[Preoperative hypoxia-radiotherapy in multimodal treatment of patients with stage III colonic cancer]. / Predoperatsionnaia gipoksiradioterapiia pri kombinirovannom lechenii bol'nykh rakom obodochnoi kishki III stadii.

The paper analyzes the results of surgical and multimodality therapies for 237 patients with Stage III colonic cancer, which were divided into 3 groups. Group 1 included 119 patients undergone only surgical management, Group 2 comprised 43 who were additionally treated with intensive radiation (4 Gy daily for 5 days) and Group 3 consisted of 75 patients who were irradiated in the presence of overall hypoxia evoked by breathing a gaseous mixture containing 9% oxygen. A five-year follow-up has indicated that there are significantly higher survival rates among those who have received a multimodality therapy rather than those merely operated on (82 +/- 5 and 53 +/- 9%, respectively). A short-term gaseous hypoxia has been found to reduce the incidence of systemic radiation reactions in patients during preoperative radiation and to fail to lower the efficiency of multimodality therapy.

[Morphological aspects of intense preoperative hypoxyradiotherapy in combined treatment of patients with sigmoid colon carcinoma]. / Morfologicheskie aspekty intensivnoi predoperatsionnoi gipoksiradioterapii v kombinirovannom lechenii bol'nykh rakom obodochnoi kishki.

Morphological study has confirmed the advantage of using doses of single radiation doses 5 Gy (total dose 25 Gy) and inhalation of a hypoxic gas mixture vs other methods of treatment. The study of radiation pathomorphosis showed significants devitalization of the tumor cells realized clinically with a fall in the number of postoperative recurrences and metastases.

[Conservative treatment of malignant liver tumors]. / Konservativnoe lechenie zlokachestvennykh opukholei pecheni.

Conservative treatment was carried out in 119 cases of hepatic malignancy (primary cancer--36 and metastatic tumors--83). Radiation therapy using a Rokus-M installation or a Saturn linear accelerator was performed in 26 cases, chemoradiation treatment--14 and cytostatic therapy alone--in 79 patients. Single focal dose used was 2 Gy, while total dose was as high as 51-70 Gy in cases receiving radiation alone and 35-40 Gy in the combined therapy group. Various combinations of carminomycin, bleomycin, cisplatinum, adriamycin, 5-fluorouracil, allopurinol and cyclophosphamide were employed. Radiation and chemoradiation treatment proved effective in 67.5% of cases. Mean survival time for patients suffering primary cancer was 15.8 +/- 4.3 months, and for those with metastatic tumor--8.3 +/- 1.6 months. Remission was registered in 14, while stabilization--in 31 out of 79 patients who had received chemotherapy. The symptomatic effect was observed in 38%.

[A method of radiation and combined treatment in inoperable cancer of the pancreas]. / K metodike luchevogo i kombinirovannogo lecheniia neoperabel'nogo raka podzheludochnoi zhelezy.

Methods of topometry , radiation and combined treatment of pancreatic cancer are discussed. The best results were obtained by application of X-ray contrast clips (type K-45) superimposed on tumor during laparotomy. The clips were intended for exposure field formation and radiation treatment using longitudinal 18-25 Mev bremsstrahlung. Radiotherapy procedures and results are presented.

[Side effects in chemoradiotherapy of bladder cancer]. / Pobochnye éffekty pri khimioluchevoi terapii raka mochevogo puzyria.

Chemoradiation treatment was given to 60 patients with locally-advanced cancers of the urinary bladder and their recurrences. Split-course radiotherapy was carried out using a rotation technique at 3-4 week intervals. Total focal dose for two courses was 65-70 Gy. Combined therapy used cyclophosphamide, dactinomycin and cisplatin. Chemotherapy was given immediately after each course of irradiation. Concomitant cardiovascular pathology was registered in 46.6% of patients and renal function derangement--in 36.6%. However, all the patients, except three, received treatment matched by symptomatic therapy. Myelosuppression was among major side effects. Response was assessed in 47 cases (75%). The immediate effect of combined treatment was observed in 57.4%.

[Use of preoperative intensive irradiation in the combined treatment of patients with colon cancer]. / Ispol'zovanie predoperatsionnogo intensivnogo oblucheniia v komibinirovannom lechenii bol'nykh rakom obodochnoi kishki.

The paper discusses the results of preoperative intensive irradiation used in combined treatment for cancer of the sigmoid colon. Diagnosis was verified morphologically. Patients were randomly assigned for irradiation+surgery (group 1-97 cases) or surgery alone (group 2-111). Those undergoing radical operations only (in both groups) were included into the analysis. No difference was found between the two groups in rate of postoperative complications development (frequency of intestinal anastomosis failure included). The frequency of recurrence and metastasis development was significantly higher in the surgery only group. In patients with metastasis into regional lymph nodes, five-year survival was significantly higher among those who had undergone irradiation.

[Hypoxyradiotherapy of malignant tumors: experience and perspectives]. / Gipoksiradioterapiia zlokachestvennykh opukholei: opyt i perspektivy razvitiia.

The results of the randomized treatment of 1,280 cancer patients (hypooxyradiotherapy (HRT)--923, radiotherapy as a control procedure--357) are discussed. HRT was administered pre-operatively to cases of stomach cancer, colonic carcinoma and breast cancer. Owing to reduced radiation injury caused by HRT, pre-operative dosage was increased by 50% (single dose--6 Gy; total dose--30 Gy; 54 isoGy) in stomach cancer patients, and by 25% (single dose--5; total dose--25 Gy; 40 isoGy) in colonic cancer patients. The time of pre-operative irradiation with a single HRT dose of 10 Gy (28 isoGy) for breast tumors was reduced 4 times. As a result of HRT application, dosage rose by 25-42% in treating pancreatic carcinoma and non-organ retroperitoneal tumors.

[Radiation therapy of patients with inoperable cancer of the pancreas]. / Luchevaia terapiia bol'nykh neoperabel'nym rakom podzheludochnoi zhelezy

Radiotherapy was employed in 60 patients, symptomatic treatment--in 10 patients with pancreatic cancer, 9 of them had the disease in stage III. Radiotherapy, using betatron 25 Mev, was conducted by a longitudinal method, distant gammatherapy--through a wolfram and the radiation source focused grid. Single focal dosage was 150--200 rad, total--5000--8000 rad. The treatment proved to be uneffective in 31.7 per cent of patients.

[Treatment of skin cancer (based on data from Moscow Region cancer institutes)]. / Lechenie raka kozhi (po materialam onkouchrezhdenii Moskovskoi oblasti)

Observations over 3308 patients with skin cancer were conducted, 77.5% of them were in stage I, 19.7%--in stage II, 2.6%--in stage III and 0.2%--in stage IV. The incidence in males was twice as rare as in females. The dependence of skin cancer on sex was studied in 1645 patients. The majority of patients aged from 51 to 70 years. According to histological findings basalioma was observed in 75.9% and squamous-cell cancer--in 24.1%. Short-focal roentgenotherapy at voltage of 40--60 kw was employed in 94,3%, the combined therapy--in 4.5% and the associated one--in 1.2%. Doses from 5000 to 7000 r (79.5% of patients) were routinely used. The clinical cure was gained in 97.7%, the duration of radiation effect realization was 3--4 weeks in 60 percent of cases. The clinical cure was seldom observed in dosage under 4000 r. The results of 10-year observations indicated that among 2616 patients recurrences were noted in 63 (2.4%). Short-focal roentgenotherapy and the combined treatment seem to be the methods of choice intreatment for skin cancer.

[The combined treatment of locally disseminated pancreatic cancer using cryosurgery]. / Kombinirovannoe lechenie mestno-rasprostranennogo raka podzheludochnoi zhelezy s ispol'zovaniem kriokhirurgii.

Experimental cryodestruction of the pancreas performed in 40 dogs served as a basis for selecting the temperature regimen, exposure time and extent of treatment to be subsequently used in man. Cryodestruction and combined cryoradiotherapy were employed in 30 patients with locally advanced pancreatic cancer. The procedure proved effective as it assured alleviation of pain, improvement in performance status and an increase in survival. CA-19-9 level and T-lymphocyte count were followed. These markers may be used to predict progression of pancreatic cancer.

[The effectiveness of breast-conserving surgery in T1-2N0M0 breast cancer]. / Effektivnost' organosokhraniaiushchikh operatsii pri rake molochnoi zhelezy T1-2N0M0.

A retrospective analysis of the end results of surgical treatment of 1.417 patients with T1-2N0-1M0 breast tumors is presented: local recurrence after radical surgery (1.151)-2.4% after radical resection (165)-5.5%, and after lumpectomy combined with axillary lymphadenectomy (101)-4.0%. In the T1N0M0 group, the end results of radical resection and radical mastectomy were identical. In the T1N0M0 and T2N0M0 groups, in which lumpectomy combined with axillary lymphadenectomy was performed, the end results were inferior to those radical mastectomy. There was a correlation between tumor cell detection in the blood and lymph vessels and extent of intervention: radical mastectomy-6%; radical resection-13% and lumpectomy combined with axillary lymphadenectomy-17%. The latter index tended to rise in cases of recurrence after breast-conserving surgery.

[Current principles of diagnosis and surgical treatment of non-organ retroperitoneal tumors]. / Sovremennye printsipy diagnostiki i khirurgicheskogo lecheniia neorgannykh zabriushinnykh opukholei.

The data on surgical treatment of 455 patients operated on for primary and recurrent non-organ retroperitoneal tumors (NRT) are discussed. 64.2% of tumors were resected; postoperative lethality was 8.2%. Particular emphasis is placed on the complex nature of diagnosis and an algorithm of examination is suggested. The sequence of main procedures and stages are described; 43% of radical procedures were performed in combination with one another. NRTs tended to relapse and malignant tumors recurred most frequently within the first 18 months. In the course of 182 operations, 54.4% of NRTs were resected: postoperative lethality was 11.1%. The end results were determined by a number of factors, primarily, nature of tumor (benign or malignant), tumor process (primary or recurrent), tumor size and histological pattern. Because of the poor end results, surgical procedures should be improved and their range should be extended.

[Intensive preoperative hypoxic radiotherapy in combined treatment of patients with cancer of the colon]. / Intensivnaia predoperatsionnaia gipoksiradioterapiia v kombinoravannom lechenii bol'nykhs rakom obodochnoi kishki.

Efficacy of combined treatment (203 patients) and surgical treatment (200 patients) alone was analyzed. In combined treatment either radiation therapy (RT) in the dose 20 Gy over 5 days (group 1) or hypoxyradiotherapy (HRT) in the same doses but in combination with hypoxia (10% oxygen and 90% nitrogen--hypoxic gas mixture HGM-10--group 2) were used in preoperative period. In group 3 HGM-9 (9% oxygen and 91% nitrogen) was used as radioprotector in preoperative period but in increased by 25% radiation doses: total 25 Gy, 5 Gy for 5 days. In the control group only radical surgical treatment was performed. Preoperative irradiation didn't increase the rate of postoperative complications. At the same time the 5-year survival rate was higher in all the groups of patients on combined treatment than in the group of patients on surgical radical treatment. In the group with HGM-9 and increased by 25% radiation doses postoperative complications rate was lower, recurrences and distant metastases occurred less frequently.

[Long-term results of radiotherapy of pancreatic cancer]. / Otdalennye rezul'taty luchevogo lecheniia raka podzheludochnoi zhelezy.

Long-term results of radiotherapy of 131 pancreatic cancer patients were discussed. The mean survival time after the therapy was 15.6 mos., in patients with histologically verified diagnosis of cancer--15 mos. During 1 year 64.4% of the patients survived, 2 years--44.7%, 3 years--35.2%, 4 years--9.6%, 5 years--3.2%. The results obtained were 2.5-fold better than those after biliodigestive anastomoses and 3-fold better than those after chemotherapy. Irradiation within a short period (0.5-1 month) after palliative or exploratory operation (the mean survival time was 20.9 mos.) seemed one of the most realistic methods for improving therapeutic results in pancreatic cancer. The mean survival after placing cholecystojejunoanastomosis and radiotherapy was 17.7 mos. (from the onset of irradiation), after exploratory laparotomy and irradiation--18.9 mos., after palliative tumor resection and irradiation--23.9 mos. The efficacy of radiotherapy was lowered with increasing an interval between explorative or palliative operation and irradiation. A split course of gamma-beam therapy was recommended depending on a patient's general status (10-20 after Karnovsky).

[Reactions and complications in the radiotherapy of pancreatic cancer]. / Reaktsii i oslozheniia pri luchevom lechenii raka podzheludochnoi zhelezy.

Radiation reactions were assessed in 140 pancreatic cancer patients. They were noted in 103 (73.5%) patients: general radiation reactions in 62 patients and local reactions in 41. Noticeable radiation reactions were noted in 17.5%, moderate in 36.9% and insignificant in 45.6% of the patients. The use of braking radiation with the energy of 18-25 MeV caused a decrease in the total number of radiation reactions to 20%, the number of noticeable radiation reactions as compared to those in gamma-beam therapy reduced 3-fold. Changes of external secretory and insular function of the pancreas caused by irradiation were studied. It was established that radiation therapy caused no inhibition of these functions, and in 45.9% of the patients it brought about their improvement or normalization. Complications of radiation therapy were observed after 7-48 mo in 21 patients for gamma-beam therapy and presented with vertebral osteopathy in the exposed site, intestinal trophic ulcer and peptic ulcer recurrence. Radiation reactions caused the termination of therapy of 6 (4.3%) patients, a radiation therapy plan in 21 (15%) patients was changed and a 5-7-day interruption or a split course of irradiation was recommended. The main reaction was a general radiation reaction, and gastric or intestinal reactions were the second reason for the discontinuation or change of a radiation therapy plan.

[Chemoradiation treatment of pancreatic cancer]. / Khimioluchevoe lechenie raka podzheludochnoi zhelezy.

Chemoradiotherapy was recommended to 40 pancreatic cancer patients following exploratory and palliative operations. To raise radiosensitivity of tumors, 22 patients received simultaneous chemotherapy with i. v. injection of 5-fluorouracil, 250 mg, 30-40 min prior to irradiation (2 Gy). A short-term therapeutic effect was obtained in 12 patients who received high (60 Gy) or moderate (40 Gy) irradiation doses and 4-7 g of 5-fluorouracil. The summation of a side effect of radio- and chemotherapy was marked. The administration of 5-fluorouracil did not enhance pancreatic tumor radiosensitivity. The mean lifetime of the patients after treatment was 11.3 mos. To 11 patients before operation 5-fluorouracil was administered i. v., 500 mg, twice a week or 1 g once a week (the mean summary dose 7.5 g). Radiotherapy was given after 2-8 weeks (the optimal time of 4-6 weeks) at a mean dose of 47.8 Gy. The mean lifetime after treatment was 18.7 mos. Chemotherapy to 7 patients was given after radiotherapy which was discontinued at doses of 24-36 Gy because of a grave general state of the patients 5-fluorouracil was administered i. v., 500 mg, twice a week (the mean summary dose 3 g) or 1-3 courses of polychemotherapy were given. The mean lifetime after treatment was 9.4 mos. The mean lifetime of all 40 patients after treatment was 13 mos., the therapy was effective in 24 (60%) patients. Thus simultaneous or consecutive chemoradiotherapy is not indicated for pancreatic cancer patients in a grave condition.