Gynecologic Oncology

Gynecologic Oncology 2023 #4


Guliayeva A.E., Kim E.A., Denchik D.A., Khailenko D.V., Grigorievskaya Z.V., Epifanova N.Yu., Komarov I.G., Kirsanov K.I., Gagulayeva K.V., Malyutina S.A., Golovina E.A., Petrovskiy A.V.
Comparison Of The Effectiveness Of Long-Term And Short-Term Courses Of Antibiotic Prophylaxis In Reconstructive Surgeries With The Use Of Endoprosthesis In Patients With Breast Cancer. Intermediate Results Of A Prospective Randomized Study.
Objective of the study is to choose the most effective regimen of antibiotic prophylaxis in reconstructive surgery with the use of endoprosthesis in patients with breast cancer.
Materials and Methods. The paper submits the preliminary results of a prospective randomized study of the choice of an optimal strategy of peri-operative antibiotic prophylaxis in reconstructive surgery with the use of allomaterials in patients with breast cancer that was conducted at the Division of Breast Cancer and Breast Diseases of the Department of Breast Medical Oncology of N. N. Blokhin National Medical Research Center of Oncology. The incidence of surgical site infection (SSI) in the study groups was assessed.
Results. Currently the study includes 141 patients, 72 patients are randomized into short-term course group and 69 — into long-term course group. The incidence of surgical site infection (SSI) in the group I is 5,6 % (4 cases), in the group II — 5,8 % (4 cases). Despite antibacterial therapy in 3 cases infectious complication resulted in the removal of endoprosthesis. In the group of short-term course of antibiotic prophylaxis in which a surgical site infection had occurred, 3 patients out of 4 (75 %) received neoadjuvant chemotherapy prior to the operation, while 1 patient (25 %) underwent surgery, chemo- and radiation therapy. Similar results were observed in the group of long-term course. No signifi cant concomitant pathology was identifi ed in patients of both groups. The most common causative agent of surgical site infection (SSI) is staphylococcus aureus.
Conclusion. At this point, the incidence of surgical site infection (SSI) in short-term course group is consistent with the group of long-term course of antibiotic prophylaxis. Considering a small number of observations it is not possible to obtain statistically signifi cant results thus far. Patient recruitment proceeds.
Keywords: breast cancer, reconstructive surgery, allomaterials, biofi lms, surgical site infections (SSI)
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Kozhevnikova O.V., Knyazev R.I., Ananyev V.S., Aliev V.A., Kuzmichev D.V., Nikogosian S.O.
The Results Of Cytoreductive Surgery In Patients With Ovarian Cancer With An Involvement Of Various Parts Of Small And Large Intestines
Feasibility. Ovarian cancer is one of the most aggressive tumors affecting female genital organs, often spreading to adjacent organs and tissues. The main type of treatment of patients with advanced ovarian cancer is a combination of cytoreductive surgery and platinum-based drug therapy. The possibility to perform surgery to achieve complete or optimal cytoreduction is inextricably linked to the involvement of various sections of small and large intestine into the tumor process.
Objective of the study is to analyze the immediate results of cytoreductive surgeries performed in patients with advanced ovarian cancer who underwent bowel resection.
Materials and Methods. Retrospective study comprises 105 patients with histologically verifi ed ovarian cancer who underwent treatment at Federal State Budgetary Institution “N. N. Blokhin National Medical Research Center of Oncology” of the Ministry of Healthcare of the Russian Federation for the period from 2005 to 2017 and whose surgery involved resection of either part of the intestine.
Results. The incidence of both intra- and postoperative complications in patients who had undergone surgery on the fi rst phase of combination treatment, didn’t differ signifi cantly compared to patient who had undergone interval cytoreductive surgeries. Penetration of malignant ovarian tumor into the resected segment of the intestine was observed in 67 patients (63,8 %), in 36,2 % of patients intestine resection was indicated both due to the involvement of the mesentery of the intestine, its vessels into the tumor process and to perifocal infl ammatory process, often mistaken for tumor process. The incidence rate of achieving complete cytoreduction was higher in patients who had previously undergone preoperative chemotherapy, and sub-optimal cytoreductive surgery was performed more often in patients who had not initially received chemotherapy. Among 105 patients with ovarian cancer, who underwent bowel resection during cytoreductive surgery, only one patient who was operated on after chemotherapy and underwent low anterior resection of the rectum and formation of end-to-end circular stapled anastomosis, developed anastomosis suture failure, that required repeat laparotomy.
Conclusion. Current concepts in surgical treatment of patients with ovarian cancer are inextricably linked to the steps of small or large bowel resection. Low rate of intraoperative and postoperative complications shouldn’t be an impediment to achieving complete or optimal cytoreduction and delay the timing of chemotherapy for this category of patients.
Keywords: ovarian cancer, cytoreductive surgery, bowel resection, anastomosis, complications
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Darenskaya A.D., Medvedeva B.M., Rumyantsev A.A.
Small-Cell Carcinoma Of The Endometrium: A Literature Review And A Rare Clinical Case Of A Radiologic Complete Response Of The Tumor To Treatment
Small-cell carcinoma (SCC) of the endometrium is a rare disease the prevalence of which is less than 1 % of all malignant neoplasms of the uterus. Data on small-cell carcinoma (SCC) of the endometrium, published in medical journals, is scarce and generally provide clinical case series descriptions (about 100 observations) or retrospective case-control studies. Due to rare incidence of the disease currently there are no uniform guidelines on the management and treatment of such patients. Most researchers rely on the guidelines developed for small-cell lung carcinoma. This article concerns clinical, pathomorphological and immunohistochemical intricacies of small-cell carcinoma of the endometrium, discusses novel approaches to diagnosis and treatment of this pathology, and reports our own clinical case of small-cell carcinoma of the endometrium with a radiologic complete response of the tumor to the treatment.
Keywords: мелкоклеточный рак тела матки, полный радиологический ответ, хромогранин А, синаптофизин, СD56, NSE, цитокератины, p16, Ki-67, низкодифференцированные нейроэндокринные опухоли
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Alimov V.A., Novikova E.G., Grekov D.N., Lebedev S.S., Afanasova P.N., Danilov A.M., Layevskaya A.A.
The Role Of Sentinel Lymph Node Biopsy With Icg Mapping In Staging Surgeries For Endometrial Cancer
Objective of the study is to assess the effectiveness and safety of hysterectomy technique involving sentinel lymph node biopsy in patients with clinical stage 1 endometrial cancer in comparison with other staging surgeries.
Materials and Methods. Retrospective analysis of 200 medical records of patients with clinical stage 1 endometrial cancer, who had undergone inpatient treatment at the Department of Gynecologic Oncology of S. P. Botkin City Clinical Hospital of Moscow Department of Healthcare for the period from 2021 to 2023 was conducted. Patients were divided into 4 groups based on the type of surgical intervention: group I — patients who had undergone hysterectomy, n = 50; group II — hysterectomy with sentinel lymph node biopsy, n = 50; group III — hysterectomy with pelvic lymphadenectomy, n = 50; group IV — hysterectomy with pelvic and lumbar lymphadenectomy, n = 50. The surgical intervention parameters — surgery time, number of removed lymph nodes, occurrence of intra- and postoperative complications were assessed.
Results. Hysterectomy with sentinel lymph node biopsy was on average 16 minutes longer compared to a simple hysterectomy. The operative time of hysterectomy with pelvic lymphadenectomy and hysterectomy with pelvic and lumbar lymphadenectomy in comparison with hysterectomy with sentinel lymph node biopsy increased on average by 55 and 88 minutes, respectively. Performing of hysterectomy and hysterectomy with sentinel lymph node biopsy virtually is not associated with the risks of intra- and postoperative complications. In the groups of hysterectomy with pelvic lymphadenectomy and hysterectomy with pelvic and lumbar lymphadenectomy intra-operative complications occurred signifi cantly more frequently. No difference in complications between the group of hysterectomy with pelvic lymphadenectomy versus the group of hysterectomy with pelvic and lumbar lymphadenectomy was revealed.
Conclusion. If technically possible, it’s more appropriate to give preference to hysterectomy with sentinel lymph node biopsy with ICG mapping technique for the purpose of staging of patients with endometrial cancer of low risk of lymphogenous metastasis. Surgical interventions in the extent of hysterectomy with pelvic lymphadenectomy and hysterectomy with pelvic and lumbar lymphadenectomy are not recommended due to similar characteristics and a higher rate of intra- and postoperative complications.
Keywords: endometrial cancer, lymphadenectomy, sentinel lymph node biopsy, Indocyanine Green (ICG)
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Tikhomirova T.E., Zuraeva I.Yu., Knyazev R.I., Rumyantsev A.A., Shevchuk A.S.
Adenocarcinoma Of Mammary Gland Type Of The Vulva: Rare Clinical Case And Review Of Current Literature
Mammary gland adenocarcinoma of the vulva (MPA) is an extremely rare disease. The pathogenesis of this pathology has not been fully studied to date, and treatment, due to the rarity of the described clinical cases, have not been developed. Differential diagnosis is also important, which is aimed, among other things, at excluding metastatic lesions of the vulva. The most important diagnostic criterion is pathomorphological examination with the determination of immunohistochemical markers of the tumor. Our article describes two clinical cases of vulvar cancer from MPA with two different immunohistochemical subtypes. In the fi rst clinical case, the successful experience of treating Her2/neu-positive tumors with surgical treatment, chemotherapy and targeted therapy was described, whereas in the second case, the progression of hormone-dependent vulvar cancer was demonstrated due to the lack of specifi c adjuvant treatment after surgery. In addition, the article provides an overview of modern literature.
Keywords: Vulvar adenocarcinoma, targeted therapy, trastuzumab, surgical treatment
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Chubykina S.V., Tatarinova M.Yu., Avakyan G.G., Knyazev R.I.
The Impact Of Chemotherapy-Induced Polyneuropathy On The Quality Of Life In Patients With Cancer
Introduction. In the treatment of an oncological patient, increasing attention is paid to the quality of life, the dynamic assessment of which allows timely correction of psychological disorders, increase adherence to treatment, and improve long-term results of treatment of malignant tumors.
Objective of the study. To assess the quality of life, severity and dynamics of depressive anxiety disorder in cancer patients with chemo–induced polyneuropathy and associated neuropathic pain syndrome during therapy with an antidepressant (Duloxetine) or an immunomodulator (Azoximer bromide).
Material and Methods. The study included 93 oncological patients with neuropathic pain syndrome who underwent drug antitumor treatment. The average age was 54.7±10.5 years. The patients were divided into groups taking into account the use of the antidepressant Duloxetine or the immunomodulator Azoximer bromide, a control group was singled out separately, in which symptomatic therapy was not performed. The assessment of general physical and functional conditions was performed using the ECOG scale (The Eastern Cooperative Oncology Group) and the Karnowski index. Neuropsychological testing was conducted using the EQ–5D questionnaires, Beck depression, self-assessment of anxiety levels according to C. D. Spielberger, Y. L. Khanin and the MFIS chronic fatigue scale before and after drug antitumor therapy.
Results. Against the background of the use of symptomatic therapy, a decrease in depressive syndrome was observed in all patients in the main groups. Patients taking Duloxetine had signifi cantly improved quality of life and reduced anxiety levels. In the group of patients receiving Azoximer bromide, only stabilization of anxiety syndrome with some positive changes in quality of life was recorded. In both groups with symptomatic therapy, it was possible to stabilize chronic fatigue.
Conclusion. In the context of therapy with neurotoxic drugs for patients with oncological diseases, it is necessary to develop individual treatment plans based on the psychological assessment of patients before and after chemotherapy, which will allow timely identifi cation and successful correction of symptoms of the anxiety-depressive spectrum, improve the quality of life of cancer patients.
Keywords: Chemotherapy-induced polyneuropathy, chemotherapy, cytostatic therapy, antitumor therapy, depression and anxiety, quality of life, psycho-oncology
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Egofarov T.N., Tkachenko G.A., Obukhova O.A., Dibirova P.A.
Eating disorders in cancer patients (literature review)
Objective of the study. Anorexia is widespread among cancer patients, however, paradoxical as it may sound, bulimia and psychogenic overeating are also diagnosed in this population of patients. Therefore, the objective of our research was to carry out a systematic analysis of the data available in world literature on the current state of this issue.
Materials and Methods. The review comprises the data of foreign and Russian scholarly articles found in Library, PubMed, Medline on the subject, published over the past 20 years.
Results. Based on the fi ndings, the article presents an up-to-date concept of the development of eating disorders in cancer patients, discusses the causes of this condition. It has been shown that eating disorders occur in 50 % of patients, and in many cases they are associated with psychological problems of patients. This necessitates psychological support and treatment. In the course of the work with a psychologist, psychosocial signifi cance of food is analyzed, the deviant form of eating behaviour is changed to an adequate one, aimed at maintaining energy and plastic balance.
Conclusion. Therefore, the role of a psychologist in correcting eating disorders in cancer patients is very important as it can improve the quality of life and adherence to treatment, so it is necessary to continue further research in this area.
Keywords: eating behaviour, oncology, anorexia, bulimia, stress
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Kiseleva M.V., Lounkova M.N., Egimbaev K.U.
Fertility Preservation In Cancer Patients. Own Experience
580 415 cases of malignant neoplasms (including 315 376 those in female patients) were identifi ed in the Russian Federation for 2021. Malignant neoplasms of reproductive organs account for the largest proportion (39,9 %) in the structure of cancer incidence in women, among which breast cancer ranks fi rst, that corresponds to 21,7 % of all diagnosed neoplasms in women [1, 2]. In recent years, due to screening programmes there has been an increasing tendency towards cancer detection at early stages. In combination with the use of novel treatment strategies it contributes to high overall and recurrence-free survival rates. However, many types of antitumor treatment have gonadotoxic effects, thereby leading to the development of secondary infertility in young patients [3]. This problem laid the ground for the creation of the fi rst biobanks for the preservation of genetic material of cancer patients. The article presents clinical examples of the management of such patients.
Keywords: fertility, cancer patients, biobanks
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