[Comparative assessment of the effectiveness of treatment for patients with lung cancer].

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

[Current problems in the combined therapy of lung cancer].

The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.

[Use of laser irradiation in the treatment of facial cutaneous melanoma].

N.N.Petrov Research Institute of Oncology, St.Petersburg Radiation from a high-energy neodymium laser is an effective means of treating superficial or bulging (1-2 mm), up to 4 mm thick, stage I melanoma (grade of invasion IV--Clark).

[Current methods in the diagnosis and therapy of lung cancer]. / Sovremennye podkhody k diagnostike i lecheniiu raka lëgkogo.

A 45-year experience of diagnosis and treatment of lung cancer is presented. In groups at high risk of cancer, photoroentgenographic screening has proved effective. The use of out-patient complex pulmonologic examination serves to improve identification of central cancer. Early cancers of the lung can be reliably detected in 92.2% of patients with central cancer and in 92.6%-peripheral localizations of tumor. After radical surgery, 5-year survival in cases of stage I tumor was 63.5: stage II-43.5 and stage III-22.9%, mean 5-year survival (irrespective of stage) being 37%. Postoperative radiation was shown to be followed survival over 5 years in cases of non-small cell carcinoma (N2). Early diagnosis and combined therapy are key in raising efficacy of lung cancer treatment.

[The potentials of impulse laser radiation in treating I-stage melanomas of the skin]. / Vozmozhnosti impul'snogo lazernogo izlucheniia v lechenii melanom kozhi I stadii.

An analysis of observation of 265 patients during 1-22 years has shown that the radiation of powerful impulse lasers is an effective means of treatment of superficial and slightly risen skin melanomas of the 1st clinical stage having the I-IV level of invasion according to Clarke which are not thicker than 4,5 mm according to Breslaw.

[The surgical correction of pressure in the lesser circulation after extensive lung resections for cancer]. / Khirurgicheskaia korrektsiia davleniia v malom kruge krovoobrashcheniia posle obshirnykh rezektsii legkogo po povodu raka.

The surgical bypass of v. azygos and v. pulmonalis sup. dext. to decompress the lesser circulation after extensive resections of the lung is elaborated. The operation was performed on 21 patients for cancer of the right lung, and in one patient with bilateral disease. The shunting followed pneumonectomy in 11 cases, the lower bilobectomy in 7, the upper lobectomy in 2. In 1 patient the operation was performed after successive left-sided lower lobectomy and right-sided upper lobectomy. The shunting reduced the middle pressure in the lung artery by 13,9-21,0% of the postresection level. The bypass did not cause statistically significant decrease of the oxygenation in the arterialized capillary blood.

[Clinical diagnosis of primary melanoma of the skin]. / Klinicheskaia diagnostika pervichnykh melanom kozhi.

Procedures for early diagnosis of primary skin melanoma have been developed on the basis of the data available on 1.500 cases. Symptoms of malignant transformation of long-term pigmented nevi have been analyzed. The problems involved in screening primary skin melanoma and differential diagnosis have been studied.

[The surgical treatment of lung cancer patients with an exacerbated hereditary factor]. / Khirurgicheskoe lechenie bol'nykh rakom legkogo s otiagoshchennym nasledstvennym faktorom.

Surgical treatment of 258 patients (1st group) with carcinoma of the lung whose hereditary case history was aggravated by the presence of malignant tumors in blood relatives was compared with treatment of 861 patients of the control group (2nd group). Lung cancer patients of the 1st group were less operable than those of the 2nd group, 60.0% and 71.2% (p < 0.001) correspondingly. Resectability was 84.1% and 93.7% (p < 0.001) correspondingly. Totally in early stages (I-II stages) operations were performed only on 118 patients (45.7%) with the aggravated heredity and 536 (62.2%) of patients of the control group (p < 0.001). The symptoms which characterize surgical treatment of lung cancer in patients with the aggravated heredity are much worse as compared with the control group of patients because of the biological features of the tumors characterized by extremely high potential of the regional and remote metastases.

[Characteristics of regional metastasis of lung cancer in patients with aggravating hereditary factors]. / Osobennosti regionarnogo metastazirovaniia raka legkogo u bol'nykh s otiagoshennym nasledstvennym faktorom.

Specific features of metastatic spreading of lung cancer have been compared in 258 surgical patients from families with a history of lung cancer incidence (group I) and in 861 controls (group II). Lesions in lymph nodes at various stages were more frequent in group I, metastatic spreading incidence increasing in step with stage. In is noteworthy that more frequent lesions in mediastinal lymph nodes (stage IV) were observed in group I (54.2%), as compared with 11.8% in controls (P < 0.001). Multiple lesions of lymph nodes at all stages of metastatic spreading featured prominently in 48.5% of group I, as compared with 17.0% in group II (P < 0.001). Metastatic spreading was studied versus such characteristics of primary tumor as size, histologic pattern and pattern of tumor growth.

[Prophylactic lymph node excision in cutaneous melanomas of the lower limbs]. / Profilakticheskie limfadenéktomii pri melanomakh kozhi nizhnikh konechnostei.

An analysis of 67 cases of skin melanoma of feet and legs aggravated by the risk of regional metastatic spreading established a significant improvement in five-year survival (over 30%) in patients who had undergone prophylactic lymphadenectomy. Indications for preventive surgery are suggested and rationale of its extent is discussed.

[Lung cancer and age factor]. / Rak legkogo i vozrastnoi faktor.

The authors provide the results of examination and treatment of 920 young patients under 45 (group I) and 462 elderly patients aged 60-74 years (group II). It has been revealed that in the young patients, primarily affected were the distal, proximal, intermediate and main bronchi. In group I patients, the tumor was localized in the intermediate or in the main (extrapulmonary) bronchus (in 6.9 and 9.8% of cases, respectively). In the elderly patients, the analogous data accounted for 2.7 and 1%, respectively. The segmental bronchi were more often involved in the patients of group II (11.3%) than in those of group I (5.3% of the cases examined). Analysis of the forms of lung carcinoma shows that in group I patients, the tumor was more often located near the root. Thus, in the young patients, the nodular peribronchial and peripheral (connected with the bronchus gap) forms of growth have been recorded in 34.1 and 25% of the cases examined whereas in the elderly patients, only in 14 and 13.1% of the cases. It has been noted that group I patients mostly demonstrated poorly differentiated carcinoma (47.6%) rather than high-differentiated epidermoid cancer (35.8%). Meanwhile high-differentiated adenocarcinoma was seen only in 16.4% of the cases analyzed. In the elderly patients, the estimates were respectively 29.6, 59.0 and 11.2%. It should be emphasized that in young male patients, poorly differentiated carcinoma occurred 1.7 times more often that in group II patients (48.8 and 28.3%, respectively).

[The possibility of performing an incisional biopsy in skin melanomas during pulsed laser radiation treatment]. / O vozmozhnosti vypolneniia intsizionnoi biopsii melanom kozhi pri lechenii impul'snym lazernym izlucheniem.

A procedure for stage I skin melanoma treatment using pulsed laser radiation was developed and employed in 94 patients. At first, a delimiting barrier around tumor was formed with laser beam. It was followed by incision biopsy of melanoma under local anesthesia to morphologically assess level of invasion (after Clark) and thickness of tumor (according to Breslow). Finally, tumor was destroyed with laser beam. The observed rates of metastasis development and 5-year survival and duration of metastasis-free period suggest that the treatment did not provoke tumor dissemination. Moreover, the procedure offered certain advantages over other therapeutic modalities for skin melanoma employing pulsed laser radiation.

[RLadiolymphography with 113mIn-chloride in the diagnosis of the lymphogenic metastases of skin melanomas]. / Radiolimfografiia 113mIn-khloridom v diagnostike limfogennykh metastazov melanom kozhi.

One hundred and thirty indirect lymphoscintigraphies (74 lower and 56 upper ones) using 113mIn-chloride were performed in 121 cases of skin melanoma. Metastatic involvement of lymph nodes was characterized by either increased or decreased accumulation of the radionuclide. The overall accuracy of the procedure was 0.85 for the inguinal, 0.82--iliac and 0.75--for the axillary lymph nodes.

[Characteristics of the metastasis of lung cancer in young patients]. / Kharakteristika metastazirovaniia raka legkogo u bol'nykh molodogo vozrasta.

Based on an investigation of micropreparations of resected lungs, findings of test thoracotomies and autopsies the authors have studied regularities of regional lung cancer metastazing in 275 patients of young age. It was shown that the intensity of regional metastazing is higher in young patients with lung cancer than in elderly patients, it grows with low-differentiated forms of tumor, nodular-peribronchial form of growth and increases in parallel with the growing size of the tumor node.

[Diagnosis of central cancer of the lungs]. / O diagnostike tsentra'lnogo raka legkogo.

Data on 396 patients with central cancer of the lung admitted to the thoracal department of the Petrov Research Institute of Oncology and the City Oncological Dispensary in 1985-1986 are presented. In 94 of them (23.7%) the disease was diagnosed by prophylactic roentgenofluorography, in 302 (76.3%)--in consultation with a doctor. Operability of the patients of the first group was somewhat higher than in those of the second group. During the two years under analysis the roentgenofluorography detected central cancer of the lung in 266 patients (11%). Radical operations were performed in 48 patients (18%), while in patients consulted by doctors after the appearance of clinical symptoms of the disease, resectability made up 13.3%. Main efforts should be directed to the active detection of central cancer of the lung in patients who addressed the polyclinic for lung symptoms.

[Evaluation of the efficacy of intensive preoperative irradiation of patients with lung cancer]. / Otsenka éffektivnosti intensivnogo predoperatsionnogo oblucheniia bol'nykh rakom legkogo.

The study discusses the results of treatment in 118 radically operated lung cancer patients: surgery alone--66 and combined therapy including preoperative irradiation (4 Gy for 5 successive days, total focal dose--20 Gy)--52 cases. Radiation treatment did not significantly affect the patient's general condition, nor did it interfere with surgical procedure, increase operative blood loss or postoperative lethality. However, the postoperative complication rate was higher in the radiotherapy group (51.9 +/- 6.9%) than in the surgery alone group (39.4 +/- 6.0%) mainly due to increased incidence of cardiovascular disorders in patient older than 55 years of age suffering heart pathology. Radiation treatment assured a higher 5-year survival rate (32.0 +/- 9.2% as compared to 14.2 +/- 5.7%) in squamous-cell lung cancer. The beneficial effect of irradiation was most apparent in cases of central squamous-cell lung cancer with intact regional lymph nodes.

[Evaluation of diagnosis and treatment of various clinico-anatomical forms of lung cancer]. / Otsenka diagnostiki i lecheniia razlichnykh kliniko-anatomicheskikh form raka legkogo.

Among 3898 cases of primary lung cancer registered in Leningrad within 1985-1986, central cancer clearly predominated (61.9%). Central/peripheral cancer ratio was 1.6:1. The most common procedure used for treatment of central lung cancer was pneumonectomy (74.6% of cases) and lobectomy--for peripheral cancer management (85.7%). Significant differences in approach to diagnosis and surgical treatment of these pathologies were established. It seems unfeasible to increase resectability of central lung carcinoma by extending surgery. Such tumors should be diagnosed at the stage of segment involvement. However, prophylactic photo-roentgenography does not assure early detection of central lung cancer. Organization of lung cancer detection in Leningrad needs to be improved.