RADIOTHERMOMETRIC PERSONALISATION OF CHEMO- AND RADIOTHERAPY FOR PATIENTS WITH ADVANCED (III, IVA AND IVB) STAGES MALIGNANT LESIONS OF ORAL CAVITY, THROAT AND EPIGLOTTIS

Autor: Vorobyov M, Kechyn I, Bazyka D, Vorobyov O, Shmykova O
Rok vydání: 2019
Předmět:
Zdroj: Problemy radiatsiinoi medytsyny ta radiobiolohii. 24
ISSN: 2313-4607
Popis: optimization of treatment of patients with advanced malignant lesions of oral cavity, throat and epiglot- tis by means of radiothermic control and personalisation of the induction radio sensitizing polychemotherapy prior to radiotherapy or by applying both methods simultaneously.Study is based on the results of treatment 280 patients with morphologically confirmed cancer of mucosae of oral cavity, throat and epigloittis staged III, IVA and IVB without remote metastases were divided into 6 groups depending on a type of a radiotherapy applied. Each group was divided into a treatment and a control subgroup. A choice of treatment for control subgroups was done on the basis of RECIST 1.1. scale; a deci- sion for treatment subgroups was done based on obtained radiothermic (RTM) personalisation data in tumours or metastases.The treatment program included follow-ups according to established guidelines, radiothermic measure- ments, immunology investigations , statistical analysis (cumulative survival by Kaplan-Meier).Groups of patients with tumours of oral cavity and epigloittis with intra-arterial polychemotherapy (IA PCT) prior to radiotherapy demonstrated improved mean 3 years survival rate. Groups with malignant tumours of upper laryngeal tract demonstrated opposite results. A comparison of mean survival rates between groups that were treated with systemic radiochemotherapy but using different combinations of different chemotherapy agents has shown that a use of polyplatilen is superior to combinations with cisplatin. A further study showed that all treat- ment groups had demonstrated better survival rates compared to control groups.The obtained results allow us to conclude that the therapy personalisation based on radiothermic per- sonalisation significantly improves quality and outcomes for patients with localized cancer of oral cavity, throat and epiglottis. RTP can be used as a treatment control method of above mentioned lesions together with standard treat- ment pathways. The application of intra-arterial polychemotheray followed by a radiotherapy of tumours of oral cavity and throat shows better outcomes compared to standard treatments only. The use of induction poly- chemotherapy with polyplatilene for patients with tumours of epiglottis is superior to intra-arterial polychemother- apy and a chemotherapy with cisplatin.Meta: pokrashchennia rezul'tativ khimiopromenevogo likuvannia khvorykh na mistsevo-rozpovsiudzhenyy̆ rak porozhny- ny rota, rotovoï ta gortannoï chastyn glotky shliakhom radiotermometrychnogo kontroliu ta indyvidualizatsiï kil'- kosti etapiv induktsiy̆noï radiosensybilizuiuchoï polikhimioterapiïï do promenevogo likuvannia abo odnochasnogo zas- tosuvannia tsykh metodiv.Materialy ta metody. Doslidzhennia bazuiet'sia na rezul'tatakh likuvannia i nastupnogo sposterezhennia za 280 khvo- rymy z morfologichno pidtverdzhenym diagnozom raku slyzovoï obolonky porozhnyny rota, rotovoï ta gortannoï chastyn glotky III, IVA ta IVV stadiy̆ za vidsutnosti viddalenykh metastaziv. Khvori buly rozpodileni na 6 grup, za- lezhno vid vydu vykonanogo khimiopromenevogo likuvannia. U grupakh vydileni kontrol'ni ta doslidzhuvani pidgru- py. U kontrol'nykh pidgrupakh pryy̆niattia rishen' shchodo podal'shogo likuvannia pryy̆maly na pidstavi otsinky efek- tyvnosti za shkaloiu RECIST 1.1, a u doslidzhuvanykh – na pidstavi zmin pokaznykiv radiotermometriï (RTM) u pukh- lynnomu oseredku i metastazakh. V programu doslidzhennia vkhodyly klinichni obstezhennia zgidno zi standartamy, RTM, imunologichni doslidzhennia, statystychnyy̆ analiz (grafichna funktsiia vyzhyvannia za Kaplan-Meier). Rezul'taty. V grupakh z vnutrishn'oarterial'noiu polikhimioterapiieiu (VA PKhT) do pochatku promenevoï terapiï u khvorykh z pukhlynamy porozhnyny rota i rotoglotky 3-richna vyzhyvanist' statystychno vyshcha u khvorykh z systemny- my kursamy PKhT. U grupakh khvorykh na zloiakisni pukhlyny gortanoglotky otrymani protylezhni rezul'taty. Pry po- rivnianni funktsiy̆ vyzhyvannia khvorykh, u kotrykh vykorystovuvavsia systemnyy̆ rezhym PKhT, ale v riznykh kombinatsi- iakh khimiopreparativ, vydno, shcho vykorystannia skhem z poliplatylenom efektyvnishe, nizh skhem z tsysplatynom, u li- kuvanni khvorykh zaznachenykh lokalizatsiy̆. Pry poglyblenomu analizi tsykh grup vyiavleno, shcho za grafikamy funktsiia vyzhyvannia khvorykh u doslidzhuvanykh pidgrupakh vyshcha porivniano z vyzhyvanniam u grupakh i kontrol'nykh pidgrupakh. Vysnovky. Algorytm indyvidualizatsiï na osnovi RTM kontroliu pomitno vplyvaie na iakist' i rezul'taty likuvannia khvorykh na mistsevo-rozpovsiudzhenyy̆ rak porozhnyny rota, rotovoï ta gortannoï chastyn glotky. RTM mozhe buty vykorystana iak metod kontroliu likuvannia zloiakisnykh novoutvoren' zaznachenykh lokalizatsiy̆ v kompleksi zi standartnymy metodamy doslidzhennia. Zastosuvannia VA PKhT z nastupnoiu promenevoiu terapiieiu pry likuvanni khvorykh z rakovymy pukhlynamy slyzovoï porozhnyny rota i rotoglotky maie perevagy ta dozvoliaie otrymaty opty- mal'nyy̆ likuval'nyy̆ efekt u porivnianni z systemnymy rezhymamy. Zastosuvannia induktsiy̆noï systemnoï polikhimioterapiï z poliplatylenom pry likuvanni khvorykh z rakovymy pukhlynamy gortanoglotky maie perevagy pe- red vykorystanniam VA PKhT ta systemnoï khimioterapiï z tsysplatynom.
Databáze: OpenAIRE
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