[Choosing combined or complex treatment approach in oral SCC patients].

The aim was to determine the different regiments of adjuvant therapy after radical surgery in patients with oral cancer based on the prognostic factors. 2-years disease-free survival in group with adjuvant chemoradiotherapy was 71.4%; in the adjuvant radiotherapy group - 66.2%. The neoadjuvant chemoradiotherapy demonstrated only 57% 2-years disease-free survival. Our results demonstrate that adjuvant radiotherapy or chemoradiotherapy combined with cisplatin is more effective in treatment of the patients with oral cancer.

[The ultrasound diagnosis of regional recurrent cancer of the thyroid gland].

Examination of 220 patients was performed using ultrasound investigation (USI) in B-regimen, color and energy Doppler encoding, 3D-reconstruction of image and sonoelastography. There were 49 recurrences in the regional lymph nodes. Main semiotic signs of regional recurrences were identified. USI with the application of the methods described is highly informative: sensitivity--94.2%, specificity--92.5%, accuracy--91.7%.

[Restoration of speech function in oncological patients with maxillary defects].

Speech quality was evaluated in 188 patients with acquired maxillary defects. Prosthetic treatment of 29 patients was preceded by pharmacopsychotherapy. Sixty three patients had lessons with a logopedist and 66 practiced self-tuition based on the specially developed test. Thirty patients were examined for the quality of speech without preliminary preparation. Speech quality was assessed by auditory and spectral analysis. The main forms of impaired speech quality in the patients with maxillary defects were marked rhinophonia and impaired articulation. The proposed analytical tests were based on a combination of "difficult" vowels and consonants. The use of a removable prostheses with an obturator failed to correct the affected speech function but created prerequisites for the formation of the correct speech stereotype. Results of the study suggest the relationship between the quality of speech in subjects with maxillary defects and their intellectual faculties as well as the desire to overcome this drawback. The proposed tests are designed to activate the neuromuscular apparatus responsible for the generation of the speech. Lessons with a speech therapist give a powerful emotional incentive to the patients and promote their efforts toward restoration of speaking ability. Pharmacopsychotherapy and self-control are another efficacious tools for the improvement of speech quality in patients with maxillary defects.

[Comparative assessment of the five-year results of surgical, combined, radiation and chemoradiotherapy in laryngeal cancer (T3N0M0)].

Four modalities of specific treatment for laryngeal cancer were compared in 158 patients. Five-year survival after chemoradiotherapy using cisplatin, 5-FU and bleomycin plus irradiation (65-70 Gy) was 87% versus 69.7; 66.2 and 45.9% after surgical, combined and radiotherapy, respectively. Chemoradiotherapy failed in 22.4%, as compared with 28.9; 31.5 and 41.7% after the alternative modalities, respectively. Organ preservation was used in 30.3% of surgical cases and 58%--in combined treatment group.

[Comparison of methods of reconstructive vascular and microvascular surgery used in management of tumors].

Choice of procedure of treatment of defects of reconstructive surgery for locally advanced tumors is discussed. Part 1 deals with use of autovenous vessels and synthetic prosthetics for management of chief artery defects, while Part 2--with bone, soft tissue and skin defects as well as combination defects. Experience with application of free grafts and flaps in microvascular anastomosis is evaluated and relevant recommendations are given.

[Variants of surgical interventions in cases of a craniofacial form of fibrous dysplasia].

From 1980 till now we observed 6 cases of fibrous dysplasia primarily in patients of an older age group with a long history of the disease. Indications to operative interventions were such increasing clinical manifestations as functional derangements, progressing pain syndrome, suspected malignant transformation. In 1 patient with fibrous dysplasia after carried out earlier radiotherapy we observed malignant transformation into sarcoma with process progressing and lethal outcome. Variants of extended operative interventions in cases of craniofacial form of fibrous dysplasia are discussed as well as modern techniques of reconstruction of such defects of craniofacial zone.

[A comparison of two modalities of complex chemoradiotherapy for locally advanced nasopharyngeal carcinoma]. / Sravnitel'naia otsenka variantov kompleksnogo lecheniia nedifferentsirovannogo mestnorasprostranennogo raka nocoglotki.

Two modalities of complex chemoradiotherapy for locally advanced nasopharyngeal carcinoma stage III-IV were compared in the treatment of 52 patients. Thirty-four patients (group I) received polychemotherapy: cisplatin--100 mg/sq.m, i.v., dropwise, on day 4, plus ACOP (adriamycin 35 mg/sq.m, i.v.--4; cyclophosphamide 750 mg/sq.m, i.v.--4, day 1; vincristine 1.4 mg/sq.m, i.v.--4, and prednisolone 100 mg/sq.m, per os, days 1-5; group II (18)--cisplatin 100 mg/sq.m, day 4, plus 5-FU 1,000 mg, i.v.--4, injection, days 1-3. Full response was registered in 93.7% (group I) and 93.3% (group II). Overall 5-year and relapse-free survival was 85 and 63% (group I), and 83 and 56% (group II), respectively. There were no significant differences in radiation-related injury incidence in both groups. The best results were reported with chemoradiotherapy using two courses: an induction one and an adjuvant cisplatin drugs treatment concurrent with ACOP or 5-FU.

[The experience in the use of DNA flow cytometry to predict the natural history of malignant neoplasms]. / Opyt primeneniia protochnoi DNK-tsitometrii dlia prognozirovaniia techeniia zlokachestvennykh novoobrazovanii.

The aim is to study the pattern of a cell population (ploidy) and to evaluate the latter's significance in the prognosis of different carcinomas. A total of 467 patients with primary carcinomas of the breast (n = 177), lung (n = 88), head and neck (n = 140), and colon and rectum (n = 62) were examined. All the patients underwent surgery alone or in combination with radiotherapy (X-ray)/chemotherapy. A follow-up lasted 6 to 120 months. DNA was measured in the operative tumor tissue specimens by using an ICP-22 flow cytometer. Diploid and aneuploid cancers occurred in 20.4-53.6 and 43.6-79.6% of cases, respectively. The frequency of recurrences was mainly associated with aneuploidy and it was more than thrice higher than that with diploidy (21.0-43.2 versus 4.5-14.4%). Five-year survival was twice worse in patients with aneuploid tumors than in those with diploid ones. The survival rates after one operation, preoperative, and postoperative radiation therapy was greater in patients with diploid tumors than in patients with aneuploid ones. Thus, DNA-ploidy of the study neoplasms is of high informative value in predicting the course of a tumorous process and in choosing treatment policy on an individual basis.

[Purulent complications in the surgical treatment of patients with mouth cancer and their prevention]. / Gnoinye oslozheneniia pri khirurgicheskom lechenii bol'nykh rakov polosti rta i ikh profilaktika.

Local purulent complications after surgical operations for mouth cancer were recorded in 49 (61.3 per cent) out of 80 cases and were mainly due to associations of 2 or more pathogens. The analysis of the factors influencing the development of the complications showed that there was no reliable increase in the number of the complications in the patients subjected at the first stage to the treatment with various antitumor agents: 17 (53.1 per cent) events in the group of the patients subjected to radiotherapy in a total focal dose of 40 Gy, 8 (72.7 per cent) events in the group of the patients subjected to radiotherapy in a dose of more than 60 Gy, 13 (59.1 per cent) events in the group of the patients treated with antitumor drugs and 8 (66.7 per cent) events in the group of the patients operated at the first stage of the treatment. The incidence of osteomyelitis was significantly higher in the group of the patients subjected to radiotherapy before the operation: 13 (30.2 per cent) events vs. 2 (5.4 per cent) in the group of the patients not subjected to radiotherapy. With increasing of the radiation dose, the incidence of osteomyelitis as well increased: 8 (25.0 per cent) osteomyelitis events in the group of the patients subjected to radiotherapy in a dose of 40 Gy and 5 (45.5 per cent) events in the group of the patients subjected to radiotherapy in a dose of more than 60 Gy. The method of osteosynthesis of the lower maxilla with titanium miniplates was also of great importance. The use of various schemes for antibiotic prophylaxis of wound infection in such patients was equally efficient.

[Surgical treatment for tumors of the upper thoracic aperture]. / Khirurgicheskoe lechenie opukholei verkhnei grudnoi apertury.

The data on the surgical treatment of 22 patients with tumors of the upper thoracic aperture at the Center's Clinic in 1986-1998 are presented. Transsternal access was made possible due to general broad approach used. The procedure had been designed and tested on 36 cadavers, particularly, with a view to locate the lymph nodes at the junction of the mediastinum and neck.

[Results of organ-preserving and reconstructive surgery of the mandible in patients with cancer of the oral cavity]. / Rezul'taty organosokhraniaiushchikh i rekonstruktivnykh operatsii na nizhnei cheliusti u bol'nykh rakom polosti rta.

Surgery is the basic procedure of combined therapy for locally-advanced carcinoma of the oral mucosa. It is intended to excise involved mucosa and soft tissues of the oral cavity and to resect the mandible. Rim resection (55) produces good functional and cosmetic results and was followed by 5-year survival in 76.4%. Due to median mandibulotomy (24), optimal access was provided to tumor involving the whole tongue and sitting at the back of the oral cavity (5-year survival--58.3%). Postoperative complication incidence was significantly lowered when titanium miniplates were used for mandibular arch reconstruction. When these miniplates and osteomyocutaneous flaps were used for mandibular reconstruction, following segmental resection, good cosmetic and functional results were recorded in 5 out of 8 cases (5-year survival--75%).

[Choice of the optimal variant of plastic surgery in head and neck tumors]. / Vybor optimal'nogo varianta plastiki pri opukholiakh golovy i shei.

Indications for planning primary and delayed operations for head and neck tumors have been evolved on the basis of our 15-year experience with 667 reconstructive surgeries (550 patients) 425 of which (77%) were conducted in one stage.

[Primary and delayed combined plastic repair of pharngoesophagostomies in patients with laryngopharyngeal cancer]. / Pervichnaia i otsrochennaia kombinirovannaia plastika faringoézofagostom u bol'nykh rakom gortanoglotki.

Primary and delayed combined plastic surgery using massive musculocutaneous pedicle flaps composed of musculus pectoralis major, musculus sternocleidomastoideus, musculus trapezius in combination with cellulocutaneous and skin flaps provides appropriate plastic repair of total and subtotal defects of the pharynx and cervical esophagus after combined interventions for oropharyngeal cancer stage III-IV. Composite flaps warrant good and satisfactory functional and cosmetic outcomes in the majority of patients without additional hospital stay.

[Combined plastic repair in head and neck tumors]. / Kombinirovannaia plastika pri opukholiakh golovy i shei.

Combinations of arterialized flaps with other grafts have to be used for repair of extensive perforating defects caused by removal of local disseminated malignant tumors of the head and neck. A total of 635 plastic surgeries were carried out during the latest 15 years at Department for Tumors of the Upper Respiratory Tract, Cancer Research Center, Russian Academy of Medical Sciences. Of these, combined plasty was carried out in 79 cases; in 28 patients the tumor was localized in the median area of the face, in 37 in the lower part, and in 14 on the neck. Primary combined plasty was carried out in 41 patients, delayed repair in 38. Musculocutaneous flaps were used in 42 cases, fatty-cutaneous ones in 37. A working schematic classification of variants of primary and delayed combined plasty in patients operated on for tumors of the head and neck has been developed.

[Reconstructive surgery and organ-sparing methods in the treatment of patients with laryngeal and oral cavity tumors]. / Rekonstruktivnye operatsii i organosokhraniaiushchie metody lecheniia u bol'nykh opukholiami gortani i polosti rta.

Some advances have been recently made to improve survival rates among patients with common advanced larynx and oropharyngeal cancer. In this connection, it is essential to improve the quality of such patients' life. A total 382 patients with Degrees III-IV laryngeal and oral cancers were followed up. New approaches to treating these patients by combining various radiation, chemoradiation and surgical treatments, as well wide application of various primary plastic surgeries have yielded good functional and cosmetic results in most patients.

[The initial location of the tumor as a prognostic factor in chemodectomas of the neck]. / Iskhodnaia lokalizatsiia opukholi kak faktor prognoza pri khemodektomiiakh shei.

Starting from 1979, chemodectomas of the neck are classified at Cancer Research Center as follows: carotid, from vagus nerve paraganglia, and atypical. A total of 135 patients with chemodectomas of the neck were observed, 84 of these with chemodectomas of the carotid body, 40 with tumors originating from vagus nerve ganglia, and 11 with atypical tumors. Analysis of clinical manifestations showed the absence of recurrences after surgery. Vagus nerve chemodectomas were associated with neurological symptoms because of tumor dissemination into the parapharyngeal space under the cranial vault; for this cause, surgical intervention was often not radical. Atypical chemodectomas were liable to stubborn relapsing, necessitating reoperations. Identification of the source of chemodectoma is the crucial prognostic factor for the patient.

[Prognostic significance of tumor necrosis in cancer of laryngeal vestibule]. / Prognosticheskoe znachenie stepeni nekroza opukholi pri rake vestibuliarnogo otdela gortani.

The degree of tumor necrosis in 245 patients with squamous cancer of the larynx were graded as: pronounced necrosis (group I), moderate necrosis (group II), insignificant necrosis (group III), absence of necrosis (group IV). Regional metastases were identified in 39%, 32%, 28.5%, 18.5% of the patients from groups I, II, III and IV, respectively. Five-year survival was, respectively, 53, 70, 14 and 78%. Tumor necrosis severity seems to be more prognostically significant than differentiation of squamous carcinoma.

[Sex steroid hormone receptors in the cytosolic fraction of cancer and leukoplakia of the oral mucosa]. / Retseptory polovykh steroidnykh gormonov v tsitozol'noi fraktsii raka i leikoplakii slizistoi obolochki polosti rta.

The paper deals with the studies of sexual steroidal hormone receptors in the tumor cytosolic fraction in 37 patients with squamous cell carcinoma and in 18 patients from leukoplakia foci in the oral mucosa. One or two types of androgen and estrogen receptors were detected in the tumor cytosolic fraction in most female (75%) and male (62%) patients with squamous cell carcinoma. The detection rate and the mean values of androgen and estrogen receptors in squamous cell carcinoma of the oral mucosa were associated with sex, age, disease stage, type of growth and site of a tumor. Detection and levels of androgen and estrogen receptors in the leukoplakia foci of the oral mucosa depended on the age of patients. Cytoplasmic estrogen receptors (50%) and oral mucosal squamous cell cancer (34.4%) were much more encountered in the foci of leukoplakia and their mean levels tended to increase. The mechanism of action of sexual steroids on normal and tumor target cells, the role of androgens and estrogens in the pathogenesis of oral mucosal carcinoma and leukoplakia, and possible methods of endocrine therapy for these diseases are discussed.