[Intensive preoperative hypoxic radiotherapy in combined treatment of patients with cancer of the colon]. / Intensivnaia predoperatsionnaia gipoksiradioterapiia v kombinoravannom lechenii bol'nykhs rakom obodochnoi kishki.

Efficacy of combined treatment (203 patients) and surgical treatment (200 patients) alone was analyzed. In combined treatment either radiation therapy (RT) in the dose 20 Gy over 5 days (group 1) or hypoxyradiotherapy (HRT) in the same doses but in combination with hypoxia (10% oxygen and 90% nitrogen--hypoxic gas mixture HGM-10--group 2) were used in preoperative period. In group 3 HGM-9 (9% oxygen and 91% nitrogen) was used as radioprotector in preoperative period but in increased by 25% radiation doses: total 25 Gy, 5 Gy for 5 days. In the control group only radical surgical treatment was performed. Preoperative irradiation didn't increase the rate of postoperative complications. At the same time the 5-year survival rate was higher in all the groups of patients on combined treatment than in the group of patients on surgical radical treatment. In the group with HGM-9 and increased by 25% radiation doses postoperative complications rate was lower, recurrences and distant metastases occurred less frequently.

[Morphological aspects of intense preoperative hypoxyradiotherapy in combined treatment of patients with sigmoid colon carcinoma]. / Morfologicheskie aspekty intensivnoi predoperatsionnoi gipoksiradioterapii v kombinirovannom lechenii bol'nykh rakom obodochnoi kishki.

Morphological study has confirmed the advantage of using doses of single radiation doses 5 Gy (total dose 25 Gy) and inhalation of a hypoxic gas mixture vs other methods of treatment. The study of radiation pathomorphosis showed significants devitalization of the tumor cells realized clinically with a fall in the number of postoperative recurrences and metastases.

[The effectiveness of breast-conserving surgery in T1-2N0M0 breast cancer]. / Effektivnost' organosokhraniaiushchikh operatsii pri rake molochnoi zhelezy T1-2N0M0.

A retrospective analysis of the end results of surgical treatment of 1.417 patients with T1-2N0-1M0 breast tumors is presented: local recurrence after radical surgery (1.151)-2.4% after radical resection (165)-5.5%, and after lumpectomy combined with axillary lymphadenectomy (101)-4.0%. In the T1N0M0 group, the end results of radical resection and radical mastectomy were identical. In the T1N0M0 and T2N0M0 groups, in which lumpectomy combined with axillary lymphadenectomy was performed, the end results were inferior to those radical mastectomy. There was a correlation between tumor cell detection in the blood and lymph vessels and extent of intervention: radical mastectomy-6%; radical resection-13% and lumpectomy combined with axillary lymphadenectomy-17%. The latter index tended to rise in cases of recurrence after breast-conserving surgery.

[Current principles of diagnosis and surgical treatment of non-organ retroperitoneal tumors]. / Sovremennye printsipy diagnostiki i khirurgicheskogo lecheniia neorgannykh zabriushinnykh opukholei.

The data on surgical treatment of 455 patients operated on for primary and recurrent non-organ retroperitoneal tumors (NRT) are discussed. 64.2% of tumors were resected; postoperative lethality was 8.2%. Particular emphasis is placed on the complex nature of diagnosis and an algorithm of examination is suggested. The sequence of main procedures and stages are described; 43% of radical procedures were performed in combination with one another. NRTs tended to relapse and malignant tumors recurred most frequently within the first 18 months. In the course of 182 operations, 54.4% of NRTs were resected: postoperative lethality was 11.1%. The end results were determined by a number of factors, primarily, nature of tumor (benign or malignant), tumor process (primary or recurrent), tumor size and histological pattern. Because of the poor end results, surgical procedures should be improved and their range should be extended.

[Hypoxyradiotherapy of malignant tumors: experience and perspectives]. / Gipoksiradioterapiia zlokachestvennykh opukholei: opyt i perspektivy razvitiia.

The results of the randomized treatment of 1,280 cancer patients (hypooxyradiotherapy (HRT)--923, radiotherapy as a control procedure--357) are discussed. HRT was administered pre-operatively to cases of stomach cancer, colonic carcinoma and breast cancer. Owing to reduced radiation injury caused by HRT, pre-operative dosage was increased by 50% (single dose--6 Gy; total dose--30 Gy; 54 isoGy) in stomach cancer patients, and by 25% (single dose--5; total dose--25 Gy; 40 isoGy) in colonic cancer patients. The time of pre-operative irradiation with a single HRT dose of 10 Gy (28 isoGy) for breast tumors was reduced 4 times. As a result of HRT application, dosage rose by 25-42% in treating pancreatic carcinoma and non-organ retroperitoneal tumors.

[Preoperative hypoxia-radiotherapy in multimodal treatment of patients with stage III colonic cancer]. / Predoperatsionnaia gipoksiradioterapiia pri kombinirovannom lechenii bol'nykh rakom obodochnoi kishki III stadii.

The paper analyzes the results of surgical and multimodality therapies for 237 patients with Stage III colonic cancer, which were divided into 3 groups. Group 1 included 119 patients undergone only surgical management, Group 2 comprised 43 who were additionally treated with intensive radiation (4 Gy daily for 5 days) and Group 3 consisted of 75 patients who were irradiated in the presence of overall hypoxia evoked by breathing a gaseous mixture containing 9% oxygen. A five-year follow-up has indicated that there are significantly higher survival rates among those who have received a multimodality therapy rather than those merely operated on (82 +/- 5 and 53 +/- 9%, respectively). A short-term gaseous hypoxia has been found to reduce the incidence of systemic radiation reactions in patients during preoperative radiation and to fail to lower the efficiency of multimodality therapy.

[Radiation pathomorphosis in intensive preoperative hypoxic radiotherapy of stomach cancer]. / Luchevoi patomorfoz pri intensivnoi predoperatsionnoi gipoksiradioterapii raka zheludka.

The authors presented the results of pathomorphological investigations of surgical specimens of 110 stomach cancer patients following preoperative radiotherapy or hypoxyradiotherapy and radical operation. Single and total focal doses depended on oxygen percentage in the inhaled mixture and were 4-5 and 20-25 Gy, respectively. Radiation pathomorphosis was established in 62.8% of the patients (in 19.1% it was marked, in 13.5% it was absent, unclassified changes were noted in 23.6%). Short-term hypoxia resulted in no tumor "protection". Radiation changes in the stomach mucose in hypoxyradiotherapy were noted 2-3-fold less frequently than in radiotherapy, suggesting predominant "protection" of healthy tissues by hypoxia.

[Performance of hypoxic radiotherapy in malignant tumors taking atmospheric pressure into account]. / Provedenie gipoksiradioterapii zlokachestvennykh opukholei s uchetom atmosfernogo davleniia.

Hypoxic mixtures, delivered during hypoxic radiotherapy, must contain different values of the volume portion of oxygen depending on atmospheric pressure variations. The authors give a formula of calculation of a necessary volume portion of oxygen and tables of atmospheric pressure variations in Moscow as well as rated values of the volume portion of oxygen, applied to possible atmospheric pressure variations.

[The combined treatment of locally disseminated pancreatic cancer using cryosurgery]. / Kombinirovannoe lechenie mestno-rasprostranennogo raka podzheludochnoi zhelezy s ispol'zovaniem kriokhirurgii.

Experimental cryodestruction of the pancreas performed in 40 dogs served as a basis for selecting the temperature regimen, exposure time and extent of treatment to be subsequently used in man. Cryodestruction and combined cryoradiotherapy were employed in 30 patients with locally advanced pancreatic cancer. The procedure proved effective as it assured alleviation of pain, improvement in performance status and an increase in survival. CA-19-9 level and T-lymphocyte count were followed. These markers may be used to predict progression of pancreatic cancer.

[Use of preoperative intensive irradiation in the combined treatment of patients with colon cancer]. / Ispol'zovanie predoperatsionnogo intensivnogo oblucheniia v komibinirovannom lechenii bol'nykh rakom obodochnoi kishki.

The paper discusses the results of preoperative intensive irradiation used in combined treatment for cancer of the sigmoid colon. Diagnosis was verified morphologically. Patients were randomly assigned for irradiation+surgery (group 1-97 cases) or surgery alone (group 2-111). Those undergoing radical operations only (in both groups) were included into the analysis. No difference was found between the two groups in rate of postoperative complications development (frequency of intestinal anastomosis failure included). The frequency of recurrence and metastasis development was significantly higher in the surgery only group. In patients with metastasis into regional lymph nodes, five-year survival was significantly higher among those who had undergone irradiation.

[Conservative treatment of malignant liver tumors]. / Konservativnoe lechenie zlokachestvennykh opukholei pecheni.

Conservative treatment was carried out in 119 cases of hepatic malignancy (primary cancer--36 and metastatic tumors--83). Radiation therapy using a Rokus-M installation or a Saturn linear accelerator was performed in 26 cases, chemoradiation treatment--14 and cytostatic therapy alone--in 79 patients. Single focal dose used was 2 Gy, while total dose was as high as 51-70 Gy in cases receiving radiation alone and 35-40 Gy in the combined therapy group. Various combinations of carminomycin, bleomycin, cisplatinum, adriamycin, 5-fluorouracil, allopurinol and cyclophosphamide were employed. Radiation and chemoradiation treatment proved effective in 67.5% of cases. Mean survival time for patients suffering primary cancer was 15.8 +/- 4.3 months, and for those with metastatic tumor--8.3 +/- 1.6 months. Remission was registered in 14, while stabilization--in 31 out of 79 patients who had received chemotherapy. The symptomatic effect was observed in 38%.

[Side effects in chemoradiotherapy of bladder cancer]. / Pobochnye éffekty pri khimioluchevoi terapii raka mochevogo puzyria.

Chemoradiation treatment was given to 60 patients with locally-advanced cancers of the urinary bladder and their recurrences. Split-course radiotherapy was carried out using a rotation technique at 3-4 week intervals. Total focal dose for two courses was 65-70 Gy. Combined therapy used cyclophosphamide, dactinomycin and cisplatin. Chemotherapy was given immediately after each course of irradiation. Concomitant cardiovascular pathology was registered in 46.6% of patients and renal function derangement--in 36.6%. However, all the patients, except three, received treatment matched by symptomatic therapy. Myelosuppression was among major side effects. Response was assessed in 47 cases (75%). The immediate effect of combined treatment was observed in 57.4%.

[Combined treatment of malignant kidney tumors]. / Kombinirovannoe lechenie zlokachestvennykh opukholei pochki.

The paper is devoted to the discussion of the results of combined therapy of 79 patients with malignant renal tumors. Eight patients underwent nephrectomy and postoperative irradiation at a mean dose of 28 Gy, a marked radiation reaction was noted in 3 of them, and irradiation had to be discontinued. All 8 patients died within 3 yrs. of a follow-up period. Thirty patients received preoperative irradiation at a single focal dose of 2-2.5 Gy and a summary dose of 30-50 Gy 3-4 weeks before nephrectomy. A dose of 30 Gy did not result in tumor reduction, a dose of 40 Gy led to an insignificant reduction of a tumor size by 1-2 cm, tumor resorption by 30-50% was noted at doses of 50-60 Gy. Thirty-eight patients were given preoperative irradiation at a daily single focal dose of 4 Gy and a summary dose of 20 Gy, followed by nephrectomy in 24-48 h. Radiation reactions in preoperative irradiation were less marked than in postoperative irradiation. The 3-year survival rate in preoperative irradiation and nephrectomy was 72.5%, the 5-year survival rate was 53.2%. A fractionation type did not influence the survival rates.

[Long-term results of radiotherapy of pancreatic cancer]. / Otdalennye rezul'taty luchevogo lecheniia raka podzheludochnoi zhelezy.

Long-term results of radiotherapy of 131 pancreatic cancer patients were discussed. The mean survival time after the therapy was 15.6 mos., in patients with histologically verified diagnosis of cancer--15 mos. During 1 year 64.4% of the patients survived, 2 years--44.7%, 3 years--35.2%, 4 years--9.6%, 5 years--3.2%. The results obtained were 2.5-fold better than those after biliodigestive anastomoses and 3-fold better than those after chemotherapy. Irradiation within a short period (0.5-1 month) after palliative or exploratory operation (the mean survival time was 20.9 mos.) seemed one of the most realistic methods for improving therapeutic results in pancreatic cancer. The mean survival after placing cholecystojejunoanastomosis and radiotherapy was 17.7 mos. (from the onset of irradiation), after exploratory laparotomy and irradiation--18.9 mos., after palliative tumor resection and irradiation--23.9 mos. The efficacy of radiotherapy was lowered with increasing an interval between explorative or palliative operation and irradiation. A split course of gamma-beam therapy was recommended depending on a patient's general status (10-20 after Karnovsky).

[Immediate results of hypoxiradiotherapy of malignant tumors]. / Neposredstvennye rezul'taty gipoksiradioterapii zlokachestvennykh opukholei.

The paper represents a comparative analysis of hypoxiradiotherapy of 202 patients with malignant tumors of different sites. A significant decrease (a 3.5-fold) in the number of severe local radiation reactions was noted in hypoxiradiotherapy of cancer of the esophagus, pancreas and metastases of seminoma to the retroperitoneal lymph nodes. A decrease in the number and intensity of general radiation reactions and the absence of pyo-inflammatory complications after radical operations were noted in preoperative large fractionated hypoxiradiotherapy of colon and lung cancer. The general number of radiation reactions was 12% less in hypoxiradiotherapy. Tumor regression after hypoxiradiotherapy did not slow down. Complete or considerable tumor resorption after irradiation against a background of gaseous hypoxia was noted in 74 +/- 7% of the patients and in 65 +/- 7% after radiotherapy alone. Hypoxiradiotherapy alone or before operation should be widely introduced into clinical practice of cancer dispensaries or radiological departments.

[Reactions and complications in the radiotherapy of pancreatic cancer]. / Reaktsii i oslozheniia pri luchevom lechenii raka podzheludochnoi zhelezy.

Radiation reactions were assessed in 140 pancreatic cancer patients. They were noted in 103 (73.5%) patients: general radiation reactions in 62 patients and local reactions in 41. Noticeable radiation reactions were noted in 17.5%, moderate in 36.9% and insignificant in 45.6% of the patients. The use of braking radiation with the energy of 18-25 MeV caused a decrease in the total number of radiation reactions to 20%, the number of noticeable radiation reactions as compared to those in gamma-beam therapy reduced 3-fold. Changes of external secretory and insular function of the pancreas caused by irradiation were studied. It was established that radiation therapy caused no inhibition of these functions, and in 45.9% of the patients it brought about their improvement or normalization. Complications of radiation therapy were observed after 7-48 mo in 21 patients for gamma-beam therapy and presented with vertebral osteopathy in the exposed site, intestinal trophic ulcer and peptic ulcer recurrence. Radiation reactions caused the termination of therapy of 6 (4.3%) patients, a radiation therapy plan in 21 (15%) patients was changed and a 5-7-day interruption or a split course of irradiation was recommended. The main reaction was a general radiation reaction, and gastric or intestinal reactions were the second reason for the discontinuation or change of a radiation therapy plan.

[Chemoradiation treatment of pancreatic cancer]. / Khimioluchevoe lechenie raka podzheludochnoi zhelezy.

Chemoradiotherapy was recommended to 40 pancreatic cancer patients following exploratory and palliative operations. To raise radiosensitivity of tumors, 22 patients received simultaneous chemotherapy with i. v. injection of 5-fluorouracil, 250 mg, 30-40 min prior to irradiation (2 Gy). A short-term therapeutic effect was obtained in 12 patients who received high (60 Gy) or moderate (40 Gy) irradiation doses and 4-7 g of 5-fluorouracil. The summation of a side effect of radio- and chemotherapy was marked. The administration of 5-fluorouracil did not enhance pancreatic tumor radiosensitivity. The mean lifetime of the patients after treatment was 11.3 mos. To 11 patients before operation 5-fluorouracil was administered i. v., 500 mg, twice a week or 1 g once a week (the mean summary dose 7.5 g). Radiotherapy was given after 2-8 weeks (the optimal time of 4-6 weeks) at a mean dose of 47.8 Gy. The mean lifetime after treatment was 18.7 mos. Chemotherapy to 7 patients was given after radiotherapy which was discontinued at doses of 24-36 Gy because of a grave general state of the patients 5-fluorouracil was administered i. v., 500 mg, twice a week (the mean summary dose 3 g) or 1-3 courses of polychemotherapy were given. The mean lifetime after treatment was 9.4 mos. The mean lifetime of all 40 patients after treatment was 13 mos., the therapy was effective in 24 (60%) patients. Thus simultaneous or consecutive chemoradiotherapy is not indicated for pancreatic cancer patients in a grave condition.