RU2336038C1 - Method of rectal cancer treatment - Google Patents

Abstract

FIELD: medicine; oncology.

SUBSTANCE: within preoperative period patients are drew with blood sample in amount 200 ml. Using centrifugation process plasma is separated from blood. Autoplasma in amount 40 ml is placed to the first bottle added with 5-fluorouracil 500 mg. The second bottle contains remained blood corpuscles, plasma and 5-fluorouracil 1000 mg. Bottles are incubated separately within 40 minutes at 37°C. Then rectum is excised. During operation incubated blood of the second bottle with chemical added is introduced intravenously drop-by-drop. After tumour rectum is extracted, haemostatic sponge impregnated with incubated autoplasma of the first bottle with chemical added is placed in tumour box (on sacral bone). Then perineal wound is tampon or cut down.

EFFECT: reduced rate of local remote metastasis.

1 ex

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 colorectal cancer.

A high incidence of relapses and distant metastases is known after the application of 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 pp.). 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 pathways, the number of tumor cells in the regional veins of the tumor zone and in the general 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.

The well-known "Method for the treatment of colorectal cancer" (see the book. Sidorenko Yu.S. Autohemochemotherapy. Rostov-on-Don: Publishing House of the Russian State Medical University, 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 apparatus with a frequency of 915 MHz at t ° 41-42 ° C. The effectiveness of treatment in severe 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 for the prevention of relapse and metastases" (see Sneshko LI. Prevention of relapse and metastasis of colon cancer. L., 1976. 176 S.). 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% treated only by surgical method. 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 well-known "Method for the prevention of relapses and metastases" (see Sidorenko Yu.S. et al. Methods of surgical chemotherapy on the body’s autologous media during operations for malignant tumors of the breast and colon // Surgery No. 10, 2006, S. 27-29 ) selected by us as a prototype. The method consists in the fact that with the aim of intraoperative prevention of the occurrence of cancer metastases and relapses in the preoperative period, 200 ml of blood is taken from patients, plasma is isolated from the blood by centrifugation. Chemotherapy drugs are added to plasma and blood vials and incubated. Then, during the operation, the incubated blood with chemotherapy is drip injected; after removal of the tumor, retroperitoneal tissue is infiltrated on the localization side of the colon tumor with incubated autoplasma with chemotherapy.

However, injection of autoplasma with chemotherapy in the bed of a removed tumor is not possible in operations involving the complete removal of fiber around the tumor, in particular during extirpation of the rectum for cancer.

The aim of the invention is to reduce the incidence of local relapses and distant metastases after surgical treatment of colorectal cancer.

This goal is achieved by the fact that in the preoperative period, 200 ml of blood is taken from patients, plasma is extracted from the blood by centrifugation, 40 ml of autoplasma and 500 mg of 5-fluorouracil are placed in the first bottle, and the remaining blood cells, plasma and 1000 mg are placed in the second bottle 5-fluorouracil; separate incubated vials for 40 minutes at 37 ° C. Then, rectal extirpation is performed; during the operation, incubated blood with a chemotherapy from the second bottle is injected dropwise; after removal of the rectum with the tumor in the tumor bed (on the sacrum), a hemostatic sponge soaked in incubated autoplasma with chemotherapy from the first bottle is placed. After that, the perineal wound is plugged or sutured.

The invention "A method for the treatment of colorectal cancer" is new, since 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, 200 ml of blood is taken from patients, plasma is extracted from the blood by centrifugation, 40 ml of autoplasma and 500 mg of 5-fluorouracil are placed in the first bottle, and the remaining blood cells, plasma and 1000 are in the second bottle mg 5-fluorouracil; separate incubated vials for 40 minutes at 37 ° C. Then, rectal extirpation is performed; during the operation, incubated blood with a chemotherapy from the second bottle is injected dropwise; after removal of the rectum with the tumor in the tumor bed (on the sacrum), a hemostatic sponge soaked in incubated autoplasma with chemotherapy from the first bottle is placed. After that, the perineal wound is plugged or sutured.

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 of the rectum.

The invention "A method for the treatment of colorectal cancer" is industrially applicable, as it can be used in healthcare, oncological medical facilities, dispensaries, and cancer research institutes.

An example of a specific application of the "Method for the treatment of colorectal cancer" in patients.

Patient S.V.G., born in 1947, medical history 24289 / t, was admitted to the Department of General Oncology, RNIIII 11.1.05. with a diagnosis of rectal tumor, stage 3, clinical group 2 ".

On admission, he complained of pain in the rectum, pseudodefecation, an admixture of blood, mucus in the feces, impaired appetite, and general weakness. Sick for 4 months. He went to the doctor at the place of residence, was sent to the RNII with a suspicion of a rectal tumor.

During fibrocolonoscopy, a saucer-shaped rectal tumor 6 cm from the anus was found in the RNII clinic, occupying 2/3 of the intestinal circumference, 5 cm long. Carcinoma cells were found during histological examination. Ultrasound examination did not reveal distant metastases. The patient was hospitalized in the Department of General Oncology.

After preoperative preparation on 19.1.05, an operation was performed - abdominal-perineal extirpation of the rectum with the formation of a single-barrel sigmoid. 5 mg-fluorouracil 1000 mg was administered intraoperatively intravenously on autologous blood, after removal of the rectum with the tumor, a hemostatic sponge soaked in incubated autoplasma with 500 mg of 5-fluorouracil was placed in the tumor bed. The perineal wound is plugged with tampons with Vishnevsky ointment.

Postoperative histological analysis 780731-33 moderately differentiated adenocarcinoma with invasion of the entire thickness of the intestinal wall, in metastasis 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 02/14/05 in satisfactory condition.

When appearances at the RNII within 2 years after treatment, data for relapse and metastases were not found.

The proposed method treated 25 patients with locally advanced rectal cancer. 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, differs in low toxicity, and does not disrupt the processes of postoperative wound healing. Patients were monitored in the range from 6 months to 3 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 for the treatment of colorectal cancer” lies in the fact that the use of the method allows to reduce the incidence of local relapses and distant metastases, low toxicity, does not increase the incidence of postoperative complications, simple to perform. 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 colorectal cancer, including surgical treatment, chemotherapy, characterized in that 200 ml of blood is taken from patients in the preoperative period, plasma is extracted from the blood by centrifugation, 40 ml of autoplasma and 500 mg of 5-fluorouracil are placed in the first bottle, in the second bottle - the remaining blood cells, plasma and 1000 mg of 5-fluorouracil; the vials are separately incubated for 40 min at 37 ° C, then the rectum is extirpated; during the operation, the incubated blood with a chemotherapy from the second vial is dripped; after removal of the rectum with the tumor, in the tumor bed, a hemostatic sponge impregnated with incubated autoplasma with chemotherapy from the first vial is placed on the sacrum, after which the perineal wound is plugged or sutured.