RU2255738C2 - Method for cancer treatment - Google Patents

Abstract

FIELD: medicine, oncology.

SUBSTANCE: method involves surgery treatment and chemotherapy. In preoperative period 150 ml of blood is taken off in patients, blood is centrifuged for separating for plasma and formed elements. Standard dose of cytostatic agent is separated and placed into the first flask with 20-40 ml of autoplasma and remained plasma part and formed elements are placed into the second flask. Flasks are incubated separately for 40 min at 37°C followed by carrying out a procedure when blood incubated with the chemopreparation from the second flask is administrated by intravenous route by drops. After removing tumor its bed in infiltrated with autoplasma incubated with the chemopreparation from the first flask or autoplasma with the chemopreparation are added in blood vessels in zone of regional blood supply of tumor. Method provides reducing frequency of topical relapses and alienated metastasis after surgery treatment of solid tumors and shows low toxicity. Invention can be used in the complex cancer treatment, in particular, regionally distributed cancer in large intestine and mammary glands.

EFFECT: enhanced effectiveness of treatment.

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Description

The invention relates to medicine, namely to Oncology, and can be used in the complex treatment of cancer, with the prophylactic prevention of the occurrence of relapses and metastases of cancer, in particular locally advanced colon cancer and breast cancer T1-2N0-1M0.

There is a high incidence of relapses and distant metastases after applying the main surgical method for the treatment of malignant solid tumors (see Sneshko LI. Prevention of relapse and metastases of colon cancer. - L., 1976, 176 p.). During surgery for malignant neoplasms, an inevitable trauma to the tumor occurs, which leads to the scattering of the tumor cells through the blood, lymphatic paths, the number of tumor cells in the regional veins of the tumor zone and in the general circle of circulation increases significantly. A decrease in the body's overall resistance caused by surgery, organ damage during surgery lead to increased processes of metastasis and relapse.

. Эффективность лечения - в выраженной регрессии опухоли, снижении осложнений предоперационного лечения. Отмечен симптоматический эффект: уменьшение болевого синдрома, патологических выделений, функциональных расстройств.The well-known “Method for the treatment of colorectal cancer” (see the book. Sidorenko Yu.S. Autohemochemotherapy, publishing house of Russian State Medical University, Rostov-on-Don, 2002. P.178-187) by autohemochemotherapy. The method consists in the preoperative administration of antitumor chemotherapy drugs in standard doses on autologous blood 2 times a week with an interval of 2-3 days for two weeks - 4 autohemochemotherapy procedures per treatment course. The treatment is carried out in combination with local microwave hyperthermia with a YAHT device with a frequency of 915 MHz at t ° 41-42 °

. The effectiveness of treatment is in pronounced regression of the tumor, reducing the complications of preoperative treatment. A symptomatic effect was noted: a decrease in pain, pathological secretions, and functional disorders.

However, the above method of preoperative treatment does not affect recurrence and metastasis. The effect of treatment is only in preparing the patient for surgery.

The well-known “Method of neoadjuvant autohemochemotherapy in the treatment of patients with locally advanced breast cancer (see Semiletkin OM, Autohemochemotherapy in the complex treatment of locally advanced breast cancer: Abstract of thesis ... candidate of medical science. Rostov-n / D , 1999). Patients with locally advanced breast cancer were treated with neoadjuvant autohemochemotherapy with standard antitumor drugs, which were 1.75 and 2 times higher than the total exchange rates of cytastatic drugs.

The autohemochemotherapy is more effective than systemic intensive chemotherapy; tumor regression in a shorter time, myelosuppressive effect is less pronounced, leukopenia did not require special medication, immediate treatment results are improved; pain syndrome decreases, edema and hyperemia decrease.

Thus, the immediate results of treatment have improved. However, the duration of the relapse-free period for 1 year is insignificant, and information about metastasis is not traced and not presented.

The well-known “Method for the prevention of relapses and metastases” (see Sneshko LI. Prevention of relapses and metastases of colon cancer. - L., 1976. 176 p.), We have chosen as a prototype. The method consists in the fact that for the purpose of suboperative chemoprophylaxis of metastasis, 750-1000 mg of 5-fluorouracil is injected into the liver into one of the veins of the portal system, most often into the vein of the greater omentum, after laparotomy, before examination of the colon tumor. Over 5 years of observation of the results of this method of treatment, liver metastases occurred in 5.3% of patients compared with 11.5% of those treated by surgery. After radical surgery for colon cancer, relapses are diagnosed in 12.5% of patients, including in 41% of cases a combination of local recurrence with distant metastases is observed (in 39.5% - dissemination in the abdominal organs and in 25.6% - solitary metastases in the liver).

The aim of the invention is to reduce the incidence of local relapses and distant metastases after surgical treatment of malignant solid tumors.

This goal is achieved by the fact that in the preoperative period they take 150 ml of blood from patients, the method of centrifugation separates blood into plasma and formed elements, 20-40 ml of autoplasma and 250 mg of 5-fluorouracil are placed in the first bottle, and the rest of the plasma in the second bottle blood cells and 1000 mg of 5-fluorouracil; separate incubated vials for 40 minutes at 37 ° C. Then the operation is performed, during the operation, the incubated blood with a chemotherapy from the second bottle is injected dropwise; after removal of the tumor, the bed of the breast tumor or the retroperitoneal tissue on the localization side of the colon tumor is infiltrated with an incubated autoplasma with a chemopreparation from the first vial or the autoplasma with a chemopreparation is introduced into the blood vessels of the region's regional blood supply to the tumor.

The invention “A method of treating cancer" is new, as it is unknown in the field of medicine in the surgical and chemotherapeutic treatment of malignant tumors, preventing the occurrence of local relapses and distant metastases.

The novelty of the invention lies in the fact that in the preoperative period they take 150 ml of blood from patients, the blood is separated by centrifugation into plasma and formed elements, 20-40 ml of autoplasma and 250 mg of 5-fluorouracil are placed in the first bottle, and the rest of the plasma in the second bottle blood cells and 1000 mg of 5-fluorouracil; separate incubated vials for 40 minutes at 37 ° C. Then the operation is performed, during the operation, the incubated blood with a chemotherapy from the second bottle is injected dropwise; after removal of the tumor, the bed of the breast tumor or the retroperitoneal tissue on the localization side of the colon tumor is infiltrated with an incubated autoplasma with a chemopreparation from the first vial or the autoplasma with a chemopreparation is introduced into the blood vessels of the region's regional blood supply to the tumor.

Thus, intraoperative chemotherapy, intravenous and, directly, in the bed of a removed tumor on autologous media, helps to prevent the occurrence of relapses and metastases in solid malignant tumors.

The invention “A method of treating cancer" is industrially applicable, as it can be used in healthcare, medical oncology facilities, dispensaries, and cancer research institutes.

Case Studies

Example 1

Patient Nedodaeva Valentina Ivanovna, born in 1939, medical history 4655 / r, was admitted to the Department of General Oncology, RNII on 03.03.01.

From the anamnesis: I discovered a tumor in the right mammary gland in February 2001, went to the doctor at my place of residence and was sent to the RNII with the diagnosis “Tumor of the right breast” During the examination in the clinic RNII performed a puncture of a tumor of the right breast. Cytological analysis dated 24.03.01 No. 6469-70: solid carcinoma (moderately differentiated). With a diagnosis of cancer of the right breast, stage 1, clinical group 2, the patient was hospitalized in the Department of General Oncology.

On admission: in the lower inner quadrant of the right breast, the tumor is dense, without clear boundaries, up to 2 cm in diameter. Regional lymph nodes are not enlarged.

04/02/01 an operation was performed - radical resection of the right mammary gland (axillary lymphadenectomy, made from a separate incision along the edge of the pectoralis major muscle). Intraoperatively intravenous drip on autologous blood was administered 5-fluorouracil 1000 mg; after removal of a breast tumor in its bed, 250 mg of autoplasma 5-fluorouracil 250 mg and cyclophosphamide 100 mg were injected into its bed. Postoperative histological analysis 686364: mucous cancer; 686672-79: there is no cancer metastasis in the lymph nodes. Postoperative diagnosis: Cancer of the right breast, T1N0M0, stage 1, clinical group 2.

The postoperative period was uneventful, without complications. The level of leukocytes, peripheral blood lymphocytes did not decrease; deviations in the biochemical analysis of blood, the general analysis of urine was not. Sutures were removed on day 12.

From April 14, 01 to May 6, 01 a distance gamma-therapy course was carried out on the Agat R apparatus for the entire remaining right mammary gland, axillary, supraclavicular, parasternal fields of 2 Gy daily, 5 fractions per week (20 fractions in total). The total focal dose was 40 Gy.

The patient was discharged 06.05.01 in satisfactory condition.

When appearances at the RNII within 2 years after treatment, data for relapse and metastases were not found. The patient's condition is satisfactory, the cosmetic effect is rated as excellent.

Example 2

Patient Shchekaturina Margarita Gennadyevna, born in 1938, medical history 8279 / r, was admitted to the Department of General Oncology, RNII on 05.21.01 with a diagnosis of “Sigmoid colon tumor, stage 3, clinical group 2”.

Upon admission, she complained of constipation, pain in the lower abdomen, periodically blood in the feces. Sick for 3 months. I went to the doctor at the place of residence, sent to the RNII.

When fibrocolonoscopy in the clinic RNII found a tumor of the sigmoid colon. The patient was hospitalized in the Department of General Oncology.

After preoperative preparation 05/29/01, an operation was performed - resection of the sigmoid colon. 5 mg of fluorouracil 750 mg was administered intraoperatively intravenously on autologous blood, 5 mg of fluorouracil 250 mg and metatrexate 10 mg were introduced regionally into the sigmoid artery and vein per 40 ml of autoplasma. Postoperative histological analysis 694216-19 - moderately differentiated adenocarcinoma with invasion of the deep muscle layers, cancer metastases in the lymph nodes of the mesentery of the sigmoid colon. Postoperative diagnosis: Sigmoid colon cancer, T2N1M0, stage 3, clinical group 2.

The postoperative period was uneventful, without complications. The level of leukocytes, peripheral blood lymphocytes did not decrease; deviations in the biochemical analysis of blood, the general analysis of urine was not. Sutures were removed on the 10th day.

The patient was discharged 06.16.01 in satisfactory condition.

When appearances at the RNII within 2 years after treatment, data for relapse and metastases were not found. The patient's condition is satisfactory.

Example 3

Patient Makotchenko Natalya Alexandrovna, born in 1958, medical history 7187 / r, was admitted to the Department of General Oncology, RNII on 05.21.01 with a diagnosis of Rectum tumor, stage 3, clinical group 2.

Upon admission, she complained of pain in the sacrum, rectum, pain during bowel movements, an admixture of blood, mucus in the feces, increased urination, decreased appetite, weakness, and dizziness. Sick for 6 months. I went to the doctor at the place of residence, sent to the RNII.

When fibrocolonoscopy in the clinic RNII found a tumor of the lower ampulla of the rectum. The patient was hospitalized in the Department of General Oncology.

After preoperative preparation 05/28/01. the operation was performed - abdominal-perineal extirpation of the rectum with the formation of a single-barrel sigmoid. 5 mg of fluorouracil 750 mg and 50 mg of leucovorin were introduced intraoperatively intravenously on autologous blood, 5 mg of fluorouracil 250 mg and 10 mg metatrexate were introduced into pararectal fiber per 40 ml of autoplasma. Postoperative histological analysis 693988-90 - moderately differentiated adenocarcinoma with invasion of the entire thickness of the intestinal wall, in pararectal lymph nodes - cancer metastases. Postoperative diagnosis: Colorectal cancer, T3N1M0, stage 3, clinical group 3.

The postoperative period was uneventful, without complications. The level of leukocytes, peripheral blood lymphocytes did not decrease; deviations in the biochemical analysis of blood, the general analysis of urine was not. Sutures were removed on the 10th day.

The patient was discharged 06/20/01 in satisfactory condition.

When appearances at the RNII within 2 years after treatment, data for relapse and metastases were not found. The patient's condition is satisfactory.

The proposed method treated 25 patients with locally advanced colon cancer and 20 patients with breast cancer T12N01M0. The use of intraoperative chemotherapy on autologous media of the body does not cause changes in the general biochemical analysis of blood, improves the general condition of patients, is characterized by low toxicity, and does not interfere with the processes of postoperative healing wounds. Patients were monitored in the range from 6 months to 2 years. During the observation period, not a single case of local recurrence or distant metastasis was detected.

The technical and economic effectiveness of the “Method of cancer treatment” is that the use of the method allows to reduce the incidence of local relapses and distant metastases, the method is low toxic, does not increase the incidence of postoperative complications, and is simple to implement. The method allows for complex treatment in a short time, parallel to surgery, reduces the length of the patient’s stay in the hospital and the cost of treating relapse and metastases of malignant tumors.

Claims (1)

A method of treating cancer, including surgical treatment and chemotherapy, characterized in that 150 ml of blood is taken from patients in the preoperative period, the blood is separated by centrifugation into plasma and shaped elements, the standard dose of cytostatic is divided and placed in the first vial with 20-40 ml of autoplasma and in the second vial with the remaining plasma and blood cells, the vials are separately incubated for 40 min at 37 ° C, then an operation is performed, during which the incubated blood is injected dropwise with chemoprepa atom from the second vial, and after removal of the tumor infiltrate its bed autoplasma incubated with chemotherapy or from the first vial autoplasma with chemotherapy is administered into blood vessels of the tumor area regional perfusion.