Objective of the study — is to evaluate immediate and long-term results of surgical treatment of patients with metastatic ovarian cancer based on previous experience.
Materials and Methods. 33 patients with gynecologic cancer underwent surgery at the Department of liver and pancreatic tumors of Federal State Budgetary Institution «N.N.Blokhin Russian Cancer Research Center» for the period from 1990 to 2016.
Results. 19 patients with intraparenchymal metastases to the liver from ovarian cancer were examined. The mean age of patients was — 45,2 years (± 14,0). Localization of metastases in the liver were: in the right lobe of the liver — 73,7%, left lobe — 5,3%. The size of liver metastases ranged from 0,5 cm to 28 cm. Atypical liver resections were performed in the majority of patients — 16 women (84,2%). 3 patients (15,8%) underwent right-sided hemihepatectomy. Only 5 (26,3%) patients of all 19 who underwent surgery had isolated liver lesions. The other types of tumor cell seedings besides liver metastases were identifi ed in the remaining 13 (73,4%) patients. Radical liver resection and excision of all visible metastases were performed in 15 (78,9%) patients. Multiple lesions of the peritoneal cavity were detected in the remaining 4 cases (21,1%). Post-operative complications were observed in 21% of patients. Post-operative mortality rate was 5,26%. The overall cumulative survival rate of patients with metastatic ovarian cancer after liver resection was as follows: 3-year — 56,2%, 5-year — 42,2%. Long-term survival rate in patients with metastases to the liver from the ovaries after surgical treatment made up: 3-year — 53,8%, 5-year — 35,9%. After radical resections 3-year survival rate was 79,1% and 5-year — 47,5%.
Conclusions. Optimal surgical cytoreduction combined with adjuvant chemotherapy or hormone therapy are the signifi - cant factors which affect the survival rate in patients with metastatic ovarian cancer.
Keywords: non-colorectal metastases, metastases to the liver from ovarian cancer, radical surgery, optimal cytoreduction, overall survival rate, combined chemotherapy.
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Objective of the study — is to determine clinical signifi cance of differential diagnosis of tumor-like lesions of the ovaries in pregnant women using logistic regression models, developed by us, as well as molecular-biological factors of angiogenesis and apoptosis in peripheral blood in order to choose the tactics of the treatment of pregnant patients.
Materials and Methods. 260 pregnant women with ovarian lesions and ovarian tumors were examined for the period from 2000 to 2014.
Results. When decisive rule was used in the ultrasound examination of pregnant women for the prediction of ovarian lesions false-positive results on the presence of true tumors were identifi ed in 11 cases of 78 observations. In the prediction of true tumors suspicion of malignancy was detected in 15 of 141 observations. Prediction of borderline and malignant lesions was correct in all observations. False — negative results were not identifi ed. Central location of vessels with a branched network (in partitions, in solid component, in papillary growths) and the presence of low resistance blood fl ow were revealed in ultrasound investigation performed before morphological verifi cation of lesions in borderline and malignant tumors. These results were correlated with the markers of proliferation, of endothelial cell differentiation, as well as of apoptosis — VEGF exceeding 500 pg/ml and IL-6 — exceeding 8,1 pg/ml. Herewith test specifi city made up 91,5%, test sensitivity — 75%.
Conclusions. Therefore, the data obtained indicates that besides ultrasound markers seen in atypical structure of ovarian lesions in pregnant women, determination of VEGF, IL-6, sFas in blood serum could be feasible in pre-operative clarifi cation of the nature of ovarian tumor found (benign or malignant process).
Keywords: benign and malignant ovarian tumors, ultrasound examination.
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The work presents a rare case of an observation of synchronous multiple primary tumors: ovarian cancer and metastasis of non-pigmented melanoma of unknown primary site.
Keywords: multiple primary malignant tumors, metastases of non-pigmented melanoma of unknown primary origin, ovarian cancer.
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Objective of the study — to conduct a review of literature data, concerning epidemiology of ovarian cancer and modern concepts of its morphological classifi cation and histogenesis.
Materials and Methods. The review is comprised of the excerpts from Russian and foreign articles published predominantly over the past 5 years.
Results. The work presents the updated statistics on ovarian cancer, highlights the current conceptions on genetic and morphological classifi cation of this disease.
Conclusion. In the majority of cases ovarian cancer is diagnosed at advanced stages, as a consequence of which the results of treatment remain unsatisfactory; fi ndings in cancer research of the last years encourage a critical refl ection on the very term and concept of ovarian cancer as well as on the approaches to its early detection and treatment.
Keywords: ovarian cancer, epidemiology.
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Objective of the study is 1) to conduct an analysis of the rates of ovarian cancer prevalence and incidence in Federal Districts of the Russian Federation with identifi cation of the subgroups of patients with BRCA1/2 gene mutations; 2) to determine the necessity of performing targeted therapy using PARP inhibitors in a population of patients with BRCA1/2 gene mutations; 3) to construct a clinical and statistical model of clinical outcomes considering an indicator “survival without progression of the disease”; 4) to assess clinical and economic aspects of the use of Olaparib preparation in a target population of patients.
Materials and Methods. As a result of the information search process statistical, epidemiological, clinical, economic data sets relating to the course and outcomes of ovarian cancer in patients, including those who had BRCA1/2 gene mutations, were selected and provided the basis of our model.
Results. A target population for targeted therapy with PARP inhibitors nationwide in the Russian Federation makes up 916 patients. The above fi gure for Central Federal District will be 249 patients, South Federal District — 105 patients, Far East Federal District – 35 patients. In the modelling of clinical outcomes on the level of a hypothetical Federal District it was detected that using strategy I (chemotherapy + monotherapy with Olaparib in supporting regimen) in all patients who need the treatment, the total number of months they will be in a conditional clinical state “healthy” (survival without progression), will make up 1204,73 months. Using strategy II (chemotherapy only) — 735,09 months. Taking into consideration an indicator of “effi cient treatment in patient-months” that has been developed and introduced, the cost of the treatment with Olaparib constitutes 305 084,75 rubles.
Conclusions. The use of PARP inhibitors in a target population of adult patients with platinum sensitive recurrent BRCAassociated ovarian cancer is reasonable and justifi ed not only in terms of clinical approach, but also economically. When planning the extent of specialized medical care for above mentioned patients it is necessary to consider the outcomes of BRCA1/2 status testing and regional disparities in ovarian cancer prevalence and incidence.
Keywords: ovarian cancer, Olaparib, BRCA1/2 mutations.
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Intravenous leiomyomatosis is a rare morphologically benign tumor, arising from uterine smooth muscle and it is capable of growing intravenously. A tumor can spread through uterine and ovarian veins into inferior vena cava, reaching the right side of the heart. Clinical manifestations of the disease are not specifi c and that can lead to late diagnosis. Radical surgery is currently the standard treatment. This patient with intravenous leiomyomatosis which spread into the right atrium and right ventricle.
Keywords: intravenous leiomyomatosis, tumors with unclear malignant potential.
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Taking into consideration that false positive and false negative results can occur in the process of a study and of an assessment of cytograms, that are primarily related to poor quality of samples obtained, the major challenge would be to fi nd the criteria that can ensure quality testing and an adequate diagnosis of precancerous lesions and cervical cancer.
Objective of the study — is to evaluate the effectiveness of various types of special devices for cytology specimen collection from the cervix in the diagnosis of cervical intraepithelial neoplasia (CIN) and cervical cancer.
Materials and Methods. 90 patients who visited the clinic of P.A. Gertsen Moscow Oncologic Research Institute — a Branch of Federal State Budgetary Institution «National Medical Research Center of Radiology» of the Ministry of Healthcare of the Russian Federation and Municipal Clinical Hospital № 57 named after D.D. Pletnev of Moscow Department of Healthcare underwent the examination for the period from September to December 2016. At the time of the investigation СIN I–III (LSIL-HSIL).was verifi ed in each patient cytologically and/or histologically. The study was conducted using cytological and histological methods.
Results. Cytological diagnosis defi nes the correct tactics of treatment in 97,5% of cases. Accuracy of cytological method in the collection of specimens from the cervix depends on the type of a special device that is used. When using Cervex- Brush® Combi and Cytobrush type F the accuracy of the method was 70%. When the samples are collected with spatula and Cytobrush type D separately the accuracy of the technique increases up to 96% (p ≤ 0,05). The percentage of errors which entail incorrect tactics of treatment is three times as high as in cases when cervical cellular specimens are collected using Cervex-Brush® Combi (p ≤ 0,05), and the percentage of errors which don’t affect the tactics of further treatment is twice as high as when Cytobrush type F is used (p ≤ 0,05).
Conclusion. Neither type of device for collecting cervical cellular samples proves to be perfect. The choice of particular cervical sampling device should be made based on the type of transformation zone, the size of an external cervical os and anatomical particularities of the cervix. The accuracy of cytological diagnosis of . CIN III and cervical cancer can be quite comparable to histological diagnosis provided that smear collection is performed adequately and obtained specimen is spread onto the glass slide correctly.
Keywords: cervical Cytobrush, spatula, Cervex-Brush® Combi, cervical intraepithelial neoplasia, CIN, HSIL, cervical cancer, effectiveness of cytological diagnosis.
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Objective of the study — is to research cellular reaction of the tissues to the implantation of TachoComb® preparation produced by «Takeda Austria GmbH» and collagen hemostatic sponge into the tissues of laboratory animals, as well as to conduct a comparative analysis of the features of infl ammatory process in the surrounding tissues, terms of their elimination and the possibilities of the use of these preparations for the prevention of prolonged lymphorrhea in patients who undergo surgery for breast cancer.
Materials and Methods. The experimental part of the study was performed on 96 sexually mature female rats of body mass 200–250 g in compliance with «Guidelines for the care and use of laboratory animals in experimental studies», regulated in the Order № 755 of 12.09.77 of the Ministry of Healthcare of the Russian Federation and with the principles, outlined in the European Convention for the protection of vertebrate animals used for experimental and other scientifi c purposes (Strasbourg, France, 1986). 20 patients who had undergone mastectomy with subclavicular, axillary, subscapular lymph node dissection, were included in the clinical prospective randomized study.
Results. Unlike standard hemostatic collagen sponge, the implantation of TachoComb ® into the tissues doesn’t induce granulomatous infl ammation in them. Complete elimination of the preparation occurs in the short term — up to one month.
Conclusions. Clinical approbation of the use of TachoComb during the surgery in patients with breast cancer showed its effectiveness for the prevention of prolonged lymphorrhea.
Keywords: TachoComb, hemostatic sponge, tissue reaction to implantation, post-operative lymphorrhea, prevention.
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Objective of the study — is to conduct a systematic analysis of the data available in current literature on the infl uence of low-molecular-weight heparins on the effectiveness and safety of antitumor treatment in oncology.
Materials and Methods. The review includes the data from foreign and Russian articles found on the subject in Pubmed and in Russian Science Citation Index which have been published over the past 10 years.
Results. The article describes the possible mechanisms of the participation of low-molecular-weight heparins in the prevention and treatment of thromboembolic complications in oncology considering pathogenesis of hypercoagulation, their principal advantages in comparison with unfractionated heparins, as well as the prospects of the use of low-molecular-weight heparins in palliative care. International guidelines on the prevention and treatment of thromboembolic complications in this category of patients are outlined.
Conclusion. Low-molecular-weight heparins proved to be safe and effective when used in surgical treatment, drug therapy and radiation antitumor treatment. Their application in palliative oncology requires further research.
Keywords: low-molecular-weight heparins, oncology, effectiveness.
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