Method for treating cervical carcinoma of exophytic tumor type

FIELD: medicine.

SUBSTANCE: method involves carrying out radiation treatment combined with textile material application on the tumor. Tumor-transformed vaginal uterus neck portion volume is determined with ultrasonic examination techniques. Koletex napkin impregnated with therapeutic cytostatic preparation dose is used as the textile material. The napkin pattern is produced on the basis of ultrasonic examination data. The napkin is quilted with ligature along the perimeter and fixed at the level of vagina fornix by drawing tightly in purse-string mode. Napkin is changed every 24 h within 10-20 days long treatment course.

EFFECT: improved life quality.

 

The invention relates to medicine, more specifically to Oncology, and can find application in the treatment of cervical cancer with predominantly exophytic forms of primary tumor growth.

There is a method of combined treatment of exophytic forms of cervical tumors, including surgery and subsequent radiation exposure (Ameno, Volvieron. Radiation therapy in gynecology and oncourology. S.-Petersburg: Folio, 2002, p.27-29).

The disadvantage of this method is low efficiency in large exophytic component, it is not always possible to perform a radical surgical intervention, to achieve the required level regression that leads to the necessity of the continuation of remote radiation therapy with increased risk of radiation complications, including from the bladder and intestines.

There is a method of treatment of cancer patients (including gynecological patients with exophytic form tumors), including irradiation in combination with applique on the tumor textile material (RF Patent No. 2089247, IPC And 61 M 5/10, 1997, prototype). In this way the cloth contains a layer of sodium alginate with metronidazole and dimethylsulfoxide.

The disadvantages of this method include the lack of direct cytotoxic actions contained components on tumor neade the cotton accommodation napkins exophytic form tumors of the cervix, the complexity of gynecological tumors.

The present invention is to remedy these disadvantages, the efficiency of treatment by direct antitumor prolonged exposure introduced into the tissue of the cytostatic agent, compliance applications complex the shape of the tumour, convenience and ease of placing napkins exophytic forms of cervical cancer, which increases the rate of regression of the tumor, reduces radiation dose.

For this purpose, the method of treatment of cervical cancer with exophytic growth form tumors, including irradiation in combination with applique on the tumor textile material, the proposed pre-determined by ultrasound tumor volume of altered vaginal portion of the cervix, as the textile material to use cloth Collex" entered into therapeutic dose of the cytostatic agent, to carry out cutting of the textile material in accordance with the received ultrasound data, a napkin pristegivat a ligature around to fix it by tightening the "pouch" at the level of the vaginal vault, change cloths to produce every 24 hours, at the rate of 10-20 days.

The method is as follows.

After establishing the patient's diagnosis of cervical cancer stage I-II with exophytic growth form of the primary tumor in pain who's cervical cancer on the whole tumor modified surface of the vaginal portion of the cervix impose a napkin "Kreteks", representing textile base with a deposited layer of dimethyl sulfoxide and anticancer drug - proxiphen at a concentration of 9 wt.%, 5-fluorouracil therapeutic complex Collex-5-ftor" for 10-20 days. Cutting the cloth is in the form of a circle, the area of which corresponds to the value of the tumor volume of altered vaginal portion of the cervix, which is determined during ultrasound examination every 4-5 days. Cloth quilted sterile silk ligature around the perimeter. Fixation is carried out by tightening the silk ligatures such as "pouch" at the level of the vaginal vault. The effect of continuously changing cloths are changed every 24 hours while conducting remote radiation therapy to the primary tumor and regional metastasis sites Rodger, 5 times a week, to SAD-gr. Weekend irradiation is not performed, the change of the tissues is described. Subsequently, the patients I IIa stage is carried out surgical treatment in the amount of operation of Wertheim, postoperative radiation therapy to areas of regional lymph nodes in standard doses. In patients with IIb-IIIb stages is combined radiation therapy.

The essence of the proposed method is illustrated by clinical examples.

Example 1.

Patient PEN., 1957 g.r., case history No. 4525, entered the LINIK, 13.10.2002 with a diagnosis of cervical Cancer Ib (TIbNxMo), exophytic form. Morphological diagnosis: No. 18385-422 - squamous non-squamous cancer. Comorbidities: Hypertension stage 2. Diabetes mellitus type 2, moderate flow. Urolithiasis. The psoriasis. Obesity 1 tbsp.

When examination revealed elongation and hypertrophy of the vaginal portion of the cervix, the external OS which comes krupnoporistaya tumor 6×5 cm on a broad basis, contact bleeding, with areas of decay on the left side and rear walls, reaching up to the roof of the vagina. Ultrasonic examination of the size of the vaginal portion of 4.4×3.8×5.6 cm, volume 49 cm3.

Produced corresponding cutting napkins - therapeutic complex Collex-5-fluoro": the area of a circle 49 cm2the diameter of a circle calculated by the well-known formula, amounted to 8 see Napkin prostigmata sterile silk ligature around the perimeter, at 0.7 cm from the edge of the circle, superimposed on the modified tumor vaginal portion of the cervix, fixed it by tightening the silk ligatures such as "pouch" at the level of the vaginal vault. On the same day started remote radiation therapy apparatus ROCUS", with 2 opposing fields 16×18 cm bottom edge of the field along the bottom edge of the womb, Rodger. Change cloths were made every 24 h, on the tea weekends irradiation was performed 5 times a week to Sadr. When monitoring ultrasound on Soggy marked decrease in the size of the tumor changed the vaginal portion of the cervix to 4.2×4.0×4.8, volume 38,6 cm3the diameter napkins reduced to 7 see

When viewed at the end of treatment: vaginal portion of the cervix size 5×3 cm, with a smooth hyperemic surface of the outer jaws formed, up to 0.5 cm exophytic tumor is not defined. Histological study No. 16861-2 painting therapeutic pathomorphosis 3 tbsp. Patient continued combined treatment. Alive without recurrence within 1.5 years.

Example 2.

Patient SNM, born in 1936, the case history No. 2179, was admitted to the hospital with a diagnosis of cervical Cancer IIIb (T2bN1Mo), exophytic form. Morphological diagnosis: No. 12792-98 - squamous non-squamous cancer.

Ultrasound volume of the vaginal portion of the cervix 143 cm3. Produced corresponding cutting napkins "Kreteks" PROXIFIER at a concentration of 9 wt.%: the area of a circle 143 cm2the diameter of a circle calculated by the well-known formula, was 13.5 cm Napkin prostigmata sterile silk ligature around the perimeter, at 0.5 cm from the edge of the circle, superimposed on the modified tumor vaginal portion of the cervix, fixed it by tightening the silk is howling ligatures such as "pouch" at the level of the vaginal vault. On the same day started ESWL. Change cloths were made every 24 hours, including weekends, irradiation was carried out 5 times a week to Sadr. When monitoring ultrasound on Soggy marked reduction of tumor altered vaginal portion of the cervix to 84 cm3the diameter napkins reduced to 10 see Subsequently, the patient continued combined radiation treatment. Alive without recurrence within 2 years.

Thus, due to the treatment in this way it is possible to achieve the required level regression cervical tumors while reducing the standard SOD 30-40%, with a corresponding reduction of the absorbed dose in the bladder and the intestine without affecting the direct and immediate results of treatment.

The method of treatment of cervical cancer with exophytic growth form tumors, including irradiation in combination with applique on the tumor textile material, wherein the pre-determined by ultrasound tumor volume of altered vaginal portion of the cervix, as the textile material used napkin "Kreteks" entered into therapeutic dose of the cytostatic agent, that you are carrying out cutting textile material in accordance with the received ultrasound data, napkin pristegivayut a ligature around the perimeter and fix it tightening the receiving-type "pouch" at the level of the vaginal vault, change cloths are produced every 24 hours, at the rate of 10-20 days.



 

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