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Our special interest is the treatment of locally advanced cancer, where medical achievements are not enough successful.
From the middle of 60s some our patients with stage IIIB breast cancer underwent combined treatment, and as result, the remission was achieved (there was no signs of cancer process). Some patients had remission for 3 and more years, and some of these patients even worked. For the best results, as we said above, we combined several kinds of therapy –hormonotherapy, radiotherapy, polychemotherapy and surgery.
In 1966 “fighting with every
separated metastasis” seemed as serious violation of existed formal rules, at
least, before wide expansion of the chemotherapy into clinical practice. Further we saw
publications of famous American investigations
“about aggressive
surgeon’s behavior in incurable forms of ovary cancer”. It was consonant with ideas of Professor L.F. Larionov, famous soviet chemotherapist. According to prof. Larionov –the quantity of malignant tissue is in inverse proportion relationship to chemotherapy effect…and ablation of cancer tissue serves as considerable improvement of chemotherapy’s effect.
But it is a future… and so
far, in 1966, basing on Larionov’s doctrine we removed peripheral separated
metastases, on background and with protection of chemotherapy, decreasing
summary mass of cancer tissue. The progressive effect was expressed by dynamic
histological tests of metastasis tissue, sectioned during combined hormone- and
chemotherapy. On the beginning –
partial, and later completed replacement of tumor’s substrate by web tissue, as
well, as an expressive necrobiotic processes in tumor structure
Since 1969 we first time
tried new method of therapy –
endolymphatic polychemotherapy (EPCT) by high dosage of antitumor drugs in
locally advanced cancer – breast, cervix uterus and etc.
So far, such method was widely performed by Professor Sh.
Kuliev (
Later, the optimal volume of infused drug solution was
found – approximately 20ml. It allowed to prevent intensive flow of drugs from lymphatic
to blood system. The dose of infused drugs should be achieved by increasing
concentration of infusing solution.
This doctrine permitted us wide establishment of EPCT in our clinical
practice. Also the special technologies were developed for infusion via
lymphatic vessels of foot (low infusion) and hand’s vessel (high infusion).
We don’t touch here the theoretic and scientific
aspects of EPCT, just add some statistics. The best clinical criterion in our
case – excellent results that’s we got, performing EPCT in specific cancer
localization, where other chemotherapy methods are insufficient. For example,
cervix cancer. According to academic Yu. S. Sidorenko
(Rostov Scientific Research Oncological Institute),
during EPCT of cervix cancer:
- tumor
totally disappeared 19%
- decreasing
on X times 30.9%
- parametrial
invasion disappeared 66.2%
- no
effect 9.5%
3 year
survival patients, operated after EPCT for
- stage
I 100%
- stage II 95.8%
- stage
III 86.2%
In our oncological practice we rather often encountered examples of locally advanced skin cancer, lip and oral cavity cancer. Ablation of such tumors causes wide wound defects, which may be compensate only by extremely hard and traumatic operations, therefore we needed to develop simpler and less traumatic operative measures, which provided radical destroyment of wide cancer process. Thinking this way and having considerable experience of partial electrocoagulation of wide skin tumors and also, tumors of rectum and tonsils areas, we decided to perform
total elctrocoagulation of
tumors under the common anesthesia (example of such kind
of the treatment of locally advanced cancer of lower lip) .
Total electrocoagulation may be successfully performed in cases where
radiotherapy is unusable because of size and decomposition of tumor and, on the
other hand, when traditional surgery is quite difficult or even impossible (see example).
Wide
solid exofits sometimes are resistant to radiotherapy, but always may be
destroyed by deep total elcetrocoagulation. We also encountered situations,
when electrocoagulation may cause serious injury (damage of facial nerve, for
example). Such occurrences enforced us to find new methods of thermal influence
on tumor tissue.
So far, we first time tried superhigh local hyperthermia in locally advanced skin
cancer, lip and oral cavity cancer.
By the
way, local hyperthermia in bounds 40-50C applied
in oncological practice as precursory modulating factor immediately before radiotherapy.
This method supposes tumor tissue heating in respected bounds to increase the
growth of tumor cells. In this status cancer cell becomes more sensitive to
radiotherapy. Therefore, combining local hyperthermia with radiotherapy allows
improving treatment results.
Both terms “super high local hyperthermia” and “local hyperthermia” or “local modulating hyperthermia” are similar
phonetically. But they are totally different in principles of action.
Indeed, in super high local hyperthermia
(75C!) , instead of activation of cancer cells, the total destroyment of
ones is taken place. Also, super high
local hyperthermia may receive status of radical treatment methods only in
cases if tumor heating is taken place on given mode not only on the surface but
in the all volume (depth) of tumor tissue. Histological analyses approved
tumor’s death and its rejection from healthy tissue after the treatment by
temperatures in approximated range of 75C, applied till 5 minutes. Due to
conform such conditions we used alternated electrical current 2MHz, flowing
through the whole volume of tumor body and provided requiring “current
density”. The generated heat in each part of tumor tissue is proportional to
current amplitude, flowed through the section of this part as square of
amplitude value. We used the special equipment - source of electrical current
2MHz with regulated voltage level and enough power output (approximately 100
Wt).
Due to provide more
homological temperature distribution inside tumor body, several output
electrodes were used on periphery of the tumor, and one large electrode
(grounded) in the center. The current flows from the peripheral electrodes
toward central one, producing heat within whole volume and depth of the cancer
tissue. Temperature monitoring was
provided by ceramic thin needle-like probes with measurement range 0-100C and
error no more than +/- 2C .
We suppose, there are other
physical methods may be used as heating factor to achieve specific advantages
(more accurate temperature control and temperature homogeneity) –microwaves,
inducted current (by alternate magnetic field, so called “Fuko’s current”) etc.
We
would like to underline, that completed electrocoagulation of tumor mass till
necrosis does not always possible, because of risk to damage large tumor’s
blood vessels. It may cause serious bleeding which quite hard to stop because
of particular structure of decomposed tumor. However, super high local
hyperthermia method with heating on 75C, experimental checked and many times
repeated on clinical practice, provides tumor regression and on the other hand,
saves inner vessels, which will be emptied later, while tumor will
disappear. (see
example)