Plasmapheresis during radiotherapy of pancreatic cancer an -its -possibilities in cancer chemotherapy
In recent decades it has seen an increase in the incidence of pancreatic cancer (PCa). Since 1940, the incidence of PCa has increased by 4 times, reaching 11 per 100 thousand of population. In the U.S., PCa is the fourth leading cause of death fr om all cancers, taking more than 20 thousand persons a year. In Russia, the incidence of PCa in 1995 was 8.6 per 100 thousand of population, while in Moscow – 11.4. In pancreatic carcinoma it accounts for 10% of all tumors of the digestive tract .
Radical treatment is possible only in 10-15% of patients. Most patients (90%) die within a year after diagnosis. In 80-85% of cases diagnosed with PCa at a stage wh ere there is already an outside pancreas spread of tumors, while 40% – distant metastases .
The problem of treating PCa is among the most complex issues of clinical oncology and abdominal surgery due to the nature and severity of the tumor surgery. Along with instant tumor spread to adjacent organs PCa often gives regional metastases, which are found in 40-50% of cases.Rich blood supply of the pancreas and tumor invasion of large vessels leads to frequent hematogenous metastasis. Long-term results of treatment of PCa, despite some tendency to improve, remain poor and life expectancy of patients after radical surgery is rarely more than 18 months. All these factors lead to the urgency of developing combined methods of treatment of this pathology.
Currently radiotherapy (RT) can be carried out with a particular effect in 50-80% of patients. The results of this treatment were significantly better than palliative surgery. The average life expectancy after combined treatment is 2.5 times higher than the average results of palliative surgery . However, with the development of radiotherapy, improving treatment outcomes of cancer patients has acquired special urgency the problem of quality of life, including in the process of treatment itself. Fundamental limitations to widespread use of radiotherapy in oncology practice are associated with side effects and complications (dyspeptic disorders, anemia, leukopenia, thrombocytopenia, etc.). Their frequency and severity increases proportionally with the dose of radiotherapy. These complications are associated not only with the consequences of the exposure, but also of the death of irradiated cancer cells. Therefore, it seems reasonable to use detoxification methods, among which the leading role belongs plasmapheresis (PA), when pathological products are eliminated from the body with the liquid part of blood – plasma.
Data base information
In the clinic of hospital surgery number 1 of I.P.Pavlov SPbGMU in the last 10 years radiotherapy for PCa was performed on 61 patients with apparatus "Agat-R" in the static mode by conventional fractionation (2 Gr), the combined total dose per week – 10 Gr, with 2-5 cross fields. The total estimated dose of treatment was 50-60 Gr.
In 7 patients, radiotherapy was preceded by surgical intervention, in others it is held after pancreatoduodenectomy (16), biliodigestive anastomoses (18) and other activities (20). Before the start of radiotherapy for patients with Karnofsky status was not less than 60 points (mostly – 80-100), Hb – not less than 120 g/l, the white blood cells count – not less than 4.5 x 109 /l and platelet count – at least 250 x 109 /liter.
The course of radiotherapy applied membrane plasmapheresis on a portable device "Hemofenix" with plasma filter “Rosa” (Treckpore Technology Corp., Moscow) to remove about 30% of the circulating plasma volume (CPV) per session [Voinov V.A., 2010]. Compensation plasma removed conducted crystalloid, colloid and rarely only at lower protein content in the blood of less than 60 g/L after the treatment was poured 250-350 ml of fresh frozen donor plasma. PA course consisted of 3-4 sessions held weekly.
PA held on 22 patients. Men – 12, women – 10. Average age – 56 years (31-74). 5 patients had stage II-III cancer at 16 – IVA (without distant metastases).
The control group consisted of 39 patients, which the PA was not performed. Men – 21, women – 18. Mean age 57.5 years (28-80). In 8 patients was II-III and 31 – IVA cancer stage.
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