[Surgical interventions with tracheal bifurcation circular resection in bronchial cancer treatment]

AIM

To evaluate results of circular resection and carina reconstruction in patients with bronchial cancer.

MATERIAL AND METHODS

Study included 82 patients with bronchial malignant tumors operated for the period from 1998 to 2014. Mean age was 56±1.1 years (range 24-75). There were 75 men and 7 women. Squamous cell carcinoma, adenocarcinoma, dimorphic cancer, carcinoid, adenocystic cancer, small cell cancer and clear cell renal cancer were observed in 66, 9, 1, 3, 1, 1 and 1 patients respectively. Stages IIB, IIIA, IIIB and IV were determined in 5 (6.2%), 45 (56.3%), 28 (35%) and 2 (2.5%) patients respectively. Tracheal carina resection was combined with right-sided pneumonectomy in 62 (75.6%) patients, left-sided pneumonectomy - in 5 (6.1%) cases, right upper lobectomy - in 10 (12.2%) cases. 3 patients underwent carina resection alone. Plasty with bronchopulmonary segment of right upper lobe was applied in 2 cases. Since 2002 primary bronhomyoplasty using m.latiss.dorsi, m.intercostalis and m.serr.anterior flaps has been used in 64 patients.

RESULTS

Postoperative complications occurred in 31.7% (26) of patients. In-hospital mortality was 10.1%. Use of primary bronhomyoplasty and head adduction reduced broncho-pleural fistula incidence and mortality (p<0.05). Long-term results in T3-T4N0 tumors were significantly better compared with T3-4N1-2 tumors (5-year survival 41.2 vs. 16.8%, p<0,05).

CONCLUSION

Results of resection with carina reconstruction may be improved using primary bronhomyoplasty and is associated with satisfactory long-term results in patients with N0-tumors.

[New approaches to treatment for malignant tumors using perfusion technologies]

The paper summarizes and analyzes the results of complex treatment of patients with malignant tumors performed in the N.N.Petrov Research Institute of Oncology using perfusion technologies. Safety and efficacy data on various chemoperfusion is presented: intraperitoneal chemoperfusion combined with cytoreductive surgery in patients with locally advanced and disseminated gastric cancer, recurrent ovarian cancer and pseudomyxoma peritonei; isolated lung perfusion combined with metastasectomy in patients with lung metastases; isolated limb perfusion with/without cytoreduction in patients with locally advanced skin melanoma and locally advanced soft-tissue sarcoma. The conclusion is made that both intraperitoneal and isolated chemoperfusions are not associated with higher incidence of intra- and postoperative morbidity. However safety of the procedures could be increased through optimizing tactics of surgical procedures prior to chemoperfusions. The use of perfusion technologies provides significant survival advantage in patients who can’t benefit from conservative treatment.

[The immediate results of bronchoplastic surgical operations in surgery for lung malignant tumors]

Bronchoplastic surgical operations by means of invaginated method on 1 semicircle in lung malignant tumors were performed in 124 patients. Of them 116 patients (93,5%) had primary and 8 patients (6,5%) metastatic tumors. There were 94 men (75,8%) and 30 women (24,2%). The average age of patients was 56,4. The lesion of the right lung was observed in 78 patients (62,9%), of the left one in 46 patients (37,1%). Bronchoplastic lobectomies were performed in 98 patients (79%), bilobectomies - 17 patients (13,7%), segmentectomy - 4 patients (3.3%), isolated resections of bronchi - 5 patients (4,0%). All operations were radical. In all cases of lung cancer there was carried out extended inpsilateral lymph node dissection. Complications of different severity were observed in 24 patients (19,4%): pneumonia (4,8%), atelectasis (0,8%), insufficiency of bronchial sutures (3.2%), granulation stenosis of the bronchial anastomosis (1,6 %), chylothorax (0,8%), recurrent nerve palsy (2,4%), heart rhythm disorders (2,4%). Postoperative lethality was 4.8%.

[Bronchoplastic surgery in lung cancer surgery]

Bronchoplastic interventions allow extending indications for radical conserving surgery and, avoiding pneumonectomy, increasing a number of operated patients, reducing the fre- quency complications and postoperative mortality, significantly improving the quality of life as well as the conditions of reha- bilitation of patients and long-term results, which of particular importance for those with limited functional reserves. However some technical aspects of the bronchial reconstructive surgery are still unresolved and require further enhancement.

[Results of complex treatment of patients with thoracic esophageal cancer]

In the open, comparative, non-randomized and prospective study conducted from 2007 to 2014 there were included 83 patients who received combined treatment for thoracic esophageal cancer. For a comparative analysis there was used a retrospective control group of 51 patients with esophageal cancer who had undergone surgery alone from 1999 to 2014. Complex treatment of patients with advanced forms of thoracic esophageal cancer included argon-plasma recanalization of the lumen of the esophagus followed by neoadjuvant chemoradiotherapy in two versions. One group of patients (29) received external beam radiotherapy, prescription dose of 40-45 Gy, the other group of patients (54) received intraluminal brachytherapy, 3 sessions of 7 Gy, prescription dose of 21 Gy. All patients synchronously with radiotherapy there were performed two cycles of polychemotherapy on PF scheme. A month after the neoadjuvant treatment there was carried out resection of the esophagus with simultaneous plastics by gastric stem. Complete local tumor regression was achieved in 34,7% of patients in group with intraluminal brachytherapy and 30% in the group with external beam radiotherapy. Long-term results could be traced in 90.8% of patients. Using chemoradiotherapy on preoperative stage we managed to increase disease-free and overall survival of patients with an increase of median of progression-free survival - 27 against 12 months and overall survival - 29 against 14 months in comparison with surgery alone.

[Prediction of the effect of neoadjuvant chemotherapy in patients with non-small cell lung cancer of stage III at phases of combined treatment]

We examined 100 patients with non-small cell lung cancer (NSCLC). In addition to surgery there was performed neoadjuvant chemotherapy (2-3 cycles) EP (cisplatin at a dose of 80 mg/m2 on first day + etoposide at a dose of 120 mg/ m2 on days 1,3,5). There were studied the levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) as prognostic factors in the use of neoadjuvant chemotherapy in patients with NSCLC. The control group consisted of 30 healthy volunteers. The baseline level of bFGF was necessary for the prediction of combined treatment in patients with NSCLC stage III. The threshold value bFGF>10,2 ng/ml allowed predicting a good effect from chemotherapy with a sensitivity of 71,4% and specificity of 80,6%, while the sensitivity of VEGF in terms of forecasting bicycles reached 42,9 %. The resulting algorithm for predicting of the effect of neoadjuvant chemotherapy of patients with NSCLC provided perspectives to improve the outcomes of such patients.

[Long-term results of isolated chemoperfusion of the lung with melphalan and cisplatin in combination with metastasectomy in treatment for resectable metastatic lung lesion]

For treatment of metastatic lung lesions there was used the method isolated chemoperfusion of the lung in combination with metastasectomy. The study includes 74 patients with metastases in the lungs who underwent 101 normothermal isolated chemoperfusion of the lung: of these 38 (37,6%) with melphalan and 63 (62,4%) with cisplatin without lethality. In the early postoperative period 1 (1,4%) patient died due to postperfusion lung edema. The period of observation of patients ranged from 2 to 99 months (median 29.3 months). Of 74 patients 53 (71,6%) patients are alive, 2 (2,7%) patients died from causes unrelated to the underlying disease. 43 (58,1%) patients showed progression of disease, what in 18 (41,9%) of them was the cause of death. Repeated appearance of metastases in perfused lung was detected in 30 (40,5%) patients. A 5-year disease-free (in the lungs) and observed survival of patients after isolated chemoperfusion of the lung with metastasectomy was 45% (median 46 months) and 59% (median not reached) respectively. There were established predictors of effectiveness of isolated chemoperfusion of the lung with metastasectomy: DFI> 13 months, ≤5 metastatic nodes in the lungs, the size of the largest metastasis in the lungs ≤20 mm, intralobular location of metastases in the lungs as well as the time of doubling the volume of metastases >64 days for chest computed tomography.

[Mini-invasive technologies in complex treatment of esophagus cancer]

It was evaluated mini-invasive endovideosurgical technologies using in complex treatment of esophagus cancer. The investigation included 28 patients with thoracic esophagus cancer. Age of patients operated in terms from April 2012 to December 2013 was from 42 to 74 years (mean 61.7 ± 8.7 years). Only surgical treatment was used in 10 patients. Neoadjuvant chemotherapy and radiotherapy were performed in 18 patients. Hybrid mini-invasive esophagectomy (laparoscopic stomach mobilization and right-side thoracotomy) were used in 14 cases. The frequency of postoperative complications was 35.5%. Mini-invasive endovideosurgical esophagectomy was done in 14 patients. The frequency of postoperative complications was 57.1%. There were not deaths. Our experience demonstrates good results of mini-invasive technologies using in treatment of patients with esophagus cancer. Endovideosurgical methods permit to perform adequate volume of surgery in case of oncological diseases.

[Intelligent distributed system of population cancer screening]

This review summarizes data dedicated to improving the efficiency of screening of malignant tumors through the use of modern information and telecommunication technologies. It is showed that currently available software solutions in the field of medical imaging is not enough adapted for population screening. So far there is no single standard that defines checking algorithms of data processing at certain controlled conditions. The most expected result will be the organization of information centralized storage, sharing diagnostic data, providing broad access to them, automated analysis and selection of diagnostically significant results through the software. The basic requirements for the development of self-learning systems for intelligent processing array of heterogeneous data through the use of technologies of semantic networks are provided.

[Immediate results of isolated chemoperfusion of the lung with melphalan and cisplatin in combination with metastasectomy in treatment for resectable metastatic lung lesions]

For treatment of metastatic lung lesions there was used the method of isolated chemoperfusion in combination with metastasectomy. The study included 74 patients (mean age 43 ± 13.4 years). There were performed 99 normothermic isolated chemoperfusions of the lung: with melphalan (39) and cisplatin (60). During surgery there were no lethality outcomes. In the immediate postoperative period it was recorded 1 (1.4%) death developed in 3 days after surgery. The cause of this death was postperfusion lung edema accompanied by increase of signs of respiratory insufficiency. There were following complications after isolated chemoperfusions of the lung: anemia--23 (23.1%), nausea--13 (13.1%), vomiting--5 (5.1%), atrial fibrillation--10 (10.1%), pneumonia-2 (2.0%), pulmonary infarction--2 (2.0%), chylothorax--1 (1.0%), pneumothorax--29 (29.3%), emphysema of soft tissues of the chest wall 73 (73.7% ). Thus isolated chemoperfusion of the lung with melphalan or cisplatin is a procedure reproducible and relatively safe.

[Treatment of patients with disseminated testicular germ cell tumors]

Testicular germ cell tumors are rare diseases of young age with high sensitive to cytostatic therapy. Their complex treatment should be based on prognostic factors and individual properties of disease. It includes chemotherapy followed by cytoreductive surgery of residual lesions according to international standards and guidelines. This approach is highly effective and allows curing the majority of patients with advanced disease.

[Automated identification, interpretation and classification of focal changes in the lungs on the images obtained at computed tomography for lung cancer screening]

This review article analyzes data of literature devoted to the description, interpretation and classification of focal (nodal) changes in the lungs detected by computed tomography of the chest cavity. There are discussed possible criteria for determining the most likely of their character--primary and metastatic tumor processes, inflammation, scarring, and autoimmune changes, tuberculosis and others. Identification of the most characteristic, reliable and statistically significant evidences of a variety of pathological processes in the lungs including the use of modern computer-aided detection and diagnosis of sites will optimize the diagnostic measures and ensure processing of a large volume of medical data in a short time.

[MINIMALLY INVASIVE ESOPHAGECTOMY]

During the period from April 2012 to December 2014 54 patients aged 29-76 years, 36 (66.6%) males and 18 (33.4%) females, with esophageal cancer underwent minimally invasive esophagectomy as final phase of treatment. Squamous cell carcinoma was diagnosed in 50 patients and adenocarcinoma identified in 4 patients. The disease was staged as follows: IA--5 (9.3%) patients, IB--11 (20.4%) patients, IIA-- (16,.%) cases, III -- (3,.%) cases, IIII --8 (33,.%), IIII -- (14,8%), III -- (1,.%). 37 (68,.%) patients had surgery after induction chemoradiation therapy. Of 54 surgical interventions there were 20 hybrid and 34 minimally invasive operations. 19 (35,.%) patients developed complications, postoperative mortality was 2 (3,.)%. Minimally invasive esophagectomy meets basic oncological principles and leads to tolerable short-term results.

[The value of intraluminal brachytherapy in the treatment for esophageal cancer]

To control dysphagia 202 patients with a verified esophageal cancer of stage cT1-4N0-2M0-1 underwent intraluminal brachytherapy with neoadjuvant chemoradiotherapy in the process of combined radiation/chemoradiation therapy and palliative treatment. Duration of event-free period in the group of patients, operated after neoadjuvant chemoradiotherapy was 10,1 ± 2,7 months, after intraluminal brachytherapy at combined radiation/chemoradiation therapy was 6,2 ± 2,6 months and at palliative brachytherapy--4,5 ± 2,0 months. Frequency of complete clinical regressions was 16,7% after neoadjuvant chemoradiotherapy, 19,3% after brachytherapy in the frames of radiation/chemoradiation therapy for esophageal cancer, 15,7% as a result of palliative intraluminal brachytherapy. Complete morphological tumor regression after neoadjuvant chemoradiotherapy using intraluminal brachytherapy was registered in 23,1% patients.

[CHEMOPERFUSION TECHNOLOGIES IN TREATMENT FOR MALIGNANT TUMORS]

The data of literature on possibility of the use of perfusion technologies in combined treatment for malignant tumors of different sites are presented. Possible complications during hyperthermic chemoperfusion are discussed and the effectiveness of this method is analyzed.

[MULTIMODAL APPROACH IN THE TREATMENT OF PATIENTS WITH MALIGNANT PLEURAL LESIONS]

The study includes data on 54 patients with pleural malignant lesions (39 with metastatic pleural malignant tumors and 15 with pleural malignant mesothelioma) received treatment using a multimodal approach: maximum cytoreduction, intraoperative photodynamic therapy and hyperthermic chemoperfusion of pleural cavity. A control group of patients with malignant pleural mesothelioma consisted of 21 patients who had undergone only conservative treatment. It was found out that the use two-thoracotomy surgical approach had advantages over standard thoracotomy across IV intercostal space. The use of multimodal treatment was accompanied by relatively low (1.85%) postoperative mortality on the background of a relatively high number (79.6%) of postoperative complications, easily cured in the early postoperative period. The use of multimodal therapy in treatment for metastatic pleural malignant lesions was accompanied by a median of disease-free survival of 11 months and a median of overall survival of 23 months. The proposed multimodal treatment compared with conservative methods of therapy improved disease-free (12 months vs. 7.5 months) and overall (18.8 months vs. 10.2 months) survival. Thus the use of a multimodal approach in treatment for pleural malignant lesions is relatively safe but requires further study.

[Immediate and long-term results of brachytherapy in complex treatment for esophageal cancer]

For treatment of cancer of the thoracic esophagus, the method of neoadjuvant chemoradiotherapy (CRT) with a use of intraluminal brachytherapy (BT) was performed. The study included 51 patients (mean age 56.9 ± 4.3 years). The length of the primary tumor up to 6 cm was determined in 18 patients, more than 6 cm--33 patients. CRT included three BT sessions (7Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d). After CRT in 30 (62.4%) patients there was marked a complete or partial radiological tumor regression. In 40-45 days after CRT surgery performed. Subtotal resection of esophagus of the Lewis type was performed in 29 cases, transtracheal ex- tirpation of the esophagus--in 2, minimally invasive esopha- gectomy--in 17 cases. Postoperative complications occurred in 22 (44%) patients; one patient died (2%). In 11 (23%) patients morphological investigation revealed a complete regression of the primary tumor. Thus, a use of intraluminal BT in combination with chemotherapy in many cases promoted reducing the size of the primary tumor of the esophagus, which was an effective factor in improving surgical results.

[Hyperthermic chemoperfusion of the pleural cavity in the combined treatment for malignant pleural mesothelioma]

The literature and our own experience were analyzed in multimodal approach to the treatment of patients with malignant pleural mesothelioma (MPM). Survival and quality of life of patients with MPM who underwent multimodal treatment, according to modern standards, are often limited by the occurrence of local recurrences. The value of a number of local therapy methods is still being explored in order to determine the possible side effects as well as the duration of disease-free survival. Photodynamic therapy and intraoperative hyperthermic chemoperfusion of the pleural cavity are the methods of the local treatment of this disease, applied after surgery. These approaches have been investigated separately in several studies, but their efficacy and tolerability is still not clear. The authors wanted to find the best indications for the use of these methods and to assess the immediate and long-term results.

[Role of single-photon emission-computed tomography and x-ray computed tomography in diagnosing lymphatic metastases in patients with non-small cell lung cancer]

Single photon emission tomography (SPECT) with 99mTc-MIBI was performed after conventional staging in 83 operated non-small cell lung cancer (NSCLC) patients. Diagnostic results of SPECT and conventional computerized tomography (CT) staging were validated by histological examinations of operation material. According to histological verification 35 of 83 evaluated patients had lymph node (LN) invasion by NSCLC. SPECT detected LN involvement in 28 of these 35 patients and was false positive in additional 16 patients. Pneumonia or atelectasis were detected in 12 of 16 patients with false positive SPECT results. Sensitivity (Sen), specificity (Sp), accuracy (Ac), positive (PPV) and negative (NPV) predictive values of SPECT in diagnosis of LN invasion by NSCLC was as follows: 80%, 66%, 72%, 65%, 82%. Diagnostic accuracy of CT for detection of LN involvement was inferior to SPECT: Sen--71%, Sp--62%, Ac--66%, PPV--58%, NPV--75%. Combination of SPECT and CT data offer promising solutions with Sen reached 94% or high Sp which in patients without atelectasis or pneumonia can reach 96%.

[A case of successful use of triple approach in a kidney cancer patient with metastatic lesion to the lung and pleural cavity]

Metastasis to the lung is the most common place connected with kidney cancer progression. Wherein metastasectomy is accompanied by satisfactory 5- and 10-year survival achieving 49% and 21% respectively. Pleural lesion due to this tumor develops as a part of systemic metastasis and, as a rule, is a consequence of neoplastic spread from lung parenchyma, which indicates a poor prognosis and is an indication for palliative care.

[Experience of the use of endovideotechnology in surgical treatment of esophageal cancer]

An investigation included 33 patients with cancer of thoracal section of the esophagus at the age from 42 to 74 years old. A surgical method of treatment was applied as only one in 13 patients and methods of nonadjuvant chemoradiation therapy were used for 20 patients. A hybrid minimally invasive esophagectomy (laparoscopic mobilization of the stomach and right-side thoracotomy) was performed on 16 patients. The rate of postoperative complications consisted of 31%. The minimally invasive esophagectomy (performed by totally endovideosurgical approach) was carried out in 15 cases. Postoperative complications developed in 53% of follow-up patients. There weren't cases of lethality. The experience of minimally invasive methods indicated the satisfactory results of application of given methods in patient treatment of esophageal cancer. The use of endovideosurgical approaches allowed performing oncologically adequate volume of operative interventions.

[Morphological, immunohistochemical and spectral characteristics of dysplasia, preinvasive and invasive forms of lung cancer]

An analysis of modern methods of diagnostics such as morphological, immunohistochemical and spectral, which included the bronchoscopy and spectrometry by using reflectance and autofluorescent regime, was made. The data involved the results of prospective follow-up study of 167 patients (620 biopsies). An obligatory spectrometry of suspicious area was carried out before the forceps biopsy. The microslides, which met the requirements of criteria of one of the carcinogen steps (n=201), were subjected to the in-depth morphological and immunohistochemical investigations. The tendency of angiogenesis (CD31 and CD34), proliferative activity (Ki-67), level of apoptosis (P53), EGFR expression were estimated. The sensitivity of combined endoscopic method was 94,74% by specificity 79,95% and high prognostic value of negative endoscopic diagnosis - 99,4%.

Structural stability and energy of a Pd2Ni nanofilm: ab initio calculations

Recently, using molecular dynamics simulation in conjunction with an embedded-atom method potential, we have predicted Pd2Ni surface-sandwich ordering at the nanoscale. These findings open up a range of opportunities for the synthesis of new kinds of Pd-Ni nanostructures such as a five-layer Pd2Ni nanofilm from which a Pd2Ni nanotube might be fabricated. In this paper, we report on an ab initio spatial optimization and structural energy calculation of a five-layer Pd2Ni nanofilm, which are performed using plane-wave pseudopotential total energy calculations in the generalized gradient approximation of density functional theory. The results of the ab-initio calculations show that the five-layer Pd2Ni nanofilm is structurally stable and its energy is approximately 0.4 eV higher than the energy of a bulk crystal alloy having the same composition.

[Pharmacoeconomic analysis of gefitinib therapy in patients with non-cell cell lung cancer]

We performed a treatment efficacy analysis for non-small cell lung cancer (NSCLC) patients' population with EGFR mutation aimed at optimization of pharmacoeconomic factors. The employment of gefitinib leads to an increase in patients' life expectancy for a median of 1.05 years. The average cost-effectiveness of this therapy is 934.8 thousand rubles per additional year (903.9-1100.5 thousand rubles for each year). If gefitinib therapy is given only to patients with proved EGFR mutation it can decrease the average expenses by 211.6-251.8 thousand rubles per patient in comparison to undiagnosed patients's population receiving gefitinib without a decrease in clinical effect. Comparison of selective gefitinib administration with isolated chemotherapy (CT) yields an incremental cost-effectiveness ratio of 960.7 to 1010.0 thousand rubles per additional year. Therefore, the strategy of EGFR gene mutations testing in patients with inoperable NSCLC with consequent gefitinib therapy administration in patients positive for mutation lead to an increase in life expectancy and is characterized by acceptable cost-effectiveness.

[Use of simultaneous double-tracer SPECT with 99m-Tc-technetril and 67-Ga-citrate for follow-up of patients with non-small cell lung cancer]

In 20 primary patients with focal abnormalities on conventional CT we evaluated diagnostic properties of simultaneous double-tracer SPECT. Scintigraphy was performed as a single examination with simultaneous registration of 67Ga and 99mTc-MIBI. Image acquisition was started 48-74 hours after IV injection of 130-175 MBq 67Ga-citrate and immediately after IV injection of 500-740 MBq of 99mTc-MIBI. All images for each agent were classified as positive and negative for primary tumor, N1 and N2 lymph-nodes (LN). According to histology 18 of 20 evaluated patients had non-small cell lung cancer (NSCLC), the other two patients had tuberculosis and nonspecific inflammation. SPECT with 99mTc-MIBI correctly visualized tumor in 18, 67Ga allowed correct visualization in 16 cases. Both tracers were truly negative in a patient with tuberculosis and false positive in a patient with nonspecific inflammation. Double-tracer SPECT was slightly more specific than CT in primary lesions. In 18 patients histological verification of LN status was obtained: NO was revealed in 9 cases, N1 in 4 and N2 in 5 cases. Both tracers correctly discriminated LN-positive and LN-negative cases with 94% specificity. On the contrary, CT was false-positive in 3 and false-negative in another 5 patients. Differentiation between N1 and N2 LN involvement is crucial for therapy planning. 99mTc MIBI and 67Ga revealed N1 in 2 cases and N2 in 4 cases, the diagnosis was later verified by postoperative morphology. In 2 patients SPECT overestimated extent of LN involvement and LN status was changed after surgery from N2 to N1. In 18 patients results of 99mTc-MIBI and 67Ga augmented each other. Accuracy of LN staging by SPECT with 99mTc-MIBI and 67Ga was 83%. CT accurately determined LN stage only in 7 patients, it was overestimated in 7 and underestimated in 4 cases. SPECT with 99mTc-MIBI and 67Ga demonstrated high overall accuracy in diagnostics of regional LN invasion for patients with NSCLC. Diagnostic value of conventional CT was significantly lower. Correct level of LN involvement was determined by SPECT in 83% of cases.

[Concurrent chemoradiotherapy with moderate dose brachytherapy as remission induction for patients surgically treated for esophageal cancer]

The locally advanced cancer of thoracic esophagus was treated by induction chemo-irradiation therapy (IHRT) with intraluminal medium dose-rate brachytherapy (IMBT). From July 2009 to February 2012 twenty five patients (mean age 54.3 +/- 1.3 years) were included in the study. The length of the primary tumor was up to 6 cm in 10 pts and more than 6 cm in 15 pts. Induction therapy consisted of three IMBT sessions (7 Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d), 26-31 days later the surgery was performed. Subtotal resection of the esophagus type of I Lewis was performed in 23 pts, transtracheal extirpation of the esophagus was performed in 2 pts.In all the cases 3F lymphodissection was performed. After IHRT in 15 of 25 pts. was obtained complete or partial response, in 10 of 25 pts was obtained disease stabilization. Perioperative complications occurred in 17 (68%) patients receiving conservative treatment, one patient (4%) died of treatment complications. In 6 cases (24%) morphology had shown the complete regression of primary tumor. Thus, the combination of intraluminal medium dose-rate brachytherapy and chemotherapy lead to reduction of primary tumor local spread and can be an efficient factor in improving the results of surgical treatment.

[Organ-preserving interventions in combined therapy of children and adolescents with osteosarcoma]

An analyzed cohort consists of 50 pediatric patients with osteosarcoma receiving combined therapy in N. N. Petrov Research Institute for Oncology (1999-2010). Thirty nine of them had localized disease, 11 patients had distant metastases. The treatment scheme included neoadjuvant therapy with cisplatin and doxorubicin, surgical treatment and adjuvant therapy depended on initial response and could include cisplatin, doxorubicin, high-dose methotrexate, ifosfamide, etoposide. Four-year overall and relapse-free survival in children with localized disease was 74.3% and 69.2% accordingly. In 62% of patients were performed organ-preserving surgical interventions, in 22 patients was performed endoprosthetics, in 4 patients the defect was replaced by a bone autograft on a vascular bundle. The effectiveness of initial treatment and secondary endoprosthetics were analyzed. Six patients with lung metastases received normotermic lung chemoperfusion, 4 of them are alive and disease-free for 8 to 24 months.

[Radical surgical treatment of the 91 year old woman with a lung cancer]

This article presents the literature data review showing an urgency of lung cancer treatment problem in elderly patients, considering that more than 40% patients are in the age category older 65. The opinion on inexpediency of baseless refusal of adequate radical operative treatment performance under condition of patient functional validity is proved. The authors demonstrate their own clinical case of the 91 year old patient with a peripheral middle lobe right lung cancer with metastasises in root lymph nodes pT2N1M0 IIB, whom upper bilobectomy with one-piece methodic ipsilateral mediastinal lymphadenectomy without any complications was made.

[Optimization of treatment methods of surgical complications in lung cancer]

The present report analyses the immediate and long-term results of treatment of surgical complications in 998 patients with lung cancer. There were complications in 37,5% of the cases, with a fatality rate of 14,7%. The most frequent complications were as follows: postoperative empyema with bronchopleural fistula (41,3%), bleeding (12,0%), pneumonia (9,8%), pulmonary arteries embolism (8,1%) and heart rhythm disorders (8,1%). Adjuvant and neoadjuvant treatment does not increase the rate of surgical complications as compared to just surgery alone (p = 0,1). Postoperative empyema with bronchopleural fistula requires intensive therapy, affects the quality of life of patients but does not decrease survival rates as compared to patients at the same stages of disease with uncomplicated course (p = 0,001). Timely drainage of pleural cavity accompanied by its adequate sanation does not differ (p = 0,1) from usage thoracoplasty (MS 29,9 months to 33,2 months).

[Current problems in the combined therapy of lung cancer]

The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.

[Comparative assessment of the effectiveness of treatment for patients with lung cancer]

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

[Application of automated quantitative cytometry in diagnosis of lung cancer]

The paper deals with evaluation of the literature data and our experience with automated quantitative cytometric examination of sputum for diagnosis of lung cancer and, in particular, early one. This novel procedure uses measurement of quantitative indices which characterise tumors-induced alterations. The LungSign computerized system was employed to scan cellular nuclei. The results were evaluated by linear discriminative analysis with the aid of ROC-curves and underlying areas. The procedures were run in 248 cases and its sensitivity was significantly higher that of a standard cytological one (36.6% and 13.3%, respectively; p = 0.033), albeit a slight decrease in specificity (93.7% and 100%, respectively; p = 0.003). Automated quantitative cytometric indices varied significantly in cohorts of patients with confirmed (-0.275871) and false (-1.24990) diagnosis of lung cancer (p = 0.0001).

[Use of autofluorescence bronchoscopy and spectrometry in the diagnosis of central lung cancer]

The paper evaluates the available data as well as our own on use of autofluorescence bronchoscopy in conjunction with spectrometric examination. We used qualitative and quantitative assessment of images obtained by conventional and autofluorescence (ClearVu Elite) means in real time. Our double-stage study evaluated sensitivity and specificity of autofluorescence bronchoscopy in diagnosing lung cancer as well as constructed spectrometric curves (ROC) and areas under them (AUC). Endoscopy was used in 171 patients with central lung cancer. Autofluorescence bronchoscopy established high sensitivity--94.74% (95%CI: 80.9-99%) and sufficient specificity--79.95% (95%CI: 75.8-83.6%). Application of a wide range of spectrometric coefficients contributed to high specificity thus reducing the number of biopsies as well as the injury from the treatment. The AUC for a best predictive index was 0.89 (99%: 0.83-0.95).

[Combined endoscopic monitoring of treatment effectiveness in tracheal and/or bronchial malignancies using autofluorescence spectroscopy]

The paper presents our experience with application of a diagnostic procedure which enhanced information potential of endoscopy. Its efficiency increased due to use of an algorithm which included several stages carried out during an endoscopic procedure: routine bronchoscopy, spectroscopy in light (400-700 nm), autofluorescence spectroscopy including nearest infrared spectrum (720-800 nm). During treatment, the latter registered the dynamics of glow intensity ratios in the red (600-680 nm) and green (500-550 nm) spectra. The efficacy of our method was determinated by the precise delineation of the involvement area and its changes in the course of treatment which matched final analysis data.

[Effectiveness of gefitinib (Iressa) as first-line therapy for inoperable non-small-cell lung cancer with mutated EGFR gene (phase II study)]

Tumor regression was reported in 20-30% of patients with inoperable non-small-cell lung cancer (NSLC) following standard first-line chemotherapy. Clinical trials with second-line gefitinib (Iressa) showed a strikingly high response in patients with mutated EGFR. However, clinical experience with gefitinib as first-line therapy had been limited to small-scale trials mostly among subjects of Asian origin. Our study was not associated with the drug manufacturer and included 25 chemotherapy-naive patients with mutated EGFR inoperable lung adenocarcinoma. Standard dose was 250 mg/day. Complete response was observed in 1 patient (4%), partial--11 (44%), sustained stabilization--13 (52%); median time until tumor progression--186 days. Median overall survival failed to be registered within the duration of the study. Among most frequent side-effects were skin rash (19; 76%) and diarrhea (14; 56%): marked side-effect -toxicity grade III (4; 16%). Gefitinib appeared highly efficient and tolerable and may be recommended as first-line treatment of mutated EGFR inoperable NSLC.

First-line treatment of EGFR mutation-positive non-small cell lung cancer (NSCLC) by gefitinib

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Background: Gefitinib shows outstandingly high rates of clinical benefit in NSCLC pts with EGFR mutation and is better tolerable than conventional chemotherapy, therefore its consideration for the upfront treatment is warranted. Methods: 21 chemonaive pts with inoperable NSCLC were selected based on the presence of EGFR mutation in the tumor DNA (16 exon 19 deletions and 5 T858G substitutions). All cases were adenocarcinomas; median age: 60 years (range: 36 - 81 years); males/females: 6/15; ECOG PS 0/1/2/3: 4/10/6/1. Gefitinib was administered at conventional dose 250 mg/d. Results: The overall disease control rate was 95% (CR: 2/21; PR: 11/21; SD: 7/21). Complete responses were observed only in tumors with exon 19 deletion, whereas the only patient with disease progression had codon 858 substitution. Grade III toxicity occurred only in 3 pts (2: skin rash; 1: diarrhea). Time to disease progression ranged from 2+ to 18 months. 3 pts achieved an operable status of the disease upon the treatment, and therefore were subjected to surgical intervention followed by adjuvant gefitinib therapy. Conclusions: Gefitinib may be considered as the treatment of choice for chemonaive EGFR mutation-containing inoperable NSCLC.

No significant financial relationships to disclose.

[Complex endoscopy-assisted treatment for pleural malignancies with concomitant exudative pleuritis]

The paper deals with complex treatment for pleural malignancies with concomitant effusions. Cytoreduction and abatement of effusion, protein loss, inflammation, intoxication and pain syndrome were reported after argon-plasma electrocoagulation of the pleura followed by photodynamic therapy and hyperthermal intrapleural chemoperfusion. Stable effusion abatement effect was confirmed in all eight cases by X-ray examination and changes in homeostatic indices and breathing function as well as lowered severity of intoxication and pain. No emergency repeat intervention or pleural puncture was reported.

[Bronchopleural fistula--risk factors, prophylactics and treatment in oncopulmanology]

The problem in question is actual because of great incidence of postoperative complications and considerable problems with treatment of them. The authors made an analysis of surgical treatment of 506 patients with primary cancer and carcinoid tumors of the lung. The authors have developed a system of individual prognosis of risk of the development of bronchopleural fistulas (BPF), introduced an original technique of bronchomyoplasty with the help of m.serratus anterior and m.lattissimus dorsi. It resulted in 1.2% less frequency of the development of BPF. Current methods and highly informative techniques were used in examining the patients. The total number of the examined patients, program and research methods allowed reliable conclusions to be obtained.

[Effect of preoperative chemotherapy, mediastinal lymph node dissection and stump cover on bronchial regeneration following experimental pneumonectomy]

The dynamics of morphological changes occurring in the bronchial stump depending on the extent of mediastinal lymph dissection, preoperative chemotherapy and the stump cover method are discussed. Stump healing after right-side pneumonectomy was assessed in 32 non-inbred dogs. Typical procedure was tested in group 1 while complete systematic mediastinal lymph dissection (CSMLD)--in groups 2-4. In groups 3-4, pneumonectomy was performed after two courses of chemotherapy (cisplatin 80 mg/m2 per day + etoposide 120 mg/m2, days 1,3,5). In groups 1-3, the stump was covered with a parietal strap; in group 4, a m. latissimus dorsi strap was fixed on a vascular "pedicle". Experiment was suspended on days 3, 7, 14, 21 and 30. One animal in group 2 died of ischemic necrosis of the esophagus terminating in mediastinitis. None of the animals developed bronchial fistula. Angiography detected reduced blood flow in the right-side third of the trachea and medial surface of the left main bronchus in the CSMLD groups. Microscopically, all the groups revealed a similar pattern of stump healing. CSMLD did not influence bronchial stump regeneration significantly. Nor was it hampered in any way by preoperative chemotherapy. The latter was followed by expansion of necrotic and edematous area thus slightly affecting regeneration. Primary bronchoplasty failed to speed up regeneration, yet it might diminish the risk of bronchial fistula.