EPIDEMIOGICAL STUDIES
Introduction. Liver cancer relates to serious cancer pathology. The study of risk factors for liver cancer is the subject of many publications including experimental research. Of 16 countries, which presented data on estimation of relative oneand five-year survival of patients with liver cancer (both sexes) in the European countries (the program Eurocare-4), only in five countries a 5-year relative survival exceeded 10 %. The European average rate of a 5-year relative survival (for both sexes) was 8.7 %. For men it was equal to 8.9 % and for women 8.4 %. Purpose. To provide for the first time in Russia on the population level an analysis of dynamics of survival of liver cancer patients in accordance with database of the Population-Based Cancer Registry of St. Petersburg, the first in Russia working on international standards, in comparison with the programs Eurocare-3 and 4. Also it was necessary to estimate a number of analytical indicators, which reflect the state of problem. Material and methods. To solve this purpose there were studied the state of problem in European registries, data on state reporting of Russia and primary materials of the Population-Based Cancer Registry of St. Petersburg. The total number of observations according to the Population-Based Cancer Registry of St. Petersburg was 4003 cases of primary liver cancer including 2218 cases among men and 1785 among women. For the estimation of observed and relative survival rates there were used estimations of rates, modified by us, of the programs Eurocar-3 and 4. Results. There has been established the level, close to the European average, of observed and relative 5-year survival of liver cancer patients, both men and women of St. Petersburg. Throughout the whole period of observation it was revealed an extremely low level in median survival. Coding of histological forms of malignant tumors of the liver was significantly improved. The proportion of ICD codes 8000/3 and 8010/3 decreased among men from 71.6 % to 8.2 %, among women with 48.48 % to 6.38 %. Conclusion. Malignant tumors of the liver are severe pathology in oncology. It is required not only an improvement of the primary estimation but also more accurate coding and providing timely medical care to patients.
CLINICAL STUDIES
Introduction. Currently, the only potentially curative treatment for gastric cancer is radical gastrectomy. Even after curative resection, death from gastric cancer is primarily due to recurrence. The purpose of the study was to analyze feasibilities of surgical treatment for recurrent gastric cancer. Methods. From 2000 to 2013, the experience in surgical treatment of 35 patients with recurrent gastric cancer was analyzed. Eight patients underwent surgery for primary gastric cancer in the Thoracic and Abdominal Department of Moscow P.A. Hertsen Cancer Research Institute and 27 patients were operated on in other hospitals including cancer centers. Recurrence from gastric cancer was observed in 6 patients after proximal subtotal gastric resection (PSGR), in 17 patients after distal subtotal gastric resection (DSGR) and in 12 patients after gastrectomy (GE). The median time to recurrence was 22.9 ± 3.4 months. Isolated locoregional recurrence of gastric cancer was detected in 29 patients. Cancer dissemination was diagnosed in 6 patients. Results. Anastomotic recurrence was detected in 22 patients, recurrence within the remnant stomach, in 3 patients, locoregional extra-gastric recurrence in 7 patients and solitary metachronous distant metastases were diagnosed in 3 patients. A total of 33 operations were performed: extirpation of the operated stomach in 12 patients, re-resection of the stomach after DSGR in 2 patients, resection of the esophageal-intestinal anastomosis (after GE) in 8 patients, removal of extra-gastric recurrence in 8 patients and removal of solitary metastases in 2 patients. The complication rate was 45.5 % (15 patients). Grade I complications according to Clavien-Dindo classification were diagnosed in 3 patients, grade II complications in 5 patients, grade IIIA in 2 patients , grade IIIB in 2 patients, grade IV in 2 patients and grade V complications (death from postoperative complications) in 1 patient. The failure of anastomosis sutures was observed in 4 patients, 1 of them died of this complication. Postoperative death rate was 3 %. Long-term treatment outcomes were observed in 32 patients. In patients who underwent surgery, the 1-, 3and 5-year survival rates were 44, 25 and 2.8 %, respectively (р = 0.08). Conclusion. Surgical intervention has been limited to locoregional recurrent gastric cancer. Results of surgical treatment for locoregional extra-gastric recurrence were no worse than those in the treatment for recurrence in the anastomosis or within the remnant stomach.
The main treatment failures of cancer of the oropharynx and oral cavity are associated with the treatment of advanced (III–IV) stages of the disease, incidence of which is extremely high. The treatment toxicity increases and quality of life reduces with increasing aggressiveness of anticancer therapy. Therefore, the search for conservative treatment methods in order to achieve optimal treatment efficacy remains relevant. The study included 233 patients with primary cancer of the oropharynx and oral cavity, who underwent concurrent chemoradiotherapy with accelerated hyperfractionated radiation and standard radiation therapy. In patients who received chemoradiotherapy with accelerated hyperfractionated radiation in the regimens of 1 Gy + 1.5 Gy and 1 Gy+2 Gy with a 4–6 hour interval, 60 Gy total dose, the objective response rate (complete + partial regressions) was significantly higher than that observed in patients who received the standard radiotherapy (97.8; 100 and 61.9 %, respectively). Severe mucositis (grade 3) was observed in 40.5 and 77.8 % of patients treated with accelerated hyperfractionated radiation in the regimens of 1 Gy+1.5 Gy and 1 Gy+2 Gy, respectively compared to 52.7% of patients treated with the standard radiotherapy (p<0.05) Late radiation-induced damage to normal tissues and organs in the radiation field occurred in 8.9; 10.8 and 20.2 %, respectively (p>0.05). Immediate treatment results and survival analysis showed that chemoradiotherapy with accelerated hyperfractionated radiation was superior to standard radiation therapy without increasing the late local toxicity. All patients completed the planned course of treatment, despite the high rate of grade 3 mucositis in the 1 Gy + 2 Gy dose regimen.
Introduction. One third of non-small cell lung cancer (NSCLC) patients have locally advanced inoperable Stage III tumors. Increasing number of induction chemotherapy (iCT) cycles may lead to delay of the start of radiotherapy (RT) and decrease survival. Objective. To evaluate a clinical impact of the starting time of RT among Stage III NSCLC patients after iCT on overall survival (OS). Materials and methods. The OS was calculated in patients, receiving radical RT during or later than 150 days after starting of iCT (RT150). Kaplan-Meier method with log-rank for intergroup comparisons was used. Correction for initial factors was made using Cox regression. Results. Overall, 49 patients with stage III NSCLC who received RT after iCT were selected. Twenty-five patients were irradiated during the period less then 150 days after the start of iCT, while other 24 – in more than 150 days. At distribution analysis, in the group RT>150 was higher proportion of patients with T4 (p=0.029) and with B stage (P=0.003), the other initial factors were distributed uniformly. The median (Me) OS was 19.9 (95 % confidence interval (CI) 16.8-23.2) and 21,0 (95 % CI 14.9-27.2) months, c2=0,017, p=0.895 in groups RT>150 and RT≤150, respectively. Me OS was 22.5 (95 % CI 10,2-34.9), 18.9 (95 % CI 16.9-20.9), and 18.4 (95 % CI 15.4-21.4) months, c2=4,42, P=0.110 for patients receiving 2, 3-4, 5 or more courses of induction CT, respectively. Hazard ratio (HR) of death in patients with a longer interval before the end of RT was 1.041 (95 % CI 0,571-1,897) and 1.485 (95 % CI 0,691-3,189) in univariate and multivariate analysis, respectively. Conclusion. In a retrospective analysis the delay of RT start after iCT leads to non-significant decrease of survival. More than two courses of iCT are not appropriate. The results need to be confirmed in a prospective randomized trial.
The problem of nosocomial infections caused by Pseudomonas aeruginosa is still being actively discussed in the medical published literature. Special attention is paid to the infectious complications caused by highly resistant (XDR – extremelyor extensively-drug-resistant) strains of P. aeruginosa which are associated with increased length of hospital stay and increased cost of treatment and mortality rates. Immunocompromised cancer patiens are at significant high risk for infections caused by XDR strains. The development of antibiotic regimens for the treatment of nosocomial infections caused by strains of XDR-P. aeruginosa is of great importance.
The aim of the study was to evaluate the relationship between serum levels of tumor markers СА 125 and НЕ 4 and disease stage, histological type as well as treatment in patients with borderline ovarian tumors. Materials and methods. Thirty patients with borderline ovarian tumors were retrospectively studied. The control group consisted of 70 patients with ovarian cancer and 30 healthy women. Results. Expression levels of СА 125 and НЕ were higher in patients with borderline tumors than in healthy women. In patients with stage I-II borderline ovarian tumors, СА 125 and НЕ 4 levels were similar to those observed in patients with ovarian cancer. However, in patients with stage III borderline ovarian tumors. After completing treatment, a significant reduction in the expression of СА 125 and НЕ 4 markers occurred. Conclusion. Tumor markers HE4 and CA125 can be predictive factors for tumor response to therapy and the tool for detecting patients at high risk for ovarian cancer.
LABORATORY AND EXPERIMENTAL STUDIES
The present study of the functional suitability and specific activity of the contrast agent gadolinium-based for magnetic resonance imaging demonstrated that the investigated contrast agent intensively accumulates in organs and anatomical structures of the experimental animals. In the model of tumor lesions in animals, study have shown that investigational contrast agent accumulates in the tumor tissue and retained there in for a long enough time.
This article presents the results of the comparative antitumor efficacy study of two test articles of therapeutic humanized monoclonal antibodies against epidermal growth factor receptor (EGFR) manufactured by Russian biopharmaceutical company CJSC “Biocad” and the commercial drug “Erbitux®” (Merck, Germany) in subcutaneous xenografts model using human epidermoid carcinoma A431NS cell line. EGFR overexpression in epithelial tumor cells is a commonly known fact that determines use of this receptor as a target for therapeutic monoclonal antibodies. The basic mechanism of action of such drugs is blocking of epithelial cells proliferation through competitive binding to EGFR. Evaluation of tumor growth dynamics in immunodeficient (Nu/Nu) mice was performed during in vivo experiment using two parameters: tumor growth index and tumor growth inhibition (TGI, %). The results received with used study design show that antitumor effects of the test articles manufactured by CJSC “Biocad” and the commercial comparator drug “Erbitux®” estimated by values of TGI and tumor growth index are comparable.
Morphological and morphometric study of biopsy showed that in the 2 age groups of subjects: 1 – 65 women of reproductive age to 35 years old, 2 – 57 women postreproductive age, over 49 years. Patients of the 1-st group were more frequent CIN2 and CIN3. It is revealed that the patients of this group in the stratified squamous epithelium of the cervix are more active processes of proliferation, expressed as a thickening layer of stratified squamous epithelium on the whole, the thickening of the basal layer, more common acanthosis, in comparison with changes of stratified squamous epithelium in women of older age. It is established that the symptoms of viral lesions of the stratified squamous epithelium (koilocytes), often encountered in young women. Assessment of the manifestations of the reaction of local immunity in the stroma of the cervix showed that more severe inflammatory reaction was marked in young patients with CIN3 as the most active perifocal inflammatory process.
ONCOLOGY PRACTICE
The experience of application of positron-emission tomography in diagnosis of eye cancer has been described.
REVIEWS
The problem adjuvant treatment of non-small cell lung cancer there are many unresolved questions, postoperative radiation therapy (PORT) is more controversial. Over the last decade there have been significant changes in the assessment of treatment results and treatment indications. Improvements in diagnostics of preoperative staging and the use of modern radiological technics improve survival in patients with resectable non-small cell lung cancer with mediastinal lymph nodes metastasis. This article presents the results of the most significant studies PORT with the modern technologies of diagnostics and treatment. Ongoing randomized trials will provide new data on the effectiveness of PORT.
Colorectal cancer is one of the most common malignancies and the leading cause of cancer-related death. There are 4 basic colon carcinogenic steps: malignant transformation of adenoma into carcinoma; HNPCC (hereditary nonpolyposis colon cancer); cancer «de novo»; chronic colitis malignant transformation. All of them, except for Lynch syndrome, are increasingly focused on stem tissue-committed cells as mutation targets and the source of malignancies. Subsequently, cancer stem cells are considered as the cause of chemoresistance of tumors, metastases and relapses. Thus, the study of the cell population can dramatically change approaches to the treatment of patients with colorectal adenocarcinoma.
The development of castration-resistant prostate cancer is an important problem of modern oncology. The review is focused on the system of growth factors – neuregulins and hepatocyte growth factor (HGF), direct pathligands of ErbB tyrosine protein kinases and hepatocyte growth factor receptor, c-Met, the activation of which triggers a cascade of signaling pathways, ending by the stimulation of proliferation of cancer cells, their migration under conditions of the development of tolerance to the treatment of castration.
HISTORY OF MEDICINE
The article presents a biographical sketch of the outstanding Russian scientist, academician of RAMS, Professor N.V. Vasiliev.
CHRONICLE. INFORMATION
JUBILEES
OBITUARY
ISSN 2312-3168 (Online)