RU2402990C1 - Method of treating basal cell carcinoma - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, oncology, and can be used for treating basal cell carcinoma. It involves cryodestruction of a tumours with a contact cryoapplicator made of porous-permeable titanium nickelide and cooled with liquid nitrogen. Cryodestruction represents one-stage pressure of the cryoapplicator to the whole surface of the tumour with exposition for 1-2 minutes. ^ EFFECT: method provides accurate localisation of a freezing area and depth delimitation of the resected tissue volume that promotes the preservation of healthy tissues; allows reducing stress loads of the treatment. ^ 4 dwg, 2 ex

Description

The invention relates to medicine and can be used for cryodestruction of basal cell carcinoma, including localized in problematic anatomical zones.

Basal cell carcinoma (basal cell carcinoma) is the most common malignant tumor of the skin. Among a variety of malignant skin epithelial neoplasms, basal cell carcinoma prevails by a wide margin from the rest - up to 97% of cases detected in Moscow from 1996 to 1999. There has been a marked increase in the incidence of BKR over the past decades around the world - in the United States daily - up to 700 thousand, with an increase of up to 10% per year; a noticeable increase in the incidence is observed in Russia. Thus, the relevance of the search for treatment for this type of cancer is great.

According to statistics, the disease prevails in a solitary form (80-85%) and only in other cases - in a disseminated or grouped multiple form, without metastasis. Typical tumor localization in open places subject to inhalation, as a rule, on the head: up to 96% of cases on the face (nose, nasolabial, periorbital regions, forehead, temples, auricles). Such a superficial, visually accessible location of the tumor, the impressive cosmetic damage created by it (Fig. 1) causes aesthetic discomfort among others, leads to additional (except oncophobia) psycho-emotional suffering of the patient.

The specificity of the disease determines the methods of treatment, among which the destructive methods typical of oncological forms prevail: surgical removal, laser therapy, close-focus x-ray therapy, electrocoagulation and curettage [Snarskaya E.S., Molochkov V.A. Basalioma M .: Medicine, 2003, p. 55]. Chemotherapy is also used (cytostatics, immunocorrector, their combination), less effective. These methods have passed their history, correlated with the development of technical means, have their own advantages and disadvantages.

So, with surgical removal of the tumor, its recurrence is provoked in unacceptably frequent - up to 40% of cases. Layer-by-layer micrographic removal with histological operational control increases efficiency, but is very laborious. Radiation therapy is immunosuppressive, and a more gentle method of photodynamic therapy is technically difficult, because it requires the use of selected photosensitizers and sophisticated laser technology.

The most modern, progressive, widely used treatment method - cryodestruction - consists in the destruction of a tumor by its quick and deep (cryo) freezing. The validity and advantages of this area of oncological surgery are explained by the superficial nature of basal cell carcinomas, thin-layered structure (penetration depth in the region of the basal layer of the skin integument of about 3 mm) and a rather sharp outline of the tumor borders. The ability to clarify the real boundaries of the tumor in vivo with the help of tomo densitometry, B-scan sonography, and optical control methods helps to increase the local correctness of destruction. Cryodestruction methods for the treatment of basal cell carcinoma vary in technical means of cryotherapy and the corresponding modes for each type of equipment.

A known method of cryodestruction of neoplasms [Rylkin A.I., Kochenov V.I. Cryotherapy in patients with chronic tonsillitis - Abstracts of the Vth All-Russian Congress of Otolaryngologists. - Izhevsk, 1989, pp. 116-117]. A cryoapplicator with liquid nitrogen circulating in its cavity is used for cryotherapy. Weak thermal contact of the cryoapplicator does not allow deep freezing of tissues.

In the known method of cryodestruction [Shental V.V., Tabolinovskaya TD, Pustynsky II Practical cryosurgery. - M., 1995, pp.19-21] to improve the thermal contact, the surface of the pathological tissue is moistened, and in the method [RF Patent No. 2237449] for this purpose, a hanging drop of liquid is applied to the applicator with complex manipulation of heating and subsequent freezing of this drop in contact with a cloth. The methods are complex in terms of technical means and functionally limited.

A known method of cryodestruction of bazadiomas, including cryotherapy on the tumor through dry contact with tissue, using chilled copper disks, cotton swabs or spraying liquid nitrogen directly onto the tumor site [Snarskaya ES, Molochkov V.A. Basalioma - M .: Medicine, 2003, p. 55]. In this method, to achieve the necessary conditions for local cryodestruction, multiple exposures are used with intermediate thawing of the tumor, in compliance with the regulations, with increased labor costs, with psychological damage to the patient. The disadvantage is the blurred outline of the boundaries of freezing, which leads to the possibility of iatrogenic errors.

By the greatest similarity with the proposal, this method is selected as an analogue - prototype.

The technical result of the invention is to increase the effectiveness of the treatment of basal cell cancer.

The specified technical result is achieved by the fact that in the method of treating basal cell cancer by cryodestruction of the tumor, said cryodestruction is carried out using a contact cryo-applicator from permeable-porous titanium nickelide cooled with liquid nitrogen, and cryotherapy on the tumor after preliminary determination of its depth is carried out by simultaneously pressing the cryo-applicator to the entire the surface of the tumor with an exposure of 1.0 ÷ 2.0 minutes.

The advantages of cryotherapy of neoplasms are known and convincing, as described in the prior art. The containment of its wide distribution is due to the lack of convenient and affordable technical means. Provincial district hospitals and even medical services of large settlements are not able to contain expensive, complex cryogenic installations of analogue methods in design and operation. The progress of cryotherapy and minimally invasive cryosurgery was indicated with the advent of cryoapplicators from permeable-porous titanium nickelide. The advantages of this material over other traditional medical materials in the function of refrigerant carriers are determined by the properties of titanium nickelide - high heat capacity and inertial heat transfer, high hygroscopicity and the ability to control heat transfer due to porosity characteristics [Melnik D. D., Gunter V.E. and other hemangiomas. SSMU; Tomsk: NIIMM, 2001, p. 76]. The material is highly biocompatible, certified for widespread use in medicine.

The increase in the effectiveness of the treatment of BCC using nickelide-titanium cryoapplicators, compared with the prototype, is due to the following factors.

1. Due to the clear localization of the freezing zone, which corresponds to the contact area of the working surface of the cryoapplicator, the method eliminates subjectivity in the resection of the intended tumor volume in its surface coordinates. The “cold” reserve, defined and determined by the volume of porous cryodepo and the constant temperature of the refrigerant (liquid nitrogen - 196 ° C), makes it possible to sharply delimit the volume of the resected tissue in depth. This is especially important for maintaining healthy tissue in a flat shape and limited thickness (several mm) of superficial basal cell carcinomas. The correctness of the resection is a preliminary determination of the proliferation depth (thickness of a flat-shaped tumor) for the correct choice of cryodepo capacity and exposure exposure. The latter was experimentally tested on different forms of basal cell carcinoma in the range of 1.0 ÷ 2.0 min. The procedure, in contrast to the prototype, is performed once, which facilitates the stress load of the patient and thereby stimulates the acceleration of convalescence.

2. Compact, structurally simple (figure 2) and relatively lightweight for delicate surgical procedures, the cryoapplicator device allows you to operate in places inaccessible and not shown for the prototype, located in the corners of the eyes, in the nasolabial region, on the wings of the nose, on the ears, on the histological type of tumor "morphea."

3. The economic accessibility of the device, the relative simplicity of the treatment process (condition for the course improvement of the oncologist surgeon) can expand the scope of the method to the scale of district hospitals. The increasing prevalence of the disease in the regions of Russia (for example, in the Republic of Tuva) makes this factor paramount in relevance.

The method after diagnosing the disease and preparing the patient is carried out by applying to the tumor a cryoapplicator cooled in liquid nitrogen (Fig. 3), its working surface 2 (Fig. 2), holding it in a state of compression for 1.0-2.0 minutes (according to indications ) With extensive tumors that exceed the area of the contact surface of the cryoapplicator, cryodestruction is carried out by a series of consecutive single actions with overlapping the entire surface of the tumor.

After cryoapplication, the process of tissue destruction and repair occurs without the intervention of a doctor. Erythema with edema develops, moderate soreness, then a bubble forms, then - necrosis and rejection of the exposed tissues and, finally, scarring of the wound.

The proposed cryotherapy regimen for a specific pathology - basal cell carcinoma - in conjunction with a well-known technical means - a nickelide-titanium cryoapplicator is original. It is not obvious in detail to the specialist, it has been identified from experimental and clinical studies, which indicates that the proposal meets the criterion of "inventive step".

The illustrations show:

Figure 1. Photos of the patient before surgery.

Figure 2. Appearance of the cryoapplicator.

1 - cryodepo, 2 - working end, 3 - contact area, 4 - insulated handle.

Figure 3. The working moment of tumor cryodestruction. 5 - a tumor.

Figure 4. Photo of the patient after surgery.

Achievability of the technical result is confirmed by animal experiments and specific examples of the treatment of basal cell carcinomas, in the Oncology Research Institute of the Siberian Branch of the Russian Academy of Medical Sciences, in the head and neck tumor clinic (Tomsk).

Example 1

Patient K., 54 years old, medical history No. 136678, was admitted to the clinic with symptoms of a tumor of the skin of the temporal region on the left (figure 1). Examination of the patient completed cytological conclusion - basal cell carcinoma. On an outpatient basis, a patient underwent surgical treatment on 16.02.2005 - cryodestruction of a skin tumor of the temporal region. The operation was performed using a cryodestructor of permeable-porous titanium nickelide (figure 2) with dimensions and characteristics:

The diameter of the cryodepo is 1-14 mm, the diameter of the working end is 2-10 mm, the porosity of the material is 50%, the cryodepo capacity when heated from nitrogen temperature to room temperature for 3 minutes. The contact pad 3 of the working end 2 is polished to prevent freezing of the tool to the fabric.

The method is as follows.

After sedation by simultaneously pressing the cryodestructor and holding it for 60 s, the standing zone of the tumor and underlying tissues were frozen to a depth of about 3 mm (Fig. 3). The entire surface of the tumor is treated with five-fold cycling of the indicated action by successive movement of the applicator in adjacent areas. Further medical actions came down to monitoring the process and the patient’s condition. 14 days after the operation, soft scar tissue was noted in the area of the former tumor; after 6 months, a whitish scar about 2 cm in size (Fig. 4). Dynamic outpatient observation of the patient for 4 years of tumor recurrence was not detected. A completely specious, satisfying patient and doctors postoperative cosmetic effect was noted.

Example 2

Patient Z., 63 years old, medical history No. 144276, was admitted to the hospital with a diagnosis - basal cell carcinoma of the medial corner of the eye on the left, after a double attempt at radiation treatment. Tumor recurrence after a temporary regression and localization, which is dangerous for eyesight, prescribed cryodestruction, which was carried out according to the proposed method on November 14, 2007.

The main processes: cryodestruction, necrotization, rejection and filling of the wound volume with delicate scar tissue, completed by the end of 14 days. In the long term - from 3 months or more - a whitish scar with a size of about 2 cm is observed at the site of the former tumor. There is no tumor recurrence. According to the method of the proposed method, 40 patients with tumor localization statistics were treated: in the temporal region - 10 patients (25%), the back and wings of the nose - 8 (20%), the rest on the cheeks, corners of the eyes, cheekbones, etc. All patients after surgery were dynamically observed. The statistics of consistency were: complete tumor regression - 92.5%. In three cases, in connection with the residual tumor, repeated courses of cryodestruction were performed.

The technical readiness of the method for wide clinical use meets the condition of patentability "industrial applicability".

Claims (1)

A method for treating basal cell carcinoma by cryodestruction of a tumor, characterized in that cryodestruction of the tumor is carried out using a contact cryo-applicator of permeable-porous titanium nickelide cooled with liquid nitrogen, and cryogenicity on the tumor after preliminary determination of its depth is carried out by simultaneously pressing the cryo-applicator to the entire surface of the tumor with exposure time 1.0-2.0 minutes

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