[Adenocystic carcinoma of the trachea]. / Adenokistoznyi rak trakhei.

It is presented 40-years experience of tracheal adenocystic carcinoma diagnosis and management in 144 patients. Peculiarities of clinical course and choice of diagnostic and therapeutic measures are discussed in relation to stenosis and hypoxia degree and severity of accompanying inflammatory complications of trachea, bronchi and lungs. Technical tools and original methods of resection and reconstruction of trachea and it's bifurcation after extended lung resection are described. Surgical management is carried out in 96 patients: all patients underwent circular resection of trachea (77) or it's bifurcation (19). Morbidity rate was 22.9% and mortality - 3.1%. Additional radiotherapy was carried out in 50 patients. 41 patients underwent radiotherapy alone. Radiotherapy improves remote results of management. 5-and 10-year survival rate was 78.3±6.1 and 45.9±7.9% after surgery alone, 92.0±3.9 and 77.1±6.5% after combined treatment and 76.4±6.5 and 55.0±10.7% after radiotherapy alone respectively.

[Economic and logistical problems of radiation oncology].

An analysis of economic and logistical problems of radiation oncology is presented based on domestic and foreign literature. Despite the high efficacy of radiotherapy this branch of oncology is not financed enough in most countries. As a consequence, it is ubiquitously marked radiotherapy capacity deficit that does not allow to fully realize its therapeutic potential. Medical electron accelerators and related equipment have become increasingly complex and expensive and radiotherapy techniques more consuming. Even in developed countries growing waiting times for radiotherapy, not using the most modern and efficient radiotherapy technologies (image guiding, etc.) has become a daily reality. Based on these data, we assessed the prospects and possibilities of upgrading the technical base of radiation oncology in Russia including the development of hadron therapy.

[Evaluation the effectiveness of radiation therapy high-grade gliomas based on the model of TDF (time-dose fractionation)].

There were showed the possibility of using the model of TDF, through which it was possible to take into account the selection of fractionation of radiation for high-grade gliomas and to judge the effectiveness of treatment. Currently, the basis of adjuvant radiation therapy in patients with primary high-grade gliomas is the use of the traditional mode of fractionation dose of radiation from a single focal dose of 2 Gy up to a total focal dose of 60 Gy to the tumor (bed of the removed residual tumor) in Grade 4 and Grade 3 - 54 Gy. In patients who underwent radiotherapy using a single focal dose of 3 Gy, overall survival rate was higher as compared to the group of patients, which was carried out using radiotherapy small dose fractionation.

[The role of functional status and recursive partition analysis (RPA) classes for the choice of fractionation regimen in patients with high-grade gliomas].

The treatment results of 396 patients with morphologically verified grade 3-4 malignant brain tumors receiving conventional irradiation regimen and irradiation by medium-sized fractions were analyzed to form institutional guidelines.The standard mode of fractionation with a single dose of 2 Gy and total focal dose (TFD) of 60 Gy is appropriate for patients with initial Karnofsky status of 60-100% and Recursive Partition Analysis (RPA) class I-III. TFD increase to 60-62 Gy in grade 4 gliomas and 54-56 Gy in grade 3 gliomas grants a significant improve in overall survival. An increase of a single irradiation fraction to 3 Gy may be used for patients with initially low functional status (Karnofsky 30-50%) and RPA classes IV-VI. In these cases it is advisable to use the TFD of 45 Gy or more (TFD of equivalent regimen with a dose greater than 54 Gy). The mentioned fractionation regimens could be recommended for the use in clinical practice to improve the results of high-grade gliomas treatment.

[The role of age and tumor grade in the choice of fractionation regimen in patients with high-grade gliomas].

There are currently no conventional guidelines for radiotherapy in gliomas. The treatment program is mainly formed in accordance with tumor morphology and the "golden standard" of irradiation is still the traditional mode of fractionation with a single focal dose of 2 Gy and total focal dose (TFD) of 60 Gy. In this report the treatment results of 396 patients with morphologically verified grade 3-4 malignant brain tumors receiving conventional irradiation regimen and irradiation by medium-sized fractions were analyzed to form institutional guidelines. The standard fractionation mode with a single focal dose of 2 Gy is preferable in patients with grade 3 glioma or elderly patients (over 60 years). TFD increase to 60-62 Gy in grade 4 gliomas and 54-56 Gy in grade 3 gliomas grants a significant improve in overall survival. An increase of a single irradiation fraction to 3 Gy may be used for patients younger than 60 years. In these cases it is advisable to use the TFD of 45 Gy or more (TFD of equivalent regimen with a dose greater than 54 Gy). The mentioned fractionation regimens could be recommended for the use in clinical practice to improve the results of high-grade gliomas treatment.

[Options of hypofractionation of proton boost in locally advanced prostate cancer].

The aim was to evaluate the effectiveness of various fractionation proton boost in the proton-photon radiation therapy of locally advanced prostate cancer. The study included 272 patients with prostate cancer and intermediate-to-high risk of progression. 114 patients received 3-D conformal local irradiation of the prostate by proton beam 220Mev. The focal dose of 28-28,8 SoGy-eq was fed to the prostate for 8, 5 or 3 fractions for 3, 4 or 5.5 Gy-eq, respectively. Given the photon component (44 Gy in 22 fractions to the whole volume of the pelvis), the dose to the prostate was 72.8., 72 and 72SoGr-eq, respectively. In 158 patients in the control group the similar doses to the pelvis were supplemented by local 4-dipole photon irradiation of the prostate to 68-72 Gy in 12-14 fractions of 2 Gy. Acute gastro-intestinal (GI) toxicity maximum, 2 St expression, were found significantly less frequently after the proton-photon therapy: in 54.4% of cases, versus 69.2% in the controls (p <0,01). Differences between acute genito-urinary (GU) toxicity were not observed. The frequency of late GI damage of 2 St. was 3 times less frequently observed in the study group: 10.2% versus 34,8 +/-% in controls. Damages of 3-4 St. were found in 1 patient of the main group and in 2 patients in the control group. GU damages of 2 St. were equally common after the proton-photon or just photon irradiation in 8.3% and 9.1% of patients respectively. Damages of 3-4 St. were diagnosed in 2.8% and 3.8%, respectively (p> 0.05). A 5-year survival without biochemical recurrence was in the study and control groups 60,0 +/- 5,4% and 61,9 +/- 4,4%, and a 9-year survival--45,5 +/- 8,5% and 42,8 +/- 7 1%, respectively (p > 0.05). Thus, precise local irradiation by a proton beam with ROD 3-5.5 Gy-eq. and SOD 28-28,8 Gy-eq supplementing photon irradiation of total small pelvis significantly reduces the severity of early and late post-radiation proctitis but does not reduce the risk of damage to the lower urinary tract and does not influence the anti-tumor treatment effectiveness compared to conventional conformal photon radiotherapy. In this case, the proton boost modes: 8 fractions for 3 Gy, 5 fractions for 4 Gy and 3 fractions for 5.5 Gy does not significantly differ in the level of toxicity.

[The role of RPA classification in the treatment of high-grade gliomas].

One of the main gliomas treatment programs development criteria is still the morphology, the RPA classification with risk factors developed for high-grade tumors is rarely taken into consideration. In our study shows a high value on the criterion of overall survival identified in the classification of the six RPA classes. The most important factors in the RPA classification are patient's age and the Karnofsky performance scale value. RPA classification can be useful for new treatment strategies development.

[Optimal doses and timing for tele-irradiation of bone metastases in patients with life expectancy more than 3 months].

The aim of the current study was to improve the bone metastases irradiation parameters in patients with life expectancy more than 3 months. The current randomized study included a total of 333 patients with bone metastases (breast cancer metastases in 71% of cases) receiving 488 courses of photon irradiation. Irradiation effect was observed in 95.8-100% of cases regardless of fraction number and irradiation regimen. The rate of complete effect was the same for all irradiation regimens, but raised gradually from 33.3% to 50.4% and 65.9% respectively when irradiation was given by 2, 3 and 4 fractions, 6,5 Gy each (p < 0.03); 78.4% (p < 0.01) cases of complete effect were observed in patients receiving irradiation by multiple small fraction compared to the groups receiving irradiation by 2 or 3 fractions of 6.5 Gy. The complete effect was more often observed in breast cancer (67%) and prostate cancer (63%) patients in comparison to lung cancer (47%) and renal cancer (30%) patients (p < 0,05) independent of metastases localization. The mean frequency of pain recurrence in irradiated area was 8.2% in all primary tumor and metastases localizations, irrespective of irradiation dose and regimen. Based on above results we recommend for breast cancer and prostate cancer patients with bone metastases and life expectancy more than 3 months the irradiation with 19.5 Gy given by 3 fractions. The patients with metastasizing lung and renal cancer should receive 26 Gy irradiation by 4 fractions 6.5 Gy each given once every 5.

[The optimal total focal radiotherapy dosage after first-line chemotherapy in patients with Hodgkin lymphoma].

Based on the treatment results of 300 Hodgkin lymphoma patients the authors formulated the basic approaches for radiation treatment in ABVD and BEACOPP-21 chemotherapy regimens recipients. In patients with complete response to chemotherapy any dose regimen (26 to 44 Gr) leads to 100% local disease control. In patients with major response to chemotherapy (PR> or =80%) the 36 Gr total focal dose allows an adequate local control, more intensive local control doesn't yield better results. In patients with PR 0-79% the implication of total focal doses less than 40 Gr leads to statistically significant increase of nodal relapse rate. These treatment approaches may be implied by specialists conducting chemotherapy and radiation therapy in Hodgkin lymphoma patients.

[The optimal radiation volume after first-line chemotherapy in Hodgkin lymphoma].

Radiation therapy has evolved from extended-field radiation therapy (EFRT) to involved-field radiation therapy (IFRT), reducing toxicity while maintaining high cure rates. Recent publications recommend a further reduction to involved-nodal radiation therapy (INRT); however, this has not been clinically validated. The need for irradiation or optimal radiation volume after chemotherapy are not defined. The treatment results of 296 Hodgkin's disease patients receiving ABVD or BEACOPP-21 chemotherapy with consequent EFRT demonstrate CR/PR > or = 80% and 99% local disease control rate. Beam therapy with EFRT is possible to use if dose levels don't exceed 30 Gy. Higher doses demands reduction of volume of radiating target. In our opinion the optimum program of beam therapy involves 2 stages with maximal possible dose level EFRT followed by additional INRT. Those approaches offer perspectives for Hodgkin's disease treatment.

[Role of response to first-line chemotherapy and of the primary lesion in Hodgkin lymphoma].

Based on the results of combined treatment with inclusion of ABVD and BEACOPP-21 chemotherapy regimens the basic principles of therapy depending on the nodal relaps criterium were developed. The most rational approach to treatment results evaluation concerns the lesions with the least response to chemotherapy. The groups of "adequate" and "inadequate" response to chemotherapy should be formed. The initial lesion localisation doesn't play an important part in the modern chemotherapy settings and should not be concerned while choosing tactics of radiation therapy. The method described should interest oncologists and radiologists involved in the treatment of Hodgkin lymphoma.

[Surgical and combined treatment for primary carcinoma of the trachea].

Our study was conducted in patients with primary squamous cell carcinoma of the trachea and adenoid cystic carcinoma (191) (radical surgery--90; combined treatment--101). The former pathology was relatively more aggressive. Combined treatment proved more effective as compared with surgery alone (5- and 10-year survival after surgery was 79 and 64%; combined treatment--92 and 79%, respectively).

[Radical radiotherapy of primary cancer of the trachea].

The paper deals with the importance of treatment of primary cancer of the trachea and, in particular, the experience of the Center in using radical therapy for inoperable squamous cell tumors and adenoid cystic carcinoma. An original system of tumor staging developed at the Center draws on international classifications (TNIVI) and methods of radiotherapy depending on tumor localization. It is shown that tracheal malignancies, especially adenoid cystic carcinomas, are characterized by relatively high radiosensitivity.

[Risk factors and long-term results of radiotherapy in grade-3 and -4 brain neoplasms].

Data on the treatment of 278 patients with brain tumors grade III-IV were evaluated, end-results compared and relevant prognostic factors identified. In our view, average fractionated radiotherapy is not inferior to standard fractionation modalities. It offers an advantage of using different single target doses. In primary patients with high-grade malignancies, an index (Karnofsky) of less than 60% appeared to be the most significant practical factor of prognosis. Both age and tumor size proved significant.

[Risk factors for hematologic toxicity and multifaceted analysis of blood in Hodgkin's disease: a model for hematologic toxicity].

Basic hematological features of CEA/ABVD medication for Hodgkin's disease were studied. An effective model was worked out on the principle of data discrimination for predicting different leukocytic toxicities induced by cytostatics-1 administration, once in two weeks. It might predict individual limits (dosage and intervals) of a chemotherapy course unless a colony-stimulation technique is used.

[Features and risk factors of post-mastectomy, locally advanced breast cancer relapse].

Multivariate analysis of risk of locally-advanced breast cancer IA-IIIB progression was carried out in 444 patients 10 years after mastectomy in the framework of two randomized studies. Combination therapy (median 156.3 months) included mastectomy, different modalities of neoadjuvant and adjuvant chemohormonal and radiotherapy.

[The role of adjuvant radiotherapy in the complex treatment of stage III-IV aggressive non-Hodgkin's lymphoma].

Immediate and end results of chemoradiotherapy of 225 patients (average age--43 years) with primary aggressive non-Hodgkin's lymphomas stage III-IV were evaluated. Stage 1 of treatment included 4-8 cycles of chemotherapy (ACOP and other standard protocols); stage 2--irradiation of residual foci with 20-50 Gy, or 20-36 Gy for originally extensive and extralymphatic foci when in full remission. The latter's rate rose from 24 to 65% (p < or = 0.05) following adjuvant radiotherapy although that of failures remained unchanged. The disease is specific, so relapse-free survival in cases of generalized primary aggressive lymphoma in full remission remained unchanged too whatever the stage at which full remission emerged.

[Multivariate analysis of risk of cardiac complications in Hodgkin's lymphoma].

A computer database was created to take care of a wide range of protocols for combined treatment of Hodgkin's disease stage I-IV (n=1,573). Early-onset radiation-related injuries (pneumonitis) and exposure of lung tissues to radiation were identified as the main risk factors for cardiopathology development. It is suggested that total focal dosage used after chemotherapy be reviewed since total dosage for the entire lymph collector in excess of 30 Gy might contribute to hazards of cardiopathology. However, a locally administered TTD ranging 36-44 Gy to deal with residual tumor offers best advantage in preventing local relapse. Nor does it increase the risk of future complications. Our approach might promote individualization of prognosis as far as cardiac complications involved in Hodgkin's lymphoma are concerned.

[An evaluation of damage caused by radiation and chemical drugs to urinary bladder mucosa in stage T1-T2N0V0 cancer].

An evaluation of damage caused by radiation and chemical drugs to urinary bladder mucosa in stage T1-T2N0V0 cancer is presented and therapeutic modalities are discussed. The authors summarize their experience and offer recommendations for optimal treatment of the disease. Also, suggestions are made how to work out indications and contraindications in dealing with a specific urinary bladder cancer vis-avis stage and possible complications.