Objective of the study is to conduct a systematic analysis of the data on current possibilities of the preservation of fertility in cancer patients of reproductive age.
Materials and methods. The review comprises the data from foreign literature on the problem of preservation of reproductive potential of patients with cancer.
Results. The article identifi es the feasible techniques of obtaining gametes in patients before and during the treatment for cancer. The review provides recommendations on the management of patients who wish to preserve reproductive function.
Conclusion. The modern assisted reproductive technologies give patients wide opportunities to preserve their reproductive function after the remission.
Keywords: preserving fertility, ovarian tissue cryopreservation, pregnancy, assisted reproductive technologies.
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Objective of the study is to conduct a systematic analysis of the data available in current literature on the possibilities of hormone therapy in the treatment of early breast cancer.
Materials and methods. The review comprises the data of foreign and Russian academic articles found in PubMed on the subject published over the past 10 years.
Results. Endocrine therapy has become an integral part of adjuvant treatment of early hormone-dependent breast cancer and is indicated in all cases when estrogen receptors are present in the tumor, while aromatase inhibitors presented real challenge to 5-year course of tamoxifen intake for women in post-menopause previously considered the «gold standard». Letrozole is one of aromatase inhibitors — nonsteroidal aromatase inhibitor which has demonstrated credible advantages in comparison with tamoxifen for the therapy of early breast cancer in postmenopausal patient.
Conclusion. As a result of a number of large-scale clinical trials, aromatase inhibitors have proven their indisputable advantage and must become an integral part of standard endocrine therapy for postmenopausal women with receptor — positive breast cancer.
Keywords: breast cancer, letrozole, aromatase inhibitors, adjuvant therapy.
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Objective of the study is to evaluate the possibility and optimal conditions of performing organ-sparing surgeries for Paget’s disease of the breast.
Materials and methods. 44 patients underwent surgery for Paget’s disease of the nipple at the Department of Radiosurgery of Federal State Budgetary Institution «N.N.Blokhin National Medical Research Center of Oncology» for the period from 1994 to 2016. Case-control study was conducted separately among the three groups: purely Paget’s disease of the breast (n = 8), Paget’s disease with intraductal component (n = 7) and Paget’s disease of the breast in conjunction with infi ltrating ductal carcinoma (n = 29). Two types of surgical intervention were performed in all groups: radical resection and radical mastectomy.
Results. Data of all 44 patients was analyzed. Patients’ age varied from 30 to 89 years (median age was 56,5 years). In the group who had underwent organ-sparing treatment death of this disease occurred in 2 patients (9,5%), in mastectomy group — in 3 (13,0%) patients. The median survival was 70 months (interquartile range — 2–206 months). Progression of the underlying disease was identifi ed in the radical resection group in 9 (42,9%) patients, in radical mastectomy group — in 5 (21,7%) patients (p = 0,197). Among them local recurrence after organ-conserving surgery was diagnosed in 6 (66,7%) patients, and after radical mastectomy — in 3 patients (p = 0,272). Progression through distant metastasis was detected in radical resection group in 3 patients and in 2 patients from radical mastectomy group (p = 0,658). Overall and relapse-free survival of patients with purely Paget’s disease of the breast in both groups was 100% (p = 0,825), and there were no cases of regional lymph node involvement.
Conclusions. Breast — conserving treatment for Paget’s disease of the breast is possible and it proves to be a reasonable alternative to radical mastectomy not yielding to it in radicalism. However, underestimation of the possibility of its co-occurrence with invasive breast cancer can lead to inadequate treatment. Therefore, the completeness of preoperative diagnosis is a key issue in developing treatment strategy for patients with Paget’s disease of the breast.
Keywords: breast cancer, Paget’s disease of the breast, organ — conserving treatment.
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Objective of the study is to carry out a systematic analysis of the data available in current literature on seromucinous borderline tumors of the ovaries in women of reproductive age and to investigate the role of endometriosis in the pathogenesis of this disease.
Materials and Methods. The review comprises the data of foreign and Russian academic articles found in PubMed on the subject published over the past 10 years, and as an example clinical observations of this pathology are examined.
Results. Seromucinous borderline tumors are a rare type of ovarian neoplasms and currently they are classifi ed as endometriosis- associated tumors. The importance of correct diagnosis of this rare pathology in young women is attributed to the determination of optimal tactics of management, appropriate treatment and fertility preservation. The work introduces our own observations of seromucinous borderline tumor in patients of reproductive age with co-occurring endometriosis.
Conclusion. Therefore, the clinical observations described above and the review of literature data suggest that endometriosis is morphologic precursor of ovarian seromucinous borderline tumors.
Keywords: ovarian seromucinous borderline tumor, endometriosis, organ-preserving treatment, ultra-conservative surgery.
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Objective of the study is to carry out a systematic analysis of the data available in current literature on the possibilities of surgical treatment for locally recurrent leiomyosarcoma of the uterus.
Materials and methods. The review comprises the data from foreign and Russian scholarly articles found in PubMed on the subject published over the past 10 years and it examines the tactics of the management of patients with this pathology.
Results. Sarcoma of the uterus — is a relatively rare malignant tumor of connective tissue and mesenchymal origin. The diffi culties in determining the tactics of treatment of sarcomas of the uterus are attributed to their rarity and heterogeneity. Standard surgical treatment for leiomyosarcoma of the uterus is primarily radical hysterectomy. The role of adjuvant and radiation therapies remains unconfi rmed. Herewith, the risk of recurrence even after radical treatment remains high. Particular challenges arise in the choice of the tactics of treatment of recurrent sarcoma of the uterus. The present clinical case study focuses on the advantages of surgical technique in the treatment of locally recurrent leiomyosarcoma of the uterus.
Conclusion. Although the issue of surgical treatment of locally recurrent sarcoma of the uterus has not been suffi ciently addressed and covered in world literature, it should be reported that in such cases the surgery is optimal and, sometimes, the only treatment method.
Keywords: sarcoma of the uterus, local recurrences, surgical technique.
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Objective of the study is to conduct a systematic analysis of the data available in current literature on the tactics of the treatment and management of pregnant patients with invasive cervical cancer.
Materials and methods. The review incorporates the results of international studies and includes, in particular, ESGO recommendations on this issue.
Results. The process itself of staging of the disease during pregnancy and the treatment should comply with current standards, to the extent possible. Surgery and/or chemotherapy are considered to be fundamental methods of treatment for invasive cervical cancer during pregnancy. Tactics in the treatment of such patients is determined by a range of factors and depends on gestational age at the time of diagnosis, the stage of the disease, tumor size, as well as on the involvement of regional lymph nodes and the woman’s desire to continue pregnancy.
Conclusion. It should be recognized that ESGO clinical recommendations, stated above, regretfully, cannot address all issues. The golden standard of the treatment of invasive cervical cancer in pregnant patients hasn’t been developed yet. Nevertheless, it is still advisable to follow the proposed guidelines for tactical approaches and to continue further research in that regard.
Keywords: invasive cervical cancer, clinical recommendations, pregnancy.
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Introduction. Rapid diagnosis of sepsis and beginning of treatment is a key factor in decline of mortality. The clinical presentation of chemotherapy toxicity can coincide with sepsis clinical manifestation. Markers of sepsis serve as an additional diagnostic tool: C-reactive protein (CRP), procalcitonin (PCT) and presepsin.
Objective of the study: Evaluation of the sensitivity of biomarkers of sepsis in patients receiving antitumor chemotherapy.
Materials and methods: In 56 patients blood sampling for the determination of sepsis markers was performed in the first hour of stay at the emergency resuscitation and intensive care unit. Levels of C-reactive protein (CRP) and procalcitonin (PCT) were measured in 56 patients, of presepsin — in 21. Results were presented as the median value. 95% confidence interval (CI) was calculated using Wilson method. Values exceeding 40 mg/ml for C-reactive protein (CRP), 2 ng/ml for procalcitonin (PCT) and 600 pg/ml for presepsin were taken into account. Results. CRP, PCT and presepsin concentrations were 178,3 mg/ml (13,1–455,9); 5,165 ng/ml (0,04–200) and 940 pg/ml (345–6464), respectively.CRP, PCT and presepsin sensitivity as biomarkers of sepsis made up 0,95 (0,85–0,98 confidence interval); 0,80 (0,68–0,89 confi dence interval); 0,86 (0,65–0,95 confi dence interval), respectively.
Conclusion. C-reactive protein has been identifi ed as a positive biomarker of sepsis showing the highest sensitivity.
Key words: sepsis, oncology, C-reactive protein, procalcitonin, presepsisn.
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Objective of the study is to conduct a systematic analysis of the data available in current literature on echinococcosis of the ovary and to consider the possibilities of differential diagnosis of this disease and benign and malignant neoplasms of this organ.
Materials and methods. The review covers the data of foreign and Russian academic articles found in PubMed on the subject published over the past 10 years and as an example a clinical observation of this pathology is examined.
Results. Echinococcosis is a disease that progresses as a result of penetration of hyper tape- worm echinococcus into a human body and of development of a larval phase of its life cycle in it. Ovary is an uncommon localization of echinococcal cyst being rare even in endemic areas. The incidence of hydatid disease of the ovary is 0,4–0,5% among all echinococcus localizations. The article describes a clinical observation of ovarian echinococcosis, analyzes the challenges in the differential diagnosis of ovarian echinococcosis.
Conclusion. In our clinical case study ovarian echinococcosis was not diagnosed at preoperative stage of the examination but this type of pathology should be in-corporated into the range of diseases to be considered in a differential diagnosis if risk factors are present and in endemic areas.
Keywords: echinococcosis of ovary, differential diagnosis, cyst.
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Objective of the study is to conduct a systematic analysis of the data on the current legislation on the use of assisted reproductive technologies whereby malignant neoplasms of any localization are contraindications for the application of a basic program of assisted reproductive technologies.
Materials and methods. The overview comprises current legislative acts as well as the data obtained from foreign and Russian academic literature on the problem of preservation of reproductive potential of patients with oncologic diseases.
Results. However, numerous studies in the fi eld of gynecologic oncology prove the effectiveness of organ-preserving methods of treatment, used for the preservation of fertility of patients of young age. The work justifi es the necessity of legal recognition of the possibility of the use of methods of assisted reproductive technologies for the treatment of infertility in persons with malignant neoplasms provided they have a positive decision of medical commission under the chairmanship of gynecologic oncologist and it must be subject to the availability of informed voluntary consent from a patient.
Conclusion. The analysis of public health protection legislation allows us to conclude that there is necessity to improve legislation on public health protection in particular in terms of securing in it the possibility of the use of the methods of assisted reproductive technologies for the treatment of infertility in persons with malignant neoplasms.
Keywords: legislation on assisted reproductive technologies, preserving fertility in cancer patients, the use of assisted reproductive technologies, treatment of infertility in cancer patients, prevention of childlessness in cancer patients.
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