Method of adjuvant therapy of stomach cancer

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and may be used in integrated treatment of stomach cancer. That is ensured by a surgical intervention to place a microirrigator into an abdominal cavity. Then 4 weeks after the surgery, blood 300 ml is taken on the first day to be centrifuged and to recover autoplasma. Autoplasma and chemopreparations are placed into a first flask, autoplasma - into second and third flasks, blood corpuscles and chemopreparations - into a forth force. The 2nd and 3rd flasks are frozen, the 1st and 4th flasks are separately incubated for 40 minutes at 37°C. The incubated blood corpuscles and chemopreparations from the 4th flask are introduced intravenously drop-by-drop. Autoplasma and chemopreparations from the 1st flask are introduced intraperitoneally through the microirrigator. It is followed by 1 session of radiation therapy on the abdominal cavity at single dose 2 Gy. On the 2nd and 4th therapeutic days, only sessions of radiation therapy are applied. On the 3rd and 5th days, the sessions of radiation therapy are preceded by freezing one flask with autoplasma added with chemopreparations, and the flasks are incubated for 40 minutes at 37°C. Then autoplasma and chemopreparations are introduced intraperitoneally through the microirrgator, and the session of radiation therapy is conducted. On the 6th and 7th days, a pause is made. Starting from 8th and 15th days, a five-day therapeutic course is repeated.

EFFECT: method enables reducing rate of metastases in the peritoneum caused by stomach cancer and increasing survival rate of the patients due to combined surgical and chemoradiation therapy in a certain mode.

2 ex

 

The invention relates to medicine, namely to Oncology, and can be used in the adjuvant treatment of gastric cancer by prophylactic prevention of the incidence of cancer metastases to the peritoneum.

The leading role in the treatment of patients with gastric cancer remains for surgical treatment. However, about half of the patients die in the first year after surgical treatment in connection with the development of distant metastases, mainly in the peritoneum.

The high incidence of recurrence and distant metastasis after application of the primary surgical treatment of malignant solid tumors (see Snesko LI Prevention of recurrence and metastasis of colon cancer. L., 1976. 176 C.) associated with the inevitable trauma of the tumor during surgery, leading to the diffusion of tumor cells through the blood, lymphatic system, peritoneum, significantly increases the number of tumor cells in regional veins zone of the tumor and in the General circulation. The decrease in the total body resistance caused by surgery, injury to organs during surgery lead to the strengthening of processes of metastasis and recurrence.

All this makes calls to methods in the overall impact on the tumoral process. The goal of chemotherapy in cancer of the stomach is the impact on metastasis is, including the metastases, remaining after surgical removal of tumors of the stomach.

Known "Method of neoadjuvant autohemotherapy in the treatment of patients with advanced gastric cancer" (see Malaco M. Autohemotherapy common forms of gastric cancer: author. dis.... Kida. the honey. Sciences. Rostov-n-D, 1998). The scheme of complex treatment of patients with stage III gastric cancer involves the use of preoperative intravenous autohemotherapy standard chemotherapy in the conventional course doses. Shown to increase the resectability of patients, improving outcomes. However, duration of recurrence-free period is not significant, and information about metastasis are not tracked and are not presented.

Thus, improved immediate outcomes of treatment. However, the method is only used for preoperative preparation of patients does not improve long-term results of treatment.

The known method of chemotherapy gastric cancer ("guidelines for chemotherapy of neoplastic diseases" Ed. by N.N. Perevozchikova, M., 2005, s), supplemented by radiotherapy. Use the following therapeutic mode: leucovorin 20 mg/m2in/in 1-5 day; fluorouracil - 425 mg/m2in/in 1-5 day. After 28 days, counting from the 1st day of chemotherapy - and radiotherapy 45 Gy (,8 Gy per day, 5 days a week, 5 weeks). At the same time: leucovorin 20 mg/m2/1-4 day; fluorouracil 400 mg/m2/1-4 day. The introduction is from 1 through 4 and in the last 3 days of exposure. One month after the end of chemoradiation therapy, a further two cycles of chemotherapy: leucovorin 20 mg/m2in/in 1-5 day; fluorouracil - 425 mg/m2in/in 1-5 day.

However, the authors note that standards for drug treatment no methods chemoradiation therapy are under development, and the immediate goal of modern chemotherapy is to achieve a median survival of patients with gastric cancer advanced stages 18 months. Information about metastasis is not presented.

Known "Method of intraperitoneal chemotherapy in ovarian cancer patients" (Stepura L.A. Prolonged intraperitoneal neoadjuvant and adjuvant chemoimmunotherapy in the complex treatment of ascitic form of ovarian cancer stage III-IV disease: author. dis.... Kida. the honey. Sciences. Rostov n/A., 1998), we selected as a prototype. The method consists in intraperitoneal administration course doses of cytostatics, diluted ascitic fluid, combined with intraperitoneal introduction of Tactivin. Then patients underwent surgical treatment. Shows less toxicity, high efficiency of this method, allowing significantly increase the ing the percentage of regression operability and resectability of the tumor, as well as the life expectancy of patients with ascitic form of ovarian cancer stage III-IV disease (16-26%) compared with other methods of treatment.

However, the method involves the treatment of patients with only ascitic form of ovarian cancer, aimed at preoperative preparation of patients, increasing operability and resectability of the tumor, rather than on the prevention of metastasis. Information about metastasis is not significant and are not presented.

The aim of the invention is to reduce the incidence of metastases in the peritoneum after complex surgery and chemoradiation treatment of gastric cancer.

This objective is achieved in that during the operation the patients in the abdominal cavity set microirrigation. 4 weeks after the operation start of the course chemoradiation treatment. For this, the first day of treatment in patients taking 300 ml of blood by centrifuging of the blood allocate autoplaza, first put the bottle autoplaza with chemotherapy, second and third vial - autoplaza, in the fourth vial is the remainder of the formed elements of blood and chemotherapy; the second and third vials frozen, the first and fourth vials separately incubated for 40 minutes at 37°C. Then intravenously injected incubated shaped elements to the Ovi with chemotherapy drugs out of the fourth vial, and intraperitoneally through microirrigation enter autoplaza with chemotherapy in the first vial. Immediately after that, spend the first session of radiation therapy to the abdominal cavity with a single dose of 2 Gy. 2 and 4 days of treatment only radiation therapy. At 3 and 5 days of treatment before radiation treatments defrost one vial autoplasma add chemotherapy, incubated bottles for 40 minutes at 37°C, then enter autoplaza with intraperitoneal chemotherapy through microirrigation and conduct sessions of radiation therapy. 6 and 7 days break. 8 and 15 days 5-day course chemo-radiotherapy repeat.

The invention "Method of adjuvant treatment of gastric cancer" is new, because it is not known in the field of medicine with chemotherapy and radiation therapy of malignant tumors, prevent the occurrence of distant metastases in the peritoneum cancer of the stomach.

The novelty of the invention lies in the fact that during the operation the patients in the abdominal cavity set microirrigation. 4 weeks after the operation start of the course chemoradiation treatment. For this, the first day of treatment in patients taking 300 ml of blood by centrifuging of the blood allocate autoplaza, first put the bottle autoplaza with chemotherapy, second and third vial - autoplaza, in the fourth vial - ostavi is camping the formed elements of blood and chemotherapy; the second and third vials frozen, the first and fourth vials separately incubated for 40 minutes at 37°C. Then intravenously injected incubated the formed elements of blood with chemotherapy drugs out of the fourth vial, and intraperitoneally through microirrigation enter autoplaza with chemotherapy in the first vial. Immediately after that, spend the first session of radiation therapy to the abdominal cavity with a single dose of 2 Gy. 2 and 4 days of treatment only radiation therapy. At 3 and 5 days of treatment before radiation treatments defrost one vial autoplasma add chemotherapy, incubated bottles for 40 minutes at 37°C, then enter autoplaza with intraperitoneal chemotherapy through microirrigation and conduct sessions of radiation therapy. 6 and 7 days break. 8 and 15 days 5-day course chemoradiation treatment repeat.

Thus, intraperitoneal chemotherapy on autoplasma, intravenous - uniform elements of blood, radiation therapy to the abdominal cavity helps prevent the occurrence of metastases in the peritoneum cancer of the stomach.

The invention "Method of adjuvant treatment of gastric cancer is industrially applicable, as may be used in health care, hospitals with cancer, clinics, research it the ideological institutions.

Examples of specific applications of the Method of adjuvant treatment of gastric cancer" on the sick.

Patient Gordeeva NM, 1955, history 5438/f, enrolled in the Department of General Oncology, RNII 20.04.08. diagnosed with stomach Cancer, T3N1M0, phase 3, clinical group 2. Condition after gastrectomy with installation of microirrigation into the abdominal cavity 29.03.08". Postoperative histological analysis 637421-29: low differentiated adenocarcinoma with invasion of all layers of the stomach wall, the lymph nodes are small gland - cancer metastasis. When receiving no complaints. The patient began a course of chemoradiation treatment.

For this, the first day of treatment, the patient scored 300 ml of blood by centrifuging of blood donated autoplasma in the first vial was placed autoplaza with 5-fluorouracil 750 mg, second and third vial - autoplaza, in the fourth vial is the remainder of the formed elements of blood and oxaliplatin 100 mg; the second and third bottles froze, the first and fourth vials separately incubated for 40 minutes at 37°C. Then intravenously introduced incubated formed blood elements with oxaliplatin from the fourth bottle, and intraperitoneally through microirrigation introduced autoplaza with 5-fluorouracil from the first vial. After that I spent the first session of radiation therapy to the abdominal cavity with a single dose of 2 Gy. N is 2 and 4 days of treatment were the only radiation therapy. At 3 and 5 days of treatment before radiation treatments were thaw one vial autoplasma, was added 5-fluorouracil 750 mg, incubated bottles for 40 minutes at 37°C, then entered autoplaza with intraperitoneal chemotherapy through microirrigation and held sessions of radiation therapy. 6 and 7 days break. 8 and 15 days 5-day course chemoradiation treatment was repeated.

Course chemoradiation treatment the patient suffered no complications. The level of leukocytes, peripheral blood lymphocytes was reduced; abnormalities in the biochemical blood analysis, urinalysis was not. The patient was discharged in good condition.

When houses in RNII within 2.5 years after treatment data on recurrence and metastases are not detected. Feeling sick satisfactory.

Sick Postanogov Sergey V., born in 1945, history 7298/f, enrolled in the Department of General Oncology, RNII 05.08.08. diagnosed with Cancer of the output section of the stomach, T3N1M0, phase 3, clinical group 2. Condition after distal Subtotal gastrectomy with installation of microirrigation into the abdominal cavity 14.07.08". Postoperative histological analysis 382543-50: poorly-differentiated adenocarcinoma with invasion of all layers of the stomach wall, the lymph nodes are small gland - cancer metastasis. When receiving no complaints. The patient began a course of production of the radiation treatment.

For this, the first day of treatment, the patient scored 300 ml of blood by centrifuging of blood donated autoplasma in the first vial was placed autoplaza with 5-fluorouracil 750 mg, second and third vial - autoplaza, in the fourth vial is the remainder of the formed elements of blood and oxaliplatin 100 mg; the second and third bottles froze, the first and fourth vials separately incubated for 40 minutes at 37°C. Then intravenously introduced incubated formed blood elements with oxaliplatin from the fourth bottle, and intraperitoneally through microirrigation introduced autoplaza with 5-fluorouracil from the first vial. After that I spent the first session of radiation therapy to the abdominal cavity with a single dose of 2 Gy. 2 and 4 days of treatment were the only radiation therapy. At 3 and 5 days of treatment before radiation treatments were thaw one vial autoplasma, was added 5-fluorouracil 750 mg, incubated bottles for 40 minutes at 37°C, then entered autoplaza with intraperitoneal chemotherapy through microirrigation and held sessions of radiation therapy. 6 and 7 days break. 8 and 15 days 5-day course chemoradiation treatment was repeated.

Course chemoradiation treatment the patient suffered no complications. The level of leukocytes, peripheral blood lymphocytes was reduced; abnormalities in the biochemical analysis of blood and, urinalysis was not. The patient was discharged in satisfactory condition.

When houses in RNII within 2 years after treatment data on recurrence and metastases are not detected. The patient's health is satisfactory.

The proposed method treated 13 patients with gastric cancer. The use of intraperitoneal and intravenous chemotherapy for autologous environments of the body during a course of radiation therapy does not cause changes in General, the biochemical analysis of blood, is characterized by low toxicity, does not increase the frequency of radiation complications. Patients traced in the interval from 6 months to 2.5 years. During the observation period did not reveal a single case of distant metastasis.

Technical and economic efficiency "Method adjuvant treatment of gastric cancer" is that the method allows to reduce the incidence of distant metastases, it is low-toxic, simple in execution. The method allows for comprehensive treatment in a short time, reduces length of stay of the patient in hospital and the cost of treatment of metastases of gastric cancer.

How adjuvant treatment of gastric cancer, including chemotherapy, radiation therapy, characterized in that 4 weeks after the operation with the installation of microirrigation into the peritoneal cavity on day 1 of treatment in patients taking 300 ml of blood, centrifuge holds is the key from the blood allocate autoplaza, 1 bottle put autoplaza with chemotherapy, in 2 and 3 vials - autoplaza, 4 bottle - rest of the formed elements of blood and chemotherapy; 2 and 3 vials frozen, 1 and 4 separately incubated for 40 min at 37°C, then intravenous infusions incubated the formed elements of blood with chemotherapy of 4 bottles, and intraperitoneally through microirrigation enter autoplaza with chemotherapy of 1 vial; immediately after that, spend 1 session of radiation therapy to the abdominal cavity with a single dose 2 G; 2 and 4 days of treatment - only sessions beam therapy; 3 and 5 days before the session of radiotherapy defrost one vial autoplasma add chemotherapy, incubated vials 40 min at 37°C, then enter autoplaza with intraperitoneal chemotherapy through microirrigation and conduct a session of radiation therapy; 6 and 7 days - break; 8 and 15 days, five days, repeat the treatment.



 

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