A retrospective analysis of medical records of 581 patients with non-muscle-invasive bladder cancer was carried out. Out of these patients, there were 467 men and 114 women, with a male-to-female ratio of 4:1. Among males, the highest incidence of non-muscle-invasive bladder cancer occurred in age range 45–59 year followed by age groups 60‑74 and 18‑44 years, representing 45.8 %, 33.4 %, and 16 %, respectively. For females, the highest incidence rate was observed in the 60 to 74 age group (58.7 %). Women aged 45‑59 and 75‑90 years represented 26.5 % and 14.3 %, respectively. The proportion of women aged 45‑49 years was almost half the proportion of men of this age group. Among female patients, there were very few women under 44 years. The vast majority of patients were residents of the Central Federal District with a primary residence in Moscow and the Moscow region. Both male and female patients were more susceptible to negative effects of smoking. Both male and female patients experienced occupational exposure to chemical carcinogens, with 3:1 male predominance. Men represented a higher proportion of those who received radiation therapy as compared to women (3.2 % versus 1.9 %). The bladder wall was the most frequent site of tumor location. The bladder fundus invasion occurred two times less frequently. The frequency of the bladder neck and apex invasion was 13 % and 9 %, respectively. Multicentric bladder cancer was observed in 6 % of the patients. Grade 1 cancer was the most common (53 %) followed by grade 2 and grade 3 (29 % and 18 %, respectively). According to results obtained, the studied cohort demonstrates the main social and clinical characteristics for patients with non-muscle-invasive bladder cancer.

Oral mucositis is the most common and significant complication of chemoradiation therapy for oral and pharyngeal cancer. There are no standard methods for preventing and treating this disease. Patients with severe adverse events need expensive supportive care and unplanned treatment breaks. The objective of the study was to assess and optimize the effectiveness of low level laser therapy (LLLT) for prevention and treatment of chemoradiation-induced oral mucositis in patients with oral and pharyngeal cancer. Material and Methods. Forty-eight patients who received chemoradiation therapy for oral and pharyngeal cancer were enrolled. All patients were randomly divided into two groups. Group I patients (n=28) received standard treatment of chemoradiation-induced complications. Group II patients (n=20) were treated with low level laser therapy (LLLT) at a wavelength of 635 nm, three times a week for three minutes prior to radiation therapy session. Results. In the LLLT group, a statistically significant decrease in the frequency and severity of oral mucositis as well as decrease in pain were observed as compared to the group with standard treatment (χ2 =64,14, р<0,0001). No significant difference in the onset of symptoms and duration of severe mucositis were found. LLLT is an effective method capable of decreasing the frequency and severity of adverse events associated with concurrent chemoradiation therapy. Key words: radiation-induced mucositis, oral and pharyngeal cancer, low level laser therapy, chemoradiation therapy.><0,0001). No significant difference in the onset of symptoms and duration of severe mucositis were found. LLLT is an effective method capable of decreasing the frequency and severity of adverse events associated with concurrent chemoradiation therapy.

 

High grade gliomas (HGG) are the most aggressive primary brain tumors. The extent of resection (EOR) is proved to be an important prognostic factor in patients with HGG. There are no yet published studies on the use of fluorescent-guided resection using 5-aminolevulinic acid (5-ALA) in HGG surgery, based on the comparison of neuroimaging characteristics, intraoperative parameters and clinical outcomes. The purpose of this study was to analyze the results of 5-ALA fluorescent-guided resection in patients with HGG by comparing neuroimaging characteristics, intraoperative parameters and clinical outcomes. Material and methods. The study included 48 patients (30 men and 18 women) aged 35 to 76 years (mean age 47.3 ± 8.4 years) with newly diagnosed HGG. The patients underwent fluorescent-guided surgery that permitted the intraoperative visualization of malignant glioma tissue and supported the neurosurgeon with real-time guidance for differentiating tumor from normal brain. The Karnofsky performance status (KPS) was assessed. Results. The maximum EOR (90–98 %) was achieved in 40 (83.3 %) patients with newly diagnosed HGG. The maximum EOR was performed in 28 (58.3 %) patients with glioblastomas and in 12 (25 %) patients with grade III gliomas (p=0.408) In addition, the maximum EOR was achieved by microneurosurgical removal of 9 (18.75 %) HGGs having a volume of ≥9 cm3 and 21 (43.75 %) of HGGs with a volume<9 cm3 (p=0.029). The tumor boundaries detected by neuronavigation differed by fluorescence data in 28 (58.3 %) patients The divergence between neuronavigation and 5-ALA fluorescence was reported in 19 (39.5 %) patients with glioblastomas and in 3 (6.25 %) patients with grade III gliomas (p=0.014); and in 9 (39.5 %) and in 14 (29.1 %) patients affected with larger (≥9 cm3 ) and smaller (<9 cm3 ) tumor, respectively (p=0.677). Overall, 36 (75 %) patients experienced an improvement in their KPS score, 9 (18.75 %) remained stable, and 3 (6.25 %) declined. Conclusion. The use of 5-ALA fluorescence in surgery for HGG makes it possible to achieve the gross total resection in most cases. The localization of HGGs and their size are the most important factors in achieving maximum EOR. Key words: high grade gliomas, fluorescent navigation, 5-aminolevulinic acid, extent of tumor resection><9cm3 ) tumor, respectively (p=0.677). Overall, 36 (75 %) patients experienced an improvement in their KPS score, 9 (18.75 %) remained stable, and 3 (6.25 %) declined. Conclusion. The use of 5-ALA fluorescence in surgery for HGG makes it possible to achieve the gross total resection in most cases. The localization of HGGs and their size are the most important factors in achieving maximum EOR.

 

 

Optimization of dose fractionation regimens is an important way to increase the effectiveness of radiotherapy for malignant tumors. To choose the optimal radiotherapy regimen, it is necessary to know the nature of tumor regression in different dose fractionation schedules. The purpose of the study was to analyze the patterns of tumor regression in various dose fractionation regimens, while having the same level of normal tissue damage in cases when damage to normal and tumor tissues can be described using the lineal quadratic model. Material and methods. We developed the algorithm for calculating survival of tumor cells under dose fractionation regimes resulting in the same degree of damage to normal tissue. Using this algorithm, the tumor regression patterns were found at various quantitative ratios between the radiosensitivities of the normal and tumor tissues. Results. It was found that in the case of equality of the ratios of radiobiological parameters characterizing the tumor and normal tissues (αt /βt =αn /βn ), the efficacy of radiation therapy did not depend on the dose fractionation regimen at any ratio between the radiosensitivities of the tumor and normal tissues. In the case of , the efficacy of radiation therapy depended on the dose fractionation regimen and increased with decreasing the dose per fraction. On the contrary, in the case of , the efficacy of radiation therapy increased with increasing a single dose. Our theoretical results were consistent with other recent studies.

Background. There is currently no information on the results of randomized studies evaluating the surgical treatment outcomes in patients with pulmonary metastases. Therefore, there is a strong need for a staging system that can permit the stratification of patients with intrapulmonary metastasis. Aim: To analyze the overall survival of patients who underwent pulmonary metastasectomy using a new classification taking account the extent of pulmonary metastasis. Material and methods. The study included 568 lung cancer patients who underwent pulmonary metastasectomy. All patients were stratified according to a new classification taking into account the number of metastatic sites and the extent of lymph node involvement. The median age of the patients was 49 years (range: 18 to 81 years). Results. Histological study revealed no evidence of metastases in 72 patients. In patients having no lymph node involvement, better results were observed in patients with a solitary site of metastasis (M_s ), with a median survival of 58 months. In patients with oligometastatic lesions (up to 5 sites) and limited metastatic sites (6–24 sites), the median survival was 36 and 26 months, respectively. In patients with multiple metastatic lesions (more than 25 sites), the median survival was 12 months. Among patients with lymph node metastases, the median survival was 32 months for patients with a solitary metastasis (M_s) and 27 months for patients with oligometastases (M_o ). In patients with limited number of metastatic sites (6–24 sites), the median survival was 12 months. In patients with multiple metastases (M_m), the median survival was 6 months (p=0.00012). Conclusion. A new classification will help to stratify patients into identical subgroups. Its use should be considered as one of the selection criteria in future multicentre randomized trials.

Background. The incidence of both malignant and benign liver tumors is steadily increasing. Because signs and symptoms of liver cancer do not usually appear until the late stages, its curable rate remains low. To improve the treatment outcomes, preoperative chemoembolization, sclerobliteration of the vessels and cryoexposure are used. In cases with benign liver tumors, vascular embolization, various types of coagulation and ultra-low temperatures are applied to reduce blood loss and to prevent disease recurrence. Objective: to analyze the results of cryosurgery for malignant and benign liver tumors. Material and methods. The original cryosurgical equipment capable of producing a temperature of -196о C was used. It comprises a cryoultrasonic scalpel, cryodestructor and cryoapplicators from porous titanium nickelide adapted for laparoscopic surgery. Cryosurgery was performed on 81 patients with liver cancer, 6 patients with Klatskin tumor, 141 patients with a hemangioma, and 9 patients with hepatic adenoma. Results. Out of 81 patients with liver cancer, 9 underwent extended hemihepatectomy using a cryoultrasonic scalpel, while the remaining patients underwent liver resection using a conventional scalpel with cryodestruction of the liver stump. Decrease in blood loss by 25 % due to freezing of vessels up to 1 mm was noted. Four patients died after resection of the liver (5.1 %). Tumor recurrence was observed in 3.8 % of the patients. The 1-, 3, and 5-yaer survival rates were 74.6 %, 52 %, and 40 %, respectively. In cases with hemangiomas, 20 cryoresections were performed. There were 91 resections using a conventional scalpel with cryodestruction of the stump and 22 laparoscopic cryodestructions of small hemangiomas (3–5 cm). The use of cryoinstruments reduced intraoperative blood loss and caused aseptic necrosis followed by sclerosis of small hemangiomatous nodes. After resection of the liver, 3 people died (2.7 %), 1 relapse occurred. Concerning liver adenoma, 9 hemihepatectomies with cryodestruction of the stump were performed. There were no lethal outcomes and relapses of the disease. Conclusion. Cryosurgery for malignant and benign liver tumors can be performed as: 1) cryoresection; 2) conventional resections with cryodestruction of the stump 3) cryodestruction of small hemangiomas and metastatic nodes, including laparoscopic approach. The use of ultra-low temperatures reduces blood loss and improves surgical ablation outcomes.

Exosomes are 30–100 nm-sized microvesicles that are generated in the cells and released into the extracellular space. Exosomes carry the various bioactive molecules including different types of RNA (miR, lncRNA, mRNA), DNA, proteins, lipids etc. The main exosomes property is the ability to incorporate into the recipient cells resulting in the cascade of both genomic changes (caused by the integration of exosomal DNA) and nongenomic changes (caused by the modulation of the expression or content of the proteins, microRNA etc.). In this review, we discuss the modern conception concerned with the structure and mechanism of the action of tumor exosomes and their role in the tumor progression and formation of tumor-like phenotype in the cells. Specially, the role of the exosomes in the tumor resistance including drug resistance, irradiation resistance and hormone independency was considered. Finally, the diagnostic potential of exosome analysis and its perspectives in the clinical practice were discussed.

Based on the results of worldwide clinical studies, survival of colorectal cancer patients with lung metastases is significantly influenced by curative resection, number of metastases and disease free interval. Intrathoracic lymph node metastases in combination with pulmonary metastases as well as the CEA level of greater than 10ng/ml are found to be the most unfavorable prognostic factors. Most studies have found no significant relationship between survival and the size of the primary tumor and unilateral/bilateral distribution of pulmonary metastases. However, some authors consider that bilateral metastasis and T3-4 tumors are unfavorable prognostic factors. The key factors for surgical treatment of pulmonary metastases are the feasibility of performing curative resection and the absence of other manifestations of the disease.

The purpose of the study was to review available literature on the efficacy of radiopharmaceuticals based on glucose derivatives labeled with radioactive isotopes for detection of various cancers. Material and methods. A systematic literature review was performed using the Scopus, Web of Science, MedLine, Cochrane Library, EMBASE, and Global Health databases from 2000 to 2016. Out of 900 papers in the field of nuclear medicine, 58 were included into the review. Results. 18F-fluoro-2-deoxy-D-glucose (18F-FDG) has been approved to be a powerful imaging tool for the detection of various cancers as well as for the assessment of tumor extent and therapy response. There is a continuous search for new more specific and effective radiopharmaceuticals for visualization of tumor tissue. Many studies are devoted to the development of radiopharmaceuticals based on technetium-99m labeled glucose derivatives for tumor visualization. Russian researches have made a significant progress in the development of imaging agents for single-photon emission computed tomography. Conclusion. Despite the widespread use of positron emission tomography technologies, which have proved to be effective, the specialists still have a great interest in radiopharmaceuticals based on technetium-99m. The literature review suggests that the emergence of a diagnostic radiopharmaceutical based on technetium-99m labeled glucose derivative will help to improve the availability of nuclear medicine methods and their effectiveness.

Uveal melanoma (UM) is the most common primary intra-ocular malignancy. Uveal melanoma is distinct from other subtypes of melanoma by its molecular and genetic characteristics. Somatic mutations in UM tumor involve genes, such as BAP1, EIF1AX, GNA11, GNAQ and SF3B1, that determine the biology and behavior of a tumor and appear to be predictors of disease. In 25 % of cases, the development of UM is associated with hereditary diseases and can be caused by germline mutations in genes that are responsible for a particular syndrome. Several such syndromes (BAP1-associated syndrome, FAMMM-syndrome, Li-Fraumeni syndrome and etc.) have been identified. In this article we analyze the modern concept of the nature of hereditary UM and present the case of hereditary UM.

 

Preservation of the rectal sphincter during surgery for rectal cancer is necessary in order to maintain control of bowel function. For this purpose, novel approaches for combining sphincter-saving surgeries with neoadjuvant radiotherapy regimens are extensively developed. There are active discussions on the effectiveness of radiosensitization with the inclusion of chemical and physical components, one of which is local hyperthermia. This article reviews the worldwide experience in treating rectal cancer patients using local hyperthermia combined with radiation therapy. A wide variety of methods, as well as facilities for the procedure, is discussed. It should be noted that the selection of patients with rectal cancer for thermochemoradiotherapy and the choice of optimal irradiation volume remain a challenge.

Formation of intra-abdominal adhesions is a common consequence of abdominal surgery. Operative trauma is an essential component of any surgical intervention. This problem is particularly relevant in patients with intestinal obstruction resulting from a tumor, when it is necessary to perform reconstructive surgery after urgent obstructive resection of the colon. The review presents the data on current views of epidemiology, etiology, and pathogenesis as well as quantitative and qualitative classifications of intra-abdominal adhesions. The methods of prevention and diagnosis of abdominal adhesions have been discussed. The results of the effectiveness of the use of surgical, pharmacological and barrier methods for adhesion prevention have been presented.

Background. Gastric cancer is the fourth most common cancer and the second leading cause of cancer-related death worldwide. Despite many advances in the diagnosis and treatment of gastric cancer, the overall five-year survival rate does not exceed 25–30 %, and distant metastases and loco-regional recurrence develop in more than 50 % of patients. Disease recurrence is not only associated with the presence of tumor micro-metastases at the time of surgery, but also with dissemination of tumor cells during mobilization of the stomach or lymph node dissection. Even after performing radical surgery, the prognosis remains extremely unfavorable. No standardized methods of treatment for isolated loco-regional recurrence have been developed yet. Cases of successful treatment of distant metastases and regional recurrence are sporadic. Case report. We present the case of a 75-year-old patient with histologically proven well-differentiated tubular adenocarcinoma of the stomach. The patient underwent neoadjuvant chemoradiation therapy (total radiotherapy dose was 45 Gy, modified Capox regimen) followed by gastrectomy and D2lymph node dissection. The control examination revealed an isolated regional recurrence of gastric cancer. It was decided to perform surgical treatment for isolated regional gastric cancer recurrence. Conclusion. There is no standardized approach to the treatment of regional recurrence of gastric cancer. Surgical treatment in such cases is a method of choice, especially for patients who previously received neoadjuvant chemoradiotherapy. According to the worldwide literature, the median survival of such patients does not exceed a few months. The key point that determines the effectiveness of neoadjuvant therapy is the achievement of complete or partial pathological response to therapy, thus demonstrating improved survival compared to surgery alone. Therefore, it is extremely important to search for immunohistochemical and molecular genetic markers for predicting tumor response to neoadjuvant therapy in order to administer it for only potential responders.

Background. Adrenocortical cancer (ACC) is a rare malignancy of the adrenal cortex. Therapeutic options for advanced ACC are limited. It is necessary to study new and more effective drug combinations and tumor biological targets. The purpose of the study was to determine the expression of somatostatin receptor subtypes 2A and (SSTR 2A and SSTR 5) using immunohistochemical (IHC) analysis of tumor tissue samples in patients with ACC, as well as to study the feasibility of using prolonged analogues of somatostatin in the treatment of advanced ACC. Material and methods. The expression of SSTR 2A and SSTR 5 was analyzed using imunohistochemistry of tumor tissue samples from 20 patients with advanced ACC. Results. The negative (0) IHC status of SSTR 2A and SSTR 5 was determined in 10 patients (50 %). A different staining intensity of SSTR 2A and SSTR 5 expression was found in tumor cells of 10 patients (50 %). The low SSTR expression was associated with low membrane immunoreactivity and high SSTR expression was associated with moderate and strong immunoreactivity. High level of somatostatin receptor expression was detected in 7 patients (35 %). Conclusion. The detection of SSTR 2A and SSTR 5 expression in tumor tissue of patients with advanced ACC, as well as the study of feasibility of using prolonged somatostatin analogs are promising in the treatment of patients with high receptor expression, however, further research is required.

Background. Rectal cancer is one of the most common malignancies worldwide. The incidence and mortality rates of rectal cancer are increasing rapidly, particularly in countries with a high-income economy. Surgery is the main treatment for rectum cancer. About 30 % of rectal cancer patients are eligible for abdominoperitoneal excision (APE) of the rectum. The conventional APE is characterized by a high frequency of local recurrences. T. Holm (2007) offered to perform extralevator abdominoperineal excision (ELAPE) of the rectum as a more radical approach than conventional APE for patients with cancer of the rectal ampulla and anal canal. Description. We present two case reports of locally advanced cancer of the anal canal. The patients underwent ELAPE with gluteus maximus flap reconstruction of the pelvic floor. Conclusion. The use of the gluteus maximus flap allows successful closure of the extensive peritoneal defect resulted from extralevator abdominoperineal excision of the rectum, without severe functional disorders of the lower extremities.