Vol 19, No 4 (2017)

Articles
Clinical and radiological evaluation the effectiveness of preoperative systemic therapy in different biological subtypes of breast cancer stages T1-3N0-1M0
Pavlikova O.A., Poddubnaya I.V., Kolyadina I.V., Abdullaev A.G., Komov D.V., Danzanova T.Y., Sinyukova G.T., Kozlov N.A., Ganshina I.P., Zhukova L.G., Aliyeva G.S., Kerimov R.A., Gordeeva O.O.
Abstract
The aim. To study the clinical and radiological evaluation of the effectiveness of preoperative systemic therapy and to compare the results of macroscopic and microscopic evaluation of response in different biological subtypes of breast cancer (BC). Materials and methods. The study included 213 women with breast cancer stages T1-3N0-1M0, treated by preoperative systemic therapy and radical surgery with morphological evaluation of the response in the N.N.Blokhin National Research Oncology Center from 2004 to 2017. All patients had clinical and radiological examination (mammography and ultrasound) before and after neoadjuvant systemic therapy. The rate of morphological response was assessed in different biological subtypes and the rate of pCR was compared with the clinical, radiologic and macroscopic morphological data, statistical analyses was made by SPSS 20.0, the differences were considered reliable at p<0.05. Results. The clinical, radiological and morphological response from preoperative chemotherapy significantly depend from the biological subtype of breast cancer (p<0.05). When comparing macroscopic and microscopic morphological data, in patients with luminal A cancer in 20% cases macroscopic analysis did not reveal a residual tumor mass, however, a microscopic examination was seen of the residual tumor tissue. In patients with HER2-negative luminal B cancer, macroscopic data corresponded to a complete response in 28.8% cases, however, in a microscopic data the true rate of pCR was 10% only. In patients with luminal HER2+ BC, macroscopic and microscopic data of complete response was a very similar (33.3 and 40%), in contrast to non-luminal HER2+ BC in which we found the discrepancy between macroscopic total response (26.9%) and true rate of pCR (42.3%). The same situation was shown in triple negative BC: by macroscopic data complete response was seen 28.2% but in microscopic data the true rate of pCR was significantly higher (43.6%). Conclusions. The tumor response from preoperative systemic therapy depends from the biological subtypes of BC (p<0.05). However, the complete clinical, radiologic and macroscopic tumor responses do not always correspond to pCR. For patients with luminal HER2-negative cancer, the true rate of pCR is significantly lower than expected in clinical and radiological evaluation in contrast to triple negative and HER2+ BC in which the true rate of pCR is significantly higher than expected in clinical and radiological evaluation.
Journal of Modern Oncology. 2017;19(4):16-21
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Head and neck cutaneous melanoma: an influence of surgical resection margin on long-term results
Pak M.B., Mudunov A.M., Demidov L.V., Azizyan R.I., Brzhezovskiy V.Z., Stelmah D.K., Alymov Y.V., Ignatova A.V.
Abstract
Introduction. Despite of recent breakthrough in the drug therapy of metastatic melanoma surgical treatment remains the key method of treatment of primary cutaneous melanoma. Resection margin of ≥3 centimeters has been considered as radical for decades. Hence, 3 decades ago the main challenge of surgical treatment of primary cutaneous melanoma was the aspect of optimal resection margin. Recent studies contest the belief about the necessity of wide resection. The aim: our study was conducted to evaluate an influence of resection margin volume on long-term results of treatment of head and neck primary cutaneous melanoma. Materials and methods. 174 patients with head and neck cutaneous melanoma were included in the study (inclusion interval: 1995-2014). In order to establish real resection boundaries we used the predefined index of cutaneous flap contraction (median: 30%). Therefore, for subsequent statistical analysis patients were defined into 3 subgroups: 1) resection margin <0.5 cm; 2) resection margin from 0.6 cm till 1 cm and 3) resection margin >1.0 cm. Results. Disease free survival did not correlate with resection margin. It was better (77,3%) with minimal resection margin and the worst with maximal resection margin (38,7%). In other words an increase in resection margin has no influence on long-term results. Conclusions. According to international clinical guidelines resection margin ≥1 сm is considered sufficient for T1-2 and 2 cm - for T3-4 cutaneous melanoma of all localizations. Our retrospective study with regard to the predefined index of cutaneous flap contraction was characterized by resection margin <1.0 cm for all stages of melanoma (T1-4) in most cases. We used ROC-curves to evaluate optimal resection margins in relation to the melanoma thickness. Optimal resection margin for tumor <2 mm was defined as 0.46 mm (p=0.13); 2.01-4.0 mm - 0.58 mm (p=0.002); >4 mm - 0.72 mm (p=0.016). Resection margin of 1.0 cm is adequate for all stages of head and neck cutaneous melanoma, even when the tumor thickness exceeds 4 mm. Five-year disease-free survival in the subgroup of resection margin <1.0 cm was 2-fold higher than in subgroup of resection margin >1 cm (59.4% vs 27.3%); p=0.00003; significant difference.
Journal of Modern Oncology. 2017;19(4):22-27
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Principles of diagnosis and surgical treatment of patients with retroperitoneal schwannomas
Bugaev V.E., Nikulin M.P., Melikov S.A.
Abstract
Schwannomas are rare tumors that arise from well-differentiated schwannoma cells of peripheral nerve sheaths. Schwannomas are usually benign tumors. However, malignant form of schwannomas may occur, which is associated with high recurrence rate and unfavorable long-term prognosis. Retroperitoneal localization of schwannomas is rare. With a little data available it is difficult to develop a unified approach for preoperative evaluation, surgical treatment and follow-up of patients with retroperitoneal schwannomas. Assessment of malignant potential of tumor before resection is challenging while immunohistochemical analysis of resected specimen allows to clearly define histological type and malignant grade of tumor. Complete resection of retroperitoneal schwannoma is the only treatment option that may provide acceptable long-term results. As most of the retroperitoneal schwannomas are localized in an anatomical complex area there is high risk of combined resection and massive intraoperative blood loss. Choice of optimal operative approach, necessity of sacral and nerve resection depending on the degree of disease extent remains the matter of debates. Benign retroperitoneal schwannomas have favourable prognosis for long-term survival while malignant tumors are associated with high recurrence rate.
Journal of Modern Oncology. 2017;19(4):28-35
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Soft tissue metastases of the gluteal region in HER2+ breast cancer: a clinical case
Kolyadina I.V., Ganshina I.P., Zhukova L.G., Abdullaev A.G., Andreeva Y.Y., Danzanova T.Y., Sinyukova G.T., Komov D.V., Kozlov N.A., Filonenko D.A., Gordeeva O.O., Lubennikova E.V.
Abstract
Soft tissue metastases of the gluteal region in solid tumors observed very rarely. We described a unique clinical case of gluteal soft tissue metastases in HER2+ breast cancer; through close collaboration were able to confirm the progression of the breast cancer and plan the treatment strategy based on clinical data and biological subtype of breast cancer.
Journal of Modern Oncology. 2017;19(4):36-38
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Clinical cases of the treatment of metastatic colorectal cancer in Russia
Goldberg V.E., Hasanova A.I., Shkuratova V.V., Belevich Y.V., Popova N.O., Simolina E.I., Vysockaya V.V., Dudnikova E.A., Kravchuk T.L., Minnabetdinova R.R., Nekrasova O.V.
Abstract
The article presents the clinical cases of the targeted therapy regorafenib in metastatic colorectal cancer (mCRC) in Russia. Russian oncologists’ experience has not only confirmed the results of international clinical trials, but also clearly demonstrated the possibility of regorafenib long-term administration on the back of high efficacy and manageable safety profile.
Journal of Modern Oncology. 2017;19(4):39-44
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