[Treatment of neoplastic lesions of the central bronchi and trachea using endotracheobronchial surgery, intraluminal brachytherapy, combined radiotherapy and chemoradiotherapy].

There are summarized the foreign and domestic references of recent years devoted to methodology and the efficiency of the use of intraluminal high-dose radiation brachytherapy in patients with lesions of the central bronchi and trachea caused by primary and metastatic malignant tumors. It is presented own experience of applying this method in 207 patients. It is showed that in some patients to ensure the delivery of the radiation source to the area of interest it is advisable to perform firstly endotraheobronhial surgery with recanalization of the lumen of the respiratory pathways. The best is the use of intraluminal brachytherapy with high dose radiation. Palliative intraluminal irradiation of inoperable patients allowed achieving a good immediate results (65-95%), a significant reduction of the main symptoms--hemoptoe (87-95%), dyspnea (75-90%), obstructive pneumonia phenomena (50-85%), and significantly increasing survival median from 1-3 to 9-14 months. Following performance of chemoradiotherapy permitted increasing the survival median up to 15-20 months. The number of complications of intraluminal high-dose radiation brachytherapy was small, usually--pulmonary hemorrhage (2-7%) more likely developing when using large fractions--more than 10 g for 1 session.

[Role of transthoracic biopsy in the modern diagnosis of tumors of organs in the thoracic cavity].

This review summarizes data of publications and meta-analyses devoted ton the use of transthoracic biopsy. It is showed that the method continues to be one of the main ways to diagnose pathological processes in the thoracic cavity's organs, especially tumors of the lungs, pleura, mediastinum and chest wall. Modern methods of navigation trepan-needles can receive sufficient volume of pathological tissue samples for subsequent full morphological study to individualize and optimize treatment algorithms.

[Clinical course of cutaneous melanoma of the head and neck, and the factors affecting patient survival].

It was found that melanomas of the skin of the head and neck, compared to the trunk and limbs, were characterized by a greater proportion of men, an older average age of the patients, high frequency spindle cell tumors, more frequent synchronous distant metastasis and worse survival. Melanomas, which are localized on the skin of the neck and scalp, have similar aggressive clinical course and are characterized by worse overall and disease-free survival than skin melanomas on the trunk and limbs. However, melanomas of the skin on the ear and face proceed more favorably as compared to skin melanomas of the scalp and neck. Multivariate regression analysis using Cox models showed that the melanoma of the head and neck Breslow tumor thickness was the strongest predictor of overall survival. For skin melanomas of the neck and scalp Breslow tumor thickness was the only significant independent factor for overall survival. In melanoma, skin and ear predictors of survival are: sex, age and tumor thickness. In skin melanomas of the face and ear predictors of survival were sex, age and tumor thickness.

[Morphological, immunohistochemical and spectral characteristics of dysplasia, preinvasive and invasive forms of lung cancer].

An analysis of modern methods of diagnostics such as morphological, immunohistochemical and spectral, which included the bronchoscopy and spectrometry by using reflectance and autofluorescent regime, was made. The data involved the results of prospective follow-up study of 167 patients (620 biopsies). An obligatory spectrometry of suspicious area was carried out before the forceps biopsy. The microslides, which met the requirements of criteria of one of the carcinogen steps (n=201), were subjected to the in-depth morphological and immunohistochemical investigations. The tendency of angiogenesis (CD31 and CD34), proliferative activity (Ki-67), level of apoptosis (P53), EGFR expression were estimated. The sensitivity of combined endoscopic method was 94,74% by specificity 79,95% and high prognostic value of negative endoscopic diagnosis - 99,4%.

[Comparative assessment of the effectiveness of treatment for patients with lung cancer].

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

[Anesthetic management in endotracheo-bronchial surgery for central bronchial and tracheal tumors].

The article summarizes the experience of anesthetic management in rigid bronchoscopy endobronchial surgery. Induction intravenous anesthesia followed by high tidal-volume mechanical ventilation proved to be more effective, than inhalation anesthesia with injector or high-frequency ventilation, although these methods are safe and effective in patients with compensated respiratory failure. The use of controlled hypotonia with mean arterial pressure of 60-70 mm Hg leads to decrease of blood loss and hypoxemia prevention without impairment of hemodynamics.

[Optimization of treatment methods of surgical complications in lung cancer].

The present report analyses the immediate and long-term results of treatment of surgical complications in 998 patients with lung cancer. There were complications in 37,5% of the cases, with a fatality rate of 14,7%. The most frequent complications were as follows: postoperative empyema with bronchopleural fistula (41,3%), bleeding (12,0%), pneumonia (9,8%), pulmonary arteries embolism (8,1%) and heart rhythm disorders (8,1%). Adjuvant and neoadjuvant treatment does not increase the rate of surgical complications as compared to just surgery alone (p = 0,1). Postoperative empyema with bronchopleural fistula requires intensive therapy, affects the quality of life of patients but does not decrease survival rates as compared to patients at the same stages of disease with uncomplicated course (p = 0,001). Timely drainage of pleural cavity accompanied by its adequate sanation does not differ (p = 0,1) from usage thoracoplasty (MS 29,9 months to 33,2 months).

[Use of autofluorescence bronchoscopy and spectrometry in the diagnosis of central lung cancer].

The paper evaluates the available data as well as our own on use of autofluorescence bronchoscopy in conjunction with spectrometric examination. We used qualitative and quantitative assessment of images obtained by conventional and autofluorescence (ClearVu Elite) means in real time. Our double-stage study evaluated sensitivity and specificity of autofluorescence bronchoscopy in diagnosing lung cancer as well as constructed spectrometric curves (ROC) and areas under them (AUC). Endoscopy was used in 171 patients with central lung cancer. Autofluorescence bronchoscopy established high sensitivity--94.74% (95%CI: 80.9-99%) and sufficient specificity--79.95% (95%CI: 75.8-83.6%). Application of a wide range of spectrometric coefficients contributed to high specificity thus reducing the number of biopsies as well as the injury from the treatment. The AUC for a best predictive index was 0.89 (99%: 0.83-0.95).

[Application of automated quantitative cytometry in diagnosis of lung cancer].

The paper deals with evaluation of the literature data and our experience with automated quantitative cytometric examination of sputum for diagnosis of lung cancer and, in particular, early one. This novel procedure uses measurement of quantitative indices which characterise tumors-induced alterations. The LungSign computerized system was employed to scan cellular nuclei. The results were evaluated by linear discriminative analysis with the aid of ROC-curves and underlying areas. The procedures were run in 248 cases and its sensitivity was significantly higher that of a standard cytological one (36.6% and 13.3%, respectively; p = 0.033), albeit a slight decrease in specificity (93.7% and 100%, respectively; p = 0.003). Automated quantitative cytometric indices varied significantly in cohorts of patients with confirmed (-0.275871) and false (-1.24990) diagnosis of lung cancer (p = 0.0001).

[Combined endoscopic monitoring of treatment effectiveness in tracheal and/or bronchial malignancies using autofluorescence spectroscopy].

The paper presents our experience with application of a diagnostic procedure which enhanced information potential of endoscopy. Its efficiency increased due to use of an algorithm which included several stages carried out during an endoscopic procedure: routine bronchoscopy, spectroscopy in light (400-700 nm), autofluorescence spectroscopy including nearest infrared spectrum (720-800 nm). During treatment, the latter registered the dynamics of glow intensity ratios in the red (600-680 nm) and green (500-550 nm) spectra. The efficacy of our method was determinated by the precise delineation of the involvement area and its changes in the course of treatment which matched final analysis data.

[Use of hypotensive anesthesia in endotracheo-bronchial surgery for tumor-related lesion of the trachea and/or central bronchi].

The paper presents a review of the literature data and our own experience with 25 endotracheabronchial operations for tumor-related stenosis of the central bronchi and/or trachea using hypotensive anesthesia. The latter condition was induced by speeding up propofol injection and maintaining general anesthesia at 4.4-9 mg/kg x hr. Mean arterial pressure was lower than in control (60-65 vs. 70-80 mmHg, respectively). As a result, blood loss fell 138-100 +/- 11 ml whereas gas exchange indices improved (pO2 112-87 mmHg). At intubation stage, rise in mean arterial pressure and heart rate was avoided.

[Results of treatment of lung cancer complicated by postoperative pleural empyema].

An evaluation of the literature and our own experience with surgical and combined treatment of lung cancer complicated by postoperative pleural empyema established the following incidence rates in 2.4% of patients: postpneumonectomy (4.2%), particularly on the side (57.4%), and in tumor stage III cases (70.6%). Bronchal stump failure (89.7%) was the main cause of postoperative pleural empyema while the risk doubled (4.5-6.0%; p < or = 0.05) after neoadjuvant therapy. Both immediate and end results were worse in postoperative pleural empyema than in similar uncomplicated cases: 12 month survival--43.8% vs. 71.1%; 3-year--18.8-36.8%; 5-year--10.4-26.3%. Also, postoperative pleural empyema patients stayed in hospital longer.