Vol 21, No 1-2 (2016)

Due to the gain in the average life expectancy in developed countries there is increased the incidence rate of malignant neoplasms. According to the forecast of the USA National Cancer Institute in the next 20 years every 2nd American man and every third American woman will get sick with cancer, and therefore oncology should be considered to be the main medical specialty. Molecular characterization of tumors will become routine, and it will provide an opportunity via screening to detect precancerous abnormalities and early forms of cancer. Surgery will become mostly organsaving modality, radical mutilating surgery will go down in history, traditional chemotherapy with low selectivity of action will send to the glue factory. In the arsenal there will stay well-aimed «targeted» drugs hitting right on target mechanisms of the uncontrolled growth of tumor cells and their dissemination.

Introduction: prostate cancer (PCa) is the second cancer after lung one among all males. The main treatmentfor patients with localized prostate cancer is a radical prostatectomy (RP). After RP PCa occurs in patients at the T1-T2 stage - in 25 - 35% of all cases and in patients at the T3 stage - in 33.5 - 66% of all cases. Currently, one of the treatment options for patients with recurrence PCa after RP is a «salvage» radiation therapy. Materials and methods: medical records of 59 patients with PCa recurrence after radical prostatectomy (pT1-3pN0M0) were analyzed. Biochemical recurrence was observed in 25 (42,4%) and clinical recurrence in 34 (57,6%) patients. Radiotherapy have been prescribed to the regional lymphatic nodes to 44,0 Gy of 2,0 Gy each, to the prostate bed to 66,0 Gy of 2,0 Gy each and if the region of the clinical recurrence was identified - to 72 Gy of 2,0 Gy. Treatment was realized on linear electron accelerators using 3D technology radiotherapy: 3DCRT, IMRT, VMAT. Results: all 59 patients were treated by the «salvage» radiotherapy. Median follow-up was 48 months (24-91). Biochemical control w as achieved in 51 (86.4%) patients, locoregional control in 58 (98.3%) patients. No acute and late grade 3 or greater toxicities were observed.

Multidisciplinary approach that comprises the passing the examination in the exam room with the Pap test, questionnaires, ultrasound or digital mammography screening (MS) according to the age is a promising way of solving the problems with the visual localization of cancer, in particular with the reproductive organs. A minimally invasive removal technology that helped to determine the nature of tumor pathologies and remove those potentially dangerous hotbeds at the same time, was an important component of this secondary prevention system. Organ preserving and reconstructive surgeries (to our knowledge to 38,8% of patients with breast cancer and 95% of patients with vulvar cancer and vulvar dysplasia) have a positive effect not only on women’s life quality, but also become a good motivation for regular women’s screening in the region. Nothing is more convincing than the vivid example and “word of mouth”. A multidisciplinary approach to solving problem with the help of different specialists helped to reduce mortality rates for breast cancer by 30,03 ± 2,1% compared with 2009 (after the introduction of reconstructive surgery) and vulvar cancer by 83,3 ± 5,7% in comparison with 2005 (after the introduction of reconstructive surgery) at the continuing trend of increasing incidence rate. Cytological screening for dysplasia and early forms of cervical cancer needs a serious adjustment in accordance with the WHO recommendations and per capita accounting used in Russia.

In an analysis of 5414 men aged 45-55 years with a PSA level > 4 ng/ml, who underwent 6 point biopsy under ultrasound control, during the first round of screening 21 prostate cancer (PCa) cases were diagnosed, that accounted 0,4% of all examined men. To improve the diagnostic for PCa in the second round of screening it was proposed to decline PSA to 2,5 ng/ml as a threshold, and in case of its excess to perform 12points biopsy. Due to this modification the detection of PCa was increased by 1,85 times. Perhaps, introducing of this method will help to make early detection for PCa more effectively.

In our clinical research we studied levels of neutrophils, eosinophils and CD8 T-lymphocytes in stroma and microenvironment of the gastric and colorectal adenocarcinomas, head and neck squamous cell carcinomas (33 patients: 15 with adenocarcinoma and 18 - with head and neck carcinoma). In gastric or colorectal adenocarcinoma expression of neutrophils directly correlates with regional lymph nodes involving, expression of CD8 has inversely correlation with differentiation of the tumor. In head and neck squamous cell carcinoma neutrophils expression inversely correlates with keratinization, CD8 expression has inversely correlation with the size of primary tumor and stage, and has direct correlation with keratinization. This study allows to draw a conclusion about heterogeneity of solid tumors depending on immunology of microenvironment, moreover squamous cell carcinoma of head and neck is more “immunocompetent” structure. Correlation analysis revealed prognostic and predictive value of immunological microenvironment, because showed impact of expression of CD8, neutrophils and eosinophils on clinical outcome of gastric and colorectal adenocarcinomas and squamous cell carcinoma of head and neck.

Clinical data on the efficacy and safety of cetuximab and panitumumab in 87 patients in the 1-4 lines of drug therapy for metastatic colorectal cancer (mCRC) with wild-type RAS with and without surgical removal of metastases were analyzed. Anti-EGFR drugs were prescribed for patients in the first line of therapy in 64.4%, in the second line - 14.9%, in the third line - 13.8% and 6.9% - in the fourth line. 14.9% of patients continued anti-EGFR therapy after progression during 2-3 lines (with the change of cytostatics). The use of anti-EGFR drugs in treatment for mCRC was shown to provide satisfactory results of overall survival rate and progression-free survival. The most important result of the analysis is the revealed significant increase in median overall survival from 13.4±1.6 to 18.7±2.3 months (p = 0.04838) in patients who had anti-EGFR therapy and chemotherapy with surgical treatment of distant resectable metastases. Manifestations specific for anti-EGFR drugs dermal toxicity were tolerable and managed with medical correction.Of the patients who has been undergone to cytoreductive surgical interventions for resectable metastases, clinically significant complications of the surgery were observed in 17.2% ofpatients.

The paper is devoted to the study of the incidence of malignant tumors in the Krasnoyarsk Krai throughout 2005-2014. The greatest increase in incidence in the region during the study period - 58.5% was determined in women. There was established the gain in the incidence in the region by 39.5%, as well as there was revealed the advancement on leading localizations. On the basis of established trends there was made calculation for medium-term forecast of the morbidity rate in the region. By 2020, there is expected the gain in the incidence in the Krai by 1.5 times: breast cancer - by 17%, skin cancer - by 22%, lung cancer - by 21.6%, prostate cancer - by 19.6%; for gastric cancer incidence rate will decrease by 5.9%.

Malignant neoplasms of the digestive system occupy a leading place among all cancer patients. Approximately one third of all cancer deaths worldwide was linked to improper nutrition and diet, and took the second place as theoretically preventable causes of cancer. Modern methods of surgical treatment of cancer patients have an aggressive nature, causing pronounced stress in the body and give rise in metabolic disorders with changes in nutritional status. One of the prevention methods is the use of nutritional support, especially in patients who received radical surgery.

In chronological order, there is presented the history of the creation of Oncology Service of the Republic of Moldova. There were mentioned most prominent public health leaders who participated in the creation and functioning of the Oncological service. There are described the main achievements and challenges of the service for the future.