The method of treatment of neoplastic pleural effusion

 

The invention relates to medicine, namely to Oncology, and can be used for the treatment of metastatic pleural effusion malignant tumors of various localizations. The method includes intrapleural introduction of anticancer drugs. The patient produce the fence autologous blood in quantities of 100 to 150 ml in a sterile vial geoconservation, centrifuged at 1500 rpm for 30 minutes, take 20 ml of the supernatant plasma, dissolve in it a single dose of the cytostatic agent, incubated at 37oC for 30 minutes Remaining in the vial cell part and the plasma is re-infused. Under local anesthesia the dotted line in the pleural cavity, the maximum evacuate the pleural effusion and enter cooked autoplaza with cytostatic vnutriplevralno. If necessary the procedure is repeated. The method improves the effectiveness of treatment through the use of modifying properties of autoplasma, provides low toxicity of chemotherapy and low cost treatment. 2 Il.

The invention relates to medicine, namely to Oncology, and can be used for the treatment of metastatic pleural effusion malignant tumors of various localizations.

Known sposob), including intrapleural administration of drugs: drugs, radioisotopes, immunomodulators or drugs nonspecific sclerosing action, including the introduction of tetracycline hydrochloride in doses of 20 mg/kg or 1200-1600 mg per patient). The method of pleurodesis is the following: the patient under local anesthesia produce puncture of the pleural cavity with the introduction of a thin silicone tube, which uses vacuum suction to evacuate the liquid. After this, the tube is clamped and under x-ray screen, make sure that easy massacred. Since the introduction of tetracycline may be accompanied by pain, it is pre-diluted in 50 ml of 0.5% solution of novocaine, and then injected into the drain tube. Last pinch for 2 hours, and the patient is asked several times to change the position of the body. After 2 hours, the clamp is removed and the drainage tube connected to a vacuum suction with a constant pressure (15 to 20 cm of water. Art.). Aspiration continue for at least 24 h, while the amount of output fluid will not be less than 150-200 ml per day. After that, the drainage tube removed. The procedure is considered successful if the patient resulting from the introduction of tetracycline developed acute pleurisy, and with the help of lauralei cavity.

However, this method has the following disadvantages: firstly, the introduction of tetracycline pain, to reduce which requires prior intrapleural injection of novocaine and change body position for 2 hours with the purpose of distribution of the drug in the pleural cavity, however, for a patient with neoplastic pleural effusion, phenomena pulmonary-cardiac insufficiency with often available with inability to lie on the affected side this recommendation is not easy to follow; secondly, the duration of the procedure and the need to aspirate fluid for at least 24 hours; thirdly, a prerequisite for the development effect is the complete drainage of the pleural cavity and the maximum convergence of visceral and parietal pleura, which is not always possible to achieve; fourthly, the possibility of developing such complications as "armoured light" in the case of incomplete lung straightening or shifting the mediastinum.

Known "Method of treatment of locally advanced breast cancer (abstract. dis. . . K. M. N. the Vladimirova L. Y. Neoadjuvant chemotherapy on the natural environment of the organism with the use of the peptide of the epiphysis of epithalamin in treatment of locally-the soap is included, that collect autologous blood in quantities of 200 to 250 ml in a sterile vial geoconservation "Gleyzer", centrifuged at 1500 rpm for 30 min, the supernatant plasma were evacuated to another sterile bottle with geoconservation, cellular precipitate is re-infused. A single dose of drugs dissolved in 40 ml of physiologic saline, mixed with 100-150 ml of autoplasma, incubated at 37,0oC for 1 hour and injected intravenously 3 times a week.

With this method of treatment group patients was significantly different from those who used standard chemotherapy, the number of patients with regression of tumors and lymph nodes and disease progression.

However, this method involves the systemic chemotherapeutic effects and are not indicated for the treatment of neoplastic pleural effusion, when you intrapleural administration of drugs. In addition, for the introduction of chemotherapy in this way, they are dissolved in 40 ml of physiologic saline, and then mixed with 100-150 ml of autoplasma, so that the amount of fluid is 140-190 Jr. However, with the introduction of chemotherapy in the pleura avoid additional fluid volume.

The aim of the invention is to increase the efficiency of treatment of patients with kolichestvo 100-150 ml sterile vial geoconservation "Gleyzer", centrifuged at 1500 rpm for 30 minutes, take 20 ml of the supernatant plasma, dissolve in it a single dose of the cytostatic for intrapleural injection, incubated at 37oC for 30 minutes remaining in the vial cell part and the plasma is re-infused, then under local anesthesia produce puncture of the pleural cavity, the maximum evacuate the pleural effusion and enter cooked autoplaza with cytostatic vnutriplevralno, if necessary, repeat procedure.

The invention "Method of treatment of neoplastic pleural effusion is new, because it is not known from the level of medicine in the field of drug therapy in Oncology.

The novelty of the invention lies in the fact that the patients make the fence autologous blood in quantities of 100 to 150 ml in a sterile vial geoconservation "Gleyzer", centrifuged at 1500 rpm for 30 minutes, take 20 ml of the supernatant plasma, which is used for the dissolution of a single dose of the cytostatic agent for intra-pleural injection, remaining in the vial cellular precipitate and the plasma is re-infused, then under local anesthesia produce puncture of the pleural cavity from which to evacuate the pleural effusion in a maximum possible number, and enter prigoryachih differences of this method of treatment used so far in Oncology is the use for intrapleural administration of cytostatics autoplasma which was first used as biorestoration drugs. First applied and a new way of introduction autoplasma in the pleural cavity.

It is known that the norm for a day through the pleural cavity passes from 5 to 10 l poor plasma protein (Moiseenko C. M., Semiglazov C. F., Tulandi S. A. Modern drug treatment of locally advanced and metastatic breast cancer. - SPb. 1997. S. 201).

Autoplasma - native environment for an organism, not an alien for intrapleural injection, does not cause painful and inflammatory changes, and other complications. However, us is not entered poor plasma proteins and physiologically adequate rich in albumin liquid part of autoblood - autoplasma as much as possible the physiological volume of 20 ml, because the norm in the pleural cavity contains no more than 5-20 ml of liquid (Moiseenko C. M. , Semiglazov C. F., Tulandi S. A. Modern drug treatment of locally advanced and metastatic breast cancer. - SPb. 1997. S. 201).

We found that during the incubation of autoplasma with chemotherapy is fragmented albumin, contributing to rapid flow of drugs into the tumor. In addition, frag the e drugs on tumor cells (Sidorenko, Y. S., Vladimirov L. Yu, Francesc E. M. the Effect of chemotherapeutic agents on the structure and functional properties of albumin in the blood serum of patients with breast cancer. Oncology issues. 2001, 3. C. 303-306). Thus, autoplasma is a modifier of the effects of chemotherapy (Vladimirov L. Yu abstract. dis.... K. M. N."Neoadjuvant chemotherapy on the natural environment of the organism with the use of the peptide of the epiphysis of epithalamin in treatment of locally advanced breast cancer. Rostov-n/A. 2000. S. 7). However, in the proposed method of treatment, it was first used as a local biomodification.

Using this method does not increase the toxicity of the treatment and, if necessary, allows to combine intrapleural injection of drugs on autoplasma with standard chemotherapy.

The invention is industrially applicable as it can be used in health care, the medical institutions for the treatment of malignant tumors, Oncology, oncologic dispensaries.

"Method of treatment of neoplastic pleural effusion" is as follows.

Patients with the presence of neoplastic pleural effusion from peripheral veins runs the fence autologous blood in quantities of 100 to 150 ml in a bottle From the resulting supernatant autoplasma take 20 ml, and use it for the dissolution of a single dose of the cytostatic agent, intended for intrapleural injection. Autoplaza with cytostatic incubated in a thermostat at 37oC for 30 minutes. During this time remaining in the vial contents (cell residue and remainder of autoplasma) the patient is re-infused.

Further, under local anesthesia with 0.5% solution of novocaine in the amount of 20-40 ml produce a biopsy of the affected pleural cavity, which are actively aspiration of the liquid in the greatest possible number. If necessary, perform radiological monitoring chest. In the pleural cavity impose pre-cooked dissolved in 20 ml of autoplasma cytostatic dose. From the pleural cavity face.

If necessary, you can repeat the procedure. When the intrapleural injection of drugs on autoplasma the combination with systemic chemotherapy.

Original post conduct a performance audit of the General analysis of blood, PETIT, total protein, ECG and x-ray studies of the chest. Observe the General condition of patients.

An example of a specific implementation of the Method of treatment of neoplastic pleural effusion".

Patient K., 49, and. b. 993/it has been treated in about the inability to lie on left side, the weakness. From history revealed that in June 1993, in hospital, Vladikavkaz after preoperative radiotherapy performed a radical mastectomy on the left about adenocarcinoma of the left breast, Art. II. The diagnosis was confirmed histologically ( 4123-28). The above symptoms appeared 3 months ago, gradually increased, which was forced to see in RNII.

When applying the General state of moderate severity. Pale skin, sticky. Marked shortness of breath up to 24 per minute conversation and movements. Thorax common forms symmetrically involved in the act of breathing. There is a weakening voice shaking at the lateral and lower parts of the chest to the left. When pulmonary percussion sound blunt below the level of the third rib on the left. Auscultatory right - vesicular respiration, left - breathing below the third rib is not heard. The rhythmic heart sounds, tachycardia. Pulse 100 beats./minutes From other organs revealed no pathology. St localis: left breast cancer postoperative scar without signs of recurrence and metastasis, regional lymph nodes are not enlarged. On FLO 5 from 25.01.01 - light without focal inflammatory changes, mediastinal lymph nodes are not enlarged. Left in the pleural cavity, the fluid dobavilo.

Diagnosed Generalization cancer of the left breast with metastasis to the pleura on the left, left-sided pleural effusion (radical mastectomy in VI-93, Art. II). Gr. IV.

26.01.01. the patient performed pleural puncture by the described method.

The patient from the peripheral arm vein taken 100 ml of autologous blood into a sterile vial geoconservation "Gleyzer". The contents of the vial centrifuged at 1500 rpm for 30 minutes. From the selected vial 20 ml of autoplasma, which was used for dissolving 40 mg thiotepa. Autoplasma with cytostatic incubated at 37oC for 30 minutes.

Further, under local anesthesia solution of novocaine with a 0.5% 40,0 ml in the 6th intercostal space left in the shoulder line produced pleural puncture with evacuation transparent dark yellow liquid in the number of 2100 ml Vnutriplevralno on autoplasma entered: thiotepa 40 mg Procedure was completed without complications. The condition of the patient after the puncture satisfactory. Cytology 1722-24 from 26.01.01 detected cell carcinoma.

01.02.01 was similarly re-pleural puncture. Evacuated 500 ml of exudate. Vnutriplevralno on autoplasma introduced 40 mg thiotepa.

After punctures state of pain is but the disappearance of the liquid level, complete resorption of pleurisy. The lungs and the mediastinum without pathology (Fig.2). Next, patients received 6 courses of chemotherapy scheme CMAV in exchange doses: vincristine 2 mg, methotrexate 60 mg, doxorubicin 60 mg, cyclophosphamide 1200 mg a Break between courses was 2 weeks. The treatment was conducted in patients receiving tamoxifen 20 mg/day. Side effects did not exceed the II degree. The last course completed 02.09.01.

Re-accumulation of fluid in the pleural cavity were observed. The effect of treatment is regarded as a complete regression. Remission to the present time is 8.5 months, which is above the average in the literature - from 2.5 to 6 months (Gorbunova C. A., Abashin S. Yu, I. Poddubnaya Century, Laktionov efficiency the Efficiency of local monochemotherapy with mitoxantrone neoplastic pleural effusion and ascites. Sat. New in Oncology. Vol. 1. Voronezh, 1995. S. 150; Gorbunova C. A., Abashin S. Yu, I. Poddubnaya Century, Laktionov K. P. Efficacy of intrapleural chemotherapy with mitoxantrone metastatic pleural effusion in patients with breast cancer. Ibid. S. 97).

Technical and economic efficiency "method of treatment of neoplastic pleural effusion" is to increase the efficiency of treatment of patients through the use of modifying properties AutoPlay toxicity of chemotherapy, does not increase the length of stay in hospital. The method allows to improve the quality of life of patients with disseminirovannam malignant process with metastasis to the pleura.

Claims

The method of treatment of neoplastic pleural effusion, including intrapleural introduction of anticancer drugs, characterized in that the patient make the fence autologous blood in quantities of 100 to 150 ml in a sterile vial geoconservation “Gleyzer”, centrifuged atabout1500 rpm for 30 minutes, take 20 ml of the supernatant plasma, dissolve in it a single dose of the cytostatic for intrapleural injection, incubated at 37C for 30 min, remaining in the vial cell part and the plasma is re-infused, then under local anesthesia produce puncture of the pleural cavity, the maximum evacuate the pleural effusion and enter cooked autoplaza with cytostatic vnutriplevralno, if necessary the procedure is repeated.

 

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