[The results of combined treatment for stage III lung cancer including the use of intraoperative radiotherapy].

The results of combined treatment including intraoperative radiation therapy (IORT) were assessed in 147 patients with stage III non-small cell lung cancer. Preoperative chemotherapy with paclitaxel/carboplatin followed by surgery with 15 Gy IORT and additional administration of radiosensitization with cisplatin resulted in a significant increase in the 5-year survival rate compared to surgery alone (39.2% and 47.9%, versus 29.2%, p<0.05).

[The analysis of perioperative period in patients with lung cancer stage III, receiving the combined treatment].

The intra- and postoperative period was analyzed in 202 patients with non-small cell lung carcinoma, treated with the combined therapy and intraoperative radiotherapy. There were no intraoperative complications registered, in spite of complex antitumor treatment. 18.8% of patients developed postoperative complications, which has no substantial influence on the outcome and were determined by the volume of the operation. The postoperative lethality rate was 3.0%.

[Effect of combined modality treatment with intraoperative radiotherapy on the morphofunctional state of the myocardium in patients with stage-III lung cancer].

Epy influence of combined treatment including neoadjuvant chemotherapy, radical surgery and intraoperative radiotherapy with a single dose of 15 Gr or 10 Gr has been studied in conditions of radiosensibilization on morphological and functional status of myocardium in non-small lung cancer patients at stage III with by means of ECG-synchronized single-photon emission computed tomography of myocardium with 99mTc MIBI. It was shown that this kind of treatment does not worsen functional status of myocardium, besides the perfusion level of myocardium correlated with initial concomitant cardiovascular pathology and extent of surgical treatment.

[Assay of methylated gene RARbeta2 in circulating DNA of blood from patients with lung cancer as a potential prognostic marker].

Blood-based methylated DNA gene RARbeta2 in circulating plasma (cir DNA) and one associated with blood cell surface were assayed in patients with non small cell lung cancer before and after combined treatment. The levels in both appeared to be significantly higher than in healthy subjects. Enhanced levels prior to treatment were associated with greater advancement of the disease and unfavorable prognosis (overall survival). After two courses of neoadjuvant therapy plus surgery methylation indices fell down to match those in healthy subjects. Our data may be instrumental in working out additional criteria to be used in diagnosis, prognosis and follow-up of patients with non small cell lung cancer.

[Lung cancer: 25-year experience with surgical and combined treatment].

Data on surgical and combined treatment of 950 patients with non-small lung cancer are evaluated. After combined treatment of lung cancer stage III using intraoperative radiotherapy and adjuvant chemotherapy or radiosensitization, recurrence-free survival rose to 13.3 +/- 2.3 and 23.0 +/- 1.1 months, respectively; 5-year overall survival--32.8 +/- 3.2% and 40.3 +/- 4.2% respectively. Compare with 10.4 +/- 1.3 months and 20.8 +/- 8.5%, respectively, for surgery alone. Despite the prejudice against preoperative radiotherapy, postoperative one administered in TTD of 40-60 Gy (median 55 Gy) may be recommended for treatment of lung cancer spreading to mediastinal lymph nodes.

[Morphofunctional changes in the bronchial epithelium in combined therapy for lung cancer].

Morphofunctional changes in the bronchial mucosa were studied in 33 patients with stage 3 lung cancer. The patients underwent intraoperative radiation therapy (IORT) in a dose of 15 Gy, using cisplatine as a radiosensitizer. No degenerative changes in the bronchial epithelium were found 2 weeks after IORT. Basal cell proliferation was observed, goblet cells were reduced in size and the basement membrane was thickened and twisted. Epithelial reparation due to pronounced local basal cell proliferation was observed 3 months later. A year later, the mucosa was covered with the multinuclear cylindrical epithelium and the cover of ciliated cells was preserved. The functional activity of goblet cells was in the normal range and scanty lymphoplasmocytic infiltration was found in the stroma. With IORT without radiosensitization, the damaged epithelium was regenerated due to the reserved cells coming from the damaged margins with the formation of an epidermoid regenerative layer and subsequent cell differentiation. Moderate sclerosis occurred in the stroma. A year later the bronchial epithelium was characterized by moderate goblet cell hyperplasia with preserved functional activity. Thus, IORT caused mucosal damage as alteration, dystrophy, and desquamation of the epithelium. Subsequently, the bronchial epithelium recovered through reparative regeneration.

[Postoperative features in lung cancer patients receiving intraoperative radiotherapy and radiosensitization].

Research Institute of Oncology, Research Center, Russian Academy of Medical Sciences, Siberian Branch, Tomsk. Postoperative course was studied of stage III non-small cell lung cancer (35) treated radically using intraoperative radiotherapy (15Gy) and cisplatin radiosensitization. Postoperative complications were reported in 11.4 +/- 5.4%. Reduction in complication rates was due to the use of a combined treatment complex. There were no postoperative lethalities.

[Ten-year experience with intraoperative radiotherapy]. / Desiatiletnii opyt intraopertsionnoi luchevoi terapii.

An analysis of the end results of combined treatment for stage III non-small cell lung cancer, stage III gastric cancer and soft-tissue sarcoma has been carried out. Radical surgery was supplemented with intraoperative radiation therapy (IORT) with a single dose of 10-20 Gy. The radiation source was an original small-size betatron installed in the operating room. IORT did not interfere with wound healing nor did it involve increase in postoperative lethality. The 5-year survival rates for lung cancer patients who received IORT or surgery alone were 34.1 and 24.4%, respectively. The same indices for gastric cancer in IORT patients were 34.2% while in surgical cases--21.7%. Two-year non-relapse survival in patients with soft-tissue sarcomas showed a rise due to reduced recurrence incidence in irradiated areas.

[Morphologic changes of bronchial epithelium after intraoperative radiotherapy of lung cancer]. / Morfologicheskie izmeneniia bronkhial'nogo épiteliia posle provedeniia intraoperatsionnoi luchevoi terapii.

Integration of intraoperative radiotherapy (IORT) with combined treatment of non-small cell carcinoma of the lung seems to be promising. Of particular interest are studies of morphological changes in the bronchial epithelium under the influence of large single dose of radiation (15 Gy). Our clinical investigation included patients with non-small cell carcinoma stage III who had received different schedules of treatment at the Center's clinics. Examination was carried out of biopsy material sampled from the bronchus stump as well as from the contralateral segment of the bronchial tree following combined therapy. Exacerbation of the chronic process in the bronchus stump after IORT was reported. One month after bronchial resection, 80% of patients suffered from catarrhal sclerosing bronchitis. Its progression triggered on bronchial sclerosis in 20%. Catarrhal sclerosing bronchitis in the contralateral segment of the bronchial tree occurred in 60%; there was no significant correlation between catarrhal sclerosis, on the one hand, and the initial condition of the bronchus, on the other. In the control group, there were also signs of chronic bronchitis exacerbation on the site of operation. On the whole, the distribution of patients by bronchitis patterns remained unchanged.

[Complications of intraoperative radiotherapy and adjuvant chemotherapy in patients with lung cancer]. / Oslozhneniia pri sochetanii intraoperatsionnogo oblucheniia i ad''iuvantnoi khimioluchevoi terpii u bol'nykh rakom lëgkogo.

A high single dose of radiation can be delivered precisely to tumor or regional metastasis area by means of intraoperative radiation therapy (IORT). A program of combined treatment including radical IORT, postoperative distant gamma-therapy and adjuvant polychemotherapy with cisplatin and etoposide has been developed at the Center. Treatment was given to 43 patients with stage III lung cancer. Complications were reported in 23.3 +/- 6.0%. Prophylactic methods have been worked out to minimize IORT--related postoperative complications. The postoperative lethality rate was 2.3 +/- 1.4%. No program-related hazards have been observed. Complications from adjuvant polychemotherapy were moderate.

[Spontaneous aggregation of thrombocytes in the risk assessment of thrombogenic postoperative complications in lung cancer]. / Spontannaia agregatsiia trombotsitov v otsenke trombogennykh oslozhnenii posleoperatsionnogo perioda pri rake legkogo.

The changes in spontaneous platelet aggregation (SPA), malonic dialdehyde (MDA) levels, total antioxidant blood volume (TABV) and total platelet count (TPC) in blood serum of patients with cancer of the lungs were postoperatively analyzed. The laboratory signs of impairments within the lipid peroxidation system/antioxidant protection were shown to take shape by postoperative days 7-14. Higher blood MDA levels were accompanied by a pronounced increase of SPA and TPC. It was suggested to use the SPA findings as an efficient laboratory criterion in diagnosing the impairments occurring in the platelet-vascular hemostasis chain.