[Using "Collegel" complex in combined therapy of rectum cancer].

The method of drug delivery to the site of lesion is an important component of drug effectiveness. To maximize the effectiveness of drugs LLC "Koletex" has developed and brought into practice the drug, "Collegel" for directed drug delivery. Hydrogel based composition "Collegel" is biopolymer consists of sodium alginate. In the gel-forming polymer one or more substance introduced on a specific technology. Studies have been conducted to examine the possibility of using hydrogel "Collegel" with 5-fluorouracil as radiomodifying agent in the treatment of rectal cancer. In the group of patients who received intrarectal introduction 5-fluorouracil, metastases were observed significantly less frequently (2.8%) than in the group of patients who received surgical treatment (15.2%) and preoperative radiotherapy in monoregimen (12.6%), as well as reduced doses capecitabine concomitantly with preoperative radiotherapy (11.4%), which gives the basis for the use of intrarectal way of introduction of therapeutic doses of 5-fluorouracil during preoperative chemoradiation therapy. The newly created method of complex treatment of patients with rectal cancer to ensure adequate local control of the disease. There is no local recurrence diagnosed over the 2-year follow-up period. We have considerable experience in the application of gel "Collegel" containing antioxidant and immunomodulator "Derinat" (deoxyribonuclease sodium) for the prevention and treatment of radiation damage to normal tissues during radiotherapy of malignant tumors. Patients can be treated without interruption and significantly reduces the incidence of adverse radiation damage.

[Effectiveness of neoadjuvant chemoradiotherapy of locally advanced rectal cancer in conjunction with local hyperthermia and metronidazole].

Our study included 36 patients with hard fixed rectal tumors (T3, T4) who had received combined treatment at the Center's Clinics. On irrigoscopic evidence, lesions were more than 10 cm long. Radiotherapy was conducted thrice a week, STD of 4 Gy--TTD of 40 Gy; capecitabine, per os, 650 mg/m2 twice a day, days 1-22; oxaliplatin, 50 mg/m2, intravenously, days 3, 10 and 17; metronidazole in polymer composition, intrarectally, 10 mg/m2, twice, days 12 and 17 of radiotherapy; local hyperthermia (the <> installation), 460 mHz, 41-45 deg. C, 60 min, days 8, 12, 15 and 17. Diarrhea (stage III) was reported in 3 (8.3%); no toxicity (grade IV). Radical surgery was carried out in 35 (97.2%); sphincter-saving operation--20 (55.5%). Therapy-related pathomorphism (grade III-IV) was detected in 15 (42.8%). Combined neoadjuvant chemoradiotherapy plus polyradiomodification featured low toxicity and good tolerability and immediate effect.

[New technologies in the diagnosis and treatment of patients with squamous cell carcinoma of the anal canal].

PURPOSE OF THE STUDY: The development of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal. MATERIALS AND METHODS: The following scheme of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal was developed and has been used in the Cancer Research Center RAMS since 1995. The irradiation is performed to the small pelvis, perineum and ilioinguinal lymph nodes, at a single dose 2 Gy, 22 sessions, total dose 44 Gy. Radiotherapy is associated with chemotherapy: cisplatin 20 mg/m2, twice a week, No 8; bleomycin 15 mg, twice a week, No 8. Irradiation is combined with 4-5 sessions of local hyperthermia. Local hyperthermia (about 42.5-43 degrees C in the tumor) was given for 60 minutes after irradiation. Local hyperthermia increases the effect of chemoradiotherapy in 1.5-2 times. If the tumor resorbtion exceeds 75%, intrarectal irradiation is performed at a single dose 3 Gy, 7-8 sessions, total dose 21-24 Gy. If the tumor resorbtion is less than 75%, abdomino-perineal resection is performed. RESULTS: This scheme was used in the treatment of 92 patients, rectum preservation treatment was performed in 76 cases (83%), abdomino-perineal resection--in 16 cases (17%). Local recurrences were in 10.0%, the overall 5-year survival was 75.2 +/- 8.5%.

[Polyradiomodification as component of combined treatment of rectal cancer: rationale and results].

The report discusses our 30-year experience with surgical and combined treatment of rectal cancer. In cases of preoperative radiotherapy, loco-regional frequency of relapse dropped to 9.6% as compared with surgery (16.3%). After preoperative thermoradiotherapy it fell to 4.6%; polyradiomodification - 0.5% (3-year follow-up). Distant metastasis formation rates were: after polyradiomodification--1.5%, radiotherapy--9.6%, and thermo-radiotherapy--6%. Recurrence-free survival rates (3 years) were: polyradiomodification--97.3%, thermo-radiotherapy--75.9%, radiotherapy--71.1%, and surgery--58%. Data on regimens and dosage of polyradiomodification alongside radiation damage for different combinations of treatment are presented.

[Surgical treatment of patients with colorectal cancer and severe concurrent cardio-vascular diseases].

The study population comprised 14 patients, operated on account of colon cancer (n=2), sigmoid cancer (n=1), rectal cancer (n=6), synchronous rectal and prostatic cancer (n=1) and lung (n=1) and liver (n=2) colon cancer metastases. The diagnosed concurrent cardiovascular pathology was: coronary heart disease (n=8), valve disease (n=2), aortic aneurism (n=2), coronary heart disease combined with aortic aneurism (n=2). Simultaneous operations were performed in 3 patients, 11 patients were operated on consecutively. No deaths were registered after simultaneous operations. In the group of consecutive operations 2 patients had died of myocardial infarction and cardiac decompensation. 3 (21,4%) patients died of tumor relapse during the follow-up period. The rest 9 patients are under observation for 3 months to 10 years, 2 patients achieved a 5-year cancer-free survival time.

[Combined treatment for rectal cancer using different radiomodification means].

The paper presents an evaluation of the results of surgical and combined treatment received by 961 patients at the Center's Clinics within 28 years. The analysis was based on 3 protocols of prospective randomized study. It dealt with assessment of the end results of surgical and combined treatment for operable rectal cancer using one preoperative hyperfractonated STD of 5-25 Gy. That was combined with local microwave hyperthermia and two radio modifiers--local microwave hyperthermia+intrarectal administration of a preparation containing metronidazolum. Due to the latter factor, the rate of 3-year relapse-free survival rose considerably. Also, loco-regional and distant metastasis incidence was cut down due to superior ablasticity of surgery.

[Detection of genetic mutations in clinical specimens from cancer patients: comparison of NIRCA and SSCP scanning methods].

Specimens of tumor with K-RAS mutations were used to compare SSCP and NIRCA efficiencies in screening long target regions for dispersed point mutations. K-RAS mutations were detected in 5 out of 10 tumor tissue samples from colorectal cancer patients (in codon 12-4 and codon 13-1). Mutant alleles occurred most frequently in adenocarcinoma of the ascending colon and rectum. Both methods proved equally efficient. In certain situations, they may be combined or used as complementary. NIRCA is suitable for screening relatively long sequences (up to 1kb) while SSCP is less sophisticated, robust and allows for mutant bands to be extracted from polyacrylamide gel when required.

[Use of combined treatment of rectal cancer involving metastases to regional lymph nodes].

Use of combined pre- and intraoperative radiotherapy for rectal cancer involving metastases to regional lymph nodes failed to lower incidence of loco-regional recurrences or improve 5-year results, as compared with pre-operative radiotherapy alone. Besides, distant metastasis rates remained rather high (ca.30%). However, pre-operative radiotherapy plus local SHF-hyperthermia were followed by a significant drop in loco-regional recurrence incidence (to 2.3%), as compared with surgery alone and combined treatment using pre-operative hyper-fractionated-radiotherapy (TTD 25 Gy). Distant metastasis rates dropped to 25%. Also, 5-year survival increased significantly.

[Preoperative thermoradiotherapy in the combined treatment of rectal tumors is the inferior ampullar segmento]. / Predoperatsionnaia termoluchevaia terapiia v kombinirovannom lechenii raka nizhneampuliarnogo otdela priamoi kishki.

Data on the examination of 260 radically-treated patients with rectal tumors in the inferior ampullar segment are presented. 107 patients received surgery alone, another 75--preoperative radiotherapy, while still another 78--preoperative thermoradiotherapy. Combined treatment of stage III tumors significantly reduced recurrence incidence and was followed by significant increase in recurrence-free survival rates. In cases of tumor disseminated to the regional lymph nodes, recurrence-free survival was observed after preoperative thermoradiation only.

[Adjuvant radiotherapy in the combined treatment of rectal cancer]. / Ad"iuvantnaia luchevaia terapiia v kombinirovannom lechenii raka priamoi kishki.

Radiotherapy was given postoperatively to 37 out of 81 patients with metastases into the regional lymph nodes (stage C after Dukes) to prevent relapse. All the patients had undergone radical surgery. No significant decrease in relapse incidence could be achieved unless an absorbed dose of 40 Gy was received postoperatively. However, combined treatment failed to produce a significant rise in five-year survival due to deaths from distant metastases.

[Definition, classification and combined treatment of locally invasive rectal neoplasms]. / Opredelenie, klassifikatsiia i kompleksnoe lechenie mestnorasprostranennogo raka priamoi kishki.

From analysis of 490 case records of patients with stage IV A rectal carcinoma, 3 groups of patients were distinguished according to the size of the tumor and the degree of its fixation to the surrounding tissues and growth into the adjacent organs. Such locally spread tumors of the rectum must be subjected to combined treatment: preoperative large-fractional radiotherapy in concurrent local SHF-hyperthermia followed by operation 24-48 hours later. If resectability of the tumor is doubtful, a relieving colostoma is formed in the first stage and distance gammatherapy is applied in a dose of 4 Gy twice a week to a total dose of 32 Gy auring medication with metronidazole and local SHF-therapy. Concurrent intraarterial chemotherapy with 5-fluorouracil (15 mg/kg body weight) has been lately introduced into practice in the treatment of such patients. The results of this complex treatment are evaluated 3-4 weeks after the course is completed.

[An assessment of the efficacy of preoperative radio- and thermoradiotherapy in treating rectal cancer]. / Otsenka éffektivnosti predoperatsionnoi luchevoi i termoradioterapii v lechenii raka priamoi kishki.

Immediate results of combined and surgical treatment of 415 patients with stage III rectal cancer were analysed. Combined treatment including intensive preoperative irradiation and preoperative thermoradiotherapy was not associated with higher postoperative lethality as compared to surgery alone, the indexes being 1.9 +/- 0.9%, 3.8 +/- 2.6% and 2.7 +/- 1.3%. Pyoinflammatory complications developed in 40.7 +/- 3.3% and 45.6 +/- 6.8% of cases in the two combined treatment groups, respectively, and in 33.2 +/- 3.8% in the control group. In patients subjected to preoperative irradiation in combination with microwave hyperthermia, no increase in the occurrence of pyoinflammatory complications was observed, but surgical wounds took longer to heal. The rate of complications following sphincter-sparing procedures, whether used alone or in combination treatment, was similar. It is concluded that the use of combined modality treatment should not bar sphincter-sparing surgery.

[Combined treatment of rectal cancer using intensive macrofractional preoperative irradiation]. / Kombinirovannoe lechenie raka priamoi kishki s ispol'zovaniem intensivnogo krupnofraktsionnogo predoperatsionnogo oblucheniia.

The article discusses the results of a cooperative randomized study according to evaluation of the efficacy of combined treatment in 451 patients among which 248 patients received an intensive course of macrofractional irradiation in cumulative local dose of--25 Gr. Intensive macrofractional irradiation increases neither the frequency of postoperative complications nor the mortality rate. At the same time, the combined method of treatment leads to a significant reduction in the frequency of a recurrent tumor and an increase in 5-year survival, particularly among patients with a stage III tumorous process. Combination of radiotherapy and surgery with the use of local UHF hyperthermia is the method of choice in the treatment of squamous cell carcinoma of the anal canal.

[Combination therapy of rectal cancer using 198Au]. / Kombinirovannoe lechenie raka priamoi kishki s ispol'zovaniem 198Au.

The authors analyzed the results of therapy of 2 groups of patients with stage I-III rectal cancer. Combined therapy of 92 patients included preoperative large fractional radiotherapy at a total focal dose of 20-25 Gy, radical operation and i.v. injection of 1.48-1.85 GBq of 198Au shortly after the operation. The control group of 131 patients underwent surgery only. The groups did not differ significantly in the main prognostic characteristics. The combined therapeutic method was shown to be more effective than surgery alone, and the 5-year survival rates were 70.6 +/- 5.2 and 55.4 +/- 4.91% respectively (P X2 less than 0.05). The frequency of postoperative complications and lethality were not increased. Leukopenia was of temporary nature and disappeared either by itself or as a result of leukostimulating and substitution therapy.

[Management of the perineal wound in the postoperative treatment of patients with cancer of the rectum]. / Vedenie promezhnostnoi rany v posleoperatsionnom lechenii bol'nykh rakom priamoi kishki.

The material showing causes of the appearance of purulent complications of the perineum would after extirpation of the rectum for cancer is presented. The pathogenes of the purulent infection were found to be polyresistant staphylococcus and gram-negative intestinal flora in most cases. The authors recommend using antibiotic therapy directly at the time of performing the operation, good drainage of the postoperative wound, irradiation of the postoperative wound by a laser radiation of a harmless intensity.

[Effectiveness of combined and complex treatment of patients with operable cancer of the rectum]. / Effektivnost' kombinirovannogo i kompleksnogo lecheniia bol'nykh operabel'nym rakom priamoi kishki.

Three hundred and eleven cases of rectal cancer received treatment according to the protocol of a cooperative randomized study. Preoperative irradiation improved three-year survival rates, particularly, in node-negative patients. In node-positive patients, frequency of relapse dropped from 30.0 +/- 8.5 to 5.7 +/- 3.9% when surgical treatment was supplemented by pre- and postoperative irradiation or drug therapy.