RU2349271C2 - Method of rectal cancer treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly oncology, and can be applied in complex rectus cancer treatment with removed two-end colostomy. Invention substance involves sampling of 200 ml of patient's autoblood in post-operation period after two-end sigmostoma removal. Then autoplasma is separated from blood by centrifugation method, 50 ml of autoplasma and 1000 mg of 5-fluorouracil is placed in first bottle and remaining blood and plasma elements are placed in the second bottle. Bottles are incubated separately for 40 minutes at 37°C. Then autoplasma with 5-fluorouracil from the first bottle is administered intratestinally to non-functioning intestine of two-end colostoma; autoblood from second bottle is reinfused intravenously by drop infusion, followed by first radiation treatment session. Intratestinal chemotherapy with autoplasma with intravenous autohemotherapy is repeated one time per week during the whole radiation therapy course.

EFFECT: enhanced efficiency of radiation treatment due to direct effect of 5-fluorouracil on tumour and to radio-sensibilising effect; possible transfer of patients to respectable condition and reduced radiation complication rate.

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Description

The invention relates to medicine, namely to Oncology, and can be used in the complex treatment of unresectable primary and recurrent colorectal cancer.

The well-known "Method for the treatment of colorectal cancer" (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 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 treatment of locally advanced cancer of the rectum" (Berdov B.A., Tsyb A.F., Yurchenko N.I. Diagnosis and combined treatment of cancer of the rectum. M., 1986. 272 S.), which consists in intravenous drip of 5-fluorouracil at a dose of 5 mg / kg in 1000 ml for 17 hours. 21-23 hours after the end of the administration of the drug, a tumor of ROD - 6 Gy is irradiated. A total of 6 sessions of chemotherapy and irradiation were carried out to a total dose of 5-FU 5.5-7.0 g, and SOD - 36 Gy. The operation was performed after 3-4 weeks. Tumor regression sufficient for radical surgery was observed in 69% of patients. Postoperative mortality was 6.7%. There was a significant increase in the frequency of suppuration of the perineal wound up to 88.9%.

The well-known "Method of radiomodification in the treatment of patients with colorectal cancer" (see Barsukov Yu.A., Tkachev SI, Oltarzhevskaya ND, etc. Polyradiomodification in the combined and complex treatment of patients with colorectal cancer // Materials of the X Russian Oncological Congress. M., p. 95-98), selected by us as a prototype. The method consists in the fact that in order to increase the effectiveness of radiation treatment of colorectal cancer, an intrarectal application of a radiosensitizing mixture consisting of metronidazole, sodium alginate and a 2% solution of the universal DMSO transporter was used. However, the method turned out to be toxic, including neurotoxic, and an accompanying therapy program was developed for the prevention of toxicity: cerucal intravenously, dexamethasone intramuscularly, intravenous mannitol, water load up to 2 liters, which is impossible with concomitant cardiovascular pathology. The use of metronidazole and 5-fluorouracil as the radiosensitization was even more toxic, and with the complete resorption of the tumors, all experimental animals died.

However, the high toxicity of the method of polyradiomodification limits its use, and long-term results are not traced.

The aim of the invention is to increase the efficiency of radiation treatment of patients with unresectable primary and recurrent colorectal cancer.

This goal is achieved by the fact that in patients with a double-barreled colostomy, 200 ml of autologous blood is collected prior to the course of radiation therapy, plasma is extracted from the blood by centrifugation, 50 ml of autoplasma and 5-fluorouracil 1000 mg are placed in the first bottle, and the remaining uniform in the second bottle blood elements, plasma; separate incubated vials for 40 minutes at 37 ° C. Then autoplasma with 5-fluorouracil from the first vial is administered intracutaneously into the non-functioning intestine of a double-barreled colostomy. Autologous blood from a second vial is reinfused intravenously. Then produce the first session of radiation treatment. Intraintestinal autoplasma chemotherapy with intravenous autohemotherapy is repeated once a week throughout the course of radiation treatment. Irradiation is carried out to SOD 60-70 Gy in the classical fractionation mode with a single dose of 2 Gy, 5 sessions per week.

The invention "A method of treating cancer" is new, as it is unknown in the field of medicine in the surgical and radiation treatment of unresectable primary and recurrent colorectal cancer.

The novelty of the invention lies in the fact that 200 ml of blood is taken from patients, plasma is isolated from the blood by centrifugation, 50 ml of autoplasma and 5-fluorouracil 1000 mg are placed in the first bottle, the remaining blood cells, plasma are placed in the second bottle; separate vials are incubated for 40 minutes at 37 ° C; then autoplasma with 5-fluorouracil from the first vial is injected intradermally into the non-functioning intestine of a double-barreled colostomy, autologous blood from the second vial is reinfused intravenously and then the first radiation treatment is performed; autoplasmic intraintestinal chemotherapy with intravenous autohemotherapy is repeated once a week throughout the course of radiation treatment.

Thus, intraintestinal autoplasma chemotherapy increases the effectiveness of radiation therapy due to the direct antitumor effect of 5-fluorouracil on the rectal tumor and the radiosensitizing effect.

The invention "Method for the treatment of cancer" is industrially applicable, as it can be used in healthcare, medical institutions of oncological profile, dispensaries, cancer research institutes.

Examples of specific applications of the "Method of treating cancer" in patients.

Patient Podorogin T.T., born in 1932, medical history 9608 / t, was admitted to the Department of General Oncology, RNII on 03.06.04 with a diagnosis of rectal cancer, stage III, clinical group II. Condition after anteroposterior resection of the rectum 12/8/2003. Relapse of cancer in the area of anastomosis.

Upon admission, he complained of constipation, periodically blood in the stool, pseudodefecation. Sick for 4 months. Turned to the RNII.

With fibrocolonoscopy in the outpatient clinic of the RNII at 9 cm from the anus, tumor infiltration of the anastomosis was detected. Histological analysis No. 746983: adenocarcinoma.

06/04/2004 operation - relaparotomy. An audit of the abdominal organs revealed: tumor infiltration in the anastomotic zone, stenotic lumen of the intestine, growing on the posterolateral wall in the sacrum. No distant tumor metastases were detected. Performed double-barreled sigmoidostomy.

The postoperative period was uneventful, without complications. Wound healing by primary intention, sutures were removed on day 11.

A 200 ml autologous blood sample was taken from the patient, plasma was isolated from the blood by centrifugation, 50 ml autoplasma and 5-fluorouracil 1000 mg were placed in the first vial, the remaining blood cells and plasma were placed in the second vial; separately incubated vials for 40 minutes at 37 ° C; then autoplasma with 5-fluorouracil from the first vial was introduced intradermally into the non-functioning intestine of a double-barreled colostomy, autologous blood from the second vial was reinfused intravenously and then the first radiation treatment was performed; autoplasmic intraintestinal chemotherapy with intravenous autohemotherapy was repeated once a week throughout the course of radiation treatment.

During the course of chemoradiotherapy, general and biochemical blood tests without features, the level of leukocytes did not decrease.

The patient was discharged in satisfactory condition.

With appearances at the RNII within 2 years after treatment, stabilization of the process was established. The patient's health is relatively satisfactory.

Patient Guselnikova TD, born in 1933, medical history 4886 / t, was admitted to the Department of General Oncology, RNII on March 15, 04 with a diagnosis of rectal cancer, stage III, clinical group II. "

At admission, she complained of pain in the sacrum, rectum, pain during bowel movements, an admixture of blood, mucus in the feces, loss of appetite, weakness, 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, March 18, 2004, an operation was performed - laparotomy. During the audit, a motionless tumor of the rectum, growing in the sacrum, uterus, tumor infiltration of pararectal tissue to the walls of the pelvis. There are no distant metastases. The case was found to be unresectable, due to partial intestinal obstruction, a double-barreled sigmostoma was imposed. Postoperative diagnosis: colorectal cancer, T4NxM0, stage III, clinical group II.

The postoperative period was uneventful, without complications. Sutures were removed on day 12.

A 200 ml autologous blood sample was taken from the patient, plasma was isolated from the blood by centrifugation, 50 ml autoplasma and 5-fluorouracil 1000 mg were placed in the first vial, the remaining blood cells and plasma were placed in the second vial; separately incubated vials for 40 minutes at 37 ° C; then autoplasma with 5-fluorouracil from the first vial was introduced intradermally into the non-functioning intestine of a double-barreled colostomy, autologous blood from the second vial was reinfused intravenously, after which the first radiation treatment was performed; autoplasmic intraintestinal chemotherapy with intravenous autohemotherapy was repeated once a week throughout the course of radiation treatment.

During the course of chemoradiotherapy, general and biochemical blood tests without features, the level of leukocytes did not decrease.

The patient was discharged in satisfactory condition.

With appearances at the RNII for 2 years, there is a remission of the disease. The patient's condition is relatively satisfactory.

The proposed method treated 30 patients with locally advanced rectal cancer and 8 patients with recurrent colorectal cancer. The use of intraintestinal chemotherapy on autoplasma with intravenous autohemotherapy 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 wound healing. Patients were monitored in the range from 6 months to 2 years. During the observation period, there was not a single case of disease progression; 13 patients with intraintestinal chemotherapy using autoleukomass with intravenous autohemotherapy did not cause changes in the general biochemical analysis of blood, improves the general condition of patients, is characterized by low toxicity, and does not disrupt the processes of postoperative wound healing. Patients were monitored in the range from 4 months to 2 years. During the observation period, not a single case of disease progression was detected, 8 patients with primary locally advanced rectal cancer managed to be converted to a resectable form and radically operated on.

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 increase the effectiveness of radiation therapy, reduce perifocal inflammation, transfer patients to a resectable state, and reduce treatment costs. The method is low toxic, does not increase the frequency of postoperative and radiation complications, simple to perform.

Claims (1)

A method of treating cancer, including surgical treatment in the volume of a double-barreled sigmoidostomy and chemoradiation treatment, characterized in that in the postoperative period before the start of the course of radiation therapy, 200 ml of autologous blood is taken from patients, autoplasma is extracted from the blood by centrifugation, 50 ml of autoplasma is placed in the first vial and 5-fluorouracil 1000 mg, in the second bottle - the remaining formed elements of the blood, plasma; the vials are incubated separately for 40 min at 37 ° C; then autoplasma with 5-fluorouracil from the first vial is injected intradermally into the non-functioning intestine of a double-barreled colostomy, autologous blood from the second vial is reinfused intravenously and then the first radiation treatment is performed; autoplasmic intraintestinal chemotherapy with intravenous autohemotherapy is repeated once a week throughout the course of radiation treatment.