УСКОРЕННОЕ ГИПЕРФРАКЦИОНИРОВАНИЕ ДНЕВНОЙ ДОЗЫ ОБЛУЧЕНИЯ В СХЕМЕ ХИМИОЛУЧЕВОГО ЛЕЧЕНИЯ БОЛЬНЫХ РАКОМ РОТОГЛОТКИ И ПОЛОСТИ РТА

The main treatment failures of cancer of the oropharynx and oral cavity are associated with the treatment of advanced (III–IV) stages of the disease, incidence of which is extremely high. The treatment toxicity increases and quality of life reduces with increasing aggressiveness of anticancer therapy. Therefore, the search for conservative treatment methods in order to achieve optimal treatment efficacy remains relevant. The study included 233 patients with primary cancer of the oropharynx and oral cavity, who underwent concurrent chemoradiotherapy with accelerated hyperfractionated radiation and standard radiation therapy. In patients who received chemoradiotherapy with accelerated hyperfractionated radiation in the regimens of 1 Gy + 1.5 Gy and 1 Gy+2 Gy with a 4–6 hour interval, 60 Gy total dose, the objective response rate (complete + partial regressions) was significantly higher than that observed in patients who received the standard radiotherapy (97.8; 100 and 61.9 %, respectively). Severe mucositis (grade 3) was observed in 40.5 and 77.8 % of patients treated with accelerated hyperfractionated radiation in the regimens of 1 Gy+1.5 Gy and 1 Gy+2 Gy, respectively compared to 52.7% of patients treated with the standard radiotherapy (p<0.05) Late radiation-induced damage to normal tissues and organs in the radiation field occurred in 8.9; 10.8 and 20.2 %, respectively (p>0.05). Immediate treatment results and survival analysis showed that chemoradiotherapy with accelerated hyperfractionated radiation was superior to standard radiation therapy without increasing the late local toxicity. All patients completed the planned course of treatment, despite the high rate of grade 3 mucositis in the 1 Gy + 2 Gy dose regimen.Основные неудачи терапии рака ротоглотки и полости рта связаны в первую очередь с лечением поздних (III–IV) стадий заболевания, частота выявления которых в нашей стране крайне высока. С увеличением агрессивности противоопухолевой терапии возрастает токсичность лечения и качество жизни снижается, поэтому поиск консервативных методов лечения данной патологии, оптимальных с точки зрения эффективность – токсичность, остается актуальным. Клинические наблюдения представлены 233 больными первичным раком слизистой оболочки ротоглотки и полости рта, которым проводили одновременную химиолучевую терапию ускоренным гиперфракционированием дневной дозы облучения и стандартное лучевое лечение. После химиолучевой терапии в режиме 1 Гр+1,5 Гр и 1 Гр+2 Гр с 4–6-часовым интервалом до СОД 60 Гр частота объективных ответов (сумма полных и частичных регрессий) была существенно выше по сравнению со стандартным лучевым лечением (97,8; 100 и 61,9 % наблюдений соответственно). В процессе химиолучевой терапии с дроблением дозы 1 Гр + 1,5 Гр и 1 Гр + 2 Гр частота тяжелых мукозитов (3-й степени) составила 40,5 и 77,8 % (р<0,05) против 52,7 % наблюдений при стандартной лучевой терапии. Поздние лучевые повреждения нормальных тканей и органов в зоне облучения имели место в 8,9; 10,8 и 20,2 % случаев соответственно (р>0,05). Непосредственные результаты лечения больных и анализ выживаемости показали статистически значимые различия в пользу химиолучевого лечения ускоренным гиперфракционированием дневной дозы облучения по сравнению со стандартной лучевой терапией без увеличения поздней местной токсичности. Все больные завершили запланированный курс лечения, несмотря на большую частоту мукозитов 3-й степени при методике дробления дозы 1 Гр + 2 Гр, благодаря своевременной и адекватной тактике симптоматической терапии

The Somatic Genomic Landscape of Chromophobe Renal Cell Carcinoma

We describe the landscape of somatic genomic alterations of 66 chromophobe renal cell carcinomas (ChRCCs) based on multidimensional and comprehensive characterization, including mitochondrial DNA (mtDNA) and whole genome sequencing. The result is consistent that ChRCC originates from the distal nephron compared to other kidney cancers with more proximal origins. Combined mtDNA and gene expression analysis implicates changes in mitochondrial function as a component of the disease biology, while suggesting alternative roles for mtDNA mutations in cancers relying on oxidative phosphorylation. Genomic rearrangements lead to recurrent structural breakpoints within TERT promoter region, which correlates with highly elevated TERT expression and manifestation of kataegis, representing a mechanism of TERT up-regulation in cancer distinct from previously-observed amplifications and point mutations

ACCELERATED HYPERFRACTIONATED DAY DOSE CHART CHEMORADIATION TREATMENT OF PATIENTS WITH CANCER OF OROPHARYNX AND ORAL CAVITY

The main treatment failures of cancer of the oropharynx and oral cavity are associated with the treatment of advanced (III–IV) stages of the disease, incidence of which is extremely high. The treatment toxicity increases and quality of life reduces with increasing aggressiveness of anticancer therapy. Therefore, the search for conservative treatment methods in order to achieve optimal treatment efficacy remains relevant. The study included 233 patients with primary cancer of the oropharynx and oral cavity, who underwent concurrent chemoradiotherapy with accelerated hyperfractionated radiation and standard radiation therapy. In patients who received chemoradiotherapy with accelerated hyperfractionated radiation in the regimens of 1 Gy + 1.5 Gy and 1 Gy+2 Gy with a 4–6 hour interval, 60 Gy total dose, the objective response rate (complete + partial regressions) was significantly higher than that observed in patients who received the standard radiotherapy (97.8; 100 and 61.9 %, respectively). Severe mucositis (grade 3) was observed in 40.5 and 77.8 % of patients treated with accelerated hyperfractionated radiation in the regimens of 1 Gy+1.5 Gy and 1 Gy+2 Gy, respectively compared to 52.7% of patients treated with the standard radiotherapy (p<0.05) Late radiation-induced damage to normal tissues and organs in the radiation field occurred in 8.9; 10.8 and 20.2 %, respectively (p>0.05). Immediate treatment results and survival analysis showed that chemoradiotherapy with accelerated hyperfractionated radiation was superior to standard radiation therapy without increasing the late local toxicity. All patients completed the planned course of treatment, despite the high rate of grade 3 mucositis in the 1 Gy + 2 Gy dose regimen

MEDULLARY THYROID CARCINOMA

Medullary thyroid carcinoma belongs to orphan diseases affecting a small part of the population. Multicenter trials are required to elaborate a diagnostic algorithm, to define treatment policy, and to predict an outcome

PLACE OF PHOTODYNAMIC THERAPY IN ORGAN-SPARING TREATMENT PROGRAMS FOR SQUAMOUS CELL CARCINOMA OF THE ORAL MUCOSA

The Medical Radiology Research Center Clinic performed photodynamic therapy (PDT) in 57 patients with cancer of the oral mucosa in the independent fashion. Pretreatment recurrent tumors were diagnosed in half (50.9 %) of the patients. Spectroscopy showed the therapeutic accumulation of the drug, which was 1.8–3 times greater than that in the skin and intact mucosa in the presence of a malignant neoplasm. Complete and partial tumor regression was achieved in 50 (87.7 %) and 4 (7 %)  patients, respectively; stabilization was seen in 3 (5.3 %) patients. Three-year overall survival was 86.7 ± 5.2 % and three-year relapse-free survival was 70.5 ± 7.1 %. PDT has an organ-saving directionality, without causing functional and cosmetic impairments, thus showing its rather high effectiveness