[A multidisciplinary approach in the treatment of elderly and senile patients with complications of colon cancer.]

The article presents the results of treatment of elderly and senile patients with complications of colon cancer, in whose perioperative management a multidisciplinary approach was used. The peculiarity of patients in older age groups, caused by polymorbidity, the phenomenon of mutual complication, requires the use of a non-standard approach in the treatment of complicated colon cancer, since the latter is accompanied by negative results. A comparative analysis of the results of treatment of 289 elderly and senile patients with complicated colon cancer by the traditional method and using a multidisciplinary approach was carried out. The patients were divided into two groups: study and control. In addition to the introduction of the principles of a multidisciplinary approach, additional diagnostic methods were used in the main group in order to more specifically determine the type, severity of complications, staging of the window process and determine functional operability. Patients of the main group, taking into account the implementation of a multidisciplinary approach, were operated using endovideosurgical technologies. In the group of patients where a multidisciplinary approach was used using additional diagnostic methods and minimally invasive treatment methods, a more favorable course of the postoperative period was noted with a decrease in postoperative complications (from 44,9 to 27,8%) and mortality (from 8,9 to 5,3%).

[Menopausal hormonal therapy and breast cancer.]

The most common treatment for menopausal syndrome is menopausal hormone therapy (MHT), however, the safety of MHT, due to the risk of developing and recurrent breast cancer (BC), is still a matter of debate. The review presents the results of randomized cohort studies of this issue. It has been shown that MHT increases the risk of developing of breast cancer and disease recurrence after treatment. Risk of breast cancer developing in women getting MHT, depends on body mass index (BMI), duration of hormone use and dose of drugs, and is greater in thin women comparing with women with increased BMI, and also greater in estrogen-progestin combined MHT users comparing with estrogen-only users. It was found that in women using MHT hormone-dependent forms of cancer developed more often, but by the time of diagnosis, disease was found in more advanced stage and metastases in lymph nodes were found more often comparing with patients who did not use MHT. Risk of breast cancer recurrence is less with the use of low doses of vaginal estrogen. An alternative option for the relief of menopausal disorders in breast cancer patients during and after treatment is using of pineal gland hormone melatonin, since, along with its anti-aging properties, it is able to suppress cancer at the stages of initiation, progression and metastasis and has the ability to reduce the toxic effects of anticancer drugs while increasing their effectiveness.

[The first results of the analysis of the activity of the cancer service of the North-Western Federal district of the Russian Federation, conducted on the basis of the created population cancer register of the Federal district.]

The completely formed database of the Population Cancer Registry (PCR database) of the North-Western Federal district of the Russian Federation in February 2019 has significantly expanded the ability to objectively assess the activities of the cancer service on a more reliable basis of analytical materials. In Russia, for the first time, it was possible to conduct epidemiological studies of malignant tumors for rare tumor locations, any age groups, and calculations of patient survival rates. The PCR database has more than 1 million observations and includes all the headings and subheadings of ICD-10 for class II - codes C00-96. The article will present the dynamics of morbidity and mortality of the population of the northwestern Federal district of the Russian Federation in comparison with the national average, the reliability of accounting and survival of patients with malignant tumors. For 8 years, the growth of cancer incidence in the Northwestern Federal district of the Russian Federation by 10,4% in standardized indicators and a decrease in population mortality in the Northwestern Federal district of the Russian Federation by 11,4% in the same indicators. The dynamics of the 5-year observed survival rate of patients with Northwestern Federal district of the Russian Federation, taking into account age groups, is calculated. The reliability of the PCR database of the Northwestern Federal district of the Russian Federation is confirmed by the fact that the materials of 3 administrative territories are included in the IARC monograph «Cancer incidence in five continents. Vol. XI¼ (Saint-Petersburg, Arkhangelsk region and the Republic of Karelia).

[The role of comprehensive geriatric assessment in the treatment of cancer patients in elderly and senile age.]

Modern approaches to the organization of diagnosis and treatment of elderly and senile patients with malignant tumors allow to maintain the necessary level of health, improve the quality of life and increase life expectancy. Assessment of geriatric status in Oncology allows: to predict complications during the complex treatment, including drug treatment; to modify treatment to reduce the risk factors of adverse outcomes; to select patients for specialized treatment using standard schemes. So, timely assessment of geriatric syndromes and their correction can expand the indications for specialized treatment of elderly and senile patients.

HIPEC in patients with primary advanced ovarian cancer: Is there a role? A systematic review of short- and long-term outcomes.

A systematic review of the studies where HIPEC combined with cytoreductive surgery was used in patients with primary advanced ovarian cancer was performed to understand is there a role for this treatment modality not only in recurrent but in primary advanced ovarian cancer. The results are controversial but there is a strong trend for improvement of the long-term outcomes of patients with primary advanced ovarian cancer after HIPEC.

Spectrum of APC and MUTYH germ-line mutations in Russian patients with colorectal malignancies.

Distribution of cancer-predisposing mutations demonstrates significant interethnic variations. This study aimed to evaluate patterns of APC and MUTYH germ-line mutations in Russian patients with colorectal malignancies. APC gene defects were identified in 26/38 (68%) subjects with colon polyposis; 8/26 (31%) APC mutations were associated with 2 known mutational hotspots (p.E1309Dfs*4 [n = 5] and p.Q1062fs* [n = 3]), while 6/26 (23%) mutations were novel (p.K73Nfs*6, p.S254Hfs*12, p.S1072Kfs*9, p.E1547Kfs*11, p.L1564X and p.C1263Wfs*22). Biallelic mutations in MUTYH gene were detected in 3/12 (25%) remaining subjects with polyposis and in 6/90 (6.7%) patients with colorectal cancer (CRC) carrying KRAS p.G12C substitution, but not in 231 early-onset CRC cases negative for KRAS p.G12C allele. In addition to known European founder alleles p.Y179C and p.G396D, this study revealed a recurrent character of MUTYH p.R245H germ-line mutation. Besides that, 3 novel pathogenic MUTYH alleles (p.L111P, p.R245S and p.Q293X) were found. Targeted next-generation sequencing of 7 APC/MUTYH mutation-negative DNA samples identified novel potentially pathogenic POLD1 variant (p.L460R) in 1 patient and known low-penetrant cancer-associated allele CHEK2 p.I157T in 3 patients. The analysis of 1120 healthy subjects revealed 15 heterozygous carriers of recurrent MUTYH mutations, thus the expected incidence of MUTYH-associated polyposis in Russia is likely to be 1:23 000.

[Hyperthermic intraperitoneal chemotherapy combined with cytoreductive procedure in patients with peritoneal pseudomyxoma].

AIM: To study the results of intraperitoneal chemoperfusion combined with cytoreductive procedure in patients with peritoneal pseudomyxoma. MATERIAL AND METHODS: For the period 2006--2015 seven patients with peritoneal pseudomyxoma underwent aggressive treatment using hyperthermic intraperitoneal chemoperfusion combined with cytoreductive procedure at the Department of General Oncology of N.N. Petrov Research Institute of Oncology. RESULTS: Two patients had postoperative complications. One of them died after 12 days postoperatively. Features of postoperative complications were predominantly determined by volume of cytoreduction. Advanced tumoral process caused death in 2 patients additionally. Other patients are still alive during 4--28 months after surgery. CONCLUSION: Hyperthermic intraperitoneal chemoperfusion combined with cytoreductive procedure is advisable for peritoneal pseudomyxoma to improve survival. Optimal cytoreduction should be developed in researches with large number of patients to decrease incidence of complications.

[Modern trends in surgery of gastrointestinal tract tumors].

Development of cancer surgery in recent decades occurs on a background of continuing scientific and technical progress. New technologies after the completion of clinical trials maximally quickly are included in the routine practice of specialized medical centers. At present an escalation of indications for extensive advanced and combined operations in locally advanced and even metastatic tumors goes in parallel with the introduction of minimally invasive interventions, search categories of patients, for whom the radicalism of treatment can be achieved without significant surgical aggression. The study of modern trends of this process will allow seeing the promising areas of scientific research, assuming the image of the future of surgery for cancer.

[New approaches to treatment for malignant tumors using perfusion technologies].

The paper summarizes and analyzes the results of complex treatment of patients with malignant tumors performed in the N.N.Petrov Research Institute of Oncology using perfusion technologies. Safety and efficacy data on various chemoperfusion is presented: intraperitoneal chemoperfusion combined with cytoreductive surgery in patients with locally advanced and disseminated gastric cancer, recurrent ovarian cancer and pseudomyxoma peritonei; isolated lung perfusion combined with metastasectomy in patients with lung metastases; isolated limb perfusion with/without cytoreduction in patients with locally advanced skin melanoma and locally advanced soft-tissue sarcoma. The conclusion is made that both intraperitoneal and isolated chemoperfusions are not associated with higher incidence of intra- and postoperative morbidity. However safety of the procedures could be increased through optimizing tactics of surgical procedures prior to chemoperfusions. The use of perfusion technologies provides significant survival advantage in patients who can't benefit from conservative treatment.

[Endovideosurgery (minimally invasive surgery) in treatment for malignant tumors of female genital organs: a 5-year experience of the clinic of the N.N.Petrov Research Institute of Oncology].

During the period of 2010-2015 laparoscopic surgery was performed in 1263 patients: 1113 with endometrial cancer (588 hysterectomies, 509 hysterectomies with pelvic lymphadenectomy, among them 16 with sentinel lymph node (SLN) mapping with Indocyanine green (ICG)); 86 with cervical cancer (80 nerve-sparing radical hysterectomies (NSRH), among them 15 with SLN mapping, 6 radical vaginal trachelectomies with endovideoassisted lymphadenectomy); 64 with ovarian malignancies. The average operating time in the group of hysterectomies was 101 minutes, in the group of hysterectomies with pelvic lymphadenectomy - 184 minutes, in the group of NSRH - 230 minutes. Average blood loss was less than 50 ml. No intraoperative complications were registered. Asymptomatic lymph cysts were observed in 122 cases. Symptomatic lymph cysts requiring surgical treatment were registered in 9 cases. Inconsistencies of vaginal sutures after radical hysterectomy were in two cases, ureterovaginal fistulas - in two cases. During a 3-year follow-up period twelve recurrences were observed in endometrial cancer patients (12/443; 2,7%), four patients (0,9%) died from disease. After NSRH two local recurrences (2,5%) were registered in patients with cervical cancer, after radical trachelectomy -two local recurrences (33%). One patient became pregnant in the group of vaginal trachelectomies. Therefore laparoscopic approach in treatment of female genital malignacies allows performing an adequate volume of surgery with minimal risk of intra- and postoperative complications, favorable course of the rehabilitation period, and oncological safety.

[Role and place of the surgical complex "Da Vinci" in treatment for the right half of colon cancer].

Currently there are a large number of publications, in which the data demonstrate advantages of laparoscopy-assisted colectomy against open surgery. These advantages include: fewer complications in the postoperative wounds, reducing the intensity of pain in the postoperative period, a decrease in length of hospital stay, faster recovery of bowel function in the postoperative period as well as the best cosmetic effect. Also it is proved that when performing laparoscopic surgery it is possible to achieve the criteria of oncological radicalism. A number of clinical studies have reported similar rates of a 3-and 5-year survival rate between these two approaches, which makes laparoscopy-assisted colectomy an attractive alternative to traditional open surgery. Despite significant advances in laparoscopic treatment for colon cancer surgeons are still faced limitations inherent to traditional laparoscopic technique. Development and distribution of surgical instruments for a robotic complex in the middle of the 2000s made it possible to overcome limitations through the use of tools with multiple degrees of freedom and stable three-dimensional high-definition images. The use of robotic technologies in laparoscopic surgery has showed their safety and effective alternative to standard laparoscopic surgery.

[Puncture cryodestruction of recurrent facial area basaliomas with ultrasound scan and surgery monitoring].

Ultrasound scan allows determining tumor border in the area of inflammatory infiltrate, creating a three-dimensional plan of the operation, performing accurate pointing injecting cryoprobes as well as managing a monitor of cryoablation. As a result the frequency of repeated recurrences of infected recurrent tumors in difficult anatomical areas of the face decreased to 4%.

[Anxiety disorders diagnostic algorithm in cancer patients].

The article defines the basic principles of anxiety disorders diagnosis (anxious-phobic disorders, panic disorder, generalized anxiety disorder) in cancer patients in accordance with the evidence-based medicine. There are provided typical clinical manifestations, features and variants of courses of disease. There is proposed the anxiety-phobic disorders diagnosis algorithm. There are characterized clinical, experimental, psychological, laboratory methods and are highlighted stages of diagnostic process.

Isolated pelvic perfusion in treatment for malignant tumors.

Rationale and feasibility of isolated pelvic perfusion (IPP) as a high-tech treatment modality for patients with pelvic malignancies was studied and analyzed based on the systematic review of the literature. Indications, techniques and regimens of IPP are reviewed. There is a focus on anticancer agents for IPP and methods of complete vascular isolation of the perfusated region. Data on the short- and long-term outcome of patients after IPP are presented. To the best of authors' knowledge this is the first Russian article regarding application of IPP in oncology practice.

Technology of minimally invasive cryodestruction of recurrent tumors.

In oncology practice it has been introduced minimally invasive technology of puncture access for cryodestruction of tumors of various sites as well as obtained positive clinical results.

Results of surgical treatment for stress urinary incontinence in prostate cancer patients after radical prostatectomy using modified version of transobturator synthetic sling.

Approximately 6-9% of prostate cancer patients suffering from incontinent of urine after radical prostatectomy are in need of surgical correction of this condition after failure of conservative treatment for 12 months. The study involved 65 patients who were divided into 2 groups of follow-up. Group №1 (n = 31) - patients with mild urinary incontinence, group №2 (n = 34) - patients with medium (moderate) urinary incontinence. Follow-up median of the group №1 was 36 months, an average of 39.5 (12-84) months. Follow-up median of the group №2 was 36 months, an average of 41.65 (12-84) months. The overall efficiency of surgery in both groups was 84% and 82.4%.

[Rationale for development of new domestic appliances theranostic apparatus for photodynamic therapy and fluorescent diagnostics in oncology].

The review discusses the relevance of creating original theranostic apparatus for photodynamic therapy (PDT) and fluorescent diagnostics (FD) to fulfill the needs and meet the objectives of oncology field specialists. Increased accuracy of diagnosis and improvement of treatment outcomes is possible only in case of the right combination of photosensitizer (PS) with the light source with a wavelength at which the maximum absorption of the PS is observed. The absence of medical devices combining functions of PDT and FD makes the development of the domestic theranostic apparatus for oncology an extremely important task.

[Intraperitoneal chemotherapy--a method of improving treatment effectiveness in ovarian cancer].

The study or antitumor effects of dioxadet, cisplatin, melphalan, paclitaxel, mitomycin C, cyclophosphamide and gemcitabine at intraperitoneal (i.p.) and intravenous (i.v.) administration as monochemotherapy and polychemotherapy in a rat model of ascitic ovarian cancer was carried out in 244 female Wistar rats. Ovarian cancer was transplanted i.p. at a number of 1 x 10(7) tumor cells. The drugs were administered once in 48 hours after ovarian cancer transplantation i.p. or i.v. for monotherapy--in maximum tolerated doses, for i.p. polychemotherapy--in half doses from maximum tolerated doses. Antitumor effects of the treatment were estimated in increase in median survival time (MST) compared to control rats who were administered saline i.p. At i.p. administration dioxadet, cisplatin and melphalan increased MST by 79%, 88% and 144%, respectively, while at i.v. administration these drugs didn't affect MST. Mitomycin C and paclitaxel had stronger antitumor action at i.v. administration increasing MST by 152% and 81%, respectively, while at i.p. administration these drugs increased MST by 35 and 45%, respectively. Combinations dioxadet + cisplatin, dioxadet + cyclophosphamide and dioxadet + paclitaxel at i.p. administration increased MST by 305%, 277% and 133%, respectively, and had additive antitumor action compared to mono-effects of these drugs. Gemcitabine and combination dioxadet + gemcitabine at i.p. administration didn't significantly affect survival of rats with ovarian cancer. Intraperitoneal monochemotherapy and polychemotherapy could be more effective in the treatment of peritoneal carcinomatosis from ovarian cancer compared to systemic administration of the drugs.

[Intraoperative intraperitoneal chemoperfusion treatment with cisplatin and dioxadet on a model of peritoneal carcinomatosis in ovarian cancer: safety and efficacy evaluation].

A comparative study of safety and efficacy of normothermic and hyperthermic intraperitoneal chemoperfusion (IPEC and HIPEC) with cisplatin and dioxadet was carried out in 143 female Wistar rats. Ovarian cancer was inoculated intraperitoneally (i.p.). In 48 hours after ovarian cancer inoculation the drugs were administered i.p. or IPEC and HIPEC with the drugs were performed using maximum tolerated doses (MTD). Content of cisplatin was determined in the perfusate and blood plasma during HIPEC with the drug. The leukocyte count was measured using veterinary hematologic analyzer in peripheral blood of rats at different time points after HIPEC with dioxadet. Efficacy of the treatment was estimated in increase in median survival time (MST). During HIPEC cisplatin was accumulated in the abdominal cavity in a considerable amount with minimal systemic absorption. HIPEC with dioxadet didn't significantly affect the leukocyte count in peripheral blood while i.p. administration of dioxadet suppressed leukopoiesis. MST of rats after IPEC with cisplatin was 37.5 days which was significantly higher compared to MST after i.p. administration of cisplatin (19.5 days, p = 0.037). HIPEC with dioxadet was the most effective regimen of treatment with MST of rats reaching 49 days which was significantly higher compared to MST after HIPEC with cisplatin (25.5 days, p = 0.002).