RU2352264C2 - Method of cancer of rectum treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely, oncology, and can be used in complex treatment of cancer of rectum. Essence of the invention consist that in the postoperative period before the beginning of radial therapy of 200 ml autoblood sampling is made, autoleukomass is allocated with the method of centrifugation from blood. Then it is placed 20 ml of the autoleukomass and 1000 mg of the 5-FU in the first vial, in the second vial - the remained formulated elements of blood and plasma, the vials with contents are incubated separately within 40 minutes at 37°C. The autoleukomass with 5-FU from the first vial is administered in intraintestinal manner into nonfunctioning intestine of the double-barrel colostomy, autoblood from the second vial is reinfused intravenously driply, then sessions of radial treatment are spent. Irradiation is made in a regimen of classical fractionating with a single dose of 2 Gy within 5 sessions in a week on primary tumour to the general dose of 40-70 Gy, the intraintestinal chemotherapy on autoleukomass with intravenous autohemotherapy is repeated once a week throughout a course of radial treatment.

EFFECT: method allows to enlarge efficiency of radial therapy, to reduce perifocal inflammation, to move patients in the resectable condition, to reduce frequency of postoperative and radial complications.

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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 with perifocal inflammation.

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 - 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., S. 95-98), selected 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, a decrease in perifocal inflammation.

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, leukomass is extracted from the blood by centrifugation, 20 ml of autoleukomass 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 autoleukomassa with 5-fluorouracil from the first bottle is injected 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 chemotherapy at autoleukomass with intravenous autohemotherapy is repeated once a week throughout the entire course of radiation treatment. Irradiation is carried out to SOD 40-70 Gy in the classical fractionation mode with a single dose of 2 Gy, 5 sessions per week.

The invention "A method for the treatment of colorectal cancer" is new, since it is not known in the field of medicine in the surgical and radiation treatment of unresectable primary and recurrent colorectal cancer with perifocal inflammation.

The novelty of the invention lies in the fact that 200 ml of blood is taken from patients, leukomass is isolated from the blood by centrifugation, 20 ml of autoleukomass 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 autoleukomass with 5-fluorouracil from the first vial is injected intracutaneously 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; intraintestinal chemotherapy with autoleukomass with intravenous autohemotherapy is repeated 1 time per week throughout the entire course of radiation treatment.

Thus, intraintestinal chemotherapy at autoleukomass increases the effectiveness of radiation therapy due to the direct antitumor effect of 5-fluorouracil on the tumor and the radiosensitizing effect, as well as reducing perifocal inflammation by bringing blood leukocytes to the site of beneficial effect.

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.

Examples of specific applications of the "Method for the treatment of colorectal cancer."

Patient G. Cheremskaya, born in 1932, medical history 14792 / f, was admitted to the Department of General Oncology, RNII on 08.08.05, with a diagnosis of rectal cancer, stage III, clinical group II.

Upon admission, she complained of cramping pains and bloating, constipation, pseudodefecation up to 6-8 times a day, periodically blood in the feces. Sick for 5 months. I went to the doctor at my place of residence in August 2005 and was sent to the RNII.

08/12/2005 operation - a laparotomy. An audit of the abdominal organs revealed: a tumor of the upper ampullar part of the rectum, inactive, fixed to the sacrum, 8 × 6 cm in size, stenotic lumen of the intestine, overlying sections of the colon are sharply expanded, up to 600 ml of turbid effusion in the abdominal cavity. No distant tumor metastases were detected. Performed double-barreled sigmoidostomy. The postoperative period was uneventful. Sutures were removed on day 12.

Postoperative diagnosis: cancer of the upper ampulla of the rectum T4N × M0, stage III, clinical group II.

200 ml of autologous blood was taken from the patient, leukomass was isolated from the blood by centrifugation, 20 ml of autoleukomass and 5-fluorouracil 1000 mg were placed in the first bottle, the remaining blood cells and plasma were placed in the second bottle; separately incubated vials for 40 minutes at 37 ° C; then autoleukomass with 5-fluorouracil from the first vial was injected 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; intraintestinal chemotherapy at autoleukomass with intravenous autohemotherapy was repeated 1 time per week throughout the course of radiation treatment. SOD for the primary tumor of 40 Gy with a single dose of 2 Gy, 5 sessions per week.

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.

A month after treatment, the patient underwent a radical operation: anteroposterior resection of the rectum. Postoperative histoanalysis No. 823660-666 - moderately differentiated adenocarcinoma with ulceration and invasion of all layers; there are no cancer metastases in the regional lymph nodes.

With appearances at the RNII within 1.5 years after treatment, there is no data for progression. The patient's condition is satisfactory.

Patient N. Lopin, born in 1942, medical history 3759 / f, was admitted to the Department of General Oncology, RNII on 10.03.05, with a diagnosis of stage III colon cancer, clinical group II. Condition after anteroposterior rectal resection 12.10.04,

Upon admission, he complained of pain in the rectum, more often during bowel movements, an admixture of blood and mucus in the feces, loss of appetite, general weakness. Deterioration of the condition notes within 3 months. Turned to the RNII.

When fibrocolonoscopy in the clinic RNII found a recurrent tumor in the area of the anastomosis. Histological analysis No. 788241 - adenocarcinoma with purulent inflammation.

After preoperative preparation, March 22, 2005, an operation was performed - relaparotomy. During the audit, a motionless tumor of the rectum, dense, motionless, growing into the walls of the small pelvis. There are no distant metastases. The case was found to be unresectable, due to partial intestinal obstruction, a double-barreled sigmostoma was imposed.

The postoperative period was uneventful. Sutures were removed on day 11.

200 ml of autologous blood was taken from the patient, leukomass was isolated from the blood by centrifugation, 20 ml of autoleukomass and 5-fluorouracil 1000 mg were placed in the first bottle, the remaining blood cells and plasma were placed in the second bottle; separately incubated vials for 40 minutes at 37 ° C; then autoleukomass with 5-fluorouracil from the first vial was injected 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; intraintestinal chemotherapy at autoleukomass with intravenous autohemotherapy was repeated 1 time per week throughout the course of radiation treatment. SOD in the pelvic area 40 Gy with a single dose of 2 Gy, 5 sessions per week.

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 health is relatively satisfactory.

The proposed method treated 20 patients with locally advanced colorectal cancer and 7 patients with recurrent colorectal cancer with perifocal inflammation. The use of primary locally advanced rectal cancer was able to translate into a resectable form and radically operated on.

The technical and economic effectiveness of the "Method of treating cancer" is that the use of the method allows to increase the effectiveness of radiation therapy, 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 colorectal cancer, including surgical treatment in the volume of a double-barreled sigmoidostomy, chemotherapy, radiation therapy, characterized in that in the postoperative period before the start of radiation therapy, 200 ml of autologous blood is sampled, autoleukomass is extracted from the blood by centrifugation, 20 ml is placed in the first vial autoleukomass and 5-fluorouracil 1000 mg, in the second vial - the remaining blood cells and plasma, vials with contents are incubated separately for 40 minutes at 37 ° C; then autoleukomass 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, then radiation treatment sessions are carried out, radiation is performed in the classical fractionation mode with a single dose of 2 Gy 5 sessions per week to the primary tumor SOD 40-70 Gy, intraintestinal chemotherapy on autoleukomass with intravenous autohemotherapy is repeated once a week during the course of radiation treatment.