Method of neoadjuvant chemotherapy of invasive bladder cancer

FIELD: medicine.

SUBSTANCE: invention refers to medicine and namely to oncourology and can be used for treatment of bladder tumours. The method is implemented in the following way: during the period prior to the operation there created is depot of cytostatic incubated with autoplasma in regional lymphatic nodes. For that purpose 50 ml of blood is taken from the patient, centrifugated at the speed of 1500 rpm during 40 min; 15 ml of the obtained autoplasma is added to cytostatic diluted in the proportion of 0.9% NaCl per 5 ml, and incubated during 1 hour at t=37°C. Then puncture of lymphatic vessel on the back of the foot is performed and cytostatic with autoplasma is injected; repeated injection in one and the same limb is carried out in 12 days.

EFFECT: use of invention provides the effect on tumour and its regional metastases owing to keeping the remedy in lymphatic bed for a long time and its being deposited in regional lymphatic nodes at low probability of complications.

1 ex

 

The invention relates to medicine, in particular to oncourology, and can be used in the treatment of patients with malignant tumor of the bladder at II-III stages of neoplastic process.

The known method chemotherapeutic treatment of invasive bladder cancer (see the book "Clinical oncourology" /edited by Matveeva BP - M.: 2003, s-368; guidelines for chemotherapy of neoplastic diseases /edited Perevozchikova NI - M, 2005) which consists in the application schema M-VAC (Methotrexate 30 mg/m2in/in 1 day, Vinblastine 3 mg/m2/the 2nd day, Doxorubicin (Adriamycin) - 30 mg/m2in the 2nd day, Cisplatin 70 mg/m2/drip in the 2nd day. Dose methotrexate and vinblastine repeat on the 15th and 22nd day when normal blood counts. A second course in 4 weeks).

Systemic polychemotherapy has a number of side effects due to its toxicity: complications of the cardiovascular system, the gastrointestinal tract, the blood-clotting system, immune system, which leads to interruption of specific treatment.

Known "Method of treatment of bladder cancer by autohemotherapy" (see Nazarov O.E. Berlov Autohemotherapy locally advanced bladder cancer: author. dis. Kida. the honey. Sciences, R-n/A. 2003). The way VC is uchet introduction patient anticancer chemotherapy sredneterapevticheskih doses:

cyclophosphamide, doxorubicin, cisplatin, diluted to 150 ml of autologous blood taken from a patient from a vein in 2 sterile vial with 50 ml of pulizia. Vials administered drugs on physiological solution. The composition is incubated for 30 minutes at t°=36,5 is 37.0°C in termostate followed by reinfusing autologous blood with cytotoxic drugs to the patient/drip under conditions of overload. The method is effective, but has drawbacks: accompanied by toxicity, no effect on the lymphatic system.

Known "Method endolymphatic chemotherapy" (see the book "the Endolymphatic chemotherapy in the clinic", Ed. Sidorenko US, Rostov-on-don, 1998, p.120), chosen as a prototype. The way endolymphatic chemotherapy of bladder cancer was used for functional contraindications to surgery and radiation treatment in the neoadjuvant mode. The results of chemotherapy (at the rate of 2000 mg of cyclophosphamide and 2000 mg of 5-fluorouracil or 100-150 mg Thiotepa) was measured at the improvement of the General condition General condition, decrease in dysuria and hematuria. However, the known method has drawbacks: endolymphatic administration of chemotherapeutic agents for the impact on the entire regional lymph collector affects the change of peripheral blood.

After infuse is a decrease in the number of cells compared to baseline levels. A slight decrease toxicity does not allow polychemotherapy in full. Changing parameters of peripheral blood after APT is of interest for further clinical research in this field.

The aim of the invention is the effect on the bladder tumor and regional lymph nodes, decrease complications of chemotherapy.

This objective is achieved in that in the preoperative period create a depot of chemical, incubated with autoplasma in regional lymph nodes: taking 50 ml of the patient's blood, centrifuged with a speed of 1500 rpm for 40 min, the resulting autoplasma in the volume of 15 ml combined with cytostatic agents (cyclophosphamide 2000 mg), diluted to 5.0 ml with 0.9% NaCl and incubated at t=37°C for 1 hour, then perform a lymph vessel on the rear foot and injected chemotherapy, incubated with autoplasma, following the introduction of the cytostatic agent in the lymphatic vessels of the same legs can be performed after 10 days, the vessels of the opposite legs after 6-7 days.

The invention "Method of neoadjuvant chemotherapy in invasive bladder cancer" is new, because it is not known from the level of medicine in the treatment of patients with malignant tumor of the bladder at II-III stages of neoplastic process.

The novelty is subramania is in the preoperative period create depot anticancer chemotherapy on autoplasma patients with bladder cancer stage II-III tumor process, has never been applied in medical practice in malignant tumors of the urinary bladder.

Due to the lack of selectivity existing anticancer drugs damage the tumor cells, and normal, fast-growing cells, the first cells in the bone marrow. With increasing total dose of cytostatic along with increase the antitumor effect usually develops oppression of the blood forming organs. Although endolymphatic chemotherapy allows you to enter massive doses of chemotherapy, this technique does not lead to a significant reduction of toxicity of the latter. Changes of parameters of peripheral blood after APT of great interest, because it is possible to judge the degree of toxic effect on the organism massive doses of chemotherapy, administered endolymphatic.

Endolymphatic autolackiererei is a perspective neoadjuvant treatment of malignant tumors of the urinary bladder in II-III stages of the process. The route of administration of cytostatic agents on autoplasma helps to improve the selectivity and efficiency of cancer treatment.

p> The method makes it possible to greatly reduce the frequency, severity and duration of toxic reactions to avoid some complications, limiting the use of systemic chemotherapy.

Achieved in the short term regression of the primary lesion and metastatically modified lymph nodes contributes to the further successful technical operation.

The invention "Method of neoadjuvant chemotherapy in invasive bladder cancer is industrially applicable, as it can be reproduced in health care, cancer research institutes, breast care clinics and other medical institutions for the treatment of patients with bladder cancer.

"The way neoadjuvant chemotherapy in invasive bladder cancer" as follows: by puncture of peripheral veins is the fence 50 ml of the patient's blood into a sterile vial with 10 ml of Pulizia, followed by centrifugation of the blood (speed 1500 rpm) for 40 minutes thus Obtained plasma of the patient is connected in a volume of 15 ml autoplasma with cytostatic agents (Cyclophosphamide 2000 mg, dissolved in 5 ml of 0.9% NaCl) and incubated at t=37°C for 1 hour. Then the corresponding method is performed lymph vessel on the rear foot, the latter shall provide for the introduction of chemical, incubated with patient plasma. Re-introduction of the cytostatic agent is 12 days. Immediately before the operation is performed assessment objective status of the patient (assessment of patient complaints and the severity of clinical manifestations, ultrasound of the bladder to assess tumor process in the dynamics). In the postoperative period is estimated degree of medical pathomorphosis of the tumor and changes in regional lymph nodes.

An example of a specific implementation of the Method neoadjuvant chemotherapy infiltrative bladder cancer".

Patient K., 71, medical card number C-2340/h, was admitted to the Department of oncourology 18.02.08 with complaints of difficulty, painful, frequent, mocheispuskanie, periodically-makrogematuriya(last 8.01.08) According to a survey (ultrasound from 21.01.08 - on the right side wall of the bladder lazerous hyperechoic education size of 0.8×2.3 cm) including ROUND-biopsy of the bladder performed at the place of residence of the patient (the state institution "Regional clinical oncological dispensary health Department of the Krasnodar region), GA. No. 106115-116 - moderately differentiated perekhodnocletocny cancer with invasion to the muscle layer, diagnosed with bladder cancer T2NoMo, CL gr. 2. Cystoscopy (11.10.07, epicrisis No. 07.2123 from 16.10.07), made in goose "Regional clinical oncological dispensary health Department of the Krasnodar region - 1-3 segments on the back wall with the transition to the right side wall several merging between a villous tumor sizes ranging from 1.5 to 3.0, see the bladder neck enlarged adenomatous nodes, on which surface a circular tumor growth. Right in the mouth area of the tumor, left outside the mouth area of the tumor, peristaltic.

19.02.08 - made right endolymphatic infusion of 2000 mg of Cyclophosphamide, incubated with 15 ml of patient plasma. On day 5 showed reduction of dysuria. 3.03.08 (12 days) - re endolymphatic introduction of cytostatics in the right lower limb. According to laboratory research (OAK, biochemical analysis of blood, leukocyte count, urea, creatinine during chemotherapy within normal limits. Adverse reactions gastro-intestinal tract, cardiovascular system, blood is not revealed

11.03.08 control ultrasound, according to which at the base of the bladder to the right lazerette hyperechoic education without a clear path, size 0,8 see 12.03.08 the operation - ROUND-vaporization of the bladder (2-3 S on the right side wall, above the mouth of the right ureter 1 cm detected 4 is castka modified mucous, 1×1.5 cm each, suspicious tumors. 2-3 S left similar plots, a total size of 1×1.5 cm In the postoperative period without complications. The patient was discharged with adequate urination, dysuria no.

Technical and economic efficiency "Method neoadjuvant chemotherapy in invasive bladder cancer is that:

The cytostatic entered endolymphatic on autoplasma, provides not only long-term presence of the drug in the lymph channel (due to its Deposit in the regional lymph nodes, as well as the plasma protein binding), but the effect on the tumor and its regional metastases.

- Reducing the likelihood of complications conducted endolymphatic chemotherapy compared with systemic chemotherapy.

- improving the patient's quality of life by maintaining adequate functioning of the bladder

- increases the duration of recurrence-free period.

The way neoadjuvant chemotherapy in bladder cancer, characterized in that in the preoperative period create depot cytostatic, incubated with autoplasma in regional lymph nodes: taking 50 ml of the patient's blood, centrifuged with a speed of 1500 rpm for 40 min, 15 ml of the obtained autoplasma connect with the cytostatic agent is m, diluted to 5 ml with 0.9% NaCl and incubated at t=37°C for 1 h, carry the lymph vessel on the rear foot and enter the cytostatic with autoplasma, repeated administration of the same limb exercise 12 days.



 

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6 cl, 5 ex, 5 tbl, 2 dwg

FIELD: medicine.

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8 cl, 3 ex

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1 ex

FIELD: medicine.

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3 cl, 2 ex

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2 tbl, 2 ex, 4 dwg

FIELD: medicine.

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1 tbl, 2 ex

FIELD: medicine.

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1 ex

FIELD: medicine.

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9 cl, 2 ex

Dietary supplement // 2368250

FIELD: food industry.

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8 tbl

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