[Role of palliative surgery in complex treatment for disseminated breast cancer].

An assessment was undertaken of survival and prognosis in 30 patients with primary disseminated breast tumors which disintegrated following palliative mastectomy carried out for sanitary purposes. That resulted in significant improvement in general condition, higher hemoglobulin and lowered intoxication which in turn made medication and radiotherapy possible: chemotherapy (4-6 cycles) followed by hormonal therapy (22-73.3%), hormonal therapy (8-26.7%), and radiotherapy for surgical scar (16-53.3%). All patients were followed up for 18 months (median--3.8 years). Tumor progression at different stages was detected in 12 (40%); local recurrences--8 out of them (26.7%). By the time of investigation, 9 (20%) out of 30, had died of tumor progression while 21 (80%) continued their treatment at the Institute's Clinic. Mean survival was 21.5 +/-2.2 months (median--19 (8-60+)). Our method proved effective due to high survival (median--18 months) and significant improvement in quality of life. However, visceral metastases (p = 0.02) and tumor growth duration (p = 0.05) were of prognostic significance. Such characteristics as presence or absence of estrogen and progesterone receptors of tumor, histological pattern, and anemia appeared insignificant, as far as prognosis was concerned. Function chi2 difference was highly significant (Cox) (p = 0.00013).

Phase I/II trial of gene therapy with autologous tumor cells modified with tag7/PGRP-S gene in patients with disseminated solid tumors: miscellaneous tumors.

BACKGROUND: The use of genetically modified autologous tumor cells appears to be a promising approach for cancer therapy. A phase I/II trial was undertaken to define the feasibility, safety and antitumor effects of the autologous vaccine prepared by transferring tag7/PGRP-S gene into malignant melanoma and renal cell carcinoma cells. PATIENTS AND METHODS: Twenty-one patients (17 with disseminated malignant melanoma and four with metastatic renal cell carcinoma) were enrolled in this study. Cytoreduction was performed in all cases prior to therapy. Autologous tumor cells were transfected with the tag7/PGRP-S gene, irradiated and injected intradermally every 3 weeks. RESULTS: Vaccinations were well tolerated by all patients, without clinically significant signs of toxicity. Delayed-type hypersensitivity was observed in 48% of cases. Antitumor immune response was observed in 95% of patients. There were no complete or partial responses; however, a minor response was achieved in one patient with renal cell carcinoma. The stabilization of neoplastic disease was observed in eight patients (seven with malignant melanoma and one with renal cell carcinoma). Median time to tumor progression was 3 months. CONCLUSIONS: The approach suggested here appears to be well tolerated and produces a number of durable clinical effects. Further studies are required to determine whether promising effects on immune activation will result in an actual clinical benefit for patients with malignant melanoma and renal cell carcinoma.

[Phase I-II trial of gene therapy with tag-7 modified autologous tumor cells in patients with metastatic solid tumors]. / I-II faza klinicheskoi otsenki éffektivnosti genoterapii na osnove autologichnykh opukholevykh kletok, modifitsirovannykh genom TAG7 u bol'nykh s disseminirovannymi solidnymi opukholiami.

A prospective (phase I-II) trial was undertaken to study the efficacy and toxicity of gene therapy with tag 70-modified autologous tumor cells in 32 patients with metastatic renal cell carcinoma (RC) (5) and melanoma (MBL) (27) treated at the Institute's Clinic (2001-2003). Resected material was reduced to cell culture, which was transfected with tag 70 gene and devitalized by irradiation. Immune blotting was used for gene expression. Clinical and immunological effectiveness was evaluated in 22 patients (MBL--17 and RC--5) who received 1-6 injections (3 on the average). Full course of vaccination was given to 8 (MBL--6 and RC--2). No complete or partial response was reported while least regression (50%) was registered in a case of RC metastatic to the lung. According to CT and ultrasound evidence, stabilization was achieved in 5 (23.8%) (MBL--4 and RC--1). Relapse-free period was 6.5+/-3.5 months beginning from the start of treatment. The vaccine was well tolerated while DHT reaction was observed in 47.6% (10 out of 17) of primary immunized patients. A trend of increased content of T- and B-cells in peripheral blood and intensified functional activity was established.

[An improved procedure for autologous gene-modified cancer vaccine preparation for active specific immunotherapy of disseminated solid tumors]. / Usovershenstvovanie metoda prigotovleniia autologichnykh modifitsirovannykh protivoopukholevykh vaktsin dlia aktivnoi spetsificheskoi immunoterapii bol'nykh s disseminirovannymi solidnymi opukholiami.

Resected material was used from 108 patients with disseminated skin melanoma and 47 patients suffering metastasized renal tumors to test procedures of tumor cell culture preparation and to search the best parameters. Gene tag 7 transfer, liposome delivery and electroporation were employed to stimulate immunogenic tumor cells. The transfer results were evaluated by expression of beta-galactosidase and EGFP genes whose products were detected microscopically. Transfer efficiency was boosted by 30% due to selecting suitable parameters of tumor cell modification. Maximum effectiveness was attained by individualized choice of the parameters. Yet, undoubtedly, the best way of cell isolation was mechanical fragmentation of tumor. To speed up cell production, DMEM/F12 medium should be recommended. It should contain cattle embryonic serum (20%), conditioned medium of cultured fibroblasts of human embryonic lungs (20%), transferin, insulin and selenium (standard dose).

[Interscapular-thoracic amputation]. / Mezhlopatochno-grudnaia amputatsiia.

An analysis of results of treatment and prostheses of 89 patients with malignant tumors of the upper extremities and shoulder girdle has shown that among the tumors there were osteogenous sarcomas, chondroid sarcomas, nonclassified sarcomas, reticulosarcomas, angiosarcoma, fibrohistocytic sarcoma, Euring's sarcoma, solitary myeloma, giant cells tumors. Interscapular-thoracic amputations were performed in all the patients. The overall survival rate was (28.6 +/- 8.3)%. An orthosis and a modified prosthesis developed at the research institute of prostheses named after prof. G. Albrekht are recommended for rehabilitation of invalids.

[The results of cytologic diagnosis of bone tumors]. / Rezul'taty tsitologicheskoi diagnostiki opukholei kostei.

The results of bone tumor cytological diagnosis in 968 patients examined and treated at the Institute Clinic (1988-1997) were analyzed. Histological examinations were performed in 479 cases. The share of cytologically inconclusive findings was significantly higher with benign lesions (17.5%) than malignant tumors (9.0%; p(0.05). The sensitivity and specificity of cytological analysis were 94.7 and 93.4%, respectively; positive predictive value--96.7, negative--89.8 and overall diagnostic accuracy--94.3%. Histological pattern of tumor was correctly identified in 73.7% of malignancies.

[Surgical treatment of soft tissue sarcomas of the pelvic girdle]. / Osobennosti khirurgicheskogo lecheniia sarkom miagkikh tkanei tazovogo poiasa.

Wide excision of neoplasm is most frequently used in surgery for soft tissue tumors, on appropriate sites and whenever the "envelope" can be preserved. The most frequent site of pelvic girdle soft-tissue tumors was the glutal area (39.0 +/- 4.8%). Out of 100 patients with such sarcomas, wide excision of tumor was performed in 82, and tumor excision + bone resection--18. The former procedure was mostly used in the management of liposarcomas (26.5 +/- 4.2%), while the latter--in synovial sarcoma (33.3 +/- 4.9%).

[Aromatase activity in human muscle tissue]. / Issledovanie aromataznoi aktivnosti v myshechnoi tkani cheloveka.

Activity of aromatase (estrogen synthetase) was investigated in muscle tissue of 14 women and 2 men. The method of hard water release from androgenic precursor 3H-beta-androstendione was used. In men aromatase activity in muscle tissue is lower than women. For the latter group the enzyme activity is highest after 5-10 year of menopause and in the case of increased body fat content. In the future it looks interesting to correlate muscle tissue aromatase activity level with blood estrogens concentration, prevailing type of muscle fibers and physical activity rate of probands.

[Interscapular-thoracic resection in the treatment of patients with tumors of the musculoskeletal system]. / Mezhlopatochno-grudnaia rezektsiia v lechenii bol'nykh opukholiami oporno-dvigatel'nogo apparata.

Data of 13 patients with tumors of the locomotor system subjected to +interscapular-thoracic resection (ITR) are presented. Main technical aspects of ITR are described. Complications took place in 6 patients, including marginal necrosis of the skin in 4 patients. As a whole the 5-year survival made up 49.9% +/- 13.8%. Data are presented on rehabilitation measures which allow to widen the functional possibilities of the extremity.

[Difficulties of differential roentgeno-diagnosis of aneurysmal cysts and tumors of flat bones and the spine]. / Trudnosti differentsial'noi rentgenodiagnostiki anevrizmaticheskoi kisty i opukholei ploskikh kostei i pozvonochnika.

Clinico-roentgenologic data on 33 cases of aneurysmal cyst of the bone (flat bones--12, spinal cord--21) were assessed. Such peculiarities of the aneurysmal cyst of flat bones as large size, cellular--trabecular structure and a peripheral periosteal "shell" were identified. Vertebral cysts involved processes, arches and body resulting in compression fracture. They sometimes extended to adjacent vertebrae and ribs. Vertebral cysts should be differentiated mainly from giant-cell tumors, metastases and myeloma.

[Interiliac-abdominal amputation in sarcoma of the bones and soft tissues of the pelvic girdle]. / Mezhpodvzdoshnobriushnaia amputatsiia pri sarkome kostei i miagkikh tkanei tazovogo poiasa.

The interilio-abdominal amputation was fulfilled in 62 patients for the period from 1960 to 1979. The postoperative mortality was 6,4%. General five-year survival was 24,3% +/- 5,6. The survival terms were dependent first of all on the tumor type. The advances of anesthesiology, reanimatology and operative oncology have considerably reduced the danger of interilio-abdominal amputation. So, indications for the operation can become wider even in the cases when it has a palliative character.