RU2445086C1 - Method of treating eyelid malignancies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, oncology, and can be used for combination treatment of the patients suffering eyelid malignancies. A method involves local radiomodification by peritumoral introduction of Methotrexate 10 mg pre-incubated in autoplasma 10 ml at t=37°C for 30 minutes preceded by subbulbar introduction of diprospan 1 ml. One hour later, the radiomodification is followed by neoadjuvant radiation therapy at depth 0.5 cm by basic dose 20 Gy, and no more than 24 hours after the radiation, a surgical operation is performed.

EFFECT: method provides intensified radicality of the tumour exposure, higher surgical ablasticity, lower risk of cancer dissemination, maximally maintained reparation ability and functions of normal ocular tissues, minimised therapeutic complications, reduced length of treatment.

1 ex

Description

The invention relates to medicine, namely to Oncology, and can be used for the combined treatment of patients with malignant tumors of the skin of the eyelids.

Analogues of the proposed solution are methods for the combined treatment of malignant tumors of the skin of the eyelids, which consist of conducting short-distance or remote gamma-therapy in the conventional mode of fractionation of 2 Gy to SOD 40 Gy with an operation performed after the radiation reaction has subsided (Brovkina A.F., Valsky V. V., Gusev G.A. et al. Ophthalmic oncology: a Guide for doctors / Edited by A.F. Brovkina. - M .: Medicine. - 2002. - P.140-152). A significant drawback of these methods is the long interval between irradiation and surgery, with the lengthening of which over 2 weeks mitoses appear in the tumor, a new generation of tumor cells appears and, thus, all the achievements of preoperative irradiation are nullified (V.Yu. Dudnik, A. V. Vazhenin. Combined treatment of colon cancer // Siberian Oncology Journal: Scientific and Practical Edition. - 2002. - No. 2. - P.9-11); as well as the preoperative radiation therapy creates additional technical difficulties during the operation due to developing tissue fibrosis in the area of intervention.

One of the approaches to increasing the effectiveness of radiation therapy is to find means to expand the radiotherapy interval: the use of non-traditional dose fractionation modes, the use of radiosensitizers. The closest in technical solution to the selected method of combined treatment of colorectal cancer (Zakharchenko A.A., Galkin E.V., Shtoppel A.E., Zykova L.D., Terskova T.V. Patent No. 2269341 dated 02/10/2006 .). The essence of the method is to conduct local radiomodification of tumor cells by endovascular perfusion of its tissue with a 5% solution of metronidazole through the upper rectal artery in the upper ampullar cancer of the rectum, the upper rectal and one of the internal iliac arteries in the middle and lower ampullary cancer of the rectum with occlusion of these vessels radiopaque emboli followed by radiation therapy at a dose of 10 Gy and radical surgery.

The main disadvantages of the selected prototype:

- the impossibility of using this method in areas of tumor localization, the blood supply of which is carried out by arterial vessels of small caliber, in particular on the skin of the eyelids and periocular region,

- the lack of a wide network of health facilities for endovascular perfusion of tumor tissue of various localization,

- the method is invasive, associated with the risk of damage to the catheterizable artery,

- metronidazole is toxic to the body, dyspeptic disorders may occur,

- the authors did not use the possibility of maximum enlargement of a single dose of radiation,

- the application of the method is limited in patients suffering from vascular diseases.

The purpose of the invention: enhancing the damaging effect of radiation exposure on a malignant tumor before surgery, increasing the ablasticity of the operation, reducing the risk of dissemination of cancer complexes during surgery.

This goal is achieved by the fact that local radio modification is carried out by peritumoral administration of 10 mg methotrexate preincubated with 10 ml of autoplasma at t = 37 ° C for 30 minutes, with the preliminary introduction of 1 ml of diprospan subbulbar, neoadjuvant radiation therapy absorbed at a depth of 0.5 cm a focal dose of 20 Gy is carried out 1 hour after radio modification, and the operation is carried out no more than 24 hours after irradiation, i.e. before the implementation of post-radiation restoration of tumor cells.

The claimed technical solution is new, because the proposed method is original, unknown and clearly does not follow from the level of development of medicine and related oncology related fields of knowledge.

The novelty of the invention is:

In the peritumoral administration of a biologically transformed cytostatic, which allows you to create maximum contact with tumor cells, increasing their sensitivity to chemoradiation.

In the choice of diprospan, which with subbulbar administration provides the maximum leveling of radiation reactions in the early postoperative period, which in turn improves wound healing, prevents the development of complications from the eyeball: keratitis, keratopathy, iridocyclitis, neuroretinopathy.

In the neoadjuvant summation of the absorbed focal dose of 20 Gy with close-focus x-ray therapy.

In the choice of methotrexate, small doses of which, along with a radiosensitizing effect, have a cytostatic and anti-inflammatory effect, which becomes an additional factor in optimizing the results of antitumor treatment.

A comparative analysis of the proposed method with the selected prototype allows us to conclude that the set of features of the claimed technical solution has significant differences in the approach to achieving the goal - increasing the damaging effect of radiation exposure on a malignant tumor before surgery, increasing the ablasticity of the operation, reducing the risk of dissemination of cancer complexes during operations.

The expansion of the radiotherapy interval is achieved on the one hand by enhancing the damaging effects of radiation therapy, and on the other hand, by predominantly protecting normal tissues, including the structures of the eyeball.

The procedure for peritumoral administration of a radiosensitizer is minimally invasive and is not associated with the risk of trauma to large arteries - unlike the prototype.

The use of small doses of cytostatic can achieve, in addition to radiosensitizing, cytostatic, anti-inflammatory and decongestant effects.

Radiation reactions do not interfere with the surgical stage, as in the first 7-10 days, their development is limited by the action of diprospan, administered subbulbarly, and do not interfere with the reparative processes in the wound, and their appearance at a later date after the healing of the postoperative wound does not affect the functional and aesthetic effect of the operation.

The proposed method allows you to maximize maintain the reparative ability of normal tissues involved in the healing of postoperative wounds due to the effects of diprospan administered subbulbarly and to minimize the post-radiation complications of radiation treatment in the form of keratitis, optic atrophy, neuroretinopathy, keratopathy, cataract and post-radiation iridocytes.

The invention is industrially applicable, as it can be used in healthcare for the combined treatment of malignant tumors of the skin of the eyelids.

Despite the accessibility of eyelid skin tumors for visual examination, up to 60% of patients receive treatment with a locally widespread process involving lesions of the ciliary region, conjunctiva of the eyelids, conjunctiva of the eyeball and transition folds, lacrimal meat, germination in the orbit tissue, with 10-44 % of patients have a recurrent course of the tumor process. The claimed technical solution can be used to treat this category of patients.

"Method for the treatment of malignant tumors of the skin of the eyelids" is as follows:

1 hour before the radiotherapy session, 1 ml of diprospan is administered subbulbarly, then peritumoral administration of 10 mg of methotrexate preincubated in 10 ml of autoplasma at t = 37 ° C for 30 minutes, neoadjuvant radiation therapy absorbed at a depth of 0.5 cm at a focal dose of 20 Gy is performed 1 hour after radiomodification, and the operation is performed no more than 24 hours after irradiation, until sublethal damage is restored in the tumor cells.

An example of a specific application can serve as extracts from medical records.

Patient B.C.A., born in 1948, and. No. 1834 / t, was admitted to the RNII on 04.17.2006 with a diagnosis of skin cancer of the lower eyelid of the right eye T3N0M0, class. column 2. Cytological analysis No. 11284/06 "basal cell carcinoma".

Objectively: the lower eyelid of the right eye is destroyed by a tumor formation that extends to the inner corner of the eye and the medial third of the upper eyelid, fixed to the periosteum of the lower wall of the orbit. Conjunctival injection of the left eye.

Peripheral lymph nodes are not enlarged.

The treatment was carried out in accordance with the claimed technical solution: 1 ml of diprospan was administered subbulbarly 1 hour before the radiation therapy session, then 10 mg methotrexate preincubated in 10 ml of autoplasma was introduced peritumorally at t = 37 ° C for 30 minutes, 1 hour after radio modification once a session of close-focus x-ray therapy was carried out using the Sverdlov-Balter protective prosthesis on the TA-02 apparatus; 40 kV, 10 mA, filter 2.5 mm Al, SPO 1.2 mm Al, RIC 7.5 cm, field 14 × 20 mm, absorbed focal dose at a depth of 0.5 cm = 20 Gy (VDF = 76 units. )

The next day, the operation was performed in the amount of: total removal of the lower eyelid, structures of the inner corner of the eye, half resection of the upper eyelid, removal of the intraorbital component of the tumor. Plastic produced by displaced skin graft from the forehead.

Postoperative wound healing by primary intention. Sutures were removed on the 8th day. The phenomena of conjunctivitis were stopped on the 5th day of the postoperative period.

The patient is under clinical supervision without relapse for 4 years.

Technical and economic efficiency of the "Method for the treatment of malignant tumors of the skin of the eyelids" is:

in expanding indications for organ-preserving treatment by increasing the radicality of surgical intervention, including as a result of reducing the risk of dissemination of tumor cells during surgery

in improving the quality of life of patients with malignant tumors of the skin of the eyelids, due to the maximum preservation of the functions of the eye and, above all, objective vision

in reducing the treatment time by reducing the duration of the preoperative stage: exposure and the period of subsidence of radiation reactions.

Claims (1)

A method for the treatment of malignant tumors of the skin of the eyelids, including surgery and irradiation, characterized in that local radiomodification is carried out by peritumoral administration of 10 mg of methotrexate preincubated in 10 ml of autoplasma at t = 37 ° C for 30 minutes, with the preliminary administration of 1 ml of diprospan subbulbarly, 1 hour after radiomodification, neoadjuvant radiation therapy is carried out at a focal dose of 20 Gy absorbed at a depth of 0.5 cm; surgery is performed no more than 24 hours after irradiation.