Vol 17, No 3 (2012)

The results of surgical versus combination treatment for rectal cancer (RC) were analyzed. Changing from the standard, the so-called orthodox, surgery for RC to total mesorectumectomy (TME) could considerably reduce the rate of local recurrences and improve the functional results of treatment. However, there has still been no general use of TME as the operation of choice for RC. The results of examining and treating 542 patients with stage I-IV RC treated at the Herzen Moscow Oncology Research Institute in 1982 to 2010 inclusive were studied. Combination treatment was performed in 242 patients. TME was used in 112 patients. The mean duration of surgery was 211.4±79.1 and 282.2±67.9 min in the non-TME and TME groups, respectively (p < 0.05). In these groups, the frequency of early postoperative complications was 43.3 and 24.1%, respectively (χ 2 = 15.31; p = 0.0009). In the TME group patients who had undergone potentially radical operations, three-year overall survival was 85.9% versus 67.4% in the non-TME group (p = 0.181). In these groups, tumor-specific survival was 89.1 and 77.0%, respectively (p = 0.116).

Two hundred and one families that had cases of colorectal cancer among first-degree relatives and had been followed up for at least 5 years were selected from the Moscow Familial Cancer Registry and divided into 3 groups: 1) 6 families with Lynch syndrome (hereditary nonpolyposis colorectal cancer); 2) 36 cancer families without Lynch syndrome; 3) 159 noncancer families. Comparative analysis has shown that the families with Lynch syndrome significantly differ from those of two other subgroups in the following respects: 1) hereditary cancer loading (cancer cases in more than 60% of relatives over 20 years of age); 2) high incidence rates for multiple cancers in women; 3) more common cancer involvement of the colon than the rectus; 4) cancer of the corpus uteri is a second malignancy after colorectal cancer among women; 5) primary malignancies occur 10-20 years earlier with the tumor-specific survival being 5-7 years longer than in the two other groups; 6) during a 5-year follow-up, new cancer cases occurred among first-degree and first-to-third-degree relatives in 50 and 83% of the families, respectively. The cancer families differed from noncancer ones only in general hereditary cancer loading (35.6 versus 12.5%) and in the rate of new cases in first-to-third relatives (33.3% versus 10.7%).

The tolerability of chemoradiotherapy procedures by irregularly adjusting a daily dose and standard radiation was studied by the toxic effect of late radiation damage to the normal tissues and organs of the oral cavity and oropharynx. There were 221 clinical cases of primary cancer of the oral and oropharyngeal mucosa. Late radiation damages to normal tissues and organs occurred in 31 (14%) of the 221 treated patients in different periods. Moreover, they happened in 20.2% of the patients after radiation therapy and in 8.9 and 10.8% after chemoradiotherapy by dividing the dose into 1+1.5 and 1+2 Gy, respectively (p > 0.05). The findings suggest that the tolerability of simultaneous differently fractionated chemoradiotherapy is satisfactory according to the late toxicity criteria - radiation damage to normal tissues and organs in the radiation area.

Breast cancer morbidity, mortality, and survival were examined in a population-based study. The survival rate is the most objective criterion to assess the activity of a cancer service. Analysis of trends in the 5-year observed and relative survival rates of women with breast cancer in 1994 to 2003 could reveal their rises from 60.5 to 65.8 and from 71.2 to 77.2%, respectively. One-year observed and relative survival rates in 1994 to 2008 increased from 84.7 to 88.3 and from 87.4 to 90.6%, respectively. There was a great difference in the survival rates in breast cancer patients treated at specialized cancer hospitals versus those at general surgical hospitals.

The authors studied the incidence of malignant neoplasms of the bone and articular cartilage (BAC) in Siberia and the Far East over 1994-2008. The regional, time, and age characteristics of BAC malignancies were analyzed using the sex and age intensive and standardized incidence rates (world standard) per 100,000. Analysis of the results of examining 7069 patients diagnosed as having BAC malignancy over 1994-2008 showed that in the average the regions of Siberia and the Far East showed a reduction in the incidence of malignancies at these sites; its peak being was notified in a 60-74-year age group. Higher incidence rates of BAC malignancies were registered in children aged 15-19 years.

The described clinical case demonstrates the efficiency of combination treatment for intracerebral metastases, which involves surgical removal of metastasis with intraoperative fluorescence diagnosis and photodynamic therapy for the bed of a removed tumor, followed by brain radiation. The patient has been alive for 17 months since intracerebral metastases were detected.

The paper reviews Russian and foreign references on the choice of treatment policy in patients with renal cancer metastases to the lung providing that primary kidney tumor can be removed or that there is a history of nephrectomy and there are no metastases in other organs. It describes the results of surgical and medical treatment (immunotherapy) in this category of patients. Particular emphasis is placed on the importance of prognostic factors when choosing treatment policy. Key prognostic factors, such as the possibility of complete removal of lung metastases, the number and sizes of foci, and a postnephrectomy disease-free interval (DFI), are identified. Four prognostic groups are made up and the long-term results of surgical treatment are given in the patients of each group. The general conclusion can be drawn regarding that drug therapy should be preferred over surgical treatment when metastases are irresectable or there is a combination of some poorfactors (more than 6 foci, a short metastasis-free interval of < 36 months or DFI = 0).