Method of rehabilitation selective chronophototherapy

FIELD: medicine; oncology.

SUBSTANCE: tumour and metastasises site diagnostics is preliminary carried out using hardware and software complex "Sozvezdie". Then photosensitiser chlorine e6 is introduced. After that tumour is exposure with of laser wavelength 660±20 nm during exhalation and heart diastole. Pulse repetition rate is 22.5±2 kHz, pulse duration is 70±30 ns, and power density is 0.1-0.5 Wt/cm2. Thus retention of tumour reheat temperature is controlled within 42-45°C. Method can be applied after operation and/or chemotherapy and/or radiation therapy.

EFFECT: accelerated rehabilitation and higher selectivity of laser exposure and increase of cellular immunity.

4 cl, 3 ex

 

The present invention relates to medicine, in particular to methods of rehabilitation of cancer patients after surgical treatment, the recovery period after chemotherapy, and radiation therapy.

The severity of the patient's condition is mainly due to depressed immunity and intoxication.

Known methods of laser photodynamic destruction of tumors using for introduction into tumor tissue, a special dye photosensitizers Photohem or photosense that increase absorption and thermal destruction of the tumor on lower power of about 1 watt (see Stranadko E.F., countries O.K. and the other Five years of experience in the clinical application of photodynamic therapy. // Photodynamic therapy of malignant tumors. Materials of the 2nd all-Russian Symposium with int. the participation. M., 1997, p.7-19 and Romodanov A.P., Savenko A.G., etc. a Method of treatment of malignant brain tumors. Auth. St. The USSR №1259532, priority 18.05.83 year).

However, the known methods of photodynamic therapy of malignant tumors do not take into account fluctuations of the heat capacity and thermal conductivity of the tissue in connection with the rhythms of the blood supply to the tissue. This reduces the selectivity and the locality of the destruction of cancer cells relative to normal.

The known method of selective destruction of cancer the notches, includes heating the tumor tissue in the range of 42-45°in moments of exhalation and diastole of the patient's heart during the time determined by the types of tumor, its size and localization (see Zaguskin S.L., and other Way selective destruction of cancer cells. Pat. Of the Russian Federation No. 2106159, from 27.09.96 year).

The disadvantages of this method are the complexity and the complexity associated with the introduction into the fabric of the ferromagnetic particles, the lack of locality of heat.

The technical nature of the closest to the invention is a method for the selective destruction of cancer cells, comprising heating the tumor tissue in the range of 42-45°in moments of exhalation and diastole of the patient's heart during the time determined by the types of tumor, its size and localization, and heating the fabric produced by means of laser radiation with wavelength (1,264±0,01) microns and a pulse repetition frequency (22,5±1) kHz at a power density of radiation of 0.5-2 W/cm2(see U.S. Pat. No. 2147847, dated 06.05.1999 year).

The disadvantages of this method is that it uses only the effect of the laser for the destruction of tumors without the use of injection in tumor tissue of photosensitizers (PS).

This reduces the selectivity and efficiency of laser exposure.

In addition, due to the lack of use of the photosensitizers snigees the diagnosis of tumors with deep localization. This method is not effective in the rehabilitation treatment of cancer, as it lengthens the process of rehabilitation and basically can only be used for destruction of cancer cells.

The technical result is to increase the efficiency of rehabilitation chronophotography by increasing the accuracy of diagnosis of tumors with deep localization, speed up recovery time and increase the selectivity of laser irradiation, and the removal of necrotic complications.

This is achieved by the fact that in the way of rehabilitation election chronophotography diagnose the localization of tumors and metastases, including early stage of their development, then enter the photosensitizer intravenously or otherwise, carry out laser treatment, korrelirovannoe biochromatography, activating entered the photosensitizer and implementing photodynamic effect, and when the diagnosis to clarify the localization of tumors and metastases using a hardware-software Complex "Constellation", and the laser treatment is performed by irradiation with wavelength (660±20) nm, with a pulse repetition frequency (22,5±2) kHz, with a pulse duration of 70±30 NS and a power density of 0.1-0.5 W/cm2in addition, as a photosensitizer used FS type Chlorin E6.

The essence invented the I is the performance of the above operations allows to determine the predisposition to cancer, localization and extent of the disease, and to improve the efficiency of photodynamic therapy using biofeedback laser effects to optimize the power density of laser irradiation, the identification of tumor borders and enhance cellular immunity, as well as to carry out the selective effect on tumor deep localizations.

Comparison of the proposed method with the closest analogue suggests the criterion of "novelty", and the lack of known analogues of the distinctive features of the present invention is speaking about the criterion of "inventive step".

A preliminary diagnosis of tumors and metastases in organs performed by means of hardware-software Complex "Constellation" (see Registration Certificate № FS a/0562-04 from 27.09.2004, and the Extract from Protocol No. 1 of the Committee on new medical technology of the Ministry of health and social development of the Russian Federation on 09.04.2004, that allows to detect violations on functions and systems of the body and to determine predisposition to cancer, and to determine the localization and extent of the disease. Further, when the diagnosis of tumors and metastases, including Randy the stage of their development, intravenous (or otherwise) introduces a small amount of the photosensitizer Chlorin E6. Upon irradiation with light of a specific wavelength (the same as in the treatment process) accumulated in the tumor photosensitizer begins to fluoresce, making it possible to record located on the skin or close to it accumulation of damaged cells. Using video fluorescence radiation is displayed on the TV screen or monitor. This method reveals tumors smaller than 1 mm on the surface of the skin. Tumor size cannot be determined by any other method. Spectrometer for fluorescence radiation allows to estimate the number of FS in a particular place (with a diameter of about 600 μm) and, therefore, tumor cells. Watching the dynamics of accumulation of FS, the physician determines the appropriate time and exposure required for rehabilitation.

FS used in the method of photodynamic therapy (PDT)have the following properties:

mainly accumulate in the tumor or inflamed areas,

virtually non-toxic,

quickly removed from the body,

under the action of light produce singlet (excited) oxygen

obtained from the light energy is converted into light of a longer wavelength (fluorescence).

In the method of photodynamic therapy filesystem used is described in two important processes - in the process of diagnosis, treatment, or rehabilitation processes.

Preparations on the basis of Chlorin E6 show photodynamic effect in the interaction of light with a wavelength of 660-665 nm. This radiation penetrates the tissue to a depth of 20 mm (according to our data, significantly deeper)that allows them to apply for tumors deeper locations. Chlorins completely eliminated from the body within a few days, have a greater coefficient of accumulation in the tumor (1:10-20) and almost have no phototoxicity.

On the body of the patient set pulse sensors (for example, in the form of clothespins on your finger, photodiode opposite the led) and respiration (for example, the area of the diaphragm in the form of a belt, the tension of which varies the resistance, or in the form of a thermistor near the nose). Signals from sensors include laser heating of tumors only at opportune moments exhalation and diastole of the heart. Heating is provided by the maximum formation of singlet oxygen at the selected pulse frequency (22,5±2) kHz with a duration of 70±30 NS and a maximum absorption at the selected wavelength (660±20) nm singlet oxygen photons of laser radiation at a power density of 0.1-0.5 W/cm2. Effect only during diastole of the heart during the expiratory phase, when the reduced perfusion of the tissue and thus the consequently, decrease the heat capacity and thermal conductivity increases the locality of heat and reduces its inertia. This facilitates the retention of heat within the corridor 42-45°in which are killed selectively only the cancer cells. The temperature range monitoring is carried out by computer automatic power control and session duration of laser irradiation using an ultrasound measurement of the temperature of the irradiated tissue.

Laser treatment specified parameters controlled by ultrasonic and differential thermometry for monitoring immune status in patients with tumors. The sessions were carried out under the control of the laser using the computer, in which the signals are input sensor pulse and respiration, takes into account the inertia effects using the developed program based on the results of calculations of the fluctuations of the heat capacity and thermal conductivity and experiments with contact ultrasonic and microwave thermometers.

The range of the average power density of the radiation is determined depending on the depth of location of the tumor.

When photodynamic effect significantly changes the immune response of the organism, which is used during the rehabilitation of cancer patients.

Taking into account the necessary amendments to the difference of time and a signal to the sensor pulse and to the field of tumor laser irradiation is performed only at the moment of exhalation and diastole of the heart. The power density of 100-500 mW/cm2depending on the depth location of the tumor. The carrier frequency of 22.5 kHz, pulse duration of 100 NS, the exposure time for a single zone from 30 s to 5 minutes

To enhance cellular immunity before, during and after the course of PDT was applied the previously developed methodology using as magnetic therapy effects in phase increase blood during inhalation and systole of the heart, thymus, spleen and venous transcutane blood. The state of cellular and humoral immunity was assessed as direct conventional methods, or by indirect assessment of cellular immunity using differential thermometry.

Example 1. Sick, K., 43 years. Diagnosis: ovarian cancer, stage 4. Ascites. Pleurisy. The diagnosis using the hardware-software Complex "Constellation". Revealed numerous violations in the system of the reproductive organs, hormonal sphere, the violation of the liver and biliary tract. Recommendations were given rehabilitation of nature. The patient held laparotomies evacuated 6 liters of ascitic fluid. Conducted two pleural puncture, evacuated 1100 ml of liquid. Conducted cytological examination, and then conducted two courses of chemotherapy due to the inability of the surgical intervention. Ultrasonography detected volumetric education of the right ovary the size 66,5 cm3. After 10 days from the beginning of the rehabilitation treatment according to the developed method using FS laser exposure, korrelirovannoe biochromatography, repeated ultrasound examination showed a reduction in the volume of education to 27.6 cm3. Only after this patient K. was successfully operated. In the future, was repeated rehabilitation treatment according to the present method and currently former patient K. completely healthy.

Example 2. Patient D., 73 years. He entered with newly diagnosed adenocarcinoma of the prostate. Ultrasonography detected 2 site in the prostate gland, left lobe 5,1×6.1 mm, in the right - 5,9×6,6 mm PSA at entry was 15,9. The results of microscopic examination after biopsy: infiltrating growth adenocarcinoma 5 points on Gleason (3+2). Within 2 weeks, patients received a course of rehabilitation election chronophotography according to the invention, then after 10 days of repeated ultrasound, which found a non-uniform node hyperplasia with indistinct outline dimensions 1,8×1,6 mm Control DOG study in 1.5.

Example 3. Patient M, 13 years. Diagnosis: gliosarcoma golovnogo the brain.

Metastases in the spinal cord. Operated in 2004 he Entered the rehabilitation treatment with complaints of dizziness, unsteady gait, podtashnivaet. Objectively, the pale skin, pronounced neurological signs. After conducting a two-week course of rehabilitation treatment according to the invention the patient's condition has improved, gone are the symptoms of intoxication. X-ray picture of a stable, neurological signs are preserved.

Presents the most illustrative cases of the application of rehabilitation election chronophotography selected from a considerable number of examples of the treatment of patients with various cancer.

Thus in the proposed method achieved the technical result.

In clinical trials for various diseases proved the efficiency of the method of the election chronotherapy:

in the absence of negative side effects due to the expansion of therapeutic range of parameters intensity,

the stability of therapeutic effect due to the formation of tissue memory and use of biological timer instead of physical,

in accelerating the healing effect by taking into account the nature of the local pathology through an adequate ratio of the depth of amplitude modulation on pulse, respiration and tremor

in the OTC is accordance adapt to the level of physical therapy effects due to uneven breathing and heart rate of the patient.

The technique of chronotherapy has broadened the indications for PDT.

The use of PDT in the mode of biofeedback in combination with chronophotography to enhance cellular immunity allows to achieve the best results in the rehabilitation of cancer patients. In cancer slows tumor growth and metastasis development are normalized immunologic and hemodynamic parameters.

1. Way as photodynamic therapy, characterized by the fact that pre-diagnose the localization of tumors and metastases, including early stage of their development, using the hardware-software complex "Constellation", then enter the photosensitizer chlorin E6, perform laser treatment on the tumor at the time of exhalation and diastole of the heart, with a wavelength of 660±20 nm, with a pulse repetition rate of 22.5±2 kHz, with a pulse duration of 70±30 NS and a power density of 0.1-0.5 W/cm2.

2. The method according to claim 1, characterized in that the laser exposure time is from 30 s to 5 min, while monitoring the retention temperature of the tumor within 42-45°C.

3. Way as photodynamic therapy, characterized by the fact that after surgery and/or chemotherapy and/or radiation therapy is administered f is desensibilization chlorin E6, perform laser treatment on the tumor at the time of exhalation and diastole of the heart, with a wavelength of 660±20 nm, with a pulse repetition rate of 22.5±2 kHz, with a pulse duration of 70±30 NS and a power density of 0.1-0.5 W/cm2when this exercise control over the retention temperature of the tumor.

4. The method according to claim 3, characterized in that the laser exposure time for a single zone from 30 s to 5 min, and a control for keeping the temperature of the tumor perform within 42-45°C.



 

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