[Pancreaticoduodenectomy - results and prospects (two-center study)]. / Pankreatoduodenal'naya rezektsiya ­ rezul'taty i perspektivy (dvukhtsentrovoe issledovanie).

OBJECTIVE: To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of postoperative complications. MATERIAL AND METHODS: There were 336 PD procedures between 2016 and mid-2022 in two centers. We assessed the factors influencing specific postoperative complications (postoperative pancreatitis, pancreatic fistula, gastric stasis, arrosive bleeding). Several risk factors were distinguished: baseline pancreatic disease and tumor size, CT-signs of a «soft¼ gland, intraoperative assessment of the pancreas, number of functioning acinar structures. We assessed surgical prevention of pancreatic fistula via preserving adequate blood supply to the pancreatic stump. The last one is provided by extended pancreatic resection and reconstructive stage of surgery, i.e. Roux-en-Y hepatico- and duodenojejunostomy with isolation of pancreaticojejunostomy on the second loop. RESULTS: Postoperative pancreatitis underlies specific complications after PD. The risk of pancreatic fistula in case of postoperative pancreatitis increases by 5.3 times compared to patients without pancreatitis. Postoperative pancreatic fistula is more common in patients with T1 and T2 tumors. According to univariate analysis, only pancreatic fistula significantly affects the risk of gastric stasis. Among 336 people who underwent PD, pancreatic fistula occurred in 69 patients (20.5%), gastric stasis - in 61 (18.2%), pancreatic fistula complicated by arrosive bleeding - in 45 (13.4%) patients. Mortality rate was 3.6% (n=15). CONCLUSION: Modern prognostic criteria are valuable to predict specific complications after PD. A promising way to prevent postoperative pancreatitis can be extended pancreatic resection considering angioarchitectonics of the pancreatic stump. Roux-en-Y pancreaticojejunostomy is advisable to reduce aggressiveness of pancreatic fistula.

Comparison of Biological Effects of γ-Radiation of Low and Ultra-High Dose Rate on Lymphocytes and Cultured Human Malignant Lymphoma Cells.

We studied the effect of low and high-dose rate photon radiation on activation of cell death by apoptosis and necrosis in malignant cell lines of lymphocytic origin Raji and Jurkat (human B and T-cell lymphomas) and normal human lymphocytes from healthy volunteers. It was shown that photon radiation with ultra-high dose rate induced significantly higher levels of "early" apoptosis and lower levels of necrosis compared to γ-radiation with dose rate used for radiation therapy.

[Hardware anastomosis in stomach cancer surgery]. / Apparatnyi anastomoz v khirurgii raka zheludka.

AIM: To choose optimal technique of esophagojejunostomy in stomach cancer regarding reliability, functionality and simplicity. MATERIAL AND METHODS: 145 patients with stomach cancer grade I-IV were enrolled. They were divided into 2 groups depending on the type of the anastomosis (manual or hardware). RESULTS: There were no significant differences between groups in the incidence of anastomosis failure, anastomotic stricture and reflux-esophagitis in long-term postoperative period. At the same time, duration of reconstructive stage with hardware anastomosis was 26±11.3 min, whereas for manual stage - 72±21.9 min (p<0.0001) depending on surgeon's experience. CONCLUSION: Hardware circular anastomosis in most clinical cases is an alternative to conventional manual anastomosis with the same reliability, safety and functionality. Moreover, principles of hardware anastomosis are the same for open and endoscopic surgery that makes this technique universal and necessary for wide development.

[Results of surgical and combined treatment for nonsmall cell lung cancer with postoperative radiation therapy in a mode of hypofranctionation. Post II. Relapse-free survival and survival without locoregional recurrence].

Conducting postoperative radiotherapy in a mode of hypofranctionation with SFD-3Gy to TFD-36-39Gy (EQD2 = 43,246,8Gy) in combined treatment of patients with non-small cell lung cancer allows significantly increasing a 5-year disease-free survival at IIB-IIIB stages of the disease (pN1-2) as well as the central cancer, squamous cell morphological type of tumor after surgery in a volume of lob-bilobectomy. The clearest effect of postoperative radiotherapy is assessed by survival without locoregional recurrence where radiation therapy in the adjuvant setting allows achieving a statistically significant increase in local control of the disease to the level of 85-95% regardless of stage of the disease, tumor size, regional lymph nodes lesion and the surgical treatment.

Genetic disorders in primary brain glioblastomas.

Glioblastomas are characterized by a variety of genetic and epigenetic disorders, identification of which allows constantly expanding a list of genes directly involved in carcinogenesis, thus increasing molecular diagnostics, monitoring and predicting disease. Molecular-genetic studies of patients with glioblastomas allowed revealing changes relevant to this disease and determining their prognostic significance. In the future molecular-biological markers along with clinical and therapeutic factors may play a role of separate and independent factors of prognosis in patients with malignant brain lesions.

[Brachytherapy as monotherapy for prostate cancer with the use of temporary sources].

The aim of this study was to investigate disease-free sur- vival and toxicity of high-dose rate brachytherapy (HDR-BT) in patients with prostate cancer at low risk of progression in monotherapy. With the use of advanced methods of imaging and planning brachytherapy allows achieving a high accuracy of radiotherapy delivering the adequate dose to the prostate and in the same time minimizing the toxic effects from adjacent organs. Brachytherapy by Ir-192 was carried out in 20 patients, in the form of monotherapy 3 fractions in a single focal dose 10 Gy with a two-week interruption between fractions to a total focal dose 30 Gy. Biologically effective dose was 230 Gy. The percentage of the prescribed dose on organ-target (V100) was not less than 95% (average 97.1 %). The critical dose on the urethra and the rectum was 110% and 70% of the prescribed dose respectively. The early and late radiation toxic reactions from genitourinary system and gastrointestinal tract in all of them were marked only as I grade. There were no adverse events of II-IV grades. Therefore HDR-BT as monotherapy has proved to be a safe and effective method of treatment prostate cancer patients of low risk of progression. Disease-free 5-year survival was 100% while minimizing toxic reactions from adjacent organs.

[Prognostic factors in treatment for low-grade brain supratentorial infiltrative gliomas].

The study showed the results of univariate and multivariate analyses of treatment of patients with low-grade brain supra- tentorial infiltrative gliomas. It was reaffirmed the importance of the most significance of such adverse prognostic factors as histology, tumor size, displacement of midline structures of the brain, age and neurological deficit. When assessing the prognostic significance of severity of the debut of clinical symptoms in this category of neuro-oncological patients as well as radical surgical treatment of the primary tumor there were obtained data confirming the absence of their independent prognostic significance.

[Automated contact radiation therapy - conditions for effective use in practical healthcare].

There are discussed the following questions: the use of import-substituting technologies in sphere of contact radiation therapy based on integration of the technological complex AGAT-VT with endostatic equipment and production meth- ods of individual application systems; the use of computed tomography and magnetic resonance tomography technologies for endostatic visualizations and dosimetry; ways of laser modification and prevention of complications and apparatus- technological possibilities of direct dosimetry.

[Analysis of predictors influencing the results of the combined treatment for anaplastic astrocytomas (grade III) of the brain].

In our study the analysis of significant predictors affecting the results of treatment of anaplastic astrocytoma brain (grade III) is showed. According to our data to assess the effectiveness of special treatment of these patients is possible with such clearly defined predictors such as age, volume of surgery, initial tumor size and functional status (the Karnofsky index). The study demonstrates that in patients who underwent radiotherapy using single focal dose of 3 Gy overall survivals was comparable with the group of patients who underwent radiation therapy using small dose fractionation. The use of adjuvant chemoradiotherapy in patients with grade III glioma does not increase overall survival rate compared with patients who received only adjuvant radiotherapy.

[The role of systemic radiotherapy in the combined treatment for hormone-resistant prostate cancer].

To relieve pain associated with multiple bone metastases radiopharmaceutical method of treatment is of great importance--the use of beta-emission isotope of strontium chloride-89 (metastron). Passing through the human skeletal system, strontium-89 accumulates in areas of high mineral density, which is it typical for osteoblastic metastases. In our institution in the frames of a randomized trial in 90 patients with metastatic hormone-resistant prostate cancer it was carried out systemic radiotherapy with strontium-89 chloride as a stage of complex treatment. Stabilization of pain syndrome during treatment was 72,7% and its progression was noted in 27,3% cases. Radiopharmaceutical therapy is well tolerated and can be used as a stage in complex treatment of patients with hormone-resistant prostate cancer.

[Results of surgical and combined treatment for non-small cell lung cancer with postoperative hypofractionated radiotherapy: overall and disease-specific survival].

Compared with surgical treatment the combined treatment of patients with non-small cell lung cancer accompanied by post-operative radiotherapy in the mode of hypofractionation from 3 Gy to SOD-36-39 Gy (EQD2 = 43,2-46,8 Gy) allowed statistically significant increasing a 5- and 10-year overall and disease-specific survival in patients with metastases to regional lymph nodes (pN1-2). The increase of overall and disease-specific survival was also observed in patients older than 60 years with the worst initial status (70-80 by the Karnofsky scale), II stage of disease, peripheral cancer and adenocarcinoma however for these groups survival differences did not reach a statistically significant level. The presented method of postoperative irradiation did not have severe toxicity and did not lead to a decrease in survival of elderly and functionally debilitated patients.

[Results of combined and complex treatment for indolent and aggressive non-Hodgkin lymphoma of the stomach].

There were retrospectively assessed long-term outcomes of 125 patients with primary non-Hodgkin's lymphoma of the stomach (indolent--50, aggressive--75) using different programs of combined and complex treatment. The immediate results of the treatment in the group of indolent lymphomas were: complete remission 39 (78%), partial remission 7 (14%), the stabilization 3 (6%), progression 1 (2%) while in the group of aggressive lymphomas: complete remission 56 (74.7%), partial remission 8 (10.7%), without effect 3 (4%) and progression 8 (10.7%). It was revealed that primary indolent lymphomas of the stomach the efficiency of complex treatment is comparable to the efficiency of local methods of treatment (surgery, radiotherapy or its combination). The combination of chemotherapy and local methods of treatment gave better results compared with chemotherapy (a 5-year overall survival is 100% and 72% respectively). In the group of aggressive lymphomas the best rates in all types of survival were demonstrated by the subgroup of complex treatment as compared with the subgroup of local methods of treatment especially in terms of overall survival (100% and 65% respectively), and as compared with the subgroup where only chemotherapy was conducted, particularly in terms of disease-free survival (100% and 40% respectively). As an adjuvant therapy after surgical treatment it was preferable to use chemotherapy because such treatment program demonstrated the best rates of overall survival, which reached 92% on a 5-year and a 10-year milestone.

[Middle fraction radiotherapy for non-small cell lung cancer. Effect of increasing the total focal dose].

There were evaluated retrospectively the immediate and long-term results of radiotherapy in 259 patients with non-small cell lung cancer stages I-IV who had contraindications to surgery. Irradiation was carried out by middle fraction with single focal dose 3-4 Gr. We compared the results of treatment in two groups of patients differed in volume of total focal dose: I group (124 patients)--45 Gy, II group (125 patients)--60 Gy. An increase of total focal dose from 45 Gy to 60 Gy did not lead to an increase of the toxicity to vital organs including patients older than 60 years and patients with initially poorer somatic status. Disease-free survival significantly increased in total in the group with total focal dose 60 Gy and predominantly in tumors over 5 cm, in patients with ECOG 2-3 and in III-IV stage disease. An increase of total focal dose to 60 Gy in the group was significantly prolonged survival without local recurrences from 37% to 50% and by one-third reduced the frequency of locoregional recurrences. Identified benefits in overall and disease-specific survival the groups of non-small cell lung cancer patients with total focal dose 60 Gy compared with a group of non-small cell lung cancer patients who received radiotherapy in total focal dose 45 Gy at terms more than 5 years did not reach statistical significance.

[Complications and effectiveness of treatment of patients with locally advanced prostate cancer after combined radiotherapy and radical prostatectomy with postoperative radiotherapy].

Treatment for prostate cancer remains a significant social problem due to the continuing trend of growth of morbidity and mortality in Russia from this disease. In recent years a real alternative to surgical treatment is radiotherapy. In treatment of locally advanced stages of prostate cancer radiotherapy plays a dominant role. At our institution from 2005 till 2011, 105 patients with locally advanced prostate cancer underwent complex and combined treatment comprising in the first group the concomitant radiotherapy with Ir-192 and the control group--radical prostatectomy followed by adjuvant remote radiotherapy. In patients treated with concomitant radiotherapy compared to the control group there were occurred fewer number of genitourinary complications according to the RTOG scale (5,8% vs. 32,7%). In patients who had undergone radical prostatectomy followed by adjuvant radiotherapy urinary incontinence was met significantly often.