Method of treating lung cancer complicated by hemorrhage

FIELD: medicine.

SUBSTANCE: invention relates to medicine, oncology and radiology and consists in carrying out complex treatment by installation of endobronchial reverse valve into bleeding bronchus. At this background performed is external beam radiotherapy (EBRT) TFD 40 Gy, with radiomodifier: 5 fluorouracil - 250 mg, course dose - 4-5 g, or cysplatin - 10 mg, course dose - 120 mg, which are introduced daily, intravenously 30 minutes before the beginning of EBRT session. 14 days after completion of the first stage of EBRT fibrobronchoscopy (FBS) is performed with removal of bronchoblocker, and the second stage of EBRT TFD 30 Gy is performed to total dose for two stages EBRT TFD 70 Gy, with application of the same radiomodifiers in the same mode. 30 days after finishing EBRT FBS is made and is tumour remains in bronchus lumen or there is a suspicion of it, photodynamic preparation is introduced intravenously, and after 4 hours FBS and laser irradiation of tumour are carried out. Control examination of tracheobroncial tree is carried out after 30 days and after 26 months.

EFFECT: method ensures increase of life expectancy and improvement of its quality for patients with non-operable lung cancer complicated by hemorrhage.

1 ex

 

The invention relates to medicine, namely to Oncology, and can be used for special treatment of lung cancer complicated by bleeding.

A method of treatment of lung cancer complicated by pulmonary hemorrhage, at the present time is urgent as pulmonary hemorrhage occurred on the background of lung cancer, is an absolute contraindication for carrying out of special treatment, namely chemotherapy and radiation treatment (this greatly aggravates the condition of the patient with lung cancer and is the leading cause of death of the patient from profuse bleeding or asphyxia). From sources not identified a method of treating lung cancer, complicated by bleeding, special methods, such as chemotherapy and radiation treatment.

There is a method of treatment of pulmonary tuberculosis (RF patent No. 2002133917), consisting in the application to stop pulmonary hemorrhage endobronchial valve, which provides prevention of asphyxia and evaperation pneumonia (in the early period pulmonary hemorrhage), and by maintaining the drainage function of the blocked bronchus excludes postobturation pneumonia - this allows you to keep the bronchial obturation up to 6 months. However, it is not used in patients with lung cancer, complicated by bleeding, for the conduct is of chemotherapy and radiation treatment.

The authors offer a highly effective method of treating patients with lung cancer, complicated by bleeding, which consists in carrying out step therapy:

the first step is to stop lung hemorrhage by asking endobronchial valve (bronchomalacia) in the bleeding bronchus;

in the second stage, 2-4 day after establishing bronchomalacia in bleeding bronchus, perform chemotherapy and the first stage remote radiation therapy SOD-40 Gr;

the third stage includes: within 14 days after the end of chemotherapy and the first stage remote radiation therapy is fibrobronchoscopy with the removal of endobronchial valve and revision of the bronchial tree to evaluate the effectiveness of the treatment. Then comes the second stage remote radiation therapy SOD-30 G during chemotherapy, the total dose of remote radiation therapy in two stages - SOD-70 Gr;

the fourth stage - at the end remote radiation therapy SOD-70 Gy in 30 days is fibrobronchoscopy to assess the effectiveness of the treatment and when saving or suspected tumor in the lumen of the bronchus, intravenous photodynamic drug, and after 4 hours the fibrobronchoscopy and laser irradiation of the tumor.

The technical result of the proposed method is to increase the longevity and improve its quality in patients with inoperable form of lung cancer, complicated by bleeding, by conducting effective special treatment in the first days after stopping lung hemorrhage by asking endobronchial valve (bronchomalacia) in the bleeding bronchus (formerly bleeding from the tumor was an absolute contraindication to chemoradiation therapy).

The technical result is achieved by the fact that the authors suggest that the only acceptable method of treatment of patients with lung cancer, complicated by bleeding from the tumor:

the first step is to stop lung hemorrhage by asking endobronchial valve in the bleeding bronchus;

in the second stage amid bronchomotor carry out the survey (2-4 days) for remote radiation therapy to the primary tumor site, regional lymph nodes and perform the 1st step radiotherapy SOD-40 Gy with radiomodifying: chemotherapy - 5 proracer 250 mg, dose rate to 4-5 g, or cisplatin 10 mg, dose rate to 120 mg administered daily intravenously 30 minutes prior to the start of the remote session radiotherapy;

the third stage includes: upon completion of chemotherapy and the first stage remote radiation therapy (2 weeks before the 2nd stage remote radiation therapy), you fibrobronchoscopy with the removal of endobronchial treatment is tion of the valve of the bronchus and revision of the bronchial tree to evaluate the effectiveness of the treatment. Then comes the second stage remote radiation therapy SOD-30 Gy to a total dose of remote radiation therapy in two stages - SOD-70 Gr, amid radiomodifying: chemotherapy - 5 proracer 250 mg, dose rate of 4 g, or cisplatin 10 mg, dose rate to 120 mg administered daily intravenously 30 minutes prior to the start of the remote session radiotherapy;

the fourth stage is the completion of a course of radiation therapy SOD-70 Gy in 30 days is fibrobronchoscopy to assess the effectiveness of the treatment and when saving or suspected tumor in the lumen of the bronchus intravenous photodynamic drug, and after 4 hours the fibrobronchoscopy and laser irradiation of the tumor.

Clinical example:

Patient S. 54 years of age, was treated in the thoracic Department.

The diagnosis of Central cancer of the left main bronchus T3N3Mx, recurrent pulmonary hemorrhage 2 severity".

Chest x-ray: left lung is reduced in volume due to hypoventilation lower lobe. At the root node is determined education with irregular contours, deforming the lumen of the proximal bronchus. The mediastinum is displaced to the left. Determined enlarged lymph nodes of all groups mediastinum on both sides.

The fibrobronchoscopy. Proximal bronchus obturated buhr stem infiltration, who goes on an extended midlevel spur, the rear wall of the upper lobe bronchus and the rear semicircle of the left main bronchus, covered in the last 1/3 of the lumen. The proximal border of 4 cm from the crest of Karina. On the surface of the tumor, the walls of the trachea blend of blood clots.

Histological diagnosis of squamous cell carcinoma.

In spite of hemostatic therapy for 9 days, bleeding from the left main bronchus continued. When fibrobronchoscopy in the left main bronchus set endobronchial valve (bronchomotor) No. 14. Pulmonary hemorrhage stopped.

Chest x-ray: left lung in atelectasis.

Control fibrobronchoscopy 2 days - bronchomotor in the left main bronchus, blood traces in the bronchus no.

Computed tomography of the chest: the left lung field is reduced in volume due to atelectasis, in the lumen of the main bronchus synthetic obturator. The right lung field normal size, the density of the lung tissue normal lung pattern is not modified, visible bronchi passable, the walls of their slightly thickened. Determined enlarged paratracheal nodes on the right. Conclusion: Central cancer of the left lung, metastases in the lymph nodes of the mediastinum.

The Council of radiologists - recommended course distance the ion radiotherapy with radiomodifying - 5 fluorouracil 250 mg, dose rate to 4-5 grams a day intravenously 30 minutes before the start of the remote session of radiotherapy. Started a course of chemotherapy after 4 days from the moment of bronchomalacia. At the first stage of treatment stop lung hemorrhage by asking endobronchial valve (bronchomalacia) in the bleeding bronchus, in the second stage of treatment the patient received: remote radiation therapy - SOD - 40 Gr and intravenous 5 fu 250 mg, dose rate - 5 year

After 14 days upon completion of the 1st stage remote radiation therapy conducted fibrobronchoscopy, during which bronchomotor removed from the bronchus. During inspection of the bronchial tree data no bleeding.

Thus, the proposed method for the treatment of lung cancer complicated by bleeding, is the gradual realization of complex treatment. To stop the bleeding bronchus is setting bronchomalacia in bleeding bronchus, conducting remote radiation therapy radical programme - SOD - 70 Gy with one radiomodifying is 5 fluorouracil or cisplatin. The first step is to stop lung hemorrhage by asking endobronchial valve in the bleeding bronchus. In the second stage of treatment amid bronchomotor held remote radiation therapy day the SOD 40 Gr amid radiomodifying: this chemotherapy with 5 fluorouracil 250 mg, dose rate to 5 g daily intravenously 30 minutes before the start of the remote session of radiotherapy. In the third stage after 14 days upon completion of the 1st stage remote radiation therapy is fibrobronchoscopy with the removal of bronchomotor of bronchus and revision of the bronchial tree to evaluate the effectiveness of the treatment and a second stage remote radiation therapy SOD-30 Gy to a total dose of remote radiation therapy in two stages - SOD-70 Gr amid radiomodifying - 5 fluorouracil 250 mg, dose rate to 4 g daily intravenously 30 minutes before the start of the remote session radiation therapy.

The fourth stage - fibrobronchoscopy 30 days upon completion of the remote radiation therapy: in the proximal bronchus is determined by the infiltration of the mucous membrane, passing to the rear wall of the upper lobe bronchus and the rear semicircle of the left main bronchus, the latter has a tumor of 0.3×0.2 cm, was introduced intravenously photodynamic Photosens 0,2%-50,0, and after 4 hours the fibrobronchoscopy and laser irradiation of the tumor from 100-300 j/cm2.

Control examination after 30 days. The fibrobronchoscopy: during the inspection of the mucosa of the tracheobronchial tree pathology it is not revealed.

The last survey in 26 months. State Boling is satisfactory, no complaints. Performed fibrobronchoscopy, in which the pathology in the mucosa of the tracheobronchial tree not found.

The claimed method of treatment with high efficiency to provide specialized care to patients with lung cancer, complicated by bleeding, which previously refused to specialized treatment, and can be used in specialized Oncology institutions engaged in comprehensive treatment of patients with lung cancer.

A method of treating patients with lung cancer, complicated by bleeding, which consists in carrying out a comprehensive treatment by asking endobronchial valve in the bleeding bronchus, against which perform remote radiation therapy SOD - 40 Gy, with radiomodifying - 5 fluorouracil 250 mg, dose rate to 4-5 g, or cisplatin 10 mg, dose rate of 120 mg, which is administered daily, intravenously 30 min before the start of the remote session of radiotherapy, at the end of the 1st stage remote radiation therapy within 14 days perform fibrobronchoscopy, during which bronchomotor removed from the bronchus, and carry out the second stage remote radiation therapy SOD - 30 Gy to a total dose of two stage remote radiation therapy SOD - 70 Gy, with radiomodifying - 5 - fluorouracil 250 mg, dose rate of 4 g, or cisplatin 10 mg, to ROWA dose of 120 mg, introducing daily, intravenously 30 min before the start of the remote session radiation therapy within 30 days after the remote radiotherapy perform fibrobronchoscopy and when saving or suspected tumor in the lumen of the bronchus intravenous photodynamic drug, and after 4 h the fibrobronchoscopy and laser irradiation of the tumor, visual inspection of the tracheobronchial tree are performed every 30 days and 26 months.



 

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