Superselective chemoembolization in a personalized approach to the diagnosis and combined treatment of metastases of locally spread hyperipervascularized malignant neoplasms of the head and neck
Abstract
Summary. The results of the treatment of head and neck malignancy metastases depend on the stage of the disease. Most (70–80 %) of patients are admitted to treatment in stages III and IV of the disease. Despite certain successes in the field of diagnosis and treatment of cancer patients, improved organization of oncological care, early diagnosis of metastases of malignant neoplasms of the head and neck, the results of treatment remain unsatisfactory. Tumor metastasis is one of the main causes of death for head and neck cancer patients. Tumor dissemination of these neoplasms occurs by lymphogenic route in 35–60 % of patients. Metastases in non-enlarged lymph nodes are found in 13 % of cases. In this regard, there is a need for timely treatment of the neck lymphatic system in patients with squamous cell carcinoma of the head and neck organs at such a time when regional metastases do not yet appear clinically. However, so far, the problem of the choice of medical tactics at patients with regional metastases of throat cancer remains up to the end unresolved. There is no consensus on the sequence of the radiation and surgical stages of treatment, on the indications for postoperative radiation. This situation requires the search for new effective approaches to the diagnosis and treatment of patients.
Purpose of the study: to increase the effectiveness of diagnosis and treatment of patients with metastases of locally advanced hypervascularized malignancies of the head and neck by developing and introducing into clinical practice a new personalized technique – locoregional superselective angiography and super-selective chemoembolization of malignant volumetric formations.
Material and methods: For the solution of this task 44 cases of the metastases of a planocellular malignant new growth of the head and a neck divided into 4 groups on classification of TNM – the I stage of development of MTS – T1N 0M0, the number of patients – 4 were studied; II – N 2N 03M0 – 7; III – T3N 03M0 – 18; IV – T4N 03M0 – 15. Superselective chemoembolization of the secondary tumor was performed on all patients.
Results. In 44 observations, super-selective angiography and super-selective chemoembolization of a metastatic tumor were performed. Embolisate was a mixture of microparticles HepaSphere 50–100mm saturated with cytostatic moxorubicin (50 mg). The highest concentration of chemopreparation in the tumor and its metastases was observed during the first 9 days after super-selective chemoebolization, which amounted to 414 nmol\g, remaining high for the next 11 days (118.7 nmol\g) and even after 14–22 days (42, 46 nmol\g) remained in the therapeutic range. The relapse-free period in this group of patients was 18–28 months, and the three-year survival rate reached 75 %.
Conclusion. A personalized method of super-selective chemoembolization of head and neck cancer by doxorubicin developed and introduced into medical practice in 34.1 % of cases was an independent method of treating tumor metastases with a good therapeutic effect. The highest concentration of chemopreparation in tumor metastases was observed during the first 9 days after super-selective chemoebolization.
About the Authors
V. G. VoronovRussian Federation
Viktor Grigor'evich Voronov
St. Petersburg
S. D. Radzhabov
Russian Federation
Saidakhmed Dzhabrailovich Radzhabov
St. Petersburg
A. A. Ivanov
Russian Federation
Arkadii Aleksandrovich Ivanov
St. Petersburg
Z. A. Radzhabova
Russian Federation
Zamira Akhmed-Gadzhievna Radzhabova
St. Petersburg
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Review
For citations:
Voronov V.G., Radzhabov S.D., Ivanov A.A., Radzhabova Z.A. Superselective chemoembolization in a personalized approach to the diagnosis and combined treatment of metastases of locally spread hyperipervascularized malignant neoplasms of the head and neck. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2021;13(4):22-28. (In Russ.)