New opportunities of drug delivery in oncology
Abstract
Objective. Development of methods for accompanying therapy to protect normal organs and tissues in the irradiation zone. Method. The study included 112 patients with cervical and endometrial cancer after combined or independent radiotherapy from 2012 to 2016. In 71 female patients of the main group, Derinat with hydrogel was applied as a supportive therapy and in 41 patients of the control group, conventional prevention methods (olive oil, sunflower oil, methyluracyl ointment) were applied. For prevention of vaginal mucosal and cervical epitheliitis in the main group, hydrogel was used as applications from the first radiation day. For prevention of radiation proctitis, hydrogel was injected into the rectum once daily from the first radiation day. Hydrogel instillations into the bladder were started only with the first clinical signs of cystitis. For prevention of radiation reactions, vaginal oil and ointment and rectal oil micro-enema were administered to patients of the control group from the first day of irradiation. Radiation cystitis was treated with vegetable diuretics and uroseptic drugs. Results. Using the hydrogel with Derinat allowed to administer a course of radiotherapy without interruption in 84.5% (60/71) of patients and only in 48.8% (20/41) in the control group. Radiation cystitis occurred 60% less frequently (25.3% ± 3.3 versus 63.4% ± 2.7, p <0.01). Analysis of radiation cystitis severity in two groups (according to RTOG) showed that 75% of patients in the main group had grade I and 25% had grade II. Grade III and grade IV did not occur. At the same time, in the control group, grade I radiation cystitis developed in 44% of patients, grade II — in 40%, and grade III — in 16% of patients. The hydrogel treatment halved the frequency of radiation proctitis (26.7% ± 3.3 vs. 53.7% ± 3.2 p <0.1). With daily application of the hydrogel with Derinat, grade I epitheliitis (53.5%) predominated in vaginal and cervical mucosa, grade II was observed in 29.5%, and grade III radiation reaction — only in 16.9% of cases; grade IV reaction was not observed. In the control group, these proportions were 26.8%, 24.3%, 31.7%, and 17.2%, respectively. Cytological criteria were developed to evaluate the course of radiation reactions in the vaginal mucosa. Three degrees of change in the cytogram were identified, which correlated with clinical picture. In the main group, incidence of grade I radiation-induced changes was increased by more than 350% (52 ± 9.9% vs. 11.5 ± 6.3%, p <0.002), and incidence of grade III was decreased by more than 70% compared to the control group (12 ± 6.5% vs. 46.1 ± 9.8%, p <0.003). Conclusion. Using the hydrogel material with Derinat as an accompanying therapy during the course of irradiation allows to reduce frequency and severity of radiation injuries of the vaginal mucosa, bladder, and rectum, administer an uninterrupted course of radiotherapy, and improve the quality of life of patients.
Downloads
References
2. Leskova G.F., Kryzhanovskij G.N., Shvets V.I., Krasnopolsky U.M. The treat effect of liposomes during haemorrhagic shock (experimental research). Patologicheskaya Fiziologiya i Eksperimental`naya Terapiya. 2012; 4: 88-93. (in Russian)
3. Kulikov O.A., Pyataev N.A., Inchina V.I., Minaeva O.V. Effects of intravenous administration liposomal form of acetylcysteine on the functional state respiratory system in rats with acute lung injury. Patologicheskaya Fiziologiya i Eksperimental`naya Terapiya. 2017; 61(1): 82-87. (in Russian)
4. Krichevskij G.Е. Nano-, bio-, chemical technologies and production of a new generation of fibers, textiles and clothing. [Nano-, bio-, khimicheskie tekhnologii i proizvodstvo novogo pokoleniya volokon, tekstilya i odezhdy]. Moscow; 2011. (in Russian)
5. SHvec V.I., Krasnopol’skij Yu.M., Sorokoumova G.M. Liposomal forms of medicinal preparations: technological features of preparation and application in the clinic. [Liposomal’nye formy lekarstvennykh preparatov: tekhnologicheskie osobennosti polucheniya i primenenie v klinike]. Moscow; Remedium; 2016. (in Russian)
6. Bojko, A.V., Korytova L.I., Oltarzhevskaya N.D. Directional delivery of medicines in the treatment of cancer patients. [Napravlennaya dostavka lekarstvennykh preparatov pri lechenii onkologicheskikh bol’nykh]. Moscow; IMK; 2013. (in Russian)
7. Kolaeva, A.V., Gusev I.V., Hlystova T.S., Valueva M.I., Fenin A.A., Byrkina T.S., Oltarzhevskaya N.D. Development of the technology of sterilization of hydrogel therapeutic materials based on sodium alginate. Butlerovskie soobshcheniya. 2014; 38(4): 73-8. (in Russian)
8. Valueva M.I., Hlystova T.S., Gusev I.V., Oltarzhevskaya N.D. Healing hydrogel materials of various degree of structuring on the basis of natural polymers. Tekhnologiya legkoy promyshlennosti. 2012; 17(3): 59-61. (in Russian)
9. Kaplina EH.N., Vajberg YU.P. Derinat — a natural immunomodulator for children and adults. [Derinat — prirodnyy immunomodulyator dlya detey i vzroslykh]. Moscow; Nauchnaya kniga; 2004. (in Russian)
10. Oltarzhevskaya N.D., Korovina M.A., Polyakov P.YU., Danilova M.A., Efimenkova M.G. Textile technologies in radiation therapy of oncological diseases. Tekstil‘naya khimiya. 2008; 30(1): 39-44. (in Russian)
11. Kurpesheva A.K., Pasov V.V., Terekhov O.V. et al. Evaluation of the effectiveness of the treatment and tolerability of hydrogel materials based on sodium alginate with derinate (sodium deoxyribonucleate) «Coletex-gel-DNA» and with derinat and lidocaine «Coletex-gel-DNA-L». Avaiable at: http: //oncology.ru events/2007/11/20 /handout/04. pdf. (Accessed 19 June 2018).
12. CHissov V.I. Diagnosis and treatment of malignant neoplasms. [Diagnostika i lechenie zlokachestvennykh novoobrazovaniy]. Moscow; FGBU «MNIOI im. P.A. Herzen» Minzdrava Rossii; 2013. (in Russian)
