RU2356589C1 - Oesophageal carcinoma therapy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used in oesophageal carcinoma therapy. Substance of the invention consist that prior to radiation therapy, autoblood 400 ml is sampled. Plasma is separated by centrifugation. The first bottle is filled with autoplasma 40 ml and 5-fluorouracil 500 mg, while the second and third bottles are filled with autoplasma 40 ml, and the fourth with residual blood corpuscles and methotrexate 20 mg. The second and third bottles are frozen, and the first and fourth bottles are separately incubated for 40 minutes at 37°C. Then mixed autoblood and methotrexate from the fourth bottle are reinfused droplet-intravenously, mixed autoplasma and 5-fluorouracil from the first bottle are introduced into oesophagus through nasoesophageal probe and followed with the first session of radiation therapy. Intraesophageal autoplasma chemotherapy is carried out one day after the autoplasma bottle is unfrozen, added with 5-fluorouracil 500 mg and incubated in a thermostat. The entire therapy cycle is carried out for the following weeks of radiation therapy; irradiation is involved to TBD (total basic dose) 40-60 Gy at a single dose 2 Gy including 5 sessions a week.

EFFECT: method allows improving effectiveness of radiation therapy ensured by direct antineoplastic exposure of intraesophageal autoplasmochemotherapy and radiosensitisation of autohemochemotherapy.

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Description

The invention relates to medicine, namely to Oncology, and can be used in the complex treatment of unresectable cancer of the esophagus with symptoms of dysphagia.

The well-known "Method for the treatment of advanced cancer of the esophagus" (V. Moiseenko. Possibilities of modern drug treatment of patients with esophageal cancer. // Practical Oncology. T.4. 2003. No. 2. P.84-90) using chemotherapy. The method consists in administering a combination of chemotherapy drugs cisplatin and 5-fluorouracil, the latter being administered as a continuous infusion over 4-5 days. The effectiveness of such treatment is 25-45%.

However, the treatment is highly toxic, up to toxic mortality. With extreme caution, such chemotherapy should be used in patients who have a pronounced loss of body weight (more than 20%) over a short period of time (3-6 months), which significantly increases the risk of complications. Such chemotherapy is contraindicated in cachexia, pronounced concomitant pathology, active inflammatory process, reduced peripheral blood counts.

The well-known "Method of endoscopic restoration of the lumen of the esophagus" (Moreira LS, Coelbo CL, Sadala RU et al. The use of ethanol injection under endoscopic control to palliate disphagia caused by esophagogastric cancer // Endoscopy. 1994. Vol.26. P.311-314) with 96% ethyl alcohol, causing aseptic necrosis of the tumor. The method consists in endoscopic chipping of the entire surface of the tumor with ethyl alcohol, with up to 1 ml of ethanol being injected in one injection, the total volume of alcohol introduced in one session does not exceed 8-10 ml.

However, the method is possible only in tumors with a pronounced exophytic component, the effect is only in improving the patency of the esophagus, recurrence, tumor metastasis, and patient survival are not traced.

The well-known "Method of conservative treatment of locally advanced cancer of the esophagus" (Rubtsov VR Conservative treatment of locally advanced cancer of the esophagus: Author. Dis. ... Doctors of Medical Sciences. L., 1989. 27 pp.), Which consists in the use of methotrexate administration against the background of radiation treatment and BCG vaccines into the lymphatic system through the lymph vessels of the lower limb. Significant antitumor efficacy of the proposed method for the combined treatment of locally advanced esophageal cancer has been established.

The well-known "Method for the treatment of colorectal cancer" (Gevorkyan Yu.A., Soldatkina N.V., Dontsov V.A. Intraintestinal chemotherapy on autoplasm during a course of radiation therapy in improving the quality of life of patients with unresectable rectal cancer. // Materials of 5 conference “Problems of the quality of life in healthcare”, October 14-19, 2007, Turkey), which we selected as a prototype. The method consists in the fact that in order to increase the effectiveness of radiation treatment of colorectal cancer, introintestinal chemotherapy on autoplasma was used. Using 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.

However, the method is applicable only in patients with colorectal cancer with a double-barreled colostomy.

The aim of the invention is to increase the efficiency of radiation treatment of patients with unresectable cancer of the esophagus, reduce dysphagia, improve the quality of life of patients.

This goal is achieved in that in patients with unresectable cancer of the esophagus with symptoms of dysphagia, 400 ml of autologous blood is taken before the course of radiation therapy, plasma is centrifuged from the blood, 40 ml of autoplasma and 5-fluorouracil 500 mg are placed in the first bottle, in the second and third vials - 40 ml of autoplasm, in the fourth bottle - the remaining blood cells and methotrexate 20 mg; the second and third vials are frozen, and the first and fourth vials are separately incubated for 40 minutes at 37 ° C. Then autologous blood with methotrexate from the fourth vial is reinfused intravenously. An autoplasma with 5-fluorouracil from the first vial is inserted through a naso-esophageal probe into the esophagus. Then produce the first session of radiation treatment. Intraesophageal chemotherapy on autoplasma is repeated every other day (before the 3rd and 5th session of radiation therapy). In the following weeks of radiation treatment, the entire treatment cycle is repeated. Irradiation is carried out to SOD 40-60 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 cancer of the esophagus" is new, since it is unknown in the field of medicine for radiation and chemotherapeutic treatment of unresectable cancer of the esophagus.

The novelty of the invention is that in patients before starting a course of radiation therapy, 400 ml of autologous blood is collected, centrifuged from the blood, plasma is isolated, 40 ml of autoplasma and 5-fluorouracil 500 mg are placed in the first bottle, and 40 ml in the second and third bottles autoplasma, in the fourth vial - the remaining blood cells and methotrexate 20 mg; the second and third vials are frozen, and the first and fourth vials are separately incubated for 40 minutes at 37 ° C. Then, autologous blood with methotrexate from the fourth vial is reinfused intravenously. An autoplasma with 5-fluorouracil from the first vial is inserted through a naso-esophageal probe into the esophagus. Then produce the first session of radiation treatment. Intraesophageal chemotherapy on autoplasma is repeated every other day (before the 3rd and 5th session of radiation therapy). In the following weeks of radiation treatment, the entire treatment cycle is repeated. Irradiation is carried out to SOD 40-60 Gy in the classical fractionation mode with a single dose of 2 Gy, 5 sessions per week.

Thus, intraesophageal chemotherapy on autoplasma with intravenous chemotherapy on blood cells contributes to an increase in the effectiveness of radiation therapy due to the direct antitumor effect of 5-fluorouracil on the tumor and the radiosensitizing effect.

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

An example of a specific application of the "Method for the treatment of cancer of the esophagus."

Patient G., born in 1932, medical history 136 / c, was admitted to the Department of General Oncology, RNII on 01.15.07 with a diagnosis of esophageal cancer, T4N1M1, stage IV, clinical group II, dysphagia.

On admission, she complained about the difficulty of passing solid and liquid food through the esophagus, weight loss, weakness. Sick for 3 months. He went to the doctor at the place of residence in December 2006 and was sent to the RNII.

An examination in the department revealed that 32 cm from the incisors, the patient has a circular stenotic tumor (FES), histological analysis No. 947532: squamous cell carcinoma. Computed tomography revealed that the tumor sprouts the entire wall of the esophagus, spreads to the mediastinal tissue, metastases in the intrathoracic lymph nodes, and lymph nodes in the celiac trunk up to 3.5 cm in diameter. Due to the unresectable tumor, the patient decided to conduct a course of chemoradiotherapy. A 400 ml autologous blood sample was taken from a patient, plasma was extracted from the blood by centrifugation, 40 ml autoplasma and 5-fluorouracil 500 mg were placed in the first vial, 40 ml autoplasma in the second and third vials, the remaining blood cells and methotrexate in the fourth vial 20 mg; the second and third vials are frozen, and the first and fourth vials are separately incubated for 40 minutes at 37 ° C. Then, autologous blood with methotrexate from the fourth vial was reinfused intravenously. An autoplasm with 5-fluorouracil from the first vial was inserted through a naso-esophageal probe into the esophagus. Then made the first session of radiation treatment. Intraesophageal chemotherapy on autoplasma is repeated one day after defrosting the autoplasma vial (before the 3rd and 5th session of radiation therapy). In the following weeks of radiation treatment, the entire treatment cycle was repeated. Irradiation was carried out up to SOD 40 Gy in the classical fractionation mode with a single dose of 2 Gy, 5 sessions per week.

During the course of chemoradiotherapy (4 weeks), general and biochemical blood tests without features, the level of leukocytes did not decrease. By the middle of the course of treatment, the patient began to regress the symptoms of dysphagia; by the end of the treatment, the patient had no complaints of difficulty in passing food.

The patient was discharged in satisfactory condition with the recommendation of conducting chemotherapy courses at the place of residence.

With appearances at the RNII within 9 months after treatment, there is no data on the progression of the disease. The patient's condition is satisfactory, there is no dysphagia.

The proposed method treated 12 patients with unresectable cancer of the esophagus. The use of intraesophageal chemotherapy on autoplasma with intravenous chemotherapy on blood cells does not cause changes in the general biochemical analysis of blood, improves the general condition of patients, helps restore patency of the esophagus and reduces dysphagia, and is characterized by low toxicity. Patients were monitored in the range from 3 months to 1 year. During the observation period, not a single case of disease progression was revealed, not a single patient needed a gastrostomy overlay for nutrition, 1 patient with unresectable locally advanced esophageal cancer managed to be converted to a resectable form and radically operated on.

The technical and economic efficiency of the “Method for the treatment of cancer of the esophagus” consists in the fact that the use of the method allows to increase the effectiveness of radiation therapy, reduce dysphagia, increase the time before applying a gastrostomy to nourish patients, transfer some 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 for treating cancer of the esophagus, including chemotherapy and radiation treatment, characterized in that 400 ml of autologous blood is collected from patients before the start of a course of radiation therapy, plasma is separated by centrifugation, 40 ml of autoplasma and 5-fluorouracil 500 mg are placed in the first vial, the second and third vials - 40 ml of autoplasm, in the fourth - the remaining blood cells and methotrexate 20 mg; the second and third vials are frozen, and the first and fourth vials are separately incubated for 40 min at 37 ° C, then autoblood with methotrexate from the fourth vial is reinfused intravenously, autoplasma with 5-fluorouracil from the first vial is injected through the naso-esophageal probe into the esophagus and the first session is performed radiation treatment; intraesophageal chemotherapy on autoplasma is repeated one day after defrosting the autoplasma vial, adding 500 mg of 5-fluorouracil and incubating in a thermostat before the 3rd and 5th sessions of radiation therapy, the treatment cycle is repeated in the next weeks of radiation treatment, irradiation is carried out until SOD 40-60 Gy with a single dose of 2 Gy, 5 sessions per week.