Malignant brain tumors are aggressive cancers. As a rule, he is diagnosed late, he is difficult to treat. The pathway to chemotherapy is blocked by the blood-brain barrier, which protects against infections. However, Russian medical scientists have found an unusual way to get around it: they have developed a method in which the brain receives concentrated doses of the drug, destructive for the tumor, but safe for the organ itself. The fact is that during medical manipulation, he is supplied with blood separately from the body using a heart-lung machine. The RIA Novosti correspondent visited the first such operation in the world.
A quiet revolution in the operating room
- Now there will be a test clamping of the left sleepy, get ready. We'll tell you when we last.
- You can stimulate.
- I stimulate.
- Do you have enough space?
This is how the real revolution in medicine happens almost on a daily basis. Its main characters are doctors from several Russian scientific centers at once: the National Medical Research Center of Radiology of the Ministry of Health of Russia, the National Medical Research Center of Neurosurgery named after Academician N.N.Burdenko, the Kostroma Oncological Dispensary, the Research Institute of the Regional Clinical Hospital No. 1 named after Professor Ochapovsky (Krasnodar) and the St. Institute of Ambulance named after I.I.Dzhanelidze.
There are more than twenty highly qualified specialists in the operating room, and each is responsible for his own stage of the most complex operation. A 45-year-old patient with glioblastoma - an aggressive malignant brain tumor that has not been dealt with by all the treatments available today - will have a chance of salvation. And Russian doctors are the first in the world to isolate the blood supply to the brain and inject a chemotherapeutic drug into the tumor. Its doses are harmful only for cancer cells and safe for surrounding tissues and organs. At the same time, both the brain and the body will continue to function properly.
“Don't give us lidocaine - one percent, one cube,” the chief freelance oncologist of the Russian Ministry of Health, Director General of the National Medical Research Center of Radiology, Academician of the Russian Academy of Sciences Andrei Kaprin addresses the surgical nurse. Now he is performing a complex manipulation: he sews special ports into the carotid arteries (they provide blood to the brain). Then small guides - cannulas - are inserted into them. You will get a kind of valves to control blood flow.
Earlier, endovascular surgeons inserted a special balloon into the inferior vena cava through the large femoral vein and inflated it. Thanks to these three adaptations, the head and brain will be separated from the bloodstream shared with the body. Their vital functions will be supported by a heart-lung machine. He's standing close to the operating table, and a team of anesthesiologists and perfusionists is already preparing him for connection. A highly toxic drug will also pass through it, which should target the tumor. This method is scientifically called chemoperfusion.
The fact is that the main problem in the treatment of brain cancer is the blood-brain barrier, which does not always allow standard anticancer therapy to pass through. And the new technique will just allow you to bypass it.
“The brain has protective properties that prevent inflammation from penetrating. Therefore, when we, for example, get pneumonia, not everyone gets meningitis. But the same barrier blocks the way for many chemotherapy drugs. In particular, our patient had a tumor removed and received radiation therapy., unfortunately, there is a residual tumor at the bottom of the sopertized part of the brain.And there is no way to destroy it. Now we are preparing the patient for the so-called chemoperfusion - when only the brain is irrigated with a chemotherapy drug. We are the first in the world to do this procedure and we hope, we are almost sure that this perfusion will have a therapeutic effect, "explains Andrei Kaprin, not stopping for a second from the operation.
Flight is normal
An hour later, the heart-lung machine was finally hooked up. On the monitors, doctors closely monitor the patient's condition. Concentrated doses of a chemotherapy drug pass through the brain isolated from the body, which now cannot penetrate into other organs and systems of the body and poison them.
"Even if there is a microleakage, the dangerous concentration will not have time to get into the main bloodstream. We have already tested this on primates," notes Academician Kaprin.
We are talking about testing a new method of treatment on 18 baboons. For several months, doctors in almost the same composition performed similar operations at the Research Institute of Primatology of the Russian Academy of Sciences in Adler. The specialists worked out various surgical access techniques and determined the safe dose of the chemotherapy drug.
“After a series of experiments, we identified one of the safest method of surgical access for this treatment. In addition, several doses of the chemotherapy were tested on primates. The maximum that we used was four times higher than the allowable one. But all the animals generally felt normal. After the procedure, we no neurological disorders were recorded in them, "says Petr Shegai, deputy director for science at the National Medical Research Center of Radiology, who is also present at the operation.
Hope for salvation
Five days later, the patient, who became the first person in the world to undergo such a procedure, was transferred from intensive care to a regular ward.
As doctors note, the severity of her condition corresponds to the timing and volume of the operation performed, and all the cognitive functions of the brain are completely preserved. She is now under close supervision of specialists and is receiving the necessary treatment.
As Andrey Kaprin explained, the technique will be tested on about ten more patients.
"These are mainly patients with brain tumors who have exhausted all lines of treatment. The operations will be carried out within the framework of a scientific protocol approved by the ethical committee. We had a preclinical stage, we worked out the method on lower primates, and we assessed the complex procedure. Therefore, we go in an absolutely normal mode. Of course, we are the first in the world, but someone has to start, "says Andrey Kaprin.
In parallel, scientists from the National Medical Research Center of Radiology of the Ministry of Health of Russia, together with colleagues from the Kostroma Oncological Dispensary, are testing a similar method of treating liver cancer. During the procedure, doctors isolate the liver from the general blood flow and irrigate it with chemotherapy. According to Academician Kaprin, ten patients have already received such treatment, the results are very good.
If everything goes as the researchers expect with malignant brain tumors, then soon chemoperfusion can be used to treat inoperable cancer. This means that millions of patients around the world will have hope - by no means illusory.