Method of treating cervical cancer

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely oncology, and can be used for treating cervical cancer. That is ensured by radiation teletherapy and brachytherapy. Each brachytherapy session is preceded by bringing the Hydrogel Coletex-M Tissue 3-5 ml to the tumour before 12-18 hours. Before gel contact, the Coletex-M Tissue is introduced. Further,1-1,5 hours prior to the brachytherapy session, the textile tissue is removed, and Hydrogel Coletex-ADL Tissue 4-6 ml is brought to the tumour. Preliminary, the Hydrogel Coletex-ADL Tissue is added with lidocaine to achieve the gel concentration 4-6%.

EFFECT: method provides reduced total toxicity and drug load ensured by the required concentration of metronidazole maintained in the tumour before the radiation session, and also analgesia without using narcotic preparations, optimised time and geometry of centring introduction that allows intensifying the damage exposure on the tumour.

2 ex

 

The invention relates to medicine, namely to Oncology, and can be used in the treatment of cervical cancer.

There is a method of treatment of recurrent cervical cancer (patent RF №2243766, IPC A61K 31/282, publ. 2005), including the introduction on the first day of platydema, and during the following three days conducting external irradiation with 2.6 Grams. On the fifth day of treatment in the space, introduce a solution of novocaine, suspension hydrocortisone solution, dipyrone, a solution of vitamin B12, gentamicin, cyclophosphamide, methotrexate. These therapeutic effects is repeated in sequence four times.

The disadvantage of this method is the trauma of injection in the space, which can lead to serious complications: injury to major vessels, nerves, abstsedirovanie on the introduction of drugs and other Method is difficult to use and requires additional training of the doctor.

There is a method of treatment of local recurrence of cervical cancer (patent RF №2240114, IPC A61K 31/17, publ. 2004), including the vagina tampons with a therapeutic composition containing ointments Viferon, linseed oil, doxorubicin, methotrexate and hydroxyacetone, within 10 days for 10 hours to conduct daily irradiation session perineal field.

The disadvantage of this method is that the pre is proposed drugs do not provide deep penetration of the medicinal compounds in the tumor tissue, do not have analgesic action, and the irradiation of recurrent cervical cancer in the pelvis with perineal field does not provide the required dose distribution and involves significant radiation dose to the rectum and urethra.

The known method and intratumoral parametreleri the introduction of metronidazole in combined radiotherapy common cancer of the cervix (Mustafin JS Improvement and the implementation of the method of intratumoral and parametrising the introduction of metronidazole in combined radiotherapy common cancer of the cervix. Abstract. Diss. for obtaining the academic degree KMN, M., 1991, p.9), which includes radiation treatment according to the scheme: in the first stage - beam radiation in static mode 4 Grams a day, three or four sessions, then 2 G daily until SOD 16-20 Gy, further holding intracavitary irradiation at 5 Gy twice a week to SOD 50 Gy over five weeks. At the same time, continued exposure zones regional metastasis 2 Gr. Metronidazole was administered before the first 3-4 sessions of exposure in the form of intratumoral injections of the cervix and parametrium.

The disadvantage of this method is its complexity, high invasiveness, high degree of pain with the introduction of metronidazole, a high probability of complications, including wound is their vessels.

The closest is a method of treatment of cancer patients (patent RF №2089247, IPC A61N 5/10, publ. 1997), including radiation therapy in combination with intratumoral the introduction of metronidazole applique on the tumor textile material containing sodium alginate with metronidazole and dimethylsulfoxide.

The disadvantage of this method is that it is necessary to apply a strong analgesic, and sometimes drugs.

The task of the invention is to remedy these disadvantages, the efficiency of the treatment, reducing the overall toxicity and drug load (including drugs) to patients through achieving necessary radiomodification concentrations of metronidazole and maintain this concentration directly into the tumor a significant period of time - before the session of irradiation required for practical work. Also the task of improving the quality of life of the patient when performing brachytherapy by providing antispasmolytic, analgesic, antiseptic and anti-inflammatory effects. This allows you to expand the range of patients who can apply this treatment, including patients with large tumors (more than 80 cm3), as well as those patients who have clinical screening is reported, for example, in heart disease, it is impossible to systematically summarize the high concentration of painkillers.

For this purpose, the method of treatment of cervical cancer, including remote radiation therapy and brachytherapy in combination with the introduction to radiological, metronidazole in the form of application to the tumor textile material containing layer of sodium alginate with metronidazole proposed before each session brachytherapy for 12-18 hours to the tumor to bring hydrogel napkin "Collex-M, volume of 3-5 ml depending on the volume of the tumor. Then before contact with the gel to enter the textile cloth Collex-M", and 1-1 .5 hours before the session brachytherapy delete textile cloth and enter hydrogel napkin "Collex-ADL" in the volume of 4-6 ml, which additionally add lidocaine to achieve 4-6% concentration in the gel, depending on the patient's pain threshold.

This procedure allows, in addition to the effect of radiological, to provide a vaginal cleansing before intrauterine intervention and to achieve good analgesia without the use of strong analgesics and narcotic drugs, to optimize the time and the geometry of the introduction of endostatin.

The implementation of the method is demonstrated on specific clinical examples.

Example 1

Patient G-VA, 57 years old, is 10-3013, was in the radiotherapy Department of Moscow them. PageRank with 05.05.2010, 28.05.10,

Diagnosis: cervical Cancer IIIB century, T2bN1M0, exophytic form of growth, right parametrium and metastatic variant. Comorbidities: hypertension 2 tbsp., ischemic heart disease, angina, paroxysmal tachycardia.

Histology: particles moderately differentiated adrenoblokatorov cancer with a significant predominance of structures endometrioid adenocarcinoma.

Gynecological status at admission: cervix in mirrors gipertrofirovanie to 6 cm in diameter, the front lip is deformed postpartum breaks. Around the external OS small tumor proliferation. Palpable neck barrel-shaped, gipertrofirovanie in both portions up to 5 cm in diameter, woody density. The body of the uterus is not enlarged. Right parametrium is determined by the cervical tumor infiltration. Left - free.

Given the prevalence of the tumor process, accepted conditionally combined treatment plan: stage 1 - preoperative chemoradiotherapy followed by the decision of the question about the possibility of surgical treatment.

With 04.05 on 25.05.2010, had started remote radiation therapy. Irradiation was performed on the device "ONCOR" (Decel. suc., 18 MeV), using multi-leaf call the matora, dynamic fractionation, GENUS - 4 Gy×3 fractions, then 2.5 G to SOD=29,5 Gr.

Brachytherapy performed on the device "GAMMAMED 12i" by introducing a system of metralleta into the uterine cavity and lateral arches of the vagina, GENUS - 5 Grams in TTA. Number of sessions - 2. Before sessions brachytherapy for 15 hours to the tumor was brought to 3 ml of hydrogel napkins "Collex-M", then the vagina was introduced textile cloth Collex-M" before contact with the gel. 1 hour before the session brachytherapy textile cloth Collex-M was removed and the tumor was summed application hydrogel napkins "Collex-ADL" in the volume of 5 ml dioksidin, which added 4% lidocaine to achieve a 6% concentration in the gel.

After that conducted the session brachytherapy.

Sessions brachytherapy did not require additional injections of analgesics, complications of inflammatory nature. Attacks of paroxysmal tachycardia was not observed.

As a result of the treatment was expressed positive dynamics. At discharge the patient examined in the chair: the cervix is formed sharply shortened, not visually changed. Palpable neck of the uterus is not enlarged, shifting. On the right side is a small cervical infiltration. The body of the uterus is not enlarged. The appendages are not palpable.

The patient is 3.5 weeks was performed radical x is surgical treatment.

The patient was under observation for 10 months with no signs of recurrence.

Example 2

The patient And society, 37 years old, was in the radiotherapy Department of Moscow them. PageRank with 15.11 on 10.12.2010,

Clinical diagnosis: Cancer of the cervix, IIIB century, T12N1Mo, mixed growth form. Metastatic option.

Morphological conclusion: no 4121/10 - infiltrative growth of undifferentiated squamous cell cancer with the presence of tumor emboli in the lymph and blood vessels.

Cytological examination punctate iliac lymph node on the right No. 11864-65/10: metastasis of squamous cell carcinoma.

Comorbidities: Nephroangiosclerosis, initial CRF. Inguinal hernia on the right. Posthemorrhagic anemia I class.

When the examination of Moscow:

St.genitalis: cervix deformed, total tumor changed. The exophytic tumor, occupies the entire upper third of the vagina, goes to the vaginal vault, with areas of necrosis, contact bleeding. Palpation supracervical portion of the neck enlarged, hardened. The body of the uterus is not enlarged, shifting, painlessly. The appendages are not enlarged. In parametric freely. Recto-vaginal septum free.

Ultrasound (from 25.10.10 g): the liver is not enlarged, the conventional structure, without focal zones. Gall bladder, kidneys, pancreas, paraaortal region - OS without the features. In supraclavicular and inguinal areas focal areas are not identified. The mammary glands are normal echo patterns. In the right iliac region - l/node 35×13×13 mm, between the external and internal iliac vessels, the group merged nodes total size 37×15×11 mm In the left iliac nodes 25×17×13 mm, 16×8×8 mm Uterus is not enlarged (68×43×65 mm), conventional structure, the endometrium is not thickened (7 mm). The neck is increased (48×40×50 mm), almost completely occupied by the hypoechoic education with increased blood flow, the upper pole of education is slightly above the internal OS. The ovaries are not enlarged (right 26×20×17 mm, left 39×27×18 mm), normal patterns.

Conclusion: the echo picture of the disease cervical cancer, signs of infestation, the entire thickness of the neck, engagement of the inner throat. Secondary lesions of the iliac lymph nodes on both sides.

Given the stage of the disease, extent of the tumor process, the morphological structure of the tumor, the young age of the patient, with the aim of preserving ovarian function in the first stage of the combined treatment was planned execution of preoperative radiotherapy with further discussion on the appropriateness of surgical intervention in the volume of extended removing the uterus with appendages.

Taking into account the presence of a large exophytic component of the tumor, metastatic time is placed in the pelvic lymph nodes, it was decided to hold preoperative radiation therapy with radiologicaly 5-fluorouracil by well-known methods. From platinum drugs to refrain from nephroangiosclerosis. With 15.11 on 06.12.2010 a course of preoperative chemotherapy: type 5-fluorouracil 2,0,

Then started remote radiation therapy LINAC "ONCOR" (Decel. suc., 18 MeV), using a multi-leaf collimator, on the pelvic area with 6 fields, dynamic fractionation, GENUS - 4 Gy×3 fractions, then 2.5 G to SOD=29,5 Gr.

Brachytherapy performed on the device "MULTISOURSE" by introducing a system of metralleta into the uterine cavity and lateral arches of the vagina, GENUS - 5 Grams in TTA. Number of sessions - 2. 18 hours before the session brachytherapy for cervical tumors summed hydrogel napkin "Collex-M with a volume of 5 ml and then, before contact with the gel, textile cloth Collex-M" with metronidazole. 1 hour before the session was extracted textile cloth Collex-M" and the cervix was brought to 5 ml of hydrogel napkins "Kreteks ADL" dioksidin and lidocaine, which added 3% lidocaine to achieve a 5% concentration in the gel.

Despite the technical complexity of the introduction of metralleta in the uterus for more pain during the session, brachytherapy was not required, inflammatory jawline is not marked. Managed to enter undostat to the bottom of the uterus and make endostatin in the lateral arches of the vagina about 2 cm (optimal length).

When the statement is viewed on the chair: the cervix is formed is not increased mucous with granular surface, but not bleeding, appeared plots epithelialization. Palpation the neck is a little thick, even woody density. The body of the uterus is not enlarged, rejected the right. The appendages are not enlarged. In parametric freely.

Thus, a positive dynamics, tumor process recognized resectable.

The patient was operated after 1 month, made an extended hysterectomy with appendages.

The proposed method of treatment of 15 patients. All has been good analgesic and anti-inflammatory, as well as a pronounced antitumor effect. The patient is observed in the period from 1 to 13 months.

The proposed method of treatment is simple and easy to use, requires no special training, helps to enhance the damaging effects of radiation on the tumor and at the same time to reduce the possibility of inflammatory complications in the vagina and the uterus, as well as to reduce and sometimes completely eliminate the use of strong analgesics and narcotic drugs for maintenance sessions brachytherapy.

The method of treatment of cervical cancer, comprising the administration is giving remote radiation therapy and brachytherapy in combination with the introduction of metronidazole applique on the tumor textile material, containing a layer of sodium alginate with metronidazole, characterized in that before each session brachytherapy for 12-18 h, the tumor down hydrogel napkin "Collex-M with a volume of 3-5 ml depending on the volume of the tumor, then before contact with the gel is injected textile cloth Collex-M", and 1-1 .5 h before the session brachytherapy remove textile cloth and injected hydrogel napkin "Collex-ADL" in the volume of 4-6 ml, which additionally add lidocaine to achieve 4-6%concentration in the gel, depending on the patient's pain threshold.



 

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and

R denotes substituted or unsubstituted groups selected from (C6-C10)aryl, (C3-C12)cycloalkyl, heteroaryl, (C6-C10)aryl (C1-C6)alkyl and heterocyclyl; where the heterocyclyl hereinafter is a 5-10-member ring radical which consists of carbon atoms and 1-5 heteroatoms selected from nitrogen, oxygen and sulphur, and heteroaryl hereinafter is an aromatic heterocyclyl, and each aryl, cycloalkyl, heteroaryl, arylalkyl and heterocyclyl can be substituted with one or more substitutes selected from halogens, including fluorine, chlorine, bromine, iodine, (C1-C6)alkyl, (C1-C6)alkoxy, (C6-C10)aryl, halogen(C1-C6)alkyl, (C6-C10)aryl(C1-C6)alkoxy, -O-(C3-C12)cycloalkyl, -O-CH2-(C3-C12)cycloalkyl, hydroxyl, NRaRb and ORa, where Ra and Rb independently denote (C1-C6)alkyl and aryl; R1 denotes (C6-C10)aryl; R2 and R3 independently denote hydrogen, (C1-C6)alkyl, -COOR5, -CONR5R6, -CH2NR5R6, -CH2CH2NR5R6, -CH2CH2OH or -CH2OH; provided that one of R5 or R6 is hydrogen or unsubstituted alkyl, the other is neither hydrogen nor unsubstituted alkyl; R5 and R6 independently denote hydrogen, (C1-C6)alkyl, (C3-C12)cycloalkyl, (C6-C10)aryl, (C6-C10)aryl(C1-C6)alkyl, heteroaryl or heteroaryl(C1-C6)alkyl, which can be unsubstituted or substituted; or R5 and R6 can be combined to form a saturated or unsaturated 3-8-member ring having 0-2 heteroatoms, including N, O or S; where the heteroaryl hereinafter is a 5-10-member ring radical consisting of carbon atoms and 1-5 heteroatoms selected from nitrogen, oxygen and sulphur, and each alkyl, cycloalkyl, aryl, arylalkyl, heteroaryl or heteroarylalkyl can be substituted with one or more substitutes selected from halogen, including chlorine, fluorine, bromine or iodine,(C1-C6)alkoxy and NRaRb; R4 denotes OH, (C6-C10)aryl, ortho-substituted aniline or amino (C6-C10) aryl, which can be optionally substituted with one or more groups selected from halogens, including fluorine, chlorine, bromine, iodine, hydroxyl, amino groups or (C6-C10)aryl; X denotes -NR7-, -CONR7- or -N R7CO; R7 denotes hydrogen or (C1-C6)alkyl; Y denotes (C6-C10)aryl or (C6-C10)aryl(C2-C6)alkenyl; m is an integer from 0 to 1; n is an integer from 0 to 1; o is an integer from 0 to 7; and p is an integer from 0 to 1.

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EFFECT: use of the apparatus provides more complete elimination of pathology of the radiated biological material.

2 cl, 4 dwg, 1 tbl

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