RU2314055C1 - Method for treating nasopharyngeal cancer - Google Patents

Abstract

FIELD: medicine, oncology.

SUBSTANCE: the present innovation deals with treating patients with nasopharyngeal cancer in cases when surgical treatment can't be carried out radically because of different reasons and potentialities of radiation therapy have been exhausted completely. Thus, after the course of radiation therapy one should affect the rest part of nasopharyngeal tumor with cryoimpact per about 5-10 sec at a 10-min-long interval. The innovation enables to liquidate the tumor, reconstruct hearing and nasal respiration from both sides, normalize the content of free triiodothyronine in blood and, therefore, improve quality of life in such patients.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to oncology, and can be used in the treatment of patients with nasopharyngeal cancer in cases where surgical treatment for various reasons cannot be carried out radically, and the possibilities of chemo-radiation treatment are already exhausted.

The development of a malignant tumor affects the state of various body systems, including the state of the endocrine glands, to one degree or another changing their functional activity and hormonal homeostasis. Radical (complete) removal of the tumor, as a transforming factor homeostasis, is an indispensable condition for the restoration of normal hormone production in patients with cancer.

In patients with nasopharyngeal cancer, prior to treatment, an increased content of free triiodothyronine in the blood was found. After a course of radiation therapy, their hormone concentration also remains elevated. One of the problems in the treatment of patients with nasopharyngeal cancer is the inability to achieve complete removal of the primary tumor focus using remote and contact radiation. Due to the anatomical and topographic features of the localization area, nasopharyngeal cancer cannot be subjected to surgical intervention. At the same time, preservation of even a relatively small fragment of the tumor significantly reduces both the immediate and the long-term result of treatment, contributing to the development of relapse of the disease and the appearance of metastases. In addition, the existence of a residual tumor focus can support metabolic changes in the body caused by the influence of the malignant process. This is an additional endogenous factor that impedes the effectiveness of antitumor treatment, which makes it necessary to completely remove the tumor in the treatment of patients with this localization of the process.

It is known to use drugs that inhibit the synthesis of thyroid hormones by suppressing the production of thyroid hormones, such as mercazolil or propicyl ("Medicines" Mashkovsky MD, M., 2004).

The disadvantage of drug suppression of the functional activity of the gland is the fact that the use of these drugs had to be carried out against the background of the presence of a residual nasopharyngeal tumor, which has an increasing effect on the concentration of the hormone in the blood. Such a situation requires constant administration of drugs and constant monitoring of thyroid function in order to adjust their dose during the dispensary control. In addition, the content of free triiodothyronine in the bloodstream is determined not only by the amount of its synthesis in the gland, but also by the rate of formation of the thyroid hormone outside the gland from another thyroid hormone - thyroxin, as well as the binding ability of the transport (hormone-carrying) blood proteins. Cancer of the nasopharynx can change any or all processes that support the physiological level of free triiodothyronine in the blood, and therefore the optimal approach to its normalization is the method of exposure, which ensures complete removal of the tumor.

A known method of influencing a nasopharynx tumor by applying ionizing radiation in a total focal dose of 60 Gy to the primary focus ("Malignant nasopharyngeal tumors and their radiation treatment", A. S. Pavlov, L. D. Stiop, M., 1985).

Radiation exposure, along with the destruction of tumor cells, has a detrimental effect on nearby surrounding tissues, on the hematopoietic system, causes osteoporosis, radiation cataracts, and mobility of the temporomandibular joint.

The aim of the invention is the elimination of residual tumors and the normalization of the patient.

The goal is achieved in that after a course of radiation therapy, visual examination, computed tomography or magnetic resonance imaging for the remainder of the nasopharyngeal tumor, cryotherapy is performed three times, for 5-10 seconds, with an interval of 10 minutes.

The analysis of the known methods for the treatment of cancer of the nasopharynx and the claimed allows us to state that the latter has novelty and is different from the known methods.

The novelty of the proposed method consists in using as a means of destroying the remaining part of the malignant tumor, exposure to it with a stream of chilled nitrogen on the nasopharynx using a cryocanula, the ability to normalize the level of free triiodothyronine in the blood.

In the available open sources of information in Russia, the CIS countries and abroad, no indications of a similar method for the treatment of nasopharyngeal cancer were found.

The method is industrially applicable. It can be reproduced and repeatedly repeated both in specialized oncological institutions and in ENT clinics of healthcare institutions.

The method is carried out in the following way. After a course of radiation therapy, subsequent visual examination, computed tomography or magnetic resonance imaging, the remainder of the malignant nasopharyngeal tumor is exposed to liquid nitrogen for 5-10 seconds, three times with an interval of 10 minutes. In the treatment room, the patient, lying on his back or sitting under local anesthesia by lubricating and spraying a 10% solution of lidocaine of the mucous membranes of the nasal cavity and nasopharynx under visual control, performs cryotherapy on the remaining part of the nasopharyngeal tumor. When a tumor is located on the posterior surface of the nasopharynx, the cryocanula is inserted through the nasal passages, and in the presence of a tumor on the anterior and lateral surfaces, it is delivered through the mouth. In order to prevent liquid nitrogen condensate from entering the oropharynx and pharynx, an electric suction pump is used with a tip that removes nitrogen vapor.

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

Patient K., born in 1949, medical history No. 9879 / f, was admitted to the department of head and neck tumors of the RNII on May 27, 2005 with a diagnosis of nasopharyngeal cancer (T3N0M0), Article III. Complaints at admission: lack of nasal breathing on the left completely, partially on the right. Hearing loss in the left ear. With posterior rhinoscopy revealed: the entire nasopharynx is occupied by a tumor with an exophytic component, covered with necrotic plaque. Gist. an. No. 803737 - squamous cell carcinoma.

06/07/2005, a study was conducted of the content of free triiodothyronine in the blood. The hormone concentration exceeded the normal indicator and amounted to 7.3 pmol / L.

From 08.06.2005 to 03.08.2005, the patient received a course of distance gamotherapy, the total focal dose was 60 Gy per primary focus. Nasal breathing and hearing have improved. However, there was a residual tumor with a diameter of 1-1.5 cm in the projection of the mouth of the Eustachian tube and the nasopharynx for the right.

09/05/2005, a repeated study of the content of triiodothyronine in the blood. Its content was increased and amounted to 6.8 pmol / L.

September 6, 2005, a patient in the treatment room in a supine position under local anesthesia by spraying and lubricating with a 10% solution of lidocaine of the nasal mucosa and nasopharynx under visual control, a cryocanule was brought to the remaining part of the tumor and nitrogen was applied for 7 seconds, three times with breaks of 10 minutes. After the procedure, nasal breathing was completely restored both on the right and on the left. The patient notes an improvement in hearing.

September 13, 2005, the content of free triiodothyronine in the blood was studied. Its concentration was normalized and amounted to 5.2 pmol / L.

September 16, 2005, the patient's condition is quite satisfactory, was discharged for follow-up.

10.10.2005, with the appearance of the control examination, the patient does not complain. A general blood test and a study on the content of triiodothyronine are within normal limits. There is no evidence for tumor recurrence.

The developed method was used to treat 20 patients with nasopharyngeal cancer in the III-IV stages of the process. All patients at the stages of treatment were controlled triiodothyronine. In all cases, after cryodestruction of the residual tumor, the hormone concentration returned to normal.

The technical and economic effectiveness of the method consists in the ability to completely eliminate the tumor, restore hearing and nasal breathing on both sides, normalize the content of free triiodothyronine in the blood, and improve the quality of life of patients.

Claims (1)

A method for the treatment of nasopharyngeal cancer, including radiation therapy, characterized in that after a course of radiation therapy for the remainder of the nasopharyngeal tumor, cryotherapy is performed three times for 5-10 seconds with a break of 10 minutes.