Determination of oxygen perfusion in the area of radiation-induced fibrosis of the skin in patients with breast cancer and its role in pathogenesis of late radiation injury.

AIM: Late radiation injury in the form of radiation-induced fibrosis (RIF) is one of the many complications of radiation therapy. The aim was to evaluate oxygen perfusion in the skin in the area of late radiation injury manifested as RIF in patients with breast cancer. MATERIALS AND METHODS: Based on our first-hand experience in treating late radiation injures of soft tissues in patients with breast cancer, we measured oxygen perfusion of the skin (tсрО2) in the area of late radiation injury using a transcutaneous monitor (oximeter) TCM 400 (Radiometer, Denmark). RESULTS: Partial oxygen pressure tcpO2 in the RIF area in patients with breast cancer didn't show any significant decrease compared to healthy tissue. Mean value of partial oxygen pressure tcpO2 in the RIF area was 42.650 ± 9.178 mmHg, in the healthy tissue it was 45.180 ± 8.025 mmHg. Maximal difference in tcpO2 between the damaged and healthy tissue was 30 mmHg. CONCLUSIONS: Results of the study suggest that there's no significant difference between oxygen perfusion (tcpO2) in the area of RIF and healthy tissue.

[Laparoscopic surgery in treatment for colon cancer].

There are presented results of treatment of 347 patients with colorectal cancer. Laparoscopic surgery had been planned for 92 (26.5%) patients (study group). In 79 (85.9%) patients surgery was performed completely by laparoscopy, 13 (14.1%) patients underwent conversion. In 255 (73.5%) patients surgery was carried out from an open access (control group). The authors showed the effectiveness of the use of minimally invasive techniques in treatment for colorectal cancer.

[FEATURES OF THE MIRIZZI SYNDROME TREATMENT].

Analysis of the possibilities of application of minimally invasive approaches in Mirizzi syndrome. Analyzed the treatment of 70 patients with the syndrome Mirizzi treated from 2002 to 2012. The study describes the features of the application of minimally invasive interventions in Mirizzi syndrome. Application of minimally invasive techniques in the treatment of Mirizzi syndrome is permissible when assessing the diagnostic characteristics obtained at the preoperative and intraoperative phases. Frequency conversion during minilaparotomic access at Mirizzi syndrome lower than for laparoscopic. Performing intraoperative cholangiography before main stages of the opera helps to concretize optimum volume of intervention.

Abituzumab combined with cetuximab plus irinotecan versus cetuximab plus irinotecan alone for patients with KRAS wild-type metastatic colorectal cancer: the randomised phase I/II POSEIDON trial.

BACKGROUND: Integrins are involved in tumour progression and metastasis, and differentially expressed on colorectal cancer (CRC) cells. Abituzumab (EMD 525797), a humanised monoclonal antibody targeting integrin αν heterodimers, has demonstrated preclinical activity. This trial was designed to assess the tolerability of different doses of abituzumab in combination with cetuximab and irinotecan (phase I) and explore the efficacy and tolerability of the combination versus that of cetuximab and irinotecan in patients with metastatic CRC (mCRC) (phase II part). METHODS: Eligible patients had KRAS (exon 2) wild-type mCRC and had received prior oxaliplatin-containing therapy. The trial comprised an initial safety run-in using abituzumab doses up to 1000 mg combined with a standard of care (SoC: cetuximab plus irinotecan) and a phase II part in which patients were randomised 1 : 1 : 1 to receive abituzumab 500 mg (arm A) or 1000 mg (arm B) every 2 weeks combined with SoC, or SoC alone (arm C). The primary end point was investigator-assessed progression-free survival (PFS). Secondary end points included overall survival (OS), response rate (RR) and tolerability. Associations between tumour integrin expression and outcomes were also assessed. RESULTS: Phase I showed that abituzumab doses up to 1000 mg were well tolerated in combination with SoC. Seventy-three (arm A), 71 (arm B) and 72 (arm C) patients were randomised to the phase II part. Baseline characteristics were balanced. PFS was similar in the three arms: arm A versus SoC, hazard ratio (HR) 1.13 [95% confidence interval (CI) 0.78-1.64]; arm B versus SoC, HR 1.11 (95% CI 0.77-1.61). RRs were also similar. A trend toward improved OS was observed: arm A versus SoC, HR 0.83 (95% CI 0.54-1.28); arm B versus SoC, HR 0.80 (95% CI 0.52-1.25). Grade ≥3 treatment-emergent adverse events were observed in 72%, 78% and 67% of patients. High tumour integrin αvß6 expression was associated with longer OS in arms A [HR 0.55 (0.30-1.00)] and B [HR 0.41 (0.21-0.81)] than in arm C. CONCLUSION: The primary PFS end point was not met, although predefined exploratory biomarker analyses identified subgroups of patients in whom abituzumab may have benefit. The tolerability of abituzumab combined with cetuximab and irinotecan was acceptable. Further study is warranted. CLINICALTRIALS.GOV IDENTIFIER: NCT01008475.

[Postoperative intraperitoneal complications in colon cancer surgery].

The authors studied the clinical characteristics and terms of the development of postoperative intraperitoneal complications in patients undergoing colon cancer surgery. It was stated, that the diversity of clinical data depended on complication characteristics. Results of investigation allowed defining of the most dangerous terms of intraperitoneal complications and risk factors.

[Possibilities of surgical treatment for disseminated breast cancer].

More than in 10% of breast cancer patients distant metastases are detected at diagnosis. The results of treatment of 191 patients are presented. Removal of the primary tumor in case of newly diagnosed advanced breast cancer (oligometastatic) increases the mean duration of life from 26 months up to 38 months (p < 0.01). 3-year overall survival increases from 49% to 71% (p = 0.001), and a 5-year survival-from 18% to 47% (p = 0.001). 9% of patients with metastatic breast cancer who underwent mastectomy live 10 years and more. The relative risk of death in the presence of distant metastases after resection of primary tumor, on average decreases by 34%. By means of multivariable analysis the best results after mastectomy were obtained in the localization of distant metastases in the bones and soft tissues, high expression of steroid hormone receptors, the absence of overexpression of HER2/neu, luminal A type, positive response to preoperative systemic therapy and attaining free surgical margins.

[Fulminant acute pancreatitis. Are there objective criteria of the disease?].

A retrospective analysis has been made of the results of the diagnosis and treatment of 71 patients having severe pancreatitis. As a result, factors were revealed which restrict the possibilities of conservative treatment associated with pessimistic prognosis of the disease. Among them there are pancretitis-specific organic abnormalities (pulmonary, cardio-vascular, renal dysfunctions), diffused pancreonecrosis and infection of destructive zones. All the parameters in question are included in the proposed model of prognosis of the fulminant course of pancreatitis having high diagnostic accuracy up to 88.3%.

[Perspectives in use of surgery for disintegrating breast tumor].

Fifty-one patients with decaying breast cancer without signs of distant metastasis were operated on at the Academy's Clinic (September 2004 - December 2009). According to the 3-year follow-up, 18 out of 27 (62.5%) survived for 3 years and longer.

XM02 is superior to placebo and equivalent to Neupogen in reducing the duration of severe neutropenia and the incidence of febrile neutropenia in cycle 1 in breast cancer patients receiving docetaxel/doxorubicin chemotherapy.

BACKGROUND: Recombinant granulocyte colony-stimulating factors (G-CSFs) such as Filgrastim are used to treat chemotherapy-induced neutropenia. We investigated a new G-CSF, XM02, and compared it to Neupogen after myelotoxic chemotherapy in breast cancer (BC) patients. METHODS: A total of 348 patients with BC receiving docetaxel/doxorubicin chemotherapy were randomised to treatment with daily injections (subcutaneous 5 microg/kg/day) for at least 5 days and a maximum of 14 days in each cycle of XM02 (n = 140), Neupogen (n = 136) or placebo (n = 72). The primary endpoint was the duration of severe neutropenia (DSN) in cycle 1. RESULTS: The mean DSN in cycle 1 was 1.1, 1.1, and 3.9 days in the XM02, Neupogen, and placebo group, respectively. Superiority of XM02 over placebo and equivalence of XM02 with Neupogen could be demonstrated. Toxicities were similar between XM02 and Neupogen. CONCLUSION: XM02 was superior to placebo and equivalent to Neupogen in reducing DSN after myelotoxic chemotherapy.

[Measures of prevention of diffuse peritonitis after operations for colorectal cancer].

An experience with treatment of postoperative complications in patients with colorectal cancer in specialized and surgical hospitals and an analysis of results of treatment of patients with incompetent intestinal anastomoses depending on the surgical strategy have shown that reoperations for exclusion of the gut with the incompetent anastomosis with the first symptoms of a developing complication allows prevention of possible complication.

[Abdomino-anal resection of the rectum (indications, technique, immediate and long-term results)]. / Briushno-anal'naia rezektsiia priamoi kishki (pokazaniia, tekhnika, neposredstvennye i otdalennye rezul'taty).

Abdomino-anal resection of the rectum with the descending is not an alternative variant of the intra-abdonimal resection with suturing devices. Each of these methods has indications and contraindications. In treatment of rectum carcinoma the observation of oncological principles is thought to be principal. The abdomino-anal resection of the rectum with the descending gave best results when the tumor was localized at the level of 6-7 cm from the anus. The application of the proposed modification might reduce the number of complications and lethality.

[Adjuvant chemotherapy with anthracyclines in comparison with the standard combination of CMF in breast cancer with high risk of relapse]. / Antratsiklin-soderzhashchaia ad''iuvantnaia khimioterapiia v sravnenii s klassicheskoi skhemoi CMF u bol'nykh rakom molochnoi zhelezy s vysokim riskom retsidiva.

The effectiveness of adjuvant therapy with adriablastin and doxorubicin for breast cancer has been compared to that of standard CMF. During 1985-1990, the study included 349 patients with T1-2N2M0 and T3N0-2M0 tumors; mean age--46 yrs; mean follow-up--96.7 months. Overall survival rate in the doxorubicin group was 73%, CMF--62%; relapse-free survival--62.1 and 55%, respectively. The absolute difference in overall survival rates (11%) proved barely significant (p = 0.056). However, the difference in overall survival (p < 0.05) after anthracyclines and CMF in patients with tumors T1-2N2M0 and T3N1M0 was significant and in favor of the former. As far as frequency and degree of side-effects is concerned, their patterns were practically identical in both groups, except for the significantly higher frequency of cardiotoxity and complete alopecia in doxorubicin therapy. Cardiotoxic complication rate was significantly reduced from 13.8 to 3.9% by cardioxane treatment.

[Intraoperative colonic sorption dialysis in colonic cancer complicated with colonic obstruction]. / Intraoperatsionnyi tolstokishechnyi sorbtsionnyi dializ pri rake tolstoi kishki, oslozhnennom tolstokishechnoi neprokhodimost'iu.

The data on treatment 84 patients with large bowel carcinoma aggravated by occlusion ileus are discussed. The study group included 49 patients who received intraoperative sorption dialysis of large bowel (ISDLB). Intraoperative lavage of large bowel (ILLB) was given to 35 patients who were in control. A significantly higher detoxication effect of ISDLB was recorded by hematological and biochemical index dynamics analysis. Lethality dropped to 6% in the group receiving ISDLB (11%). The latter patients spent 15 +/- 4 days in hospital as compared to 25 +/- 4 days in control. The postoperative complication rates were 14 and 29%, respectively. ISDLB should be indicated in complex therapy of bowel carcinoma aggravated by occlusion ileus because of its cleansing effect which significantly reduces end-genuous intoxication.