Preoperative radiotherapy in combination with metronidazole for resectable gastric cancer: long-term results of a phase 2 study.

AIM: Surgery remains the main treatment of stomach carcinoma. Poor long-term survival mandates the study of other techniques. An original treatment scheme with preoperative radiotherapy and metronidazole as a radiosensitizer is reported here. METHODS: Between 1982 and 1988, MRRC RAMS carried out a prospective clinical trial of preoperative radiotherapy (20 Gy/5 days) in combination with metronidazole (given orally, 3 times, 5 gms per metre(2)). Of 91 patients who received preoperative radiotherapy, 67 patients were operated on with curative intent and were eligible for further analysis. RESULTS: Acute gastro-intestinal toxicity was significant but manageable without surgery delay in most cases. There were 4 postoperative deaths. Overall 5-year, 10-year survival and median survival were 46%, 36% and 46 months. Serosal and nodal involvement were the most significant adverse prognostic factors. Tumours confined to the gastric wall, node negative cases, middle and distal location, differentiated tumours, female sex and age more than 50 years were associated with relatively good long-term results: overall 5-year survival was 50% or better, overall 10-year survival was 40% or better. CONCLUSION: The combined treatment showed significant but manageable acute toxicity. The long-term results seem encouraging and support further investigations in multimodal treatment of gastric cancer.

[Fast neutrons in the treatment of malignant neoplasms]. / Bystrye neitrony reaktora v lechenii zlokachestvennykh novoobrazovanii.

More than 250 patients, mainly with locally advanced tumors of the head, neck and breast were treated with a I MeV beam of fast neutrons emitted from a BR-10 reactor. The fast neutron contribution to the total dose of the radical component of complex gamma-neutron therapy was 20-40%. Said modality was shown to improve the results of treatment for laryngeal and breast tumors. The 5-year actuarial survival following complex gamma-neutron therapy for laryngeal cancer was 89.25, while in controls--65.2% (p < 0.005). The 5-year actuarial overall survival in breast cancer patients treated with fast neutrons was 66.5%: gamma-neutron therapy alone--46.0% (p < 0.05).

[Pathomorphosis of laryngeal cancer after neutron and gamma-neutron therapy using fast neutrons of the reactor]. / Patomorfoz raka gortani pri neitronnoi i gamma-neitronnoi terapii s ispol'zovaniem bystrykh neitronov reaktora.

Studies of tumours and adjacent tissue were carried out in 29 patients with carcinoma of the larynx after preoperative irradiation with fast neurons at a total focal dose 5.6 Gy alone or in combination with gamma therapy. Pronounced pathomorphosis was established in all the cases, up to a full disappearance of the tumor in 2 patients, the degree of pathomorphosis did not depend on location, macroscopic form of growth, degree of dissemination. No changes were found in the wall of the larynx outside the tumor.

[Biological markers of precancer of the large intestine]. / Biologicheskie markery predraka tolstoi kishki.

Current views on focal defect in colorectal mucosa as a risk factor for development of tumours are presented. It is characterized by such phenotypical changes of the mucosa as cell proliferation activation, changes in ornithine decarboxylase activity and polyamine synthesis, changes in the expression of the blood group antigens and associated carbohydrate antigens as well as the development of small adenomas. All these changes may be biological markers of colonic precancer.

[Combination treatment of rectal cancer using preoperative combination radiotherapy]. / Kombinirovannoe lechenie raka priamoi kishki s predoperatsionnoi sochetannoi luchevoi terapiei.

The paper is concerned with analysis of the results of therapy of 122 rectal cancer patients divided into 2 groups by sex, age, tumor site, type of anatomical tumor growth, and stage of disease: I (72 patients)--combined therapy including preoperative radiotherapy and operation; II (50 patients)--surgery alone. Indications for combined therapy with preoperative irradiation were worked out. The results of histological investigation showed that this method brought about deep radiation injuries of tumors with minimum damage of the adjacent normal tissues. A conclusion was made that combined therapy including preoperative irradiation decreased the number of recurrences and metastases and increased (in combination with surgical intervention) the 5-year survival rate up to 79.6%.

[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.

[A rare case of rupture of a syphilitic aortic aneurysm into the esophagus]. / Redkii sluchai proryva sifiliticheskoi anevrizmy aorty v pishchevod.

A case of the rupture of a syphilitic aortic aneurysm into the esophagus in a woman aged 64 with cured breast cancer was observed. A clinical picture, autopsy and microscopy findings were described. The authors underlined the rarity of the case, difficulty of intravital and morphological diagnosis which could be attributed to syphilis pathomorphosis. Of great importance for diagnosis are a detailed life history, clinical symptoms, instrumental methods of investigation, especially in oncological practice where differential diagnosis with exophytic esophageal cancer seems difficult.

[Theory and practice of the morphometry of human tumors]. / Teoriia i praktika morfometrii opukholei cheloveka.

It is stated that if adequate qualitative and quantitative knowledge of tumor development is to be gained, a systems approach must be used, in which a given process is considered as representing the sum total of hierarchically organized and interrelated parts, and that quantitative data on processes of tumor development are needed for cognitive, diagnostic, evaluative, and prognostic purposes.

[Cellular apoptosis: its morphology, biological role and the mechanisms of its development]. / Apoptoz kletok: morfologiia, biologicheskaia rol', mekhanizmy razvitiia.

The literature review reports data on morphology, biological role and mechanisms of apoptosis as a special type of cell destruction. Apoptosis is very common in humans and animals in health and disease, and therefore needs further investigation.