Vol 21, No 3 (2016)

Articles

Results of surgical treatment of patients with multiple brain metastases

Kurilina L.R., Rekhalov A.F., Pavlov S.S., Kolesnikov V.A., Smirnov P.V.

Abstract

Objective: to evaluate the results of surgical treatment ofpatients with multiple brain metastases and to determine prognostic factors. Material and methods. 57 patients with multiple brain metastases were operated, 146 metastatic foci were removed. All metastases were removed in 42 persons; only large clinically significant metastases were removed in 15 patients. Whole brain radiation therapy was applied in 37patients, alone or in combination with chemotherapy, 20 patients after surgery received only corticosteroid and symptomatic therapy. Results. Median survival time of the whole group was 7.3 months; for patients, who received adjuvant whole brain radiation therapy - 11.6 months. Two-year survival was 8.8 %. The number of patients with Karnofsky performance score ≥ 70 increased from 12 persons (21,1%) at admission to the hospital to 38 (66.7 %) at 9-1th day after surgery. Median survival time for patients with complete resection was 9,2 months, with partial resection - 3,7 months. Prognostic factors were Karnofsky performance score and RPA class, estimated before operation, but after the corticosteroid therapy: median survival time for patients with RPA-class I was 19.5 monthsversus 5.6 months for patients with RPA- class II and III. Conclusions. Surgery rapidly improves the condition of patients with multiple brain metastases and saves the time for postoperative adjuvant treatment. Median survival time for patients who received adjuvant whole brain radiation therapy reaches 11.6 months. Favorable prognostic factors for prolonged survival are total resection of all lesions, RPA-class I and adjuvant whole brain radiation therapy.
Russian Journal of Oncology. 2016;21(3):116-121
pages 116-121 views

The relationship of osteoporosis with severity of pain dirung the treatment of breast cancer patients of childbearing age

Tretyakova N.Y., Kotljarov E.V.

Abstract

Aim. The analysis of the relationship of osteoporosis with severity of pain and the improvement of the diagnosis of osteoporosis in breast cancer (BC) patients of the reproductive age. Methods. There were examined 60 women, including 30 BC patients at the age from 30 to 50 years and 30 women of similar age as comparison group. The examination included a blood test for osteocalcin, calcitonin, alkaline phosphatase, parathyroid hormone, thyroid stimulating hormone, calcium and phosphorus. The degree ofpain in BC patients was evaluated according to the McGill Pain Questionnaire and classification of pain. Osteodensitometry was made in all BC patients and cases from the comparison group. These 30 BC patients were examined prior to the appointment of specific treatment and a half year after the performed treatment Results. In the analysis of 30 breast cancer patients of childbearing age in 26 patients the onset of artificial menopause occurred. Pain syndrome prior to the treatment of the underlying disease was determined in 20% of cases. 6 months after treatment of BC pain breast cancer was detected in 70% of patients. Artificial menopause is associated with the delivery of chemotherapy and shutdown of ovarian function. Hormone therapy with tamoxifen was prescribed to 16 BC patients, 5 of them were transferred to second-line hormone therapy due to side effects of antiestrogens. At that the menopause is the basic condition for the appointment of aromatase inhibitors. In the examination of the whole group ofpatients in 63,3% of cases were revealed to have osteopenia and osteoporosis. Conclusion The prevalence rate of osteoporosis in BC patients of reproductive age is directly related to the performed specific treatment when the appointment of the therapy of osteoporosis it is necessary in complex treatment of cancer patients for the its prevention
Russian Journal of Oncology. 2016;21(3):122-125
pages 122-125 views

Multislice computer tomography in detection of pseudocapsule of renal cell carcinoma

Filippova J.G., Ignatyev Y.T., Leonov O.V., Kharchenko T.V., Kopyltsov E.I., Podkorytov S.V.

Abstract

In order to evaluate the diagnostic efficiency of MDCT with bolus contrast enhancement in the visualization of renal cancer pseudocapsule a retrospective study, included 74 patients with histologically confirmed renal-cell cancer, was performed. Images were acquired in native, arterial, portal and nephrographic - excretory phase on a 64-detector CT scanner. The accuracy of MDCT in detecting pseudocapsule was determined by comparison with histological findings. Native axial images and multiplanar reformations were analyzed. According to the results of the study there was obtained high diagnostic efficiency of MDCT in detecting of the tumor pseudocapsule, that allows to use this method for the preoperative evaluation, assessment of the possibility ofperforming organ-saving surgery.
Russian Journal of Oncology. 2016;21(3):126-130
pages 126-130 views

Association between XRCC1 ARG399GLN, TP53 ARG72PRO and MDM2 T309G polymorphisms and the risk of breast cancer in women of the Kyrgyz population

Isakova J.T., Talaibekova E.T., Makieva K.B., Asambaeva D.A., Sultangazieva B.B., Aldashev A.A.

Abstract

Aim. To study an association between Arg399Gln of XRCC1 gene, Arg72Pro of TP53 gene and T309G of MDM2 gene polymorphisms and breast cancer (BC) rate in women of the Kyrgyz population Material and Methods. Genomic DNA was obtainedfrom the whole blood of 117 breast cancer patients and 102 cancer-free healthy women residing in the Kyrgyz Republic. XRCC1 (Arg399Gln), TP53(Arg72Pro) and MDM2 (T309G) genotyping was carried out by restriction fragment length polymorphism (RFLP) assay. Results. Women with the 399Gln allele had 1,57 fold higher risk (OR=1,57; p=0,034) of developing breast cancer than cases without these alleles. Individuals carrying the heterozygous genotype Arg399Gln had 2,77 fold higher risk (OR=2,77; p=0,0010) of BC. Notably, haplotype analyses revealed a stronger association with breast cancer risk if compare with data of the genotype analysis at each locus alone. The combination of heterozygous XRCC1 (Arg399Gln) variant and TP53 (Arg72Pro) genes increased even more the risk of BC (OR=3,98; p=0,0059). The combination of Arg399Gln and T309G genotypes of - XRCC1 and MDM2 genes is significant association with risk of BC (OR=3,0; p=0,034). We showed the combinations of Arg399Gln, Arg72Pro and T309Ggenotypes of-XRCC1, TP53 andMDM2 genes is related to the strong association with risk of BC in Kyrgyz women (OR=6,40; p=0,025). Conclusion. The polymorphisms Arg399Gln of XRCC1 gene, Arg72Pro of TP53 gene and T309G of MDM2 gene are associated with an increased risk of BC in Kyrgyz females. Combinations of unfavorable genotypes of several candidate genes increase even more the risk of BC.
Russian Journal of Oncology. 2016;21(3):131-135
pages 131-135 views

Acute stroke in pituitary adenomas complicated by pituitary apoplexy

Azizov M.M.

Abstract

Pituitary apoplexy is a clinical syndrome that is manifested by headache, visual disturbances, ophthalmoplegia or impaired consciousness. It can develop as a result of necrosis or hemorrhage in the pituitary gland or in cases of pituitary tumors. A favorable prognosis is possible if early diagnosis and timely surgical treatment. Pituitary apoplexy complicated by the disorder of the cerebral circulation occurs relatively rare. We observed the female patient aged of 51 year with pituitary adenoma, clinical signs of which were sudden depression of consciousness, right hemiparesis and left-sided ptosis. Signs of pituitary apoplexy were revealed after performed examinations. The sharp increase in the size of the tumor resulted in a compression of supraclinoid portion of the left internal carotid artery, which was the cause of ischemic brain damage in the pool left middle cerebral artery. After 2 weeks of conservative treatment, the patient was undergone to the surgery via transsphenoidal access. Histological examination confirmed the hemorrhage and necrosis of the pituitary adenoma. Complication developed 3 months after surgery partially regressed. Taking into account the relatively rare occurrence of pituitary apoplexy complicated with cerebrovascular ischemic type, clinicians should be alert to this complication. The method of choice is transsphenoidal delayed adenomectomy with conservative therapy.
Russian Journal of Oncology. 2016;21(3):136-139
pages 136-139 views

Tobacco addiction and economic efficiency of treating tobacco addiction in patients of the Krasnoyarsk regional oncological dispensary

Kutumova O.Y., Kononova L.I., Shulmin A.V., Dobretsova E.A., Korotkova K.M., Rossieva T.V.

Abstract

Smoking tobacco was proved to be the one of the most critical risk factors contributing to the development of malignant neoplasm in the respiratory system. In 2015, lung cancer morbidity rate and the threat in the Krasnoyarsk Region were 1,3 times higher for men and 1,5 times higher for women in comparison to standardized figures per hundred thousand of population in Russia. The economic expenditures associated with diagnostics and treatment of such patients are enormous. That is why the significance of studies in this area is beyond doubt. The goals of this work is the study of the prevalence rate as well as duration and frequency of smoking among patients of the Krasnoyarsk Regional Oncologic Dispensary, calculation of relative and population attributable risks of oncological diseases development and estimation of the economic expenditures associated with smoking in the studied group. Data were collected by using of the questionnaire survey method. 389 patients of the oncologic dispensary were questioned. The data obtained were processed statistically. Relative and population attributable risks were calculated with the help of the corresponding formulas. Data analysis shows that the half (49.9%) ofpatients of the oncologic dispensary have either never smoked, 30% do not smoke now but used to smoke in the past and 20.1% continue smoking. Patients dispensary (65.9% in men and 87.7% - in women). About the half of the patients (41.6%) smoke 11-20 cigarettes a day. Calculations of the population attributable risks show that smoking is the cause of 21.3% of oncological disease incidences, of which lung cancer accounts for 73.7%. The total expenses for health system connected with smoking in oncological diseases in a year made 140 million 527 thousand rubles. These are the expenses that would not have been incurred if there were no impact of the risk factor.
Russian Journal of Oncology. 2016;21(3):140-145
pages 140-145 views

Some indices characterizing medical care to children with cancer in the Russian Federation

Rykov M.Y., Susuleva N.A., Polyakov V.G.

Abstract

Introduction. The large size of the Russian Federation, different size and density of the child population in the regions of the country require for careful planning organization of care for children with cancer and the rational use of available resources, since in spite of the significant progress made in pediatric oncology, malignant neoplasms (External testing) are the second most common cause of the death in children. Purpose of the study. Perfection of the organizational-methodological approaches to care for children with cancer in Russia in order to improve the quality and effectiveness of treatment. Material and methods. In a non-randomized non-controlled study there were included reports of regional ministries and departments of health from 83 subjects of the Russian Federation for 2013. Results. The highest incidence rate of malignant tumors (per 100,000 ofpopulation agedfrom 0 to 17 years) was registered in the Lipetsk region - 21.7, the lowest - in the Republic of Tyva - 5.5. The number of patients newly diagnosed in 2013 was the highest in the Central and Volga Federal Districts - 775 and 653, respectively. The smallest - in the Far Eastern Federal District - 138. The number of primary patients referred to the federal clinic, was the largest in the North Caucasus Federal District (North Caucasus Federal District) - 80%, the lowest - in the South - 32.5%, the largest number of doctors who do not have primary specialization in “Children’s oncology”, was registered in the North Caucasus Federal District and the Volga Federal District - 50%, the lowest - Urals - 14.2%. Total in Russia 51 children’s oncological department operate, while the number of beds in which we treat these patients, including beds in non-core branches is 2021. 390 doctors treat children with cancer, out of which 252 (64, 6%) did not have a certificate in pediatric oncology. In 2013, 33 78 children were registered with the External testing, 1705 (50.5%) of them were directed for the management in federal clinics. Conclusion. It is necessary to improve further the existing vertical provision of high-tech medical care for children with cancer, the creation of regional cancer registers, certification of specialists and the quality control of medical care through the implementation of internal and external audit.
Russian Journal of Oncology. 2016;21(3):146-150
pages 146-150 views

State of oncological care for the rural population of the Tomsk region

Pikalova L.V., Ananina O.A., Zhuikova L.D., Odintsova I.N., Kudyakov L.A.

Abstract

There was shown the urgency of the study of the problem of malignant tumors (MT) in the Tomsk region. There was performed an analysis of the major cancer oncoepidemiological indices (morbidity rate, mortality rate, neglect, one-year mortality rate), characterizing the state of the organization of anti-cancer activities among the urban and rural population. Indices of the state of cancer care in the districts of the region are worse than in cities. Neglect (p = 0.004) and one-year mortality rate (p = 0.0003), including as a result of MT of exterior locations, in the rural population are higher than that of the urban population. There was evaluated the the activitiy offeldsher-midwife stations (FMS) and examination rooms of district hospitals of the region in terms of organization of measures for the early detection ofMT of visual locations in the rural population. Most of them (221,523 people) of the rural population is assigned to the examination room of district hospitals, to FMS there are attached 82 877people of the adult population. In FMS with the aim of detection of cancer pathology there was examined only 10.8% of the population attached. Coverage of men by preventive examinations amounted to 9% (29.2% were to be inspected), women - 13% (50% were to be inspected). During the year, the FMS specialists identified 571 disease, out of which 70% - chronic processes, 24% - precancerous lesions and 6% - MT. Coverage ofpreventive check-ups of the female population was 35.5%, of males - 8.5%. In total in examination rooms there were identified 12,624 cases of the disease (19.6% of examined cases), out of them chronic diseases - 71.7%, precancerous states - 27.1%, MT - 1.1%. In order to optimize the early detection ofMT of visual localizations in the rural population of the Tomsk region there was suggested to perform a complex of measures
Russian Journal of Oncology. 2016;21(3):151-155
pages 151-155 views

Results of locally advanced laryngopharyngeal and cervical part of esophagus cancers treatment

Rudyk A.N., Sigal E.I., Burmistrov M.V.

Abstract

Issues of locally advanced cancers which involve into the pathological process laryngopharynx and cervical part of esophagus remain to be actual till the present time. Unsatisfactory long-term results lead to the absence of common approaches and clear guidelines on the methods of the treatment choice (radiotherapy, chemoradiation therapy, surgery). Many researchers suppose that the foremost decision is to include surgical component into the treatment schemes of such patients. Main surgical method of the treatment is laryngopharyngectomy or laryngopharyngoesophagectomy. It depends on the extension of cancer. Different kinds of grafts (gastric, jejunal and colon) are used for esophageal reconstrution. The high frequency of complications after surgery, low survival rates are main motives for the search of effective methods of treatment.
Russian Journal of Oncology. 2016;21(3):156-159
pages 156-159 views

The role of positron emission tomography combined with computed tomography in the diagnosis and evaluation of treatment effectiveness of non-small cell lung cancer

Meshcheryakova N.A., Dolgushin M.B., Davydov M.M., Laktionov K.K., Odzharova A.A., Nevzorov D.I., Eremin N.V.

Abstract

Single photon emission computed tomography (SPECT) with the use of various tumor-tropic radiopharmaceutical preparations (RFP) has shown its effectiveness in the identification of tumor process in the lungs and metastatic lesions of mediastinal lymph nodes. In lung cancer such RFPs as Technetium-99m methoxy isobutyl isonitrile (MIBI) I) and 99mTc-depreotid got the largest traction. Increasingly frequently for the initial assessment of the prevalence ofprimary non-small cell lung cancer (NSCLC) there was used positron emission tomography combined with computed tomography (PET/CT) with 2-[18F]Fluoro-2-deoxy-d-glucose ([18F]FDG). The combined PET/CT image consider metabolic and morphological data, that allows to localize precisely the dissemination of the process and is used for the confirmation of the stage, detection of metabolically active extrathoracic lymph nodes, including those of the standard size (<8 mm), and other manifestations of the metastatic process. PET/CT with 18F-FDG is superior to other non-invasive diagnostic methods in the detection of mediastinal lymph node lesions and remote metastases in bones, adrenal glands, liver and soft tissues. This allows to perform the most accurate staging of NSCLC. Thus, according to the data of a number of authors after a whole series of diagnostic tests, additional metastases are detected with PET/CT in 5-29% ofpatients. According to the results of PET/CT the stage of the disease can be changed in 27-62% ofpatients, and the treatment strategy - in 19-52% of cases. In addition, there was proved the important role of PET/CT in the evaluation of the effectiveness of the treatment of NSCLC. Studies have shown that the performance of PET/CT after chemotherapy and/or radiation therapy permits to obtain auxiliary prognostically significant information indicating to the progression-free survival. In addition to the assessment of results of neoadjuvant chemotherapy in NSCLC, PET/CT with 18F-FDG has shown its importance in the monitoring of tumor process in the treatment with targeted agents, such as inhibitors of the protein tyrosine kinase epidermal growth factor receptor. Thus, PET/CT plays an important role in the primary diagnosis and early assessment of the effectiveness of treatment of NSCLC, having the highest sensitivity and specificity.
Russian Journal of Oncology. 2016;21(3):160-164
pages 160-164 views

Modern approaches to the treatment of gastric neuroendocrine tumors

Peregorodiev I.N., Bokhian V.Y., Stilidi I.S., Delektorskaya V.V.

Abstract

Gastrointestinal neuroendocrine tumors (GI-NETs) include a wide range of tumors with different variants of the course of the disease. At the one end of the clinical spectrum there are highly differentiated type I GI-NETs, with five-year survival rate over 95%, at the another end there are low-differentiated neuroendocrine carcinoma (large-, smallcell cancers) representing a tumor with extremely poor prognosis. Therapeutic approaches to different types of tumors are different. It is necessary to distinguish the treatment of well-differentiated neuroendocrine neoplasms (I and II clinical-morphological type) and low-differentiated neuroendocrine carcinomas. At the same time, it should be noted how different is the treatment of well-differentiated neuroendocrine tumors with high proliferative activity index (III clinico-morphological type of tumor) and low-differentiated neuroendocrine carcinomas (large-, small-cell cancers).
Russian Journal of Oncology. 2016;21(3):165-168
pages 165-168 views

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