How pharmacological treatment desmoidnyi of fibroids in women

 

(57) Abstract:

The invention relates to medicine, in particular to the treatment of desmoidnyi of fibroids. Asked to identify the level of bound and free estradiol, testosterone, FSH, and increasing estradiol and/or testosterone 10-20% and FSH decrease by 10% from the norm prescribed Tamoxifen in therapeutic doses for 2 months. Re-define these hormones, and normalization of these indicators continue taking Tamoxifen for 6 months. While maintaining the original performance of estradiol, testosterone, FSH or negative dynamics appoint Zoladex for 6 months. The proposed method allows to reduce the number of relapses by 40%.

The invention relates to medicine, in particular to methods for treating desmoidnyi of fibroids.

Desmoidnyi fibroma (DF) is attributed to a relatively rare pathology of the connective tissue.

The essence of this pathology is not fully clear. In the histological classification of who they are conditionally included in the group of fibromatosis - opuholepodobnoe fibroblastic lesions of unclear Genesis. The definition of "opuholepodobnoe" is not accidental. Formally morphological paintings is redstavleny fields fibrous connective tissue, among which are scattered isolated fibroblasts and fibroblasts.

The morphological examination no signs of malignancy, and the tumor never gives metastases. However, desmoid prone to frequent recurrence and aggressive local destroyuser growth rate far exceeding soft tissue sarcoma. The tumor has no capsule and therefore penetrates deep into the fibers between the muscles. In addition, desmoid able to spread in the form of spicules at far distance from the main array.

Historically, desmoid was divided into abdominal (AD) and extraabdominal (ED).

A common method of treatment of desmoid remains surgical (Shpitz D. , Siegal , A., Wits M. , Kaufman z , Dinbar A. Desmoid tumor - Reviewand follow-up of teu cases - J. Surg, Oncol. , 1985, 28, n. . . 1, 67-71).

But AF, regardless of the amount of interference, not only is not a guarantee against relapse but, on the contrary, as it provokes his appearance. In other words, re-intervention only reduce relapse-free period. Not directly life threatening, these tumors as recurrences lead to severe disability patients in force re-mutilating operations or fast is I DF, but the effect was minimal (Kill K. D. , Suit N. R. , Radiation therapy in the treatment of aggressive fibromatoses - desmoid tumors - Cancer, 1984, 54, n. 10, 2051-2055). We began to apply radiation therapy doses, comparable to those of malignant tumors. Good results in the stabilization process, reducing tumor volume, and sometimes complete resorption. But remained unresolved following points: 1) because of the necessity of deciding on high doses of ionizing radiation to large amounts of tissue has increased the threat of serious radiation damage; 2) prevent the use of radiation therapy in patients with repeated relapses after repeated surgical or radiation treatment with serious trophic tissue changes over the tumor.

There is a method of combined treatment of desmoids (M. A. Kuznetsova, the dissertation on competition of a scientific degree of candidate of medical Sciences " the Role of radiotherapy in the treatment of desmoidnyi fibroids soft tissues. " The defense of Moscow in them. P. A. Herzen 1984). But this method has the same drawbacks as radiation therapy.

There is a method of treatment of AF using Vinblastine and Methotrexate (Low-dose chemotherapy of desmoid tumors / Weiss Arthur G. , Richard D. Lackman / Cancer. - 1989-64, n. 6, 1192 - 1194).

The disadvantage of this method is you who women allowing to reduce the number of relapses.

This problem is solved by the method lies in the fact that determine the level of bound and free estradiol, testosterone, FSH, and increasing estradiol and/or testosterone by 10 to 20% and decrease FSH 10% from the norm prescribed Tamoxifen in therapeutic doses for two months. Re-define the above hormones, and normalization of these indicators continue taking Tamoxifen for 4 months; when you save a baseline estradiol, testosterone, FSH or negative dynamics appoint Zoladex in therapeutic doses for 6 months.

Clinical examples 1.

Patient I. , 67 years old, came with complaints about the presence of tumor in the anterior chest wall on the left. Ultrasound: on the left surface of the chest wall, axillary region is defined tumor mass with irregular contours. Education is closely adjacent to the ribs and motoblaze fits their size 12,3+10,7+5.8 cm with spurs, dendritic outgrowths. In the study of hormonal status Estradiol 108,3 PG/ml (N 15-60 PG/ml), FSH 38,7 mIU/ml (N 35,0 -121,2 mIU/ml), Testosterone 0.08 ng/ml (N 0.10 to 1.20 ng/ml).

is Nicholas in size by 1/3; Estradiol levels decreased to 56.4 PG/ml; FSH and Testosterone on the original figures. The patient continued hormone therapy with Tamoxifen for another 4 months. From neoplastic process further improved, hormonal status within normal limits according to age. The patient is kept under observation for 3 years, data for recurrence and continued growth. ///2 2. Patient C. , 19 years old, came to the Institute regarding multiple relapses desmoidnyi fibroids in the area of the left n/limbs. Four years ago, twice operated on for a tumor in the popliteal fossa to the left. When contacting the Institute: in the soft tissues of the left tibia in the rumen on the border with/3 and n/3 hypoechoic education, size 14+9 mm. lies lateral to the C/3 postoperative scar in the soft tissues of education 14+8+15 mm; in the popliteal fossa education 47+12+17 mm On the rear surface of the left tibia at a depth of 12 mm in the muscle is visualized education 32+7+14 mm, and below him on the middle line in the muscle is visualized chain similar in structure formations, size 18+7+14 mm; 12+4+8 mm, 14+7+9 mm Levels of Estradiol in the blood was 1. 286 PG/ml (N folliculinum phase (FF) - 30-120 PG/ml, ovulation (s) ng/ml (N 0.10 to 1.20 ng/ml). The patient started hormone therapy with Tamoxifen at a dose of 20 mg daily for 2 months. When hormonal control study, the levels of estradiol, testosterone, FSH remained the same, although clinically was celebrated positive dynamics: the tumor nodes decreased in diameter to 5 mm, on the back surface of the left tibia at a depth of 12 mm in the muscle formation also decreased in size to 2.7+4+0.5 mm, and below him on the middle line has ceased to render similar in structure formation. The patient was transferred to the Zoladex 3.6 mg p/1 injection per month N 6. Already after the first injection of hormonal status within normal limits: Estradiol LF - 178,6 PG/ml, Testosterone -0,16 ng/ml, FSH LF - 6,21 mIU/ml After 7 months after the start of treatment clinically and according to instrumental methods found a cure. The patient is observed in the clinic for 2 years. Data for recurrence and continued growth.

In this way treated 29 patients. No recurrence in 25 patients.

The proposed method allows to reduce the recurrence rate of 40%.

How pharmacological treatment desmoidnyi of fibroids in women, characterized in that determine the level of bound and free will estradiolum Tamoxifen for 2 months at therapeutic doses, re-define these hormones, and normalization of their indicators continue taking Tamoxifen for 4 months, while maintaining baseline estradiol, testosterone, FSH or negative dynamics appoint Zoladex in therapeutic doses for 6 months.

 

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