Vol 20, No 4 (2018)

Articles
Modern radiation therapy in part of treatment primary mediastinal (thymic) B-large cell lymphoma (results of 131 patients treated at N.N.Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation)
Trofimova O.P., Zavodnova I.Z., Tumyan G.S., Pryamikova Y.I., Volkova N.V., Zaichenko O.S., Nazarenko A.V.
Abstract
Background. For many decades of the twentieth century, radiation therapy has played a leading role in the treatment of patients with lymphoproliferative diseases, which are highly susceptible to ionizing radiation by neoplasms. But due to the effective development of chemotherapy, the discovery and rapid introduction of targeted drugs into practice, the role of radiation treatment in various types of lymphomas becomes less defined in many clinical situations. Primary mediastinal (thymic) B-cell lymphoma (PMBCL) belongs to the primary extranodal tumors and originate from a thymic medullary B cell. The disease has specific morphoimmunological and genetic characteristics that allows it to be identified from the others similar in manifestations lymphoproliferative diseases. The standard of treatment for PMBCL is immunochemotherapy with subsequent irradiation of a residual tumor in the mediastinum. Currently, the benefits of one chemotherapy regimen over the other ones have not been shown in controlled studies. Aim. To study the modern approaches to the chemoradiotherapy in PMBCL patients with an attempt to "individualize" them depending on various prognostic factors. Methods. The study conducted a thorough analysis of the treatment results of 131 patients with PMBCL who were treated in the N.N.Blokhin National Medical Research Center of Oncology from 2005 to 2017. More than half of the patients were women (58%), the median age was 30 years. At different historical periods, the treatment of PMBCL was applied according to different chemotherapy regimens: MACOP-B+R - 55 (42%), R-CHOP - 40 (30.5%), R-DA-EPOCH - 36 (27.5%); 99 patients received radiation therapy. Results. The efficacy of treatment in the whole group of PMBCL patients was high: remission was achieved in 87% of patients, 3-year progression-free survival was 78%, and overall survival was 88%. With a median follow-up of 37 months, 17 (13%) of 131 patients had a relapse or progression of the disease within 13 months from the start of treatment; no late relapses were detected. Treatment of this group was ineffective: the 12-month overall survival did not exceed 37%. In the group of 99 patients with immunochemoradiotherapy, high rates of 3-year overall survival and progression-free survival (with a median of 37 months) were achieved - 91% and 88%, respectively. It has been shown that intensive immunochemotherapy regimens (R-MACOP-B, R-EPOCH) do not differ in efficacy and have statistically significant advantages over the standard R-CHOP regimen. Positron emission tomography (PET) is an important prognostic tool in the treatment of patients with PMBCL: 3-year progression-free survival in the PET-negative group was 92% compared with 26% in the PET-positive group. The frequency of radiation damage to the lungs during conventional and 3D conformal radiation therapy was analyzed. Conclusion. The algorithm of optimal treatment for PMBCL patients was determined based on clinical factors, the drug treatment program, the degree of regression of the tumor and its metabolic activity, volume and method of irradiation.
Journal of Modern Oncology. 2018;20(4):5-15
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The effectiveness of targeted therapy in the treatment of common forms of ovarian cancer
Saevets V.V., Vazhenin A.V., Chernova L.F., Shimotkina I.G., Kurchenkova O.V., Mukhin A.A., Taratonov A.V.
Abstract
Purpose of the study. To evaluate the effectiveness of the targeted drug bevacizumab (Avegra®) in the complex treatment of patients with common forms of ovarian cancer after suboptimal cytoreductive surgical interventions. Materials and methods. For the period from January 2017 to November 2018. A clinical study included and treated 71 patients with a diagnosis of ovarian cancer, stage IIIC-IV disease. The prevalence of the tumor process was estimated according to the classification of FIGO and TNM (2009). Patients were randomized into two groups. The first group included 31 patients, the treatment was carried out according to the scheme: paclitaxel 175 mg/m2, carboplatin AUC 6, bevacizumab 15 mg/kg with an interval of 21 days. The second group (control group) included 40 patients who received standard drug therapy. Interval suboptimal cytoreductive surgery was performed in all patients - hysterectomy with appendages, epiploic resection, peritonectomy. Evaluation of the effectiveness of immediate and remote The results were carried out by the method of statistical processing using the program Statistic 6.0. Results. According to the criteria of RESIST 1.1 in the first group, a complete response was registered in 25.8%, a partial response in 51.6%, stabilization of the disease in 12.9%, progression of 9.6% of cases. In the second group, the complete response was in 20% of cases, a partial response was 45%, stabilization was 22.5%, progression was 12.5%. The median overall survival in the first group was 16.5 months аgainst 10.1 months in the second group.
Journal of Modern Oncology. 2018;20(4):16-19
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A method of laparoscopic installation of port systems for intra-abdominal chemotherapy in patients with advanced ovarian cancer
Lozovaya V.V., Cherkes L.V., Malikhova O.A., Poddubny B.K.
Abstract
Ovarian cancer is one of the leading causes of death in the world, in 80% of cases the diagnosis is made at a late stage. In 50% of cases, a relapse occurs even after the optimal treatment has been performed. The initial treatment of ovarian cancer, regardless of the stage of the tumor process, begins with surgical treatment, and at the second stage, combined chemotherapy is performed. Since the tumor process in ovarian cancer, as a rule, local, limited in the abdominal cavity, in order to reduce the toxicity of chemotherapy drugs on the body as a whole, the alternative options for the administration of chemotherapy drugs is intra-abdominal, which allows increasing the concentration of the drug directly in the tumor locus. Purpose of research. In our study, we want to describe the laparoscopic method of placement of intra-abdominal port systems, assess the disadvantages and advantages, as well as the risks of complications in the case of port installation at the first stage of treatment (intraoperative port installation during laparotomy) and at stage 2 (laparoscopic). Materials and methods. Technically, the implantation of the intraperitoneal port system in order to carry out subsequent chemotherapy courses was carried out in two ways: 1) intraoperative; 2) laparoscopic approaches. In the first case, the installation is carried out directly after the implementation and evaluation of the surgical intervention. In the second, the intraperitoneal catheter is implanted with laparoscopic access after revision and assessment of the quality of cytoreductive surgery. The study included 77 patients with ovarian cancer stage Ic-IV, who underwent optimal cytoreduction at the first stage of treatment (residual tumor up to 1 cm in diameter). At the second stage of treatment, patients were planned to undergo intra-abdominal chemotherapy with palixaxel drugs in combination with intravenous cisplatin. Port systems in 56 cases (72.7%) were installed intraoperatively and in 21 cases (27.3%) laparoscopically. Results. In total, port systems were installed in 77 patients, of which - in 56 cases intraoperatively and in 21 cases laparoscopically. However, a total of 30 (38.9%) laparoscopic interventions were performed: in 21 (27.2%) cases a port system was installed, in 6 (7.8%) cases during laparoscopy contraindications were detected for port implantation, in 3 (3.9%) cases required a reinstallation of the port system due to complications arising after intraoperative implantation. As described above, 6 patients had contraindications for installing port systems, of which in 4 (5.2%) cases, it turned out to be a marked adhesive disease after primary cytoreduction, in two patients (2.6%) non-optimal amount of cytoreductive interventions in the first stage. Multiple metastases in the peritoneum of up to 3 cm in diameter were visualized in one patient, which did not correspond to the protocol of the operation, the patient subsequently received standard treatment; in the second case, there was a large omentum with metastatic lesions. The patient was re-operated in the optimal volume and intraperitoneal intraperitoneal port system was installed intraoperatively. Thus, in 7.8% of cases, the protocol data of the operation did not match the laparoscopic data. Conclusion. The method of laparoscopic implantation of intra-abdominal port systems is safe and effective, which in comparison with the intraoperative installation method provides several advantages: additional revision of the abdominal cavity to assess the optimality of cytoreductive surgery performed at the first stage, assessment of the degree of adhesions in the abdominal cavity, which in turn affects the uniform distribution of the drug.
Journal of Modern Oncology. 2018;20(4):20-22
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Quality control of immunohistochemical analyzes in Russia: yesterday, today, tomorrow
Kolyadina I.V., Frank G.A., Poddubnaya I.V., Andreeva Y.Y., Zavalishina L.E.
Abstract
The opening of the Russian program of quality control of immunohistochemical analyzes will increase the quality of diagnosis and treatment of malignant tumors, as well as optimize financial costs of oncology.
Journal of Modern Oncology. 2018;20(4):23-26
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Diagnosis of metastatic pulmonary disease: review
Komarov I.G., Belova O.S.
Abstract
The review presents literature data on the possibilities of modern diagnostic methods in detecting and determining the nature of secondary lung tumors, and also analyzes their main advantages and disadvantages.
Journal of Modern Oncology. 2018;20(4):27-31
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Non-small cell lung cancer with the tracheal bifurcation involvement. Carinal pneumonectomy or chemo-radiation therapy?
Dadyev I.A., Davydov M.M., Shogenov M.S., Abdullaev A.G., Ibraev M.A., Filatov A.A.
Abstract
The aim of the study: the aim of this study was to compare the immediate and long-term results of treatment of patients with non-small cell lung cancer with involvement of tracheal bifurcation, which were underwent pneumonectomy with resection of the tracheal bifurcation or radical chemo-radiation therapy (CRT). Materials and methods. We conducted a retrospective non-randomized clinical study with following groups of patients: 1) 65 patients who underwent pneumonectomy with resection of the tracheal bifurcation; 2) 30 patients to whom CRT was performed. Evaluation of the effectiveness of immediate and long-term results was carried out by statistical processing using the Statistic 6.0 program. A case-control analysis was performed to compare two groups. The time of the operation, intra- and postoperative complications was estimated depending on the type of resection of the tracheal bifurcation. Results. The complication rate was 46.1% in the surgical group. In the CRT group complications developed in 13 (43.3%) patients. The overall 1-, 3-, 5-year survival rate in the group of patients with surgical treatment was 56.92, 31.7 and 26.1%, respectively. The median overall survival was 14.5 months. Indicators of 1-, 3-, and 5-year survival in the group of patients who underwent radical CRT were 31.6, 24.4, 16.2%.
Journal of Modern Oncology. 2018;20(4):32-35
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Pneumonectomy with carinal resection in patients with non-small cell lung cancer: short and long-term results
Dadyev I.A., Davydov M.M., Abdullaev A.G., Kulik I.O., Ambalova Z.A., Akhmedov P.I., Anokhin A.Y., Karasheva B.M.
Abstract
Objective. With to compare short- and long-term treatment outcomes of different carinal resection techniques in patients with non-small cell lung cancer (NSCLC) and carina involvement. Materials and methods. We performed retrospective nonrandomized clinical trial with following groups of patients: patients underwent pneumonectomy with sleeve carinal resection (47 patients); patients underwent pneumonectomy with marginal and wedge carinal resection (18 patients). Statistical analysis was made using Statistic 6.0 program. Case-control analysis of the both groups was performed to evaluate short- and long-term treatment outcomes of different carinal resection techniques in patients with NSCLC and carina involvement. Results. Frequency of non-surgical and surgical complications was 27.7% and 18.5% correspondingly. Postoperative mortality was 8.5% in sleeve carinal resection group and 11.1% in marginal and wedge carinal resection group. Five-year survival rates were 32.6% in sleeve carinal resection group and 11.1% in marginal wedge carinal resection group.
Journal of Modern Oncology. 2018;20(4):36-40
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Bendamustine in the treatment of B-cell non-Hodgkin lymphoma
Babicheva L.G., Poddubnaya I.V.
Abstract
Bendamustine is a uniquely structuredalkylating agent that lacks cross-resistance with other alkylators. This agent has a high degreeof activity against a variety of tumor cell lines.Based on clinical data from randomized phase III trials, bendamustine, with or without rituximab, hasbeen shown to be an appropriate option for first-line treatment or treatment of relapsed/refractory patients with indolent non-Hodgkin’s lymphoma or elderly patients with mantle cell lymphoma. Bendamustine treatment is associated with abetter therapeutic index and offers an improved overall quality of life compared to R-CHOP or R-CVP. It is now often used as achemotherapy backbone for combination with novel drugs including ibrutinib or idelalisib. This article provides a comprehensivesummaryof the clinical data along with practical adviceonhowto optimallymanagepatients with bendamustine therapy, includingdose recommendations, antiemetic prophylaxis, prevention of infusion and skin reactions, as well as prophylaxis of opportunisticinfections. This information might be helpful for clinicians using bendamustine in their daily practice.
Journal of Modern Oncology. 2018;20(4):41-46
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