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 GrAfter 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 GrThe 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.
FIELD: medicine, oncology.
SUBSTANCE: the present innovation deals with treating patients with uterine cervix cancer with relapses in parametral fiber and in case of no possibility for radical operative interference and effect of previous radiation therapy. During the 1st d of therapy one should intravenously inject 30 mg platidiam incubated for 1 h at 37 C with 150 ml autoblood, during the next 3 d comes external irradiation per 2.6 G-r. During the 5th d of therapy one should introduce the following composition into presacral space: 60 ml 0.5%-novocaine solution, 1 ml hydrocortisone suspension, 2 ml 50%-analgin solution, 1 ml 0.01%-vitamin B12 solution, 1.6 g gentamycine, 800 mg cyclophosphan, 10 mg metothrexate. These curative impacts should be repeated at mentioned sequence four times. The method enables to decrease radiation loading and toxic manifestations of anti-tumor therapy at achieving increased percent of tumor regression.
EFFECT: higher efficiency of therapy.
FIELD: medicine, oncology.
SUBSTANCE: invention relates to a method for treatment of uterus body topically spread cancer involving applying chemotherapy and intrauterus irradiation. Method is carried out by the following manner: at the 1-st day of treatment cyclophosphan is administrated in the dose 1200-1600 mg by interstitial paratumoral route; at the 2-d day cream-like based fluorouracil in the dose 300-550 mg or adriablastin in the dose 20-30 mg is administrated into uterus cavity; on the next day sйance of intracavitary irradiation is carried out in the dose 10 Gr. All these procedures are repeated three times with interval for 6 days. Method provides high topical concentrations of chemopreparations in tumor zone in reducing their adverse toxic effect that results to the curative effect of patients of elderly age with accompanying therapeutic diseases.
EFFECT: improved method for treatment.
SUBSTANCE: method involves carrying out argon plasma of tracheal and/or bronchial lumen recanalization by applying power of 60-90 W with argond discharge rate being 2.0-2.4 l/min large. Brachitherapy is applied next to it moving the source with 5 mm large step. Trajectory length is 5 to 20 cm large. Reference isodose depth is 10 mm far from the source with applicator moving above and below the tumor from 1 to 3 cm. Dose from 14 to 28 Gr is to be administered once a week in 7 Gr large portions.
EFFECT: enhanced effectiveness of treatment; reduced risk of complications; prolonged remission period.
FIELD: medical equipment; radiation therapy.
SUBSTANCE: radioactive source has radioisotope disposed inside air-tight biocompatible container. At least some part of container is made profiled and have rough, non-smooth surface. Radioactive source is made by loading it inside air-tight container. Composition has assemblage of radioactive sources mounted in line onto biologically decomposed material. Invention helps to improve ultrasonic visibility of source and/or reduce the trend of source to migrate in patient's body after implantation.
EFFECT: improved quality of treatment.
22 cl, 8 dwg
SUBSTANCE: the innovation deals with irradiating lymphatic collector, that is: at the first stage it is necessary to perform irradiation for the whole volume of affected lymph collector at total focal dose being 26 Gy, at the second stage one should carry out irradiation at collector's areas depending upon the degree of their destruction at decreasing the size of fields: for the area of residual lymph nodes remained after polychemotherapy - up to the total focal dose being 44 Gy, for the area of massively affected lymph nodes in case of total effect after polychemotherapy - up to 36 Gy, for the area of moderately affected lymph nodes in case of total effect after polychemotherapy - up to 30 Gy. The method enables to decrease the number of complications and local relapses, shorten terms for therapy, improve values for patients' survival rate at decreasing total integral dose of irradiation.
EFFECT: higher efficiency of radiation therapy.
FIELD: medical engineering.
SUBSTANCE: device has active zone of water-to-water nuclear reactor, biological reactor protection concrete mass, slow neutron collimator, which internal surface is coated with material like polyethylene having large scattering cross-section and conically shaped, filter for cleaning slow neutron radiation beam from gamma-quanta and aperture for regulating slow neutron radiation beam diameter. Retarder manufactured from beryllium or graphite or heavy water is available in the space between whole-metal water pool tank casing and adjacent active zone surface. Retarder height and width is not less than corresponding dimensions of the adjacent active zone surface. A hole is available in the bulk of biological reactor protection concrete mass for discharging slow neutrons. The collimator is arranged in the hole so that spatial angle cut out with it contains the whole active zone surface. Its outlet opening is manufactured flush with the external wall of the bulk of biological reactor protection concrete mass and conjugated with the aperture.
EFFECT: high density of slow neutron flux; reduced share of fast neutrons.
3 cl, 3 dwg
SUBSTANCE: the method deals with 2 courses of polychemotherapy at the first stage due to regional intra-arterial introduction of cisplatin at the dosage of 100 mg/m2 during the first day of every course and 6-h-long intra-arterial infusion of 5-fluorouracil at total dose of 750 mg/m2 in the morning since the 2nd to the 6th d of every course. Chemotherapy should be performed at the background of total magnetotherapy at frequency of magnetic field being 98-112 Hz, intensity of 25-30 oersted, duration of every seance being 30 min, the number of seances corresponds to the duration of chemotherapeutic courses. At the second stage in 2-3 wk after finishing chemotherapy it is necessary to conduct the course of distance radiation therapy (DRT) at multifractioning the dosage by SFD being 1.2 Gy twice daily 5 times weekly up to TFD being equivalent to TDF (time-dosage-fraction) of 62-70 Gy onto primary focus and 40-46 Gy onto areas of regional lymph outflow. As modifiers one should apply cisplatin during the first 2 wk of radiation therapy, hyperbaric oxygenation during the first 10 d of radiation therapy and total magnetotherapy since the 11th d of DRT course till its ending. At the third stage in case of residual metastases in lymph nodes of patient's neck in 2-3 wk after the end of radiation therapy one should conduct operative interference in lymph outflow pathways. The method enables to decrease toxicity of chemo-and radiation therapy due to decreased radiation reactions, stimulation of immune system and improved microcirculation.
EFFECT: higher efficiency of therapy.
FIELD: experimental medicine, oncology, biology.
SUBSTANCE: invention relates to a method for inhibition of tumor growth using radiation therapy as ionizing radiation with additional administration of mixture of octa-4,5-carboxyphthalocyanine sodium cobalt salt or oxocobalamine with sodium ascorbate in the ratio = (1:10)-(1:30). Method of combined using irradiation and indicated mixture of substances provides enhancing the effectiveness of anti-tumor treatment resulting to 70-100% recovery of experimental animals and reducing radiation loading and toxicity.
EFFECT: improved method for inhibition.
2 tbl, 3 dwg, 3 ex
FIELD: medicine, oncology.
SUBSTANCE: the method deals with applying chemopreparations incubated with autolymph and radiation therapy. Lymph taken out of patient's thoracic duct should be centrifuged for 30 min at 2200 rot./min, lymphatic plasma should be taken and frozen at -40 C, lymphatic formic elements should be incubated in a thermostat at 37 C for 1 h together with chemopreparations by a certain scheme to be reinfused for a patient intravenously by drops according to the given scheme. Then, 2 wk later, one should perform therapy with a split course of distance gammatherapy at single focal dosage (SFD) of 4 Gy. At the first stage one should apply per 2 Gy twice daily at 4-5-h-long interval 5 times weekly, at achieving focal dosage of 28 Gy it is necessary to have a week-long interval. Then radiation therapy should be continued but SFD of 4 Gy should be applied at once. One should fulfill 3 fractions of irradiation per a week, there are 6 fractions during the second stage, totally. Total focal dosage (TFD) per the whole course of irradiation corresponds to 52 Gy. About 4 wk after radiation therapy one should defrost lymphatic plasma to incubate it with the same chemopreparations in a thermostat at 37 C for 1 h to be then reinfused for a patient intravenously by drops. The method enables to decrease tumor volume and tumor process metastasing without any operative interference.
EFFECT: higher efficiency of therapy.
FIELD: medicine, oncology.
SUBSTANCE: before irradiation it is necessary to cool the tumor to achieve the temperature of freezing at clinically detectable border between the tumor and healthy tissue to perform irradiation directly after natural tissue defrosting with a single focal dosage (SFD) being 2-2.5 Gy daily for 5 d a week at 2-d-long interval to achieve total focal dosage (TFD) of 60-65 Gy. Moreover, the area of healthy tissue should be protected with a shielding applicator - a lead plate - during irradiation. The present innovation enables to maximally keep anatomical relief and function of local tissues.
EFFECT: higher efficiency of therapy.
1 cl, 4 ex