[Treatment of primary malignant melanoma of the esophagus]. / Lechenie pervichnoi melanomy pishchevoda.

OBJECTIVE: To present treatment of primary esophageal melanoma in a young patient, as well as review of modern data on this issue. MATERIAL AND METHODS: We describe the results of treatment of a patient with primary melanoma of the esophagus. PubMed, SCOPUS, and elibrary databases were used for the review. RESULTS: We present a rare case of primary esophageal melanoma and variant of radical surgical treatment. The review is devoted to historical information about this nosology, statistical data, options for diagnosis and treatment. CONCLUSION: Such a rare clinical case is of great scientific interest due to the rarity of this disease. In our opinion, a certain register of orphan malignant tumors is necessary for diagnosis and treatment of various rare malignancies.

[The structure of pathogenic germline variants in colorectal cancer in Moscow patients]. / Struktura patogennykh germinal'nykh variantov pri kolorektal'nom rake v vyborke patsientov Moskvy.

OBJECTIVE: Describe the structure of pathogenic germline variants and clinical and anatomical features in colorectal cancer patients in Moscow. MATERIAL AND METHODS: The whole genome sequencing results of patients with suspected hereditary cancer syndrome were evaluated. All identified genetic variants were validated using Sanger sequencing. RESULTS: The study included 238 patients with colorectal cancer, 41/238 (17.2%) patients have pathogenic germline variants associated with hereditary cancer syndromes or increased cancer risk. Lynch syndrome accounts for 8% of all colorectal cancer cases (19/238), and familial adenomatous polyposis - 1.7% (4/238). 5 new genetic variants were described for the first time in a Russian colorectal cancer patients: MLH1 c.1921dup (p.Leu641fs), APC c.2929C>T (p.Gln977Ter), PMS2 c.327del (p.Ala110LeufsTer2), MSH2 c.1857dup (p. Val620CysfsTer24), ATM c.895G>T (p.Glu299Ter). In 197 of 238 patients, no significant variants were identified or variants with an uncertain clinical underlying cause were identified. CONCLUSION: According to the results of the study, an earlier manifestation of a malignant neoplasm and a more frequent occurrence of high-grade carcinomas in the presence of pathogenic germline mutations were noted compared to the group of patients without clinically significant varianrs, while in the group with identified mutations, the frequency of regional and distant metastasis was not increased.

[Anatomical resection for non-small cell lung cancer: cardiopulmonary exercise testing in assessing the risk of respiratory complications]. / Anatomicheskie rezektsii po povodu nemelkokletochnogo raka legkogo: kardiorespiratornoe nagruzochnoe testirovanie v otsenke riska respiratornykh oslozhnenii.

OBJECTIVE: To assess the role of cardiopulmonary exercise testing in examination of patients with high risk of respiratory complications in anatomical resections for non-small cell lung cancer. MATERIAL AND METHODS: A non-randomized retrospective single-center study was devoted to immediate results of surgical treatment of patients with NSCLC between December 2020 and April 2021. Median age of patients was 65 (84; 30) years, male-to-female ratio - 129 (57%)/98 (43%). All patients were examined according to a unified algorithm recommended by the American (ATS) and European (ESTS) societies of thoracic surgeons. At the first stage, we analyzed airflow rate and performed non-invasive exercise tests (6-minute walk and/or stair test). Resections of lungs were performed in 231 patients, anatomic lung resections - in 227 patients (lobectomy - 199, bilobectomy - 4, segmentectomy - 17, pneumonectomy - 7). We excluded 4 patients who underwent non-anatomic lung resections (marginal resections). RESULTS: Among 236 patients referred for anatomical lung resections, 34 (14.4%) ones were selected for cardiopulmonary testing. Selection was based on low exercise tolerance and/or severe decrease in predictive respiratory parameters (FEV<50%). Patients were divided into 4 groups depending on peak oxygen consumption. There were 5 (2%), 10 (29.4%), 11 (32.3%) and 8 (23.5%) patients with extremely high, high, moderate and low risk of respiratory complications, respectively. Surgeries were performed for IA1 (n=6), IA2 (n=50), IA3 (n=37), IB (n=31), IIA (n=19), IIB (n=37), IIIA (n=25) and IIIB (n=4) stages. The overall incidence of postoperative complications was 23% (95% CI: 18-28.8). Complications Clavien-Dindo grade I, IIIA, IIIB, IVA, IVB and V prevailed in both groups. Median postoperative hospital-stay (6 (6; 8) vs. 7 (6; 8) days) and time of pleural drainage (4 (2; 5) vs. 3 (3; 4) days) were similar. Organ-sparing procedures prevailed in the main group (5 (26%) out of 19 (95% CI: 11.81-48.8) vs. 12 (6.7%) out of 180 (95% CI: 3.8-11.3)). Overall mortality (n=231) was 1.7% (95% CI: 0.7-4.4). Mortality throughout the first postoperative year was 24% (95% CI: 12.2-42.1) and 7.4% (95% CI: 4.2-11.3), respectively. CONCLUSION: Cardiopulmonary exercise testing makes it possible to objectively assess exercise tolerance and identify high-risk patients for respiratory complications. These data are valuable when planning the treatment of patients with non-small cell lung cancer.

[Fast track recovery protocols for extended pelvic surgery]. / Protokoly uskorennogo vyzdorovleniya pri rasshirenno-kombinirovannykh operatsiyakh na organakh malogo taza.

OBJECTIVE: To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice. MATERIAL AND METHODS: The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p=0.046), patients with recurrent (46.2% vs. 22.0%; p=0.009) and complicated tumors (26.9% vs. 11.9%; p=0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p=0.068). RESULTS: Surgery time was higher (319±125 min vs. 236±79 min, p<0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p=0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p=0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p=0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p=0.034) and local infectious complications (19.2% vs. 42.4%; p=0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p=0.89). CONCLUSION: FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

[Clinical efficacy of ct-guided transthoracic needle biopsy of peripheral lung lesions]. / Klinicheskaya effektivnost' transtorakal'noi biopsii perifericheskikh novoobrazovanii legkikh pod kontrolem MSKT.

OBJECTIVE: To evaluate the effectiveness of a step-by-step protocol for GT-guided transthoracic biopsy in verification of peripheral lung tumors. MATERIAL AND METHODS: A retrospective analysis of the results of GT-guided transthoracic biopsies of focal lung neoplasms was performed between October 2019 and December 2020. The analysis included the results of 176 biopsies in 158 patients. RESULTS: Primary biopsy was informative in 139 (87.97%) out of 158 patients. There were 155 (88.07%) informative and 21 (11.93%) non-informative biopsies. Lung adenocarcinoma was diagnosed in 41 (25.95%) patients, squamous cell carcinoma in 35 (22.15%) patients, and small cell carcinoma in 9 (5.7%) patients. There were 17 (10.76%) patients with uninformative biopsy results. Sensitivity, specificity and accuracy were 86%, 95.5%, and 87.8%, respectively. PPV was 98.9%, NPV - 58.3%. Various complications occurred after 65 (36.93%) out of 176 biopsies (95% CI 30.15-44.27). Pneumothorax followed by pleural drainage was detected after 8 (4.55%) biopsies. CONCLUSION: Accuracy of a step-by-step protocol for transthoracic biopsy was 88% that is not inferior to similar results in large-scale studies devoted to specialized navigation systems.

[Enhanced recovery in thoracic surgery]. / Uskorennaya reabilitatsiya v torakal'noi khirurgii.

OBJECTIVE: To present an experience of adapting the accelerated rehabilitation protocol at the thoracic surgery department of the Moscow City Clinical Oncology Hospital No. 1. MATERIAL AND METHODS: An effectiveness of the accelerated rehabilitation program in the city oncology hospital was retrospectively analyzed for the period from February to December 2019. Lung resections were performed in 252 patients with median age 66 (59; 71) years and an equal ratio of men and women (124/128). Primary non-small cell lung cancer was noted in 194 (77%) patients, secondary malignant neoplasms of lungs - in 58 (23%) cases. ASA grading system of anesthetic risk was applied (American Society of Anesthesiologists): grade II - 56 (22.2%) patients, grade III - 203 (75.2%) patients, grade IV - 7 (2.8%) patients. RESULTS: Lobectomy was performed in 147 patients, segmentectomy - in 32, bilobectomy, pneumonectomy and marginal resection - in 1, 3 and 69 cases, respectively. Endoscopic operations made up 13.6% (n=20), 12.5% (n=4) and 78% (n=54). Postoperative 30-day complications occurred in 19 (7.5%) out of 252 patients (95% CI 4.9-11.5). Postoperative 30-day mortality was 1.98% (5 out of 252 patients, 95% CI 0.9-4.6). Median postoperative hospital-stay was 7 (6; 8) days. CONCLUSION: Implementation of fast track protocol requires time and the first results can be assessed after 6-12 months. Continuous monitoring of implementation of the protocol elements by all members of multidisciplinary team, analysis of complications and long-term results are required to realize all potential benefits of this program.

[How necessary to perform neoadjuvant chemoradiotherapy for rectal cancer in geriatric patients?]

A comparative analysis of the efficacy and safety of neoadjuvant chemoradiotherapy (CRT) in colorectal cancer patients older and younger than 60 years has been performed. It was determined that the risk of complications of neoadjuvant CRT, as well as the degree of its adverse effect on outcomes after surgical treatment, are not significant for the age of patients. However, the use of preoperative CRT in elderly patients is associated with a less significant increase in recurrence-free survival in comparison with younger patients. Thus, the age factor should not limit the use of neoadjuvant CRT in patients with satisfactory general status and the absence of severe complications of the pathological process.

[Low dose-rate contact radiation therapy (brachytherapy) for prostate cancer using domestic I-125 seeds as a monotherapy and combined with pelvic lymphadenectomy].

INTRODUCTION: In 2014, the incidence of prostate cancer in the Russian Federation was 116.4 per 100,000 population. It is noteworthy that from 2004 to 2014, the proportion of patients with stage I-II prostate cancer increased from 35.5% to 52.5%, while that of patients with stages III and IV disease decreased from 38.4% to 29% and from 22.7% to 16.5%, respectively. All of this allows an increasing number of prostate cancer patients to be treated with radical treatment - low dose-rate brachytherapy. For the first time in this country, we report a clinical trial of low dose-rate brachytherapy for prostate cancer using domestically manufactured I-125 seeds. The successful results of this clinical trial are presented in this article. The aim of this work was to show the clinical efficacy and safety of domestically manufactured I-125 seeds for low dose-rate prostate cancer brachytherapy. MATERIALS AND METHODS: The clinical trial comprised 36 patients with stage T1-T2 prostate cancer. Patients were randomly assigned according to the risk of cancer progression. Low and intermediate risk groups comprised 30 (83.3%) and 6 (16.7%) patients, respectively. Patients of low risk group underwent brachytherapy alone with the minimum therapeutic dose of 145 Gy. I-125 seeds of two activities, 0.55 and 0.35 mCi per seed were used for implantation. Depending on the prostate volume, from 40 to 80 seeds, 57 on average were implanted. Mean implantation time was 85 minutes. In patients of the intermediate risk group brachytherapy was performed in combination with laparoscopic pelvic lymphadenectomy which was carried out 4-5 weeks prior to brachytherapy. RESULTS: Follow-up examination at 6 months after implantation showed that PSA decreased in all patients on average by 87% from the baseline. No adverse events were reported. CONCLUSION: The findings of the clinical trials of domestically manufactured I-125 seeds showed they are effective, safe and comply with international standards.

Efficacy of photodynamic therapy for basal cell carcinoma using photosensitizers of different classes.

The paper presented results of photodynamic therapy for 139 patients with basal cell carcinoma. We conducted a study of the efficacy and safety of four methods of photodynamic therapy. There were used the following photosensitizers: photohem, photosens, photolon and photodithazine. Photodynamic therapy using photosensitizers of chlorine series (photolon and photoditazin) provides a better long-term results improving disease-free 3-year survival rate to 90.4% and 92.3%, respectively compared to 54.7% and 71.1% in groups, in which treatment was restricted by photohem and photosens.

[New opportunities for proton therapy in Russia].

On November 23, 2015 in Protvino of the Moscow Region there was begun proton therapy using Russia's first medical therapeutic complex "Prometheus" produced by JSC "PRO- TOM" and certified to treat patients with head and neck tumors. The complex allows irradiating patients with active scanning beam. Energy of beam is 30-250MeV and maximum field size is 10 cm vertically and 40 cm horizontally. The manufacturer declared parameters were confirmed during preclinical stud- ies. By April 8, 2016 the successful proton therapy received 20 patients with complex "targets" mostly located, from the point of view of radiation tolerance, near the critical structures.

[Clinical picture, diagnostics and treatment of acute pancreatitis].

In clause results of treatment of 1794 patients with a sharp pancreatitis are analyzed. The interstial form was observed at 1186 are sick, for 608 (33,9%) patients has been diagnosed pancreonecrosis. Men (73%) prevailed, the age was within the limits of from 18 till 75 years, middle age has made 46,7 years. The basic part of patients (97,3%) have acted in hospitals in a phase fermental [Cyrillic word: see text]. During till 24 o'clock from the beginning of disease 24,6% patients have acted only, at other patients terms from the beginning of disease exceeded 24 and more hours. Spent complex infusion, antifermental and antibacterial therapy. During medical-diagnostic laparoscopic spent [Cyrillic word: see text] a belly cavity, retrogastric bags and formation of holecyctostoms. At presence of purulent complications of pancreonecrosis a unconditional priority gave littletrauwm to methods of treatment (a puncture abscesses under UZ prompting, and as during retroperitoneoscopy). Duration of treatment at a simple pancreatitis has averaged 15,4 days, at pancreonecrosis 22,9, at purulent complications of a destructive pancreatitis it reached 39,8 day. Mortalyti at a sharp pancreatitis has made 2,2% (26 patients), at pancreonecrosis 9,7% (59 patients), and at purulent complications of a destructive pancreatitis 25,7% (17 patients).

[Diagnosis and surgical treatment of nonepithelial tumors of the small intestine]. / Diagnostika i khirurgicheskoe lechenie neépitelial'nykh opukholei tonkoi kishki.

The article is devoted to an analysis of 51 cases of nonepithelial formations of the small intestine. Benign tumors were diagnosed in 22 of them (leiomyomas, lipomas, fibromas). Malignant tumors were found in 29 cases (leiomyosarcomas and fibrosarcomas) The article describes the clinical picture, diagnosis and surgical treatment of nonepithelial formations of the small intestine.

[Non-epithelial tumors of gastrointestinal tract: diagnosis and surgical treatment]. / Diagnostika i khirurgicheskoe lechenie neépitelial'nykh opukholei zheludochno-kishechnogo trakta.

Non-epithelial tumors of the gastrointestinal tract (GIT) are rare diseases, their rate is less than 2.6% of all tumors of this localization. Analysis of 271 clinical cases of non-epithelial tumors demonstrated that most of them (n = 174) belonged to smooth muscle tumors. Features of growth and localization of benign and malignant non-epithelial tumors were demonstrated. It was revealed that only morphologic study (frequently with histochemical methods) verified the diagnosis of neoplasm. The choice of the scope of surgical intervention depends on the localization, spread and morphology of tumor. Difficulties of verification before surgery lead to active surgical policy for non-epithelial GIT tumors.

[Transanal intervention for malignant nonepithelial rectal tumors]. / Transanal'nye vmeshatel'stva pri zlokachestvennykh neépitelial'nykh opukholiakh priamoi kishki.

The authors have analyzed their observations of 30 patients. Nonepithelial tumors were shown to be rare. Complex employment of endoscopic and X-ray methods of examination should be used for their diagnosis and differential diagnosis. Transanal interventions are thought to be palliative and can be used in patients with a high operative rick.

[Immune disorders in congenital hydronephrosis complicated by obstructive pyelonephritis]. / Immunnye nausheniia pri vrozhdennom gidronefroze, oslozhnennom obstruktivnym pielonefritom.

Congenital hydronephrotic transformation complicated by obstructive pyelonephritis with intact renal function in children exhibited association with some antigens of the major histocompatibility system and their combinations, changes in immunity and nonspecific resistance. Marked and stable shifts in immune reactivity give grounds for inclusion of immunomodulating drugs in combined treatment of the above patients.

[Differential diagnosis and surgical treatment of colorectal nonepithelial tumors]. / Differentsial'naia diagnostika i khirurgicheskoe lechenie pri kolorektal'nykh neépitelial'nykh opukholiakh.

An analysis of results of the examination and treatment of 92 patients with nonepithelial colorectal tumors has shown that the correct diagnosis can be made in 82% of the cases on the basis of using complex X-ray, ultrasonic and endoscopic methods. Of decisive significance in determination of the tumor tissue character is the morphological investigation. Extensive surgical interventions were performed due to suspected malignization on 21 patients with benign nonepithelial tumors. In other cases (n = 49) the organ-saving operations were fulfilled. The decision between the volumes of the surgery for malignant nonepithelial tumors (n = 24) was not difficult in most cases and depended on the spread of the oncological process. The 5-year survival in this group of patients was 57%. No recurrences were noted after ablation of benign tumors.

[Changes in the enzymic activity of monooxygenase components of rat hepatocytes after administration of tilorone]. / Izmenenie fermentativnoi aktivnosti komponentov monooksigenaz gepatotsitov krys pri vvedenii tilorona.

It is established that tilorone-hydrochloride, the antiviral agent, stimulating the interferon synthesis in the organism of animals under experiment inhibits monooxygenase reactions in the albino rat hepatocytes being administered in combination with phenobarbital and 20-methylcholanthrene. The tilorone effect on the N- and O-demethylase activity of the liver microsomes in vitro was studied. It is established that the rate of dimethylaniline N-demethylation and anisole O-demethylation in this case lowers considerably, the character of the kinetic curves being unchanged.