Method for treating locally disseminated kidney cancer

FIELD: medicine.

SUBSTANCE: method involves carrying out 5-10 sessions of general magnetotherapy beginning from 3-rd day after surgical intervention in static mode: magnetic field rotation frequency is equal to 100 Hz, magnetic field intensity of 30 oersted, magnetic field shape is sinusoid half-cycle, raising time being equal to 30 s, time of recession 30 s; the number of procedures is equal to 15. Then, remote radiation therapy is administered 4 weeks later after surgical intervention. The treatment is applied to removed kidney bed and lymphatic collectors in single stage in classical fractioning mode at a doze of 2 Gy 5 times a week within 5 weeks up to reach total doze of 50 Gy with general magnetotherapy being concurrently applied in 1 session per day mode, the number of procedures being equal to 25. The first biotherapy course with recombinant human alpha tumor necrosis factor (TNF-α) is given at a dose of 2 mln units 2 weeks later after the radiation therapy being done. Total З biotherapy courses are to be given with 21 days long pause available between the courses.

EFFECT: enhanced effectiveness of treatment; reduced risk of postoperative complications; increased immune activity.

 

The invention relates to medicine, namely Oncology, and can be used for the treatment of patients with locally advanced kidney cancer.

Among tumors urinary system kidney cancer in Russia takes the second place and mortality is in the first place. In 1990, the Russian Federation registered 7456 patients with kidney cancer, in 2001 - 13933 patients. The incidence of kidney cancer over the past decade has increased from 6.2 to 12.4 per 100 thousand population. The average annual growth rate is 6.5%, and kidney cancer is on the 1st place in terms of frequency of occurrence among tumors of the urinary tract. Despite the wide implementation of health ultrasound and computed tomography, the number of patients with common forms of kidney cancer is more than 50%, while the treatment of kidney cancer with stage III-IV have only a slight tendency for improvement: 5-year survival rate ranges from 12 to 37%.

Known methods of treating patients with locally advanced kidney cancer (stage T2-4N0-2M0), which includes chemotherapy and radiation therapy in various combinations (Clinical oncourology/edited Aborina, M, Medicine, 1975 p.á305).

However, the method is ineffective and causes lots of complications.

The closest achieved a positive result (the prototype)is a method of treating patients with locally advanced kidney cancer, consisting in the carrying out of intraoperative radiation therapy for 15-20 G for 1 session with subsequent radiotherapy 3-4 weeks up to a total focal dose of 55-60 Gy in combination with three courses of immunotherapy with interferon - alpha, intramuscularly or subcutaneously, 30-50 million units in year 1 ("Combined treatment of locally advanced and spread of kidney cancer", Obisakin, Shi et al., in Proc. of Topical treatment of urologic diseases. The materials of the 3rd all-Russian scientific conference with the participation of CIS countries", Moscow, 1999, s-193).

However, the known method is not effective enough, there is a high frequency of complications in the postoperative period and phase distance radiotherapy treatment requires expensive special equipment.

The authors propose a new and effective method of treating patients with locally advanced kidney cancer, which consists in stage-by-stage treatment: surgery followed by radiation therapy and biotherapy recombinant human tumor necrosis factor - alpha. A positive result of the proposed method is to increase the efficiency of treatment by improving elasticnet in the area of surgical intervention, reducing the number of postoperative complications, increased immune activity is theta.

A positive result is achieved by the fact that the conduct of General magnetotherapy in the pre - and postoperative period in a special program; then 4 weeks after surgical treatment prescribed external beam irradiation on the bed of the removed kidney and lymphatic collectors at one stage in the classic mode fractionation in a dose of 2 Gy, 5 times a week for 5 weeks to a total dose of 50 Gy; then 2 weeks after completing radiation treatment first course of biotherapy recombinant human 3 tumor necrosis factor - alpha (TNF-α) 2 million units intravenously daily 10 days to a total dose rate of 20 million units; just spend 3 courses of biotherapy interval between courses of 21 days.

The invention consists in that in the preoperative period start prevention of complications early postoperative period by the total magnetic therapy performed on the apparatus "Magnetar-AMP". Magnetotherapy impact provides simultaneous effect on the whole body uniform modulated rotating magnetic field. Session magnetotherapy spend entered into the computer program: the rotation frequency of the magnetic field of 100 Hz, the magnetic field 30 e, the shape of the magnetic field of a sinusoidal half-cycle, rise time 3, the fall time of 30 s, the number of sessions 15. Sessions are conducted daily: in the preoperative period for 5 days, then starting 3-4 days after surgery in 10 days. Prevention of complications of postoperative radiation therapy is of the General magnetotherapy on a similar program in the entire course of 1 session per day, the number of sessions 25.

2 weeks after the radiation treatment biotherapy recombinant human tumor necrosis factor - alpha (TNF-α) 2 million units intravenously, daily for 10 days to a total dose rate of 20 million units Just spend 3 courses of biotherapy interval between courses of 21 days.

The inventive method is as follows: conduct patient surgery, after which the rate of postoperative radiation therapy and 3-year biotherapy recombinant human tumor necrosis factor - alpha (TNF-α) 20 million units in a single course. Surgical intervention was extended nephrectomy - produce separate ligation of the first artery, then Vienna) renal vessels to reduce the risk of migration of tumor emboli. The dissection on the pathways of lymphatic drainage performed from the level of the bifurcation of the aorta to the legs of the diaphragm with the removal of fiber latero-, retrocaval zone and mozartkugeln gap with cancer of the right kidney and is Etro-, latero - and premortal fiber with cancer of the left kidney.

In the postoperative period with the aim of strengthening local antitumor effects and increase elasticnet surgical intervention in patients conduct remote radiation therapy. Perform photon irradiation on γ-therapeutic setting "Rocus-M with an average energy of the radiation of Co-60 to 1.4 MEV, a single dose of photon radiation is 2.0 gray, mode radiation 5 times a week, total dose of 50 Gy. Prevention of complications of radiation therapy is carried out using magnetic therapy to be performed on the apparatus "Magnetar-AMP" in the static mode: rotation frequency of the magnetic field of 100 Hz, the magnetic field of 30 OE, the shape of the magnetic field of a sinusoidal half-cycle, rise time 30, the fall time of 30 s, the number of sessions 15. 2 weeks after completing radiation treatment 3 courses of biotherapy of recombinant human tumor necrosis factor - alpha (TNF-α) - "Almarin, Russia, 2 million units intravenously, daily for 10 days to a total dose rate of 20 million units with an interval between courses of 21 days. Biotherapy in the specified mode is directed to stimulation of cellular and humoral immunity, increased systemic antitumor effects.

Clinical example of the complete method.

Ill the I Semchenko LI, 27.03.1953 treated at the Department of oncourology goose ACAD since October 1997, case history No. 21867, diagnosis: Cancer of the left kidney, FTA, T3N1M0. Within 4 months indicated a constant low-level pain in the left lumbar region. By ultrasound scanning and computed tomography revealed a tumor of the left kidney, in the region of its middle third, size 86×72 mm, with evidence of tumor invasion beyond the renal capsule. In regional lymph nodes, pathological changes were found. In the preoperative period for the prevention of postoperative complications were 5 sessions of General magnetotherapy apparatus "Magnetar-AMP" in the static mode: rotation frequency of the magnetic field of 100 Hz, the magnetic field 30 e, the shape of the magnetic field of a sinusoidal half-cycle, rise time 30, the fall time of 30 s, 1 session per day. Operation 04.11.1997 - extended nephrectomy on the left. Histological diagnosis No. 4179 from 10.11.1997 - moderately-differentiated renal cell carcinoma with invasion into the perirenal tissue, 1-m of 7 lymph node metastasis of a cancer. 3 days after surgery, continued General magnetotherapy for the prevention of postoperative complications in static mode: rotation frequency of the magnetic field of 100 Hz, the magnetic field 30 e, form MAGN what these fields are sinusoidal half-cycle, the rise time of 30 s, the fall time of 30 s, 1 session per day, the number of sessions 15. The postoperative period was uneventful, the wound healed by first intention. 14.11.1997, the patient was discharged from hospital on a scheduled break in treatment.

With 09.12.97, 18.01.98, patients received postoperative course γtherapy, single focal dose was 2 Gy, 5 times per week, total of 50 Gy. Prevention of the complications of radiation produced by a magnetic field apparatus "Magnetar-AMP", magnet therapy course consisted of 25 sessions daily for 10 minutes before radiation therapy. Magnetic therapy was performed in static mode: rotation frequency of the magnetic field of 100 Hz, the magnetic field of 30 OE, the shape of the magnetic field of a sinusoidal half-cycle, rise time 30, the fall time of 30 s For radiation therapy without complications.

2 weeks after completing radiation therapy, the patient started the first course of biotherapy of recombinant human tumor necrosis factor - alpha (TNF-α) 2 million units intravenously, daily for 10 days to a total dose rate of 20 million units Just spent 3 courses of biotherapy interval between courses of 21 days. The total dose was 60 million units

The proposed method only treated 56 patients. In a clinical study in the lo 30 men and 26 women aged from 28 to 73 years. All patients had III-IV stage of kidney cancer(T2-4M0-2M0), localized in the upper third of the kidney - 23 patients, in the middle third of 14 patients in the lower third in 19 patients.

At the 1st stage of complex treatment of all patients was carried out surgical treatment in different sizes. Carried out the following activities: extended nephrectomy - 5 patients, combined extended nephrectomy with adrenalectomy - 39 patients, combined extended nephrectomy with rescia inferior Vena cava, thrombectomy - 6 patients, combined extended nephrectomy with hemicolectomies - 2 patients, combined extended nephrectomy with resection of liver - 2 patients, combined extended nephrectomy with splenectomy - 1 patient, combined extended nephrectomy with resection of the pancreas - 1 patient.

In the pre - and postoperative period all patients received General magnetotherapy for the prevention of postoperative complications with the following parameters: rotation frequency of the magnetic field of 100 Hz, the magnetic field 30 e, the shape of the magnetic field of a sinusoidal half-cycle, rise time 30, the fall time of 30 s, 1 session per day. Postoperative complications occurred in 8 (14.3 per cent) - postoperative paresis of the intestine, 5 - bleeding - 1, exudative pleurisy - 1.

At the 2nd stage is ecene all patients received a course of distance gamma-therapy in the aftercare plan in total focal dose equal to 50 Grams. Prevention of radiation reactions were performed using a magnetic field apparatus "Magnetar-AMP". Magnet therapy course standard consisted of 25 sessions daily for 10 minutes before radiation therapy. Magnetic therapy was performed in static mode: rotation frequency of the magnetic field of 100 Hz, the magnetic field 30 e, the shape of the magnetic field of a sinusoidal half-cycle, rise time 30, the fall time of 30 seconds Among 56 patients receiving magnetic therapy, postradiation reactions and complications occurred in 34 (60,7±6,7%). Dyspepsia was observed in 29 patients (51,8%); myelosuppression - 16 (28,5%) patients; reactive enterocolitis in 11 (19,6%) patients. Application of General magnetotherapy contributed to the shift early radiation reactions (dyspepsia) in the dose range 40-42 Gr compared with 24-32 Grams in the control group, there was no necessity in the suspension or cancellation of radiation therapy.

On the 3rd stage of complex treatment all patients received 3 courses of biotherapy of recombinant human tumor necrosis factor - alpha (TNF-α) 2 million units intravenously, daily for 10 days to a total dose rate of 20 million units with an interval between courses of 21 days.

Thus, the inventive method has a high efficiency and can be used in specialized Oncology institutions complex is achenium patients with malignant neoplasms of the kidney.

A method of treating patients with locally advanced cancer of the kidney, consisting of the surgical intervention and subsequent remote radiation therapy and biotherapy enjoys, characterized in that pursue a common magnetic therapy - 5 sessions before and 10 sessions of 3 days after surgery in static mode: rotation frequency of the magnetic field of 100 Hz, the magnetic field 30 e, the shape of the magnetic field of a sinusoidal half-cycle, rise time 30, the fall time of 30 with the number of procedures 15, then 4 weeks after surgery appoint external beam irradiation on the bed of the removed kidney and lymphatic collectors in one stage in the classic mode fractionation in a dose of 2 Gy, 5 times a week for 5 weeks to a total dose of 50 Gy with concomitant administration of General magnetotherapy 1 session per day, number of procedures - 25, then 2 weeks after completing radiation treatment first course of biotherapy of recombinant human tumor necrosis factor - alpha (TNF-α) 2 million units, just spend 3 courses of biotherapy interval between courses of 21 days.



 

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1 ex

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