[Combined treatment of patients with locally advanced rectal cancer].

The objective of this study was to improve the immediate and long-term results of combined treatment of patients with locally advanced rectal cancer. The study included 128 patients with morphologically confirmed diagnosis and clinical stage cT3/T4 and N-/N+, treated from 1998 to 2009. The comparison group had 64 patients, combined treatment included prolonged preoperative radiotherapy 4 Gy and 40 Gy, surgery was performed after 4 weeks. In the study group--also 64 patients--combined treatment consisted of preoperative chemoradiotherapy (continuous a-120 hour infusion of 5-fluorouracil at a dose of 500 mg/m2 in the first and last week of radiotherapy in 2 Gy to 50 Gy), surgery was performed through 6 weeks after chemoradiotherapy. Excision of the primary tumor was performed in 40 (62.5%) patients in the control group and in 53 (82.8%) patients in the study group. Wherein R-0 resections were performed in 32 (67%) patients and in 41 (73%), and R-1 resections--in 1 (2%) patients, and 7 (13%) patients in the control and study groups respectively. A 5-year survival rate was 43.6 ± 7.2% control and 62.7 ± 5.1 % in the study group.

[Comparative analysis of long-term results of combined and surgical treatment at the patients with signet ring cell carcinoma of stomach].

Overall 194 patients with signet ring cell carcinoma of stomach were treated, 124 (64%) of them underwent combined treatment (preoperative radiotherapy with subsequent operation), 70 (36%) - only surgical treatment. There were no differences in survival rate between two groups at early (pT1) cancer. The combined method has advantages over isolated surgical at T2 tumors (both with and without regional lymphatic metastases) and at T3 tumors without regional lymphatic metastases (p=0.03). At T3N1-2 tumors with regional lymphatic metastases and T4 tumor neither combined no surgical method demonstrated positive results of treatment. Generally combined treatment with preoperative radiotherapy has statistically significant advantage (p=0.007) over surgical treatment at the patient with signet ring cell carcinoma of stomach.

[Comparative assessment of immediate results of combined and surgical treatment of gastric cancer].

The 30-year experience with combined and surgical treatment of gastric cancer gained at the Center is discussed. The results of surgery were improved due to use of intensive preoperative radiotherapy, metronidazole and dynamic fractionated treatment. There was no correlation between intensive preoperative radiotherapy and postoperative complication incidence or lethality, irrespective of extent of surgery or lymph node dissection. Moreover, radiotherapy was followed by a considerable decrease in postoperative incidence of pancreatitis due to inhibition of secretory function by the pancreas. Use of modern technology of radiotherapy planning and implementing left virtually no serious damage. Considering the recent changes introduced to standards for surgical treatment of gastric cancer, our findings point to a safe combination of preoperative radiotherapy with extended surgical and combined treatment.

[Comparative analysis of long-term results of combined and surgical treatment in gastric cancer].

The end-results of combined and surgical treatment of gastric cancer are compared. Survival rates were sufficiently high in both procedures in cases without extension through the serosa (T1-2) or regional metastases with adenocarcinoma cells were well differentiated (NO). However, combined treatment proved more effective in cases of the opposite situations (p=0.04-0.0001). Considering the possibility of inadequate staging, the following indications for preoperative radiotherapy are suggested: low cell differentiation, signet-cell or undifferentiated gastric tumor of 3-10 cm in diameter. In other words, early cancer of the stomach and total involvement must be excluded.

[Efficacy of low-carbohydrate diet in the treatment of obesity in adolescents].

The article presents our experience of low-carbohydrate ketogenic diet usage in fifteen children with primary stage 1-3 constitutional obesity. Criteria for assessment were dynamic changes of weight, serum lipid profile, changes in percentage of body fat content according to "total body" densitometry data, changes in indices of insulin resistance. The obtained data support that this type of diet is well tolerated by children; it normalizes cholesterol, triglyceride, and beta-lipoprotein serum values; reduces indices of insulin resistance while effective weight and appetite loss.

[Long-term results of pre- and intraoperative radiotherapy in the combined treatment for stomach cancer].

The paper discusses the end results of combined treatment of stomach cancer (radical surgery plus pre- and intraoperative radiotherapy). A randomized evaluation showed that it might be used for loco-regional monitoring. Five-year rates and median of survival rose significantly, as compared with surgery alone, in tumor extension through the stomach wall (T3-4), metastatic dissemination to lymph nodes (N1-2), combinations of such pathologies as well as in cases of low-differentiated, undifferentiated and signet- cell cancer.

[Pre- and intraoperative radiotherapy for locally advanced gastric cancer in conjunction with extended lymph node dissection: results of phase II clinical study]. / Pred- i intraoperatsionnaia luchevaia terapiia v sochetanii s rasshirennoi limfodissektsiei pri lechenii mestorasprostranennogo raka zheludka: rezul'taty II fazy klinicheskogo issledovaniia.

The paper discusses our findings on a phase II clinical study of an original procedure for therapy of locally advanced gastric cancer including pre- and intraoperative radiotherapy (IORT) and extended lymph node dissection. Out of 24 patients, none had intraoperative complications while postoperative ones developed in 16%; lethality rate was 4%. As far as immediate results are concerned, intensive pre- and intraoperative radiotherapy proved fully compatible with any surgical procedure including extended and extended-combined ones. Survival rates (Kaplan-Meier) were: 1 yr--90 +/- 6%; 2-, 3-year--74 +/- 9%. Indications of adjuvant radiotherapy and approaches to its effective use are discussed.

[Intraoperative radiotherapy in the combined treatment of stomach cancer. Methodological and technical aspects]. / Intraoperatsionnaia luchevaia terapiia v kombinirovannom lechenii raka zheludka. Metodologicheskie i tekhnicheskie aspekty.

Theoretical, experimental and clinical rationale is discussed for selection of targets and main parameters of intraoperative radiotherapy for gastric cancer. Topometric and dosage research has been carried out. Original technological equipment has been developed for safe treatment using the domestic accelerator Mikrotron-M. Procedures for continuous relay pre- and intraoperative radiotherapy of gastric tumors in conjunction with radical surgery have been devised and adapted to operation of a specialized clinical facility.

[Results of clinical studies of the efficacy of intraoperative radiotherapy in combined treatment of stomach cancer]. / Rezul'taty klinicheskogo issledovaniia éffektivnosti intraoperatsionnoi luchevoi terapii v kombinirovannom lechenii raka zheludka.

The results of clinical application of an original method of operable gastric cancer treatment including pre- and intraoperative irradiation (IORT) and radical intervention are presented. According to a randomized study, combination treatment did not involve intra- and postoperative complication rates higher than those of surgery alone. Moreover, a significant decrease in postoperative pancreatitis was registered. IORT is a highly effective method of adjuvant treatment of operable gastric cancer. Due to its application in conjunction with preoperative irradiation and radical surgery, the end results of locally-advanced gastric cancer improved.

A prospective, randomized trial of pre-operative and intraoperative radiotherapy versus surgery alone in resectable gastric cancer.

INTRODUCTION: Worldwide, gastric cancer remains one of the most common malignancies. Discouraging survival rates after surgical treatment promote the study of adjuvant therapy. A prospectively, randomized, controlled clinical trial was performed in order to determine whether pre-operative and intraoperative radiotherapy improves treatment results of gastrectomy for stomach carcinoma. METHODS: From 1993 to 1998, 112 patients were randomized and underwent exploratory laparotomy; among them 78 satisfied protocol requirements and entered in the trial. Patients in the experimental group were treated with pre-operative radiotherapy (20 Gy/5 days), gastrectomy and intraoperative radiotherapy (20 Gy using 8-12 electrons). Patients in the control group underwent surgery alone. RESULTS: Incidence and distribution of post-operative complications were similar in both groups except significantly higher incidence of pancreatitis after surgical treatment. No late radiation-related morbidity was registered. There was no significant difference in survival between the two treatment groups (Chi(2)=1.026, df=1, P=0. 311) as well as in N0 (Chi(2)=0.0029, df=1, P=0.956) and T1-2 subgroups (Chi(2)=0.1928, df=1, P=0.660). In contrast, combined treatment had marked survival advantage in more advanced stages: in the case of lymph-node involvement (Chi(2)=4.19, df=1, P=0.04) and extragastric tumour extension (Chi(2)=4.118, df=1, P=0.042). CONCLUSION: The proposed intensive treatment programme is feasible, shows good acute and late tolerance and has the potential to improve survival in patients with locally advanced gastric cancer.

[Use of reactor neutrons in the multimodal treatment of patients with breast cancer]. / Problema ispol'zovaniia reaktornykh neitronov v kompleksnom lechenii bol'nykh rakom molochnoi zhelezy.

The results of multimodality treatment are analyzed in 56 patients with local breast cancer. Combined gamma-neutron therapy with the use of fast reactor neutrons enhances the efficiency of breast cancer treatment and does not increase the number of radiation reactions and complications. The three-year survival increased from 44 +/- 12 to 75 +/- 9%. The test reactors specifically adjusted may be useful for the radiation therapy of patients with various malignant neoplasms. Combined gamma-neutron therapy is more promising for this purpose than neutron therapy alone.

[Thermoradiotherapy of rectal cancer]. / Termoradioterapiia raka priamoi kishki.

Methods of combined and multimodality therapy are widely used for the treatment of malignant rectal tumors. However radical operation cannot be performed in 50% of patients, in some cases patients refuse surgery. In such cases patients are given a split course of radiation therapy using local heating of a tumor and a method of daily dose fractionation. Altogether 58 patients with stage T2-4N0-1M0-1 were treated by this method: 38 received thermoradiotherapy, 20 were controls. At the 1st stage the summary focal dose (SFD) was 40 Gy, temperature in a tumor was 42-44 degrees C, interval 3-4 weeks. At the 2nd stage radiotherapy was given with daily dose fractionation (1 + 1.5 Gy at 4-5- h interval), the SFD was 35-40 Gy. The SFD over the entire therapeutic course was 75-80 Gy. Radiation rectitis in thermoradiotherapy was more frequent and severe. Complete tumor regression was observed in 7 (18.4%) patients, marked regression--in 24 (63.2%) patients, insignificant regression--in 5 (13.1%); 2 patients (5.3%) were treated without any effect. 29 (76.3%) patients lived over 2 yrs., 6 (25.8%) patients died of tumor progression.

[Changes in the lungs in radiation treatment of head and neck tumors]. / Izmeneniia v legkikh pri luchevom lechenii opukholei golovy i shei.

A study was made of the roentgenomorphological and roentgenofunctional appearance of pulmonary lesions in 120 patients with head and neck tumors during radiation therapy. Laryngeal cancer was diagnosed in 56 patients, cancer of the oral cavity in 48, and neck tumors in 16 patients. X-ray examination was done 1 month before and after the termination of gamma-beam radiotherapy, the summary focal doses varying from 40 to 75 Gy. The chief modes of lung examination were roentgenography and roentgenopneumopolygraphy. It was established that even before treatment the patients had latent signs of respiratory insufficiency. Radiotherapy, irrespective of the summary focal dose value, had a mediated effect on the lungs. One month after the discontinuation of radiotherapy the pulmonary pattern changed: its elements were enhanced and dilated, the general biomechanism of respiration impaired, particularly at the expense of reducing the respiratory mobility of the diaphragm and mediastinum, disorders of the bronchopulmonary ventilation increased. A multimodality x-ray study including roentgenopneumopolygraphy helps to detect in time regional disorders of lung function which is very important for prevention of lung complications.