The method of palliative treatment of advanced cancers, predstatelnoy cancer with metastatic lesions of the spine
The invention relates to medicine, in particular to Oncology, urology, and can be used in the treatment of patients with advanced prostate cancer with metastatic lesions of the spine. The method includes vnutrikabinnoe introduction suspension hydrocortisone in combination with sinestrola. The suspension is injected into the intervertebral space from Th12 to L5, and 2% oil solution sinestrola enter in the amount of 80 mg and hydrocortisone in the form of a 25% suspension - 125 mg, five times a day. The method allows efficient arrest of chronic pain syndrome without systemic side effects, delay the appearance of pain in the adjacent vertebrae. table 1.
The invention relates to medicine, in particular to Oncology, urology, and can be used in the treatment of patients with advanced prostate cancer with metastatic lesions of the spine.
The known method of bilateral orchidectomy. In most countries, bilateral orchidectomy still considered the method of choice for the treatment of disseminated prostate cancer. As a result of such surgical intervention concentrate favorable effect. After castration experiencing acute degenerative changes that apply to the glandular and muscular elements with the subsequent development of connective tissue. Although orchidectomy has a palliative effect in 70-80% of patients, surgery itself is not without flaws [Dunaevsky J. A., Arie C. M., Myshko I. C. Indications for castration for prostate cancer. In Proc. of "Diagnosis and treatment of urologic diseases, 1991, S. 134-138].
Orchidectomy irreversible and its beneficial effects for those 20-30% of patients, the tumors are not hormone dependent, can be challenged. In addition, most patients with prostate cancer are elderly and therefore surgery and General anesthesia are sometimes a significant risk to their lives. For younger patients is a severe psychological trauma. Side effects of castration - loss of libido and impotence, hot flashes, gynecomastia, osteoporosis, mental disorders.
There is a method of hormone therapy generalized prostate cancer, including the use of estrogen (honvan, astragalin, Sinestro and others). The results of estrogenic is about the same in all countries: full regression - 2%, partial regression - 44%, one-year survival - 70-78%, five-year survival rate is 20-30%. In assessing the effectiveness of the treatment has not been complete regression of the tumor. Often when hormone therapy using 2% solution sinestrola at 60-80 mg daily intramuscularly for 2.5-3 months. Upon reaching the clinical effect after the course of treatment of patients transferred to supportive therapy. Sometimes very effective is the combination of astroventure with the introduction of prednisolone 20-40 mg daily [Sviridova, T. C. Complex hormone-beam treatment of patients with prostate cancer stage IV. In the book: The Plenum Of Scientifically Conference. General urologists, Saratov, 1994. - S. 170-171].
In the pathogenesis of the cardiovascular complications of astroventure leading place is occupied by a breach in the system of gemokoagulyatsii (60-70%), increase the aggregation of blood platelets, decreased concentration antithrombin factor III and fibrinolytic activity (30-40%). The highest risk of severe cardiovascular complications in the first 6 months of treatment. The estrogen in high doses inhibit hepatic enzymes than contribute to the development of toxic hepatitis in 80% of cases, there are disorders of urodynamics with significant distri the national physiological activity of the immune system from 80 to 100% of cases.
There is a method of interrupting the flow of afferent pain impulses, i.e., blockade of sympathetic ganglia in patients with severe uncontrollable pain in metastatic lesions of the spine in the form of nerve block. Epidural and subarachnoid chemical denervation (alcohol, phenol, and other) based off of pain sensitivity by exposure piroliticheskom of the drug, leading to the destruction of sensitive nerve posterior roots [C. A. Crackin, C. I. Strashnov. Spinal and epidural anesthesia. - SPb.: Published by OOO “Saint-Petersburg medical publishing house, 2000, S. 95].
The known method vnutrimembrannogo chemohormonal effects in metastatic tumors of the nervous system. Glucocorticoid hormones can alter the expression of genes encoding the synthesis of DNA, RNA and proteins apparatus for transcription and translation. On the background dehydratation therapy is endolyumbalno introduction 125 mg hydrocortisone and methotrexate at the rate of 2 mg/kg of body weight. Efficiency vnutrimembrannogo injection of hydrocortisone is associated not only with direct anti-inflammatory and antitumor activities. Activation diencephalic, the hypothalamic-hypothesentesten combination of metastatic tumor formation in the brain. [Komissarenko B. N., et al. Current views on the mechanism of action of glucocorticoid hormones//journal of physical.-1982.- No. 6 - n-721-723].
Disadvantages: not used in the treatment of metastatic prostate cancer.
The objective of the invention is the reduction of pain syndrome in patients with disease of the prostate gland.
The problem is solved in that in the method of palliative treatment of generalized cancer, including vnutrikabinnoe introduction suspension hydrocortisone in combination with them to impose 2% oil solution sinestrola in the amount of 80 mg five times a day. Hydrocortisone is administered in the form of a 25% emulsion in the amount of 125 mg.
The method is as follows.
In the position of the patient on the side, the belly knees and bent his head, located in the same horizontal plane with the body, the puncture is carried out in one of the intervertebral spaces from h12 to L5. Needle for spinal anesthesia is administered strictly in the midline between the spinous processes in accordance with the inclination of the spinous processes. The depth to which includes a needle, ranges from 4.5 to 6.0 cm, on average, 5.5, refer To the moment of puncture of the Dura aborignal accurate localization. To facilitate puncture of the most appropriate use needles a size 18-20 G sharpening Grawford. The medicinal effect is realized by the combination of 2% oil solution sinestrola dose of 80 mg and 25% suspension of hydrocortisone 125 mg. order To create adequate analgesia appropriate fivefold introduction this combination of hormones in the spinal canal with an interval between doses one day. The treatment for 10 days with a total introduction sinestrola at a dose of 400 mg and hydrocortisone 625 mg. After injection of hormones, the patient is recommended to lay on his stomach without a pillow for 30-60 min to reduce the expiration of the cerebrospinal fluid in the epidural tissue through the needle hole in the Dura membrane and reduce the likelihood cephalgia.
According to the proposed methodology began the treatment of 27 patients. Two of them were not included in the development, rejecting the holding of hormone therapy after the first and third injections. In the main group 3 patients treated twice in the range of 9-14 months (table).
The main clinical manifestation of prostate cancer was pain in the bones with the restriction and stiffness, up to paraplex the ptx2">As with any invasive procedure, endolyumbalno hormone therapy does not exclude the probability of obtaining a number of complications. Our patients on intrathecal drug treatment was observed following complications: hypotension - 4 (16%); headache (cephalalgia with a bad headache, especially in the occipital region, accompanied by dizziness, nausea, vomiting, stiff neck) - 1 (4%).
Severe complications occurring after spinal puncture (spinal cord or its nerve roots, paresis of cranial nerves with neurological complications, aseptic meningitis, air embolism syndrome ponytail, adhesive arachnoiditis), we have not recorded.
Additional supplies of anti-inflammatory and antimicrobial drugs is not required.
The control treatment. Of the 25 patients, at the time of testing (1998-2000,) lived 16, and 12 (75%) survived analgesic effect resulting from the treatment. A cause of mortality in all of the cases was the progression of the underlying disease.
The use of the proposed endolyumbalno method of introduction of combination hormonal drugs has come catechesis lesions of the spine on 8-14 months;
- delays the emergence of new foci of pain in adjacent vertebrae, avoiding systemic side effects of estrogen;
- can be used as an independent method of treatment or as an addition to radiotherapy or drug therapy;
- it is better tolerated by patients than radiotherapy with its complications;
- reduces costs associated with treatment and hospital stay.
The method of palliative treatment of advanced lung cancer, prostate cancer, with metastatic lesions of the spine, including vnutrikabinnoe introduction suspension hydrocortisone in combination with sinestrola, wherein the suspension is injected into the intervertebral space from Th12 to L5, and 2% oil solution sinestrola enter in the amount of 80 mg of hydrocortisone in the form of a 25% suspension - 125 mg, five times a day.
with antitumor activity and low toxicity, which can be used in boron neutron capture therapy had cancer