[Advances in radiotherapy of malignant tumours].

The authors discuss changes in the equipment and technologies of radiotherapy during the past 10-15 years. These changes ensured the improvement of diagnostics and treatment of neoplasms by two other main methods, surgical and medicamental. Modifications in the combined application of radiotherapy and surgery and of radio- and pharmacotherapy are discussed.

[Resection and prosthetics of abdominal aorta by surgical treatment of invasive retroperitoneal tumors].

Data of 5 patients, who required resection and prosthetics of abdominal aorta during radical excision of malignant retroperitoneal lesions, were analyzed. Therefore, 2 patients demonstrated retroperitoneal lymph node metastases of nonseminoma hermonogenous tumour, 1 patient had colorectal liver and lymph node metastases, another had ovarian tumor, and the rest--leiomyosarcoma of the aorta. Tubular Gore-tex aortic prostheses were used. Radical tumor excision provided absence of local recurrence in all patients. Only one patient showed further progression of the tumor as liver metastases. Thus, such an aggressive surgical approach could be appropriate in carefully selected group of patients.

[Results of surgical treatment of residual and recurrent anal tumors].

Radio- or chemotherapy is a modern standard of anal cancer treatment. Recurrence or partial remission rate after radiochemotherapy achieves 20-40%. The study is aimed to evaluate the role of abdominoperineal resection in the treatment of residual and recurrent anal cancer. 120 patients (aged from 30 to 81 (59+/-11) years, men:women ratio--1:9) were prospectively studied in the period of 1995 to 2007. The TNM distribution was as follows: T1-2N0M0--66(55.0%), T3-4N0M0--18(15.0%), T1-2N1-3M0--15(12.5%) and T3-4N1-3M0--21(17.5%) patients. The radiotherapy delivered in a dose range of 55-65 Gy was used alone or in combination with chemotherapy with 5-fluoruracil, mitomycin C or Xeloda. The complete tumor regression after radiotherapy/radiochemotherapy was achieved in 74(61.1%) of 120 patients with cancer-specific survival rate of 81.7%. Partial tumor regression was registered in 46 of 120 patients. The abdominoperineal resection was performed in 39(84.8%) of patients with the residual tumor. Thus, surgical treatment allowed secondary local tumor control in 76.9% of patients with the 5-year survival rates of 69.0%. The median survival time for the non-operated patients, including those, received an extra course of radiotherapy, was 19 months. The locoregional tumor relapse was diagnosed in 10(13.74%) of 74 patients with the complete tumor regression. The use of abdominoperineal resection allowed the secondary local tumor control and 5 year survival. Thus, abdominoperineal resection remains the method of choice in the treatment of residual and recurrent anal tumors.

[The development of radiotherapeutic techniques at the beginning of the 21st century in Blokhin Russian Oncological Research Center of Russian Academy of Medical Sciences].

The article describes the development of radiotherapeutic techniques in Blokhin Russian Oncological Scientific Center of Russian Academy of Medical Sciences at the end of the 20th and the beginning of the 21st centuries. Such developmental directions in radiation oncology as the development of non-conventional modes of radiation dose fractioning, the development of new radiotherapeutic techniques based on volumetric 3D dosimetric radiotherapy planning, the perfection of combined (contact plus distant) radiotherapy, the use of multidirectional radiomodifying agents, the application of radiotherapy as a part of combined and complex treatment with chemotherapy and surgery in different tumoral sensitivity to conservative treatment, are considered in the article. Immediate and long-term results achieved at the institution by the use of radiotherapy alone or as a part of combined or complex treatment in cases with certain malignant tumor localizations are described.

[Sentinel lymph nodes in squamous cell cancer of the head and neck].

Twenty five patients with squamous cell oral cancer and without clinical evidence of regional cervical metastases have undergone 99mTc lymphoscintigraphy of cervical lymph nodes to localize the sentinel node 24 hours before surgery. Intraoperative localization of the sentinel node with gamma-probe (the probe was removed afterwords) was followed by operation on the primary focus and radical neck fat dissection. The removed tissues were examined histologically. The sentinel nodes were detected in 22 (88%) patients. A total number of the sentinel lymph nodes was 44. Six patients had metastases in the sentinel nodes, in 3 of them metastases were detected in the removed fat. The results of the study show that the technique is informative in localization of the sentinel lymph node.

[Infiltrating lobular breast cancer: histological and immunohistochemical characteristics].

Lobular carcinoma ranks second among most frequent tumors of the breast. Metastases to the lymph nodes and distant organs are one of the most important prognostic factors. 60% regional lymph node metastases were morphologically diagnosed during surgical removal of the tumor. Distant metastases rate was 1% at the beginning of the treatment and reached 10% within 5-year follow-up. Cases of secondary uterus and epiploon lobular carcinoma are rare and tumor location in the breast should be proved.

[Laser DNA-flow cytofluorometry in the differential diagnosis and prognosis of the cervix uteri cancer].

Laser DNA-flow cytofluorometry (DNA-FC) was used to examine 102 primary patients with morphologically verified pathology of the epithelium of the cervix uteri. There was a significant reduction in the count of cells in the cellular cycle phase (CCP) G0/1 and its increase in the CCP S and G2 + M, as well as a rose in the cell proliferation index (PI) in actually invasive (n=45) and microinvasive cancer of the cervix uteri (CCU) (n=21) as compared with the baseline values (n=8), CIN I-II (n=7), and CIN III (21 patients with severe dysplasia and cancer in situ; their DNA-FC parameters were close and significantly indistinguishable). With unfavorable clinical and morphological factors of CCU prognosis (age over 50 years, postmenopause, stages II-III, high-grade tumor, more than 3 mm stromal invasion, more than 4 cm in size, lymphovascular invasion in the regional lymph nodes, the endophytic form of growth, and a primary focus in the endocervix), aneuploid tumors were more significantly frequently found. The poor CCU prognostic factors significantly decreasing total and relapse-free 4-year survival included tumors of aneuploid type, those containing greater than 40% of aneuploid cells, those containing less than 70% of tumor cells in CCP G0/1, those having 10% of tumor cells or more in CCP S or more than 30% cell PI. While predicting CCU, the DNA index (DNAI) and PI with 0.09 and 0.05 informative value coefficients, respectively are the most significant DNA-FC parameters (after Shenon). By using them, the risk of progressive disease may be predicted with 67.9% probability. When DNAI and PI are used in combination with the most significant clinical and morphological factors of CCU, the likelihood of the latter increases up to 89.3%.

[Problems of radiation therapy of patients with malignant tumors and modern ways of resolving them]. / Problemy luchevoi terapii bol'nykh zlokachestvennymi opukholiami i sovremennye puti ikh resheniia.

At the present stage of radiation oncology, treatment successes are mainly determined by improvement of multimodality therapy that utilizes benefits of each modality in individual patients. Radiotherapy is mostly empiric, as demonstrated by dose fractionation. Its significance in many situations is underestimated, which leads to unreasonably excessive irradiation or, vice versa, to its unreasonable refusal. So clinical searches for new knowledge of the actual role of radiotherapy in specific clinical situations are therefore continued. The advent of new-generation radiation therapy apparatuses opens up fresh opportunities for development of rational radiation methods by mathematically optimizing dosage fields of irradiation and creating its conformable conditions. The necessary conditions for further radiotherapy successes are continuation of research developments in rational simulation of spatial dosage distribution, in the use of radio sensibilizers and radio protectors, and in contact methods of radiotherapy and intraoperative irradiation.

[The role of tele-thoracoscopic parasternal lympho-dissection in the diagnosis and treatment of breast cancer]. / Rol' videotorakoskopicheskoi parasternal'noi limfodissektsii v diagnostike i lechenii raka molochnoi zhelezy.

The outcomes of treatment were studied in 190 patients with breast cancer who had undergone radical mastectomy with telethoracoscopic parasternal lymphodissection. An association of this parameter with the sizes of a primary tumor, with the extent of damage to the axillary lymph collector, with the histological pattern of a tumor, and with the site of a primary focus was analyzed. Radical removal of the parasternal lymphatic chain was proved by scintimammography in the pre- and postoperative periods. The high diagnostic value of telethoracoscopic parasternal lymphodissection was shown as a miniinvasive axilliary of radical mastectomy for breast cancer, which makes it possible to establish a stage of the disease reliably and to plan chemoradiation treatment adequately.

[Breast cancer with neuroendocrine differentiation]. / Rak molochnoi zhelezy s neiroéndokrinnoi differentsirovkoi.

One rare case of mammary carcinoma with an unusual clinical course and non-typical morphology is described. The diagnosis of mammary carcinoma with neuro-endocrine differentiation was established on the basis of histologic, immunomorphologic and electron-microscopic examination.

[Current possibilities of surgical and combined treatment of patients with uterine cancer]. / Sovremennye vozmozhnosti khirurgicheskogo i kombinirovannogo lecheniia bol'nykh rakom tela matki.

Surgical treatment alone was given to 88 patients with endometrial tumors while 182 patients underwent combined therapy. Three-year survival was 92.1%: 88.5% survived 5 years. With tumor invasion depth down to 10 mm, the method of choice was surgery: 5-year survival rate--89.1%. Postoperative irradiation of the small pelvis was indicated in cases of deep invasion of more than 10 mm. 5-year survival after surgery was 66.7 and combined therapy--76.7%. The end results appeared to depend on site: on sites in the upper two-thirds of the endometrium, 5-year survival after surgery was 90.4%; combined treatment of tumor sitting in the lower third or cervical canal--66.6 and 60.9%, respectively.

[Diagnosis and therapy of rhabdomyosarcoma in children]. / Diagnostika i lechenie rabdomiosarkomy u detei.

An analysis of 24-month relapse-free survival in 62 patients with rhabdomyosarcoma (S.I.O.P.-89) is presented. All children with rhabdomyosarcoma (RMS) stage I have survived; stage II--90, and stage III--62%, i.e. twice as many as compared with those treated before 1993. RMS sites included retroperitoneal space, spatium perinei, urinary bladder, testicle, abdominal and thoracic cavity. Diagnosis was based on clinical, instrumental, laboratory, X-ray, radionuclide, ultrasound and morphological data. Recommendations for examination of RMS suspects were worked out for different levels of expertise.

[Prognosis of epidermoid anal carcinoma regression after conservative treatment]. / Prognoz regressii opukholi pri konservativnoi terapii épidermoidnogo raka anal'nogo kanala.

The prospective study was concerned with definition of the clinical and therapeutic factors behind poor response of anal cancer to radio- (RT) or chemoradiotherapy (CRT). Out of 64 female and 8 male patients at the mean age of 57 (33-81), thirty six had split-course of 60-65 Gy (RT), twenty--60-65 Gy, 5-FU and mitomycin C (CRT) and eighteen--up to 55-65 Gy (1.5 Gy--session 1, 1.0 Gy--session 2) (hyper-fractionated RT) plus 5-FU, for squamous cell anal carcinoma. There was no endorectal ultrasound evidence of perirectal lymph node involvement (uN0): T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin or endorectal ultrasound: T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin metastases) were detected in 7 patients: T1-2uN1-2M0 (n=7), T3-4N1-3M0 (n=10). Endorectal ultrasound staging (ERUS) used a linear 7.5 MHz transducer. The uTNM system was devised on the basis of tumor invasion parameters. There were no tumors confined to the subendothelial layer of the anal canal (uT1); 24 (32.4%) tumors were confined to the internal anal sphincter (uT2); 19 (25.7%) invaded the external anal sphincter (uT3) and 31 (41.9%)--levator ani (uT4). All carcinomas T4 (n=9) corresponded to the uT4 category. Only T-stage and tumor invasion (uT) proved significant prognostic variables. Complete response of T1-2 was 79.2%, T3-4--33.3% (p=0.0003); uT2--95.8%, uT3--68.4%, and uT4--41.9% (except T4) (p=0.0001). In multivariate logistic analysis, uT alone appeared an independent variable (p=0.015). ERUS uTNM staging is more effective in prognosis for RT and CRT and, therefore, should be recommended for preliminary management of epidermoid anal carcinoma.

[Use of the device "microselectron" with high-speed delivery of Iridium-192 (192-Ir) in radiotherapy of some neoplastic diseases]. / Primenenie apparata "mikroselektron" s vysokoi moshchnost'iu dozy istochnika iridiia-192 (192-Ir) v luchevoi terapii nekotorykh onkologicheskikh zabolevanii.

An experience of managing inoperable tumors of extrahepatic ducts in patients with medially- and centrally-localized breast tumors, using large doses of 192Ir radiation (10 curie) emitted from a MecroSelectron installation, is presented. The installation has proved instrumental in carrying out intraluminal and intrastitial radiotherapy since it provides access to localizations inaccessible by other means used in such procedures.

[Is it possible to improve the quality of life of patients who have undergone pelvic evisceration?]. / Vozmozhno li uluchshenie kachestva zhizni bol'nykh pri évistseratsii taza?

Locally spread cancer makes up considerable percent (20-30%) in statistical structure of rectal tumors. In cases of cancer spread into the area of urine bladder triangle the operation of choice is pelvic evisceration. From 1977 to 1997 in the State research Centre of the Ministry of Health for Coloproctology pelvic evisceration in cancer spread to back wall of urine bladder in the area of triangle was carried out in 22 patients (20 male and 2 female). Mean age was 43.4 (29-56) years, 16 patients have undergone typical infralevator pelvic evisceration. There were no intraoperative lethality. Postoperative lethality made up 6.3%, complications--68.8%, 5-years survival rate--25%. Presence of two fecal fistulas on the anterior abdominal wall has decreased considerably the quality of life of the patients. Since 1993 the conception of preservation and restoration of natural passage of urine and bowel contents was adopted. In 4 cases infralevator pelvic evisceration with various types of ileocystoplasty and pull-through of colon into small pelvis with creation of smooth muscle cuff in perineal colostomy was carried out. In 2 patients evisceration was of supralevator-character cystoplasty of local tissues and performance of coloanal anastomosis were carried out. The application of reconstructive-restorative ways in coloproctology and urology considerably contributed to the improvement of the quality of life of the patients after pelvic evisceration.