The method of combined treatment of locally advanced cancers of the maxillary sinus

 

(57) Abstract:

The invention relates to medicine, namely to Oncology, and can be used in the combined treatment of locally advanced cancer of the maxillary sinus. In the way that patients spend preoperative course of photon therapy in an accelerated procedure a single dose of 3.0 Gy, 5 fractions per week to a total focal dose of 30-36 Gy. Before surgery, depending on the magnitude of the preoperative dose rate and duration (5-10 days) break before the operation to determine the optimal value of a single dose 10 to 20 Gr of intraoperative radiation therapy by fast electrons 6 MeV compact betatron. Simultaneously perform prosthetic metal with shape memory of nickelodian. The total dose rate of the mixed exposure does not exceed 65-75 Gy in compliance with the tolerance of the surrounding tissues to ionizing radiation and does not prevent postoperative wound healing. The total dose rate 65-75 Gy is applied to pathological lesion in 2.5-3 weeks. The method helps to reduce the frequency of local recurrence and improve the quality of life of patients. 2 Il.

The invention relates to medicine, namely to oncovoietoare of the maxillary sinus, prone to recurrence.

There is a method of combined treatment of locally advanced cancer of the maxillary sinus when a preoperative course of photon therapy fractions of 3 Gy 5 times a week, up to a total focal dose of the pathological focus 36 Gy, which corresponds to isoeffective 44 Gr standard course of radiation therapy (2 Gy, 5 fractions per week, 22 sessions), and subsequent surgery within a week after completion of radiotherapy (prototype) (1).

The disadvantages of this method are: small (40 Gy) dose preoperative course for radioresistant malignant neoplasms of the maxillary sinus; conditional radicalism of operations at the locally advanced tumors of the maxillary sinus, in consequence of which appear relapse on the first or second year of life; mutilating operations, as a result which affects the quality of life of patients after combined treatment.

There are also known methods of combined treatment of malignant tumors of various localizations, including tumors of the head and neck (similar) (3) where the "bed" of the removed tumor after preoperative chickens the betatron single dose of 10 Gy, which corresponds to isoeffective 24 Gr standard course.

The disadvantage of this method is that the combination of IORT fast electrons with a preoperative course of remote gamma-therapy (DHT) there is no method of calculating the total dose rate 65-76 Gr within the tolerance of the surrounding normal tissues, which is essential for the healing of postoperative wounds in intensive irradiation.

There is a method of replacement of defects of the person with a prosthesis made of metal with shape memory, nickeled-titanium (analog) (4). The disadvantage of this method is that the substitution of facial defects after cancer surgery of the maxillary sinus was not carried out in conditions of high single doses in combination with remote gamma-therapy in the preoperative period.

Thus:

a) in the conditions of combined treatment with preoperative course of the irradiation dose applied to pathological lesion, limited to 40 Gy, which often leads to tumor recurrence after combined treatment of malignant tumors of the maxillary sinus;

b) when combined remote gamma-therapy with intraoperative postoperative wounds, because there is no methodology for estimating the total dose rate for mixed radiation;

C) substitution of the defect of the face after surgery to remove the tumor of the maxillary sinus, nickeled-titanium prosthesis shape memory is not performed at the pre-engagement of the nidus large doses of different types of ionizing radiation.

The aim of the present invention is to reduce the number of relapses and improving the quality of life of patients with resistant forms of malignant neoplasms of the maxillary sinus.

This goal is achieved by the fact that in the conditions of combined treatment of cancer of the maxillary sinus, the total dose rate radiation therapy is 65-75 G, as and when irradiated radical programme, and consists of a total dose of 30-36 Gy (40-44 Gy on isoeffective compared to standard radiation therapy) preoperative rate of photon therapy and a single dose intraoperative radiotherapy with fast electrons 6 MeV conducted using small betatron when a patient is on the operating table. The value of a single dose of IORT within 10-20 G determined by the magnitude of the preoperative dose rate and duration of the break before the start of the operation, which ends prosthetics, nickeled-titanium prosthesis with shape memory according to pre-calculated individual dimensions of the bone fragment of the upper jaw to correct the defect of the face, and achieve the goal of the present invention in comparison with the prototype.

New in the proposed method is that in order to reduce the frequency of relapses and improve the quality of life in patients with locally advanced cancers of the maxillary sinus in the combined treatment uses a mixed irradiation - remote gamma-therapy and single intraoperative irradiation by fast electrons 6 MeV compact betatron by achieving the pathological focus total dose rate 65-76 Gr. Thus a single value of intraoperative irradiation within 10-20 G is determined for each patient depending on the total dose preoperative course of 30 to 36 Gy and duration of break (5-10 days) before the operation that ends with the simultaneous prosthesis formed of a defect facial prosthesis from nickeled-titanium shape memory. The total dose rate of the mixed radiation in the proposed method corresponds to the course is through the program in malignant tumors of the maxillary sinus is 65-75 Gy over 5-6 weeks (2). The total course dose - 65-75 Grams of mixed exposure to the pathological focus in the proposed method is applied for a shorter period of 2-3 weeks, which provides greater efficiency effects of radiation therapy on the tumor and its "bed" after executing conditionally radical surgery.

A prosthesis made of metal with shape memory for replacement of defects of the face in the combined treatment of locally advanced cancer of the maxillary sinus, the proposed method is used if the total dose rate of the mixed exposure does not exceed 65-75 Gy, as it wound healing and engraftment of the transplant does not suffer.

Widely used in clinical radiology of factors WDF to calculate the standard courses of irradiation involves the use of single doses only within 10 Gy (6).

To bring high single doses of IORT doses characterizing normal fractionation, it is proposed formula, which used the model WDF by expanding the scope of its application in doses large 10 Gr

After preoperative rate of photon therapy in the proposed method p formula

< / BR>
where Dml- once absorbed dose IORT in Gr; Dwith- selected in each case the total isoeffective dose rate of 65-75 Gy; N and T are respectively the number of sessions and duration (days) preoperative therapy; T break in the day between gamma-ray therapy and intraoperative radiation therapy.

The above formula is obtained based approach using extended field of application of the known models WDF (6) at single doses up to 20 Gy. The validity of this approach is confirmed by our clinical studies.

Calculations showed that the total dose rate when using preoperative course of DHT in mode 3 Gy, 5 times per week, the total focal dose of 30-36 Gy (35-44 sogr) and IORT within doses of 10-20 Gy (24 To 72 Gr in isoeffective), taking into account the break of 5-10 days before surgery, is 65-76 G, which corresponds to the dose used in radiation therapy radical programme in the treatment of radioresistant forms of locally advanced tumors of the maxillary sinus, and makes reasonable use of the proposed method.

The proposed method is performed as follows. Patients with the logical focus of a single dose of 3 Gy, 5 times a week, up to a total focal dose of 30-36 Gy. On the eve of the planned operation is correction of the treatment plan given doses of preoperative course and break before the operation to select the value of a single dose of IORT fast 6 MeV electrons so that the total dose rate of mixed irradiation did not exceed 65-76 Gr. The operation is completed, replacing the defect facial prosthesis shape memory of nickeled-titanium on a pre-calculated individual dimensions of the bone fragment of the upper jaw (5).

Thus, a course of radiation therapy mixed radiation in the combined treatment of radioresistant forms of malignant neoplasms is under the control of the assessment of biological effects with mathematical models WDF by expanding the scope of its application to single doses above 10 Gy that has not been used previously. Depending on the dose preoperative radiation therapy and duration of the interruption of treatment is determined by the value of a single dose within 10-20 Grams in factors WDF and isoeffective standard rate of dose applied during the surgical procedure, which is completed simultaneously receivedtime biggest dose of radical radiation therapy, but summed to pathological nidus for shorter periods of time (2.5-3 weeks), compared with radical radiation therapy (5-6 weeks), thus preventing recurrence of the disease in first or second year of life after combined treatment with this dose 65-75 Gy does not exceed the tolerance of the surrounding normal tissues and does not impede the wound healing after implantation of nickeled-titanium prosthesis shape memory, and achieving the goal of the proposed method.

The authors are not found in the patent and medical literature methods, the symptoms of which coincide with the distinctive features of the proposed method, therefore, we can conclude that the proposed solution meets the criterion of "significant differences".

Example 1.

Patient, 70 years. Diagnosis: recurrence of adenocarcinoma of the maxillary sinus and the nasal cavity, the condition after surgical treatment. Radiation map N 154.

A patient with 29.05.96 on 11.06.96 conducted preoperative course of gamma-therapy apparatus Rocus" field 4x10 cm, sector 120oswing, GENUS - 3,0 Gr, SOD - 30,0 G. Break prior to surgery was 5 days. Therefore, when the allowable value of dose rate 65 G pokazatelemvysokogo exposure:

< / BR>
In operation, the patient produced IORT - 11,1 G, with simultaneous prosthetic metal with shape memory.

Example 2.

Patient D. , 73. Diagnosis: recurrence of adenocarcinoma of the upper jaw, the state after photon therapy in 1989. Radiation map 515 N.

A patient with 16.11.96 on 01.12.96 conducted preoperative course of gamma-therapy apparatus Rocus" 2 fields 10x10 cm, GENUS -3,0 Gy, 5 fractions per week, SOD - 36,0 Gr. Break - 10 days. Completed the second phase of treatment is surgery. Therefore, when the allowable value of the course a dose of 75 Gy figures were: Dc= 36,0 G, N=12; T = 15 days., T = 10 days.

Determined by the formula the value of a single dose of intraoperative irradiation:

< / BR>
Patients received prosthesis on the operating table. When observing within 12 months of tumor recurrence was not found.

In terms of the use of the maximum permissible value exchange rate 65-75 Gy, when preoperative course equal to 0, the value of a single dose of IORT electron 6 MeV is 18.7-20.6, the Gr

The proposed method performed combined treatment of 21 patients with cancer of the maxillary sinus. During the first year of life recurrence rate SOS is authorized method (1): SORT - a 3.0 G, 12 fractions (prototype) tumor relapses appeared in 6 of 25 (28%) patients, and when using the standard exposure mode: RACE - 2.0 Gy, 20 fractions - 10 of 26 patients (40%), and achieved the purpose of the invention.

The quality of life of patients treated with the proposed method with simultaneous porous prosthesis, nickeled-titanium, does not suffer because of the patient is virtually no different from a healthy person, as evidenced by the below photo (Fig. 1). For reference, here is a photo of the patient without prosthesis after the combined treatment of cancer of the maxillary sinus (Fig.2).

Literature

1. Novikov Century A. Combined treatment of tumors of the nasal cavity and paranasal sinuses using photon and neutron therapy: author. Kida. Diss... - Tomsk, 1989, - 24 C.

2. Kozlov A. C. Radiation therapy of malignant tumors. - M.: Medicine, 1971.

3. Novikov, C. A., Musabayev, L. I., M. Mukhamedov R., Yasenchak Y. F. Combined treatment and rehabilitation of patients with tumors of the maxillofacial region / head and neck Tumors: diagnosis, treatment. Materials of all-Russian Conf. - Tomsk. 1994. - S. 99.

4. Mukhamedov M. R. Arthroplasty implants of porous nick is the lack of sinuses: author. Kida. Diss... - Tomsk, 1995.

5. Yasinchuk Y. F., Novikov Century A. Individual prosthetics midface // head and neck Tumors: diagnosis, treatment. Materials of all-Russian Conf. - Tomsk, 1994. - S. 142-144.

6. Ratner, So, Fadeeva M. F. Technical and dosimetric support of the remote gamma-therapy. - M., 1982.

The method of combined treatment of locally advanced cancer of the maxillary sinus with a preoperative course of photon therapy mode to 3.0 Gy, 5 fractions per week, the total focal dose of 30 to 36 Gy, characterized in that after 5 to 10 days after preoperative irradiation performed intraoperative radiation therapy fast 6 MeV electrons with a single dose calculated by the formula

< / BR>
where DML- once absorbed dose IORT, Gr;

Dwith- selected in each case the total isoeffective dose rate in the range 65 - 75 Gr;

N and T are respectively the number of sessions and duration (days) preoperative therapy;

T - break in the day between gamma-ray therapy and intraoperative radiation therapy,

with simultaneous prosthetic defect facial prosthesis from nickeled-titanium.

 

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