No 8 (2017)

Despite the increase in the incidence of neuroendocrine tumors (NET) in recent decades, the diagnosis of bronchopulmonary NET predominantly occurs in the disseminated form of the disease. The clinical course of small-cell lung cancer is characterized by rapid growth, early lymphogenous and haematogenic metastases, and high sensitivity to pharmacotherapy and radiation treatment, but the results of treatment remain unsatisfactory. This clinical case of successful treatment of disseminated small-cell lung cancer reflects the individuality of tumor sensitivity to combined treatment.

Endometrial cancer is the most common gynecological tumor in developed countries, and its incidence is growing. The most common histological subtype is the endometrioid adenocarcinoma. The disease is often diagnosed when the tumor is still limited to the uterus. The standard treatment includes primary extirpation of the uterus with appendages, often using minimally invasive methods (laparoscopic). The surgical strategy for the removal of lymph nodes depends on a number of factors: the histological variant of the tumor (subtype, malignancy, involvement of the lymphovascular space), the stage of the disease (including invasion of the myometrium), the characteristics of patients (age and concomitant diseases), national and international recommendations. The choice of the best adjuvant treatment is carried out in accordance with the histological type and stage of the disease. Different classifications are used to assess the risk of relapse and determine the optimal post-operative treatment. The overall 5-year survival of patients with early stages of endometrial cancer ranges from 74 to 91%. High-risk group is the most uncertain group of patients with regard to the choice of optimal adjuvant treatment, and research with the inclusion of chemotherapy, as well as chemoradiotherapy, in relation to this group of patients is still under way. The purpose of these studies is to determine the best balance between survival and quality of life of patients.

The results of univariate and multivariate analyzes for the detection of significant factors predicting the survival of colorectal cancer patients with liver metastases are presented. The following significantly significant factors of favorable prognosis were established: achievement of III-IV degrees therapeutic pathomorphosis; normalization of the cancer-embryonic antigen levels of after preoperative chemotherapy; the prevalence of metastatic liver damage within one lobe. A treatment algorithm that has made it possible to achieve high survival rates has been proposed.

The formation of intraperitoneal adhesions in abdominal or pelvic surgery is very common. Adhesions can be congenital or acquired, manifested as a local inflammatory process. Some adhesions can be asymptomatic, but more often cause serious complications, such as chronic pelvic and abdominal pain, female infertility, and also the most formidable complication in the form of intestinal obstruction. There are several pro-inflammatory mechanisms in the formation of the adhesions, a number of which have not been fully studied to date. Laparoscopic procedures, despite the reduction in intraoperative aggression, do not completely reduce the possibility of postoperative adhesions. The numerous meta-analyzes have been analyzed, and based on their results it is necessary to point out the advisability of using the «correct» surgical technique, reducing the trauma of the peritoneum and internal organs, which leads to a decrease in the frequency of postoperative adhesions.

This article presents the results of a prospective randomized study of biochemical therapeutic combinations based on Aranose (arabinopyranosyl-methyl-nitrosourea), a domestic antitumor drug from chemotherapeutic group of nitrosourea derivatives. The aim of this study was to the evaluation of the efficacy and tolerability of the three biochemotherpeutic regimens developed on the basis of domestic antitumor drugs: Aranose, Reaferon and Roncoleukin. The results of the study showed that the combination of Aranose and Reaferon is most preferable for outpatient use, allowing to achieve disease control in 52% of patients and an objective response in 25% of patients with metastatic skin melanoma. This combination can be used after the progression of the disease against the background of application of targeted and/or immuno-oncologic drugs.

The effectiveness of traditional chemotherapy (temozolomide, fotemustine, lomustine) alone and in combinations with radiotherapy for the entire brain in melanoma patients with brain metastases does not exceed 7-10% without significant effect on overall survival, which is 2-4 months. Targeted therapy improved the survival of patients with disseminated melanoma and BRAF-V600 mutations. In patients with brain metastases, targeted drugs allow not only to control the systemic tumor process, but also achieve an effect in the treatment of brain metastases. Thus, according to the published data, the effectiveness of targeted therapy using BRAF inhibitors vemurafenib and dabrafenib in melanoma patients with BRAF V600 mutations and metastatic brain lesions reaches 18.0-39.2%, with a median survival of patients ranging from 5.3 to 8, 2 months. Data on the effectiveness of combined targeted therapy (BRAF inhibitors + МЕК inhibitors) in melanoma patients with brain metastases are not yet available in the literature. In the RORC n.a. N.N. Blokhin, a study aimed to the evaluation of the efficacy of combined targeted therapy with the inclusion of BRAF inhibitor dabrafenib and МЕК inhibitor trametinib in melanoma patients with brain metastases is under way. According to preliminary data of study, partial regression of brain metastases was achieved in 36.3% of patients, stabilization of the disease - in 27.3% of cases. The median time to progression of the disease was 5.0 months, the median overall survival was 8.5 months. The data presented indicate that the use of a combination of dabrafenib and trametinib in melanoma patients with metastatic brain lesions can provide disease control in most patients and has a significant advantage over standard chemo- and radiotherapy for the entire brain. It is necessary to conduct further studies of combined targeted therapy as the first-line antitumor drug treatment for melanoma patients with BRAF-V600 mutations and metastatic brain lesions.

5НТз receptor antagonists are an integral part of complex antiemetic therapy. Palonosetron as a representative of latest generation 5НТз antagonists has new pharmacological characteristics: the longest half-life and the highest affinity for 5НТз receptors. The properties of palonosetron are the basis of its high efficiency, especially in the long-term period (cross-talk effect). According to published studies, palonosetron is the drug of choice among 5НТз receptor antagonists in one-day chemotherapy, and it has high efficacy in multi-day chemotherapy. Numerous studies have shown the efficacy and safety of palonosetron during chemotherapy in children.