Method for performing photo-dynamic therapy of surface cancer of urinary bladder

FIELD: medicine, in particular, oncology and urology, possible use for treatment of surface cancer of urinary bladder.

SUBSTANCE: in accordance to method, tumor is irradiated by laser with output power 0,5-2 Wt with wave length 662 nm and light energy of 300-600 J/cm2 during 10-30 minutes in presence of specified photosensitizer injected intravenously in volume of 0,8-1 mg/kg. Then a silicon vessel is inserted into urinary bladder with fibro-optical filament with cylindrical diffuser positioned therein. Vessel is filled with distilled water and laser irradiation of whole mucous tunic of urinary bladder by light energy at 30-40 J/cm2 is continued during 40-60 minutes.

EFFECT: possible decrease of frequency of relapses and collateral reactions.

1 ex

 

The invention relates to medicine, in particular to Oncology and urology, and can be used for the treatment of superficial bladder cancer.

Bladder cancer is one of the most common (after prostate cancer) cancer in urology. In the structure of oncological morbidity Russia occupies 8th place men's and 18th women. From 1990-1998, the incidence of bladder cancer increased by 34.8% and continues to increase on average by 13% per year. According to the world health organization on the proportion of bladder cancer accounts for 70% of all tumors of the urinary tract and about 3% of all cancers (Nagapattan. Manual of urology. - M.: Medicine, 1998, - v.3, - s.257-258).

The treatment of this disease is one of the most significant problems of modern urology. Bladder cancer occurs mainly among patients aged 65-75 years, and in men it occurs three times more often than women (S.J.Cutler and J.L.Young RUTTAG; 1981).

According to current clinical classification of bladder cancer to the surface are of the tumor, not beyond the mucosal layer: TA (noninvasive papillary carcinoma), Tis (carcinoma in situ) and Tl (tumor extends to the subepithelial connective tissue). (TNM classification of malignant tumors./Ed.B Sobin, Wittekind. Fifth edition.-New-York: Wiley-Liss, 1997).

In addition to the depth of invasion of great importance in relation to forecast the effectiveness of treatment and life expectancy is the degree of tumor differentiation, denoted by G, and measured in points from 1 to 4. Bladder cancer should be considered as a disease of the whole of the mucous membrane, and not its local defeat.

Superficial forms of bladder cancer (TA, Tl, Tis) have a pronounced tendency to recurrence: recurrence rate ranges from 50% to 95%. The high-risk group in relation to the frequency of relapses and a possible change in the invasive stages are patients with multifocal lesions of the bladder, immature forms (G3), as well as cancer in situ. So, at high superficial bladder cancer recurrence after treatment occur in 80% of patients and almost half of them superficial cancer becomes invasive forms. Carcinoma in situ of the bladder progresses to invasive forms 54% of patients (Lamm, D.L. Carcinoma in situ//Urol.clin. North.Amer. in 1992, the - vol.19, - P.499).

In the treatment of superficial RMP oncologists follow 3 principles: 1. Most radical removal of all visible tumors within healthy tissue 2. To prevent tumor relapse 3. To avoid the progression of the process.

To solve the first task is successful is used transurethral bladder resection (TUR). However, the recurrence rate for 1-year averages 50%.(Lamm, D.L. Long term results of intravesical therapy for superficial bladder cancer//Urol.clin. North.Amer. in 1992, the - vol.19, - P.573-580). When performing a TOUR of the bladder is not always possible to talk about radicalism and elasticnet intervention.

For relapse prevention in certain indications used chemotherapy and immunotherapy (Koryakin Abhinivesa treatment of bladder cancer. - In the book. The Plenum of the all-Russian society of urologists. - Kemerovo. - 1995, - c.223-224).

Of the best-known drugs for chemotherapy should include thiotepa, doxorubicin, epirubicin and mitomycin C.

For relapse prevention in certain indications used chemotherapy and immunotherapy (link).

Of the best-known drugs for chemotherapy should include thiotepa, doxorubicin, epirubicin and mitomycin C.

In recent years, the popularity of chemotherapy for superficial bladder cancer decreased significantly due to the wide distribution of immunotherapy. Of all chemotherapy drugs only mitomycin C can be compared in efficiency with immunotherapy, but the cost of treatment is much higher.

The disadvantage of chemotherapy and immunotherapy is the toxicity of the drugs needed for their conduct and their high cost, vozmozhnosti use in elderly and senile age, and people with complicated medical status.

Closest to the proposed method for the treatment of bladder cancer is intracavitary photodynamic therapy. When conducting photodynamic therapy 61 patient using domestic photosensitizer "Photohem" and diode laser with a dose of light energy of 10-15 j/cmIIIthe recurrence rate was 31.1% (Igusa, ATV Surgical treatment, chemo - and immunotherapy of patients with superficial bladder cancer". Practical Oncology, vol. 4, No. 4 - 2003, s-224).

In addition, all patients noted any phototoxic skin reaction during the month.

The present invention is a method of treatment of superficial cancer of the bladder, allowing to reduce the frequency of relapses and reduce adverse reactions.

The problem is solved by photodynamic therapy of tumors diode laser with output power of 0.5-2 watts with a wavelength of 662 nm and light energy 300-600 j/cm2for 10-30 min in the presence of photosensitizer "Photodithazine", injected from the calculation of 0.8-1 mg/kg, then injected silicone placed in it with a fiber optic cylindrical diffuser, the container filled with distilled water and continue laser irradiation of the entire mucosa of the urinary PU is Ira light energy 30-40 j/cm 2within 40-60 minutes

The following example illustrates the method according to the invention.

Patient Krasko, VA, 65 years old, was admitted to the Department of urology clinical hospital No. 51 in a planned manner with suspected bladder cancer. During the examination, including ultrasound, cystoscopy with biopsy, rentgenoradiologicheskoe study was established clinical diagnosis of bladder Cancer T1N×Mo. The surgical treatment of this patient was associated with a high risk due to comorbidities. It was decided to produce PDT of bladder tumors by the proposed method. 2 hours before the session photodynamic therapy was introduced photoditazine rate of 1 mg/kg of body weight. Then under intravenous anesthesia performed laser treatment using the apparatus of the ATCUS 2". The power of the apparatus was 2 W, the luminous energy of 600 j/cm2the exposure time is 10 minutes. Immediately after the bladder is entered silicone, inside of which is placed a fiber-optic fiber with a cylindrical diffuser and the container was filled with distilled water. The dose of light energy was 40 j/cm2. The exposure time of 55 minutes

When the control cystoscopy after 2 weeks marked destruction of the tumor. Over the next 1.5 year recurrence of the tumor was not found.

The treatment offered is th way was held on 6 patients, including persons of elderly and senile age with complicated somatic status. In all cases, the destruction of tumor, no recurrence within one year of the survey and skin phototoxicity.

The method of photodynamic therapy for superficial bladder cancer, which consists in the fact that the tumor is irradiated by the laser with output power of 0.5-2 watts with a wavelength of 662 nm and light energy 300-600 j/cm2for 10-30 min in the presence of a photosensitizer of Photodithazine, injected from the calculation of 0.8-1 mg/kg, then into the bladder injected silicone hosting the optic fiber with a cylindrical cone, cylinder filled with distilled water and continue laser irradiation of the entire bladder mucosa light energy 30-40 j/cm2within 40-60 minutes



 

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