[Experience of surgical treatment of abdominal and intraabdominal desmoid fibromas].

It is presented the treatment results of abdominal and intraabdominal desmoid fibromas. Group of abdominal localization included 19 patients. 15 of them had primary tumors, 4 - recurrent tumors after surgical treatment. Radical (R0) operations were performed in all cases. Tumor removal was associated with plastic of abdominal wall by synthetic implant in 17 patients. Wide excision of surrounding tissues and musculo-aponeurotic layer of anterior abdominal wall allows to achieve long-term disease-free period. There weren't recurrent symptoms in terms from 4 to 60 months of observation. The second group included 28 patients with intraabdominal desmoid fibromas. Operations were performed in 11 (35.2%) patients including 3 cases of reoperations. There were 14 operations. Radical (R0) volume was applied in 11 (78.6%) operations, cytoreductive (R2) volume - in 1 (7%) operation. Explorative laparotomy was used in 3 (21.4%) cases because of involvement of mesenteric vessels. Combined treatment was performed in 4 (14.3%) patients. 14 (50%) patients received conservative therapy because of unresectable tumor including chemo-, hormone- and radiotherapy. Operated patients were under observation in terms from 11 to 156 months, median was 63.2 months. Recurrence developed in 4 of 10 (40%) patients after R0-surgery. Cytoreductive (R1/R2) volume is admitted for intraabdominal desmoid fibromas. But even in case of unresectable process and explorative intervention stabilization and regression of tumor is possible by means of chemo-, hormone- and radiotherapy in different combination. It allows to preserve a good life quality.

[The radiobiologycal approaches of the individual prognosis of the radiotherapy efficacy of the tumor deseases].

The results of several years standing investigations about the develop of the way to the individual prognosis of tumour sensitivity to radiotherapy are brought. The initial level of proliferative activity of different tumour types of individual patients--carcinoma of oropharingeal zone, stomach, oesophagys, rectum, glioblastoma have been studied. It was shown that for the several tumours the high initial level of proliferative activity is the indication of good prognosis. For the all tumours studied the significant decreasing of proliferative activity in the beginning of the radiation treatment is the good prognostic factor of tumour regression (decreasing of volume on 70-100%) or the strong damages of tumour tissue (III-IV grade of patomorphosis). The data of literature of last years are discussed and the proposal is that for the determination of prognostic factors the multiparameter analysis is need.

[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.

[Combined treatment of stomach neoplasms]. / Kombinirovannoe lechenie raka zheludka.

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.

[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.

[Function-sparing surgery in the combined therapy of laryngeal cancer]. / Funktsional'no-shchadiashchie operatsii pri kombinirovannom lechenii raka gortani.

The reports deals with the principle and methods of making a two-stage diagnosis of laryngeal tumor evolved on the basis of the data on two calibrated groups of 250 patients each and a computer-supported procedure of mathematical analysis. Two programs for a MC-52 microcalculator are suggested to select the scope of surgical intervention. Such procedures of preoperative radiation therapy as exposure under hyperbaric oxygenation conditions, cutting down the preoperative radiation dosage and shortening the interval between ir radiation course and surgery have been improved. Five improved procedures of saving therapy for tumors of the supraglottic area and four--for glottic cancer were used in 142 patients. The functional and oncological results of saving surgery were evaluated in 458 patients receiving combined treatment for laryngeal tumors. Said results were found to be beneficial.

[The proliferative activity of stomach cancer and evaluation of its individual radiosensitivity]. / Proliferativnaia aktivnost' raka zheludka i otsenka individual'noi radiochuvstvitel'nosti.

An indirect immunofluorescent method with polyclonal antibodies to thymidine was used to assess the proliferative activity (PA--percent of cells in the S-phase of the cell cycle) of 79 stomach tumors from primary cancer patients. Stomach cancer PA was shown to vary from 0.1 to 69.7%. PA did not depend either on a tumor size or a degree of the involvement of regional lymph nodes. The mean PA of well-differentiated adenocarcinoma was slightly lower (14.9 +/- 4.7%) than that of low differentiated ones. Of 79 patients a tumor process was interpreted as a resectable one in 62. They were given preoperative irradiation at a total focal dose of 36 Gy followed by operation. In addition to initial investigation PA in tumor biopsy specimens was assessed after delivering a dose of 12 Gy. PA changes at the beginning of a course of irradiation were compared with a degree of a radiation injury of tumor tissue after a course of irradiation was discontinued in 32 (explorative laparotomy was performed in 30). It was shown that tumor radioresistance could be predicted in unchanged PA indices of their increase at the beginning of a course of irradiation with the probability of 95%.

[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.

[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%.

[Approaches to predicting the reaction of human tumors to radiotherapy]. / Podkhody k prognozirovaniiu reaktsii opukholei cheloveka na luchevuiu terapiiu.

Immunofluorescent method using anti-thymidine antibodies was employed to assess proliferative activity of 217 human tumors including oropharyngeal, esophageal, gastric, rectal and lung cancer. The activity was evaluated before and, in 38 neoplasms, in the course of radiotherapy. It was shown that changes in the proliferative activity of oropharyngeal and gastric malignancies observed early in the course of radiation treatment may serve for predicting response.

[Approaches to the individual prognosis of tumor reaction to radiation and drug exposures]. / Podkhody k individual'nomu prognozirovaniiu reaktsii opukholei na luchevoe i lekarstvennoe vozdeistvie.

The problem in individual prediction can be viewed in two aspects: 1. to define the nature of tumor response to antitumor therapy; 2. to determine whether a specific therapeutic method is sufficient for a patient's cure. Individual prediction cannot solve the problem of therapy of cancer patients, however it will noticeably improve the results of routine cancer therapy and will help to use correctly uncommon therapeutic methods. The choice of patients with radioresistant malignant tumors out of the whole population will enable one to select correctly radiomodifiers.

[Organ-sparing surgery in laryngeal cancer]. / Ekonomnye operatsii pri rake gortani.

Basing on their experience with sparing surgery in combined treatment of pharyngeal carcinoma, the authors have developed a method for specification of the diagnosis before treatment and in the course of surgical intervention. Preoperative gamma-beam therapeutic scheme has been improved: long-distance irradiation is carried out under hyperbaric oxygenation with medium-fractionated doses and the total dose is reduced to 23.1 Gy, the intervals between the irradiation and surgery being 7-10 days. In order to improve the functional efficacy of economic radical surgery, methods of sparing surgery for Stages III-IV pharyngeal carcinoma were developed. Favorable functional and 3-year results were achieved in 314 patients with pharyngeal carcinoma, treated according to a multiple-modality scheme, including economic surgery as its second stage.

[Nontraditional fractionation of doses of ionizing radiation in clinical practice]. / Netraditsionnoe fraktsionirovanie dozy ioniziruiushchego izlucheniia vklinicheskoi praktike.

Various types of non-routine dose fractionation were used in 2062 patients with malignant tumors of different sites. The conclusion was that superfractionation was more preferable for tumors with a high proliferative pool, with fast growth rates, marked radiosensitivity. It ensures the protection of normal tissues without a decrease or even with an increase in an antitumor effect. Such fractionation can be recommended when large tissue areas are to be irradiated. Dynamic dose fractionation regimens proved to be more effective than the use of large fractions not only in squamous cell carcinoma but also in sarcoma both before operation and as therapy after a radical program.

[Preoperative radiotherapy under hyperbaric oxygenation of locally disseminated cancer of the larynx using a reduced total focal dose]. / Predoperatsionnaia oksibaroradioterapiia mestnorazprostranennogo raka gortani s umen'shennoi summarnoi ochagovoi dozoi.

Proceeding from an analysis of immediate and short-term results of combined therapy of laryngeal cancer (stage III) patients, the authors compared the efficacy of preoperative irradiation with relation to an oxygen regimen and the level of total focal doses in 3 groups of patients: 23.1 Gy under HBO conditions (the study group), 33 Gy (the 1st control group) and 33 Gy (the 2nd control group) in the air. Dose fractionation was 3.3 Gy at 48 h-interval in all cases. It was shown that a decrease in a dose of preoperative irradiation of laryngeal cancer (stage III) patients from 33 to 23.1 Gy under HBO conditions made no changes in immediate therapeutic results but it ensured noticeable advantages: the reduction of a period of preoperative irradiation and an interval between its discontinuation and operation, and an increase in the rate of first intention healing as a result of a sharp decrease in local radiation reactions.

[Radiotherapy in the combined modality treatment of patients with malignant tumors]. / Luchevaia terapiia v kombinirovannom lechenii bol'nykh so zlokachestvennymi opukholiami.

Proceeding from an analysis of their own experience in the combined treatment of over 4000 patients with malignant tumors of the main sites, the authors evaluate the importance of the methodological aspects of pre- and post-operative radiation therapy: levels of total absorbed doses, techniques of their fractionation, object and volume to be irradiated, and values of an interval between modalities of combined therapy. Their improvement on the basis of the latest advances in oncology, clinical radiology and radiobiology is one of the realistic ways for improving therapeutic results. The prospects of such improvement are associated with the development of uncommon dose fractionation schemes and the use of various modifiers in preoperative irradiation and extended indications for post-operative irradiation.