RU2372950C2 - Thermochemoradiation therapy of oesophageal cancer - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, oncology, and can be used for thermochemoradiation therapy of oesophagus cancer. That is ensured by local transoesophageal hyperthermia, gamma-ray teletherapy and chemotherapy as preoperative actions. Herewith gamma-ray therapy is carried out within 2 weeks in average fractionation mode at 3 Gy 5 times a week to total focal dose 30 Gy. Chemotherapy accompanies the whole course of gamma therapy by daily introduction of fluorouracil dosed 300 mg/m² to the central vein in continuous infusion mode and daily intravenous introduction of cisplatin dosed 6 mg/m² daily within 1 hour. Hyperthermia is applied on 4^th, 8^th and 12^th days of gamma therapy immediately before irradiation session at temperature 42-44°C within 60 minutes.

EFFECT: method allows optimising treatment of the patients suffering from oesophagus cancer and improving clinical effectiveness owing to advanced local control.

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Description

The invention relates to medicine, namely to combined thermo-chemoradiotherapy, and is intended for the most effective multicomponent treatment of cancer of the esophagus.

Known recognized methods for the combined treatment of cancer of the esophagus. The treatment standard for patients is combined exposure to preoperative radiation or chemoradiotherapy [1].

Promising methods for increasing the effectiveness of radiation therapy include local hyperthermia [2], which is a powerful adjuvant of radiation and chemotherapeutic effects. According to the criterion of complete regression, the effectiveness of thermal radiation therapy is one and a half to two times higher than that of radiation therapy alone.

The use of hyperthermia in combination with chemoradiotherapy or chemotherapy as a neoadjuvant effect in patients with esophageal cancer is also known [3, 4]. Radiation therapy is carried out in the traditional fractionation mode for 3-4 weeks.

However, an analysis of the results of surgical, combined and radiation treatment of cancer patients suggests that in 5-30% of cases, the cause of death is a relapse of the tumor. This indicates a lack of effectiveness of the applied methods of treatment.

The aim of the proposed method is to increase the efficiency and optimization of the treatment of patients with cancer of the esophagus.

The essence of the proposed method consists in the application of local hyperthermia in the radio frequency mode of radiation and chemoradiotherapy according to a certain scheme.

The proposed method meets the criterion of "novelty," because, unlike the analogue and prototype, it has the following significant distinguishing features:

- a session of hyperthermia is carried out for 60 min in the regime of hyperthermia with a temperature of 42-44 ° C;

- the frequency of hyperthermia sessions 3 times in 2 weeks during preoperative chemoradiotherapy;

- dose hypofractionation regimen during radiation therapy;

- use as an additional radiomodification of polychemotherapy.

Due to the presence of these features in this method, as well as their use in combination and a certain sequence of actions, we can conclude that the proposed method corresponds to the inventive step.

The proposed method is as follows.

Radiation therapy is carried out in the mode of average fractionation of 3 Gy 5 times a week to a total focal dose of 30 Gy, which corresponds to 38 isoGy of traditional fractionation. The duration of radiation treatment is 2 weeks.

Polychemotherapy is carried out from the first day of radiation treatment by applying 300 mg / m ² fluorouracil daily intravenously into the central vein in a continuous infusion mode throughout the entire course of remote radiation therapy with a total dose of the drug for the entire course of 3600 mg / m (5500 mg) and cisplatin 6 mg / m ² daily intravenously for 1 hour with a total dose of the drug for the entire course of 72 mg / m ² (110 mg).

Radiomodification through local hyperthermia through the transesophageal electrode is carried out, starting from the fourth session of radiation therapy, after summing up the total focal dose of 12 Gy, immediately before the irradiation session, at 4, 8 and 12 days of treatment, at a temperature of 42-44 ° C, for 60 minutes .

After a 2-week break, the effectiveness of thermo-chemotherapy is assessed by the degree of resorption of the primary tumor, after which the surgical stage of treatment is performed.

The proposed method was applied in 8 patients suffering from cancer of the esophagus. The frequency of complete tumor regressions was 55%, partial regressions - 45%. The overall effect was 100%. Subsequently, all patients underwent surgical treatment according to a radical program. There were no complications during the proposed method.

We present clinical examples of the application of the method.

Example 1. Patient L., 57 years old. Diagnosis: cancer of the middle third of the esophagus T2N0M0. Dysphagia 2 tbsp. Histological conclusion: highly differentiated squamous cell carcinoma. Conducted preoperative thermo-chemoradiation treatment of the claimed method. In the study of the removed drug established therapeutic pathomorphism 3 tbsp.

Example 2. Patient G., 65 years old. Diagnosis: cancer of the middle third of the esophagus T3N0M0. Dysphagia 2 tbsp. Histological conclusion: moderately differentiated squamous cell carcinoma. Preoperative thermo-chemoradiotherapy was performed by the claimed method, after which a subtotal resection of the esophagus was performed. In the study of the removed drug, therapeutic pathomorphosis of 4 tbsp.

Example 3. Patient Yu., 50 years old. Diagnosis: cancer of the middle third of the esophagus T3N0M0. Dysphagia 3 tbsp. Histological conclusion: moderately differentiated squamous cell carcinoma. Conducted preoperative thermo-chemoradiation treatment of the claimed method. In the study of the removed drug, therapeutic pathomorphosis of 4 tbsp.

Thus, the application of the proposed method can improve the efficiency and optimize the treatment of patients with cancer of the esophagus.

Literature

1. Berdov B.A., Kurpeshev O.K., Mardynsky Yu.S. The effect of hyperthermia and hyperglycemia on the effectiveness of radiation therapy for cancer patients. // Russian Oncology Journal. - 1996. - No. 1. - S.12-16.

2. Mardinsky Yu.S., Berdov B.A., Konoplyanikov A.G. Radiobiological substantiation and clinical results of thermoradiotherapy of malignant tumors // Questions of Oncology. - 1995. - No. 2. - S. 61-64.

3. Sugimachi K., Kuwana H., Baba K., et al. Hyperthermia combined with chemotherapy and irradiation for patients with carcinoma of the oe sophagus: a prospective randomized trial // Int. J. Hyperthermia. 1992; 8: 289-295.

4. Sugimachi K., Kitamura K., Ide H .., et al. Chemotherapy combined with or without hyperthermia for patients with oesophageal carcinoma: a prospective randomized trial // Int. J. Hyperthermia. 1994; 10: 485-493.

Claims (1)

Method for thermo-chemoradiotherapy of esophageal cancer by combining local transesophageal hyperthermia, remote gamma therapy and chemotherapy as a preoperative effect, characterized in that gamma therapy is carried out for 2 weeks in the mode of average fractionation of 3 Gy 5 times a week to the total focal doses of 30 Gy, chemotherapy is carried out throughout the course of gamma therapy by introducing 300 mg / m ² fluorouracil daily into the central vein in a continuous infusion regimen and cisplatin according to
6 mg / m ² daily intravenously for 1 h, and hyperthermia is carried out on days 4, 8 and 12 of gamma therapy immediately before an irradiation session at a temperature of 42-44 ° C for 60 minutes.