LONG-TERM PROGNOSIS IN PATIENTS WITH A LOCAL BREAST CANCER RELAPSE AFTER ORGAN-SAVING TREATMENT

The paper presents the results of a follow-up of 861 patients who have undergone organ-saving treatment (OST) for early breast can- cer. The relapse rate was 7.3% (63/861). The main task was to study an association of survival rates with the predictors characteriz- ing a local relapse. Five-year overall survival after the start of treatment for a local relapse was 65.7% (standard error 8.3). A Cox multivariance regression analysis led to the conclusion that the local relapse is a statistically significant factor of worsening survival without distant metastases when it develops within 3 years after primary OST

Тактика оперативного лечения при местно-распространенных опухолях органов малого таза с поражением мочевого пузыря

As high as 40% of patients have locally advanced pelvic tumors without distant metastases and many of them have previously undergone radical treatment. The only possible treatment for these patients is combined and expanded surgery.Subjects and methods: In 1996 to 2004, a total of 38 patients with locally advanced pelvic tumors involving the bladder underwent different types of evisceration at the Department of Radiosurgery, Russian Cancer Research Center. There were internal fistulas in 18 cases. Total evisceration was performed in 4 (10.5%) patients, subtotal supralevator evisceration in 25 (65.8%), subtotal infralevator evisceration in 3 (7.9%), and frontal evisceration in 6 (15.8%) patients. Thirty-one (81.6%) patients underwent ureteral reconstruction without ureterostomy; normal stool restored in 35 (92.1%) patients.Results: One (2.6%) patient died intraoperatively. Twenty-eight patients had postoperative complications that needed resurgery in 12 cases. Three patients with the single-stage ileal orthitopic bladder reported that they had a fair urinary retention. One patient complained about nocturnal urinary incontinence. Stool retention was fair in all cases.Conclusion: Careful selection of patients, comprehensive preoperative preparation, and improved surgical performance will reduce the incidence of postoperative complications.

Comparative analysis of parasternal lymph collector exposures in the organ-sparing treatment of patients with operable breast cancer

The paper presents the results of a follow-up of 593 patients with the internal and central localization of clinical stages I-IIb breast cancer whose treatment comprises parasternal treatment techniques: teleradiotherapy (TRT), intratissue radiotherapy (ITRT), and video-assisted thoracoscopic parasternal lymphadenectomy (VAPL). A control group included 846 patients with the external localiza- tion of a tumor. There was a statistically significant increase in 5-year overall (98.2%) and relapse-free (96.2%) survival rates in Stage I in the VAPL versus TRT and ITRT groups (overall survival, 92.5 and 89.7%; relapse-free survival, 80.8 and 73.4%, respectively) (p < 0.05). There was no difference in survival rates between the study and control groups. It is concluded that VAPL permits the objective staging of the disease and any therapeutic exposure of the parasternal area made survival rates similar in the study and control groups

NEOPLASMS IN ACROMEGALY

Acromegaly is a  rare disease with increased growth hormone secretion most often caused by pituitary adenoma. Not adequately treated acromegaly may lead to early death related to increased rates of acute cardiovascular events, sleep apnea, metabolic disorders and malignancies. Prevalence of malignancies in acromegaly is in the range of 4.5 to 25%, with some specifics in their pathogenesis, and their proportion as mortality cause is 9 to 50%. Overall and cancer-related mortality in acromegaly are associated with activity of the disease. There is a direct correlation between high levels of insulin-like growth factor 1 and the risk of malignancies. The most common types of cancer in patients with acromegaly are colorectal (1 to 20%) and thyroid cancer (7.8 to 11%). This review of literature describes the results of epidemiological studies on malignancies and some aspects of their pathogenesis in patients with acromegaly

PREDICTORS OF A LOCAL RECURRENCE AFTER ORGAN-PRESERVING TREATMENT FOR EARLY BREAST CANCER: STATE-OF-THE-ART

There are currently many unsolved problems associated with the optimization of treatment in patients with breast cancer (BC) who have undergone organ-preserving operations. The occurrence of BC recurrences after organ-preserving treatment, their determination and prognostic factors are a challenge

Rationale for repeat breast-conserving surgery after in-breast recurrence of breast cancer

The main outcomes of our interest were local control and survival of 76 patients with local recurrence of breast cancer treated with conservative surgery (n = 32) or mastectomy (n = 44). There was not statistically significant difference in the probability of 5-years overall (81 %, 64.2 %; p = 0,245) and metastatic-free survival (60.7 %, 57.1 %, p = 0,553), as measured from the recurrence, and in rates of subsequent in-breast (12.5 %) or chest wall (11.4 %) recurrences between women of these two groups respectively. This fact is rationale for repeat breast-conserv- ing surgery in appropriately selected patients and requires further investigations

Surgical treatment policy for locally advanced small pelvic tumors involving the bladder

As high as 40% of patients have locally advanced pelvic tumors without distant metastases and many of them have previously undergone radical treatment. The only possible treatment for these patients is combined and expanded surgery.Subjects and methods: In 1996 to 2004, a total of 38 patients with locally advanced pelvic tumors involving the bladder underwent different types of evisceration at the Department of Radiosurgery, Russian Cancer Research Center. There were internal fistulas in 18 cases. Total evisceration was performed in 4 (10.5%) patients, subtotal supralevator evisceration in 25 (65.8%), subtotal infralevator evisceration in 3 (7.9%), and frontal evisceration in 6 (15.8%) patients. Thirty-one (81.6%) patients underwent ureteral reconstruction without ureterostomy; normal stool restored in 35 (92.1%) patients.Results: One (2.6%) patient died intraoperatively. Twenty-eight patients had postoperative complications that needed resurgery in 12 cases. Three patients with the single-stage ileal orthitopic bladder reported that they had a fair urinary retention. One patient complained about nocturnal urinary incontinence. Stool retention was fair in all cases.Conclusion: Careful selection of patients, comprehensive preoperative preparation, and improved surgical performance will reduce the incidence of postoperative complications

Optimization of indications for parasternal radiotherapy in patients with breast cancer

Detection of regional lymph nodes involvement is an extremely important step in the diagnosis and treatment of breast cancer. As with axillary lymph node metastases, parasternal lymph nodes metastases are an important prognostic factor. 1125 patients with breast cancer were under- went to thoracoscopicinternal mammary lymphadenectomy. Metastases were found in 204 of 1125 cases (18,3 %), representing 33,9 % of all cases of regional metastases (n = 601). Median overall survival in patients with internal mammary lymph nodes metastases who received radiation therapy and appropriate systemic treatment was 7,8 years, which is contrary to the earlier experience and is consistent with the results of the last years publications. We believe this excellent result is due to irradiation of the internal mammary nodes, and we believe that the thoracoscopic internal mammary lymphadenectomy should be a part of the diagnostic process in patients with breast cancer