Objective. To carry out an analysis of the data of current literature on the possibilities and perspectives of the use of immunotherapy in patients with malignant neoplasms of the organs of reproductive system.
Materials and Methods. Analytical review comprises the data from foreign and Russian academic sources.
Results. Immunotherapy is an effective method of the treatment of oncologic diseases, in particular as a part of a combined treatment. The feasibility of the study and use of immunotherapy methods in patients with gynecologic cancers is assessed.
Conclusion. Further research which will provide new strategies of antitumor therapy is required.
Keywords: gynecologic oncology, immunotherapy, adoptive therapy, immune checkpoint inhibitors, vascular endothelial growth factor, tryptophan-catabolizing enzymes, vaccination strategies.
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Neuroendocrine tumors (NETs) — are a heterogenous group of malignancies mostly occurring in digestive tract (67.5%) and lungs (25.3%) but still can be found in any organ of the human body including female reproductive tract. Primary welldifferentiated ovarian neuroendocrine tumors (ovarian carcinoids, O-NETs) represent 0.5–5% of all NETs and less then 0.1% of all ovarian tumors. Ovarian NETs are poorly studied and only few multicentered retrospective analyses and individual clinical cases exists. Considering the rarity of these malignancies there are no separate clinical guides for O-NETs and neither prospective clinical trials. In this article we present literature review for the last 30 years and a clinical case of the patient with well-differentiated O-NET treated in N.N. Blokhin National Medical Research Center of Oncology.
Keywords: neuroendocrine tumors (NETs), ovarian malignancies, ovarian carcinoid.
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Introduction. The properties of hematopoiesis in some types of lymphomas, identifi ed to date, provided a ground for subsequent research on the study of hemopoiesis in tumors of non-hematopoietic origin. Notably, the study of the erythroid lineage of the bone marrow, the changes of which are revealed in certain types of cancer, is gaining increasing interest.
Objective — is the study of indicators of erythropoiesis in ovarian cancer.
Materials and Methods. The study material comprised 52 bone marrow aspirates obtained from 52 patients with ovarian cancer. Serous adenocarcinoma accounted for 47 cases (90,4%) and prevailed in the study. Stage I and II tumors represented 15,4% (n = 8) and 7,7% (n = 4) of all cases, respectively. Stage III was identifi ed in 61,2% (n = 32), and stage IV — in 15,4% (n = 8) of cases. Morphological examination of the bone marrow was performed. The content of myelokaryocytes in the aspirates, the total content of bone marrow nucleated red cells (basophilic, polychromatophilic, oxiphilic normoblasts) were evaluated. Microscopic examination of bone marrow aspirate samples was performed and metastatic involvement of bone marrow was excluded in all patients. Statistical processing of the data was carried out using IBM-SPSS Statistics v.21 software package.
Results. The examination revealed that in most cases erythroid lineage was transformed. The count of basophilic and polychromatophilic forms compared to the normal values was reduced (in 61,1% and 55,6% of cases respectively), and the level of oxiphilic normoblasts in the bone marrow of patients with ovarian cancer was increased in 79,6% of observations. However, at the same time the total count of erythroid lineage cells in most cases remained within the normal range. Erythropoiesis indicators were altered to the same extent both in primary and recurrent cancer. Increased levels of oxiphilic normoblasts were coupled with low levels of hemoglobin compared to the group of patients who had no increase in oxiphilic form count: 109,8±3,0 g/l versus 116,6±12,3 g/l. The total content of bone marrow nucleated red cells almost in half of the cases was within the normal values in the group with an increased content of oxiphilic normoblasts, and predominantly reduced with the normal content of the terminal forms of nucleated red blood cells, that was observed in 70% of specimens.
Conclusion. The features of erythropoiesis in patients with ovarian cancer that were related to the change in the proportion of erythroid precursors were identifi ed. The relationship between the increased level of oxiphilic normoblasts and reduced levels of hemoglobin and increased total count of nucleated red blood cells of the bone marrow in comparison with the group of patients who had no percentage increase of oxiphilic forms, was revealed. The development and progression of ovarian cancer is associated with impaired differentiationbone marrow nucleated red cells.
Keywords: bone marrow, erythropoiesis, ovarian cancer, serous adenocarcinoma.
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Objective of the study. To carry out an analysis of the data available in the literature on the clinical course, diagnosis, treatment strategy and prognosis of synchronous endometrioid endometrial and ovarian carcinomas.
Materials and Methods. The literature review comprises the data of foreign and Russian authors.
Results. Clinical picture, variety of diagnostic techniques and the choice of the strategy of treatment of patients with multiple primary synchronous ovarian and endometrial cancer of endometrioid histotype in most cases are determined by summarizing the data relating to each of these nosologies considered separately. Prognosis for this category of patients is relatively favourable. The issue of the role of endometriosis in the development of this type of tumors remains unclear.
Conclusion. A relatively rare occurrence of synchronous endometrioid endometrial and ovarian adenocarcinomas and the consequent absence of extensive research doesn’t not allow to comprehensively characterize the clinical picture, diagnosis, treatment and prognosis for this category of patients. It is necessary to continue research of markers for making differential diagnosis of synchronous and metastatic tumor processes.
Keywords: endometrial cancer, ovarian cancer, endometrioid adenocarcinoma.
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Objective of the study: to confi rm that the use of protective containers allows to reduce the possibility of tumor cell dissemination.
Materials. The study includes patients who underwent myomectomy for benign leiomyoma at the department of minimally invasive gynecologic surgery in the period 2018-2019.
Methods. Washings from abdominal cavity were collected 3 times during the surgery: at the beginning of surgical procedure, after myoma excision and suturing the myometrium incision, after performing wave morcellation, histological samples of tumor tissue fragments and cell blocks were prepared.
Results. Histologic examination of cell blocks prepared from pelvic washings showed the presence of smooth muscle cells after morcellation without using protective containers in 32% of patients and only in 7% of patients after morcellation when protective containers were used. Positive expression of desmin and smooth muscle actin confi rmed the presence of smooth muscle cells in the samples, prepared from peritoneal washings obtained after performing morcellation.
Conclusion. Myomectomy is accompanied by tissue destruction, and, apparently, promotes tissue dissemination even in the absence of morcellation. Power morcellation using a contained bag system in laparoscopic myomectomy, undoubtedly, contributes to reducing the volume of spreading tissue, and as a result, to minimizing potential undesirable effects.
Keywords: morcellation, laparoscopic myomectomy, sarcoma, peritoneal washings.
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Objective of the study. To carry out a systematic analysis of the data available in current literature on the risk factors for the formation of lymphocysts in patients with endometrial cancer who underwent pelvic lymphadenectomy.
Materials and Methods. The review comprises the data from foreign and Russian academic articles found in PubMed on the subject published over the past 10 years.
Results. Various factors resulting in lymphocyst formation are outlined. Active and passive pelvic drainage, complete tight suture closure of vaginal cuff, total or partial peritonization — are the factors that contribute to an increased incidence of lymphocyst formation.
Conclusion. Pelvic lymphadenectomy is a standard stage of surgical intervention in patients with endometrial cancer and it is performed to assess the status of pelvic lymph nodes, to determine the necessity for post-operative therapy. Lymphocyst or lymphocele formation is the most common complication after pelvic lymph node dissection. As a result of the compression of the surrounding structures lymphocysts of large sizes can cause pelvic pains, lower extremity edema, hydronephrosis, ileofemoral thrombosis, infectious complications. In some cases adjuvant radiation therapy is delayed or is absolutely contraindicated in the commonly used surgical techniques can lead to a decreased risk of lymphocyst formation.
Keywords: endometrial cancer, pelvic lymphadenectomy, lymphocysts, drainage, peritonization.
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Objective of the study: to carry out a systematic analysis of the data available in current literature on the recurrence rate after radical trachelectomy in patients with invasive cervical cancer, time of the relapse, localization and treatment approaches, as well as to identify recurrence risk factors depending on surgical access.
Materials and Methods. The review comprises the data from foreign and Russian found in PubMed on the subject published over the past 5 years.
Results. Radical trachelectomy is a standard of surgical treatment for early stage invasive cervical cancer in young women who wish to preserve their reproductive function. Oncological safety of radical trachelectomy is proved in many researches, precise criteria for patient selection for performing radical trachelectomy by various accesses (vaginal, laparotomic, laparoscopic, robot-assisted) were developed. Despite this, some patients have a recurrence of the disease. In view of the fact, that this surgery is not frequently performed at various oncologic institutions and the accumulation of knowledge, experience and evidence occurs slowly, analysis of the results of treatment of a small number of patients often doesn’t allow the authors to draw fi nal conclusions on the subject. The present analysis covers more than 40 studies.
Conclusion. The fi ndings of the analysis confi rm the need for strict selection of patients with invasive cervical cancer for fertility-sparing surgery in order to achieve optimal oncologic results.
Keywords: fertility-sparing surgery for cervical cancer, radical trachelectomy, oncologic results, recurrences.
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Objective of the study: To carry out an analysis of literature data on the novel techniques of chemoradiation therapy of locally-advanced cervical cancer.
Materials and Methods. The review comprises an analysis of the articles submitted in PubMed database.
Results. Image guidance in intracavitary radiation therapy provides a possibility to individually optimize the dose distribution for bringing the maximum dose to the target volume while minimizing the radiation dose load to organs at risk. Intracavitary radiation therapy is a decisive stage of treatment, at which the local tumor volume in cervical cancer receives the maximum dose of exposure equivalent to the total dose achieved from external beam conformal radiation therapy, and therefore, intracavitary radiation therapy is a major prognostic factor in a local control of cervical cancer.
Conclusion. It is expected that the use of 3D-planning in intracavitary radiation therapy will scale up in the clinical practice in the near future, and it will be comparable in complexity with conformal radiation therapy technologies.
Keywords: cervical cancer, conformal radiation therapy, intracavitary radiation therapy, intratissue radiation therapy.
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