Method of sighting intraorganic chemotherapy of cancer of body of uterus
The invention relates to medicine, namely to Oncology, and can be used as the first stage of treatment, preoperative therapy for tumors of body of uterus. The method includes the introduction in the preoperative period of chemotherapy drugs in the maximum single therapeutic dose in the wall of the uterus under ULTRASOUND control in place of direct contact to the surrounding tissue with lesion with the most pronounced vascular pattern, with the introduction of the produce repeatedly. The method allows for the shortest possible period of time to bring to focus the maximum permissible dose of chemotherapy to eliminate toxic side effects on normal tissue and to achieve operability of the tumor. 2 Il. The invention relates to medicine, more specifically to Oncology, and can be used when carrying out the first stage of treatment of preoperative chemotherapy in cases of the presence in the body of uterus malignant destruction.There is a method of treatment of endometrial cancer with unresectable its forms, involving the use of the system hormonotherapy. Used mono - or polychemotherapy with intravenous anticancer preparato the t intravenous drip or intravenous bolus, repeating a course every 4 weeks (Anticancer chemotherapy. Ed. by N. And. Perevozchikova, M., 1996).Recommended usage of anticancer chemotherapy long, the way of their delivery to the site of tumor is very long. On the way to the lesion chemotherapy drugs have adverse effects, primarily on the rapidly dividing cells of normal tissues, and this predetermined expressed General toxic action of almost any cytostatic. It is a side effect of chemical forces them to reduce the dose, change the tempo and mode of chemotherapy that reduces toxicity, contributes to tumor resistance to cytotoxic drugs. All this leads to a decrease in the efficiency of treatment, tumor progression, deterioration of the patient and casts doubt on the possibility of radical treatment.To reduce the side effects of cytotoxic therapy trying to shorten the journey from the place of introduction to the lesion and the residence time of the chemical in the body.So, there is a method of injection of anticancer drugs in the treatment of oncological diseases, according to which the drugs are injected into the blood vessels in the continuous infusion or less duration, but with the temporary shutdown of the General circulation of the extremities (Gasparian, S. A. and other "Regional long-term intra-arterial chemotherapy of malignant tumors". M: "Medicine", 1970).The offered method of administration of anticancer chemotherapy has a very significant effect on the tumor. It decreases in size, it appears foci of necrosis. Despite the effect that the method has significant drawbacks. He is associated with the inevitable surgery, need for a long stay patient in a state of immobility, use of the apparatus for catheterization arterial, sophisticated x-ray equipment, set anticoagulation drugs. Moreover, resulting from the influence of intra-arterial chemotherapy necrosis often contributes to the emergence of threatening the life of the patient bleeding. The main disadvantage of systemic chemotherapy is the detour delivery of chemotherapy drugs to the diseased area and the minimum difference between its therapeutic and toxic doses. All this leads to the search for more sustainable ways of introduction of anticancer chemotherapy.Overcoming common toxicolcology hearth, creating the conditions for long-lasting local impact.The purpose of the invention is the creation of long-term local concentrations of anticancer drugs in the area of the lesion is malignant.This objective is achieved in that after the implementation of clinical studies, morphological verification of diagnosis, General examination, detection of extragenital pathology spend transvaginal and transabdominal ultrasound scan to determine the shape, size, volume of tumor, its location in the uterine wall, depth of invasion, extent of injury to surrounding tissue. Next, the patient is placed on the examination table, after local processing antiseptic anterior or posterior lip of the cervix is taken on bullet forceps, reduced or diverted to fold (depending on the localization of the tumor in the anterior or posterior walls of the uterus) and under ultrasound through the anterior or posterior vaginal vault long needle produce repeated injection of anticancer drug in the uterine wall in direct contact with the lesion to the surrounding tissue and the most pronounced vascular pattern in the most valid comparison with the known routes of administration of anticancer drugs, as it is based on the exact determination of the location of tumor localization. This allows you to focus a specific action of anticancer chemotherapy directly to the lesion, to minimize the destructive effect of chemotherapy on normal cells.The proposed "Method of sighting intraorganic chemotherapy of cancer of body of uterus" industrially applicable, it can be repeated and duplicated in specialized hospitals with cancer.The method is as follows.The patient carry out clinical studies to verify the diagnosis, evaluation of the General condition, identification of extragenital pathology. Spend transvaginal and transabdominal study to determine the shape, size, tumor volume, prevalence, extent of invasion (up to 1/2 myometrium, more than 1/2 of the myometrium to serosa, in the cervical canal), type of invasion (even, uneven-local, non-uniformly-distributed), echoes, echoes, of the boundaries of the affected area in the body of the uterus. Next, the patient is placed on the examination table, anterior or posterior lip of the cervix is taken on bullet forceps hung in Eragny or posterior vaginal vault with a long needle into the wall of the uterus produce repeated injection of anticancer drug in place of direct contact with a lesion to the surrounding tissue and the most pronounced vascular pattern in the maximum therapeutic single doses.The principle of specific performance "Method of sighting intraorganic chemotherapy of patients with cancer of the womb" can serve as a summary of the history of the disease.Example 1. Sick,, 54 years, history 1424/0, was admitted to the gynecological Department of the Rostov cancer research Institute 30.01.2002 was diagnosed with cancer of the uterine body metastasis in the left ovary, stage III, group II, obesity IV degree, hypertension grade II-histological analysis 635431-33 - moderately differentiated adenocarcinoma.When the primary bimanual examinations was determined rigid, increased accordingly sizes 14-15 weeks of pregnancy the uterus is enlarged to the size 86 cm left the uterus, infiltration paracervical tissue and left parametrium. Selection bloody, moderate.At the time of the study the patient neoperabelna due to the spread process on the lower segment of the uterus, oclamation tissue.1.02.02. Before treatment performed transabdominal and transvaginal ultrasound 358, during which the detected uterus size 119,358.75 cm with tumors of the tion of tumor component sizes indicated above, unevenly widespread invasion of the myometrium of the front wall to serosa and endocervix to the middle third. Left appendages presents cystic-solid education 9,07.0 cm in diameter.Next, the patient is laid on the examination table, after local processing antiseptic on bullet forceps taken and revealed anterior lip of the cervix. Under ultrasound through the vaginal vault with a long needle was injected and the injection of 2 g of platinum in the anterior wall of the uterus in place of direct contact with focal damage to the surrounding tissue and the most pronounced vascular pattern (Fig.1, 2).4.02, 7.02, 12.02.2002, Similarly produced following injection of cyclophosphamide in a total dose of 6, bimanual examination after treatment was determined uterus, increased respectively 11-12 weeks. pregnancy, increased due to metastatic lesions of the left uterine appendages 65 cm; resorption paracervical and parametrial infiltration. The process became operable. With repeated ultrasound indicated a positive trend: decreased the size of the uterus - 7,888,539,48 cm; the e than 27%); the size of the metastasis in the left ovary decreased to 8.07,8 see On the front wall of the uterus tumor invasion was reduced to half the thickness of the wall.13.02.02. Transaction in the amount of panhysterectomy with the upper third of the vagina, omentectomy. The postoperative period was uneventful. The morphological study of remote tissues and organs 637218 - 637236 in the body of the uterus was detected moderately differentiated adenocarcinoma with large foci of necrosis and invasion biometra 0,2-0,4 cm (the thickness of the wall of the uterus 1.5 cm). In the ovary, left, size 1075 cm - metastatic adenocarcinoma of the above-described structure, with extensive foci of necrosis. In adipose tissue the greater omentum - single layers of cancer cells. 18.02.02 a course of intraperitoneal chemotherapy: 200 ml cisplatin, 600 ml of cyclophosphamide and intravenous 50 ml of doxorubicin. Treatment satisfactorily.With 20.02.02 started a course of radiation treatment.Thus, the above clinical example illustrates expressed the immediate effectiveness of the proposed method of treatment, in terms of the reduction of the size of the uterus, the tumor itself perifocal infiltration the economic effectiveness of the proposed Method aimed intraorganic chemotherapy of patients with cancer of the womb" is: - in the shortest possible time to carry out the injection of the maximum therapeutic doses of anticancer drugs; - to avoid the harmful toxic effects of chemotherapy; - to achieve resectability of the tumor and rapid removal.
ClaimsMethod of sighting intraorganic chemotherapy of cancer of body of uterus, including ultrasound scans and chemotherapy, characterized in that in the preoperative period anticancer chemotherapeutic drug is administered in the maximum single therapeutic dose in the wall of the uterus under ULTRASOUND control in place of direct contact to the surrounding tissue with lesion with the most pronounced vascular pattern, with the introduction of the produce repeatedly.
< / BR>where R1represents a hydrogen atom, a metal group2-C6is an alkyl group, acetyl group, -CO-C2-6is an alkyl group or-CO-C6-18-aryl group, unsubstituted or substituted-HE or-O-C1-6is an alkyl group; or a counter cation selected from the group comprising cations of alkaline or alkaline earth metals such as Li+, Na+, K+, CA++, Mg++, NR16R17R18R19( + ) where R16, R17, R18and R19independently from each other selected from hydrogen or C1-C6-alkyl; R2and R3form part of the group with a double bond WITH17= C18or tautomer, enantiomer, or stereoisomer, or its physiologically acceptable salt, or MES, or mixtures thereof
< / BR>where R and R are independently selected from the group consisting of hydroxyl and a moiety that can be converted in vivo in hydroxyl, such as acyloxy, -OR4, -OC(O)R7or-OC(O)OR4(where R4represents alkyl, alkenyl, quinil or aryl; and R7represents amino, alkylamino, aminoalkyl and alkylsulfonyl); and R3represents-CH2- or-CH2CH2-; or its pharmaceutically acceptable salt, where the specified compound or salt is optically active because they contain more than 50% (by weight relative to all stereoisomers) 2S stereoisomers
SUBSTANCE: method involves examining eyeball and retrobulbary space by means of ultrasonic scanner. Ultrasonic gray scale orbit scanning is applied in real-time mode to determine ultrasonic eye reposition. Positive ultrasonic eye reposition is determined and normal state is diagnosed when recording mobile unchanged shape and free oscillation orbit tissue movements. Changes in shape, contours and size of the eyeball and immobility of orbit tissues being recorded, negative ultrasonic reposition is determined and solid full-tissue neoplasms and structures are diagnosed to occur.
EFFECT: high objectivity of received data; accelerated examination; high accuracy of differential diagnosis.