Objective of the study is to establish the relationship between the indicators of systemic and local immunity of patients with primary operable breast cancer and clinical pathology parameters.
Materials and Methods. The samples of peripheral blood and surgical resection specimens of 68 patients with primary operable breast cancer were examined under the study. The evaluation of the expression of immune checkpoints and lymphocyte subpopulation composition was carried out using fl ow cytometry.
Results. The relationship between Ki-67 proliferation marker and the content of cytotoxic T cells and T-lymphocytes in peripheral blood and B-cells in tumor infi ltrating lymphocytes (TILs) is shown. The inverse correlation of estrogen and progesterone receptors with the content of lymphocytes suppressor populations including CD4+CD25+ICOS+, CD4+CD25+CTLA-4+ and Lag-3 cells is established. The interrelationships of inhibitory molecule expression were more pronounced in tumor infiltrating lymphocytes (TILs) than in peripheral blood that indicates the suppressor phenotype of tumor microenvironment. The increase in the content of CD8 cells in peripheral blood and tumor infi ltrating lymphocytes (TILs) is associated with an increase in suppressor molecule coexpression, that signifi es an unfavourable prognostic relevance of this population, however, it provides advances in the use of immunotherapy for this category of patients.
Conclusion. An analysis of subpopulation structure of peripheral blood immune cells and tumor microenvironment demonstrated the relationship between effectory and regulatory mechanisms of the immune response and the major clinical pathology parameters in patients with primary operable breast cancer.
Keywords: fl ow cytometry, immunity checkpoints, peripheral blood, tumor infi ltrating lymphocytes (TILs), breast cancer
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With every year an increasing number of young women are diagnosed with breast cancer during pregnancy. The novel approach to the treatment using both surgery and chemotherapy allow to provide the full range treatment options for the principal diagnosis, while preserving pregnancy. However, the prognosis of the disease in this group highly depends on timely diagnosis. Delay and errors, occurring in diagnostics worsen the prognosis and the course of breast cancer, often leading to fatal outcomes. This article focuses on the analysis of such clinical cases.
Keywords: breast cancer, pregnancy, diagnosis, prognosis.
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Objective of the study is to carry out a systematic analysis of the current literature data on rare types of malignant trophoblastic tumors (MTT), on their incidence rate, their diagnostic features, clinical course and treatment strategy.
Materials and Methods. The review comprises the data of foreign and Russian academic research, performed on the subject, published over the past 10 years.
Results. Epithelioid trophoblastic tumor (ETT) and placental site trophoblastic tumor (PSTT) — are the types of malignant trophoblastic tumors that occur extremely rarely. As a rule, the diagnosis is based on histologic examination of tumor that was excised by surgical resection, prospective and randomized research is absent, thereby the data on optimal treatment strategy is limited. Biological behavior of tumor is unpredictable, at stage I the cure rate exceeds 90%, in tumor dissemination process the prognosis is unfavourable. Due to low sensitivity of tumor to drug therapy in the majority of cases patients should receive combination treatment — surgery and chemotherapy.
Conclusion. The data obtained in the analysis confi rm the necessity of combining the clinical observations on rare types of malignant trophoblastic tumors (MTT) in a single international database to accumulate experience and develop optimal strategy of the treatment of placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT).
Keywords: trophoblastic tumors, placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT).
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Objective of the study is to investigate the effi cacy and tolerability of chemoradiation therapy (CRT) combined with local hyperthermia in patients with locally-advanced cervical cancer.
Materials and Methods. Prospective study involving patients with locally advanced stages II B-III B (T2b-3bN0–1M0) cervical cancer was carried out for the period from 2012 to 2017. The patients were randomly assigned to 2 groups: group I — experimental (core) (n = 39) received chemoradiotherapy (CRT) and local hyperthermia (LH), group II — a control group (n = 42) — received chemoradiotherapy (CRT).
Results. The tumor objective response in the group that received chemoradiotherapy (CRT) and local hyperthermia (LH) and in the group with chemoradiotherapy(CRT) didn’t differ signifi cantly, complete regression made up 38,5 and 31% respectively (p > 0,05). The number of patients with early radiation reactions was remarkably lower in the core group than in the control group — 76,9 versus 100% (p < 0,05). The number of patients with late radiation adverse effects in the core and control groups was not statistically different — 35,9 and 40,5% (p > 0,05). Period of patient follow-up was 5 years: in the group that received chemoradiotherapy (CRT) combined with local hyperthermia (LH) progression of the disease was identifi ed in 15 (38,5%) patients, in the control group — in 24 (57,1%) patients. 5-year relapse-free and overall survival of patients in the group that underwent chemoradiotherapy (CRT) combined with local hyperthermia (LH) was signifi cantly higher than in the control group — 61,5 and 69,2% versus 42,9 and 52,4% respectively (p < 0,05).
Conclusion. The use of local hyperthermia (LH) combined with chemoradiotherapy (CRT) doesn’t affect the level of early radiation reactions and late radiation complications, but it ensures and contributes to the statistically signifi cant improement in a 5-year recurrence-free and overall survival of patients with locally advanced cervical cancer compared to a group of patients who undergo only chemoradiotherapy (CRT).
Keywords: locally advanced cervical cancer, radiation therapy, combined radiation therapy, chemotherapy, local hyperthermia
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Objective of the study is to carry out a systematic analysis of current literature data on the guideline recommendations for perioperative antibiotic prophylaxis in gynecologic oncology.
Materials and Methods. The review comprises the data of foreign and Russian research pursued on this subject, published over the past 10 years.
Results. Infections after surgical interventions are associated with increased morbidity, mortality, healthcare expenditures and occur in up to 20–30% of gynecologic cancer patients, undergoing laparotomy. An appropriate antimicrobial prophylaxis plays a crucial role in reducing the incidence rate of surgical site infection. The fi rst generation cephalosporins (cefazolin) should be the fi rst choice when performing a simple hysterectomy. Additional anaerobic coverage is recommended if extended hysterectomy procedure involves the intestine during pelvic surgery for cancer (category — 1B recommendation). The dosages of antimicrobial agents administered must be suffi cient to obtain adequate drug concentrations in blood serum and tissues. Standard initial dose in patients with normal renal function is 2 g of cefazolin, in patients with a body weight of 120 kg and more — is 3 g, metronidazole — 500 mg. The route of drug administration is intravenous. It is critically important to observe the time of an initial antibiotic dose administration (30–60 minutes before an incision) and of redosing, administered intraoperatively in cases when surgery duration exceeds two antibiotic half-lives, as well as in case of acute blood loss of 1500 ml and more.
Conclusion. Perioperative antibiotic prophylaxis is one of the component of providing high-quality surgical care and an effi cient approach to reducing the incidence of infections in surgical interventions, along with the improvement of surgical technique and observation of the rules of aseptic and antiseptic surgery.
Keywords: antimicrobial prophylaxis, antibiotics, surgical site infection, hysterectomy, oncology.
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Objective of the study is to present the modern view on the role of assisted reproductive technologies (ART) in achieving pregnancy after the treatment of malignant neoplasms in young patients.
Materials and Methods. Analysis of clinical studies, guidelines, reports, overviews, published over the past 10 years.
Results. Each cancer patient of reproductive age should be counseled before the treatment for oncologic disease by a reproductive endocrinologist to assess their reproductive status and the possibility to preserve fertility considering the side effects of the treatment for cancer. The preservation of the reproductive function, of genetic material is a challenge that is addressed involving close collaboration between an oncologist, a reproductive endocrinologist and a patient. Enhancing clinical practice guidelines, that consistently regulate the order, terms and methods of preserving fertility in patients with cancer is a signifi cant milestone in the development of «oncofertility» medical practice as a new approach in medicine and an area of reproductive medicine.
Conclusion. The novel techniques of assisted reproductive technologies are effective in achieving pregnancy and are relatively safe for a signifi cant proportion of young patients diagnosed with malignant neoplasms.
Keywords: malignant tumors, fertility, assisted reproductive technologies
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Objective of the study is to carry out an analysis of current literature data on the state and perspectives of the use of rehabilitation «technologies» in patients with malignant neoplasms of reproductive system organs.
Materials and Methods. The analytical overview is performed based on the data obtained from Russian and foreign scholarly papers.
Results. The article covers the range of challenges, occurring in women after antitumor treatment, as well as the possibilities of traditional and alternative methods of correction of the complications. The work places particular emphasis on recovery activities ensuring recurrence-free survival, on the quality of life issues.
Conclusion. Higher level of medical care is feasible only with employing of integrated, personifi ed and multidisciplinary approaches. Further research on the use of rehabilitation «technologies», the development of legal basis, enhancement of the existing system of rehabilitation treatment is required.
Keywords: gynecologic oncology, rehabilitation, life quality
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The largest cancer center in Europe — Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Healthcare of Russia — celebrated its 70-th anniversary.
Since its establishment in 1951 the Center of Oncology has become a fl agship of the Soviet and subsequently of the Russian oncology. The founder and the fi rst director of the Center — academician N.N. Blokhin led a team of eminent doctors and scientists who developed and adopted a comprehensive approach to the treatment of oncologic diseases. Presently the world-class professionals of the clinic perform the most advanced, complicated and complex surgeries, carry out extensive fundamental research, develop the novel effi cient methods and techniques that afterwards are widely introduced into clinical practice.
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