[Neck skin-muscular flap use in cases of expanded operations on the occasion of malignant neoplasms of maxillo-facial region].

Comparative analysis of the results of different flaps, cut out on side surface of the neck for plastic cover of extensive defects of maxillo-facial region (MFR) formed after malignant tumors ablation, use was carried out. Reconstructive plastic operations were performed in 84 patients: displacement of neck skin-facial flap on the stem in 54 (64.1%) patients, use of neck skin-muscle flap (SMF) in 20 (23.8%) patients, use of improved method of skin-muscle transplant forming from only medial part of nodding muscle in 10 (12.1%) patients. Good cosmetic and functional results were received in 62 (73.8%) observations. Use of complex SMF after surgical interventions in cases of malignant tumors in MFR let reduce the number of postoperative complications and provide earlier rehabilitation of this heavy group of patients.

[Assay of thyrocalcitonin in cervical lymph node using fine-needle washings for the diagnosis of disseminated medullary thyroid carcinoma]. / Opredelenie soderzhaniia tireokal'tsitonina v punktate limfaticheskikh uzlov shei dlia diagnostiki metastazov medulliarnogo raka shchitovidnoi zhelezy.

Fine-needle aspiration biopsy of cervical lymph nodes was carried out in 22 patients with suspected metastatic involvement with medullary thyroid carcinoma (MTS). It was followed by cytopathological examination of aspirates and assay of of thyrocalcitonin (TCT) in fine-needle washings. TCT determinations proved highly informative as well as significantly high in all seven cases of MTS involvement (26-8,484.87 pg/ml, mean 2,208 +/- 1,722 pg/ml).

[Clinical assessment of various methods of radio-modification in radiotherapy of advanced oropharyngeal cancer]. / Klinicheskaia otsenka razlichnykh metodik radiomodifikatsii pri luchevoi terapii rasprostranennogo raka orofaringeal'noi oblasti.

The purpose of the study was to evaluate the effectiveness of RF-hyperthermia and regional intraarterial hyperglycemia as adjuvant radiotherapy vs conventional radiotherapy of advanced head and neck cancers. Altogether 115 patients with advanced T3-T-4 carcinoma of the tongue, oral cavity and oropharynx underwent external radiotherapy (Co-60). An RF capacitative heating device operating at 40.68 MHz was employed twice a week, a total of 4 sessions per patient. Intratumor temperature was 41.5-43 degrees C. Hyperglycemia was performed via the branches of the carotid artery, a total of 3 sessions per patient. There were 4 groups (1-31 patients on conventional radiotherapy; 2-24 patients on thermoradiotherapy; 3-30 patients on radiotherapy plus regional hyperglycemia; 4-30 patients underwent combined radio-modification). A complete response was 29% for conventional radiotherapy, 67% for thermoradiotherapy, 60% for radiotherapy plus hyperglycemia, and 77% for combined radio-modification. A 2-year local control was found to be 13% for radiotherapy, 37% for thermoradiotherapy, 17% for radiotherapy plus hyperglycemia, and 35% for combined radio-modification. Only hyperthermia was found to improve a 2-year local control of advanced oropharyngeal cancer.

[The technology of preparation and experience in the clinical use of 252Cf sources]. / Tekhnologiia izgotovleniia i opyt klinicheskogo primeneniia istochnikov 252Cf.

The paper is concerned with analysis of technology, developed in our country for the manufacture and use of pin sources with linear and inhomogeneous (stepped) distribution of 252Cf and sources of flexible assemblies in interstitial radiotherapy of tumors. Clinical analysis contains 407 cases of therapy of head and neck tumors over the period of 1979-1987. In the authors' opinion, the most promising sources (with regard to the frequency of use) are pin sources with homogeneous radionuclide distribution and flexible assemblies.

[Contact neutron therapy of tumors with 252Cf irradiation]. / Kontaktnaia neitronnaia terapiia opukholei izlucheniem 252Cf.

Clinical experience gained from a combined study of 252Cf brachytherapy by the staff-members of the Research Institute of Medical Radiology, USSR AMS, was generalized. To provide neutron beam therapy they employed contact apparatuses and flexible assemblies of 252Cf sources and the ANET-B neutron therapeutic unit. The immediate, short- and long-term results of therapy of 571 patients with malignant tumors of different sites, spread and histogenesis were assessed. Contact neutron beam therapy was shown to be a new effective method for local therapy of various neoplasms. Further progress in 252Cf brachytherapy necessitates a search for optimum schemes of 252Cf radiation in combination with gamma-beam therapy, radiomodifying agents, antineoplastic drugs and surgical interventions in order to influence primary, regional and distant tumor growth foci.

[Combined neutron and gamma-therapy of tongue cancer]. / Sochetannaia neitronnaia i gamma-terapiia raka iazyka.

The authors conducted a comparative study of the electivity of various schemes of interstitial therapy with 252Cf of 37 tongue cancer patients with tumors corresponding to the clinical stage T2N0M0. The immediate, short- and long-term results of contact neutron therapy alone, by the conventional scheme of combined therapy and a new method were assessed. Interstitial neutron therapy of a primary tumor was given at the first stage, gamma-beam therapy of a primary focus and regional metastatic zones was given at the second stage. A focal dose of neutron therapy was 3.5 Gy, dose rate 10-14 cGy/h. In 5-6 days neutron therapy was followed by a course of gamma-beam therapy at a focal dose of 40 Gy. The results of the study corroborate the conclusions of clinical radiobiology to the effect that neutron therapy damages cancer cells at the first stage more than gamma-rays. This facilitates the process of reoxygenation of tumors and increases general radiosensitivity to subsequent gamma-beam therapy. A mathematical analysis of the patients' survival has shown advantages of this therapeutic method.

[Interstitial neutron therapy using flexible 252Cf sources]. / Vnutritkanevaia neitronnaia terapiia s ispol'zovaniem gibkikh istochnikov iz 252Cf.

The authors describe the technique of interstitial neutron therapy using 252Cf flexible sources developed at the clinic of the Research Institute of Medical Radiology, USSR AMS. Altogether 75 patients with head and neck tumors of different site and spread were treated. The characteristics of the 252Cf flexible sources and the neutron radiation dose field distribution are provided. This technique is based upon the utilization of the afterloading principle. Clinical observations are illustrated by different uses of flexible sources (loop-shaped, planar, radiosurgical). Dosimetry methods are described, general problems of radiation safety are considered. A conclusion has been made of a possibility to extend indications to interstitial therapy using 252Cf flexible sources.

[Patterns of the formation of a dosage field in arranging 252Cf and 60Co sources in a single plane]. / Zakonomernosti formirovaniia doznogo polia pri razmeshchenii istochnikov iz 252Cf i 60Co v odnoi ploskosti.

A computerized study was made of a change in the correlation between the sizes of an irradiated volume and the distribution of sources. Criteria have been established for the utilization of 252Cf and 60Co sources of different active length and design placed on the same plane. Reference dose rate and its derivatives have been chosen as the main parameters that characterize a dose field. A dosimetric analysis was performed using the data for an absorbed dose of neutrons in the tissue, taking account of high RBE of 252Cf fast neutrons that equals 6-7, and a slight change of the local RBE value near the source resulting from a change of the effective spectrum of neutrons in combination with the growth of a contribution of gamma-radiation into the summary dose with the removal from the source. The irradiated volume was evaluated by introducing 3 linear parameters--length, thickness and width. It has been shown that the ratio of the length of an irradiated volume to the active length of 252Cf sources with radionuclide regular linear density changes from 0.7 with the isodose value of 85% up to 0.97 with the isodose value of 60%. For 60Co sources with a higher linear density of the radionuclide on the edges the lower limit of this value equals 1. Intervals of changes in the rest of parameters have also been defined. The results obtained are presented graphically. The results of the study are used for a dosimetric control of the clinical trials of 252Cf and 60Co sources in the treatment of patients with tumors of the tongue, oral cavity fundus, lip and other sites.

[Intrathyroid iodine in the diagnosis of thyroid cancer]. / Intratireoidnyi iod v diagnostike raka shchitvidnoi zhelezy.

The stable intrathyroid iodine concentrations characteristic of nodular goiter, thyroid adenoma and cancer were determined by means of neutron activation analysis of resected material, Mean iodine levels in the destruction focus in cancer, adenoma and nodular goiter were 32 +/- 5, 174 +/- 38 and 344 +/- 43, respectively. while 960 +/- 91, 527+/-138 and 639+/-66 micrograms of iodine per 1g of wet weight were found in the surrounding apparently intact tissues of thyroid parenchyma. The importance of the difference between the absolute value of iodine concentration in the destruction focus and that in intact tissue for differential diagnosis of thyroid cancer is discussed.

[Surgical interventions on the carotid arteries in removing metastatic tumors of the neck]. / Khirurgicheskie vmeshatel'stva na sonnykh arteriiakh pri udalenii metastaticheskikh opukholei shei.

An analysis is presented of the treatment in 55 patients with cancer metastases in jugular lymph nodes with the carotid wall proliferation. While removing metastatic conglomerates all patients were subjected to different surgical procedures on carotid arteries, including denudation, circular and edge resection of the common and internal carotid arteries, resection of the exterior carotid artery. Consideration is given of the complications observed, frequency of tumor recurrences, the immediate, late and remote results of the treatment. Surgical treatment in this group of patients resulted in the survival over 3 years in 20% of cases, up to 5 years and longer--in 18%.