[Current methods of surgical rehabilitation of patients with pelvic exenteration]. / Sovremennye vozmozhnosti khirurgicheskoi reabilitatsii bol'nykh posle évistseratsii organov malogo taza.

An original procedure for supravesical urinary diversion to a small intestine pouch, intended to facilitate urination following pelvic exenteration, is suggested. Post-operative complications are minimized due to formation of a "dry" urinostomy, reduced pressure in the pouch and absence of reflux-pyelonephritis. If required, urine flow can be channeled to the pouch by connecting the sigmoid colon to the anal canal. Said procedure offers optimal advantage of rehabilitation as far as urine channeling is concerned.

Thermoradiotherapy of patients with locally advanced carcinoma of the rectum.

The effectiveness of local hyperthermia was investigated in 56 patients with locally advanced carcinoma of the rectum (T4N0M0). All received combined heat and radiation therapy as a pre-operative treatment. The control group consisted of 59 patients with the same stage of disease as those who were only irradiated. Both groups of patients underwent the same surgical procedure. The total tumour dose of ionizing radiation was 40 Gy in 10 fractions, three times a week. The tumour was heated four or five times to a maximum of 42-43 degrees C by electromagnetic waves with a frequency of 905 MHz before irradiation. Each heating session lasted 60 min. Patients were selected on the principle of randomization: 16.1% of patients (n = 9; n: actual number of patients) showed complete response and 53.6% (n = 30) showed significant regression of the primary tumour compared with 1.7% (n = 1) and 33.9% (n = 20) in the control group, respectively. The differences were significant (p less than 0.05). It was found that thermoradiotherapy allowed the 5-year survival rate of patients to increase up to 35.6% (n = 12) compared with 6.6% (n = 7) in the control group (p less than 0.05).

[Thermoradiotherapy of rectal cancer]. / Termoradioterapiia raka priamoi kishki.

Methods of combined and multimodality therapy are widely used for the treatment of malignant rectal tumors. However radical operation cannot be performed in 50% of patients, in some cases patients refuse surgery. In such cases patients are given a split course of radiation therapy using local heating of a tumor and a method of daily dose fractionation. Altogether 58 patients with stage T2-4N0-1M0-1 were treated by this method: 38 received thermoradiotherapy, 20 were controls. At the 1st stage the summary focal dose (SFD) was 40 Gy, temperature in a tumor was 42-44 degrees C, interval 3-4 weeks. At the 2nd stage radiotherapy was given with daily dose fractionation (1 + 1.5 Gy at 4-5- h interval), the SFD was 35-40 Gy. The SFD over the entire therapeutic course was 75-80 Gy. Radiation rectitis in thermoradiotherapy was more frequent and severe. Complete tumor regression was observed in 7 (18.4%) patients, marked regression--in 24 (63.2%) patients, insignificant regression--in 5 (13.1%); 2 patients (5.3%) were treated without any effect. 29 (76.3%) patients lived over 2 yrs., 6 (25.8%) patients died of tumor progression.

[Method of local hyperthermia combined with gamma therapy in patients with locally disseminated rectal cancer]. / Metodika lokal'noi gipertermii v sochetanii s gamma-terapiei u bol'nykh mestnorasprostranennym rakom priamoi kishki.

Altogether 32 patients with locally disseminated rectal cancer received thermoradiotherapy. Local hyperthermia was used in combination with preoperative radiotherapy in a single focal dose of 4 Gy up to a summary focal dose of 40 Gy. Starting from the third session preliminary heating of a tumor was done using a VHF-unit with a wave length of 33 cm, frequency of 915 MHz. Temperature was controlled in the rectal lumen on the tumor surface with the help of a thermocouple. The temperature of 42-43.5 degrees was maintained for 1 hour. Therapeutic efficacy was assessed after 4 weeks and compared to the results in a similar group of 74 patients who received radiotherapy by the same scheme but without hyperthermia. The results were assessed by the regression of a primary focus: complete (tumor resorption); pronounced (50% and more of the initial volume); insignificant (a decrease in the size up to 50% of the initial volume); the absence of effect (including the progression of a process). In thermoradiotherapy a complete regression was noted in 7 patients (21.9%), pronounced in 18 (56.2%), insignificant in 6 (18.8%) and the absence of effect in 1 (3.1%). In the group of patients who received radiotherapy only no complete regression was noted, pronounced regression was observed in 25 patients (33.8%), insignificant in 31 (41.9%) and the absence of effect in 18 (24 3%). Radiation reactions were more frequently observed with thermoradiotherapy in the form of rectites (62.5 and 42.9% respectively). The first experience with the use of combined thermoradiotherapy in patients with locally disseminated rectal cancer holds promise for the development of the above trend.

[Thermo-radiotherapy in local rectal cancer]. / Termoradiotherapiia pri mestno-rasprostranennom rake piamoi kishki.

The results of preoperative radiation therapy with a cumulative focal dose of 40 Gy were compared in 2 groups of patients suffering from local rectal cancer. 74 patients of the first group received radiation therapy without any additive treatment. 36 patients of the second group before several treatments of radiation therapy received local 915 MHz electromagnetic hyperthermia in the range of 42 to 43.5 degrees C for 1 hour. The patients were operated on 4-6 weeks later. In the second group, full regression was observed in 7 cases. Radical surgery was performed in 15 patients (20.3%) of the first group and 17 patients (47.2%) of the second group. The nature and incidence of postoperative complications in both groups didn't differ significantly. In 4 out of 17 surgical patients of the second group, histologic examination of the resected material failed to detect any tumor elements; the remaining cases revealed deep dystrophic changes.