[Clinical-morphological parallels of malignant ovarian tumours].

The detection of the malignant ovarian tumor takes place at a later stage because of a symptomless process of the tumor formation at an earlier stage, hence leading to the delayed diagnostics and inefficient treatment. The objective of the research is the development of an efficient treatment of the malignant ovarian tumor patients, finding the most adequate methods and a delineation of the proper tactics for the achievement of the improved long-term results. We have studied the medical cards of the patients checked into A. Gvamichava Gynecological Clinic of the National Oncology Center in 1990-2000. The research has led to the conclusion that the epithelial malignant ovarian tumors outnumber the non-epithelial malignant ovarian tumors by 5 to 2. The most widespread histotype of the epithelial malignant ovarian tumors is the serous carcinoma, most frequently detected among the 50-69 year old patients and diagnosed at the third and the fourth stages. In non-epithelial malignant ovarian tumors, the most widespread histotype is the granule-cellular tumors, most frequently detected in the 50-69 age group, diagnosed at the II and the III stages. In our clinic, the surgical treatment, with a subsequent chemotherapy is preferential.

[Treatment of malignant ovarian tumours in Georgia in 1990-2000].

The adequate treatment of ovary tumor and the issue of improvement of subsequent results still remain the urgent question of oncology. In 60-80% of diseased the pathology appears at the final--the third and the forth i.e. later stages, while the prolongation of life for the five years period is quite rare--13-47%. Our aim is to study the effectiveness of treatment of malignant ovary tumor based on the data of 1990-2000 provided by A. Gvamichava National Oncological Centre, to develop optimal methods of treatment and select the right tactics in order to improve subsequent results for patients with malignant ovary tumor. The research revealed that the epithelial neoplasm (malignant ovary tumor) is 5.2 times more spread than nonepithelial (malignant ovary tumor). In our clinic the preference is given to the operational method combined with further chemotherapy (ch/t) for treatment of malignant ovary tumor. The advantage is given to the radical surgery (59.4%), amputation of uterine appendages and omentum resection (79.3%). In the case of less radical surgery (23%)--amputation of uterine appendages (63.8%), while for non-radical surgery (17.5%)--ovariectomy, omentum resection (60%). The number of radical surgery of epithelial neoplasm 3 times exceeds less radical surgery and 12 times--non-radical surgery, while in the case of non epithelial neoplasm the number of radical surgery is two times more than less radical surgery and 3 times more than that non radical. In 1990-2000 in the National Oncological Centre ch/t without platinum and audrioblastin (44.8%) had been most frequently used for treatment of ovary tumor. The main schemes were: cyclophosphan + phtoruracyle and cyclophosphan + phtoruracyle +metotrexat.

[Strategy and results of treatment in trophoblastic disease]. / Taktika i resul'taty lecheniia trofoblasticheskoi bolezni.

The study involved 457 cases of ordinary (261), invasive (75) vesicular mole and choriocarcinoma (121-stage I-51.2; stage II-19.8 and stage III-27.3%). Enhanced chorionic gonadotrophin titer in urine was registered in 67-72%. Choriocarcinoma had no link to pregnancy in 6.6%. It is suggested that cases with a 10-year latency period and longer should be referred to this category of patients. Five-year survival was observed in 98-99% of patients with vesicular mole and in 74.1% with choriocarcinoma in 1977-1989. A special synoptic procedure has been developed for optimal planning the therapy and rehabilitation of cases of trophoblastic disease. Four forms of non-invasive vesicular mole have been identified, and strategies of treatment versus type of tumor and patient's peculiarities worked out. The extent of therapeutic effort has been decreased.

Optimal version of I and II stages vulvar carcinoma--surgical treatment.

In gynaecological clinic years during 1970-1986, 270 vulval carcinoma patients (I stage 12.6%; II 50.3%; III 29.3%; IV 7.8%) underwent treatment. 34.8% patients age was 60-69, 32.2% 70-79. Average age 66 years. In 70% patients diagnostic epidermoidal, 22.2% low differentiated cancer and 1 case (0.4%) adenocarcinoma. 187 patients underwent total vulvectomy (additional telecurie therapy 18 patients, 2 chemotherapy), 54 total vulvectomy + regional lymphadenectomy, 29 chemo (6), radio (3), symptomatic (20) therapy. 5-year recovery generally equated 40.1% (vulvectomy + lymphadenectomy 58.4%; vulvectomy only 35.8%), at I-II stage 52.1% (vulvectomy + lymphadenectomy 85.7%; vulvectomy 50.0%), at III stage 11.4% (vulvectomy + lymphadenectomy 42.9%; vulvectomy 6.7%), at IV stage 0%. T1 regional lymph nodes involvement, clinical signs (N1, N2, N3) were present in 24.1% patients, T2 36.1%, T3 70.8%. Out of marked 92 patients, lymphadenectomy was performed in 54, mainly with T1 and T2. Histological metastases observed in 48.1%, i.e. no more than 14% T1 and T2 patients. Considering the above raised question rised - it is justifiable in I and II stage patients with negative lymph nodes, regarding advanced age and concomitant diseases, perform protracted traumatic operation. But without histology it's hard to decide lymph nodes condition. Taking into account certain stage characteristic of metastatic spreading, in our clinic from 1985 in T1 and T2 vulval carcinoma without (N0) and/or with (N1, N2) regional lymph nodes involvement signs modified less traumatic one stage extensive vulvectomy with bilateral inguinal lymphadenectomy is performed. Suboperational morphological (cytology, histology) lymph nodes study is conducted. Upon metastases discovery dissection is carried out on femoral lymph nodes as wall.(ABSTRACT TRUNCATED AT 250 WORDS)

[Optimization of the treatment of patients with malignant polyps of the cervix uteri]. / Optimizatsiia lecheniia bol'nykh s malignizirovannymi polipami sheiki matki.

The study was concerned with an analysis of 5-year results of treatment of Ca in situ (II) and invasive cancer (53 patients) arising in cervical polyps. Recurrences were observed in 15.1% of cases undergoing sparing procedures. Conization assures an optimal removal of tissue for Ca in situ. Reproductive patients with invasive carcinoma should also undergo conization. Extirpation of the uterus with appendages should be carried out in menopausal patients and cases of concomitant uterine pathology.

[Optimal treatment modality for patients with stage-I cervical cancer]. / Optimal'nyi variant lecheniia bol'nykh rakom sheiki matki I stadii.

Expansive extirpation of the uterus was performed in 726 cases of stage TIbNXMO cervical cancer. 19.3% of 600 cases of pTIb cancer showed metastatic involvement of lymph nodes. Metastases into regional lymph nodes were found to be resistant to preoperative large-fraction irradiation. The long-term results of treatment of 484 patients with pTIbNOMO cervical cancer receiving 3 different treatment modalities (operation alone, surgery + preoperative irradiation and surgery + postoperative distant irradiation) did not show any significant difference. Complications and relapse were rarer in patients who received surgery only. Therefore, expansive extirpation of the uterus unaccompanied by distant radiotherapy should be a method of choice in treatment of stage I cervical cancer (pTIbNOMO).

[Comparative study of the female genital cancer morbidity in the Georgian SSR, Latvian SSR and Kazakh SSR]. / Sravnitel'noe izuchenie porazharmosti rakom zhenskikh polovykh organov v Gruzinskoi SSR, Latviiskoi SSR i Kazakhskoi SSR

Within a period of 1966-1970 in the three republics according to standardized indices for 100.000 females cancer of the female genitalia was found in 42.32 (in Georgia--29.1; in Kazakhstan--43.02; in Latvia--54.85). Dynamically, there was noted a stabilization of indices on cervial cancer and growth in ovarian and, especially, endometrial cancer incidence. In dynamics there is an "ageing" of cancer of the female gentalia.