No 8 (2012)

In 2008 in Russia, the proportion of lung cancer accounted for 20,4 % of all cancer cases in men, with majority of patients with non-small cell lung cancer (NSCLC) diagnosed at late stages. Some histological subtypes of NSCLC (nonsquamous cell lung cancer compared to squamous cell lung cancer) and mutations (EGFR, KRAS, EML4-ALK) are associated with a higher efficacy of chemotherapy and biological therapy. The correctness of assignment of these treatments depends on the exact histological classification of tumors and analysis of the genetic mutation that allows to choose the most effective individual method of treatment without empirical therapy and associated risk of side effects. This review presents the current understanding of treatment options for advanced-stages NSCLC based on histological and molecular characteristics of tumors.

In most countries, morbidity and mortality from primary malignant liver tumors is increased; hepatocellular carcinoma (HCC) is diagnosed among 85 % of patients. Viral hepatitis and liver cirrhosis are main etiological factors for HCC. Diagnosis of the HCC at an early stage only allows to achieve success in the treatment of disease; therefore, all high-risk patients should be screened 2 times a year. Currently, liver resection remains the primary treatment for HCC, which allows to hope for a satisfactory long-term results. Best results of surgical treatment were subject to the Milan criteria. However, HCC is diagnosed at later stages in most patients. Therefore, many hospitals have expanded the indications for surgical treatment of HCC and developed the new treatment strategies in recent years.

Neutropenia is one of the major side effects of cytostatic treatment of tumor diseases, contributing to the development of infectious complications. Prolonged neutropenia often does not allow chemotherapy as planned, and can lead to chemotherapy dose reduction, which ultimately reduces the effectiveness of antineoplastic therapy. Therefore, carefully evaluation of myelotoxic potential of modern chemotherapy regimens and identification of patients at high risk of febrile neutropenia, in need of prophylactic colony-stimulating factor, are required. The success of the treatment of febrile neutropenia depends on early detection of possible infection and early treatment.

The article discusses in detail the primary diagnosis of acute abdomen syndrome (AAS) at the pre-hospital stage, and the problem of differential diagnosis of diseases of internal organs with clinical picture that may mimic an acute surgical pathology, often encountered in the therapeutic practice. The relevance of timely diagnosis of the AAS is emphasized; it is associated with a direct dependence of postoperative lethality on the time from onset of illness to the admission of the patient in a surgical hospital and performing necessary surgery. It is shown that the solution to this problem is directly related to skills of physical examination of patient and ability of physician, taking part in the initial diagnosis of the syndrome, to correctly interpret the results of this examination.

Breast cancer is the leading cause of cancer mortality among women. The disease is often diagnosed at advanced stage. Despite recent advances in metastatic breast cancer (MBC) treatment, optimal therapy regimen is still to be determined. We have conducted this prospective multicenter trial to assess the efficacy and safety of weekly infusion of paclitaxel (Taxacad®) 80 mg/m 2 in MBC patients. The trial has included 19 MBC patients. All patients have received 24 paclitaxel infusions (3 cycles). Grade 3 adverse events (AEs) (rated according to NTICTCAE v. 2.0) were reported in 6 (31,6 %) patients (neutropenia, peripheral sensory neuropathy, AST elevation). No cases of grade 4 AEs were observed. In 1 patient grade 3 AE (peripheral sensory neuropathy) has lead to treatment discontinuation. Treatment response was assessed using RECIST criteria in 18 patients. After 3 cycles of chemotherapy partial response was achieved in 11 (57,9 %) patients, disease stabilization - in 4 (21,1 %) patients. The disease has progressed during the treatment in 4 (21,1 %) patients. Median follow-up was 8,5 (2-24) months; median time to progression was 9 (1-12) months. In conclusion, weekly paclitaxel monotherapy can be safely used in MBC patients.

From 1985 to 2011, in the Department of Surgery of tumors of the liver and pancreas ROSC named after N.N.Blokhin 329 pancreatoduodenal resections for malignant diseases of periampullar localization were performed. The short-term results of treatment of operated patients were analyzed with the aim to determine the effects of obstructive jaundice in the perioperative period. It was revealed that high bilirubin levels have no significant effect on intraoperative parameters, as well as on the frequency of postoperative complications and mortality; whereby, possibility of radical surgery without preoperative bile diversion can be discussed.