RU2352340C1 - Method of chemotherapy at bladder cancer - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, in particular, oncourology and can be used at treatment of a cancer of bladder. The essence of the method consists that after endoscopic oncotomy of a bladder a flexible needle is pulled in a resectoscope radiographic cone, 200 mg of Cyclophosphanum, incubated with 20 ml of plasma of the patient is injected through the submucosal layer in the basis of the removed tumour and in 6 points round it and a depot of chemical preparations is created in a zone of the removed tumour.

EFFECT: reduction of frequency of local recuring of tumours at the expense of cytotoxic action of chemical preparation by lymphogenous micrometastasises at intraparietal introduction, decrease of frequency of postoperative cystitis at the expense of chemical preparations introduction on autoplasma.

1 ex

Description

The invention relates to medicine, in particular to oncology, and can be used in the combined treatment of patients with superficial bladder cancer.

The well-known "Method of endoscopic surgical treatment of superficial bladder cancer" (see the book "Modern Diagnosis and Surgery of Bladder Cancer". / Edited by MI Kogan and VA Perepechay Rostov-on-Don, Rostov State Medical University , 2002, p.61-66), which consists in removing the tumor with a resectoscope loop, starting from the front or back surface of its papillary part, followed by resection of the tumor base and coagulation of bleeding vessels. It is recommended to combine transurethral resection of the surfaces of the bladder tumor with postoperative intravesical chemotherapy, since surgical treatment does not stop the development of the tumor process.

The well-known "Method of chemotherapeutic treatment of superficial bladder cancer" (see the book "Clinical Oncourology". / Under the editorship of Professor Matveev BP M: Russian Cancer Research Center named after Blokhin RAMS, 2003, p. 260-270 consisting mainly of adjuvant intravesical chemotherapy. It is usually prescribed after surgery (TUR), i.e. it is a question of drug chemotherapy to prevent relapse of the disease. Currently, doxorubicin and epirubicin are most often used for this purpose. dose of 20-50 mg in 50 ml saline exposure 1-1.5 hours. Instillation 1-2 times per week 6-10 procedures.

The disadvantages of this method of chemotherapeutic prophylaxis of relapse are relatively low efficiency (relapse rate from 30 to 56%), the occurrence of toxic cystitis, sometimes not allowing the course of treatment to be completed, the frequency of treatment courses.

The aim of the invention is to reduce the frequency of local recurrence of superficial bladder tumors, reduce the toxic effects of chemotherapy with topical application and postoperative cystitis, increase the effectiveness of treatment. This goal is achieved by the fact that the "Method of chemotherapy for bladder cancer" is presented, including transurethral resection of the bladder, intravesical administration of antitumor chemotherapy drugs, characterized in that after endoscopic removal of the tumor of the bladder, a flexible needle is passed into the tube of the resectoscope and a submucosal layer is passed through it 200 mg of cyclophosphamide, incubated with 20 ml of the patient’s plasma, is introduced into the base of the removed tumor and at 6 points around it, and chemotherapy is created in the area of the removed tumor.

The invention "A method for chemotherapy for bladder cancer" is new, as it is unknown from the level of medicine in the field of chemotherapeutic and endoscopic surgical treatment of superficial bladder cancer.

The novelty of the invention lies in the fact that after endoscopic removal of a tumor of the bladder, a flexible needle is passed into the tube of the resectoscope, 200 mg of cyclophosphamide incubated with 20 ml of the patient’s plasma is introduced into the submucosal layer at the base of the removed tumor and 6 points around it. chemotherapy depot in the area of the removed tumor.

The invention "A method for chemotherapy for bladder cancer" is industrially applicable, as it can be reproduced in healthcare institutions, cancer research institutes, cancer dispensaries and other medical institutions involved in the treatment of patients with bladder cancer using transurethral resection techniques.

The method of chemotherapy for bladder cancer is as follows. A patient with superficial bladder cancer who is scheduled to undergo transurethral resection is sampled to receive 20 ml of plasma by natural separation in a sterile vial for 4 hours. The plasma is then incubated with 200 mg of cyclophosphamide for 30 minutes at a temperature of 37 ° C. The drug is administered endoscopically, during a transurethral operation immediately after removal of the tumor and vaporization of its base with coagulation of bleeding vessels, using a specially designed flexible needle, which is an ureteral catheter No. 6, the tip of the injection needle is mounted in the “working” end, and in the opposite - a cannula for attaching a syringe to the base of the removed tumor and 6 points around it at a distance of about 1 cm under visual control. A chemically injected area is created up to 4 cm in diameter. The operation is completed by the installation of a three-way urethral Foley catheter. In the postoperative period, in order to prevent relapse before removal of the urethral catheter, an intravesical instillation of 20 mg doxorubicin diluted in 50 ml of physiological saline is performed with compression of the catheter for 2 hours. Intravesical instillations are repeated once a week for 6 weeks. The method of transurethral intraoperative intravenous administration of a chemotherapy drug on the patient’s autoplasma provides high treatment efficiency, which is expressed in a decrease in the frequency of local recurrence of bladder cancer (on average by 28%), a decrease in the number of cases of toxic cystitis compared with the use of intravenous injections of chemotherapy without autoplasma. Intramenal administration of a chemotherapy also has a direct cytotoxic effect on lymphogenous micrometastases around the main focus of tumor lesion.

An example of a specific implementation of the "Method of chemotherapy for bladder cancer."

Patient N., 63 years old, medical record No. 20332 / x, was admitted to the Department of Oncourology 10/29/06. According to the survey, including an ultrasound examination of the pelvic organs, cystoscopy with a biopsy of a tumor of the bladder, the diagnosis was established: bladder cancer T1N0Mo, class 2. On 03/03/06, the patient was sampled to obtain 20 ml of plasma, which was incubated for half an hour with 200 mg of cyclophosphamide. After transurethral resection of the bladder, endoscopically under visual control, an intra-wall injection of a chemopreparation on autoplasma into the base of the removed tumor and 6 points around it was performed. Surgery is completed by staging a three-way urethral catheter. On the third day, the patient's condition is satisfactory, an intravesical instillation of doxorubicin 20 mg was made, 1.5 hours after which the urethral catheter was removed, urination is independent, free.

On the 5th day after the operation, the patient was discharged in a satisfactory condition from the hospital for follow-up and recommended continuing intravesical instillation of doxorubicin once a week for 5 weeks at the oncologist's place of residence.

02/08/06 during the control examination, the patient's condition is satisfactory, urination is not impaired. According to ultrasonographic examination and cystoscopy, no relapse of the bladder tumor was detected, observation continued.

The technical and economic effectiveness of the "Method of chemotherapy for bladder cancer" is that it is possible to achieve:

- reduce the frequency of local recurrence;

- reduce the incidence of postoperative cystitis;

- improving the quality of life of the patient.

Claims (1)

A method of chemotherapy for bladder cancer, including transurethral resection of the bladder, intravesical administration of antitumor chemotherapy drugs, characterized in that after endoscopic removal of the tumor of the bladder, a flexible needle is passed into the tube of the resectoscope, a submucosal layer is inserted through it into the base of the removed tumor and 6 points around it 200 mg of cyclophosphamide, incubated with 20 ml of the patient’s plasma and create a depot of chemotherapy in the area of the removed tumor.