DIAGNOSIS AND TREATMENT OF BREAST CANCER IN SITU. RUSSIAN ASSOCIATION OF ONCOLOGICAL MAMMOLOGY CLINICAL GUIDELINES (PROJECT)

One of the first and foremost tasks of the Russian Association of Oncological Mammology (RAOM) is to develop clinical guidelines on diagnosis and treatment of breast cancer taking into account international experience. The guidelines must also be applicable in all regions of the Russian Federation allowing all Russian specialist to be informed about the latest strategies of diagnosis and treatment.These clinical guidelines are based on the following consensus documents:• St. Gallen Expert Panel (2011, 2013),• Expert Panel of the IX International Conference “White Nights – 2012”,• Expert Panel of the RAOM (2013),• International consensus on treatment of metastatic breast cancer ABC 1,• NCCN (2014)  and ESMO (2011) practical guidelines,as well as the results of large international randomized studies conducted in partnership with Russian oncological centers.The guidelines take into account the results of the analysis of a cumulative database on breast cancer treatment methods performed at• N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia,• Saint  Petersburg City Clinical Oncological  Dispensary.Our guidelines are based on methods that are available everywhere in the Russian Federation, treatment schemes and drugs are presented in accordance with the marketing authorization of the Ministry of Health of Russia, drug therapy takes into account biological subtypes of breast cancer, different courses of the disease as well as nonuniform situation with drug availability in various regions of the Russian Federation.Obviously, such materials cannot serve as a direct guide for action (every patient’s disease is different), but they can lend a helping hand to a doctor striving to treat patients according to the latest achievements of modern oncology.All-Russian non-governmental organization Russian Association of Oncological Mammology. President of the RAOM, corresponding member of the RAS, Prof. V.F. Semiglazov; Vice-President of the RAOM, corresponding member of the RAS, Prof. G.M. Manikhas; Executive Director of the RAOM R.M. Paltuev, PhD

Многоликая биология рака молочной железы: поиски адекватного лечения

The article describes the results of the latest studies focused on the mechanisms of resistance for endocrine therapy of ER+ luminal tumors and anti-HER2 therapy of HER2-positive tumors. Also the author gives an information about six molecular-genetic subtypes among triple-negative breast cancer (BC) concluding that more precise molecular-genetic tests of clinical subtypes (IHC) would improve planning of adequate treatment.В статье представлены результаты последних исследований механизмов резистентности к эндокринотерапии ER+ люминальных опухолей и анти-HER2 терапии HER2 – позитивных опухолей, а также информация о существовании шести молекулярно-генетических подтипов среди трижды негативного рака молочной железы (РМЖ). Делается вывод о том, что более точная молекулярно-генетическая характеристика клинических (ИГХ) подтипов РМЖ улучшит планирование адекватного лечения

ЧТО ЛУЧШЕ: МАММОГРАФИЧЕСКИЙ СКРИНИНГ ИЛИ СИСТЕМНОЕ ЛЕЧЕНИЕ?

At least for the past 25 years, mammography screening has been the official policy of the healthcare systems of European countries, North America and Australia. Seven huge randomized trials have shown a reduction of mortality from breast cancer (BC) by 20-35% in women 50-61 years old, accepted the invitation to mammography screening. At the same time, some epidemiologists and other researchers in biostatistics doubt the success of mammographic screening, considering "suboptimal" randomization in some of these studies. Nordic Cochrane Centre also does not recommend this strategy to reduce mortality from breast cancer. There is no doubt that the progress of adjuvant systemic therapy (chemo-, endocrine and targeted therapy) has reduced mortality from breast cancer. Therefore, the contribution of screening and systemic therapy in reducing mortality from breast cancer has evolved in favor of therapy. Nevertheless, mammography screening still should be recommended, especially for women 50-69 years old. This strategy is confirmed by the recomendations of the European Union, ESMO (2014), and ASCO (2014).По крайней мере на протяжении последних 25 лет маммографический скрининг был официальной политикой здравоохранения европейских стран, Северной Америки и Австралии. Семь крупных рандомизированных исследований показали сокращение смертности от рака молочной железы (РМЖ) на 20–35% у женщин 50–61 лет, принявших приглашение на маммографический скрининг. В тоже самое время некоторые эпидемиологи (Goetzche, 2013; Jorgensen, 2013) и другие исследователи по биостатистике сомневаются в успехах  маммографического  скрининга,  считая «субоптимальной»  рандомизацию  в некоторых  из этих исследований. Нордический Кохране центр (Nordic Cochrane Centre) также не рекомендует эту стратегию для сокращения  смертности  от РМЖ. Нет сомнения в том, что беспрецедентный  прогресс адъювантной системной терапии (эндокрино-химиотерапии,  таргетного лечения) сам по себе сократил смертность от РМЖ. Поэтому вклад скрининга и системной терапии в сокращении смертности от РМЖ эволюционировал в пользу терапии. Тем не менее маммографический скрининг по-прежнему следует рекомендовать, особен6но для женщин 50–69 лет. Эта стратегия подтверждается указаниями Европейского Союза, ESMO (2014) и ASCO (2014).

Comparative evaluation of lethal outcome prediction methods in severely burned patients

Background: Regarding burn injury there are many approaches to assessing the possibility of death in severely burned patients. Despite the ease of use and the maximum prevalence of existing models, the assessment of the outcome in each of them is questionable, since the emphasis in different indices is on different indicators, avoiding the overall clinical picture of the disease.Objective: Comparative analysis of the effectiveness of methods for predicting a lethal outcome in patients with extensive skin burns.Material and мethods: Calculated characteristics of known in the literature and widely used Baux rules, Frank index, probit analysis and a new method of logistic regression were obtained and applied to evaluate the results of treatment of 282 adult patients with extensive skin burns, hospitalized in the Department of Anesthesiology and Intensive Care of the Thermal Injuries Unit, Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine in the period 2015–2021.Results: During the study a descriptive characteristic of methods for predicting a lethal outcome was obtained. Based on the data obtained, four-field contingency tables were compiled and a comparative analysis of the effectiveness of the models was carried out.Conclusion: Despite the high frequency of use of such forecasting methods as the Baux score, the Frank index and probit analysis in the combustiology practice, the results of the calculation indicate that these methods have low efficiency: the Baux score method accuracy of a lethal outcome prediction is 49.7%, the Frank index method – 41.5%, probit analysis method – 60%. The logistic regression model developed by us showed high efficiency compared to those presented earlier (the accuracy of predicting a lethal outcome was 93%), which gives grounds for recommending it for practical application

Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006

Neoadjuvant (primary systemic) treatment has become a standard option for primary operable disease for patients who are candidates for adjuvant systemic chemotherapy, irrespective of the size of the tumor. Because of new treatments and new understandings of breast cancer, however, recommendations published in 2006 regarding neoadjuvant treatment for operable disease required updating. Therefore, a third international panel of representatives of a number of breast cancer clinical research groups was convened in September 2006 to update these recommendations. As part of this effort, data published to date were critically reviewed and indications for neoadjuvant treatment were newly define

ДИФФЕРЕНЦИАЛЬНАЯ УЛЬТРАЗВУКОВАЯ И СОНОЭЛАСТОГРАФИЧЕСКАЯ ДИАГНОСТИКА ДОЛЬКОВОГО РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ

The study performed failed to reveal any reliable differential-diagnostic ultrasound and sonoelastography signs of the lobular or ductal carcinomas. Lobular carcinomas and inflammatory lesions had similar sonography patterns. The infiltrative ductal carcinomas and nodal mastopathy had similar sonographic patterns as well. Sonography allowed differentiation of the data obtained owing to difference in harshness indices of the inflammatory, benign and malignant tumors.На основании проведенного исследования надежных дифференциально-диагностических ультразвуковых и соно-эластографических признаков дольковой и протоковой карцином установлено не было. Дольковые карциномы имели идентичную эхографическую картину с воспалительными изменениями молочной железы. Инфильтративный тип строения протоковой карциномы имел схожие эхографические характеристики с локализованным фиброаденоматозом. Соноэластография позволила дифференцировать данные изменения за счет различных показателей жесткости воспалительных, доброкачественных и злокачественных образований

Метформин в лечении рака молочной железы

Clinical trials of metformin efficacy in breast cancer were reviewed in this article. According to some data from cohort and case-controlled studies, the use of metformin with combined therapy of breast cancer improves overall and disease-free survival. Initial data from randomized clinical trials of metformin in adjuvant and neoadjuvant therapy of breast cancer are expected in the nearest future. В обзоре освещены клинические исследования, посвященные эффективности метформина при раке молочной железы (РМЖ). Согласно результатам ряда работ когортного и «случай-контроль» типа, применение метформина на фоне комплексного лечения больных РМЖ приводит к увеличению безрецидивной и общей выживаемости. В скором времени ожидаются первые публикации рандомизированных клинических исследований метформина на фоне неоадъювантного и адъювантного лечения больных РМЖ.