Comparative analysis of the efficacy of definitive chemoradiation therapy and surgery followed by adjuvant radiation therapy in advanced-stage oral tongue cancer.

The aim of the study was to compare the efficacy of definitive chemoradiation therapy (CRT) and primary surgery followed by adjuvant radiotherapy (RT) or CRT in the management of patients with stage III-IVA-B resectable oral tongue squamous cell carcinoma (OTSCC). MATERIALS AND METHODS: It is a retrospective analysis of the treatment outcomes of 211 patients with stage III-IVA-B resectable OTSCC. The patients were divided into two groups depending on the treatment modality: 114 patients received surgery followed by adjuvant RT or CRT (S-RT/CRT) group; the definitive CRT group consisted of 97 patients. RESULTS: The five-year overall survival (OS) was 57.0% in S-RT/CRT group vs 20.4% in CRT group; the five-year disease-free survival (DFS) in S-RT/CRT group was 56.5% vs 15.5%, in the CRT group. Comparison of survival curves revealed statistically significant higher OS and DFS rates in patients of S-RT/CRT group as compared with those in CRT patients (hazard ratio = 0.33 (95% confidence interval 0.23-0.47), p < 0.001 vs hazard ratio = 0.25 (95% confidence interval 0.17-0.37), p < 0.001). A multivariate analysis showed a statistically significant prognostic effect of the primary tumor extension cT4 (p = 0.004), cervical lymph node involvement cN2 (p < 0.001), cN3 (p = 0.04) and treatment modality (p < 0.001) on OS. There was also found a statistically significant prognostic effect of the primary tumor extension cT4 (p = 0.02), cervical lymph node involvement cN2 (p < 0.001) and treatment modality (p < 0.001) on DFS. 18 (15.8%) patients of S-RT/CRT group and 13 (13.4%) patients (p = 0.77) of CRT group developed mandibular osteoradionecrosis. CONCLUSION: Primary surgery with adjuvant RT or CRT in advanced-stage resectable OTSCC significantly increases five-year OS and DFS rates as compared to those after definitive CRT.

Clinical and pathological prognostic factors in patients with stage III-IVA-B oral squamous cell carcinoma.

The aim of the work was to study clinical and pathological factors affecting the prognosis of the disease in patients with stage III-IVA-B oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: A retrospective review of medical records of 234 patients with stage III-IVA-B OSCC was performed in order to study the impact of clinical and pathological factors on disease-free survival (DFS) and overall survival (OS). RESULTS: Multivariable analysis of clinical factors revealed a statistically significant effect of stage IVA-B and the presence of surgical complications on DFS (hazard ratio (HR) = 4.9 (95% confidence interval (CI) 2.9-8.3), p < 0.001; HR = 1.6 (95% CI 1.0-2.6), p = 0.047), respectively. Stage IVA-B, the presence of surgical complications and the retromolar trigone subsite were found to have a statistically significant impact on OS (HR = 4.0 (95% CI 2.5-6.5), p < 0.001; HR = 1.8 (95% CI 1.1-2.8), p = 0.01; HR = 1.9 (95% CI 1.1-3.2), p = 0.02), respectively. Multivariable analysis of pathological factors showed a statistically significant effect of positive resection margins, the multiple lymph node involvement and high-grade tumor on DFS (HR = 3.7 (95% CI 2.0-6.6), p < 0.001; HR = 4.3 (95% CI 2.8-6.7), p < 0.001; HR = 1.6 (95% CI 1.1-2.2), p = 0.01), respectively. Besides, positive resection margins and multiple lymph node involvement were found to cause a statistically significant impact on the OS (HR = 3.6 (95% CI 2.0-6.5), p < 0.001; HR = 3.7 (95% CI 2 5-5.6), p < 0.001), respectively. A tumor grade tended to worsen OS (HR = 1.4 (95% CI 1.0-1.9), p = 0.053). CONCLUSION: Stage IVA, B, the presence of surgical complications, the retromolar trigone subsite, positive resection margins, multiple lymph node involvements and high-grade tumor were found to be significant clinical and pathological prognostic factors in patients with stage III-IVA-B OSCC.

[PECULIARITES OF SIMULTANT INTERVENTIONS FOR SOME TYPES OF CHRONIC PHTHISIC PLEURITIS, COEXISTENT WITH PULMONARY TUBERCULOSIS].

In coincidence of chronic phthisic pleuritis in a rigid stage with pulmonary tuberculosis operative intervention is indicated of a pleuropulmonectomy type, what is a complex situation for performance and preservation of the patient's functional state. Pleuropulmonectomy in some patients is complicated by empyema and pathological processes in bronchi. Possibilities of operative interventions application, alternative to pleuropulmonectomy, were studied. Of 48 patients, to whom pleuropulmonectomy is indicated in accordance to data of clinic-roentgenological investigations, in 7--simultant operative treatment were conducted with positive results.

[Possibilities of surgical treatment for advanced multiresistant pulmonary tuberculosis].

The results of surgical treatment of 37 patients, suffering relatively advanced pulmonary tuberculosis (PT), were analyzed. Chemoresistant PT was revealed in 35 (94.6%) observed patients, and multiresistant one--in 30 (81.1%). Preoperative preparation during 2-3 mo was conducted in two main directions: administration of a line II antibacterial preparations and a pneumoperitoneum (PP) establishment. A main operative procedure was resection. Intrapleural thoracoplasty in our own modification have constituted a seconf direction of treatment, it consisted obligatory of the 5 ribs resection. Initially a rib V was partially resected 8-10 cm in length, and a rib I was excised completely. Complications were absent. The patients were discharged from the hospital in 2-3 mo postoperatively. PP in 34 (91.9%) patients was completed in a same terms. In a remote postoperative period (1-4 yrs) a tuberculosis reactivation was absent. All operated patients were bacilli free.

[Prophylaxis of thrombohemorrhagic complications in surgical treatment of chemoresistant pulmonary tuberculosis].

Analysis of thrombohemorrhagic complications was conducted in 98 patients, operated on for various forms of chemoresistant pulmonary tuberculosis. To prevent such complications it is necessary to prescribe heparin in minimal doses or fraxiparine preoperatively and intraoperatively. It permits to lower the prethrombotic background significantly, to prevent thrombohemorrhagic complications, and in their incidence--to eliminate thrombotic and hemorrhagic clinical features with minimal losses.

[EXPERIENCE OF DIAGNOSTICS AND MEDICAL TREATMENT OF THE DIEULAFOYS DISEASE].

The article is dedicated to the features of diagnostics and medical treatment of the Dieulafoys disease. Clinical description of six cases of foregoing pathology is resulted. The morphological features ulcers Dieulafoy are described. One fatal outcome of disease is analysed.