Отдаленные результаты консервативного лечения больных раком предстательной железы II—III стадии

The results of treatment of 170 patients with prostate cancer (T2—3N0—1M0—1) who received radiotherapy or radiotherapy plus antiandrogenic therapy from 1998 to 2003 were reviewed. The mean age was 69,5 year. The diagnosis was verified morphologically (Gl — 146 (85%), G2 — 10 (6%), G3 — 14 (8%) patients). The mean level of PSA was 24 ng/ml. Morphologic characteristics of tumors with defining of their differentiation grade according to Glisson scale were studied in 75 patients. Conformation radiotherapy with three dimensional planning was carried out by linear accelerator. Multipetal collimator was used for figured fields construction taking into account the spread of tumor.The total dose of radiation was 70—74 Gy. Only radiation therapy was carried out to 45 patients, whereas in 125 patients the radiotherapy was supplemented by administration of antiandrogenic therapy with Flucin or Zoladex. For initial assessment of tumor extent and evaluation of the treatment effect, we used transrectal ultrasound investigation (TRUSI) with ultrasonographic angiography. According to TRUSI, capsule invasion was found in 25 (16%) patients, which determines the risk of disease progression. Five year disease free survival in the absence of capsule invasion was 92%, whereas the capsule invasion diminishes it to 60%. With increasing levels of PSA long term results deteriorates: 5-year disease free survival was 80% at PSA level below 10 ng/ml, 72% at PSA level 10,1 — 20 ng/ml and 50% at PSA level higher than 20 ng/ml (p=0,36). Capsule invasion found on TRUSI and US angiography, high PSA level and Glisson sum are indications for administration of radiotherapy with antiandrogenic therapy. Unfavorable prognostic factors are found in one third patients over 70 years old, which demands employment of adequate antitumor treatment. Radiation therapy is an effective treatment for prostate cancer: 5-year observed survival was 86%, corrected survival — 91% and disease free survival — 78%

RESULTS OF ORTHOPEDIC TREATMENT IN CANCER PATIENTS WITH MAXILLOFACIAL DEFECTS

The fates of 450 patients with different defects of the upper jaw and midfacial tissues were traced after maxillofacial replacement were traced. The follow-up was 1 to 15 years. The immediate and late results of orthopedic treatment were studied using the follow-up and assessed from both the underlying disease and the degree of functional and cosmetic efficiency of orthopedic apparatuses

STOMATOLOGIC ASPECTS IN THERAPY OF LOCALLY DISTRIBUTED CANCER OF ORAL CAVITY MUCUS

Aim of the investigation: to improve prophylaxis of dental complications during the therapy in the patients with locally distributed cancer of oral cavity mucus.Materials. Results of sanation of oral cavity in 305 patients with cancer of oral and pharyngeal area are analyzed.Results. The best results are noted in the patients given surgical sanation before chemo-radial therapy. The most number of complications is observed when teeth were extracted after chemical therapy in the period of radial therapy at summary focal dose above 20 Gy as well as in the late periods after radial therapy.Conclusion. A complex of preventive measures with using haemostatic sponge with canamycin in such patients decreases the number of complications and the terms of healing of alveoli of extracted teeth

MEDULLARY THYROID CANCER AS PART OF MEN 2B SYNDROME. CASE REPORT

MEN 2B syndrome is a subtype of the multiple endocrine neoplasia type 2. It is characterized by the development of aggressive forms of medullary thyroid cancer at an early age, pheochromocytoma and hyperparathyroid syndrome. This article provides an own clinical observation of the patient with MEN 2B syndrome associated with a mutation in the proto-oncogene RET

GENERAL ASPECTS OF THE DIAGNOSIS AND TREATMENT OF LOCALLY ADVANCED THYROID CANCER

The paper deals with current trends in the diagnosis and treatment of locally advanced, recurrent and metastatic medullary and low-grade thyroid cancer. It highlights problems in the diagnosis and surgical treatment of this pathology on the basis of our clinic’s experience. Data on global trends in medical treatment for low-grade radioactive iodine therapy-refractory thyroid tumors, as well as disseminated and metastatic medullary cancer are given

Long term results of conservative treatment for stage II—III prostate cancer

The results of treatment of 170 patients with prostate cancer (T2—3N0—1M0—1) who received radiotherapy or radiotherapy plus antiandrogenic therapy from 1998 to 2003 were reviewed. The mean age was 69,5 year. The diagnosis was verified morphologically (Gl — 146 (85%), G2 — 10 (6%), G3 — 14 (8%) patients). The mean level of PSA was 24 ng/ml. Morphologic characteristics of tumors with defining of their differentiation grade according to Glisson scale were studied in 75 patients. Conformation radiotherapy with three dimensional planning was carried out by linear accelerator. Multipetal collimator was used for figured fields construction taking into account the spread of tumor.The total dose of radiation was 70—74 Gy. Only radiation therapy was carried out to 45 patients, whereas in 125 patients the radiotherapy was supplemented by administration of antiandrogenic therapy with Flucin or Zoladex. For initial assessment of tumor extent and evaluation of the treatment effect, we used transrectal ultrasound investigation (TRUSI) with ultrasonographic angiography. According to TRUSI, capsule invasion was found in 25 (16%) patients, which determines the risk of disease progression. Five year disease free survival in the absence of capsule invasion was 92%, whereas the capsule invasion diminishes it to 60%. With increasing levels of PSA long term results deteriorates: 5-year disease free survival was 80% at PSA level below 10 ng/ml, 72% at PSA level 10,1 — 20 ng/ml and 50% at PSA level higher than 20 ng/ml (p=0,36). Capsule invasion found on TRUSI and US angiography, high PSA level and Glisson sum are indications for administration of radiotherapy with antiandrogenic therapy. Unfavorable prognostic factors are found in one third patients over 70 years old, which demands employment of adequate antitumor treatment. Radiation therapy is an effective treatment for prostate cancer: 5-year observed survival was 86%, corrected survival — 91% and disease free survival — 78

PROSTHETICS IN CANCER PATIENTS WITH ORBITAL DEFECTS

Orthopedic treatment was performed in 53 patients with postoperative defects in the orbital area during 1969–2012. The developed practical guidelines could improve the cosmetic aspects of ectoprostheses, their fixation, and quality of life in the patients

REHABILITATION OF CANCER PATIENTS WITH DEFECT AND COMPLETE SECONDARY ADENTIA AFTER REMOVAL OF BOTH UPPER JAWS

In 1969–2012, prosthetic replacement was performed in 102 patients with postoperative maxillary defects, including 90 patients with complete secondary adentia and 12 with total maxillary defect. Procedures for fixation of immediate prostheses (protective plates) were improved; practical guidelines were elaborated to transform the protective plate into a primary permanent prosthesis with an obturator. The primary permanent (forming) prosthesis is recommended in the postoperative period (on days 10–15)

PHONATION AND SPEECH RECOVERY IN CANCER PATIENTS WITH MAXILLARY DEFECTS

Speech quality was evaluated in 188 patients with acquired maxillary defects. Prosthetic treatment of 29 patients was preceded by pharmacopsychotherapy. 63 patients had lessons with a logopedist and 66 practiced self-tuition based on the specially developed test. 30 patients were examined for the quality of speech without preliminary preparation. Speech quality was assessed by auditory and spectral analysis. The main forms of impaired speech quality in the patients with maxillary defects were marked rhinophonia and impaired articulation. The proposed analytical tests were based on a combination of “difficult” vowels and consonants. The use of a removable prostheses with an obturator failed to correct the affected speech function but created prerequisites for the formation of the correct speech stereotype. Results of the study suggest the relationship between the quality of speech in subjects with maxillary defects and their intellectual faculties as well as the desire to overcome this drawback. The proposed tests are designed to activate the neuromuscular apparatus responsible for the generation of the speech. Lessons with a speech therapist give a powerful emotional incentive to the patients and promote their efforts toward restoration of speaking ability. Pharmacopsychotherapy and self-control are another efficacious tools for the improvement of speech quality in patients with maxillary defects

METHODS FOR CORRECTION OF RHINOPHONIA IN PATIENTS WITH ACQUIRED MAXILLARY DEFECTS

Speech recovery sessions were conducted in 63 patients with acquired maxillary defects. Assessment of speech quality in patients after auditory maxillary resection without a prosthestic has indicated 100 % significant rhinolalia, indistinct articulation. Prosthetic defect replacement completely corrects speech dysfunction and creates conditions for forming correct speech stereotypes. Speech therapy sessions and testing are aimed at increasing the performance of the speech apparatus and at improving the automatizaton of speaking skills. The techniques to remove nasal emission include: – articulation exercises (activation of the muscles of the lips, cheeks, tongue, pharynx, neck, and larynx); – speech respiratory gymnastics; – phonopedic (vocal) exercises. The elements of rational psychotherapy have extensive applications during each session and include suggestion, an emotional exposure to correct personality disorders, as well as pedagogical elements