RU2405462C2 - Method of treating tongue cancer - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, oncology, and can be used for treatment of tongue cancer. For this purpose high-frequency hyperthermia of tongue tissues by thermal impact at temperature from 60 to 80 degrees Celsius is performed for two minutes. For this purpose antenna of device with active electrode is introduced into tongue tissue by multiple sticking on middle line from tongue tip to its root. Depth of sticking is increased from 1 cm to 3 cm respectively. After that total ablation of tumour nidus is carried out. After that indenting from middle line of tongue 1 cm toward the side of ablated tumour nidus, HF-hyperthermia of tongue tissues is repeated in the same modes. For this purpose antenna of device with active electrode is introduced into tongue tissue by multiple sticking on line parallel to middle line of tongue from tongue tip to its root. Depth is increased from 1 cm to 3 cm respectively. After that device antenna is repeatedly introduced into depth not less than 1-2 cm on lateral edge from the side of ablated tumour nidus from tongue tip to its root.

EFFECT: method allows to ensure the destruction of tumour cells as a result of total and even hyperthermia due to creation of spatial net with heating of each cubic centimetre of tumour to temperature of 60-80 degrees Celsius, prevention of henatogeneous and lymphatic metastases, prevention of intraoperational complications, in particular bleeding, preserve speech and chewing functions of tongue.

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Description

The invention relates to medicine, namely to oncology, and can be used in the surgical treatment of cancer of the tongue.

The problem of treating cancer patients with various localizations, including cancer of the maxillofacial region (maxillofacial region), is still far from being resolved and is still the subject of study and discussion. It is known that modern methods of radiation therapy and chemotherapy do not always give a sufficient therapeutic effect, and an increase in the radiation dose leads to the formation of various complications in the form of necrosis of healthy tissues surrounding the tumor. Cancer of the tissues of the oral cavity, including the tongue, a widespread disease, accounts for, according to various authors, from 20 to 32% of all cases of human malignant neoplasms.

A known method of treating cancer of the lateral parts of the tongue and the bottom of the oral cavity by removing the affected half of the tongue and tissues of the bottom of the oral cavity to the level of the hyoid bone together with the contents of the submandibular triangle of the neck (SU 1113929, class A61B 17/00, 1983).

A known method of surgical treatment of cancer of the tongue with combined access, resection of half of the tongue to the level of the hyoid bone with organ lymphadenectomy and plastic surgery of the resulting defect in the tongue and the bottom of the oral cavity. Combined access begins with an incision in the submandibular region from the midline of the neck to the inner edge of the sternocleidomast, departing from the edge of the lower jaw by 1.5-2.0 cm, expose the submandibular case and cellulose of the carotid triangle, secrete the vascular pedicle from the facial artery and vein, they cut out a skin-muscle or mucous-muscular flap from the cheek and take it outwards, the fascial case is separated from the lower jaw, organ lymph nodes are determined, and they are excised using the device for lymphodissection in a single unit with the resected part tongue and extraorgan lymphatic vessels connecting the tongue with regional lymph nodes, the resulting defect is replaced by a flap on the vascular pedicle.

Both known methods are traumatic, difficult, dangerous with complications and give significant mortality.

A known method for the photodynamic treatment of cancer of the tongue (M.A. Kaplan, BCMedvedev, V.V. Polkin, V.N. Kapinus, A.N. Shubina, I.S. Spichenkova, Photodynamic therapy of cancer of the tongue, oral mucosa and oropharynx, No. 1 / volume 7/2008, Russian Biotherapeutic Journal, p.17), which consists in the intravenous administration of a photosensitizer and the subsequent irradiation of tumor zones using Atkus-2 and Lamed laser therapeutic units with an output power of 0.4 up to 1.5 watts.

Compared with the above methods, the method of photodynamic treatment of cancer of the tongue is much simpler to perform, reduces the likelihood of intra- and postoperative complications. At the same time, the results of its use indicate a slight increase in the life expectancy of patients due to continued tumor growth, metastasis (disease progression).

A known method of treating cancer of the tongue by using local microwave hyperthermia and a CO ₂ laser, which we adopted as the closest analogue of the proposed method (Laptev P.I. The use of local microwave hyperthermia and CO ₂ laser in the treatment of cancer of the lip, mucous membrane of the tongue and bottom oral cavity, Dentistry. - 2004. - No. 1. - P.30-32). To carry out hyperthermia, the Yacht-2 apparatus operating at a frequency of 2450 MHz was used (NPO Istok). The dose and exposure during local microwave hyperthermia were selected individually depending on the size of the tumor and its location. When applying energy and creating a therapeutic dose, the contact method was used, and to increase the depth of exposure to uniform heating and thus increase the efficiency of microwave hyperthermia, a wet pad was placed between the antenna and the tumor, so that a temperature of up to 48-50 ° С was reached in the pathological focus with reversible damage to surrounding tissue. At the site of exposure, a focus of necrosis was formed, which was eliminated using a laser surgical unit Scalpel-1. However, the use of the known method also has several disadvantages: for example, the temperature used to heat the tumor tissue (up to 48-50 ° C) is insufficient to prevent further tumor progression and metastasis; the lack of developed exposure criteria reduces the effectiveness of treatment; only a pathological focus is exposed.

Our proposed method is aimed at overcoming the disadvantages of the known methods, including the closest analogue.

The technical result of the proposed method is the possibility of increasing the effectiveness of treatment by using a combination of techniques performed in stages, together providing the opportunity to achieve:

- death of tumor cells due to total and uniform hyperthermia due to the creation of a spatial grid with heating of each cubic centimeter of the tumor to a temperature of 60-80 ° C;

- prevention of hematogenous and lymphogenous metastasis;

- prevention of intraoperative complications, in particular bleeding.

The method that allows to achieve this technical result is as follows:

At the first stage, using the apparatus for high-frequency hyperthermia (HF hyperthermia, HF thermoablation), for example, using the Metatom-2 apparatus, HF hyperthermia of the tongue tissue is produced by thermal exposure at temperatures of 60-80 ° C for two minutes why the antenna of the apparatus containing the active electrode is repeatedly introduced by injections into the tissue of the tongue along the midline to a depth of 1 cm in the region of the tip of the tongue and up to 3 cm in the region of the root (Fig. 1). In the second stage, immediately following the first, a total biopsy of the tumor ulcer is performed, that is, complete removal of the tumor focus. Immediately after removal, they proceed to the third stage: they retreat from the midline of the tongue 1 cm to the side of the removed tumor site and re-perform HF hyperthermia of the tissues of the tongue in the same modes, for which the antenna of the device containing the active electrode is repeatedly inserted by injections into the tissue of the tongue from its tip to the root to a depth of 1 cm to 3 cm, respectively (figure 2). After completing this stage of thermoablation (hyperthermia), they begin to introduce the antenna repeatedly in the region of the lateral (free) edge of the “interested” half of the tongue (that is, the half where the tumor was) from the tip of the tongue to its root, to a depth of at least 1-2 cm (fourth stage) (figure 3).

Thus, the used set of methods allows:

- carry out ablation (hyperthermia) of the tumor itself;

- carry out a step-by-step effect on the capillary and lymphatic network of the tongue, which helps to prevent a possible relapse of the tumor, the prevention of metastasis;

- to save the speech and chewing function of the tongue due to the fact that conducting RF hyperthermia according to the described technique allows you to remove only the tumor itself.

Example: Patient A., 62 years old, was admitted to the P.A. Herzen MNIIO with a diagnosis of cancer of the tongue without spreading to the bottom of the oral cavity, stage II. Histology: squamous cell carcinoma with keratinization. The patient was treated in accordance with the proposed method.

Using the apparatus for high-frequency hyperthermia, RF thermoablation (hyperthermia) of the tissues of the tongue was carried out by thermal exposure at temperatures of 60-80 ° C for two minutes. At the first stage, the antenna of the apparatus containing the active electrode is repeatedly introduced by injections into the tissue of the tongue along the midline to a depth of 1 cm in the region of the tip of the tongue and up to 3 cm in the region of the root. At the end of the first stage, after stopping blood and lymph circulation, a total biopsy of the tumor ulcer was performed. Then, retreating from the midline of the tongue 1 cm in the direction of the removed tumor ulcer, HF hyperthermia of the tongue tissues was repeated in the same modes, for which the device’s antenna containing the active electrode was repeatedly injected into the tongue tissue from its tip to the root to a depth from 1 to 3 cm, respectively. After this stage of hyperthermia is completed, the antenna of the apparatus is repeatedly introduced by injections from the tip to the root of the tongue along the lateral (free) edge of the “interested” half of the tongue. Depth of introduction is not less than 1-2 cm.

No intra- or postoperative complications were noted. The patient regularly passes control examinations. There was no evidence of signs of continued tumor growth or metastasis. Speech and chewing functions are satisfactory.

Claims (1)

A method for treating cancer of the tongue, including high-frequency hyperthermia (HF hyperthermia) and removal of the tumor focus, characterized in that at the first stage, HF hyperthermia of the tongue tissue is carried out by thermal exposure at a temperature of 60 to 80 ° C for two minutes, for which the antenna of the apparatus containing the active electrode is inserted into the tissue of the tongue by repeated injections along the midline from the tip of the tongue to its root, increasing the depth of injections from 1 to 3 cm, respectively; at the second stage, total removal of the tumor focus is performed; at the third stage, departing from the midline of the tongue 1 cm in the direction of the distant tumor site, they re-perform RF hyperthermia of the tissues of the tongue in the same modes, for which the antenna of the apparatus containing the active electrode is introduced into the tissue of the tongue by multiple injections into the tissue of the tongue along the line parallel to the midline of the tongue, from the tip to its root, increasing the depth from 1 to 3 cm, respectively; at the fourth stage, the antenna of the apparatus is repeatedly introduced to a depth of at least 1-2 cm along the lateral edge of that half of the tongue where the tumor site was removed, from the tip of the tongue to its root.

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