Method for applying postoperative radiation therapy in stomach carcinoma cases

FIELD: medicine.

SUBSTANCE: method involves applying preradiation topometry with irradiation fields being formed. Irradiation is carried out 5 times a week from two opposite fields to reach total radiation dose of 50 Gy under unit focal dose being equal to 2 Gy. The irradiation is applied from rectangular fields having the following boundaries. The lower one is upper edge of the second lumbar vertebra body. The upper boundary is 10 cm higher than the lower one. The right one is 2 cm far from vertebral column contour to the right. The left boundary is 15 cm far from the right one. Removed stomach bed, paracardial lymph nodes, lymph nodes of lesser omentum, gastropancreatic ligament along the left gastric and splenic arteries to the splenic porta and celiac lymph nodes. The tumor propagating over abdominal or supradiaphragmatic esophageal segments, additional anterior and posterior rectangular irradiation fields are formed with paraesophageal and bifurcational nodes being included into the zone.

EFFECT: reduced risk of complications after radiation treatment; maximum amount of healthy tissues retained.

3 cl, 3 dwg

 

The invention relates to medicine, namely to the combined treatment of such cancers, like cancer of the stomach, and improves the method of radiation therapy after the surgical phase of treatment.

The main reasons for failure of surgical treatment of gastric cancer is the inability to prevent the spreading of tumor cells within the peritoneal cavity, blood vessels and lymph nodes and the presence of subclinical metastases on serous surfaces of the bed of the stomach and perigastric lymph nodes in invasive carcinomas. In this regard, it is appropriate to use the potential of postoperative radiation therapy. One of the main advantages of postoperative radiation therapy is that it is carried out on the basis of reliable data, intraoperative revision and morphological studies.

Known combined method of treatment of gastric cancer, including postoperative radiation therapy (Russian oncological journal. No. 4, 2003. - P.24-26). Locoregionally area, which included the removed tumor bed and regional areas of lymphatic drainage, provided the accent marks on the skin of the anterior and posterior surface of the abdominal wall with the subsequent drawing curly fields exposure on x-rays. Irradiation of the giving of the area was conducted with two opposite epigastric fields, used two methods of fractionation: classical - daily single focal dose (ROD) 2 G and hyperfractionation - daily GENUS of 2.5 Gy with day split dose. Total focal dose (SOD) did not exceed 50 Grams.

The main disadvantage of this method is the high complexity preglacial topometry, which leads to a significant increase in the time spent by medical staff in the room with the radiator.

In addition, greater complexity is the combination of the two colliding beams.

Partly these drawbacks are eliminated in the method of postoperative radiation therapy for cancer of the stomach, including the formation of the radiation field using the standard curly blocks (Johnin A.G. Combined treatment of patients with gastric cancer with the use of postoperative radiation therapy. 14.00.14 - Oncology. The dissertation on competition of a scientific degree of candidate of medical Sciences. - Volgograd: Volgograd medical Academy, 2001. - S-93). The known method postoperative gamma therapy includes preglacial topometry with the formation of curly fields of irradiation and irradiation according to the following scheme: total focal dose (SOD) - 50 Gr, single focal dose (GENUS) - 2 Gr 5 times a week, after reaching SOD 30 Gy doing a two-week break. In the process preduce the Oh topometry form field complex configuration, have the following bounds:

right - stump 12 duodenal ulcer or projection hepatoduodenal ligament;

top and bottom of the right CRUs of the diaphragm;

on the left is the gate of the spleen;

below is a projection of the body of the second lumbar vertebra.

In the zone of irradiation include lymph nodes ligaments and vnespisochnye lymph nodes: paracardial, retroprojection, the area of the celiac trunk, retroperitoneally, adventitiously, the gate of the spleen and liver, along the common hepatic artery, mesenteric and paraaortal.

In the case of the transition of tumors in the esophagus, the upper border of the field was raised to the level padronale segment of the esophagus.

The main disadvantages of this method postoperative radiation therapy are:

for the application fields of complex configuration requires multiple x-ray examination of the patient, which leads to an increase in radiation exposure to the patient and medical personnel;

the planning of radiation therapy is performed on the maximum size of the field of irradiation and the dose field formation in the area of critical organs goes from 30 to 80% isodose that does not provide adequate protection of normal tissues;

the complexity of combining and playing fields figure form;

high material costs, etc.

Predlozhennogo postoperative radiation therapy for cancer of the stomach, including preclusively the topometry with the formation of the radiation field and carrying out irradiation with two opposite fields to achieve total focal dose of potentially metastasized tissues 50 Grams at a single focal dose of 2 Gy, 5 times a week.

The difference of the proposed method is that the radiation is delivered with two opposite rectangular fields that have the following bounds:

lower the top edge of the body of the 2nd lumbar vertebra;

the upper 10 cm above the bottom;

right - 2 cm to the right of the contour of the spine;

left - to-15 cm from the right edge.

In a rectangular irradiation field include bed remote stomach, paracardial lymph nodes, lymph nodes of the lesser omentum, stomach, pancreas ligament, along the left gastric and splenic arteries down to the gate of the spleen and celiac lymph nodes.

The difference is that with the transition of a tumor on abdominal or epiphrenic the esophagus to form additional front and rear rectangular field exposure, which respectively include the area paraesophageal or bifurcation lymph nodes.

The positive effect from the use of the proposed method lies in the fact that preserves healthy tissue, there is no postradiation complications and red eye reduction) what is the intensity of radiation reactions, patients feel satisfactorily during radiation therapy.

The invention is illustrated by the exemplary embodiment and the drawing, in which figure 1 shows a rectangular frame for the rear of the field irradiation, figure 2 is a rectangular frame for the front of the field of irradiation, figure 3 - x-ray inspection of the alignment of the rear and front of irradiation fields.

To conduct preglacial topometry of rentgenopozitivee material is made of two rigid rectangular frame through which the radiologist controls the accuracy of the marking on the skin of the patient front and rear beams. Frame 1 is used for marking and control of the back field exposure and consists of the side bars 2, 3, the lower strap 4, the upper rod 5, the diagonal strips 6 point interdict 7 and additional straps 8, mounted on the frame at a distance of 2 cm from the side of the strap 3 and parallel to it.

Frame 9 is used for marking and control front-irradiated and consists of the side bars 10, the lower bracket 11, the upper strap 12 and diagonal strips 13 with the point of their intersection 14. Both frameworks have the same dimensions: width 15 cm, height 10 cm

The patient laid on his stomach on the turntable-the tripod in therapeutic situation and under the control of the x-ray on the skin of the back causing the projection of the right top is the first corner of the second lumbar vertebra, then with the specified point connecting point of intersection 15 of the bottom 4 and an additional 8 bars of the frame 1 and under the supervision of fluoroscopy produce the combination of additional trims with the contour of the spine. The lead round marker on the patient's skin of the outer contour of the frame 1 and is temporarily fixed to the skin with adhesive tape. The patient is turned on his back and the x-ray tube relative to the center of the crosshairs 7 fixed frame 1, and then on his stomach stack frame 9 to the full alignment of the crosshairs 7 and 14 of the framework. The contour of the frame 9 lead round the skin of the abdomen and both of the frame removed. Rectangular field exposure have the following bounds:

lower the top edge of the body of the 2nd lumbar vertebra;

the upper 10 cm above the bottom;

right - 2 cm to the right of the contour of the spine;

left - to-15 cm from the right edge.

In a rectangular irradiation field include bed remote stomach, paracardial lymph nodes, lymph nodes of the lesser omentum, stomach, pancreas ligament, along the left gastric and splenic arteries down to the gate of the spleen and celiac lymph nodes.

Crosshairs 7 and 14 frames allow you to cancel the effect of the projection magnification of frames during transmission and accurately combine and fix on the skin of the patient the progress of the Central beam gamma-emitter. The orientation of RA is OK to produce bone landmarks (the spine), which are unchanged in size in adults. Use for marking fields rectangular framework increases the speed of marking the radiation field, which reduces the total radiation load on the patient and medical personnel, increases the accuracy of topometry and ensures reproducible formation of dose fields before radiation therapy.

Irradiation is carried out 3-4 weeks after surgery. The treatment in the patient on the back and abdomen, using the technique of classical fractionation dose split rate: single focal dose of 2 Gy, 5 times a week, after SOD 30 Gy doing a two-week break, the second half of the course irradiation is carried out before SOD 50 Gr with shielding the spine 1 cm lead block.

In the treatment using two direct boxes: back and front. The amount of radiation given primary tumor, its distribution, changes in the regional lymph nodes. The entire amount of exposure should be located in the area of 80-90% isodose.

With the transition of a tumor on abdominal or epiphrenic the esophagus to form additional front and rear rectangular field exposure, which respectively include paraesophageal lymph nodes or group bifurcation lymph nodes. These fields can have the following dimensions: Shi is in - 6 cm, height - 8, see the Exposure of specified fields produced separately from the main by the same method.

The proposed method preglacial training and subsequent adjuvant radiotherapy is easy to implement and helps reduce overall radiation exposure and economical use of x-ray film.

1. The way postoperative radiation therapy for cancer of the stomach, including preclusively the topometry with the formation of the radiation field, conducting irradiation with two opposite fields to achieve total focal dose of potentially metastasized tissues 50 Grams at a single focal dose of 2 Gy, 5 times a week, characterized in that the radiation produces rectangular fields that have the following bounds: lower upper edge of the body of the 2nd lumbar vertebra; the upper 10 cm above the bottom, right - 2 cm to the right of the contour of the vertebral column; the left is 15 cm from the right edge.

2. The method according to claim 1, characterized in that the rectangular irradiation field include bed remote stomach, paracardial lymph nodes, lymph nodes of the lesser omentum, stomach, pancreas ligament, along the left gastric and splenic arteries down to the gate of the spleen and celiac lymph nodes.

3. The method according to claim 1, characterized in that during the transition of a tumor on abdominal or epiphrenic the esophagus forms the t additional front and rear rectangular field exposure, which include respective zone paraesophageal and bifurcation lymph nodes.



 

Same patents:

FIELD: medicine.

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1 tbl

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4 cl, 4 dwg, 6 tbl

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1 dwg

FIELD: medicine, pediatrics, hematology.

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4 cl, 5 ex

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3 ex

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1 ex

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1 ex

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22 cl, 8 dwg

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3 cl, 3 dwg

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1 ex

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2 tbl, 3 dwg, 3 ex

FIELD: medicine, oncology.

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EFFECT: higher efficiency of therapy.

1 ex

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EFFECT: higher efficiency of therapy.

1 cl, 4 ex

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