РАСПРОСТРАНЕННЫЙ РАК ГОРТАНИ: ОБЗОР ЛИТЕРАТУРЫ

Background. Squamous carcinoma of the larynx is still the most common head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. According to the world literature, 23,800 new cases of laryngeal cancer and 106,000 deaths from this disease are registered annually in the world. Laryngeal cancer treatment is aimed at achieving tumor control while optimizing functional outcomes.Objective: to review available data on surgical and non-surgical treatment options for locally advanced laryngeal cancer, as well as the evidence supporting each of these, including oncological outcomes (overall survival, disease-free survival, local control of the disease, functional outcomes and quality of life).Material and Methods. A systematic literature search was conducted in the electronic databases Medline, Cochrane Library, and Elibrary in the interval time between 1987 and 2016.Conclusions. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from surgery (total laryngectomy) as the gold standard of treatment to nonsurgical organ-preserving treatment using radiation therapy or chemoradiation therapy. However, concerns have arisen regarding functional outcomes after chemoradiation therapy, as well as a possible reduction in overall survival in laryngeal cancer patients, risk factors, laryngectomy.Актуальность. Плоскоклеточная карцинома гортани остается самым распространенным злокачественным новообразованием области головы и шеи во многих западных странах. По данным мировой литературы, ежегодно в мире регистрируется 238 000 случаев рака гортани и 106 000 летальных исходов от этого заболевания. Гортань играет ключевую роль для таких важных функций организма, как дыхание, голосообразование, защита дыхательных путей и глотание. Таким образом, цель лечения рака гортани – обеспечить максимально возможный контроль над прогрессированием онкологического заболевания с одновременной оптимизацией функциональных результатов.Целью исследования является обзор хирургических и нехирургических вариантов лечения поздних стадий рака гортани, а также доказательств, подтверждающих эффективность каждого из них, включая онкологические результаты (общая выживаемость, безрецидивная выживаемость, локальный контроль над болезнью, функциональные результаты и связанное с ним качество жизни).Материал и методы. Поиск литературы осуществлялся в поисковых системах Medline, Cochrane Library, Elibrary, включались исследования с 1987 по 2016 г.Выводы. Парадигма лечения последних стадий рака гортани перешла от оперативного вмешательства (тотальной ларингэктомии) в качестве золотого стандарта лечения к нехирургическому органосохраняющему лечению с использованием лучевой терапии или химиолучевой терапии. Однако возникли опасения относительно функциональных результатов после химиолучевой терапии, а также возможного снижения общей выживаемости у пациентов с раком гортани

ЛЕЧЕНИЕ ПЛОСКОКЛЕТОЧНОГО РАКА КОЖИ С ПРИМЕНЕНИЕМ КРИОГЕННЫХ ТЕХНОЛОГИЙ

Background. The incidence of skin cancer has been steadily increasing worldwide. Squamous cell skin carcinoma (SCSC ) is the second most common form of epithelial cancer. Treatment of SCSC remains a challenge, and the 10-year survival rate does not exceed 20 % in patients with regional lymph node  metastases and 10 % in patients with distant metastases.The aim of the study was to evaluate the treatment outcomes in SCSC patients using modern cryogenic technologies.Material and Methods. Between 2013 and 2019, 64 patients with SCSC were treated at N.N. Petrov Research Center for Oncology (St. Petersburg, Russia). All patients were divided into two groups. Group I consisted of 32 patients who underwent cryosurgery. Group II comprised 32 patients who underwent conventional surgery.Results. No significant differences in the treatment outcomes between Group I and Group II patients were found. Cryosurgery has several advantages over other surgical modalities. The duration of surgery was shortened by an average of 54 %. Cryosurgery is less invasive than surgery; therefore, pain and bleeding are minimized. The procedure was well tolerated by all patients. According to the «VAS » scale, the intensity of the pain syndrome in the first day after surgery was 70 % lower in Group I than in Group II . In Group I patients, the length of hospital stay was shortened by 7–9 days (57 %), and postoperative complications were not observed. In Group II , local complications were noted in 3 (9.4 %) patients. Cryosurgery was proven effective in 40.6% of elderly patients with the Charlson Comorbidity Index of more than 7 points, to whom palliative therapy is usually recommended.Conclusion. Cryosurgery for patients with SCSC was safe and did not cause any negative impact on the immediate and long-term treatment outcomes. Cryosurgery is a method of choice in the treatment of patients with a comorbidity.Введение. Заболеваемость раком кожи растет повсеместно. Плоскоклеточный рак кожи занимает второе место по частоте среди эпителиальных опухолей. Существующие методы лечения больных с плоскоклеточным раком кожи нередко сопровождаются локальными рецидивами, при этом 10-летняя выживаемость при пораженных региональных лимфатических узлах не превышает 20 %, а при наличии отдаленных метастазов составляет менее 10 %. Цель исследования – оценить результаты лечения пациентов с плоскоклеточным раком кожи с применением современных криогенных технологий. Материал и методы. Исследование проводилось на базе ФГБУ «НМИЦ онкологии им. Н.Н. Петрова» Минздрава России с 2013 по 2019 г. В исследование включены 64 пациента с диагнозом плоскоклеточный рак кожи, которые были разделены на две группы. Первая группа состояла из 32 больных, у которых основным методом лечения была криодеструкция опухоли. Вторая группа включала 32 человека, которым были выполнены различные виды хирургических вмешательств. Результаты. Сравнение результатов лечения больных с плоскоклеточным раком кожи при начальных стадиях заболевания при использовании криохирургического лечения не показало отличий от традиционного хирургического лечения. Применение криодеструкции имело ряд преимуществ. В частности, сократилась продолжительность  операции в среднем на 54 %. Процедура может быть выполнена бескровно, а в сложных случаях объем кровопотери меньше, чем во время хирургического вмешательства. Пациенты легко перенесли процедуру криодеструкции, Интенсивность болевого синдрома после криодеструкции по показателям шкалы «ВАШ» в первые сутки ниже на 70 %, чем в хирургической группе. Срок пребывания в стационаре после криодеструкции опухоли может быть сокращен на 7–9 дней (57 %). Отдаленные косметические потери после криодеструкции опухоли менее выражены. Осложнений вследствие проведения криогенного лечения либо после него не отмечено.  При хирургическом лечении локальные осложнения отмечены у 3 (9,4 %) человек, что укладывается в общеизвестную статистику. У 40,6 % пациентов старческого возраста с индексом коморбидности Чарлсон более 7 баллов, с тяжелыми сопутствующими  заболеваниями, сочетающимися с местнораспространенными формами поражения, которым в большинстве случаев показана только паллиативная терапия, проведено эффективное криогенное лечение. Выводы. Криодеструкция в лечении больных плоскоклеточным раком кожи является безопасным методом, не ухудшает ближайшие и отдаленные результаты по сравнению с хирургическим вмешательством и может служить методом выбора для лечения больных с отягощенным коморбидным статусом.

To the question of improving the medical and social rehabilitation of patients of reproductive age with infectious and inflammatory pathology of the urogenital tract

The study assessed the clinical and microbiological efficacy and safety of a comprehensive and standard treatment method for 84 patients of reproductive age with infectious and inflammatory pathology of the urogenital tract (inflammatory diseases of the genitalia and aggravated obstetric history). A standard etiopathogenetic therapy with the inclusion of an immunomodulatory polyoxidonium and the multi enzyme wobenzym received 42 women, and standard therapy was prescribed to patients of the comparison group (42 people). The control group consisted of 20 women, free from urogenital pathology. Control tests 4 weeks after the end of therapy revealed clinical and microbiological efficacy in 82,4% of patients in the main group, and in the comparison group in 43,3% of patients, i.e. almost 2 times lower than in patients receiving complex therapy. In patients of the main group, the relapse of the disease also decreased, the quality of life improved.В исследовании дана оценка клинико-микробиологической эффективности и безопасности комплексного и стандартного методов терапии 84 пациенток репродуктивного возраста с инфекционно-воспалительной патологией урогенитального тракта (воспалительные заболевания гениталий и отягощенный акушерский анамнез). Стандартную этиопатогенетическую терапию с включением иммуномодулятора полиоксидоний и полифермента вобэнзим получали 42 женщины, а пациенткам группы сравнения (42 чел.) была назначена стандартная терапия. Контрольную группу составили 20 женщин, свободные от урогенитальной патологии. Контрольное обследование через 4 недели после окончания терапии выявило клинико-микробиологическую эффективность у 82,4% больных основной группы, а в группе сравнения у 43,3% пациенток, т.е. почти в 2 раза ниже, чем у пациенток, получавших комплексную терапию. У больных основной группы снизились и рецидивы заболевания, улучшилось качество жизни

The 4q25/PITX2 SNP rs6817105 and Atrial Fibrillation in Uzbek Patients with Arterial Hypertension

Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and a major predictor of morbidity and mortality. In recent years, genome-wide association studies (GWAS) have identified common genetic variants associated with a higher risk of AF. The aim of our research was to study the possible association of the 4q25/PITX2 SNP rs6817105 with the risk of developing AF in patients with arterial hypertension (AH) in the Uzbek population. Methods and Results: The study included 142 AH (Grades 1-3; ESC/ESH, 2018) patients of Uzbek nationality who were initially diagnosed with paroxysmal form (15[10.6%]), persistent form (43[30.3%]), and permanent form of AF (84[59.1%]). The mean age of these patients was 64.8±10.9 years. AF was verified using ECG Holter monitoring. The control group (n=88) consisted of AH patients without AF with a mean age of 56.5±12.3 years. Echocardiography was carried out according to the recommendations of the American Society of Echocardiography in M- and B-modes. We genotyped SNP rs6817105 (T>C) and examined the relationships among rs6817105 genotype, clinical characteristics, and echocardiographic parameters in AH patients with AF and non-AF AH patients (controls). The rs6817105 minor C allele frequency was significantly higher in AH patients with AF than in non-AF AH patients (71.8% vs. 59.7%, P=0.007). Analysis of the multiplicative model for the rs6817105 SNP showed a significant risk of AF in the carriage of the C allele (OR=1.72, 95% CI: 1.16-2.56, P=0.007). The dominant and additive models for the rs6817105 SNP showed a significant risk of AF with the carriage of the CC+CT genotypes (OR=3.16, 95% CI: 1.37-7.27, P=0.005) and the homozygous CC genotype (OR=1.63, 95% CI: 0.95-2.81, P=0.008), respectively. The allelic distribution showed that the carriage of the C allele was dominant in permanent and persistent AF (110/68.75% vs. 50/31.25% for the T allele [(χ2=22.50, P=0.000], and 73.61% (64/74.41%) vs. 26.39% (22/25.58%) for the T allele [χ2=20.512, P=0.000], respectively). Among AH patients with paroxysmal AF, the C allele prevailed to the greatest extent: 20(90.9%) vs. 2(9.1%) for the T allele (χ2=14.727, P=0.000), indicating a significant accumulation of the C allele and CC genotype among patients with paroxysmal AF. In general, in AH patients with AF, carriers of the CC genotype, the left atrial volume index (LAVI) was significantly higher than the carriers of the CT and TT genotypes: 46.8±13.9 ml/m2 vs. 40.4±13.0 ml/m2 and 36.1±11.0 ml/m2, respectively (P=0.0083). Conclusion: Our results indicate the rs6817105 minor C allele and CC genotype are associated with the risk of developing AF in AH patients of Uzbek nationality. The highest accumulation of the rs6817105 minor C allele and CC genotype is found in paroxysmal AF. In carriers of the rs6817105 CC genotype, the LAVI was significantly larger than in carriers of the CT and TT genotypes

ПУНКЦИОННАЯ КРИОДЕСТРУКЦИЯ ПОД УЛЬТРАЗВУКОВЫМ НАБЛЮДЕНИЕМ В ЛЕЧЕНИИ РЕЦИДИВНЫХ БАЗАЛИОМ ЛИЦА

Basal cell carcinoma is the most frequent human skin malignant tumor. The risk of recurrence exists regardless of the treatment method. The ultrasound assisted treatment in patients with face and neck skin basalioma is analyzed in this study. It was shown that the ultrasound assisted method with usage of modern domestic equipment allowedincreasing the treatment effi cacy of recurrent basal cell skin cancer.Базально-клеточная карцинома — это наиболее часто встречающаяся y человека раковая опухоль кожи. Опасность рецидивирования заболевания сохраняется вне зависимости от способов лечения. В данной работе проведен анализ лечения больных с базалиомой кожи лица и шеи под УЗ-наведением с целью улучшения результатов лечения. Исследование показало, что использование ультразвукового метода и нового отечественного оборудования позволяет повысить эффективность лечения при рецидивирующем течении базально-клеточного рака кожи

Surgical management of locally advanced thyroid cancer (narrative review)

A review of the literature on the problem of surgical treatment of local invasive thyroid cancer with damage to surrounding structures is presented. The comparative characteristics of various surgical tactics for the invasion of highly differentiated thyroid cancer into recurrent guttural nerves, larynx and trachea, esophagus have been performed. The advantage of intraoperative neuromonitoring was shown when deciding whether to retain the recurrent laryngeal nerve in the presence of invasion. The systems of staging of laryngotracheal invasion depending on the degree of its spread and surgical tactics used for each degree of laryngotracheal invasion are considered

Chondrosarcoma of trachea: case report of successful surgical treatment of local recurrence

The study objective is to report a case of tracheal chondrosarcoma, which is a very rare malignant tumor. Only 18 cases have been described so far in English medical literature.Materials and methods. A 74-year-old male patient visited an otorhinolaryngologist in August 2011 with complaints of hoarseness of voice, which have been gradually increasing during the last 3 years. The patient was diagnosed with myxoid chondrosarcoma.Results. In September 2011, the patient underwent thyroidectomy and circular resection of the trachea at the level of its second ring with the creation of a tracheal anastomosis. This volume of surgery was determined by the presence a thyroid nodule in the right thyroid lobe, which invaded the cricoid cartilage and the first ring of the trachea. In November-December 2011, the patient underwent a course of adjuvant external beam radiotherapy with a total dose of 50 Gy delivered in 2.0 Gy fractions, 5 days per week. No cancer recurrence had been observed during 3 years and 9 months of follow up. In September 2015, the patients was found to have a 24-mm thyroid nodule with an exophytic component in the right thyroid cartilage plate. This finding was considered as recurrent chondrosarcoma. In May 2016, the patient had laryngectomy. We performed margin-negative (R0) resection. The patient has now been in remission for 2 years and 9 months.Conclusion. We demonstrate successful treatment of a patient with tracheal chondrosarcoma with a long-term remission after surgery for recurrent tumor

ADVANCED LARYNGEAL CANCER (LITERATURE REVIEW)

Background. Squamous carcinoma of the larynx is still the most common head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. According to the world literature, 23,800 new cases of laryngeal cancer and 106,000 deaths from this disease are registered annually in the world. Laryngeal cancer treatment is aimed at achieving tumor control while optimizing functional outcomes.Objective: to review available data on surgical and non-surgical treatment options for locally advanced laryngeal cancer, as well as the evidence supporting each of these, including oncological outcomes (overall survival, disease-free survival, local control of the disease, functional outcomes and quality of life).Material and Methods. A systematic literature search was conducted in the electronic databases Medline, Cochrane Library, and Elibrary in the interval time between 1987 and 2016.Conclusions. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from surgery (total laryngectomy) as the gold standard of treatment to nonsurgical organ-preserving treatment using radiation therapy or chemoradiation therapy. However, concerns have arisen regarding functional outcomes after chemoradiation therapy, as well as a possible reduction in overall survival in laryngeal cancer patients, risk factors, laryngectomy

A lesion of contralateral neck lymph nodes in oral tongue cancer with clinically negative neck lymph nodes (clinical case)

The objective is to present a clinical case of combined treatment of cancer of the tongue and its progression to the contralateral lymph nodes of the neck using data on individual lymphatic outflow from the primary tumor of the tongue.Clinical case. Clinical, laboratory, radiological and pathomorphological data of a 50-year-old patient with a diagnosis of squamous human papillomavirus-negative cancer of the free part of the tongue and clinically negative lymph nodes of the neck with cT2N0M0. The patient underwent radical surgical treatment in the amount of hemiglossectomy and ipsilateral selective cervical lymphadenectomy after two courses of polychemotherapy according to the cisplatin + 5-fluorocracil regimen with partial regression and adjuvant treatment in the amount of conformal remote radiation therapy combined with chemotherapy. 9 months after the end of treatment, progression to the lymph nodes of the neck of the contralateral side was revealed, which accumulated a radiopharmaceutical before treatment.Conclusion. The described clinical case shows the importance of studying the lymphatic outflow from the primary tumor of the tongue to the regional lymph nodes in order to plan surgical treatment on the regional lymphatic collector in patients with squamous cell carcinoma of the free part of the tongue

Sentinel lymph node biopsy for oral tongue squamous cell carcinoma cT1–2N0: prospective single-center study

The study objective is to evaluate the informativeness of the biopsy technique of the signal lymph node (LN) in squamous cell carcinoma of the tongue cT1–2N0.Materials and methods. A prospective, single-center study included 26 patients with morphologically verified squamous cell carcinoma of the tongue cT1–2 and the lack of clinical and radiological data for metastatic damage to the LNs of the neck. All patients underwent a radioisotope study of the lymphatic flow from the primary tumor and the topography of the signal LNs. The informativeness of the biopsy of the signal LNs was evaluated in accordance with 2 diagnostic models. When using the first diagnostic model, all LNs accumulating colloids labeled with the 99mTc isotope were considered signal LNs. In the second model, only nodes accumulating radiocolloids and located in the immediate vicinity of the primary tumor of the tongue and / or connected with the primary tumor by the “pathway” of the lymphatic vessels were considered as signal LNs. Results. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy, according to the 1st diagnostic model, were 66.6 % (95 % confidence interval (CI) 9.43–99.16), 100 % (95 % CI 85.18–100 %), 100 %, 95.83 % (95 % CI 82.28–99.13 %), 96.15 % (95 % CI 80.36–99.90 %), and when all LNs located along with the signal LNs were removed at the same levels as regional LNs, the sensitivity increased to 100 %. In the second model, the diagnostic values were: 33.3 % (95 % CI 0.84–90.57), 100 % (95 % CI 85.18– 100.00), 100 %, 92 % (95 % CI 83.78–96.24), 92.31 % (95 % CI 74.87–99.05 %). Conclusion. Evaluation of lymphatic outflow from the primary tumor and assessment of sentinel lymph node location in patients with stage cT1–2N0M0 squamous cell carcinoma of the tongue allow a doctor to determine the volume of lymph node dissection for each patient individually. Unilateral lymph node dissection is acceptable in patients with unilateral lymphatic outflow, whereas in patients with bilateral lymphatic outflow, it is associated with a quite high (up to 10 %) risk of metastatic lesions in the lymph nodes on the opposite side of the neck. It is necessary to excise all lymph nodes accumulating radiocontrast agent and regional lymph nodes located at the same levels