RU2411018C1 - Method of local chemotherapy of hepatic metastases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used in chemotherapy of hepatic metastases. The method involves radio-frequency thermal ablation followed by treating hepatic tissue within a necrosis region with an aqueous solution of 5-fluorouracil. The solution contains 5-fluorouracil 0.087 wt %, water for injections 1.754 wt %, low-molecular polyethylene 67.114 wt %, emulsifier T-2 16.778 wt %, microcrystalline gelatine 6.717 wt %, oil olive 7.550 wt %.

EFFECT: invention provides prevention of general toxic effect and malignant cell enlargement ensured by prolonged release 5-fluorouracil for 4 weeks.

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Description

The invention relates to medicine, namely to oncology, and may find application in the treatment of malignant tumors in the liver.

It is known that radiofrequency thermal ablation is an effective method of treating malignant neoplasms in the liver (Vorobyev G.I., Kashnikov V.N., Orlova L.P., Dolgushin B.I., Kosyrev V.Yu., Rybakov E.G., Pikunov D.Yu. Radiofrequency ablation of colorectal cancer metastases in the liver.Current issues of coloproctology.Materials of the second congress of coloproctologists of Russia with international participation, Ufa - 2007, p.5). A known method of local chemotherapy of liver metastases after radiofrequency thermal ablation is that after radiofrequency thermal ablation, a collagen hemostatic sponge impregnated with a solution of cytostatic is glued onto a liver capsule in a tissue necrosis zone (patent RU No. 2331421 of 08.20.08). This method is taken as a prototype.

For the effectiveness of chemotherapy, it is necessary to achieve a constant presence of cytostatic in the tumor. This is achieved through systemic chemotherapy. It is obvious that significant damage to healthy tissues and cells is caused, a general toxic effect is noted, there is a need for repeated chemotherapy courses. From the point of view of creating a high concentration of cytostatic in an alternative tumor, local chemotherapy with a collagen hemostatic sponge soaked in a solution of cytostatic can be considered. However, this method has several disadvantages. Firstly, a sponge soaked in a solution of cytostatics adheres to the liver capsule in the area of tissue necrosis, that is, the cytostatic acts only on the part of the tumor that is closer to the liver capsule. Part of the tumor, which is located in the thickness of the liver, is inaccessible to the action of cytostatic. Secondly, it is impossible to calculate the exact dose of the cytostatic agent administered with the collagen sponge, and the exact time of release of the cytostatic agent.

The objective of the invention is to improve the results of radiofrequency thermal ablation of metastases in the liver by combining it with local chemotherapy.

EFFECT: death of tumor cells remaining in the thickness of the liver remaining after radiofrequency ablation.

The specified technical result is achieved by the fact that in the method of treating liver metastases, including radiofrequency thermal ablation, followed by exposure to an aqueous solution of 5-fluorouracil in the necrosis zone of the liver tissue, according to the invention, the necrosis zone is punctured with an agent containing additional low molecular weight polyethylene, T-2 emulsifier, microcrystalline gelatin , olive oil in the following ratio of components, wt.%:

5-fluorouracil 0,087 water for injections 1,754 low molecular weight polyethylene 67,114 emulsifier T-2 16,778 microcrystalline gelatin 6,717 olive oil 7,550

The essence of the proposed method for local chemotherapy of liver metastases after radiofrequency thermal ablation is as follows. With laparotomy and revision of the abdominal organs after palpation of the location of the metastatic node and the choice of the site of insertion of the probe, radiofrequency thermal ablation is performed according to the usual method. After this, the tissue necrosis zone is punctured with a product that contains 5-fluorouracil, water for injection, low molecular weight polyethylene, T-2 emulsifier, microcrystalline gelatin, olive oil in the following ratio, wt.%:

5-fluorouracil 0,087 water for injections 1,754 low molecular weight polyethylene 67,114 emulsifier T-2 16,778 microcrystalline gelatin 5,717 olive oil 7,550

(patent No. 2366423 dated 09/10/2009). This tool provides a prolonged release of the cytostatic agent for 4 weeks, which prevents the reproduction of the remaining tumor cells. Sustained release of cytostatic prevents a toxic effect. The proposed method provides contact of the cytostatic agent with the tumor even with deeply located tumors.

The proposed method is used in the treatment of 3 patients who underwent radiofrequency thermal ablation of liver metastases in combination with local chemotherapy by chipping a necrosis zone with a prolonged dosage form containing 5-fluorouracil.

Clinical example: Patient M., born in 1957, with a diagnosis of cancer of the sigmoid colon stage III. From the anamnesis in January 22, 2009, a resection of the sigmoid colon was performed. A control ultrasound of OBP revealed a solitary metastasis in the S6 segment. 05/23/09, Kocher mini-laparotomy and radiofrequency thermoablation of a single metastasis in the VI segment of the liver 2.5 cm in diameter with chipping of the affected area with a prolonged dosage form containing 5-fluorouracil were performed. There were no complications during the postoperative period. During the control ultrasound examination on September 17, 2009, a zone of hepatic tissue necrosis was noted in the VI segment of 4 × 4 cm, no new metastatic lesions were detected.

The positive effect of the proposed method for local chemotherapy of liver metastases after radiofrequency thermal ablation is to prevent the multiplication of tumor cells remaining after ablation and to reduce the overall effect of cytostatic on the body, which helps to reduce the frequency of progression of metastases and improve the quality of life of patients.

Claims (1)

A method for treating liver metastases, including radiofrequency thermal ablation, followed by exposure to an aqueous solution of 5-fluorouracil in the necrosis zone of the liver tissue, characterized in that the necrosis zone is chipped with a tool containing additional low molecular weight polyethylene, T-2 emulsifier, microcrystalline gelatin, olive oil in the following ratio components, wt.%:
5-fluorouracil 0,087 Water for injections 1,754 Low molecular weight polyethylene 67,114 Emulsifier T-2 16,778 Microcrystalline gelatin 6,717 Olive oil 7,550