[Mixed (photon-neutron) therapy in complex treatment for locally advanced breast cancer].

Long term results of treatment of patients with locally advanced breast carcinoma with the use of mixed photon-neutron therapy (PNT) are presented. Among 201 patients with locally advanced breast cancer receiving radiation therapy, in 95 of them it was implemented as a combination of photon and neutron radiation therapy and in 106--in the form of mega-volt photon therapy (PT). Comparative evaluation of the long-term results of treatment proved the superiority of PNT. The immediate effect after PNT in the form of complete and partial response of tumor was registered in 87.4%, and after PT--in 49% of cases. Five-year and ten-year survival rates without signs of disease after PNT were 58.1% and 29.5%, and after PT--36.4% and 7.4% respectively. Substantial differences in toxicity of techniques were not observed.

[Immediate and long-term results of simultaneous chemoradiotherapy in non-traditional modes of fractionation in the treatment of patients with oropharyngeal squamous cell carcinoma].

The analysis of the effectiveness of treatment was carried out in 257 patients with squamous cell carcinoma of the mucous membranes of the oral cavity and oropharynx. Two methods of irradiation were used in combination with concurrent polychemotherapy: standard radiotherapy (2 Gy 5 times a week) and radiotherapy in non-traditional modes of fractionation with uneven breaking of the daily dose into two fractions (1 Gy + 1.5 Gy or 1 Gy + 2 Gy with 4-hour intervals) to a focal dose of 60 Gy. Chemoradiotherapy with fractionated dose was more effective than standard chemoradiotherapy in frequency of objective tumor responses and regional metastases in the absence of increasing the number of early radiation reactions and late radiation damages. External beam radiotherapy in non-traditional modes of fractionation with simultaneous polychemotherapy exposure can significantly improve the results of the overall five-year survival compared with conventional fractionation technique--60.4 +/- 4.5%, 63.3 +/- 8.2% vs 27.6 +/- 10.2%, respectively.

[Fas receptor and Fas-ligand expression by cells of primary melanoma, effect on lymphoid infiltration through tumor bed and long-term results of therapy].

Predictive significance of lymphoid infiltration (LI) at the boundary of tumor and intact tissue was evaluated as well as the effect of Fas-receptor (Fas) and Fas-ligand (FasL) melanoma cell expression and lymphoid infiltrate generation, on the one hand, and end results on the other. Samples of melanoma tissues from 283 patients given combined and complex treatment were examined by a single morphologist. Immunohistochemical analysis was done on paraffin-embedded bioptates from 61 patients with marked LI or without it, to assess Fas and FasL expression. Actuarial specific 5-year survival for LI(+++) was 86.7 +/- 5.6%, LI(++)--69.1 +/- 5.8%, LI(+)--45.4 +/- 5.3% +/- and LI(-)--45.9 +/- 5.9%. Most tumors were grade III-IV: more than half of them--up to 4 mm thick. Five-year survival among patients with tumors of the former group was 78.9 +/- 8.4%, 73.3 +/- 6.19%, 46.4 +/- 6.3% and 55.9 +/- 7.7%, respectively, while the latter group--90.4 +/- 5.3%, 70.9 +/- 7.1%, 65.0 +/- 6.9% and 69.7 +/- 8.0%, respectively. All samples from primary skin melanoma expressed Fas and FasL in 60.7%. No significant effect of FasL expression by tumor cells on LI generation and 5-year survival was observed.

[Adjuvant chemotherapy as a component of complex treatment for skin melanoma].

The efficacy of adjuvant chemotherapy as a component of complex treatment for skin melanoma and that of combined treatment alone was compared. 502 patients were given combined treatment including intensive preoperative irradiation of primary foci (STD-19Gy, TTD-50 Gy, 5 days), their extended excision with or without lymphadenectomy and postoperative irradiation of regional lymph nodes. Combined treatment was administered to 124 patients; additional adjuvant chemotherapy--5-fluorouracil, methotrexate, vincristine and cyclophosphamide (4 components)--200; neo- and adjuvant chemotherapy with cisplatin and doxorubicin (2 components)--106; cisplatin, doxorubicin and dacarbazine (3 components)--29. Forty-three patients receiving individualized chemotherapy were not included in the study. None of the 502 patients showed local recurrence. Five-year actuarial survival in combined treatment group was 69.2 +/- 4.4% (M +/- m), 4-component therapy--58.2 +/- 3.6%, 2 components--68.7 +/- 4.9% and 3 components--80.0 +/- 8.3% (p > 0.2); 5-year recurrence-free survival- 68.1 +/- 4.4%, 57.5 +/- 3.6%; 63.1 +/- 5.0% and 60.9 +/- 10.0% respectively. No significant differences were found as far as a correlation was concerned between actuarial survival and recurrence-free one, on the one hand, and tumor stage, depth and extent of invasion, on the other. Hence, no beneficial effect of said adjuvant chemotherapeutic measures on combined treatment for locally-advanced skin melanoma was found.

[Comparative analysis of long-term results of combined and surgical treatment at the patients with signet ring cell carcinoma of stomach].

Overall 194 patients with signet ring cell carcinoma of stomach were treated, 124 (64%) of them underwent combined treatment (preoperative radiotherapy with subsequent operation), 70 (36%) - only surgical treatment. There were no differences in survival rate between two groups at early (pT1) cancer. The combined method has advantages over isolated surgical at T2 tumors (both with and without regional lymphatic metastases) and at T3 tumors without regional lymphatic metastases (p=0.03). At T3N1-2 tumors with regional lymphatic metastases and T4 tumor neither combined no surgical method demonstrated positive results of treatment. Generally combined treatment with preoperative radiotherapy has statistically significant advantage (p=0.007) over surgical treatment at the patient with signet ring cell carcinoma of stomach.

[Local ultrasound hyperthermia as a component of radiotherapy for osteogenic sarcoma of tubular bones in children and adolescents].

An evaluation of the end results of combined treatment for osteogenic sarcoma by standard chemoradiotherapy (n = 66) and novel thermochemical therapy (n = 108) using local ultrasound hyperthermia (total number--174) demonstrated their dependence on the temperature range in target tumor tissues. Use of subhypertemperatures of 39--41-45 deg.C (TTD--36 Gy) did not improve the results of treatment. However, 41-45 deg.C (TTD--36 Gy) was followed by a significant increase in 3- and 5-year survival and improved quality of life in cured patients as compared with those receiving standard radiotherapy (TTD--60-110 Gy). Hyperthermic therapeutic effect in osteogenic sarcoma depends on certain conditions. Effective temperatures can generally be reached in patients with relatively large-size tumors and rather thin coats of subcutaneous fat.

[Comparative assessment of immediate results of combined and surgical treatment of gastric cancer].

The 30-year experience with combined and surgical treatment of gastric cancer gained at the Center is discussed. The results of surgery were improved due to use of intensive preoperative radiotherapy, metronidazole and dynamic fractionated treatment. There was no correlation between intensive preoperative radiotherapy and postoperative complication incidence or lethality, irrespective of extent of surgery or lymph node dissection. Moreover, radiotherapy was followed by a considerable decrease in postoperative incidence of pancreatitis due to inhibition of secretory function by the pancreas. Use of modern technology of radiotherapy planning and implementing left virtually no serious damage. Considering the recent changes introduced to standards for surgical treatment of gastric cancer, our findings point to a safe combination of preoperative radiotherapy with extended surgical and combined treatment.

[Comparative analysis of long-term results of combined and surgical treatment in gastric cancer].

The end-results of combined and surgical treatment of gastric cancer are compared. Survival rates were sufficiently high in both procedures in cases without extension through the serosa (T1-2) or regional metastases with adenocarcinoma cells were well differentiated (NO). However, combined treatment proved more effective in cases of the opposite situations (p=0.04-0.0001). Considering the possibility of inadequate staging, the following indications for preoperative radiotherapy are suggested: low cell differentiation, signet-cell or undifferentiated gastric tumor of 3-10 cm in diameter. In other words, early cancer of the stomach and total involvement must be excluded.

[Gender, tumor localization and regional metastases as prognostic factors in combined and complex treatment of cutaneous melanoma].

Data on 373 patients treated for cutaneous melanoma were evaluated to test a hypothesis whether there is a correlation between mechanism of protection from ultraviolet radiation and gender. Cutaneous melanoma of the extremities was identified in 63.2% of females and 26.6% of males (p<0.001) versus 26.1% and 54.0%, respectively, with tumors of the trunk (p<0.001). Five-year survival in women was 80.8% versus 76.9% in men in the first group (p>0.2) and 59.5% and 50.0% , respectively, in the second one (p>0.2). Hence, the correlation was concerned with tumor site rather than gender.

[Role of radiotherapy of lung cancer].

Data on the 3-year end results of radiotherapy of inoperable localized nonsmall-cell lung cancer (286) and 5-year (98)--for chemoradiotherapy are compared. Three-year survival after hyperfractionated radiotherapy was 23.7% as compared with 11.3% when standard procedures were used. Five-year survival after hyperfractionated radiotherapy using dose escalation, induction consolidation chemotherapy with iphosphamide, etoposide, cisplatin or carboplatin rose from 3.8 to 24%, while patients were discharged 2-3 weeks earlier.

[Long-term results of pre- and intraoperative radiotherapy in the combined treatment for stomach cancer].

The paper discusses the end results of combined treatment of stomach cancer (radical surgery plus pre- and intraoperative radiotherapy). A randomized evaluation showed that it might be used for loco-regional monitoring. Five-year rates and median of survival rose significantly, as compared with surgery alone, in tumor extension through the stomach wall (T3-4), metastatic dissemination to lymph nodes (N1-2), combinations of such pathologies as well as in cases of low-differentiated, undifferentiated and signet- cell cancer.

[Low-dose accelerated hyperfractionated radiotherapy for local control of chemoresistant Hodgkin's disease (a prospective randomized trial)].

The results are evaluated of the combined treatment of 154 patients with relapsed refractory Hodgkin's disease, which was conducted using standard dosage of conventional chemotherapy. Out of those, 117 with residual lesions were randomized to receive either focal radiotherapy (20-24 Gy) in accelerated hyperfractionation (1.3-1.5 Gy, twice a day, at 5-hr interval) or 38-40 Gy in standard fractionation. Local control persisted in 85-97% of irradiated sites (median follow-up of 24 months), irrespective of irradiation technique. TTD being lowered down to 20-24 Gy due to use of accelerated hyperfractionation, the frequency of late-onset radiation injuries of paramediastinal lung tissue was lower than in standard treatment, with a subsequently lower fraction of patients with stage II fibrosis.

[Pre- and intraoperative radiotherapy for locally advanced gastric cancer in conjunction with extended lymph node dissection: results of phase II clinical study]. / Pred- i intraoperatsionnaia luchevaia terapiia v sochetanii s rasshirennoi limfodissektsiei pri lechenii mestorasprostranennogo raka zheludka: rezul'taty II fazy klinicheskogo issledovaniia.

The paper discusses our findings on a phase II clinical study of an original procedure for therapy of locally advanced gastric cancer including pre- and intraoperative radiotherapy (IORT) and extended lymph node dissection. Out of 24 patients, none had intraoperative complications while postoperative ones developed in 16%; lethality rate was 4%. As far as immediate results are concerned, intensive pre- and intraoperative radiotherapy proved fully compatible with any surgical procedure including extended and extended-combined ones. Survival rates (Kaplan-Meier) were: 1 yr--90 +/- 6%; 2-, 3-year--74 +/- 9%. Indications of adjuvant radiotherapy and approaches to its effective use are discussed.

[Accelerated fractionation regimens in radiotherapy of inoperable non-small-cell lung cancer]. / Uskorennye skhemy fraktsionirovaniia v luchevom lechenii neoperabel'nogo nemelkokletochnogo raka lëgkogo.

The results of definitive radiation treatment (1988-2000) for 375 patients with inoperable non-small cell lung cancer were analyzed. Three regimens of fractionation were used: (1) accelerated fractionation (AF)--(133), 2.5 Gy, 3 days a week, to a total of 47.5--55 Gy; (2) accelerated hyperfractionation (AHF)--(93), 1.25 Gy, daily, to a total of 60-72.5 Gy and standard fractionation (SF)--(149), 2 Gy, daily, to a total of 58-68 Gy. The advantages of AHF were established as regards complete regression rate (54.9% vs. 18.6%--SF and 18.1%--AF; p(0.001), median survival (30.5(2.4 months vs. 18.9 (1%--SF (p = 0.004) and 20.4 (2.4--AF (p = 0.004)), and 3-year survival (36.6% vs. 16.7%--SF (p = 0.005) and 15.5%--AF (p = 0.005). 17.9%, 9.0% (p = 0.11) and 8.1% (p = 0.08) have survived, respectively. Overall survival in the AHF group was superior in stages IIB--III; in stage I, the results were identical. Immediate response to radical radiotherapy appeared the only statistically significant factor of survival (p = 0.005-0.008) in all the groups.

[Choice of fractionation regimen in radiotherapy of inoperable esophageal cancer]. / Vybor rezhima fraktsionirovaniia v luchevom lechenii neoperabel'nogo raka pishchevoda.

The results of definitive radiation treatment for 303 patients with inoperable esophageal cancer were analyzed. Four regimens of fractionation were used: (1) accelerated hyperfractionation (AHF) (70)--1.3 Gy, twice a day, 5 weeks, to a total of 57.2-70 Gy; (2) AHF (49)--1.5-d = 1.5 Gy to a total of 54-63 Gy; (3) AHF (37)--1.7-d = 1.7 Gy to a total of 56.1-57.83 Gy and (4) standard fractionation (SF) (147) to a total of 58-70 Gy. The complete regression rate in the AHF groups (1.3-1.7, 69, 61 and 73%, respectively) was significantly higher than in that of SF (38%) (p(0.01); the median survival in the AHF groups and SF--21, 22, 12.3 and 14.3 months, respectively, and the 5-year survival 14, 12, 4 and 0%, respectively; all the differences in the groups 1.3 and SF were significant. The common independent prognostic factors for all patients were age (p = 0.04), immediate effect of radiation therapy (p = 0.01) and the length of tumor (p = 0.02).

[Intraoperative radiotherapy in the combined treatment of stomach cancer. Methodological and technical aspects]. / Intraoperatsionnaia luchevaia terapiia v kombinirovannom lechenii raka zheludka. Metodologicheskie i tekhnicheskie aspekty.

Theoretical, experimental and clinical rationale is discussed for selection of targets and main parameters of intraoperative radiotherapy for gastric cancer. Topometric and dosage research has been carried out. Original technological equipment has been developed for safe treatment using the domestic accelerator Mikrotron-M. Procedures for continuous relay pre- and intraoperative radiotherapy of gastric tumors in conjunction with radical surgery have been devised and adapted to operation of a specialized clinical facility.

[Results of clinical studies of the efficacy of intraoperative radiotherapy in combined treatment of stomach cancer]. / Rezul'taty klinicheskogo issledovaniia éffektivnosti intraoperatsionnoi luchevoi terapii v kombinirovannom lechenii raka zheludka.

The results of clinical application of an original method of operable gastric cancer treatment including pre- and intraoperative irradiation (IORT) and radical intervention are presented. According to a randomized study, combination treatment did not involve intra- and postoperative complication rates higher than those of surgery alone. Moreover, a significant decrease in postoperative pancreatitis was registered. IORT is a highly effective method of adjuvant treatment of operable gastric cancer. Due to its application in conjunction with preoperative irradiation and radical surgery, the end results of locally-advanced gastric cancer improved.

[Thermotherapy for laryngeal cancer]. / Termoluchevaia terapiia raka gortani.

An analysis of the data on the treatment of 91 cases of advanced cancer of the larynx showed that local UHF-hyperthermotherapy is more efficient than the SHF one as a component of radiotherapy. Use of the latter procedure was followed by a higher rate of late-onset radiation injuries. Moreover, combined application of hyper-fractionated irradiation and UHF-hyperthermotherapy involved practically no grave complications while 5-year survival increased.

[Physico-technological standards of remote neutron radiotherapy and quality assurance (literature review)]. / Fiziko-tekhnicheskie aspekty garantii kachestva neitronnoi distantsionnoi luchevoi terapii i problemy eë obespecheniia (obzor literatury)

Issues in physico-technological support of remote neutron therapy are discussed. On the basis of evaluation of the literature, conclusion is made that a number of important problems are still to be solved.