[The possibilities of surgical and combined treatment of patients with locally-disseminated renal cell carcinoma].

A comparative analysis of surgical and combined treatment of renal carcinoma in 84 patients has shown that preoperative embolization of the renal arteries failed to reduce blood loss and duration of operation, failed to increase recurrence-free period and 3 to 5 years survival of the patients. Specific features of combined interventions are described.

[Influence of immunological parameters on the effectiveness of systemic and loco-regional immunotherapy in disseminated renal carcinoma].

Survival was assessed among patients with disseminated renal carcinoma from different prognostic groups as established by MSKCC protocol. Multivariate evaluation pointed to prognostic value of IL-6 (spontaneous and induced production), IL-8 (spontaneous and induced production),TNF-alpha (spontaneous production), IFN-gamma (induced production), TNK-cells (CD3+CD16+CD56+), and T-regulatory cells (CD4+CD25+Treg). It was demonstrated that additional criteria may be used to evaluate prognosis.

[Arterial embolization as palliation for inoperable renal carcinoma].

Embolization of the renal artery was performed as a palliative measure in 93 inoperable patients at the Center's Clinic in 1991-2000. Radio-endovascular intervention was indicated in cases of bleeding (19, 20.5%), case-history macrohematuria with high risk of relapse (54, 58%) and drug-controlled pain (20, 21.5%). Bleeding was suspended for 3-16 days (average 7.5 +/- 4) after occlusion of the artery in 16 out of 19 patients and decreased significantly in 3 (16%). There was no bleeding after embolization among macrohematuria patients. Pain syndrome was abated in 70% while post-intervention complications occurred in 13%: they were transitory in 6.5% and--fatal in another 6.5%. Catheter-assisted arterial embolization is a fairly safe and efficient means of arresting bleeding from inoperable renal kidney coupled with marked analgesic effect.

[Poorly differentiated prostate cancer may be associated with cytomegalovirus infection in prostatic tissue].

Polymerase chain-reaction procedure was used to test archival samples of prostate tissue from 90 cancer patients for cytomegalovirus infection detected in 46.7%. The median Gleason score and G-index (TNM classification) were significantly higher in CMV-positive patients (8 and 4, respectively) than those in CMV-negative ones (6 and 2, respectively). A relationship between cytomegalovirus infection and poor prognosis of prostate cancer is suggested.

[Role of hormonal profile in adjusting therapy for prostate cancer].

Changes in testosterone, prolactin and estradiol levels were evaluated vis-a-vis outcome and different patterns of androgen suppression--continuous androgen blockade or intermittent therapy--for prostate cancer patients. There was a significant difference between pre- (3.4 +/- 0.5 mM/l) and post- (1.0 +/- 0.3 mM/l) treatment levels of testosterone in cases of tumor progression and that in patients with positive response--(9.1 +/- 0.6 mM/l) and (4.3 +/- 0.4 mM/l), respectively. Relatively low levels of testosterone involved tumor progression. Prolactin level was significantly higher in patients with multiple distant metastases--(18.6 +/- 1.2 microg/l) and isolated foci--(9.5 +/- 0.8 microg/l) while tumor progression was associated with enhancing correlation with PSA concentration. It was established that prolactin level can be used as a criterion for resumption or discontinuation of intermittent therapy. Estradiol dynamics was similar to that of prolactin. The difference between pre- (172.9 +/- 9.8 pM/l) and post- (246.5 +/- 12.8 pM/l) treatment levels of estradiol in cases of tumor progression was significantly higher than that in patients with positive response (85.0 +/- 3.8 pM/l) and (76.9 +/- 4.4 pM/l), respectively.

[Positron emission tomography with 18-fluorine deoxyglucose in the diagnosis and assessment of prostate cancer].

Results of PET studies using 18-fluorine deoxyglucose (18-FDG) in patients with large-size masses (51) are discussed. Histologically-confirmed prostate cancer was diagnosed in 36 (70.5%), benign hyperplasia--12 (23.5%) and chronic prostatitis--3(6%). 18FDG PET was conducted as whole body irradiation. Our results established its high predictive significance in identifying the scope of tumor involvement. However, the latter's potential is limited in diagnosis of primary tumor node due to low rate of glycolysis in it.

[Lymphoprostatic scintigraphy in regional lymphatic mapping in patients with prostate cancer].

The purpose of the investigation was to upgrade the diagnosis quality for metastatic lesion to the regional lymp nodes in prostate cancer. The results of the most widely used diagnostic techniques (computed tomography (CT), magnetic resonance Imaging, (MRI), radionuclide studies (RNS), and ultrasonography (USG)), which had been compared with those of histology of removed lymph nodes, were assessed. For this, 74 patients with prostate cancer were comprehensively examined and treated at the Central Research X-ray Radiolological Institute. The comparative assessment of radiodiagnostic techniques (USG, CT, MRI, and RNS) showed the high informative value of retroperitoneal lymph nodal MRI in the detection of structural-and-morphological and anatomic-and-topographic changes in the lymph nodes (87.5% sensitivity, 83.3% specificity, and 85.7% accuracy). The developed lymphoprostatic scintigraphy (LPSG) is an informative technique that allows the better diagnosis of prostate metastases to the regional lymph nodes (92.4% sensitivity, 91.7% specificity, and 92.1% accuracy; the prognostic value of a positive result is 90.7%). LPSG is superior in its informative value to small pelvic USG and CT and inferior to indirect lymphoscintigraphy and yields valuable additional information on the physiological function of the small pelvic lymphatic collector.

[Capacities of complex ultrasound study in the diagnosis of prostate cancer].

Prostate cancer (PC) constitutes the bulk of male small pelvic abnormalities. The early diagnosis of PC is the most topical problem in oncourology. At present, ultrasound imaging is common in the diagnosis of prostatic diseases. With the advent of ultrasonic angiography, the diagnosis of PC has gone to a new level. The high-accuracy diagnosis of early PC has been made by complex ultrasound study that yields images of prostatic tissue and vascular structures. The sensitivity and specificity of transrectal ultrasound study of the prostate in the detection of PC and in the estimation of the extent of a local neoplastic process.

[Prognosis of efficacy of organ-saving treatment of invasive bladder cancer].

It is suggested that Scr-index for radiation-induced apoptosis in leukocytes in vitro be determined prior to combined therapy of urinary bladder cancer in order to estimate its efficacy. It was identified by studying leukocytes of peripheral blood from patients in whony white blood cells DNA level decreased after exposure to 2 Gy and 3-hr incubation at 37 degrees C. Values over 1.0 predicted relatively longer relapse-free survival. Scr-index of over 1.20 pointed to an insignificant decrease in leukocyte count during therapy. When it ranged 1.00-0.75, leukocyte count fell by approximately 25%; S(cr)-index below 0.55 indicated grade III blood poisoning.

[Role of Ki-67, mutated gene-suppressor p53 and HER-2neu oncoprotein in the prognosis for the clinical course of bladder cancer].

A retrospective analysis included 63 patients with urothelial cancer. Untreated tumor tissue sampled in the course of primary surgery was examined by immunostaining procedure. After surgery, superficial tumors were treated with intravesical chemotherapy, invasive cancer--chemoradiotherapy. Overall survival was significantly higher in cases of low expression of antigen Ki-67 and gene-suppressor p53 while relapse-free survival in patients without HER-2 expression was significantly higher than in cases of overexpression.

[Positron emission tomography in oncourology].

The authors present the results of the examination of 61 patients with genitourinary space-occupying lesions, using 18F- fluorodeoxyglucose positron emission tomography (PET) in whole body mode. In all cases the diagnosis was verified morphologically. The results demonstrated high diagnostic accuracy of PET, including possibility to determine the extent of oncourological cancer. However, the method displays poor efficacy in cases of hypernephroid cancer due to low level of glycolysis in this type of tumor.

[Effectiveness of repeated systematic radiotherapy for generalized prostate cancer].

Examination of 127 patients with generalized prostate cancer established a low prophylactic effect of systematic treatment with strontium-39 chloride: it failed to alleviate pain in metastatic cancer, nor was it followed by longer mean survival. Repeat systematic radiotherapy is not indicated when palliative measures such as hormonal therapy, local radiotherapy and chemotherapy are still effective.

[Combined therapy for patients with invasive bladder cancer]. / Kombinirovannoe lechenie bol'nykh invazivnym rakom mochevogo puzyria.

Organ preservation has been investigated inmuscle-invasivebladder cancer over the past years as an alternative to standard radical cystectomy. However, the morbidity of radical cystectomy and early reports of good results of radical transuretheral resection of bladder tumors (TURBT) have stimulated interest in combined treatment for muscle-invasive bladder cancer. Organ preservation requires a trimodal schedule, including transuretheral surgery, mega voltage radical external beam radiotherapy (EBRT) and adjuvant chemotherapy (ACT). Our results point to the effectiveness of combined therapy of urinary bladder in old patients with invasive, advanced cancer (stage T2). These results demonstrate the effectness of intra-arterial ACT when used in combination with EBRT.