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Section 5. Medical science
DOI: http://dx.doi.org/10.20534/ESR-17-3.4-68-69
Khasanov Doniyor Shukhratovich, associate Professor of the chair of Oncology and medical radiology of ASMI Urmanbaeva Dilbar Abdulqosimovna, Assistant of the chair of Oncology and medical radiology of ASMI Nasriddinov Shokhrukh Bahodirovich, 3rd year student of ASMI master's degree E-mail: dilya_o@mail.ru
Combined treatment of unresectable primary cancer of the liver by using intraoperative intratumoral destruction by ethanol
Abstract: in this article discusses the results of treatment of unresectable forms of primary liver cancer and using intraoperative minimally invasive sclerotherapy of the tumor with 96% ethanol. The study was conducted with 33 patients who were in Andijan regional oncologic dispensary.
Keywords: Unresectable liver cancer.
In recent years, along with the increasing of cancer incidence has increased and the number of patients with primary and metastatic liver cancer, and mortality from them. According to WHO, every year around the world recorded a quarter of a million new cases of primary liver tumors and their relation all other tumors is 5-11% [1].
According to the International Agency for Research on Cancer, age-standardized incidence rate of HCC among men in developing countries is 17,4/100000 and 8,7/100000 in developed countries [7].
The morbidity of primary liver cancer is 8,7% of the total morbidity of the malignant tumors. Among men, liver cancer is in 5th place after cancer of the lung, stomach, prostate and colorectal cancer and is 13,06/100 000, at women on 8th, and makes 5,25 per 100 000 people [5].
In Uzbekistan in recent years increasedincidence of liver cancer in cities and rural areas. Thus, in the structure of total cancer incidence in the Republic the liver cancer in 2000 year was 4,0%, in 2006 year 4,3% and in 2009 year 4,6%. For example, the intensive incidence rate increased from 18,99 in 2003 year to 22,84 in 2006y.
Materials and methods:
The study is based on clinical and laboratory examination of 33 patients with primary unresectable liver cancer, who were on treatment in thoracoabdominal department of the Andijan regional Oncology dispensary over the period from 2011 to 2016.
Results and discussion:
When ethanol is injected into tumor, the maximum intensity changes of the liver tissue was observed throughout the tumor. To determine the effectiveness of alcohol exposure determines the ratio of the volume of the edema to tumor volume and volume index, in the calculation of which the formation of an edema zone exceeding the diameter of the tumor node by 1 cm was taken into account. Data showing the relationship between exposure conditions and treatment efficacy indicators are shown in table 1.
The volume index was calculated as the ratio of the volume of the edema area to the volume of the conditional formation, the diameter of which was taken as the diameter of the tumor node, increased by 1 cm. The effect was considered effective at values of the volume index greater than 1 (i. e. edema > 100,0% of the tumor volume). From the results given in table it is seen that the magnitude of the volume index exceeds 1, than the effect is effective.
The index of hepatotoxicity were evaluated before the operation 1-2, 3-4, 7-10 days after and at discharge. Comparison of hepatotoxicity indexes before and after DED operation showed a short-term worsening of liver function during the first several days after the intervention. Index of hepatotoxicity in all patients before surgery did not exceed 0-3 points through 1-4 days after the operation, the level of 0-3 points was observed in six, 3-8 points - twenty-four and 9 to 14 points - in three patients.
Table 1. - The relationship between the quantity of ethanol injected into the tumor and the characteristics of the edema area
Indicators Patients (n = 33)
Tumor volume before treatment (cm 3) 185,3 ± 30,8
The volume of the edema area (cm 3) 232,4 ± 28,4
Volumetric index 1,54 ± 0,22
The ratio of the volume of the tumor to edema area 0,79 ± 0,02
As you can see, soon after surgery (1-4 days) in 78,5% of patients were observed I degree and a 3.6% - II degree of hepatotoxicity. However, in subsequent days in the postoperative period and on the day of discharge, the hepatotoxicity was normalized in almost all patients.
From these data it follows that there are no significant changes in liver function under the influence of local alcoholic destruction.
After destruction by ethanol and a full course of treatment in patients observed reduction of initial tumor volume on 81,5% (table 2).
Table 2. - The dynamics of reducing the volume of tumor sites in patients with primary liver cancer
Size of the tumor Patients (n = 33)
Before treatment 185,3 ± 30,8
After treatment 102,1 ± 15,6*
The effectiveness of the treatment was also evaluated in accordance with WHO recommendations after treatment (Table 3).
Complete regression was observed in 2 patients (6,1%), partial regression was observed in 42,4%, and the stabilization process was observed in 54,5% of cases progression was observed in only 15,2%.
Ultrasound examination of the liver was carried out according to standard methods not less than 1 times a week during the
Combined treatment of unresectable primary cancer of the liver by using intraoperative intratumoral destruction by ethanol
course of the combined treatment and after 2, 4, 8 and 12 weeks at the end.
Echosonography signs of therapeutic pathomorphism, we considered the change of the texture pattern in the area of influence of ethanol, increased echogenicity of both - the tumors and its surrounding liver parenchyma, the disappearance of texture elements "granularity", dopplerographic signs of the reduction of pathological blood flow.
Table 3. - The effectiveness of chemotherapy according to WHO, patients with unresectable forms of primary liver cancer
Condition Patients (n = 33)
Number of patients %
Complete regression 2 6,1
Partial regression 14 42,4
Stabilization process 12 54,5
Progression 5 15,2
Treatment was considered effective in the presence of ultrasonographic signs of development fibrosis in the area of influence of ethanol. In all cases, effective local effects were accompanied by no evidence of increase in tumor size. The appearance of additional nodes considered as evidence of the ineffectiveness of the treatment.
Local destruction by ethanol of unresectable malignant primary tumors of the liver does not affect the functional state of the organism as a whole and the liver, in particular, as well as damage to large vessels and bile ducts.
Conclusions:
1. Our experience ofusing local injection therapy with ethanol for malignant liver tumors testifies to the safety of the method and does not require expensive equipment.
2. The use of intraoperative local destruction by ethanol in combination with adjuvant chemotherapy and immunotherapy in unresectable forms of primary cancer has led to a partial regression 42,4%, and the stabilization of the process of 54.5%.
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