Vol 19, No 6 (2014)

There is highlighted special small subgroup of patients with non-small cell lung cancer who has translocation of gene ALK in tumor. The modified gene encodes a fusion of pathological protein, leading to activation of ALK receptor on the membrane of tumor cells and then malignant transformation. Clinical studies of crizotinib noted a high frequency (> 60%) of complete and partial responses in chemoresistant metastatic ALK-positive lung cancer; median of progression-free survival reached more than 9 months. Crizotinib is the ATP competitive inhibitor of tyrosine kinase receptor like ALK, MET and ROS1, is one of the most effective drugs for the treatment ofALK-positive lung cancer. However, it is almost inevitable that almost all patients, even in the most pronounced immediate effect to 24 months of treatment crizotinib marked progression of the disease, which is associated with the development of tumor resistance. Currently, clinical studies of the second generation inhibitors of tyrosine kinases, such as ceritinib, alectinib, AP26113 etc, are continuing. Their application is possible in case of the development of resistance to crizotinib.

Objective - to determine the role of ultrasound in the diagnosis of cholangiocarcinoma. Material and methods. Ultrasound examination conducted in 120 cholangiocarcinoma patients. The results were confirmed by data from other research methods, biopsy, surgical palpation and histopathological examination of the resected material. Results. The most difficult is to diagnose tumors of the distal portions of common bile duct. Sensitivity of ultrasound, X-ray CT, MRI, surgical evaluation in the diagnosis of cholangiocarcinoma was: in intrahepatic type - 100%, 100%, 100%, 100%; hilus type - 69%, 75%, 86%, 92%; distal type - 37%, 42%, 69%, 80%. Ultrasound found no evidence of intrahepatic CCA semiotic signs that would distinguish it from other liver cancers. The features of infiltrative tumor growth bile ducts - hyperechoic structure infiltration along the outer contour of the ducts, or hypoechoic structure infiltration at the thickening of the walls of the ducts. The ultrasonic semiotics of modified metastatic lymph nodes has been developed. Conclusion. Ultrasound showed highly informative diagnostic ultrasound in determining the expansion of the bile ducts; the tumor has spread to the liver and lymph nodes. Recommended to extend indications for intraoperative ultrasonography with extrahepatic cholangiocarcinoma to delineate tumor lesions ducts.

Presented clinical case demonstrates the importance of regular use of somatostatin analogues and interferon-alpha in patients with well differentiated NETs.

The aim of the study was confirmation of advantage risk-adapted therapy by creation of mathematical models of the individual forecast of Hodgkin’s lymphoma in children and adolescents. Material and methods. Data of 138 patients with Hodgkin’s lymphoma aged from 4 to 18 years old (median 14 years old) treated on risk-adapted programs are included in the investigation. Results. Two factors significant increased recurrence risk at criteria selection and assessment: disease IV stage (correlation coefficient of 0,1904, p=0,024) and B symptoms (correlation coefficient of 0,1876, p=0,026). It wasn’t revealed collinear signs. The regression equation looked as follows: y =-0,156702+0,056748Х st + 0,092922Х В; the determination coefficient was 0,05241494. Separate elements and the whole equation stopped being significant in multiple regression analysis that doesn’t allow to use them for forecasting of lymphoma recurrence. Conclusion. Thus, inclusion in the correlation analysis of the parameter «treatment program» levels influence of adverse factors on the recurrence, and proves adequacy of selection of therapy burden and advantage of risk-adapted protocols before the unified programs. It is once again proved that it is necessary to consider the principles of «response-adapted therapy» when effective treatment partially compensate negative influence of some adverse signs, minimizing their weight in prognostic models.

Adrenocortical carcinoma (ACC) - a rare and very aggressive malignant tumor originating from the adrenal cortex. About 60% of tumors are hormone producing. Surgical treatment is the only method that can heal the sick ACC. Adjuvant therapy may be recommended for patients with a high risk of relapse. Treatment of advanced ACC includes systemic therapy in combination with local methods of exposure, such as surgery, radiofrequency ablation, and chemoembolization. For the treatment of ACC uses a combination of steroidogenesis mitotane inhibitor with cytotoxic drugs. The most effective chemotherapy regimen in metastatic ACC is a combination of etoposide, doxorubicin and cisplatin against the background of continuous use mitotane (Scheme EPD-M). In the second-line treatment is possible to use a combination of gemcitabine and fluoropyrimidines. The results from the use ACC drugs, which have direct action on the receptor of insulin-like growth factor (IGF-1R) and insulin receptor (IR) as a monotherapy and in combination with inhibitors ofserine-threonine kinase mTOR. The clinical introduction of new effective drugs will improve the results of patients with ACC treatment.