Transcript INSULIN POTENTIATION THERAPY (IPT) COMBINED WITH

INSULIN POTENTIATION THERAPY
COMBINED WITH ULTRASONIC ASSISTANT
CHEMOTHERAPY OF TONGUE TUMOURS
A CASE REPORT
Dr. Christo Damyanov, Dr. Ivan Maslev,
Dr. Desislava Gerasimova, Dr. Veselinka
Yankova, Dr. Vladislav Tashev
Medical Center of Integrative Medicine,
Sofia, Bulgaria
TONGUE CANCER
• The average age of tongue cancer patients is 61, the diagnosed
cases represent about 25 per cent of the oral cavity tumors. Total
survival rate of the patients for 5 and 10 years is 61 and 51 percent
respectively. Mortality from the disease has not significantly
changed during the last 40 years. Annually in Europe there die
about 8,000 tongue cancer patients. The main reason for the
increased mortality is the late cancer diagnosis.
• In the early stages treatment is operative (partial glossectomy)
while in the advanced stages the combined treatment includes
surgery, radiotherapy and chemotherapy.
• The problems of the late stage treatment are the increased
recurrent rate, the seriously compromised quality of life and the
reduced survival rate.
• In the current report we present a case from our practice of locoregional advanced
tongue tumor
treated with IPTLD in
combination with local chemotherapy and ultrasonic irradiation.
A CASE REPORT
• A 60-year-old man of was admitted for treatment
progressively complaining of speech and eating
disturbances, a swelling and ulceration on the
left halve of the tongue. For these complaints he
consulted in Oral and Maxillofacial surgery
department on December 2011, following which
a biopsy was performed with a histological result
– a squamous cell carcinoma. The case was
considered as a locally advanced tumor and
radical surgical treatment was proposed or radio
and chemotherapy, which were declined by the
patient.
EXAMINATION BEFORE TREATMENT
• Tumor nodular lesion and ulceration in the left side of
the tongue with a diameter 4/3 cm. Submandibulary to
the left a lymph node palpitated of about 2,5 cm in
size.
• PET/CT (01.2012) A metabolically active tumor process
in the area of the tongue, without defining the size due
to available artifacts in the oral cavity (teeth dentures).
Dissemination of the process in the left submental
lymph node 17 mm size, submandibular lymph nodes
of 14 and 11 mm sizes as well as other two behind the
left sternocleidomastoid muscle of 14 and 12 mm sizes.
Macroscopic findings
before treatment
TREATMENT
• IPT treatment with Cisplatin/5-FU (Four IPT
applications)
• Alternating treatment with a new chemotherapy
scheme: Epirubicin, Methotrexat, Carboplatin in four
consecutive applications, once a week.
• Length one scan treatment – 4 applications in every 5
days interval, then sustaining treatment in gradual
increasing intervals (four applications in 10 days, 2, 3
and more weeks).
• In the interval an vitamin therapy, immune therapy and
ozone therapy.
• IPT therapy was combined with a local DMSO and 5-FU
application and a local ultrasonic (sonodynamic)
treatment of the tongue and left cervical area two time
weekly.
ULTRASOUND DEVICE
• The ultrasonic treatment (1 watt/cm2 and frequency
1 Mhz) is applied ten minutes after the local 5-Fu
application with a duration 10 minutes.
RESULTS
• In the course of the treatment the patient’s complaints
of speech and eating disturbances phased out. The
Beretta symptomatic index of 12 points went down to 1
point. Right now the patient is stabilized and with a
totally restored to a working capacity. Treatment
continues to the present.
• Examination after the treatment: a tumor nodular
lesion and ulceration in the left side of the tongue with
a diameter about 15 mm. Submandibulary to the left a
lymph node palpitated of about 5 mm in size.
• Control investigation with MRI (03.2012): A slight
asymmetry of the tongue. With the applied native and
post contrast MRI techniques also including dynamic
evaluations could not categorically verify the tumor
formation in the tongue. The lesions described in the
lymph nods from the preceding PET/CT underwent a
negative development in quantity.
RESULTS
Macroscopic findings 1 months
after treatment
RESULTS
Macroscopic findings
2 months after treatment
Macroscopic findings
3 months after treatment
SIDE EFFECTS
• No serious side effects were observed
excluding increasingly growing
thrombocytopenia of up to 76 g/l which was
medically treated. Following the treatment
the thrombocytes values steadied within 112118 g/l. The thrombocytopenia was explained
by the available hypersplenism before the
treatment and a side effect of the
chemotherapy applied.
DISCUSSION
• Searching for a possibility of lowering the side effects from
the treatment and maintaining the functional capacities of
the tongue, we applied a combined treatment on a patient
with a locally advanced tongue tumor who had declined
conventional treatment.
• Treatment started by an IPTLD combined with Cisplatin/5-FU.
Aiming at increasing the local anti tumor effect, after the
third application the chemotherapy scheme was changed and
the treatment included a local chemotherapy with a 20
percent solution of 5-Fluorouacil in DMSO and ultrasonic
therapy of the tongue lesion in the left cervical area.
• The ultrasonic treatment (1 watt/cm2 and frequency of 1
Mhz) is applied ten minutes after the local 5-FU application
with a duration of 10 minutes. The local treatment is applied
at the same time with IPTLD as well as in the interval of twice
weekly.
DISCUSSION
DMSO
•The idea of applying locally a 5-FU dissolved in DMSO is
based on experimental and clinical researches
demonstrating the potentiation effect of the organic
solvent DMSO on the chemotherapy.
•On 1968 it was discovered that dimethyl sulfoxide
(DMSO) had a very high affinity for cancer cells so DMSO
targeted cancer cells.
•DMSO could bind to other substances, and still target
cancer cells. It would bind to certain types of molecules,
and then DRAG these molecules inside cancer cells.
•In later studies DMSO was found to bind to Adriamycin,
Cisplatin, 5 Fluorouracil, Methotrexate, and others.
DISCUSSION
• Resistance to chemotherapy is the important reason for treatment failure in
patients with cancer. Current methods which focus on the identification of
more selective and potent drug resistance reversing agents are not satisfying.
It is an urgent need for development of new approaches to overcoming drug
resistance. The use of low power ultrasound in cancer therapy is a developing
field. Recently, it was found that some anticancer drugs, upon ultrasonic
irradiation, could create active oxygen species and effectively destruct
cancer cells. This means that, in addition to cytotoxicity, these
chemotherapeutic agents may be used as sonosensitizers and kill cancer
cells by another mechanism. Moreover, local hyperthermia induced by
ultrasound could enhance drug cytotoxicity. For the unique advantage of
ultrasound, which are quite different from current therapy, we hypothesize
that ultrasound assistant chemotherapy may be a new strategy to block drug
resistance, which might enhance the efficacy of chemotherapeutic drugs, and
reduce undesired side effects.
Med Hypotheses. 2009 Oct;73(4):526-7. Epub 2009 Jul 1.
Ultrasound assistant chemotherapy may be a novel modality for solid tumors
HuiXuan Pan, XiaoPeng Ma MingZhong Li., JunZhang Chen, Hong Jiang, Summary Department of Medicine, Clinic
Medical College of Yangtze University, Jingzhou 434000, China.
CONCLUSION
In the presented case,
complementing the standard IPT
with local chemotherapy and
sonodynamic therapy
demonstrates an increased
therapeutic efficiency and alludes
to potential possibilities for the
successful combination of IPTLD
with other methods in the
treatment of metastatic tumors.