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.
The retrospective clinical records of surgical (combination) treatment in 1420 patients with non-small cell lung cancer were used to determine the rate of regional metastases and to reveal their regularities, by taking into account the size, site, and pathological type of a tumor. On the data available in the literature and the results of their study, the authors proposed a classification of lymphadenectomies in the surgical treatment of lung cancer. A standardized approach to removing mediastinal lymph nodes will make it possible to make a radical surgical volume, to correctly stage the diseases, to adequately plan adjuvant anti-tumor drug treatment, to correctly analyze the long-term results of surgical (combination) treatment, and to compare them with those obtained in different clinics.
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.
The quality of rectal cancer surgery was morphologically estimated during total mesorectumectomy (TME). Analysis of the findings has indicated that the type of an operation, the site of a tumor, and the depth of tumor invasion are major factors that influence the quality of TME. Macroscopic assessment of TME quality is an independent prognostic factor that identifies patients at high risk for a local recurrence, defines a postoperative management tactic, and serves as an indication for adjuvant therapy.
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 gives the results of a molecular genetic study of tumor tissues from 13 patients with uterine carcinosarcoma. Having determined damages to genes (K-RAS exon 1, TP53 exons 5-9, PTEN exons 5 and 8) in the components of carcinosarcoma, the authors assessed each of the study parameters as a potentially clinical prognostic criterion. Whether aberrant TP53 and PTEN and tumor clonality could be used as clinical markers was confirmed.
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.
The authors consider current approaches to diagnosing MALT lymphoma of the stomach. Seventy-six patients diagnosed as having MALT lymphoma of the stomach, including 38 with low-grade malignancy, 22 with signs of blast transformation, and 16 with high-grade malignancy, have been examined. Procedures for endoscopic, histological, and immunohistochemical studies used to detect MALT lymphoma of the stomach are described.
The studies of the relationship between body mass index (BMI) and breast cancer (BC) risk showed that the latter was 1.16 and 1.66 in subjects with a BMI of 25-29.5 and above 30 kg/m2, respectively. Within the framework of a screening program for the early diagnosis of BC, a mass questionnaire-based survey of women was conducted to identify predominant risk factors. The study indicated that a BMI of more than 25 kg/m2 was found in 54.8% of the district's women; obesity was observed in 21% of the women asked. The local population had higher BMI than had the female newcomers. The most unfavorable indicators were revealed among women over 46 years of age. In this group, overweight was found in 76.6%, including in 37% with second-third-degree obesity.
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 describes a rare case of massive chyloperitoneum concurrent with chylothorax in a female patient with kidney cancer developing 4 years after multimodality treatment (surgery, radiotherapy, and immunotherapy). The data available in the literature on chyloperitoneum are analyzed in detail. The etiology of this condition and current approaches to its treatment are described. A treatment algorithm is given in detail to treat patients with the similar clinical situation.
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.
Based on the experience in examining more than 2000 patients, the authors show the capacities of chest ultrasound study (USS) for space-occupying lesions. They describe a lung USS procedure and a normal chest echographic pattern. The procedure permits imaging of the minimum amount of fluid in the pleural space, pleural tumor nodules, and afflicted mediastinal lymph nodes located above the aortic arch. USS enables one to diagnose intergrowth of a peripheral lung tumor in the chest (93.7% sensitivity), to identify the involvement of the pericardium, heart, and large vessels in the process (94-100% sensitivity), and to detect decay cavities in atelectasis and in the tumor. During follow-up, the technique allows an intrathoracic locoregional recurrence to be found in patients who have undergone surgery. It is particularly effective in patients who have undergone pneumonectomy (94.2% sensitivity).