[A retrospective cohort study of the effect of zolendronic acid on mandibular bone optical density in cancer patients]. / Issledovanie vliyaniya zolendronovoi kisloty na plotnost' nizhnei chelyusti u onkologicheskikh patsientov.

THE AIM THE STUDY: To analyze the density of the mandible in cancer patients during treatment with zoledronic acid. MATERIALS AND METHODS: A retrospective cohort study included 45 patients with cancer aged 26-81 years (average age 55±12.88 years), of whom 14 patients had bone metastases (n=14) and took 4 mg of zolendronic acid once every 28 days. The patients underwent standard PET-CT examinations in the «whole body¼ mode, and the density of the mandible was examined on CT. Radiation therapy was performed by intracavitary administration of strontium 89 chloride; remote radiation therapy with cisplatin radiomodification. In the presence of bone metastases, patients received complex supportive therapy with zolendronic acid. The effect of zolendronic acid on the density of the mandible in the frontal and lateral sections was studied by multidimensional dispersion analysis. RESULTS: Statistically significant differences (p=0.002) were revealed for density indicators according to CT scans of the mandible in the frontal region against the background of zolendronic acid therapy. We attribute the absence of statistically significant differences for the density of the mandible in the lateral sections (p=0.101 and p=0.082) against the background of zolendronic acid therapy to a measurement bias. We attribute the absence of statistically significant differences in density indices against the background of hormonal, radiation, targeted and chemotherapy to the design of the study. CONCLUSION: Density measurement based on CT examination data can be recommended for use as an additional tool in assessing the effect of zolendronic acid on the density of the mandible. However, the method of measuring the density of the mandible in the lateral sections requires improvement to prevent measurement bias.

[Undifferentiated pancreatic carcinoma with osteoclast-like giant cells]. / Nedifferentsirovannaya kartsinoma podzheludochnoi zhelezy s osteoklastopodobnymi gigantskimi kletkami.

In the structure of malignant oncological diseases of the Russian population, pancreatic cancer (PCa) occupies the 10th place with a high mortality rate in case of late diagnosis, which is primarily due to the minimal clinical manifestations of this pathology and the absence of precancer as a potential substrate for screening. Undifferentiated pancreatic carcinoma with osteoclast-like giant cell (UC-OGC) is a rare histological variant of PCa with discussed bidirectional histogenesis (epithelial and mesenchymal), epithelial-mesenchymal transition in the tumor and variable prognosis depending on the predominant cellular component. A review of the literature reflecting debatable issues of origin, clinical and pathological characteristics and prognosis of UC-OGC, as well as a description of a clinical case is relevant due to the rare occurrence of this tumor in the routine work of pathologists and oncologists.

[ALPPS in case of massive liver metastases].

It was presented the first experience of ALPPS technique using in treatment of massive liver metastases in the Urals. The technique allows to carry out surgical treatment without danger of development of post-operative liver failure. Also it permits to complete treatment during one hospitalization without stretching the therapeutic process in time.

[Immediate results of combined treatment for soft tissue sarcomas including intraoperative radiation therapy].

Nowadays the most popular and justified, from oncological positions, method of treatment for soft tissue sarcomas is a combined approach with the use of conservative surgery followed by postoperative radiation therapy. In this regard, intraoperative radiation therapy (IORT) in a single dose of 10-20 Gy is a method that optimizes the role of radiation therapy in treatment of this pathology allowing precise localization of radiation zone within the "tumor bed", thereby minimizing damage of normal tissues and critical organs. The aim of the study was to investigate the effect of IORT on the frequency and structure of post-operative complications. Testing group (n = 49) was compared to the group without IORT (n = 57) and group with only surgery (n = 171). According to the study it was not obtained statistically significant differences in the incidence of postoperative complications in the groups (p = 0,57), not marked influence on the structure of post-operative complications.

[Results of combined treatment with intraoperative radial therapy of soft tissue sarcoma].

The intraoperative radiation therapy (IORT) in combined therapy of soft tissue sarcoma in a single dose 10-20 Gy is the method, which can optimize the role of radiation therapy in treatment of this nosology. This method allows exact localization of the irradiation zone in the frames of "tumor bed", thereby minimizing the damage of normal tissues and critical organs. The aim of the study was the influence of IORT on the rate and structure of postoperative complications and long-term results of treatment in the group under study (n = 49) in comparison with the group of combined treatment without IORT (n = 57) and the group of surgical treatment. No statistically reliable difference in the rate of postoperative complications in groups (p = 0.57) was obtained and there was no influence on the structure of postoperative complications. At the same time the statistically reliable increase of general survival rates (p = 0.025) and the survival without relapse in the main group (p < 0.025) were obtained. Thus, the application of IORT in combined treatment of soft tissue sarcomas showed the satisfactory profile of "surgical safety", provided the reliable increase of general survival rates and rates without relapse.

[Preventive lymphadenectomy in complex treatment of melanoma of the skin, trunk and extremities].

Results of treatment of 90 patients with primary melanoma of the skin, trunk and extremities with stages T2-T4N0M0 were analyzed. Different strategies were used in relation to regional lymph nodes. It was found that prophylactic lymphadenectomy in terms of more than 4 weeks after excision of primary cutaneous melanoma reliably prolongs total and recurrence-free survival as compared with the method without fulfilling prophylactic lymphadenectomy. Prophylactic lymphadenectomy fulfilled in terms less than 4 weeks fails to have statistically significant influence on the results of treatment.

[Expanded D2 lymphodissection in combined treatment of gastric cancer: unification of treatment approaches].

The authors present an analysis of results of using D2 operations in combined treatment of gastric cancer. Such volumes of operations combined with preoperative irradiation are not followed by greater number of complications and lethality. The incidence of progressing in terms more than a year proved to be considerably lower in the group of patients with combined treatment with D2 lymphodissection than in the groups without lymphodissection and preoperative radiation therapy.

[Preoperative radiotherapy and extended surgical procedures for stomach cancer--assessment of safety of the combined approach].

Immediate results of D-2 surgery for stomach cancer are presented. No significanty was reported during combination therapy including preoperative gammatherapy 2) a rise in complication incidence or lethality. Hence, D-2 surgery is a safe antitumor procedure.

[Surgical complications of the combined treatment of rectum carcinoma with preoperative irradiation]. / Khirurgicheskie oslozhneniia kombinirovannogo lecheniia raka priamoi kishki s predoperatsionnym oblucheniem.

An analysis of results of treatment of 323 patients has shown that the postoperative complications and continence of feces and gases (incontinence) is not more frequent than after preoperative irradiation in total dose up to 25 Gy.

[Complications of combined therapy for stomach cancer]. / Oslozhneniia kombinirovannogo lecheniia raka zheludka.

An original classification of complications of combined treatment for gastric cancer is suggested. The results of treatment of 300 cases are evaluated. The qualitative and quantitative characteristics of complications after combined treatment differ from those of surgery alone. They are mostly transient in nature and cannot influence the strategy of therapy, nor do they contribute to a significant rise in mortality rates. According to the present results, no complications should ever justify a refusal to undertake combined treatment.

[Surgical management of acute cholecystitis in elderly and old age patients]. / Khirurgicheskaia taktika pri ostrom kholetsistite u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of treatment of 233 old and elderly patients with acute cholecystitis were analysed. In 206 from them percutaneous transhepatic drainage of the gallbladder (PTDGB) was carried out under US control with creation of temporary microcholecystostoma for elimination of acute attack of cholecystitis by decompression of the biliary system, in 2 patients laparoscopic cholecystostomy was performed, and in 27 patients with choledocholithiasis and jaundice early endoscopic papillosphincterotomy was carried out. Elimination of acute attack of cholecystitis in early terms contributed much to improvement of the patients condition, to carrying out further examination and correction of concomitant diseases. After adequate premedication 189 patients were operated on early after admission (on day 2-4). The operation of choice was cholecystectomy, in 49 patients being combined with various interventions on the choledochus. Postoperative mortality rate made up 4.2%. 44 patients were not operated because of elimination of the attack by PTDGB (17) and endoscopic papillosphincterotomy (27).