RU2403917C1 - Clay pipe cancer therapy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used within integrated treatment of locally advanced clay pipe cancer. That is ensured by blood sampling in the amount 200-250 ml from the median cubital vein, centrifugation and plasma separation in the amount 10 ml in 9 syringes of 20 ml. Plasma containers are placed in a freezing chamber, and the rest cell suspension is added with 150 ml of physiologic saline and reinfused intravenously drop-by-drop. On the following day, the lingual artery is catheterised to introduce a mixture incubated at temperature 37 C for 30 minutes and containing 10 ml of autoplasma and 30 mg of methotrexate in one syringe and 500 mg of 5-fluorouracil and 10 ml of autoplasma in the second syringe. Such mixture is introduced daily during 4 days. 3 weeks later, a surgical removal the tumour follows with a bed of the removed tumour being injected all around during the operation with the mixture of 30 mg methotrexate and 10 ml of autoplasma incubated similarly that is followed with operative wound closure.

EFFECT: method allows higher clinical effectiveness in the case patients that is ensured by chemopreparations depot in a tumour lesion.

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Description

The invention relates to medicine, more specifically to oncology, and can be used in the complex treatment of locally advanced malignant tumors of the tongue.

A known method for the treatment of malignant tumors of the oropharyngeal zone with lesions of the mucous membrane of the bottom of the oral cavity and tongue, when the first stage is carried out two courses of chemotherapy, after which surgery. The operation consists in removing part of the tongue, the bottom of the oral cavity, and a fragment of the lower jaw ("The operational stage in the combined and complex treatment of patients with squamous cell carcinoma of the oropharyngeal zone", IV Vikhlyanov and other Russian Oncological Journal, No. 5, 2007).

The proposed method of treatment allows you to have a very significant effect on the tumor by conducting preoperative chemotherapy. Chemotherapy drugs, administered intravenously into the bloodstream, have a systemic effect, with side effects coming from here, which weakens the patient's body. Extended surgery also brings suffering to the patient.

There is a method of treating malignant tumors of the organs of the oral cavity and tongue, when surgical removal of the tumor lesion focus with previous or subsequent radiation therapy is performed. In case of cancer of the tongue, an operation is performed to remove the tumor within healthy tissues (A.I. Paches. "Medicine", M., 2003). With a significant local spread of the tumor, extended and combined interventions are performed with resection of half of the tongue, the bottom of the oral cavity, lower jaw with cervical lymphadenectomy.

However, even the author himself indicates the severity of the condition of patients after such extensive surgical interventions, the need for subsequent plastic surgery. The quality of life of this group of patients suffers due to the long period of feeding through the nasophageal tube, lack of intelligible speech in the postoperative period.

All this limits the possibilities of surgical treatment of malignant tumors of the oral cavity and tongue, leads to frequent refusals of patients from surgery, being the reason for the search for more effective and less traumatic methods of treatment.

The aim of the invention is the creation of a depot of chemotherapeutic agents in the field of tumor damage.

This goal is achieved by the fact that a patient is taken 200-250 ml of blood from the cubital vein, centrifuged and plasma is taken in 9 syringes of 10 ml each. The above-mentioned containers with plasma are placed in the freezer, and the remaining cell suspension is reinfused to the patient, combining it with 150 ml of physiological saline, intravenously.

The next day, the lingual artery is catheterized and a mixture of 30 mg methotrexate per 10 ml of autoplasma and 500 mg of 5-fluorouracil per 10 ml of autoplasma is injected into it, incubated at 37 ° C for 30 minutes. The introduction of a similar method of incubated mixtures is carried out daily for 4 days.

After 3 weeks, the patient undergoes surgical removal of a malignant tumor; the bed of the removed tumor is intraoperatively chipped with a mixture of 30 mg methotrexate and 10 ml autoplasma incubated in a similar manner. The surgical wound is sutured. After which the patient undergoes postoperative radiation therapy.

A comparative analysis of the known methods of treating cancer of the tongue and the developed one allows us to state the presence of novelty and significant differences.

The novelty of the claimed "Method for the treatment of cancer of the tongue" lies in the possibility of creating in the field of malignant tumor depot antitumor chemotherapy drugs. The introduction of chemotherapy is carried out in the lingual artery, and a pre-prepared autoplasma is used as a solvent.

In the well-known open sources of information in Russia, the CIS countries and abroad similar to the claimed method could not be found. A "method for treating cancer of the tongue" is industrially applicable. It can be reproduced and repeated many times in medical healthcare institutions, especially in specialized ENT clinics of a surgical profile.

The method is as follows.

A patient is taken on an empty stomach with 200-250 ml of blood from the ulnar vein, centrifuged and plasma is taken in 9 syringes with a volume of 20 ml of 10 ml each. Plasma containers are placed in the freezer, 150 ml of physiological saline are added to the remaining cell suspension and the patient is re-infused intravenously.

The next day, the lingual artery is catheterized and a mixture of autoplasma (10 ml), 30 mg of methotrexate in one of the prepared syringes and 500 mg of 5-fluorouracil per 10 ml of autoplasma in the second of the prepared syringes are incubated, incubated at 37 ° C for 30 minutes. The introduction of a mixture incubated in a similar way is carried out daily for 4 days.

After 3 weeks, the patient undergoes surgical removal of a malignant tumor; the bed of the removed tumor is intraoperatively chipped with a mixture of 30 mg methotrexate and 10 ml autoplasma from the last syringe incubated in a similar manner. The surgical wound is sutured. Next, the patient is given postoperative radiation therapy.

An example of a specific implementation of the method can serve as an extract from the medical history. Patient A., 57 years old, medical history No. 18740/4, was admitted to the Department of Head and Neck Tumors of the Federal State Institution “Russian Research Institute of Medical Technologies” on September 9, 2008 with a diagnosis of Tongue Cancer St IV (T3N2M0). On examination: speech is illegible, eats through a nasophageal tube, notes intense pain in the tongue, profuse salivation. In the oral cavity, a tumor with ulceration of 2/3 of the tongue on the left, spreading to the mucosa of the bottom of the oral cavity, the tongue is fixed. Bad breath. On the neck in the upper left 1/3 of the fixed conglomerate of metastatic lymph nodes 6.0 × 5.0 cm. The result of a tumor biopsy: highly differentiated squamous keratinizing cancer - histological analysis No. 198844-45.

September 15, 2008, a patient on an empty stomach took 230 ml of blood from the ulnar vein. Blood was centrifuged and 10 ml of each plasma was taken in 9 syringes. Plasma syringes were placed in a freezer. The remaining cell suspension was diluted with 150 ml of saline and reinfused to the patient intravenously.

09/16/08, the operation was performed catheterization of the left lingual artery. The contents of one syringe with autoplasma thawed and connected with 30 mg of methotrexate and another syringe with autoplasma and 500 mg of 5-fluorouracil were incubated at 37 ° C for 30 minutes and introduced to the patient through a catheter installed in the lingual artery. Every day for four days the patient was similarly injected with a similar mixture into a catheter. A total of 120 mg of methotrexate and 2000 mg of 5-fluorouracil were administered.

Tumor regression up to 40%. Swallowing and speech restored, pain and hypersalivation decreased.

September 26, 2008 the patient was discharged from the department under the supervision of an oncologist at the place of residence.

11.24.08, re-hospitalized for surgical treatment.

December 1, 2008, the operation was performed: fascial-shear excision of the fiber and lymph nodes of the neck on the left with ligation of the external carotid artery, hemi resection of the tongue with the removal of the tumor, resection of the bottom of the oral cavity. The bed of the removed tumor was intraoperatively chopped by incubating at 37 ° C for 30 minutes with a mixture of 30 mg of methotrexate and 10 ml of autoplasma from the last syringe. The wound was sutured in layers.

Histological analysis No. 72988-90 / 08 - moderately differentiated squamous cell carcinoma with keratinization.

Postoperative wound healing by first intention, nasophageal probe removed 12 days after surgery, speech is preserved. The patient is under observation for 5 months in satisfactory condition with no signs of tumor recurrence.

The technical and economic efficiency of the developed method consists in the possibility of creating a maximum concentration of an antitumor chemotherapy drug in the tumor site, reducing the general toxic effect of chemotherapy drugs, reducing the volume of surgical intervention due to previous autoplasma chemotherapy, and, as a result, preserving the patient’s nutrition in a natural way, speech, and improving the patient’s quality of life.

Claims (1)

A method for treating cancer of the tongue, including catheterization of the lingual artery, intra-arterial administration of chemotherapy drugs, surgical removal of the lesion site and intraoperative chipping of the bed of the removed tumor with a mixture of the patient’s autoplasm and chemotherapy drugs, characterized in that 200-250 ml of blood from the cubital vein are collected, centrifuged and plasma is taken in 9 syringes with a volume of 20 ml of 10 ml each, plasma containers are placed in a freezer, 150 ml of physiological saline and reinf are added to the remaining cell suspension they are injected intravenously, the next day the lingual artery is catheterized and a mixture of 10 ml of autoplasma, 30 mg of methotrexate in one syringe and 500 mg of 5-fluorouracil per 10 ml of autoplasma in the second syringe are incubated, incubated at 37 ° C for 30 min, the introduction of the mixture incubated in the same way is carried out daily for 4 days, after 3 weeks the patient is promptly removed from the malignant tumor; the bed of the removed tumor is intraoperatively chipped with a mixture of 30 mg methotrexate and 10 ml of autoplasma incubated in a similar manner, the surgical wound is sutured.