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.
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