Method of treating choroidal melanoma with size of more than 6,5 mm

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly to ophthalmology. What is involved is a brachytherapy of an intraocular melanoma with a size of more than 6.5 mm by anchoring a beta-applicator with ruthenium-106 +rhodium-106 to an episclera for 7-14 days on a projection of the melanoma at total radiation dosage 3000 Gy. The brachytherapy is combined with a diode-laser transpupillar therapy of the melanoma at radiation power 800 mWt. Then, 6-12 months after the beta-applicator has been removed, a restrictive retinal coagulation at power 500 mWt and an endoresection of the residual melanoma follow. The method enables avoiding such complications, as vitreous body and retina haemorrhage, retinal detachment, complete loss of vision, as well as reducing a probability of metastases due to the preliminary brachytherapy and the following restrictive retinal laser coagulation.

EFFECT: combined application of the thermal therapy and brachytherapy enables affecting the melanoma from both sides for more complete destruction of its structure.

1 ex

 

The invention relates to medicine, in particular to ophthalmology.

Melanoma of the choroid is a severe disease that is difficult to treat, ends with different degrees of intensity of vision, leading to blindness and even death of the patient.

Disease intraocular melanoma currently in Moscow is 13.3 cases per 1 million adults. In the get it from 6,23 up to 8 people to 1 million people.

Melanoma in the developing choroid usually sporadic. This is evidenced by chromosomal changes found in patients with melanoma.

The bulk of melanomas (57%) are localized postequalization, 26% Equatorial 17% prekatrina.

Eyes with intraocular melanomas large size (greater than 6.5 mm) often nuclearwaste due to the limited capacities of the impact on melanoma and the potential for metastasis.

The closest analogue is a method of treating melanoma comprising andarticle intraocular melanoma with its preliminary heat for 2-3 days before surgery (British Journal of Ohtalmolodgy. August 2008 vol 92, No. 8, str-1049).

However, this method has significant drawbacks. During and after surgery and there are many complications: hemorrhage, retinal detachment, total loss of vision, and there is a possibility METAS is aerovane.

The objective of the invention is to provide an effective method for the treatment of intraocular melanoma of large size.

The technical result is the reduction of complications such as hemorrhage, retinal detachment, total loss of vision, as well as reducing the likelihood of metastasis.

The technical result is achieved in that in the method of treatment of intraocular melanoma larger than 6.5 mm, including her therapy and interesection, according to the invention, first produced brachytherapy by filing for episclera for 7-14 days on the projection melanoma beta-applicator with radionuclide Ru-106 + Rhodium-106, with a total dose of 3000 G, in parallel with brachytherapy transpupillary produce diode-laser transpupillary therapy of melanoma with radiation power of 800 mW to the maximum coating its surface coagulates, 6-12 months after withdrawal of beta-applicator transpupillary produce restrictive laser coagulation of the retina with the capacity of 500 mW and then andarticle residues melanoma.

Brachytherapy radiation load on the sclera up to 3000 Gr and transpupillary thermotherapy could destroy the structure of melanoma fully or partially, to form a chorioretinal scar, and thus, to avoid complications such as retinal detachment, hemorrhage in the retina and is clonidne body and dissemination of melanoma.

According to the invention, prior brachytherapy before andarticle melanoma and the formation of a chorioretinal scar allows operation in a more "comfortable" conditions, to avoid complications such as retinal detachment, hemorrhage into the vitreous body.

Restrictive laser coagulation of the retina with the capacity of 500 mW is done with the purpose of prophylaxis of retinal detachment with subsequent andarticle melanoma.

therapy allows to destroy the top of melanoma to 3 mm, thus, the impact on melanoma comes from two sides: therapy from the top, and brachytherapy from the base, allowing you to more fully destroy the structure of the melanoma, and andarticle residues melanoma allows you to completely remove it.

The method is as follows.

The first stage was performed brachytherapy by filing for episclera for 7-14 days on the projection melanoma beta applicator with radionuclide Ru-106 + Rhodium-106, with a total dose of 3000 G, in parallel with brachytherapy transpupillary produced the diode-laser transpupillary thermotherapy radiation power of 800 mW to the maximum coating its surface coagulates. 6-12 months after withdrawal of beta-applicator transpupillary produced restrictive laser coagulation of the retina with the capacity is 500 mW

Then ran Subtotal vitrectomy technology 25 G. were removing modified vitreous body. Then one sclerotomies puncture was expanded to 20 G and using tiglapsetag tweezers took the plot of melanoma for histological study. Next, using vitrectomy performed a complete resection of melanoma, then the vitreous cavity was temporaroly gas. If patients secondary retinal detachment produced tamponade vitreal cavity silicone oil.

Control examination was performed one week, one month, 3 months and ultrasound on the subject of metastasis every 6 months.

Histological and cytological examination showed that the resulting material live tumor cells was not detected.

Clinical example: patient 52 years have complained of decreased vision in his left eye. After ophthalmological and General surveys of distant metastases not detected. Diagnosed and intraocular melanoma of the left eye and the lower outer segment according to the In - scan reached the height of 8.0 mm, base 10.3 mm Patient produced treatment: brachytherapy + transpupillary thermotherapy. 12 months regressed melanoma and its height residue was 5.8 mm diameter 9.1 mm, formed chorioretinal the scar. Then made restrictive laser coagulation of the retina with the capacity of 500 mW and andarticle residues melanoma to the sclera. The observation period of 5 years. Distant metastases no.

Method for the treatment of intraocular melanoma larger than 6.5 mm, including her therapy and interesection, characterized in that the first produce brachytherapy by filing for 7-14 days to episclera on the projection melanoma beta applicator with radionuclide Ru-106 + Rhodium-106, with a total dose of 3000 G, in parallel with brachytherapy transpupillary produce diode-laser transpupillary therapy of melanoma with radiation power of 800 mW to the maximum coating its surface coagulates, 6-12 months after withdrawal of beta-applicator transpupillary produce restrictive laser coagulation of the retina with the capacity of 500 mW and then andarticle residues melanoma.



 

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FIELD: medicine.

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2 dwg, 4 ex

FIELD: medicine.

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2 ex

FIELD: medicine.

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3 ex

FIELD: medicine.

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FIELD: medicine.

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2 tbl, 2 ex

FIELD: medicine.

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1 ex

FIELD: medicine.

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1 ex, 1 tbl

FIELD: medicine.

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3 tbl, 3 ex

FIELD: medicine.

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3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to oncology and radiotherapy, and deals with prediction of efficiency of radiotherapy of malignant neoplasms of oropharyngeal zone. Before treatment index of blood microcirculation Im and average degree of oxygenation of mixed blood of microcirculature StO2 in tumour are registered. Said indices are used to determine perfusion oxygen saturation, and values of blood microcirculation index Im' and average degree of oxygenation of mixed blood of microcirculature StO2' in intact zone are measured. Average volume blood filling Vb in tumour and in intact region Vb' are registered, level of activity of oxygen metabolism in cells in examined areas MA, MA' is determined by given formulas. If MA/MA'≥2.5, efficiency of radiotherapy is predicted, if MA/MA'<2.5, conclusion about high probability of residual volume of tumour after carrying out radiotherapy is made.

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3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to localisation facilities for therapeutic sources. The device comprises an applicator implanted into a target area and having at least one guide passage for a radiation source or seed, a number of image-visible support points comprising a number of electromagnetic sensors with the support points being attached to a patient's body and adjoining the target area; what is also provided is an electromagnetic tracking system for localising the electromagnetic sensors on the support points; the device is equipped with a processor to form a brachytherapy session program on the basis of a combination of a relative position of the electromagnetic sensors on the applicator and the electromagnetic sensors on the support points, and images are also presented. According to the second version, the device also comprises a field generator with a number of the electromagnetic sensors for position indication signalling responding to the field generator. One of the electromagnetic sensors is placed on the applicator, and another one - on the target. The device comprises a number of processors for localising the source and target in response to the signals of the electromagnetic sensors.

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14 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, oncology, and radiology, and can find application in a combined method of treating laryngeal and laryngopharyngeal cancers. The method involves applying tracheostoma, approaching and excising the tumor, ensuring wound hemostasis and conducting radiotherapy. The tumour excision is followed by making an intraoperative individual tissue-equivalent applicator formed after the bed of resected larynx or laryngopharynx consisting of a self-polymerising material. Conductive ferromagnetic particles and intrastats of the brachytherapeutic apparatus are pre-inserted into the applicator. The applicator is fixed in the tumour bed; the wound is sutured. The local hyperthermia immediately follows through the applicator at 42-43°C for at least 60 minutes. The brachytherapy is conducted immediately thereafter in a single dose of 10 Gy. On the 7-8th postoperative day, the applicator is removed, and 8-12 days later, the area of the extracted tumor is additionally exposed to the radiation teletherapy (RTT) at a dose of 2 Gy per day, 5 times a week up to a total RTT dose of 24-26 Gy.

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5 cl, 2 ex

FIELD: medicine.

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EFFECT: inventions provide the application radiation therapy in the irregular surface profile, immediate delivery of the radiation source to the tumour without damaging the surrounding tissues, reproducibility of the sessions in any brachytherapeutic apparatus with wireline supply of the radiation source, homogenous graduated distribution in the target, minimised dose for urethra, reduced frequency and intensity of radioreactions.

4 cl, 3 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, oncology, and can be used for chemoradiation therapy of low-located tumours of rectum and anal canal. For this purpose standard teleirradiation is performed. Additionally performed is conformal intraluminal brachytherapy of high power dose 5-10 Curie 4-6 irradiation sessions with reference dose 3.5 Gy at depth of 10 mm from irradiation source. In addition, on daily basis derivative of capecitabine fluoropyrimidines in amount 600 mg/m2 is introduced per os.

EFFECT: method allows to increase treatment efficiency, increase local response of tumour and reduce risk of metastases development due to exposing tumour to higher tumoricidal doses of irradiation and adding brachytherapy, intake of capecitabine enhancing local regress and reducing risk of tumour metastasis.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, oncology, and can be used for treatment of locally advanced and inoperable cancer of esophagus. For this purpose before beginning chemoradiation therapy argon plasma coagulation of tumour is performed. After that on 1-st, 8-th and 15-th day of the course intraluminal brachytherapy with high power dose 5-10 Curie with single dose 7 Gy is carried out. In addition, on 1-st, 8-th and 15-th day of the course intravenously taxoter 45 mg/m2 and carboplatin AUC 2 are introduced. After that teleirradiation SFD 1.8 Gy 5 fractions/week TFD 40-45 Gy is carried out.

EFFECT: method allows to increase efficiency of chemotherapeutic and radiation effect after preliminarily eliminated by argon plasma coagulation tumour stenosis of esophagus, succession of treatment stages allows to ensure maximal response of tumour, enhance degree of tumour regress and reduce probability of metastasis.

2 ex

FIELD: medicine.

SUBSTANCE: invention concerns medical equipment, namely to devices for gamma radial therapy and can be used for treatment of malignant tumours. The equipment contains a leg with fastening for placing on a tomograph table, the carriage bound to bars with possibility of vertical moving and fixing, the console connected to the carriage, the co-ordinate device and a guide of a therapeutic radioactive implant. Thus the carriage is bound to the bars referring in the form of a ruler and has possibility of additional moving across, and the protractor is fixed on each flexure of a rotary part. The guide is executed in the form of a plate with placed in apertures referring for installation of a therapeutic radioactive implant, containing the extended carrier in a kind of concentrically located tubes bridged by the extremities among themselves and supplied with sources of radioactive radiation, located along longitudinal axis of the extended carrier. The sources are executed in the form of the silver substrates having the form of rings, covered with radioactive iodine-125 and placed on an external surface of the internal tube, thus the surface of the internal tube between the silver substrates and surfaces of the internal tube between silver substrates and the extremities of tubes bridged among themselves are covered by a varnish, and the distance between silver substrates makes 0.6-1.2 of substrates width.

EFFECT: reduction of terms of gamma radial therapy at the expense of an exact implant locating, provided with the equipment.

4 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, ophthalmology, and can be used in uveal melanoma brachytherapy ensured by an ophthalmologic applicator type C with isotope Sr90+Y90 along the tumour thickness to 4 mm. Herewith the irradiation parametres are specified so that the biological cumulative effect is within 4558 to 5696 Gy2. If the tumour thickness exceeds 4 mm, brachytherapy is performed with an ophthalmologic applicator type P with isotope Ru106+Rh106. And the irradiation parametres are specified so that the biological cumulative effect is within 1451 to 2143 Gy2.

EFFECT: disclosed method allows improving biological effect of ionising radiation on uveal melanoma cells and increasing probability of complete tumour resorption.

2 tbl, 4 ex

FIELD: medicine; traumatology.

SUBSTANCE: method can be used for treatment of patients suffering from posttraumatic osteoarthrosis in decompensation stage with high degree of inflammation activity with evident exudative component (synovitis). Radonotherapy is carried out by means of alpha-applicator with radon daughter product placed within inflamed joint region. Radioactivity concentration is 8-24 Bq/m3, specific radioactivity is 1-3 nCu/cm2 (37-110 Bq/cm2). Procedures are performed daily within 120 minutes. Therapeutic course is 10 procedures.

EFFECT: method provides dehydration of inflammatory centre.

1 ex, 4 dwg

FIELD: medicine; ophthalmology.

SUBSTANCE: needle attached to a syringe with 2.0 ml of sterile saline solution is inserted projective to the flat part of the ciliary body. Sclerotomy is performed on the opposite side projective to the flat part of the ciliary body, and a needle with a thread are loaded in the injector, the needle is fixed in the injector, an oval silicon guide is put on the cutting surface of the needle, and the loaded injector is then inserted in the sclerotomy and moved to the prospective radiation area. The intraocular pressure is increased by injecting saline solution till the pulse of the retina stops. The needle is pushed forward through the retina, choroid, and sclera, and then the thread and needle are brought out by removing the injector. A source of beta-radiation is tied to the thread and inserted in the sclerotomy, by pulling the inserted thread the source of beta-radiation is placed on the silicon guide on the retina, the thread is fixed on the episclera, and the needle is then removed. To achieve the desired curative doze of radiation the stitched end of the thread is cut, the source of beta-radiation with the silicon guide are pulled out through the primary sclerotomy, and loop suture is applied on the sclerotomy.

EFFECT: reducing the number of complications; higher efficiency of brachytherapy.

5 dwg

FIELD: medicine, instrumentation engineering, and biology.

SUBSTANCE: proposed radioactive source in the form of radioactive yttrium or strontium oxide that can be used, for instance, in medicine for preparation of drugs incorporating radioactive materials, for treatment of oncological diseases, as well as for producing β-sources used in instrumentation engineering and biologic investigations is solidly capsulated by molten bio-inert glass. Powdered yttrium and strontium oxides are mixed up with glass frit, mixture is applied to metal holder, dried out, and fused; rough surface is produced using definite combination of differently dispersed powders.

EFFECT: simplified design, facilitated production of radioactive source; inactivity of radioactive source with respect to organism tissue.

2 cl, 1 dwg, 1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmic surgery and can be applied for squint correction. Extraocular muscle is exposed and divided longitudinally into three equal parts. Lower 1/3 is excised on 5-6 mm, upper 1/3 is dissected from sclera, middle 1/3 is transected. Upper and medium parts of muscle are sewn edge-to-edge with one thread with one needle by application of one uninterrupted "X"-like suture and tying up one submerged knot.

EFFECT: method makes it possible to reduce trauma, and reduce scarring.

3 ex, 5 dwg

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