RU2414890C1 - Method of treating signet-ring cell carcinoma of stomach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to oncology, and can be used for treating patients with signet-ring cell carcinoma of the stomach (SRCC). Method includes carrying out an operation and intraoperational introduction of chemical preparations and an immunomodulator. After gastrectomy exposure and mobilisation of spleen veins is realised, vascular clips are applied on said veins, preventing outflow of vein from the spleen, into splenic artery by means of a syringe introduced are: 5-fluoruracyl 1000 mg/m², leukovorin 100 mg/m², 3 mln IU reaferon alpha2. Preparations remain in spleen vessels; after 30 minutes vascular clips are removed from spleen veins, discharge of blood is carried out, with realisation of chemical immunosanitisation of blood stream of patient's organism, spleen is preserved according to the operation plan.

EFFECT: application of the method makes it possible to increase efficiency of SRCC treatment due to sanitisation of organism with cytostatics and immunomodulator, incubated with autoblood from spleen.

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Description

The invention relates to medicine, namely to oncology, and can be used to treat patients with cricoid cancer of the stomach.

Surgical treatment remains today the main component in the treatment of gastric cancer in general and cricoid cancer, in particular. However, the modest results of surgical treatment, even in a radical volume, require additional effects in the form of adjuvant chemo and / or immunotherapy, due to the high viability of cancer cells and the accompanying immunodeficiency state of the body of patients with gastric cancer.

There is a method of neoadjuvant chemotherapy for gastric cancer (Tuzikov S.A., Afanasyev S.G., Kardashova Yu.V. "Neoadjuvant chemotherapy (CCNU, etoposide, cisplatin) in the combined treatment of stomach cancer." In the book: Modern technologies in oncology: materials of the VI All-Russian Congress of Oncologists. Volume 1. - M., 2005. - P.301).

The authors developed a combination treatment regimen comprising 2 courses of neoadjuvant chemotherapy according to the CCNU regimen of 80 mg / m ² in 1 day; cisplatin 40 mg / m ² on days 2 and 8; etoposide 120 mg / m ² at 4.5 and 6 days. The interval between courses was 3 weeks, then a radical operation was performed with intraoperative radiation therapy to the areas of regional lymphogenous metastasis at a dose of 15 Gy. According to this scheme, 6 patients aged 45-60 years were treated (5 men and 1 woman). Performed 4 subtotal distal gastric resection and 2 gastrectomy.

However, a large number of complications in the form of hematological and late myelotoxic complications, which are cumulative in nature and coinciding in 2 patients with an early postoperative period, gastrointestinal complications of varying severity in all patients, neurotoxic complications in 2 patients, severe surgical complications in 2 patients and, finally, the death of one patient in the observation period of up to 9 months as a result of the progression of the process, led the authors to the conclusion that it was necessary to refine the chemotherapy regimen.

Obviously, chemotherapy aggravated the existing immunosuppression, which was the reason for so many complications.

There is a method of combined treatment of gastric cancer, including radical surgery and immunostimulation in the postoperative period (Zyryanov B.N., Kolomiyets L.A., Tuzikov S.A. Gastric cancer: prevention, early diagnosis, combined treatment, rehabilitation. - Tomsk: Publishing House - in Tom. University, 1998. - 528 p.), selected as a prototype. The authors treated 57 patients with stage III gastric cancer (32 men and 25 women) aged 40 to 70 years according to the scheme: radical surgery and immunostimulation in the postoperative period. According to the macroscopic type of growth, tumors were divided almost equally into exophytic - 47.9% and endophytic - 52.1%. The histological structure was dominated by adenocarcinoma of varying degrees of differentiation, but undifferentiated cancer was found in 16.7%.

Immunostimulation with pyrogenal was started 2 weeks after radical surgery in the uncomplicated postoperative period. The drug was administered intramuscularly once a day for 10 days according to a scheme representing a series of successively increasing doses of the drug from 20 to 200 μg. The initial dose of pyrogenal in 20 mg and its subsequent increase in 20 mg daily were established by the authors in the clinic empirically in order to maintain an increased temperature reaction of the patient in the range of 37-380 ° C. When a hyperergic reaction occurred (increase in body temperature above 380 ^° C), the dose of the drug for subsequent administration remained the same or decreased. When complications occurred, treatment was discontinued. The course dose of pyrogenal was 1000-1100 mcg. Immunostimulation was performed for 2 years. Of the complications associated with taking pyrogenal, 2 cases of fever caused by an overdose, which was stopped by taking antipyretics and heart drugs, were noted.

The two-year survival of patients was 58.5 ± 3.72%.

However, the authors do not indicate the use of such a treatment method for cricoid cell carcinoma of the stomach, indicating only the presence in this group of patients of 10 patients with undifferentiated cancer, while not citing the results of treatment of this particular contingent of patients. And, as you know, undifferentiated cancer and cricoid cancer of the stomach are the most unfavorable in relation to the results of treatment and prognosis of life.

The aim of the present invention is to improve the immediate and immediate results of the treatment of patients with cricoid cancer of the stomach.

This goal is achieved by the fact that they perform surgery and intraoperative administration of chemotherapy and an immunomodulator, after gastrectomy, the spleen veins are extracted and mobilized, vascular clamps are applied to them, preventing blood outflow from the spleen, 5-fluorouracil 1000 mg / m ² is injected into the spleen artery with a syringe, leucovorin 100 mg / m ² , 3 million IU of reaferon alpha-2, drugs remain in the vessels of the spleen; after 30 minutes, vascular clamps are removed from the spleen veins, blood is discharged, chemoimmunosanization of the bloodstream of the patient’s body is carried out, the spleen is maintained according to the intended plan of operation.

The invention is new, since it is unknown from the level of medicine in the field of oncology in the treatment of cricoid cancer of the stomach with chemo-and immunotherapeutic agents. The novelty of the invention lies in the fact that in the treatment of patients with cricoid cell carcinoma of the stomach, cytostatics and an immunomodulator are intraoperatively injected into the spleen, after applying vascular clamps to the splenic veins for incubation in it, and then the blood is discharged with the drugs into the bloodstream, producing chemotherapeutic sanitation of the body simultaneous immunomodulation.

The invention has an inventive step, as it is not known to an oncologist in this field and does not explicitly follow from the level of clinical oncology.

Incubation of drugs in the spleen causes a combination of their specific antitumor activity with additional stimulation of the cells of the immune system caused by reaferon alpha-2, i.e. there is a combination of chemo and autoimmunotherapy.

In available sources of information from Russia, the CIS countries and abroad, no indications of a similar method for improving the results of treatment of patients with cricoid cancer of the stomach were found.

The invention is industrially applicable, as it can be repeatedly reproduced and used in healthcare, in medical institutions of specialized and surgical profile.

The method is as follows.

After gastrectomy with gastrectomy, a patient with cricoid cell carcinoma is mobilized and splenic vessels (arteries and veins) are secreted at the gates of the spleen. Vascular clamps are applied to the spleen vein, then 3 ml of ME reaferon alpha-2 is injected into the spleen artery with a syringe, a solution of 5-fluorouracil at a dose of 1000 mg / m ² and leucovorin at a dose of 100 mg / m ² , leave them in the spleen for 30 minutes , then remove the clamps from the splenic veins and discharge the blood with the drugs into the bloodstream. After performing the above manipulations, the spleen is maintained according to the intended plan of operation.

To prove this, we provide extracts from case histories confirming the clinical effect of treatment by the proposed method.

Example: Patient K., born in 1956, medical history 16295 / c, was admitted to the Department of General Oncology, RNII on August 14, 2007.

From the anamnesis: considers himself a patient for 1 year, when there were complaints of heaviness in the stomach, weight loss of 8 kg. In July 2007, gastric cancer, T3NxMx, St. II, C. gr. II. histological analysis No. 29148-52 - cricoid cancer with infiltrative growth. Ultrasound of the abdominal organs has no data for distant metastases. The patient was hospitalized in the department for gastrectomy. When laparotomy revealed infiltrative total tumor lesion of the stomach. After gastrectomy, the splenic vessels were mobilized and isolated at the gates of the spleen (branches of the splenic artery and splenic vein), vascular clamps were applied to the branches of the splenic vein, a solution of 5-fluorouracil at a dose of 1000 mg, leucovorin at a dose of 100 mg and 3 million were injected into the spleen artery. ME reaferon alpha-2 chemotherapy drug left in the spleen for 30 minutes.

After 30 minutes, the vascular clamps from the splenic vein were removed, there was a discharge of blood with incubated chemotherapy and reaferon into the bed, after which the spleen was saved.

The postoperative period was uneventful, without complications.

The level of leukocytes, peripheral blood lymphocytes did not decrease; deviations in the biochemical analysis of blood, the general analysis of urine was not. Sutures were removed on day 12. The patient was discharged in satisfactory condition. Until now, he has been under follow-up observation without signs of progression of the process (relapse and distant metastases are absent).

The proposed method was treated 11 patients with cricoid cancer of the stomach. Ten patients are observed in the period of 11-18 months with no signs of progression of the process.

The improvement of treatment results seems to us to be a combination of various positive factors, which include an increase in the antitumor activity of chemotherapy drugs after their preliminary incubation with autologous blood from the spleen, stimulation of the immunity of patients with reaferon alpha-2 with its direct effect on the spleen, as a peripheral immunity organ.

The technical and economic effect of the use of the “Method for the treatment of cricoid cell carcinoma of the stomach” consists in the possibility of increasing the duration and improving the quality of life of patients due to sanitation of their body by cytostatics and an immunomodulator, incubated with autologous blood from the spleen.

Claims (1)

A method of treating cricoid cell carcinoma of the stomach, including surgery and intraoperative administration of chemotherapy and an immunomodulator, characterized in that after gastrectomy, spleen veins are extracted and mobilized, vascular clamps are applied to them, preventing blood outflow from the spleen, 5-fluoruria is injected into the splenic artery with a syringe: 1000 mg / m ² , leucovorin 100 mg / m ² , 3 million ME reaferon alpha-2, drugs remain in the vessels of the spleen; after 30 minutes, vascular clamps are removed from the spleen veins, blood is discharged, chemoimmunosanization of the bloodstream of the patient’s body is carried out, the spleen is maintained according to the intended plan of operation.