RU2303446C2 - Method for treatment of patients with locally spread squamous cell larynx cancer - Google Patents

Abstract

FIELD: medicine, oncology.

SUBSTANCE: method involves carrying out the preliminary catheterization of larynx artery and the following intra-arterial chemotherapy by administration of cisplatin as 6 h infusion of 80-100 ml of 0.0025% solution from 1-st to 4-th day of treatment in the total dose 100 mg/m², 5-fluorouracil as 3 h infusion of 20 ml of 5% solution from 5-th to 7-th day of treatment in the total dose 3 g. After termination of chemotherapy in 2-3 weeks after arresting adverse reactions in tumor regression above 50% the larynx resection is carried out and in regression less 50% - laryngoectomy. In 3-4 weeks after surgery operation the distance radiation therapy is carried out in a single irradiation dose 2.0 Gr in irradiation regimen 5 times per a week and in the total dose 40-46 Gr in laryngoectomy and 60-66 Gr in organ-retaining surgery operation depending on the stage of the primary process. Method provides the functional rehabilitation of patients and decreasing expression and amount of total complications of complex therapy based on step-by-step carrying out the treatment. Invention can be used in treatment of patients with locally spread squamous larynx cancer.

EFFECT: improved method of treatment.

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Description

A method for the treatment of patients with locally advanced squamous cell carcinoma of the larynx.

The invention relates to medicine, in particular to oncology, and relates to methods for treating patients with locally advanced squamous cell carcinoma of the larynx.

Known methods for treating patients with locally advanced squamous cell carcinoma of the larynx, including radiation therapy and surgical intervention in various combinations (Tumors of the head and neck, A.I. Pachez, M., Medicine, p.346-379, 1997), as well as combining systemic polychemotherapy with radiation therapy or surgery (G. B. Adilbaev et al. Materials of the 3rd Congress of Oncologists and Radiologists of the CIS, Minsk, p. 4, 2004).

The closest to the achieved positive result (prototype) is a method of treating patients with locally advanced squamous cell carcinoma of the larynx, which consists in the appointment of 2 courses of chemotherapy by intravenous administration of cisplatin and 5-fluorouracil and in the second stage of combined treatment of surgical intervention (Materials of the 3rd Congress of Oncologists and Radiologists of the CIS Long-term results of treatment of patients with laryngeal cancer TT M, N.M. Amiraliev et al., Ministry of Health of the Republic of Belarus, Minsk, May 25-28, 2004, part 2. Tonpik ODO 2004, 5). The disadvantage of this method is the low efficiency and high toxicity.

The authors propose a new effective method for treating patients with locally advanced squamous cell carcinoma of the larynx, consisting in phased treatment: chemotherapy, surgery and radiation therapy followed by surgical rehabilitation.

The technical result of the invention is to increase the effectiveness of treatment, functional rehabilitation and improving the quality of life of patients.

The technical result is achieved by the fact that at the first stage of complex treatment a neoadjuvant intra-arterial regional chemotherapy course is carried out: cisplatin in the form of a 6-hour infusion of 80-100 ml of a 0.0025% solution from the 1st to the 4th day of treatment (total dose 100 mg / m ² ), 5-fluorouracil in the form of a 3-hour infusion of 20 ml of a 5% solution from the 5th to the 7th day of treatment (total dose of 3 g), at the second stage of complex treatment, simultaneous surgery on the lymphatic drainage pathways and primary focus. 3-4 weeks after surgery, patients undergo remote radiation therapy.

The proposed method of treatment is as follows

The patient is given a course of polychemotherapy, then surgery, followed by a course of postoperative radiation therapy. Laryngeal artery catheterization is performed, the catheter is placed retrograde through the superior thyroid artery, which is distally ligated. Drugs are administered intraarterially through a catheter. The infusion is carried out using a dispenser of medicinal substances "Lineomat", KARL-MARX-STADT. The chemotherapy regimen includes two drugs: cisplatin in the form of a 6-hour infusion of 80-100 ml of a 0.0025% solution from the 1st to the 4th day of treatment with a total dose of 100 mg / m ² , 5-fluorouracil in the form of 3- x-hour infusion of 20 ml of a 5% solution from the 5th to the 7th day of treatment with a total dose of 3 g. After chemotherapy is completed, 2-3 weeks after stopping adverse reactions, patients undergo combined surgery on the lymphatic pathways of the neck and the main focus. With regression of the tumor, more than 50% perform laryngeal resection in various modifications; with regression less than 50%, laryngectomy is performed. 3-4 weeks after surgery, patients undergo remote radiation therapy. Irradiation is performed on the Rocus-AM gamma therapeutic unit, a single dose of radiation is 2.0 Gy, the irradiation regime is 5 times a week, the total dose reaches 40-46 Gy with laryngectomy, with organ-preserving surgery the dose to the larynx is 60-66 Gy depending on the stage of the primary process. After 3-6 months, if necessary, a laryngo- and tracheostomy is closed.

The essence of the invention lies in the fact that in the preoperative period they conduct a course of neoadjuvant intraarterial regional chemotherapy: cisplatin in the form of a 6-hour infusion of 80-100 ml of a 0.0025% solution from the 1st to 4th day of treatment with a total dose of 100 mg / m ² , 5-fluorouracil in the form of a 3-hour infusion of 20 ml of a 5% solution from the 5th to the 7th day of treatment with a total dose of 3 g. Laryngeal artery catheterization is performed retrograde using access through the superior thyroid artery.

Clinical example

Patient Samsonov A.V., 46 years old, was treated in the department of head and neck tumors since September 2003. Diagnosis: laryngeal cancer, 3 tbsp. TK N0M0. DG number 1159 from 09.16.03. squamous cell carcinoma with a tendency to keratinization. Objectively, before the start of treatment, the patient was determined by the ulcer-infiltrative form of growth of the tumor, which occupies the entire left vocal fold with the transition to the sub-fold space, there was paresis of the larynx on the left. 09/30/03. operation performed: catheterization of the upper thyroid artery on the left. 1-6.10.03. a course of intra-arterial regional polychemotherapy was carried out according to the above scheme. After polychemotherapy, examination revealed a residual tumor of mixed growth, occupying part of the left vocal fold. The effect after chemotherapy was more than 50%. On December 27, 2003, the patient underwent an operation in the amount of: anterior-lateral laryngeal resection on the left. DG No. 3810 dated December 5, 2003. squamous cell cancer, therapeutic pathomorphism 4 tbsp. The wound healed by primary intention.

12.22.03.-4.02.04. the patient received a course of remote postoperative gamma therapy, a single focal dose was 2 Gy, 5 times a week, total - 66 Gy.

06/08/04. the patient underwent plastic surgery of the laryngostomy with reinforcement of the skin flap with an auto-rib. The wound healed by primary intention. The voice and dividing functions of the larynx are restored.

According to the proposed method, only 3 patients received treatment. At stage 1, all patients received a course of regional chemotherapy according to the scheme: cisplatin in the form of a 6-hour infusion of 80-100 ml of a 0.0025% solution from the 1st to 4th day of treatment with a total dose of 100 mg / m ² , 5-fluorouracil in the form of a 3-hour infusion of 20 ml of a 5% solution from the 5th to the 7th day of treatment with a total dose of 3 g. The laryngeal artery was catheterized in all patients. In all 3 cases, after 1 course of regional chemotherapy, tumor regression of more than 50% was achieved.

With regard to regional metastases in one case (T3N1M0), a partial regression of the metastatic lymph node was noted. It should be noted that in this case, a complete regression of the primary tumor was noted.

Therapeutic pathomorphosis (all patients operated on) amounted to: IV Art. - 2 patients, II tbsp. - 1 patient. Complications of RPHT: in 1 case, when carrying out RPHT through the laryngeal artery, soft tissue necrosis developed in the blood supply zone of the latter after the introduction of 4 g. 5-FU. In a subsequent patient, a laryngeal resection was performed. After reducing the dose of 5FU to 3 g, we did not encounter any complications of this nature.

Surgery

Primary foci: in 2 cases after RPCP, laryngeal resections were performed. In 1 case, given the initial tumor volume, a laryngectomy was performed. In the presence of metastases in the regional lymph nodes of the neck in 1 case, FFIC of the neck was performed. Reconstructive operations were performed in 2 patients after resection of the larynx. There were no complications after operations.

At the 3rd stage of treatment, all patients received a course of remote gamma therapy in the postoperative SOD plan of 46 Gy after laryngectomy and 60-66 Gy after resection, depending on the prevalence of the process by TNM.

Thus, the entire group of patients taken into the study managed to conduct a radical comprehensive treatment.

The proposed method allows to treat patients with locally advanced squamous cell carcinoma of the larynx with high efficiency and can be used in specialized medical institutions (departments of head and neck tumors of oncological dispensaries).

Claims (1)

A method of treating patients with locally advanced squamous cell carcinoma of the larynx, which consists in conducting polychemotherapy, characterized in that after a preliminary catheterization of the laryngeal artery, intra-arterial chemotherapy is carried out by introducing cisplatin in the form of a 6-hour infusion of 80-100 ml of a 0.0025% solution from the 1st on the 4th day of treatment with a total dose of 100 mg / m ² , 5-fluorouracil in the form of a 3-hour infusion of 20 ml of a 5% solution from the 5th to 7th day of treatment with a total dose of 3 g, and after chemotherapy through 2-3 weeks after stopping In case of tumor regression, more than 50% perform laryngeal resection, laryngectomy with regression less than 50%, remote radiation therapy is carried out 3-4 weeks after surgery, with a single radiation dose of 2.0 Gy, irradiation mode 5 times a week and total dose of 40-46 Gy for laryngectomy, 60-66 Gy for organ-preserving surgery, depending on the stage of the primary process.