LibRar.Org.Ua — Бібліотека українських авторефератів


Головна Медицина. Медичні науки → Роль і місце променевої терапії в комплексному лікуванні раку яєчників

мониторинге больных на этапе ремиссии можно отнести к неблагоприятным прогностическим факторам.

Включение лучевой терапии в схему радикального противоопухолевого лечения рака яичников приводит к активизации липидного обмена, о чем свидетельствует развитие гиперлипидемических реакций. Показатели клинической эффективности во всех случаях положительно коррелировали с повышением уровня общего холестерина и липопротеина низкой плотности. Липограммы больных в состоянии длительной ремиссии демонстрировали повышение в 1,5 – 2 раза изучаемых показателей по сравнению с рецидивами заболевания.

Dissertation for academic degree of Doctor of Medical Sciences by speciality 14.01.23. – radiodiagnostics, radiotherapy. Grigoriev Institute for Medical Radiology, Academy of Medical Sciences of Ukraine, – Kharkiv, 2001.

Dissertation is devoted to development of new methodical approaches to realization of radiotherapy for ovarian cancer.

The given research is based on the analysis of the results of treatment of 383 patients with ovarian cancer of I – IV stage (243 patients have received anti–tumor therapy: surgery and chemotherapy, 118 – additional therapeutic irradiation, among them 2 patients have received only chemoradiotherapy and 22 patients – only chemotherapy).

Presence of residual tumour, ascites, commissure process, rash on peritoneum and bilateral ovarian affection are the factors causing the extremely adverse influence on average duration of the period without recurrency at the standard combined treatment modes.

Inclusion of radiotherapy as adjvant course in complex treatment of the patients with ovarian cancer undergone radical surgery has increased the relapse-free survival even at presence of such adverse factors as ascites and commissure process in the patients with Т2N0M0 – Т3N0M0 stages of the disease. Median relapse-free survival in patients with Т2N0M0 stage for 9.0 months has exceeded the given parameter in the control at the average duration 50.3 and 39.4 months in the groups of comparison, respectively, and at Т3N0M0 – for 14.0 months, at the average duration 52.8 months and 37.2 respectively. Five year relapse-free survival at Т1N0M0 was 90.09.8 %; at Т2N0M0 – 76.24.4 %; at Т3N0M0 – 83.37.2%; and in the control group – 82.44.6 %; 47.12.9 %; 46.23.4 %.

Frequency of relapses of ovarian cancer with adjuvant radiotherapy in postoperative period has a twice decrease at Т2N0M0 and three-fold decrease at Т3N0M0.

At primary non–cured patients with ovarian cancer the addition of the combined treatment with radiotherapy has extended the terms of remission. Median was: at the patients with locally disseminated form (Т2N0M0) in the basic group – 18.0 at the average duration of stabilization of the process 34.1 months, and at dissemination of the process for small pelvis (Т3N0-1M0) – 18.0 and 25.9 months, respectively. In control group – at Т2N0M0 stage – 8.0 and 16.8 months, at Т3N0-1M0 – 6.0 and 11.6 months. The application of therapeutic irradiation in these patients is expedient at the stage III of the antitumour treatment. It has increased the median period of the remission for about 24.0 months at the average duration of 30.4 months, that is 2.5 and 1.7 times higher than radiotherapy treatment at stage I.

Use of therapeutic irradiation for patients with residual tumour has a twice lowered frequency of cases with prolonged disease in the area of small pelvis at locally disseminated forms and 1.2 times – at dissemination of the process on abdominal cavity.

Five year survival of the patients with primary non–cured ovarian cancer Т2N0M0 undergone therapeutic irradiation was 38.56.9 % and 15.43.9 % in the control; at Т3N0-1M0 – 22.52.1 % and 15.41.9 %. At the dissemination of the process for abdominal cavity the distinction were marked only for first two years of the follow up: 70.07.2 % and 40.05.3 % in the basic group, and 45.53.4 % and 18.22.0 % – in the control.

The duration of remission between the first and second relapses of ovarian cancer depends on radicality of the operative intervention. At the patients undergone radical surgery the clinical form and size of the recurrent tumour influences on the given parameter . Median period of the remission at solitary relapse in small pelvic was 18.0 months at the average duration 25.5 months and was reduced with the increase of the size of the a relapse – 10.0 months at average duration of the stabilized process – 9.8 months.

At the application of the radiotherapy almost in 42.8 % cases the irreversible changes of ultrastructure of cancer cells are observed in comparison with 22.2 % in case of treatment only with chemoagents.

The application of radiosensitization of tumour with low dozes of ionizing irradiation at treatment of recurrent ovarian cancer the period of remission has increased irrespectively with radicality of the program of first line antitumour therapy up to 21.8 and 21.0 months according to an extensive affection of the organs of small pelvis and dissemination of the tumour process on abdominal cavity.

The addition of adjuvant antitumour therapy with radiomethod results in stabilization of immune reactivity of the patients with ovarian cancer up to the level close to the referred to the limits of regional physiological norm. At primary non–cured patients the degree of immunological insufficiency does not depend on the mode of the therapy. The high level of Т–suppressors on the background of depressed digestive function of neutrophils and increase of the contents of circulating immune complexes at monitoring of the patients at the stage of remission might related to the adverse predicting factors.

The inclusion of radiotherapy in the scheme of the radical antitumour treatment of ovarian cancer results in activization of lipid exchange that is testified by the development of hyperlipidemic reactions. The parameters of clinical efficiency in all cases positively correlated with increase of the level of general cholesterol and low density lipoprotein. Lipograms of the patients in long remission demonstrated 1.5–2 times increase of the investigated parameters in comparison with the relapses of the disease.