RU2301088C2 - Method for treating mammary gland carcinoma relapse cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying alternating sinusoid magnetic field for 8 days in interrupted mode with sending and pause duration equal to 2 s, inductance of 60 mTesla units and frequency of 50 Hz during 5-10 min. Antitumor chemopreparations combined with autoblood are introduced at the first and eighth treatment day in intravenous and drip feed mode. Blood is taken from peripheral vein into two bottles containing blood preservative in the amount of 100 ml in each. 30 mg/m² of Doxorubicine is introduced into the first bottle, 500 mg/m² of 5-fluorouracyl and 600 mg/m² of cyclophosphane into the second one. Then both bottles are incubated and the contents of the first bottle is injected, and then the content of the second one. Surgical removal of relapse is carried out two weeks later after the last antitumor preparation introduction.

EFFECT: avoided adverse toxic side effects; no additional medical preparations consumption; completely eliminated lesion focus.

2 dwg, 1 tbl

Description

The invention relates to medicine, more specifically to oncology, and can be used in the treatment of patients with complications in the postoperative scar after surgical removal of breast cancer.

There is a method of treating relapse of breast cancer, in which the resulting focus is exposed to ionizing radiation in a total focal dose of 30 to 60 Gy (Kachanov I.P. Clinic, diagnosis and treatment of relapses and metastases of breast cancer. Abstract. Diss. Cand. Honey . Sciences, M., 1980).

The treatment method proposed by the author has, along with positive and negative aspects. Destroying tumor cells, ionizing radiation leads to a deterioration of the immune status, blood formation. Muscle tissue becomes loose, which often becomes an obstacle to suturing, as the threads cut through them. This leads to suppuration in the postoperative wound, healing by secondary intention. A known method for the treatment of relapse of breast cancer by the use in the preoperative period of antitumor chemotherapy drugs for a week. The intervals between the courses were 4 weeks (Iba T., Yagi Y., Kidokoro A., Fukunaga M., Monose F. “Efficacy of combination chemotherapy with mitoxantrone, vincristine, prednisolone (MVP) for reccurence of breast cancer.” Japanese Journal of Cancer & Chemotherapy. 11 (1): 83-6, 1995 Jan.).

The duration of the proposed method of treatment significantly increased both the total period of stay of the patient in the hospital, and adversely affected the condition of the patients. The high toxicity of the applied antitumor chemotherapeutic drugs was manifested, which led to a reduction in doses, the need for additional therapeutic effects, hemostimulating and antibacterial therapy.

With this course of the treatment process, the question of radical surgical removal of relapse was postponed indefinitely or was technically impossible.

The aim of the invention is to reduce toxic side effects of chemotherapeutic agents and the possibility of surgical removal of relapse.

The goal is achieved by exposing the tumor to the place of tumor recurrence with an alternating magnetic field with induction of 60 mT, sinusoidal shape, frequency of 50 Hz, with pauses of 2 seconds, lasting 5-10 minutes. Then, intravenous drip administration of anticancer chemotherapy is carried out - doxorubicin 30 mg / m ² , 5-fluorouracil - 500 mg / m ² , cyclophosphamide - 600 mg / m ² , combined with autologous blood previously prepared from the peripheral vein in two blood preservative vials and incubated . Exposure to the magnetic field is continued for seven days. On the eighth day of treatment, similar therapeutic effects are carried out in the same sequence and duration.

Analysis of known methods for the treatment of relapse of breast cancer and the claimed allows us to talk about the novelty of the latter and its significant differences.

The novelty of the developed method lies in the complex effect on the site of relapse and systemic administration of antitumor chemotherapy drugs that suppress the activity of tumor cells both in the relapse and throughout the patient’s body.

In open sources of information in Russia, the CIS countries and abroad similar to the proposed method is not found.

A method for treating breast cancer recurrence is industrially applicable. It can be reproduced and repeated many times in medical institutions, therapeutic departments and specialized oncological hospitals.

The method is as follows.

After a cytological examination of the formation in the postoperative scar and confirmation of the recurrence of breast cancer, the patient on the first day of treatment is exposed to an alternating magnetic field (PeMP) with an induction of 60 mT, a sinusoidal shape, a frequency of 50 Hz, an intermittent pattern with pauses of 2 seconds, a duration of 5- 10 minutes. Then, autoblood is collected from a peripheral vein in two bottles with a blood preservative of 100 ml each. 30 mg / m ^{2 of} doxorubicin, previously dissolved in physiological saline, is introduced into one vial. In the second bottle add 5-fluorouracil at the rate of 500 mg / m ² and cyclophosphamide - 600 mg / m ² . Both bottles are incubated, after which a mixture of the first and then the contents of the second bottle are injected intravenously. The effect of PeMP continues in the same regimes and duration for the next seven days. On the eighth day of treatment, similar therapeutic actions are carried out in the same sequence and duration. Two weeks after the last injection, surgical removal of tumor recurrence is performed.

An example of a specific implementation of the method can serve as an extract from the medical history No. 4935 / K.

Example 1

Patient K., born in 1946, first entered the OMT RINOI department on 03/15/05. On admission, she complained of the presence of a postoperative scar in the soft tissue area, which she discovered 6 months after the operation.

Medical history: in 1999 - combined treatment for stage II A cancer of the right mol. glands (pT2N0M0), G.A. dated 05/17/99 No. 544382, 534571-574: infiltrating ductal carcinoma, mts no. Currently, in the soft tissues of the postoperative scar, a recurrent tumor.

General status: Proper physique, satisfactory nutritional status. Skin and visible mucous membranes are normal. Peripheral lymph nodes are not detected. With auscultation in the lungs, vesicular breathing. Heart sounds are clear, rhythmic. Heart rate - 74, blood pressure - 130/90 mm Hg On palpation, the abdomen is soft, painless, the liver at the edge of the costal arch. The symptom of lumbar effusion is negative on both sides. Physiological administration is not disturbed.

Local status: left mammary gland without pathology. In place of the right mammary gland, there is a postoperative scar, above it is a dense tuberous tumor that rises above the surrounding skin, up to 10.0 cm in diameter, another dense tuberous mass extending from the upper medial pole, reaching the clavicle, up to 3.5 cm in size diameter. The skin over the formations is stretched, thinned, shiny. Tumors are displaced relative to the chest wall. Regional lymph nodes are not enlarged.

The results of laboratory studies.

General blood analysis DATE OF Hb, g / l See, × 10 ¹² CPU ESR, mm / hour L × 10 ⁹ Metamiel.% P, % FROM, % E% B% M% Lf,% 03/16/05 132 4,5 0.88 22 3.8 - 13 34 0 - eighteen 35 03/20/05 114 4.2 0.88 45 3.6 - 2 54 - - 3 41 03/25/05 84 4.1 0.8 thirty 3.2 - 9 47 0 - 5 39 03/28/05 92 4.3 0.8 24 5.3 - 6 45 0 - 8 41

General urine analysis

03/16/05: the reaction is acidic, density 1023, no protein. White blood cells 0-1-1 in n / a., Eri no, epithelium 2-3-3 in n / a.

ECG dated 03.15.05: semi-vertical electrical position of the heart, left ventricular hypertrophy, restoration processes of the posterior, posterior diaphragmatic region of the left ventricle are reduced.

FLO No. 44 of 03/14/05: no data were found for mts.

Ultrasound of the abdominal organs from 03/18/05: the liver is not enlarged, the contours are smooth, the parenchyma is diffuse-heterogeneous, the focal zones are not located, the calculus in the gallbladder cavity is up to 1.0 cm.

Ultrasound of soft tissues of the area of relapse from 03/18/05: above the postoperative scar with a transition to the subclavian region of a heterogeneous echo structure, formation up to 4.9 cm with a tuberous contour, an identical nodule adjacent to the lower edge of it up to 1.4 cm. Below the postoperative scar with the transition hypoechoic, tuberous multinodular formation 6.0 × 4.2 × 4.5 cm in size in the right axillary region

Thermography of soft tissues of the area of relapse from 03/18/05: upon thermal imaging examination of the anterior surface of the chest on the right, a general asymmetric “warm-up” in the area of the postoperative scar and surrounding soft tissues is recorded.

After cytological verification of the recurrence of breast cancer (puncture biopsy No. 121-22 of 03/21/05: scattered lying accumulations of carcinoma cells were found among a large amount of blood), a course of magnetotherapy and autohemochemotherapy was started on March 21, 2005.

In the treatment room, the place of tumor recurrence was exposed to an alternating magnetic field (PeMP) by induction of 60 mT, a sinusoidal shape, a frequency of 50 Hz, intermittent in nature, duration of sendings and pauses - 2 seconds, exposure time - 10 minutes. Then the patient, who was in the treatment room, underwent puncture of the peripheral vein, making sure that the position of the needle in the vein lumen was reliable for further manipulations, 200 ml of blood was taken in two bottles with Glyugitsir, 100 ml each. The blood of the first vial was combined with doxorubicin previously dissolved in physiological saline at a dose of 30 mg / m ² . The autocut of the second vial was combined with a solution of 5-fluorouracil at the rate of 500 mg / m ² and cyclophosphamide at a dose of 600 mg / m ² . Vials containing autologous blood with chemotherapy were incubated in a thermostat at t = 37 ° C for 30 min. After that, a mixture of autoblood and doxorubicin was administered intravenously, then the contents of the second vial were injected, the administration was carried out on the first and eighth days of treatment. The effect of PeMP continued for eight days in the same regimes and the same duration.

The total doses of chemotherapy drugs were: doxorubicin - 60 mg, 5-fluorouracil - 1000 mg, cyclophosphamide - 1200 mg. The treatment was tolerated satisfactorily, there were no complications, blood leukocytes in the range of 4.1-5.3 × 10 ⁹ / L. Patient with a diagnosis of C-h of the right breast, pT2N0M0, Art. II A, comb. treatment in 1999, relapse in the soft tissues of the postoperative scar, condition after a course of MT and AHCT, class. column 2, was discharged for 2 weeks to realize the clinical effect.

Reapplied April 4, 2005

Conducted general clinical examination: all indicators are within normal limits.

Ultrasound of the soft tissues of the area of relapse: after the treatment, the size of the formation decreased 5.0 × 3.2 × 2.8 cm, the structure was heterogeneous with hyperechoichesia, the blood flow was mixed.

Thermography of soft tissues of the area of relapse from 04/04/05: when comparing thermograms before and after treatment (Figs. 1, 2), a decrease in the total infrared radiation of the right half of the anterior surface of the chest wall is recorded against a background of a decrease in the intensity of vascularization of this area.

Local Status:

The left mammary gland without pathology. In place of the right mammary gland, a postoperative scar, above it is a dense tuberous tumor that rises above the surrounding skin, size. up to 7.0 cm in diameter, another dense tuberous formation extending from the upper medial pole extending to the clavicle, size. up to 2.5 cm in diameter. Education more clearly contoured, somewhat flattened. Tumors are displaced relative to the chest wall. Regional lymph nodes are not enlarged.

04/05/05 performed OPERATION: Removal of relapse of breast cancer in the soft tissues of the postoperative scar.

Macrodrug: nodular tumor of two nodes with a total size of 7.0 × 5.0 × 3.5 cm, irregular in shape, dense, in a section of gray color with brown inclusions.

G.A. No. 794164-165 of 04/07/05: fibrous, predominantly hyalinized and adipose tissue with mts of cancer, which has a predominantly solid structure.

The postoperative wound healed by primary intention. Sutures were removed 10 days after surgery.

Final diagnosis: S-h right mol. glands, pT2N0M0, Art. II A, comb. treatment in 1999, mts in m / tissue of the region of the scar site, condition after complex treatment (1 K. AGHT + MT + operation), class column 3.

The patient was discharged for 2 weeks with subsequent attendance at the course of radiation therapy (DHT). Tamoxifen was prescribed at 20 mg / day for a long time.

At the end of the DHT course in terms of treatment, consult a chemotherapist to resolve the issue of polychemotherapy courses.

The technical and economic effectiveness of the method consists in the possibility of avoiding toxic side effects of chemotherapy and conducting preoperative therapy in full without prescribing additional drugs, as well as the possibility of radical removal of the lesion.

Claims (1)

A method for the treatment of recurrence of breast cancer, including the introduction of antitumor chemotherapy drugs and surgical treatment, characterized in that for eight days of treatment they are exposed to an intermittent alternating magnetic field with a duration of 2 seconds and pauses, 60 mT induction, sinusoidal shape, frequency 50 Hz, lasting 5-10 minutes, and on the first and eighth days of treatment, intravenous drip administration of antitumor chemotherapy drugs connected with autologous blood is then carried out, for which purpose from a peripheral vein two vial gemokonservantom produce blood sample of 100 ml in each; 30 mg / m ^{2 of} doxorubicin is introduced into the first, 500 mg / m ^{2 of} 5-fluorouracil and 600 mg / m ^{2 of} cyclophosphane are introduced into the second; after which both vials are incubated and the contents of the first and then the second vial are introduced; two weeks after the last administration of anticancer chemotherapy, surgical relapse removal is performed.

Images