Vol 16, No 5 (2011)

The results of combination treatment with neoadjuvant chemotherapy using paclitaxel/carboplatin and docetaxel/cisplatin regimens, radical surgery, and 15-Gy intraoperative radiotherapy (IORT) were studied in 105 patients with stage III non-small cell lung cancer. Neoadjuvant chemotherapy resulted in a high immediate response rate (40.2 ± 5.7%). Chemotherapy response is directly correlated with tumor tissue involvement confirmed by histological examination. Preoperative systemic anti-tumor therapy showed a statistically significant increase in relapse-free and overall survivals in patients with locally advanced non-small cell lung cancer.

A new atomic force microscopy (AFM) method was used to examine 51 cytology specimens from breast and thyroid tumors and pretumors and 17 uterine cervix scrapes. The authors formulated the main tasks of using AFM in oncocytology: to search for objective criteria for differential diagnosis between intact and cancer cells; to identify viral changes in the squamatous epithelial cells; and to objectify the immunocytochemical reaction of Her-2/neu oncoprotein hyperexpression. The studies have revealed as follows: glandular cancers are characterized by an increased nucleus/cytoplasm height ratio (from 1.8 to 2.5 for breast cancer and from 1.9 to 2.5 for thyroid cancer); the squamatous epithelial cells show an inverse trend (a decrease from 2.96 to 2.08 for keratinizing carcinoma of the cervix uteri); viral squamatous cell lesion appears as a perinuclear groove 200 nm in depth; Her-2/neu oncoprotein hyperexpression corresponds to the increase in cytoplasmic height from 248 to 850 nm.

Abnormal methylation of the CDH1, RASSF1A, MLH1, N33, and DAPK genes was studied in the intraoperative specimens of gastric carcinomas and adjacent nontumor tissues from 47 patients with gastric cancer. For comparison, methylation of these genes was examined in 25 specimens of the nontumor gastric mucosa obtained by endoscopic biopsy from patients with esophageal cancer or burn. A surgical material comprising 3-5 tissue samples from each patient was obtained by a definitive procedure. The N33 and CDH1 genes were methylated in the tumor significantly more frequently than were the RASSF1A and MLH1 genes (p < 0.01). Abnormal methylation of the N33, CDH1, and DAPK genes were more often detectable in all gastric tissue segments (1, 2, 3, 4), including morphologically intact tissue with the upper and lower resection margins. The RASSF1A and MLH1 genes had low methylation rates (19 and 17%, respectively). Their methylation was found mainly in the tumor samples (2, 2e) and was not in the samples obtained from the resection margin.

The paper presents the results of using the kinetics of tissue distribution of alasens-induced protoporphyrin IX (PPIX) in patients with tumors of various sites during local and systemic administrations of alasens. The time to achieve the maximum intensity of alasens-induced PPIX fluorescence in tumor and the fluorescence ratio "tumor/norm value", as well as the level of alasens-induced PPIX fluorescence are shown to depend on the route of alasens administration. Procedures for fluorescence diagnosis using alasens are clarified in accordance with the findings.

High technologies used to treat patients with cancer, hematologic and rare diseases are always regarded in society as expensive. Modern medicine, particularly oncology and hematology, cannot be imagined today without monoclonal antibodies and genetic engineering. Who must determine the introduction of new and existing procedures into routine practice and how, as well as where are the reference points for those who make decisions in terms of the costs of these treatments? To determine a cost threshold for inclusion or exclusion of new treatments is one of the most important tasks in the light of healthcare reform and drug provision in the Russian Federation. These questions can be answered via studies of the willingness to pay (WTP) threshold. The latter will allow understanding of the country citizens' preference in estimating expenditures for medical products and services. This will in turn enable them to understand more properly the amount of expenses the state has to bear when developing treatment standards and lists of drugs to be freely dispensed. Within the framework of the study, a questionnaire survey on a random sample of Russia's respondents was conducted to measure WTP for one additional quality adjusted life year, by applying the conditional estimation method and analyzing sociodemographic indicators. According to the results, WTP for one year of life saved with its quality borne in mind was 69,000 rubles or US$2.300, which is much lower, in absolute terms, than those obtained in other countries. Thus, a similar study of WTP for one year of life saved with its quality taken into account showed that WTP was US$41,000 (Japan), 74,000 (Korea), 77,00 (Taiwan), 36,000 (United Kingdom), 47,000 (Australia), and 62,000 (USA). If WTP is compared to the average annual per capita income, Russia approximates that in such countries as the United Kingdom and Japan.

The described clinical case demonstrates that extended radical surgery, radiotherapy, and orthotopic repair of the laryngopharynx with the cervical esophagus could be successfully combined in one step. Microsurgical autotransplantation of a visceral flap contributed to a smooth postoperative course and a reduction in the time of adequate rehabilitation with recovery of good nutrition and social adaptation in the patient. The ten-year relapse-free follow-up suggests that it is adequate to determine treatment volume and policy in the patient.

The paper considers the etiology and key pathogenetic components of radiation damages to mediastinal organs in breast or lung cancer, lymphogranulomatosis, as well as their magnitude during radiation in different doses and in different periods after radiation. It discusses the leading role of radiation-induced microcirculatory disorders resulting in myocardial fibrosis, exhaustion and perversion of the endothelial compensatory dilatatory capacity that is an obligatory component of the pathogenesis of virtually all cardiovascular diseases, including atherosclerosis, hypertension, coronary heart disease, and chronic heart failure.