RU2228182C2 - Method for treating the cases of prostate cancer - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out testis parenchyma enucleation operation and administering regional chemotherapy. To do it, spermatic cord is selected after the enucleation and catheter is introduced under the tunic for 1.5-2 cm and fixed on the tunic. 400 mg of cyclophosphane is introduced into the catheter. The same operations are carried out on the opposite side. Operation wound is sutured layer-by-layer and the catheters are attached to skin. 400 mg of cyclophosphane are repeatedly introduced into the catheters and the catheters are removed. EFFECT: enhanced effectiveness of metastases treatment; applying high preparation doses with reduced toxic manifestations. 2 dwg

Description

The invention relates to medicine, more specifically to oncology, and can be used in the treatment of patients with malignant tumors of the prostate gland with a significant prevalence of the process as one of the components of therapeutic effects.

A known method for the treatment of prostate cancer of various stages of the prevalence of the process, when one of the stages of treatment, the first, carry out drug "castration". The suppression of testicular function, which is closely interconnected with activity in the body of the prostate gland, is achieved by intramuscular administration of large doses of estrogens (sinestrol, diethylstilbestrol or honvan, diphostilbene, proginol), daily for 1.5-2 months.

When the effect of the first course is achieved, small doses of any estrogen are prescribed throughout life (Clinical Oncourology. Edited by B. Marienbach. - M .: Medicine, 1975).

The proposed and applied method of hormonal therapy and castration leads to the achievement of the latter. However, the side effects of hormone therapy with estrogens - cardiotoxicity, nausea, vomiting, loss of appetite, painful swelling of the mammary glands, edema, are very pronounced.

In most patients, the mammary glands swell, the pigmentation of the breast nipples, the papillary circles, and the perineal skin along the midline increases. The mammary glands and nipples become sharply painful, pigmentation acquires a dark brown color. The listed toxic manifestations of drug therapy serve as an indication of saturation of the body with estrogens and a signal of the need to reduce the dose of the drug or stop taking it. Hormonal castration by estrogens affects the hormonal function of the body, but does not have an antitumor effect on tumor cells. In most cases, primary resistance of the tumor can develop, secondary resistance in which estrogens cease to be effective. In other words, the patient is left without specific antitumor therapy, and negative side effects of estrogen therapy accumulate and intensify.

In addition, the known method is carried out for a long time, 1.5-2 months, which also negatively affects the patient's condition and contributes to the development of the process.

A known method of treating malignant tumors of the genitals, internal female genital organs and mammary gland by introducing BCG and methotrexate vaccines into the lymphatic vessels of the rear foot or hand (Method for the immunotherapy of female genital cancer and breast cancer. Auth. Certificate. No. 1253009, A 61 K 39/00, A 61 B 10/00, 1986).

The described method of treatment allows to achieve significant positive results, expressed in achieving tumor mobility, reducing its size. In the future, the authors of the method, in order to consolidate the effect obtained and prevent possible complications, resorted to combined radiation exposure on the lesion and lymph nodes.

However, the known method for the treatment of malignant tumors has disadvantages that make it difficult to use in the treatment of common forms of prostate cancer. The introduction of an antitumor drug into the lymphatic vessels of the extremities significantly lengthens the path of the drug to the tumor itself, is absorbed along the route, as a result of which only a small part of it affects the tumor, and the concentration of the drug decreases.

The aim of the invention is to increase the effectiveness of treatment, preventing the appearance and reduction of existing metastases in bone structures and lymph nodes, reducing toxic side effects of antitumor chemotherapy.

This goal is achieved by the fact that for patients with prostate cancer during the enucleation testis parenchyma, the left or right spermatic cord is mobilized after the main stage of the operation, a catheter is inserted to a depth of about 2 cm under it, fixed with a catgut thread to the spermatic cord, then 400 mg of cyclophosphamide is introduced into the catheter. Similar manipulations are performed on the opposite side. The surgical wound is sutured in layers, the catheters are additionally fixed to the skin. On the seventh day after surgery, 400 mg of cyclophosphamide is additionally introduced into each catheter, after which the catheters are removed.

The inventive method has significant differences and novelty compared to known methods of treating prostate cancer, as it involves the introduction of antitumor chemotherapy drugs in the immediate vicinity of the tumor location. This allows you to achieve the greatest impact of a specific agent on the tumor cells of the tumor itself, the existing metastases, and to prevent the appearance of new ones.

The proposed "Method for the treatment of prostate cancer" is industrially applicable, it can be reproduced and repeated many times in specialized institutions of oncological or surgical profile.

The method is as follows. After carrying out the necessary clinical and laboratory studies, verification or diagnosis, the necessary general somatic preparation for the patient enucleation of testicular parenchyma is performed. At the end of the main stage of the operation, the right or left spermatic cord are highlighted. A catheter is inserted under the membrane of the spermatic cord to a depth of 1.5-2 cm and fixed to the membrane of the spermatic cord. 400 mg of cyclophosphamide is intraoperatively injected into the catheter; similar manipulations are performed on the opposite side. After the introduction of the chemotherapy drug, the surgical wound is sutured in layers, the catheters brought out to the outside are additionally fixed to the skin. On the 7th day after the operation, 400 mg of cyclophosphamide each is additionally introduced into the catheters, after which the catheters are removed.

An example of a specific implementation of the method can serve as an extract from the medical history.

Patient S., born in 1949, medical history No. 6099 / l. He entered the urology department of the Rostov Research Institute on 05/07/2000. During the examination, a diagnosis was made of prostate cancer T3BN × M1 class 2, metastases in the pelvic bones. Complaints of pain during urination in the perineum, frequent urination.

Blood PSA from 11.04.00 - 80.44 mg / ml.

According to an ultrasound scan dated 04/21/00 - a prostate with a volume of 53 cm ³ is 5.4 × 4.1 × 5.6 cm, rounded in shape, somewhat asymmetric due to the left lobe. The contours are uneven, the structure is heterogeneous, the zones do not differentiate. In the posterior caudal region, more to the left, there is a 5.5 cm ³ hypoechoic focus; at the base of the gland, between the proximal urethra and the electromechanical passages, a node of a heterogeneous structure with a volume of 9.5 cm ³ . Histological examination No. 2966-2978 from 04.24.00 - low-grade adenocarcinoma with diffuse growth of tumor cells in the stroma, growing in the seminal vesicles.

In digital rectal examination: the rectal ampoule is free. Prostate 5 × 6 cm, stony density, rectal mucosa above the prostate is inactive.

According to osteoscintigraphy from 05/03/00, a focus of moderate hyperfixation of the X-ray pharmaceutical in the projection of the right sciatic tubercle, the second and fourth lumbar vertebrae is determined (Fig. 1). When moving and at rest, pain in the lumbar region.

05/19/00, the testicular parenchyma was enucleated, after the main stage of the operation, the left spermatic cord was mobilized, a catheter was inserted under its membrane about 2 cm deep, and fixed with catgut suture to the spermatic cord. 400 mg of cyclophosphamide was introduced into the catheter.

Similar manipulations are performed on the right side. The surgical wound is sutured in layers, the catheters are additionally fixed to the skin.

During the operation, only 800 mg of cyclophosphamide was introduced into the catheters.

May 23, 00, a chemotherapy course was carried out on the patient’s blood. Introduced cyclophosphamide - 1000 mg, adriamycin - 70 mg, platidiam - 150 mg.

05/26/00 400 mg of cyclophosphamide were introduced into the right and left catheters. The patient received only 1,600 mg of cyclophosphamide in catheters. Catheters removed.

The patient tolerated treatment satisfactorily. Adverse reactions and complications were not observed. PSA from 03.11.00 - 0.00 mg / ml.

11/3/00 repeated finger examination. The rectal ampoule is free. Prostate 4 × 4 cm, soft elastic consistency, smooth, painless, median groove flattened. The rectal mucosa above the prostate is mobile.

According to osteoscintigraphy from 02/05/2001, the foci of pathological hyperfixation of the radiopharmaceutical is not determined (figure 2).

The patient was discharged 02.17.01 in satisfactory condition.

10.10.01 at the next examination, the patient is in satisfactory condition. He does not experience difficulty with urination, there are no movements in full, there are no pain in the lumbar region.

To date, the patient is under dispensary observation.

Technical and economic effectiveness of the method lies in the possibility of:

- to introduce into the patient's body an increased amount of an antitumor drug with a simultaneous decrease in the toxic manifestations of the latter;

- to achieve restoration of the integrity of bone structures, the disappearance of metastases;

- to achieve social rehabilitation of patients, improve their quality of life.

Claims (1)

A method of treating prostate cancer, including the operation of enucleation of the testicular parenchyma and regional chemotherapy, characterized in that after the enucleation of the testicular parenchyma, a spermatic cord is secreted, a catheter is inserted under the casing to a depth of 1.5-2 cm and the catgut thread is fixed to the casing of the cord, into the catheter 400 mg of cyclophosphamide are administered; similar measures are performed on the opposite side, the surgical wound is sutured in layers, the catheters are additionally fixed to the skin; on the seventh day, 400 mg of cyclophosphamide is repeated, after which the catheters are removed.

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