[Prognostic value of clinical and morphological characteristics in radiation and combined treatment for tongue cancer].

It is now possible to identify several key factors that determine biological characteristics of squamous cell cancer of the head and neck: genes p53, p16, cyclin D1, P13-K/Akt connected with metastasis proteins (proteases, proteins mesenchymal cells, cell adhesion molecules chemokines), angiogenesis factors (VEGF, PDGF, FGF, TGF-alpha and TGF-beta), IL-8; epidermal growth factor receptors. An important role of tumor cells plays microenvironment. Of course the above mentioned is only a small part of the factors that determine the livelihoods and the activity of cancer cells. All of these factors are potential predictors of the effectiveness of radiation and chemoradiation treatment and actively studied in recent decades.

[Decrease of the number of involved lymph nodes after preoperative chemoradiotherapy in rectal carcinoma].

The total of 296 T3-4NO-2 Federal Coloproctology Science Center colon cancer patients received treatment since 2004 to 2011, 165 patients (main group) also received treatment (pre- and postoperative irradiation, surgery, adjuvant chemotherapy) in P.A.Herzen State Clinical Research Center for Oncology. The control group (131 patients) received only surgery with adjuvant chemotherapy. Based on our results, prolonged chemoradiotherapy leads to statistically significant decrease of regional mesorectal lymph nodes metastases, the decrease is most evident in N1 stage patients group (1-3 lymph nodes metastases). However, the number of diagnosed involved lymph nodes also depends on the depth of tumor penetration and the timing between chemoradiotherapy and surgery. The most important prognostic criterion is not the state of involved lymph nodes, but their number.

[Influence of a total focal dose of preoperative chemoradiotherapy on direct results of treatment of rectal cancer].

An analysis of complex treatment of 154 patients with T2-4N0-2 stage rectal cancer is presented who were given preoperative chemoradiotherapy in regimen of dynamic functioning with total focal dose 39.5 Gy (71 patients of the first group) and 47 Gy (83 patients of the second group) using 5-fluororacil and cisplatin. A multivariant analysis has demonstrated a reliably increased frequency of total and close to total regressions of rectal cancer (1-2 stage by Mandard) in the second group as compared with reduced duration of the operative intervention the 1st group (43.2% and 23.9). Frequency of postoperative complications did not have reliable difference in both groups as well as the number of sphinctersaving surgical procedures.

[Effect of the duration of time between chemo-radiotherapy and surgical intervention on the results of the combined treatment of rectal cancer].

Complex treatment included preoperative radiochemotherapy (fractionated TTD of 47 Gy), 5-FU 2.75-3.5 g, cisplatin 90 mg, surgery and postoperative adjuvant chemotherapy (XELOX). The radiochemotherapy/ surgery interval ranged 21-72 days (average--40; median--41.2 +/- 7.9). Patients were divided into two groups: those operated on within days 21-40 (1) and days 41-72 (2) to evaluate the impact of the interval between surgery and completion of radiochemotherapy. The intervals longer than 40 days were not followed by longer sphincter-saving operations, higher intraoperative blood loss or postoperative complication incidence, as compared with the 21-40 day interval. Besides, radiochemotherapy-related alterations in tumor tissues arising more than 40 days after exposure were more pronounced, yet unaccompanied by significantly better end results.

[Prognostic value of rectal cancer regression after preoperative chemoradiation therapy].

Despite the international experience enriched in the number of observations of combination treatment in patients with rectal cancer, many issues remain to be the subject-matter of the discussion. This also applies to the estimation of the value of tumor regression after neoadjuvant chemoradiation therapy in order to develop indications for sphincter-sparing operations depending on the site of a tumor in the organ and their impact on long-term treatment results. The authors have gained experience with combination treatment in 157 patients with rectal cancer (T2-4 N0-2 M0) receiving neoadjuvant chemoradiation therapy in a cumulative radiation dose of 39.5-47 Gy and radical surgery 4-6 weeks after radiation. The direct effect of chemoradiation therapy has been investigated using a set of studies involving ultrasonography, magnetic resonance imaging, endoscopic diagnosis, as well as the data of a postoperative morphological study of primary tumor and lymph nodes. The authors have evaluated the impact of preoperative chemoradiation therapy on the rate and degree of resorption of a primary tumor, including the depth of its invasion through the intestinal wall and exit into the cellular tissue, its localization in the organ and the distance to the anus, a difference in the preoperative estimation of stages and according to the data of pathomorphological studies of intraoperative specimens, etc. The degree of tumor resorption was comparatively analyzed with the long-term results and the rate of sphincter-sparing operations.

[Miniinvasive interventions for focal liquid accumulations in region of pancreas and surrounding tissues].

The results of treatment of 264 patients, suffering an acute and chronic pancreatitis, are analyzed. In 30% of observations the liquid peripancreatic accumulations observed have had regressed under the influence of complex conservative therapy and in other--there were performed transcutaneous punctures under ultrasonographic guidance, the cysts drainage, using laparoscopic method. The recurrence free postoperative period had lasted not less than 3 months.

[Should desmoid fibromas be operated?]. / Nuzhno li operirovat' desmoidnye fibromy?.

The 30-year experience of P.A. Herzen Moscou Cancer Research Institute in the treatment of soft tissue desmoid fibromas (DF) is summarized. A comparative study of effectiveness of surgical, combined, radiation and medicamentous methods was carried out. Frequency of recurrences after surgical treatment made up 94%, after combined treatment with preoperative radiation it decreased 3-fold (27.5%), in cases of postoperative radiation it made up 53%, and after radiation therapy--15.7%. However radiation therapy may have limitations due to necessity for irradiation of large tumour masses and usage of high-dose ionized irradiation which results in development of postradiation tissue damages. Further research brought about an original chemohormonal therapy (tamoxiphen, vinblastin, methotrexate), which provides stable recovery in 81.3% of patients. Principal positions for management of DF are formulated.

[Intraoperative radiation therapy: its technological support, potentials and prospects]. / Intraoperatsionnaia luchevaia terapiia: tekhnologicheskoe obespechenie, vozmozhnosti, perspektivy.

The authors' experience with intraoperative radiotherapy (IORT) in 129 patients with a tumorous process at various sites has demonstrated that in most clinical events, single radiation doses of 10-20 Gy is insufficient to have a persistent local effect and requires additional pre- or postoperative remote irradiation. The use of IORT as a single component of radiation exposure does not lead to significant radiation damages to normal tissues. When IORT is combined with remote irradiation (the latter using doses of 30-60 Gy), 30% of patients develop radiation-induced normal tissue lesions. In the context of enhancing the local effect and, if possible, decreasing the dose of remote irradiation, it is expedient to increase IORT doses, which is in turn fraught with higher incidence and severity of radiation lesions. In this connection, it seems urgent to have a look for the potentialities to expand the radiotherapeutical range. This follows several directions.

[Surgical treatment of nonparasitic cysts of the liver]. / Khirurgicheskoe lechenie neparazitarnoi kisty pecheni.

The authors have observed 218 patients with nonparasitogenic cyst of the liver. Of them 94 were operated on. The cyst enucleation, partial excision of its wall, external cyst drainage, cystodigestive anastomosis formation, combined liver and the cyst resection were done. Preference to the cyst enucleation (in 22.5% of observations), its partial excision (in 33.8%) and combined resection of liver with the cyst (in 19.4%) was given. In polycystosis the partial excision of large cysts were the alternative operations as well as omento-hepatopexy. One (1.06%) patient have died. Postoperative complication occurred in 23 (24.2%) of patients.

[Present trends in the development of radiotherapy]. / Sovremennye napravleniia sovershenstvovaniia luchevoi terapii.

New potentialities of radiotherapy of cancer patients are associated with three scientific directions: investigations in clinical radiology, the use of advantages of radiation advanced technology and guarantees of therapeutic quality. The first direction includes scientifically substantiated regimens of non-classic dose fractionation, various radiomodifiers and their combinations, and individual prognosis of a tumor response to ionizing radiation. This direction based on 3000 cases, holds promise. The second direction is associated with the advantages of modern technology used for diagnosis, topometry and radiotherapy design. The third direction is intended to reduce differences in radiotherapy quality between research institutes and cancer hospitals.

[Prospects of development of radiotherapy in an oncological clinic]. / Perspektivy razvitiia luchevoi terapii v onkologicheskoi klinike.

It is believed that new anticancer potential of radiotherapy lies in further research efforts in the fields of: clinical radiobiology, utilization of the last developments in radiological equipment, overall high quality of radiological service. Research in radiobiology should be aimed at the design of nonstandard dose fractionation, introduction of various modifiers and their combinations, prediction of individual responses of the tumor to ionizing radiation. First-hand clinical data on 3000 cases support the promise of such approach. The advantages of modern equipment could be successfully realized at the stage of confirming the diagnosis and topography++, design of the treatment schedule and in the process of radiotherapy. To warrant the same quality of radiological service rendered in large cancer research centers and provincial hospitals, the latter should be provided with relevant equipment, methodological instructions, participate in current cooperative programs.

[The prognostic significance of the direct effect in the conservative treatment of small-cell lung cancer]. / Prognosticheskaia znachimost' neposredstvennogo éffekta pri konservativnom lechenii melkokletochnogo raka legkogo.

A tumor response to chemoradiotherapy was studied in 260 patients with small-cell lung carcinoma in situ on the basis of clinical parameters using different regimens of dose fractionation and various levels of total focal doses. Nonclassical irradiation regimens were found superior to routine dose fractionation. At present it seems improbable routine dose fractionation. At present it seems improbable to predict a response of small-cell lung carcinoma to irradiation and polychemotherapy on the basis of clinical parameters in each individual case. A varied response of small-cell cancer to conservative antitumor therapy is likely to be determined by its morphological, biological and genetic heterogeneity.

[Prognostic problems in the oncology clinic]. / Nekotorye voprosy prognozirovaniia v onkologicheskoi klinike.

The purpose of this paper is to consider a number of biological and clinicomorphological signs of human tumors which influence the prediction of a course of disease as well as prognosis of a tumor response to radiation exposure. Analysis of the literature has shown that some factors of quite a favourable course of a tumor process are likely to be the signs of clinical radioresistance of the tumor. A strong possibility of individual prognosis of a tumor response to radiation therapy was shown for oropharyngeal and stomach tumors even at its onset, guided by change in the level of their proliferative activity, determined with an indirect immunofluorescent rapid method. The probability of detecting tumors, which are clinically radioresistant to proposed therapy, is 82.4-95%.