Method for the treatment and prevention of malignant lymphoma of the conjunctiva using a beta application therapy

 

(57) Abstract:

The invention relates to medicine, in particular to ophthalmology, and is intended for the treatment and prevention of malignant lymphoma of the conjunctiva. Conduct beta application therapy. Total focal dose of 100 Gy to the base of the tumor and the conjunctiva of all codes of both eyes in 5 fractions. The method provides a complete regression of tumors of the conjunctiva without damaging surrounding the tumor tissue and the prevention of the development of new lymphoma codes of the same or different eyes. table 1.

The present invention relates to ophthalmology, more precisely to oftalmologii, and is intended for the treatment and prevention of malignant lymphoma of the conjunctiva.

To lymphoproliferative diseases include reactive lymphoid tissue hyperplasia and malignant lymphoma Knowles DM with co-authors (1992) propose to divide lymphoproliferative disease benign reactive hyperplasia, atypical lymphoid hyperplasia, which is intermediate between benign and malignant tumors and malignant lymphoma (Knowles DM, Jakobiec FA Malignant lymphoma and lymphoid hyperplasia occurring in the ocular adnexa. // In Knowles DA (ed). Neoplastic hematology/ Baltimore: Wi special wastemanagement research. Given the complexity of the differential diagnosis of reactive hyperplasia and malignant lymphoma of the conjunctiva, each case is a lymphoproliferative disease of the conjunctiva require treatment. According to different authors, the frequency of malignant lymphoma of the orbit and paranasal apparatus of the eye make up 4% of all extranodal lymphomas. Dominated by orbital lymphoma. Lymphoma of the conjunctiva are about one-third of all malignant lymphomas of the organ of vision. According to the Moscow city ophthalmologische Cabinet annually register 6-10 new cases of malignant lymphoma of the conjunctiva.

The involvement of the tissues of the conjunctiva with disseminated lymphoma is rare. Dominated by primary lymphoma of the conjunctiva (Canellos GP, Lister TA, Sklar JL // The Lymphomas.- WB Saunders Company.- p 450-465). According to the latest classification of lymphomas REAL (1994) the majority of primary lymphoma of the conjunctiva are MALT-Ohm low-grade malignancy, i.e., tumors associated with mucous membranes. These lymphomas have a sluggish pace and require local treatment.

Lymphoma of the conjunctiva, usually, have a look valikoobraznye tumors, predominantly located P> Lymphoma adventitious eye device, refer to the radiosensitive tumors. The traditional method of treatment of lymphoproliferative diseases of the conjunctiva is remote radiotherapy - radiotherapy, gamma-therapy is recommended or photon radiation (Petrella T, Bron A, Froulet A et al Report of a primary lymphoma of the conjunctiva. A lymphoma of MALT orign? //Pathol-Res-Pract. - 1991.- vol. 187 (l).-p 78-84. Petrella T, Bron A, Froulet A et al Report of a primary lymphoma of the conjunctiva. A lymphoma of MALT origin?//Pathol Res-Pract.- 1991.- vol.l87 (l).-p 78-84).

For lymphoproliferative diseases of the conjunctiva characterized by both synchronous and metachronous involvement of all four conjunctival vaults. Repeated exposure to the same eye leads to such severe complications as radiation keratopathy, radiation cataract, secondary hypertension. The emergence of keratopathy is largely due to the development of so-called dry eye syndrome associated with hypofunction of the lacrimal gland in the case of inclusion in the exposure zone. The latter circumstance makes the search for new methods of local treatment of primary lymphoma of the conjunctiva.

Method of contact radiotherapy - brachytherapy using beta applicators, widely used in oftalmologii not found applied therapy allows to irradiate the affected areas of the conjunctiva with minimal radiation exposure to adjacent healthy structures of the eye and orbit: at a depth of 3 mm total dose of 25% of the surface, and at a depth of 5 mm only 1%. Different shapes and sizes of applicators allow you to create almost any configuration field exposure. The use of beta - application of brachytherapy is a highly effective method of treatment of lymphoma of the conjunctiva without the risk of radiation complications.

The possibility of metachronous development of lymphoma of the conjunctiva of the upper and lower arches of both eyes dictates the need for prophylactic irradiation in doses of half a therapeutic.

The objective of the proposed invention is to achieve complete regression of tumors of the conjunctiva and the prevention of the development of new lymphoma of the conjunctiva another code or other eye, preventing the development of radiotherapy complications.

Malignant lymphoma of the conjunctiva referred to radiosensitive tumors, and traditionally in their treatment using electron beam, photons or gamma rays. Total focal dose is 25-30 Grams. when a single dose of 1.5 - 2 Gy. Remote radiation therapy, as a rule, allows to achieve complete regression of tumors of the conjunctiva, but its use is associated with risk of developing the complications of radiation: radiation cataract, secondary hypertension, dry eye syndrome, radiation Coeur is injunctive other eye, or other conjunctival fornix of the same eye. Most often lymphoma arise metachronous, i.e. a few months after first diagnosis of conjunctival tumors and significantly less likely to have simultaneous conjunctival lesion of several arches. Re remote therapy 100% leads to the development of radiotherapy complications in the form of keratopathy and the subsequent development of cataract.

The closest analogue of the invention is a method of treatment of malignant lymphoma of the conjunctiva using a method of remote radiation therapy using electron beam described in article Dunbar S. F. et al. Conjunctival lymphoma: results and treatment with a single anterior electron field. A lens sparing approach [see comments]/ Int-J-Radiat-Oncol-Biol-Phys. 1990.- vol. 19 (2).- pp. 249-257.

The authors analyze the results of treatment of 12 patients with malignant lymphoma of the conjunctiva electron beam from the right front of the field and the stress that persistent positive effect of radiotherapy was achieved by irradiation in total focal dose (SOD) at least 24-30 Gy. for 8-16 fractions. Despite the use of special plastic prostheses for the protection of the anterior eye segment and a corresponding reduction in radiation exposure to the lens to 5-18% of summary the ptx2">

These drawbacks are deprived of contact method of radiation therapy of beta-applicators (brachytherapy) tumors of the eyelids, bulbar conjunctiva and cornea. When the beta application therapy dose distribution of the field is such that the tumor-surrounding tissues are not exposed to radiation (table 1).

Thus, the cornea and lens is not more than 1% of the total surface dose.

However, the beta application therapy has not previously been used for the treatment of malignant lymphoma of the conjunctiva.

The technical result of the invention is the complete regression of tumors of the conjunctiva without damaging surrounding the tumor tissue and the prevention of the development of new conjunctival lymphomas codes of the same or different eyes.

The technical result is achieved due to the irradiation lymphoma beta astitsy SR ophthalmoplegia. Total focal dose is determined by the thickness of the tumor (table 1) so that the base had a dose of 100 Gy. Total focal dose is supplied in 5 fractions.

The prevention of the development of new lymphoma in other conjunctival vaults at the expense of their preventive obleceni prevents the development of new lesions due to exposure zones most likely the presence of tumor cells razed growth without clinical manifestations in minimum cytostatics dose, which is also tolerant to normal cells of the conjunctiva.

We practically found that the total dose of 100 Gy on the basis of lymphoma, summed up large fractions over 5 sessions, leads to complete regression of tumors and does not cause any side effects on healthy tissues. At the same time, we know that for brachytherapy of malignant tumors of the conjunctiva of another nature (melanoma, cancer) applied total dose on the basis of the tumor to 200 G at single doses of 10-15 Gy (Beta therapy of tumors of the organ of vision. Methodical recommendations. Moscow, 1988, pp. 9 - 10). Thus, the proposed method uses specially selected dose of beta radiation for the treatment of malignant lymphoma of the conjunctiva.

The method is as follows. Irradiation of the patient is done as an outpatient procedure in the dental chair in the reclining position. Before laying on the head of the patient can be put on and tight, button head clamp. After instillations anesthesia for ever and insert the appropriate applicator appropriate form. Pre applicator desinfiziert is close to the eyeball, that excludes the possibility of its displacement from the installed location. Depending on tumor irradiation produced in one of four fields. The total dose is determined based on the basis of tumor 100 Gr. The irradiation is carried out daily. Single dose of 1/5 of the total, which is much higher than the irradiation of such malignant tumors as cancer or melanoma, and due to the fact that lymphoma of the conjunctiva - the tumor is low-grade malignancy. The session lasts, depending on the capacity of the applicator 10-15 minutes for prophylactic irradiation of SOD is 100 Grams for each conjunctival fornix (the diseased and healthy eyes) at a dose of 20 Gy, i.e., in 5 fractions.

The total course of treatment is 5 days. Radiation reaction in the form of local hyperemia of the conjunctiva quickly and completely passes within 1-3 weeks after appropriate medical treatment - vitamin and multi-drops.

Example 1. Patient M., aged 57, in February 1996 received remote x-ray treatments regarding lymphoma upper conjunctival fornix of the left eye. Treatment was discontinued because of the development of radiation keratopathy. After 3 months. she spent brachycerinae. By the end of treatment showed complete regression of the tumor. The observation period of 3 years without recurrence. Remain phenomenon of radiation keratopathy after radiotherapy.

Example 2. Patient R., aged 40, has received brachytherapy lymphoma of the conjunctiva of the upper fornix of the right eye and the lower arch of the left eye (bilateral lesions). Prophylactic respectively from the irradiation of the lower arch of the right eye and the top of the arch of the left eye. SOD at the base of the tumor and the healthy conjunctiva was 100 Gy to the top of tumor - 150 Gy in 5 fractions. The observation period of 1 year without recurrence. Radiation and there are no complications.

Example 3. Patient M., 50 years. About lymphoma of the conjunctiva of the lower arch of the right eye with the purpose of treatment received brachytherapy. Irradiation of 4 fields, SOD on the basis of tumor 100 Gr, on top of the tumor was 200 Gy. With the preventive purpose the irradiation of the upper arch to the right and the upper and lower arches to the left (6 fields) in a total dose of 100 Gy. Single dose of 24 Gy. Complete regression of the tumor. The term complete remission 9 months. Radiation and there are no complications.

Thus, the proposed method beta application therapy of lymphoma of the conjunctiva allows you to attain a stable local remission b and prevention of malignant lymphoma of the conjunctiva by radiation therapy, characterized in that as radiation therapy using a beta application therapy, while the total focal dose of 100 Gy to the base of the tumor and the conjunctiva of the arches of both eyes in 5 fractions.

 

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