後許多困惱
    記憶:在某些方面感覺有影響 還好不嚴重
    目前還是2G人 只有email
  • 感謝你的分享,頭髮掉光沒關係,以後還會再長出來,Cincia不會擔心啦!^^
    我們一起加油~

    Cincia 於 2015/06/04 13:28 回覆

  • 寶寶
  • 還記得師公說的話, 再加上這個好籤詩, 星西亞要有信心! 加油加油!!
  • 感謝鼓勵~Cincia會繼續加油的。

    Cincia 於 2015/06/04 13:28 回覆

  • 悄悄話
  • zlon
  • 祝你一帆風順,我們狀況差不多希望真的有新藥出現
  • 廖醫師去參加ASCO跟我說新藥很多,所以我們不用擔心,一起努力吧!!

    Cincia 於 2015/06/05 09:00 回覆

  • 悄悄話
  • 悄悄話
  • 悄悄話
  • David
  • 看到妳被迫要做全腦放療 為妳不捨 真的很難過
    全腦放療真的只能做一次
    之後要靠什麼方法阻止腦腫瘤復發 妳有沒有想好?
  • 有的,我也想好下一步了。^^Y

    Cincia 於 2015/06/05 08:54 回覆

  • 茫茫求生的無助者
  • 請問 David
    看到您對星希亞一直以來的建言 覺得您非常熱心 專業建議也很具可行性
    我和好幾位病友都是肺轉骨也轉腦了
    PD1抑制劑和CTLA4抑制劑真的能有幫助嗎?
    大約需要多少花費?我們可以跟誰連絡取得進一步的訊息?
    Novartis藥廠的實驗 真的是對抗腦腫瘤最佳選擇?
    我要如何可以加入實驗?
    除了星希亞外 我們也希望能得到您的協助
    救人一命,勝造七級浮屠
    感恩...
  • David
  • #60 茫茫求生的無助者
    抱歉 讓你久等了
    我有看到你的訊息 正在回答中
    請回 "該做決定的時候到了"
  • David
  • Risks of Adjuvant Whole Brain Radiation Therapy Outweigh Benefits for Patients With Limited Brain Metastases

    A federally funded phase III trial provides additional information regarding a long-standing discussion about the impact of adjuvant whole brain radiation therapy (WBRT) on cognitive function. Patients with 1-3 small brain metastases who received radiosurgery followed by WBRT were more likely to experience cognitive decline than those who received radiosurgery alone. Furthermore, WBRT did not significantly extend patient survival, though it did help control growth of brain metastases.

    Up to 650,000 patients newly diagnosed with cancer in the United States every year will develop brain metastases. At least 200,000 of these patients will receive WBRT at some point in the course of their disease (i.e., as adjuvant, salvage, or end-stage therapy).[1]

    Patients with limited metastases often receive radiosurgery, a type of radiotherapy that aims beams very precisely at the area of the brain tumor. Brain metastases are removed by conventional surgery in only a select minority of patients.

    “We used to offer whole brain radiation early on, but we now know that the toxicities of this therapy are worse for the patient than cancer growth or recurrences in the brain,” said senior study author Jan C. Buckner, MD, a professor of oncology at Mayo Clinic in Rochester, MN. “We expect that practice will shift to reserve the use of whole brain radiation therapy for salvage treatment and end-stage palliative care.”

    In the study, 213 patients were randomly assigned to receive radiosurgery or radiosurgery followed by WBRT. All patients had 1-3 brain small brain metastases (up to 3 cm in width). At three months, more patients experienced cognitive decline in the WBRT group (92%) than in the radiosurgery group (64%).

    Specifically, patients who received WBRT had a greater decline in immediate recall (30% vs. 8%), delayed recall (51% vs. 20%), and verbal communication (19% vs. 2%). The analysis of quality of life data from this study has not yet been completed. The difference in overall survival was not statistically significant between the two treatment groups.

    According to the authors, the findings of this study have broad implications for oncology practice, as brain metastases are a common complication in cancer care. Melanoma and cancers of the lung, breast and colon spread to the brain especially often. Patients with bladder, kidney and gynecologic cancers can also develop brain metastases.

    Dr. Buckner remarked that while adjuvant WBRT continues to be an option for patients with resected (surgically removed) brain metastases, the ongoing NCCTG/Alliance trial comparing WBRT to stereotactic radiosurgery to the surgical cavity in patients with resected brain metastasis will eventually determine which treatment approach is better.

    This study received funding from the National Institutes of Health.

    View the full abstract.

    http://www.asco.org/press-center/advances-treatment-melanoma-oral-cancer-brain-metastases-and-childhood-cancers
  • 林影
  • 勇敢的Cincia ,我相信老天必会为你安排一条很妥当的路途,菩萨会庇佑你。加油
  • 謝謝你,Cincia會努力的,我還要創造存活率的奇蹟呢!!XD

    Cincia 於 2015/06/07 18:47 回覆

  • 加油
  • 看了你的部落格很久了,很佩服你,祝福你,一定可以過關的
  • 謝謝你的鼓勵,Cincia會加油的~

    Cincia 於 2015/06/05 13:58 回覆

  • 阿頓
  • 我最近也面臨要放療的階段,謝謝你努力收集資料樂於分享,嘉惠病友。我們一起努力吧!互相加油!來擊掌~~
  • 阿頓姊,化療+全腦放療應該不會一起做吧!看你的格子寫6/22開始,我也是那天開始放療哩~我們一起加油!擊掌~

    Cincia 於 2015/06/14 17:29 回覆

  • 高妹
  • 加油!
  • 高妹我會的,我們還沒一起出去玩哩!等我唷~

    Cincia 於 2015/06/07 19:04 回覆

  • 重感冒
  • Cincia

    變笨前要先抓好我的手,我怕妳變笨後會抓錯人,我可是會吃醋の⋯哈哈哈⋯(開玩笑的啦)

    人無法練習失去,但可以學會珍惜!
    我始終相信失去的,老天會再補妳的!
    信念才是最強的良藥^^

    啾咪 啾咪 啾咪 啾咪 啾咪
  • Dear, 謝謝你的關心耶!
    收到你給我的書和卡片了,都還沒來的及跟你道謝~
    放心!!我會沒事的啦~也不會有傷口阿!!等我穩定一點還要跟你約吃飯哩!

    Cincia 於 2015/06/05 13:58 回覆

  • 臨恩
  • 千言萬語概括ㄧ句:妳絶對沒有問題的。
  • 謝謝臨恩的鼓勵,Cincia會加油的。

    Cincia 於 2015/06/07 18:47 回覆

  • 重感冒
  • 那天有和觀音娘娘說了
    觀音娘娘ㄧ定會保佑妳的
    下星期在去和觀音娘娘說說話

    我們還有很多餐要吃吃吃吃吃吃⋯
    在妳還沒變笨,我還能走動的時候,快來約會⋯哈哈哈
  • 我不會變笨的啦!你也不會走不動,我們都還可以活很久很久的~^_^

    Cincia 於 2015/06/14 17:27 回覆

  • 重感冒
  • Cincia
    我13日要上台北,要不要來約會呢?
    ㄧ起去看假髮如何?
  • 6/13我要去練習龍舟耶!我們再來約時間好了~私下聊吧!^_^

    Cincia 於 2015/06/07 19:01 回覆

  • cecilia188
  • 我買了好幾頂,品質還可以,就是容易掉髮,所以在梳理時留意些即可,妳再評估看看。總之,妳要好好的治療,心情放輕鬆,一切都會沒問題。我們還要見面吃飯呢!
  • 沒問題的。Cincia會繼續加油的~假髮先買頂來試看看。^^
    等一切治療穩定後我們來約吃飯吧!

    Cincia 於 2015/06/07 19:00 回覆

  • 玫
  • 你一定要加油。看你的po。知道你平安。是我的動力也給了我面對事情勇氣。加油!
  • 謝謝~Cincia會沒事的啦!
    不管你遇到什麼困難,一定可以順利度過的,一起加油!!

    Cincia 於 2015/06/07 18:44 回覆

  • 梁以薰
  • 姐姐我又來看妳嘍
    今天我來的比較晚些
    繼續給妳支持繼續給妳打氣

    加油!
  • 漂亮小妹,謝謝你的鼓勵唷!^^

    Cincia 於 2015/06/07 18:43 回覆

  • 悄悄話
  • Helen Mac
  • 有“疾病漸安”保佑的星西亞,一切都沒問題的啦。越來越順心如意是一定的。
  • 謝謝Helen, Cincia會加油的。

    Cincia 於 2015/06/10 08:49 回覆

  • David
  • Blood-Brain Barrier Opened For The First Time In Human Patients In Cancer Breakthrough

    Oct 22, 2014 06:34 PM

    Two of the most aggressive forms of neurological illness, Alzheimer’s disease and brain cancer, may see tougher fights now that scientists have opened up the blood-brain barrier in humans for the first time.

    The surgery is already being hailed as a breakthrough. Considered the “front frontier” in neuroscience, the blood-brain barrier is the sheath of cells that separates the organ from the rest of the body. While it stops harmful toxins in the blood from hijacking vital tissues, it also prevents helpful drugs from rooting out tumors and disease. But now scientists say all that could change.

    Four patients made up the focus of the study, carried out by neuroscientist Michael Canney and his colleagues at the Paris-based medical start-up CarThera. Each patient was getting treated for glioblastoma, the most aggressive type of brain tumor. Normally, patients with this type of cancer undergo surgery to have the tumor removed, then chemotherapy to remove any remaining cancer cell traces. But this method is imperfect, since it relies on a closed barrier.

    Under normal circumstances, the blood-brain barrier lets through virtually no drugs into the brain — the ideal target, because that’s where the cancer lives. If more of the chemotherapy drugs could get through, they’d do a better job of killing cancer, Canney says. So he and his team set to exploring that possibility.

    Using a hole in the patients’ skulls, which measured no more than 10 millimeters by four millimeters and had already been used for eliminating brain tumors, doctors inserted a tiny ultrasound brain implant. They also injected a supply of microbubbles. When the pulses emitted by the ultrasound hits the bubbles, it causes them to vibrate. This in turn pries open the cells of the blood-brain barrier.

    Canney estimates the tandem approach helps keep the barrier open for up to six hours, during which time they can supply the patient’s brain with far greater drug dosages than when it was closed. A follow-up MRI scan showed a marker chemical that was injected along with the bubbles (as a way to track permeability), was smoothly crossing the blood-brain barrier.

    "We hope this means the chemotherapy drug is doing the same thing," said Canney, who presented the team’s observations recently at the Focused Ultrasound symposium in Bethesda, Md. It will still be several months before the researchers can test the method on tumors, Canney concedes.

    In the meantime, they’ll continue looking at the interaction between Alzheimer’s disease and amyloid protein plaques. The leading theory in Alzheimer’s research suggests that an overabundance of misfolded proteins disrupts neural connections. When these neurons can’t talk to one another, normal processes like memory lose their function. Canney suspects that merely opening up the barrier, even without introducing drugs, liberates the immune system to fight back.

    “We think we will have a significant effect on these tumors,” Canney said.

    Source: http://www.medicaldaily.com/blood-brain-barrier-opened-first-time-human-patients-cancer-breakthrough-307737
  • David
  • Breaking through the barrier

    Getting drug molecules into the brain means crossing the defensive blood-brain barrier. Anthony King investigates how chemists are infiltrating the brain's fortress

    Ordinary activities like exercising or eating can alter our blood composition fairly dramatically. Blood potassium may increase, for example, and there can be significant shifts in its lipid and amino acid content. Metabolites toxic to nerve cells can even enter the bloodstream.

    The blood-brain barrier, thankfully, blocks flotsam or jetsam in our blood from traversing into our brains. This is crucial because neuron signalling in the brain relies on electrical signals and fine chemical signals, which require a precisely regulated microenvironment, and this can be easily disturbed by molecules coming in from the blood.

    'You don't want your communication centre disrupted by things that may be happening in the stomach, gut or other area of the body. You want to have it stable and working perfectly whether you are sleeping or being chased by a tiger,' Lester Drewes of the University of Minnesota in Duluth, US, explains. The blood-brain barrier, or BBB, consists of the endothelial cells lining the blood vessels in the brain. These fortress cells are glued together very tightly and, in contrast to other organs and tissues, there are no chinks between them for blood-borne materials to leak into brain tissue.

    This defence is a real headache for treating brain tumours and other neurological conditions. Drugs, treated as foreign molecules by the BBB, are unable to pass. In fact, over 95 per cent of drugs do not show useful activity in the brain and many show poor penetration of the BBB. A high proportion of large molecule drugs do not cross, which encompasses all the products of biotechnology: recombinant proteins, monoclonal antibodies and RNA interference drugs.

    William Pardridge, director of the Blood-Brain Barrier Research Laboratory at the University of California Los Angeles, US, believes the drug development mission for Alzheimer's disease and other brain disorders has suffered by focusing on central nervous system drug discovery while a blind eye was turned to drug delivery. He says that no large pharmaceutical company in the world today has a BBB drug-targeting programme.

    Slippery customers

    An early strategy for crossing the barrier was to make drugs more lipid soluble; this allowed them to penetrate the lipid-loving endothelial cells in the brain. Most drugs of abuse, such as alcohol, cocaine and heroin, are lipophilic. But there is a downside: 'If you make something lipophilic, it'll penetrate every organ and cell in the body and so you must use large amounts. If it can have a bad side-effect on another organ or tissue, it will occur,' says Drewes.

    Some small drugs - such as L-DOPA used to treat Parkinson's - can be ferried in on natural 'nutrient transport systems', but this approach has complications in finding the right dosing regime, as patients' transporters have differing efficiencies. Also, although lipid-soluble drugs may get into the brain endothelial cell membrane, they may get thrown out just as quickly by efflux transporters.

    'The biology is really against drug delivery to the brain, so clever strategies are needed,' says Joan Abbott, a neuroscientist at King's College London, UK. 'In the past, big drug companies had simplified things by sticking to small molecules which had the right chemistry and avoided the efflux transporters.' One important recent insight is that increased lipid-solubility is not necessarily better; for most drugs it is the 'free unbound' concentration in the brain that is important, whereas lipophilic drugs tend to stick to other structures inside the brain, including lipid membranes. 'Company drug chemists are now taking this on board,' Abbott adds.

    However, these days companies realise they need much more intelligent drugs to make them more specific with fewer side effects. 'That's why they are trying to explore novel chemistries, novel delivery vehicles and even techniques for briefly opening the BBB then closing it again after a drug has entered,' says Abbott.

    Temporary portals

    Tumours that begin in the brain are among the most aggressive and lethal cancers, yet treatment options are limited by the BBB. Last summer, researchers in Taiwan reported successfully disrupting the barrier using focused ultrasound (see Chemistry World, September 2010, p24). Led by Kuo-Chen Wei of Chang Gung University, the group injected magnetic nanoparticles, coated with a chemotherapy drug, into rats. They used ultrasound to open up a small area of the BBB and a magnetic field to guide the particles to a precise location in the brain.1

    Ultrasound could also help in conditions such as Alzheimer's and Parkinson's, says Kullervo Hynynen from the University of Toronto Medical School, Canada who has done similar work with ultrasound and microbubbles. The exact physical and biological mechanism of ultrasound is not known, he points out. 'We know that bubbles are expanding and contracting with the ultrasound wave, and some fast microscopy experiments have shown that the small blood vessels - at least in vitro - expand and contract with the bubble. Therefore the endothelial cells are stretched.'

    Electron microscopy has supported this idea of physical stretching of the barrier cells, though some active vacuole transport across endothelial cells is also induced, notes Hynynen. The potential risk of any BBB disruption methods is that you let your guard down. Molecules will enter the brain during disruption, but this risk is small as only a defined area of the brain is exposed. The difficulties with ultrasound relate to the lack of knowledge about the mechanism by which it works, along with factors relating to safety, efficacy and timescale (such as how long the barrier is open).

    Another disruptive approach is to inject a hyperosmotic solution (one which has a higher solute concentration than the surrounding cells) into the carotid arteries to open the BBB for a time. This method has been championed by Edward Neuwelt of Oregon Health and Science University in Portland, US, for some years now. 'The fluid flowing through the blood vessels is hyperosmotic and so draws water out of the endothelial cells, causing them to shrink', explains Drewes. 'This pulls apart the tight junctions, forming gaps and spaces. If you administer an antitumour drug to the blood stream, it can diffuse into the brain and into the tumour.' The cells gradually swell back to their usual size, so the effect is transient.

    While cancers that develop in the brain are relatively rare; 10 times as many people develop brain tumours from cancers that begin elsewhere in the body. The BBB stymies modern cancer therapies that work elsewhere in the body. US researchers recently gave the field a lift, however, using erectile dysfunction drugs. Julia Ljubimova of Cedars-Sinai Medical Centre in Los Angeles and her colleagues found that Viagra (sildenafil) and

    Levitra (vardenafil), which inhibit an enzyme called phosphodiesterase 5 (PDE5), increased the permeability of the blood-brain barrier. Using a mouse model, they showed that these drugs can increase the amount of Herceptin, a large monoclonal antibody used to treat lung and breast cancers, crossing the BBB and increase its anti-tumour effect in the brain.2

    Piggy-backing on the BBB

    Beverly Davidson, a neurologist at the University of Iowa, US, has been seeking a therapy for children who suffer from lysosomal storage disease, caused by the absence of a particular brain enzyme . 'We know we can't simply deliver the enzyme into the blood and have it access the brain, so we try to devise methods to overcome this problem,' she explains. Her group took barrier endothelial cells and engineered them to produce the missing enzyme and secrete it into the brain itself.3 'Essentially we're turning the BBB into our friend as opposed to our enemy.'

    The recombinant DNA that produces the enzyme was delivered into the endothelial cells using a viral vector that the researchers had modified to home in on the diseased brain endothelia. Davidson hopes that the new genetic material will remain in the endothelia for many years. 'We have no evidence that these cells are dividing at all, at least in rodents,' she explains, so a single round of gene therapy could last for decades. The treatment reconstituted enzyme activity throughout the brain of a mouse model; the next step is to move to a large animal model of the disease.

    Canadian company AngioChem has developed a different way to sneak therapies across the barrier - by harnessing its own transport receptors. These receptors, like the lipoprotein receptor related protein (LRP-1), normally allow essential substances like glucose, insulin and growth hormones to enter the brain. 'They are seeing what appears to be the first success on delivering something that will attack a tumour,' says Drewes. 'There is some excitement about that and they are trying to develop it into a more general drug delivery system.'

    Delivery vehicles and Trojan horses

    Another area of real growth is in artificial constructs, or engineered delivery vehicles, says Abbott: 'Over the next 10 years I'm expecting lots of those.' Nanoparticles and various polymers can be engineered to have the right features to bind drugs but also to recognise receptors on the brain endothelial cells so they get taken across the barrier. One advantage of polymers is you can tune them chemically, notes Martin Garnett of the Children's Brain Tumour Research Centre at the University of Nottingham, UK, who has begun some work on polymer nanoparticles.

    Ljubimova believes that nanomedicine will bring about a major leap forward for cancer treatment and improve the quality of life for patients by reducing the toxicity of treatments. 'There are lots of things in clinical trials, predicting big gains "in five to ten years time",' she says. However, Abbott offers a word of caution concerning such drug vehicles. 'The difficulty is the same as with transporters in the BBB. Calculating how much of a drug gets into the brain via delivery vehicles is quite hard. Most of the evidence suggests the amount reaching the right target is quite small, so you have to go for really active agents.'

    A Trojan horse method, which links therapeutic agents to molecules that normally transit the barrier, is championed by Pardridge. He has re-engineered glial-derived neurotrophic factor (GDNF) as a molecular Trojan horse. GDNF is a potent neurotrophin that can revive damaged nerves in animal models of Parkinson's disease; it's also a potential therapy for stroke and drug addiction, but it does not cross the BBB.

    Using implanted drug reservoirs and ventricular catheters - both invasive procedures - researchers discovered that the GDNF they delivered was biologically active but lacked clinical efficacy. The problem was distribution; very precise location of catheters was needed, and this was not achieved in all clinical trials. Pardridge's Trojan is a monoclonal antibody against the human insulin receptor, which can deliver GDNF across the BBB.4 In trials with Rhesus monkeys, he has seen no adverse events associated with administration of large doses of the antibody-GDNF fusion protein.

    Breaking out of the lab

    Abbott suggests that one reason progress on BBB drug delivery has been slow is a lack of funding and interest from industry. She explains that big pharma has largely withdrawn from aspects of brain chemistry and drug delivery because they've put a lot of money into programmes that have turned out not to be productive. They are now more cautious, more pessimistic, or are focusing on areas with greater chances of success. Some companies may even feel they are not competent to pursue brain targets where the BBB is a challenge. Its complex chemistry makes predictability more difficult.

    There are positive signs, though. In vitro cell culture models of the barrier - needed for drug permeability assays - have been improved over the last few years. Imaging techniques like positron emission tomography (PET) and magnetic resonance imaging (MRI) help show what the BBB is doing and which drugs get to the right targets in sufficient concentration.

    This is critical, as researchers have come to realise that the barrier is not a static defensive structure. It's an active, regulated and regulatory interface; it is altered at and around the site of injury after a stroke, for example. According to Neuwelt, brain tumours, epilepsy, Alzheimer's disease and Parkinson's disease are all associated with 'perturbations in the normal BBB that contribute to their pathology.'5

    Information on the status of the barrier in a particular patient may be necessary to devise and refine appropriate therapies. Increasingly in, for example, post-traumatic stress injuries, it is being recognised that you need to know what the barrier is doing to adjust your treatment, says Abbott. You may need to adjust treatment over a period of months or weeks.

    Garnett says pharmaceutical companies have, up until now, concentrated on small drug molecules rather than drug delivery systems, but he believes that this is now changing. Moreover, there is an active research community within universities and research institutes looking at ultrasound, Trojan fusion proteins, polymer constructs and other means of surmounting the barrier and getting therapy to where it is needed.

    Abbott concludes with an upbeat assessment on the BBB and efforts to get therapies across it: 'There's been lots of progress in the last five years. We see all sorts of things that are now possible - so in terms of basic understanding, I think things are looking really good. But it is probably true to say that much of the innovation is coming from small companies; some of these are partnering with or have been taken over by bigger companies. Traditional big pharma is still rather cautious in trying new ways of getting things into the brain, although this is changing.'

    Anthony King is a freelance science writer based in Dublin, Ireland

    Source: http://www.rsc.org/chemistryworld/Issues/2011/June/BreakingThroughTheBarrier.asp
  • 訪客
  • 美女,這籤詩挺有趣的。

    趙子龍救阿斗,子龍是妳還是阿斗是妳。都是很棒的人物。
  • 如果我是阿斗的話那廖醫師就是趙子龍了,哈哈~

    Cincia 於 2015/06/07 18:36 回覆

  • 悄悄話
  • 悄悄話
  • 悄悄話
  • 悄悄話
  • home10250
  • 一定能平安健康的,加油喔!
    謝謝妳之前火速的郵寄兩罐苦樟芝給我,媽媽的肺部腫瘤已經切除,正式物理報告是非小細胞癌第二期,目前術後第五天已出院療養。
    希望大家都一起健康,平安:)
  • 希望令堂可以穩定控制,一起加油喔!

    Cincia 於 2015/06/09 10:12 回覆

  • 悄悄話
  • 三三阿姨
  • 好想幫妳挑假髮喔~~我最近對假髮很有研究唷!!!(用手機app研究XD)

    加油!!Fighting!!!

  • 我買便宜的假髮而已耶!價差有夠大的啦~
    不打算花大錢買這種東西~

    Cincia 於 2015/06/08 17:36 回覆

  • 珠兒
  • 大家一起為妳祈福!這麼勇敢又樂觀的妳!一定會度過難關的!加油!
  • 謝謝珠兒的鼓勵,Cincia會加油的。

    Cincia 於 2015/06/10 08:45 回覆

  • 每天
  • 文章分享:
    在發現罹癌後,她甩掉一切去看世界7大奇景
    http://www.teepr.com/248614/

    Cincia 也豪不遜色喔!
    相信妳能完成所有的願望清單!

    每天健康,每天開心,每天多愛自己一點點! ^^
  • 哈哈!我也希望有朝一日可以完成我的心願清單所有項目,但數量真的不少(怎麼這個病人還這麼貪心),就一項一項實現它。

    Cincia 於 2015/06/12 08:34 回覆

  • 想想
  • 得了重病,到底要如何才能驚險過關?
    俗話說:斬草不除根,春風吹又生。醫生負責斬草,一支草都不能漏,沒得商量(當然神醫難尋,得靠ㄧ點運氣)。病人負責除根,少許根都不能留,沒得討價還價(100%,就算拔除99.999999%都不被允許)。兵貴神速,第一擊見效且用最短時間完成任務,兩種搭配天衣無縫,恭喜這位病人,他已成功在望!

    病人又將如何除根?
    病人必須找出病因進行避險為首要任務!接著病人必須就保本部份,進行兩項重要任務,第一項要保持暢通,提高血液循環的流量,第二項要增加血液免疫細胞的濃度。我不能說這樣做會帶來任何驚喜!但是如果病人膽敢讓患處血液循環不良、膽敢讓血液免疫細胞濃度不足,後果絕對會讓病人很驚訝!如此反推,會讓這兩項更具有說服力,也凸顯其重要度。

    第一項要保持暢通,提高血液循環的流量(運動也可以達到這樣的効果,對受輕傷的人或許已足夠,但是對受重傷的人而言顯然不足,針對患處或是不能運動的患者,使用原始點或溫敷或熱薑湯是很好的工具,必要也有其迫切性)。對於血液循環不良是萬病之源,我倒是十分認同張釗漢。

    第二項要增加血液免疫細胞的濃度,重點就是丟掉包袱、保持平衡,讓身體徹底休生養息!到底有沒有一個方程式,可以套用在不同人身上。老實說每個人情況差異很大、變數很多,任何決策都帶有風險,不可能十全十美。所以每一個人都必須要為自己找到一個適合自己的方程式,掌握原則(避開風險!保持暢通!丟掉包袱、保持平衡!),只要是正確的路就堅持走下去,不要搖擺、不必想太多!

    丟掉包袱、保持平衡,有些人聽他人說:這個(運動)好、那個(營養食品)好,就拼命加碼!他們忘了,任何人事物,少則不行,但過頭更是要命(會嚴重虛耗身體寶貴的能量,當能量耗盡也代表一個生命即將結束)。重症病人誰先同時完成以上3項任務,誰就更靠近成功,個人感想!
  • 感謝分享,cincia要再來重新檢視自己的每日作息,希望可以做到除根的動作啊!^_^

    Cincia 於 2015/06/12 08:36 回覆

  • 訪客
  • 今天因為查肺癌資料無意間來到了你的部落格,看過一篇又一篇你的心路歷程,樂觀又正面的你一定可以戰勝病魔,擁有更美好的明天!
    真心誠意給你勇氣! 加油!!
  • 謝謝你的打氣,Cincia會繼續加油的!
    也祝福你一切平安順利。

    Cincia 於 2015/06/12 08:38 回覆

  • jc
  • 親愛的星希亞
    妳真的很棒很勇敢。謝謝妳的部落格,帶給我們這些驚慌失措的病患和家屬正面的力量。我們也是在台大腫瘤部接受診療。誠心祈禱治療順利。
  • 謝謝你的鼓勵,我們一起努力喔!^_^

    Cincia 於 2015/06/12 08:38 回覆

  • 流浪的人兒
  • 有問過質子重離子治療嗎?
    台灣長庚有機器,德國跟日本還有美國也都有,目前我看到的病人只要符合治療條件的癒後都還不錯。如果你未曾聽過可以上網蒐集一下資料,需要幫忙也能說一下。
  • 質子我去長庚諮詢時有問過,不適合我的狀況,謝謝喔!^_^

    Cincia 於 2015/07/19 08:35 回覆

  • Johnny
  • 加油喔, 也只能加油了
  • 謝謝!cincia會加油的。^_^

    Cincia 於 2015/07/12 07:11 回覆

  • 悄悄話