RU2521371C1 - Method of treating degree iii-iv skin radiation injuries on radiation fields following neutron therapy in patients with local recurrent breast cancer - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for treating degree III-IV radiation injuries on radiation fields following neutron therapy in patients suffering from local recurrent breast cancer (BC). That is ensured by wound irrigation with ozonised distilled water with ozone concentration of 10,000 mcg/l; a skin ulcerous defect is processed in a vacuum container for 10-15 minutes with gaseous ozone with the concentration of 10,000 mcg/l. That is followed by ozonised air applications with the parameters of: peroxide number - 18%, acid number - 71 mg CFU/g on the skin ulcerous defect once or twice a day for 10-15 days every 5-7 days for 2-3 courses.

EFFECT: ulcer detersion from purulent deposits, active regeneration and the skin ulcerous defect healing.

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Description

The invention relates to medicine, in particular to oncology, and can be used to treat radiation injuries of the skin of the III-IV degree after neutron therapy to patients with local relapses of breast cancer (breast cancer).

Due to radiobiological features, neutron therapy is one of the possible ways to increase the effectiveness of radiation therapy for malignant neoplasms resistant to photon radiation. However, 6.3 MeV fast neutron therapy due to the location of the maximum dose at a depth of 1.2 mm from the skin surface is accompanied by pronounced radiation reactions, and in some cases, in 16 (23%) of 71 patients with local recurrences of breast cancer - radiation skin lesions in the form of focal atrophy, telangiectasias (10%), skin fibrosis (7%), radiation skin ulcers (6%).

There is a method of treating trophic ulcers and long-term non-healing purulent wounds, which consists in the simultaneous exposure to ultraviolet radiation and ozone therapy with an ozone concentration of 0.7-1 mg / l and an exposure of 1-15 minutes by creating an ozone medium with a pressure of 2-3 mm RT in the wound area .Art. [1]. The scope of the known method is limited by the fact that ozone therapy was not used for radiation injuries of the skin and soft tissues after neutron therapy,

A known method of postoperative management of patients after radiosurgical treatment of malignant tumors and benign neoplasms of the oral mucosa, which consists in applying for 8-12 minutes ozonized oil solution on the wound surface after the operation. Moreover, applications of ozonized oil solution 3-4 times a day for 4-5 days are used for treatment [2].

The disadvantages of this method are the lack of effectiveness, due to the fact that instead of concentrated ozonized oil for applications, an oil solution is used for a short period of time, which is not enough for the regeneration process, and the limited scope is only for the oral mucosa.

Closest to the proposed is a method of treating early radiation reactions and late radiation injuries after a combined or complex (chemotherapy and radiation therapy) treatment of malignant neoplasms of various localizations. After the main treatment, 10-15 intravenous infusions of ozonized saline are carried out in a concentration of (18-20): 1000; in the form of irrigation with ozonated distilled water with an ozone concentration of (25-30): 1000 or applications of ozonized oil [3]. The disadvantages of this method are:

- the possibility of an allergy to ozonized physiological solution due to the fact that when it is administered intravenously, chloride acids are formed,

- ozone therapy methods were used in patients with radiation reactions and injuries only after gamma therapy,

- the scope of the method is limited to tumors of the head and neck, tumors of the reproductive organs.

A new technical task is to expand the scope, increase efficiency, by obtaining a stable therapeutic effect in patients with radiation damage to the skin in the fields of irradiation with fast neutrons.

To solve the problem in a method for the treatment of radiation damage to the skin of the III-IV degree in the radiation fields after neutron therapy in patients with local recurrences of breast cancer (BC), including irrigation with ozonated distilled water with subsequent applications of ozonated oil, the wound is washed with ozonated distilled water with an ozone concentration 10000 μg / l, treat skin ulcer in a vacuum container for 10-15 minutes with gaseous ozone with a concentration of 10000 μg / l, after which an app ozonated oil with parameters: peroxide number - 18%, acid number - 71 mg KOH / g, for skin ulcer 1-2 times a day, for 10-15 days, followed by a break of 5-7 days, for 2- 3 courses.

The treatment method is as follows: in patients with local recurrences of breast cancer after neutron therapy with radiation injuries of the skin of the III-IV degree (the degree of which is determined by the RTOG / EORTS classification (1995), at the first stage of treatment, the wound is washed with ozonated distilled water, which is obtained by ozonation of 100 ml (the required volume of water for use) for 5 minutes, and the time depends on the volume of ozonated water and the performance of the ozonizer, with an ozone concentration of 10,000 μg / L. The treatment of skin ulcer defect with gaseous ozone in a vacuum container for 10-15 minutes, the time is determined on the basis of experimental studies and is optimal for cleansing of the bacterial purulent contents of the ulcer, while the ozone concentration is 10,000 μg / L. Then the skin fields irradiation with a wound surface, ointment applications of ozonized oil are applied.The procedures are carried out 3-5 times a week. At the same time, at home, apply ozonized oil applications 1-2 times a day for one month. The frequency and duration of treatment, the parameters of ozonated oil: (peroxide number - 18%, acid number - 71 mg KOH / g) are based on experimental studies and clinical observations.

The duration of one course of ozone therapy - 10-15 days was the most effective for patients in this category after neutron therapy. A subsequent break of 5-7 days is necessary for tissue regeneration. In general, this category of patients is the optimal appointment of 2-3 courses of ozone therapy. The indicated duration of treatment and the total number of courses of ozone therapy is due to the fact that these patients in the radiation fields had an IV degree of radiation damage to the skin according to the classification RTOG / EORTS (1995). A concomitant adverse factor is the presence of altered tissues after previous treatment for primary breast cancer (radical mastectomy, a preoperative course of radiation therapy) in individual patients in the form of severe skin atrophy and sclerosis of the subcutaneous tissue.

The mode of the proposed method is based on the analysis of the results of clinical observations of 4 patients with local relapses of breast cancer.

According to the results of the effectiveness of ozone therapy, this group of patients was compared with the group of the prototype [3].

Clinical testing of the application of the proposed method in 4 patients with local recurrences of breast cancer showed satisfactory tolerance of ozone therapy.

It is known that ozone therapy has a bactericidal, anti-inflammatory and analgesic effect. As a result of bringing the treatment according to the proposed method using ozone therapy, three out of four patients with local recurrences of breast cancer with radiation ulcers of 2x4 cm in the region of the anterior chest wall after neutron therapy and in one patient (out of four) with ulcerative form of local recurrence of breast cancer significant improvement in general condition, reduction of pain. From side effects: all patients during the ozone therapy session had a desire to fall asleep. After 4 sessions of ozone therapy, the disappearance of an unpleasant odor from the wound, the cleansing of the bottom of the ulcerative defect from purulent fibrin were noted. After 7 sessions - reduction of purulent plaque in the wound, flattening of the edges of the wound defect, the appearance of granulations, restoration of sensitivity of healthy tissue.

The following clinical examples demonstrate the effectiveness of the proposed method for ulcerative skin lesions.

Clinical example No. 1. Patient B., 69 years old. No. of medical history 142862.

Diagnosis: Cancer of the left breast T2NxMO. Condition after combined treatment in 1986 (radical mastectomy and 2 courses of polychemotherapy according to the CMF scheme, radiation therapy was not performed).

The histological conclusion No. 2569/86 - infiltrative lobular cancer. In July 2010, local ulcer relapse was verified.

Objectively: on the anterior chest wall, in the area of the postoperative scar there is a peptic ulcer, 4 cm in diameter, with purulent plaque. Diagnosis: local recurrence of breast cancer, ulcerative form (Figure 1). According to ultrasound, in the medial sections of the postoperative scar in the soft tissues, an elongated form of a recurrent tumor of 37 × 9 mm with an uneven, clear contour is determined. Regional lymph nodes are not enlarged. Conclusion: relapse in soft tissues in the area of the postoperative scar.

After an additional examination and exclusion of pathology from other organs and systems, the patient was prescribed treatment on September 16, 2010 according to the proposed method. The patient had ozone therapy sessions 5 times a week, which included washing the wound with ozonated distilled water, treating the ulcer with gaseous ozone for 5 minutes, followed by an increase in exposure time to 10 minutes. After treatment with gaseous ozone, applications of ozonized oil were carried out with the following parameters: peroxide number - 18%, acid number - 71 mg KOH / g. In addition, the patient was recommended at home additionally in the evening to apply ozonated oil with the same parameters to the area of the ulcer defect. After the 4th session of ozone therapy, positive dynamics were noted: a decrease in purulent plaque in the area of the ulcer defect. Considering that the patient had a local recurrence of breast cancer, in parallel with ozone therapy, electron-neutron therapy was prescribed in the area of relapse from 09/22/10. Radiation therapy with fast electrons of 7 MeV, ROD-2.0 Gy to SOD-40 Gy. As a result: on SOD-24 Gy and 15 sessions of ozone therapy, a positive effect was noted, which consisted in reducing the recurrent tumor and purulent plaque (Figure 2).

Additionally, neutron therapy, ROD-1.6 Gy, 2 sessions, SOD-13.5 Gy was prescribed to the patient from 10/20/10 to 10/24/10. The total course dose of electron-neutron therapy was 53.5 isoGy.

From October 14, 10 to October 27, 10 the second course of ozone therapy was carried out. The break between the courses of ozone therapy was 7 days (for tissue regeneration).

Ultrasound from 11/08/2010 - reduction of a recurrent tumor to 27 × 6 mm. Conducted 10 sessions of ozone therapy.

At the control examination after 3 months. there is a decrease in the ulcerative form of local relapse to 1.5 cm, there are moderate discharge of serous fluid. A cytological study (No. 7110) of serous fluid from a peptic ulcer was performed. No tumor cells were found.

After 6 months - regression of local recurrence of breast cancer, confirmed by ultrasound.

At the control examination (1 year after radiation therapy and ozone therapy) - the ulcer defect healed, there is moderate soft tissue fibrosis. Ultrasound from 12/19/11 - no data for relapse (Figure 3).

Clinical example No. 2. Patient L., 72 g., No. history of the disease 134977.

Diagnosis: Cancer of the left breast T2N2MO. Condition after combined treatment in 2006 (radical mastectomy, 4 courses of polychemotherapy according to the FAC scheme, radiation therapy was not performed). Local recurrence in the area of postoperative scar (May 2007). The state after neutron therapy in the area of local recurrence of breast cancer in June 2007 in SOD-35 isoGy. Radiation skin ulcer in the anterior chest wall 1.5 years after neutron therapy (January 2009).

The histological conclusion No. 5288-97 / 06 - infiltrating ductal carcinoma of the breast with metastases of 8 l / nodes.

Objectively: on the anterior chest wall, in the area of the postoperative scar there is a peptic ulcer 2.5 cm in diameter, with purulent plaque. Diagnosis: Radiation skin ulcer after neutron therapy of local recurrence of breast cancer (Figure 4). After an additional examination and exclusion of pathology from other organs and systems, the patient was prescribed treatment on January 16, 2009 according to the proposed method. Sessions of ozone therapy were carried out 3 times a week and included washing the wound with ozonated distilled water, treating the ulcer with gaseous ozone for 10 minutes, followed by an increase in exposure time to 15 minutes. After treatment with gaseous ozone, applications of ozonized vegetable oil were carried out with the following parameters: peroxide number - 18%, acid number - 71 mg KOH / g. In addition, the patient was recommended at home additionally in the evening to apply ozonated oil to the area of the ulcer defect. After the 4th session of ozone therapy, there was a positive trend: a decrease in dyspnea when torso, the disappearance of an unpleasant odor from the wound, cleansing the bottom of the ulcer from purulent fibrin (Figure 5). After 15 sessions of ozone therapy, a positive effect was noted, which consisted in improving the general well-being of the patient, in reducing purulent plaque in the wound, flattening of the edges of the wound defect, and the appearance of granulations (Figure 6). Further, after a 5-day break, treatment was continued with the proposed method. In total, 3 courses of ozone therapy were conducted, which ended on March 13, 2009.

During the control examination (3 measures after the last course of ozone therapy), a decrease in radiation ulcers to 0.7 cm, the appearance of granulation tissue around. Ultrasound of the anterior chest was performed (June 2009) - there is no data for relapse of breast cancer. A scraping was taken from a ulcerative defect - atypical cells were not found. The patient was released under dynamic observation with recommendations for external use of ozonized oil.

After 2 months according to the MRI study, the patient was diagnosed in the patient’s place of residence: Discirculatory encephalopathy with an episode of a cerebrovascular accident.

The patient did not appear for subsequent follow-up examinations. According to relatives - deterioration of health due to concomitant pathology. Locally - without deterioration.

Thus, the proposed method for treating patients with local recurrences of breast cancer with radiation injuries of the skin in the form of ulcerative defects after neutron therapy is highly effective, it helps cleanse ulcers from purulent plaque, actively regenerates and heals ulcerative skin defects and is promising for use in clinics.

Sources of information taken into account when compiling the description

1. RF patent No. 2218197 dated 12/10/2003. A method for the treatment of trophic ulcers and long-term non-healing purulent wounds // E.A. Nazarov, I.A. Fokin.

2. RF patent No. 2424816 from 07/27/2011. The method of postoperative management of patients after radiosurgical treatment of tumor-like lesions and benign neoplasms of the oral mucosa // E.A. Durnova, N.A. Yanova, N.E. Khomutinnikov.

3. Titova V.A., Shipilova A.N., Kreinina Yu.M., Shevchenko L.N., Kurganova I.N., Petrovsky V.Yu., Klimenko K.A. Systemic and local ozone therapy in the prevention of complications caused by multicomponent treatment of malignant tumors // Medical Radiology and Radiation Safety, 2007, V. 52, No. 4, p. 47-52.

application

Figure 1. Patient B., 69 years old. Diagnosis: Cancer of the left breast T2NxM0. Condition after combined treatment in 1986 (radical mastectomy, 2 courses of polychemotherapy according to the CMF scheme, radiation therapy was not performed). Local recurrence of breast cancer ulcerated up to 4 cm in diameter, with purulent plaque (July 2010).

Figure 2. Patient B., 69 years old. Condition after 10 sessions of ozone therapy and electronic therapy in SOD-24 Gy in the area of the ulcerative form of local recurrence of breast cancer. Pronounced positive effect: reduction of recurrent tumor and purulent plaque, flattening of the edges of the wound

Figure 3. Patient B., 69 years old. Control examination 1 year after ozone therapy and radiation therapy in the area of the ulcer form of local recurrence of breast cancer. There is a regression of local recurrence of breast cancer, confirmed by ultrasound, the ulcer defect healed, there is moderate soft tissue fibrosis.

Fig 4. Patient L., 72 g. Cancer of the left breast T2N2MO. Condition after combined treatment in 2006 (radical mastectomy, 4 courses of polychemotherapy according to the RAS scheme, radiation therapy was not performed). Condition after neutron therapy in the area of local recurrence of breast cancer in the area of the postoperative scar in 2007. Radiation skin ulcer in the anterior chest wall 1.5 years after neutron therapy.

Figure 5. Patient L., 72 g. After 4 sessions of ozone therapy - the disappearance of an unpleasant odor from the wound, cleansing the bottom of the ulcer from purulent fibrin.

6. Patient L., 72 g. After 7 sessions of ozone therapy, a decrease in purulent plaque in the wound, flattening of the edges of the wound defect, and the appearance of granulations are noted.

Claims (1)

A method for the treatment of radiation injuries of the skin of the III-IV degree in the radiation fields after neutron therapy in patients with local relapses of breast cancer (BC), including irrigation with ozonated distilled water followed by applications of ozonated oil, characterized in that the wound is washed with ozonated distilled water with an ozone concentration of 10000 ozone μg / l, treat skin ulcer in a vacuum container for 10-15 minutes with gaseous ozone with a concentration of 10,000 μg / l, after which ozone applications are performed oil with parameters: peroxide number - 18%, acid number - 71 mg KOH / g, for skin ulcer 1-2 times a day, for 10-15 days, followed by a break of 5-7 days, for 2-3 courses.

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