Courses Of Polychemotherapy Research Articles

Assessment of Specific Biomarkers' Profile and Structural, Functional Parameters of the Left Ventricle in Patients With Lymphomas Undergoing Antitumor Therapy.

To evaluate the dynamics of specific biomarkers for cardiotoxicity, endothelial dysfunction, fibrosis, systemic inflammation, and morpho-functional alterations in the left ventricular (LV) myocardium in patients with newly diagnosed lymphomas during 6 courses of polychemotherapy (PCT). The study included 30 patients with newly diagnosed lymphomas. All patients were evaluated for laboratory markers of cardiotoxicity at baseline and after 6 courses of chemotherapy (6 months), including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hsTnI), endothelin-1 (ET-1), circulating cardiac biomarker ST-2, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and LV structural and functional echocardiographic (EchoCG) parameters. The changes in NT-proBNP and hsTnI concentrations during 6 courses of PCT were not statistically significant. Comparison of the baseline values with those after 6 courses of PCT showed increases in the median concentrations of ET-1 (3.38 and 5.5 pg/ml, respectively; p=0.438) and ST-2 (12.21 and 26.75 ng/ml, respectively; p=0.687). Markers of systemic inflammation were significantly decreased after 6 courses of PCT: the median CRP decreased from 15.2 to 0.72 mg/ml (p=0.006), and the median IL-6 decreased from 12.2 to 5.1 pg/ml (p=0.034). EchoCG data revealed a statistically significant impairment of the LV diastolic function parameters (E/A; E/e' lateral; E/e' average; left atrial volume index; isovolumic relaxation time). A moderate direct correlation was found between the ET-1 concentration and the isovolumic relaxation time at baseline and after 6 courses of PCT, respectively (r1 = 0.387, p=0.047 and r2 = 0.391, p=0.035). No changes in the LV systolic function were observed. The study showed that patients with lymphoproliferative diseases had no signs of cardiotoxicity during PCT according to the accepted criteria. This study described and highlighted for the first time the interrelation of endothelial dysfunction, profibrotic status, and LV diastolic dysfunction as manifestations of cardiovascular toxicity in patients with lymphoproliferative diseases. It is advisable to supplement the integrated strategies for the prevention and monitoring of PCT cardiovascular toxicity with a thorough evaluation of instrumental parameters of diastolic dysfunction for timely initiation/correction of cardioprotective therapy.

PROGNOSTIC SIGNIFICANCE OF CERTAIN GROWTH FACTORS AND THEIR RECEPTORS IN BLOOD SERUM OF PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA

The heterogeneity of diffuse large B-cell lymphoma (DLBCL) is the reason for an unfavorable response to therapy in 40 % of patients. Thus, the search for prognostic markers is relevant. Цель. Изучить содержание в сыворотке крови больных ДВКЛ некоторых факторов роста и их рецепторов для выявления прогностической значимости в течении заболевания. The aim of the study is to examine the content of some growth factors and their receptors in the blood serum of patients with DLBCL and to identify prognostic significance during the disease progression. Materials and methods. The ELISA method was used to determine the level of growth factors VEGF-A, VEGF-C, EGF, TGFβ1, IGF-I, IGF-II and their soluble receptors sVEGFR3, sEGFR, sTGFβR2 in the blood serum of patients with DLBCL after 4 courses of polychemotherapy, R-CHOP regimen. Thirty-two men and thirty-one women were enrolled in the study, average age 55.6 years. The parameters of healthy donors were considered the norm. STATISTICA 10.0 was used for data processing. Results. Before treatment, VEGF-A, IGF-I, IGF-II and TGFβ1 levels in the blood serum of all patients exceeded the norm by 2.1–4.3 times; the content of soluble receptors sEGFR and sTGFβR2 was lower by 1.4 and 3 times, respectively; EGF/ sEGFR and TGFβ1/ sTGFβR2 increased by 1.8 and 6.1 times, respectively. After 4 cycles of R-CHOP VEGF-A and sEGFR levels normalized in patients with subsequent remission; IGF-I, IGF-II, EGF/sEGFR and TGFβ1/sTGFβR2 decreased by 1.6, 1.8, 1.6 and 2.7 times, respectively, compared with the parameters before treatment; sTGFβR2 increased by 2.4 times. Normalization of indicators was not observed in patients with an unfavorable outcome. Conclusion. Minimally invasive and effective method for determining the content of certain growth factors and their receptors, in particular TGFβ1, sTGFβR2, VEGF-A, EGF, and sEGFR, in patients with DLBCL can be effective for predicting the disease progression.

Gastric carcinoma and peritoneal mesothelioma – a rare case of synchronous cancer. Clinical observation

Primary-multiple malignant neoplasms develop in about 9 % of cancer patients in the Russian Federation, while synchronous tumors are detected in a quarter of them, which dictates the need for a mandatory multidisciplinary approach to the choice of treatment. Localization of synchronous primary-multiple tumors in one anatomical zone requires a qualitative interpretation of instrumental diagnostic methods and morphological analysis after biopsy of each tumor. Along with this, there is a possibility of an erroneous opinion about the presence of different histological structures of the detected tumors and the data of visual assessment methods are interpreted in favor of a single disease.This paper presents a clinical observation of a rare combination of gastric adenocarcinoma and peritoneal mesothelioma. The case was discussed at a multidisciplinary consultation with the participation of a surgeon, a chemotherapist and a radiologist. Taking into account the clinical stage of gastric body cancer c T3N1M0, III stage, it was decided to conduct preoperative polychemotherapy at the first stage. Repeated diagnostic laparoscopy revealed no negative dynamics, multiple small dropouts in the peritoneum persisted. Subsequently, the operation was performed in the volume of gastrectomy, total parietal peritectomy and appendectomy without macroscopic signs of a residual tumor. It was decided to refrain from intra-abdominal chemoperfusion with hyperthermia due to the large volume of surgery and the previous 8 courses of polychemotherapy. Microscopic examination of the altered part of the stomach wall revealed residual adenocarcinoma (type according to Lauren – intestinal) with signs of therapeutic pathomorphosis G3 (according to Mandard), which had grown into the subserous layer and the fiber of the small omentum, with signs of perineural invasion, in the absence of vascular invasion; resection edges – R0. On the surface of the removed fragments of the peritoneum, various foci of malignant epithelioid mesothelioma were found. At the control examination a year later, according to computed tomography and esophagogastroduodenoscopy, there were no signs of progression, the patient’s condition was satisfactory.

Experience of cytokine therapy in the treatment of recurrent cervical cancer

Cervical cancer is the most common malignant tumor of the female genital organs. In general, the prognosis in patients with advanced cervical cancer is unfavorable. The option of choice for stage IV of the disease and relapses is systemic platinum-containing chemotherapy. Its effectiveness is about 20-26%, life expectancy is 12 to 13 months. Undoubtedly, the search and development of new methods of treating this disease is an extremely urgent task. Immuno-oncology has emerged as a potential new strategy to improve the treatment outcomes of patients with malignant neoplasms. Much attention in research is focused on the opportunity of using interleukin-2, tumor necrosis factor (TNF) and interferon-gamma (IFNγ) for tumor immunotherapy, since these cytokines play a special role in antitumor protection. Due to the active search for new hybrid molecules based on TNFα, some domestically developed recombinant antitumor drugs are implicated into modern practice of clinical oncologists, in particular, “Refnot” (TNFα-thymosin-α1) and “Ingaron” (IFNγ preparation). We analyzed the result of combined treatment (standard polychemotherapy at the 1st line augmented with cytokinotherapy including Refnot + Ingaron therapy) in one patient with recurrent cervical cancer. According to the control examination, upon completion of the polychemotherapy course, a complete tumor response was registered according to the Recist 1.1 criteria. The patient continued to receive cytokines as supporting therapy. Currently, according to control quarterly examinations, a complete regression of recurrent tumor persists from the end of polychemotherapy to 28 months of observation. One should note that when monitoring the state of the immune system during therapy with Refnot and Ingaron, we noted an increase in absolute and relative numbers of T cells to normal levels along with higher cytotoxic and antitumor potential of NK cells without increasing their number. The patient well tolerates the therapy, improved quality of life is documented, and there are no clinically significant side effects. Hence, the therapy with “Refnot” (TNFα-thymosin-α1) and “Ingaron” (IFNγ) in this clinical case proved to be a safe method of maintenance therapy with a positive therapeutic effect thus allowing effective control of recurrent cervical cancer for more than 2 years, as well as significantly improve quality of life of the patient. This type of therapy may be recommended for usage in clinical oncology.

Determination of the affiliation of metastases in metachronous polyneoplasias of the breast and soft tissues of the thigh

A clinical case of primary multiple metachronous malignant breast tumors and a rare malignant schwannoma of the right hip is presented. Difficulties in differential diagnosis arose with the appearance of a metastatic process in the lungs, solving the issue of their source and further treatment. In oncological practice, only morphological examination can finally verify the diagnosis. The choice of treatment regimen depends on the affiliation of metastases to a particular tumor. At the first immunohistochemical examination, tumor foci in the lung were regarded as breast cancer metastases, which it allowed to conduct 4 courses of polychemotherapy according to the TS scheme (paclitaxel + cyclophosphane) with negative dynamics. This led to doubt about the correctness of determining the source of the metastatic process. Repeated immunohistochemical examination revealed that the metastatic lesion of the lung tissue was a consequence of the progression of malignant schwannoma of the right hip. Appropriate polychemotherapy was prescribed.

Anthra­cycline-Induced Cardiotoxicity: the Role of Genetic Predictors

Aim To evaluate the predictive significance of gene polymorphism in endothelin-1 type 2A receptor, NADPH oxidase, p53 protein, endothelial nitric oxide synthase, caspase 8, interleukin-1β, tumor necrosis factor-α, superoxide dismutase-2, glutathione peroxidase-1, β1-adrenoceptor, angiotensin-converting enzyme, and matrix metalloproteinase-3 (MMP-3) genes in evaluating the risk of anthracycline-induced cardiotoxicity (AIC) in women without concurrent cardiovascular diseases (CVD).Material and methods This study included 176 women aged 45.0 [42.0; 50.0] years with breast cancer without concurrent CVD who were scheduled for polychemotherapy (PCT) with anthracycline antibiotics. Echocardiography was performed for all patients at baseline and at 12 months after the end of PCT course. Genetic polymorphism was determined with the polymerase chain reaction.Results At 12 months, all patients were in remission of the underlying disease. They were retrospectively included into 2 groups: 1st group, 52 patients with AIC and 2nd group, 124 women without AIC symptoms. The development of AIC was associated with the presence of the p53 protein gene Arg / Arg genotype (odds ratio (OR), 2.972; p=0.001), NOS3 gene T / T genotype (OR, 3.059; p=0.018), NADPH oxidase gene T / T genotype (OR, 2.753; p=0.008), GPX1 gene C / C genotype (OR, 2.345; p=0.007), MMP-3 gene 5A / 5A genotype (OR, 2.753; p=0.008), and ADRB1 gene G / G genotype (OR, 3.271; p=0.043).Conclusion Evaluation of genetic polymorphism in p53 protein (rs1042522), NOS3 (rs1799983), NADPH-oxidase (rs4673), GPX1 (rs1050450), ADRB1 (Arg389Gly, rs1801253), and MMP-3 (rs3025058) genes can be recommended for use prior to starting chemotherapy in women with breast cancer without CVD for assessing the risk of AIC. A maximum risk of cardiotoxicity is associated with the presence of the p53 protein gene Arg / Arg genotype and NOS3 gene T / T genotype.

PREDICTION AND STUDY OF THE OCCURRENCE OF CERVICAL CANCER RECURRENCE

Cervical cancer has been found to have increased morbidity and mortality in women around the world. Despite complex treatment according to stratification, the risk of relapse is observed in up to 40% of patients Purpose of the study: - Improving the result of early diagnosis of recurrence of cervical cancer stump after complex treatment, by determining the value of the immune response by immunohistochemical markers in combination with the results of complex research methods Materials and methods: - The basis of the research work was a retrospective analysis of the results of the examination and complex treatment of 87 patients with cervical cancer who were treated and treated at the Republican Specialized Scientific and Practical Center of Oncology and Radiology of Uzbekistan, as well as in its Samarkand Regional Branch from 2012 to 2017. All patients underwent complex treatment of 4 courses of polychemotherapy according to the scheme fluorouracil + cisplatin, laparotomy, extended hysterectomy according to Wertheim type and combined radiation therapy of the small pelvis according to the BOX type. All patients were divided into 2 groups. The first control group consisted of 32 (36.8%) patients with cervical cancer who underwent complex treatment in various sequences, without relapse for three years. The second group included 55 (63.2%) patients with the same diagnosis, but in whom, after complex treatment, an early relapse was detected at the preclinical stage. Results: - In the study of intense infiltrate with lymphoid follicles, it was mainly observed with the degree of tumor differentiation G-3 and G-4, which amounted to 21 (80.7%) patients in the relapse group, while in the control group in 19 (61%) which significantly higher (p≤0.05). In group 1, negative expression was noted in highly and moderately differentiated tumors 9 (29%). With low and undifferentiated tumors, moderate and high expression of VEGF (50%) was noted, with further observation in these patients, locoregional recurrence was noted. In the second group, where there was a relapse of the cervical stump by histological examination, high expression with G-4 was noted in 8 (30.7%), and with G-3 moderate expression in 6 (23%) cases. Low intensity was observed only in 1 (3.8%) G1.As can be seen in Table 4.2, negative expression during relapse, i.e. the absence of lymphoid Conclusions: - Based on our research, differences in cellular immunity play a significant role. In patients without relapses, an increased cellular density of T3DM and T20 was observed, and in patients with relapses and severe course of the disease, low lymphoid density. We should note that in our study, the strongest predictor of prognosis is the number of CD3 + cells per mm 2.

Correlation between the level of C-reactive protein and the parameters of the functional status of the left atrium in patients with lymphoproliferative diseases against the background of chemotherapy

Aim. To assess the dynamics of functional changes in the left atrium (LA) in patients with lymphoproliferative diseases (LPD) before polychemotherapy (PCT), during treatment, after 6 courses of treatment, and the frequency of supraventricular arrhythmias (SVA) as well as the level of C-reactive protein. Material and methods. This is a prospective observational study of patients with confirmed diagnosis of lymphoma (n = 30; 57% men; median age 52 [34; 65] years old), who had no prior polychemotherapy. The comparison group included persons without lymphoma (n = 30; 49% men; median age 49 [36; 65] years old) comparable to the main group in terms of sex, age and risk factors for cardiovascular diseases. Patients with lymphoma underwent 24h-ECG monitoring and advanced transthoracic echocardiography with 2D speckle-tracking at baseline, and after 3 and 6 cycles (within 3 and 6 months) of anticancer treatment. Biomarkers of inflammation were measured. The results were compared to the data of the comparison group. Results. In lymphoma patients GLS LA, LA strain reservoir, LA strain conduit, and LA strain booster pump were found to be impaired at baseline but were comparable with these in matched controls. There was a significant decrease in GLS LA (LA strain reservoir 30% [26–41] vs 17% [15–31], p = 0.015) after 6 courses of PCT. In lymphoma patients before PCT, supraventricular tachycardia (SVT) was recorded significantly more often than in patients of the comparison group: 53% (n = 16) versus 20% (n = 6), (p = 0.02). The frequency of SVT was comparable in patients with LPD before and after 6 courses of chemotherapy: 53% (n = 16) vs 47% (n = 14) (p = 0 .7). Associations between the parameters of structural and functional changes in the LA and the incidence of SVA were not identified. A close correlation was found between the level of ESR, CRP and the parameters of the functional state of the LA. There was a significant relationship of the average strength between the ESR and the number of SVE in the analysis at all control points (rxy = 0.44, p < 0.05). Conclusions. In lymphoma patients LA dysfunction occurs, which progressively worsens against the background of antitumor therapy, and is associated with the severity of systemic inflammation that may be a manifestation of the cardiotoxic effect of PCT, but additional studies are required.

Clinical case of torpid course of metastatic triple negative breast cancer

Background. Breast cancer is the most common cancer and the leading cause of cancer death in women worldwide. The presence of an unfavorable molecular biological subtype significantly worsens the prognosis, making it necessary to individualize treatment strategy for each patient.The aim of the study was to demonstrate the achievement of long-term remission in the treatment of metastatic triple-negative breast cancer. Case description. A 42-year-old patient presented to Ryazan Oncologic Dispensary in October 2006 with complaints of lump in her left breast. She was diagnosed with stage cT2N0M0 triple-negative carcinoma of the left breast. She underwent radical mastectomy for left breast cancer (October, 2006). Disease progression (metastases to lungs and mediastinal lymph nodes) occurred in June 2009. The patient received 6 courses of polychemotherapy according to the FAC regimen with a favorable response. In February 2011, the patient was found to have metastatic lesion in the brain, which was surgically removed in March, 2011. She received metronome chemotherapy. Recurrence of brain metastasis occurred 6 months after chemotherapy. The patient received external beam radiation therapy, which resulted in tumor regression, and metronomic chemotherapy was continued with a positive effect. The patient was followed up for 6 years with no evidence of disease progression. In July 2019, the follow-up examination revealed stage cT2N0M0 triple-negative cancer in the right breast. The patient underwent radical mastectomy for the right breast and 8 courses of adjuvant polychemotherapy (4 courses of AC + 4 courses of paclitaxel). The patient is alive with no signs of disease progression.Conclusion. This clinical case demonstrated personalized approach to the treatment of patients with triple-negative breast cancer. Fifteen years had passed since the detection of the primary tumor. During this time, the disease progressed three times, and breast cancer was diagnosed on the opposite side. Combined modality treatment including chemotherapy, surgery and radiotherapy allowed satisfactory results to be achieved. The patient is still alive with no signs of disease progression.

Differentiated approach in the treatment of diffuse large B-cell lymphoma according to c-MYC and BCL2 status

Background. The treatment results of patients with diffuse large B-cell lymphoma (DLBCL) with c-MYC proto-oncogene and BCL2 protein positivity according to the CHOP-21 ± R scheme remain unsatisfactory, which dictates the need to intensify the therapy regimen. Due to the fact that most authors combine DH (double hit) lymphomas and DE (double expressor) lymphomas for analysis, these data do not allow forming an accurate idea of the independent significance of the phenomenon of activated transcription factor c-MYC and BCL2 protein in patients with DLBCL and the results of treatment specifically in this group. Some researchers believe that the presence of c-MYC gene aberration and BCL2 protein expression are associated with negative clinical characteristics. Nevertheless, the clinical features of this subgroup of DLBCL remain poorly understood.The objective of the study was to analyze the incidence of c-MYC gene aberrations, BCL2 expression in DLBCL patients and to evaluate the effectiveness of intensive R + Hyper-CVAD chemotherapy regimen in this group of patients.Materials and methods. We analyzed the data of 80 patients aged 18–65 years with a newly diagnosed DLBCL for the period from 2018 to 2020. The diagnosis was established by histological and immunohistochemical examination. The tumor stages (II–IV) were assessed according to the Ann Arbor classification; the patient’s somatic status – according to the ECOG scale with a total of no more than 3 points. To detect c-MYC gene aberrations in the tumor tissue, fluorescent in situ hybridization was performed; to determine the BCL2 protein expression and Ki-67 proliferative index – an immunohistochemical study was performed. Patients with identified c-MYC gene aberrations received treatment, which included 8 courses of polychemotherapy according to the R + Hyper-CVAD scheme and high-dose chemotherapy according to the BFR scheme with autologous hematopoietic stem cell transplantation. Patients with DLBCL, in whom c-MYC gene aberration was not detected, were assigned to the group of intermediate and low malignancy. They received a polychemotherapy regimen according to the R-CHOP-21 scheme (up to 8 courses).Results and conclusion. For the first time in Kazakhstan, we studied the incidence of c-MYC proto-oncogene aberrations, BCL2 protein expression and proliferative activity (Ki-67) in DLBCL patients, which made it possible to identify groups of highly aggressive tumor and intermediate, low malignancy, apply personalized polychemotherapy programs and evaluate the immediate treatment efficacy. This approach made it possible to increase treatment effectiveness in the group of patients with highly aggressive DLBCL and to achieve comparable results with therapy in patients with a more favorable prognosis.

Studying the strength of the tibia during the replacement of a post-resection defect with a segmental allograft using locked intramedullary nailing (experimental clinical study)

Background. To achieve success in the incorporation of allografts and bone of the recipient, many factors are taken into account, which can be divided into two main groups: those related to sterilization and processing of the bone allograft and factors affecting the reliability of implant fixation in the bone of the recipient. The second important factor is the method for fixing the allografts and the bone of the recipient. The purpose was to determine the mechanical properties of bone after segmental bone alloplasty. Materials and methods. Female patient Sh., 30 years old, diagnosed with osteosarcoma of the left distal tibia T2N0M0 GIII, degree II, clinical group II, underwent polychemotherapy courses, surgical intervention according to the developed method. The tumor was removed en block, a post-resection defect was replaced with an articulating segmental bone allograft, fixed to the recipient’s bone through a stepped osteotomy and an intramedullary locked nail. Bone autografts were additionally placed into the area of the allograft contact with the recipient’s bone. After 2 years, the patient underwent surgery: amputation at the left third of the thigh. Radiographically, fusion of the allograft and the recipient’s bone was noted. An experimental study of the tensile strength of the tibia after segmental alloplasty of a post-resection defect was carried out using the developed surgical technique and a segmental allograft. Results. To compare the results of an experimental study of the tibia preparation after segmental bone alloplasty, data about the values of the ultimate strength of the bone tissue under compression and bending loads were selected. As shown by the experiment, the ultimate strength of the tibia preparation after its bone alloplasty was 51.82 MPa. This value corresponds to the minimum ultimate strength of a compact bone in bending — 51 MPa. Although this is twice as low as the maximum value of the ultimate strength of a compact bone in bending (133 MPa), it should be borne in mind that all the given reference values were obtained when testing intact preparations of a compact bone. Conclusions. The use of a segmental bone allograft to replace a post-resection defect in a long bone with its fixation to the recipient’s bone through a stepped osteotomy and locked intramedullary nailing with additional bone autoplasty in the area of the allograft contact with the recipient’s bone makes it possible to obtain in the osteotomy zone the bone, the ultimate strength of which corresponds to that of the intact tissue.

Colorectal Cancer in Patient with Functional Gastrointestinal Symptoms

Aim. A clinical observation to highlight the importance of detailed examination in patients with functional gastrointestinal symptoms.Key points. A 28-yo female patient was admitted with complains of left ileal pain, abdominal distention and up to 4-day stool delay. The complaints had long been interpreted as clinical manifestations of irritable bowel syndrome. No significant abnormalities were revealed in outpatient check-up (general and biochemical blood panels, stool test, abdominal ultrasound, oesophagogastroduodenoscopy). Colonoscopy was performed on admission, with diagnosis of rectal adenocarcinoma. The patient had a prompt surgical intervention, repeated courses of polychemotherapy and is currently followed by an oncologist and coloproctologist. No relapse signs have been reported.Conclusion. Patients with the complaints satisfying the Rome Criteria Revision IV for functional gastrointestinal diseases should have a thorough examination as per recommendations of the Russian Gastroenterological Association and Russian Association of Coloproctologists.

Результати ендопротезування суглобів при хондросаркомі кістки

У статті повідомляється про результати ендопротезування суглобів при хондросаркомі кістки. У результаті проведеного ендопротезування суглобів у 28 хворих ортопедичні ускладнення спостерігалися у 2 (7,1 %) пацієнтів та рецидиви пухлини у 2 (7,1 %) пацієнтів. Інфекційні ускладнення спостерігалися в 1 хворого, виконано видалення ендопротеза, встановлено цементний спейсер, через 6 місяців виконано реедопротезування кульшового суглоба. Асептична нестабільність ніжки ендопротеза спостерігалася в 1 пацієнта після ендопротезування колінного суглоба, виконано реендопротезування суглоба. При рецидиві хондросаркоми, який виявлено у 2 хворих в строки від 18 до 53 місяців, 1 пацієнту виконано ампутацію нижньої кінцівки на рівні середньої третини стегна, 1 пацієнту виконано ампутацію нижньої кінцівки на рівні нижньої третини стегна, у 3 хворих при дедиференційованій та мезенхімальній хондросаркомі з метастазами в легені проводились курси поліхіміотерапії з наступною метастазектомією. Функціональний результат кінцівки залежно від локалізації пухлини (за шкалою MSTS) після ендопротезування становив від 68,4 до 89,2%. Якість життя хворих за опитувальником EORTC QLQ-30 підвищилась з 40–50 балів до ендопротезування і становила в середньому 85–90 балів після ендопротезування. Загальна трирічна виживаність пацієнтів при хондросаркомі — 95,3 ± 1,7 %, п’ятирічна — 89,7 ± 2,1 %. При мезенхімальній і дедиференційованій хондросаркомі трирічна виживаність становила 0 %.

Evaluation of cardiotoxicity of chemotherapeutic treatment in breast cancer patients according to a local register

objective: assess the risk of cardiotoxicity of chemotherapy in breast cancer patients and prevention options according to the Nizhny Novgorod Local Register, as well as assess the prevalence of cardiovascular risk factors, cardiovascular status and baseline cardioprotective therapy of patients included in the register depending on the stage of chemotherapy treatment. Materials and Methods: a local retrospective-prospective register of breast cancer patients receiving polychemotherapy has been created. According to the retrospective part from November 2018 to February 2020, 150 high or very high cardiovascular risk patients with breast cancer receiving chemotherapy treatment are included in the register. Follow-up continued for 4 or 8 courses depending on the prescribed chemotherapy regimen. Cardiotoxicity of chemotherapy was assessed by echocardiography and troponin I (TnI) levels. Results: the register was dominated by patients of high (82%) and very high cardiovascular risk (18%). There were also no significant differences in therapy composition at the time patients were included in the register. After 4 courses of polychemotherapy (PCT), 28 patients (18.9%) showed objective signs of cardiotoxicity. In 22 patients (14.8%) — signs of early cardiotoxicity (18 patients — an increase in the level of TnI, 4 — the appearance of diastolic dysfunction after PCT). In 4 patients (2.7%) — the appearance of heart failure (HF) symptoms without reducing left ventricular ejection fraction (LVEF) and increasing biochemical markers. In 2 patients (1.3%), the development of symptomatic HF with low LVEF. During the follow-up in the cardiotoxicity group, cardioprotective therapy was prescribed. Against the background of the prescription of cardioprotective therapy, 16 patients (88.8%) showed normalization of the level of TnI, on average by 6 courses of PCT. Conclusions: breast cancer patients receiving polychemotherapy with anthracycline antibiotics included in the regimen have a significant risk of cardiotoxic effect, especially early biochemical cardiotoxicity. Timely prescription of cardioprotective therapy allows correcting early signs of biochemical carditoxicity and continuing chemotherapeutic treatment.

Changes in the level of cardiomarkers in the development of acute myocardial infarction on the background of chemotherapy of a patient with tongue cancer

Cancer is one of the leading causes of death and disability worldwide. Timely diagnosis and the introduction of new effective treatments, including intensive radiation and chemotherapy regimens, have significantly improved survival forecasts in recent years. At the same time, the use of these types of treatment increases the risk of complications, one of which includes chemotoxic cardiopathies. In this regard, timely detection and treatment of complications from the cardiovascular system in patients receiving chemotherapy courses in combination with surgical methods of treatment is important. This paper presents an assessment of the significance of the use of cardiomarkers in the early diagnosis of acute myocardial infarction that developed during chemotherapy in a patient with tongue cancer with a complicated cardiac history. Patient M., 45 years old, was admitted for surgical treatment for cancer of the tongue St. IVA, T4aN1M0, cl. gr. 2. Planned laboratory and instrumental studies were performed. Contraindications for surgical treatment were not identified. A preoperative course of chemotherapy was performed, against the background of which the patient's condition worsened with symptoms of acute cardiopathy. A second ECG was urgently performed, as a result of which an increase in the ST segment in III, aVF was established, as well as a study of the concentration of cardiomarkers: highly sensitive troponin I, N-terminal propeptide of natriuretic hormone, creatine phosphokinase MB, myoglobin, the dynamics of changes in the level of which indicated the development of acute coronary syndrome. The complex application of diagnostic procedures, including the determination of the level of cardiomarkers, made it possible to timely diagnose the development of acute type 1 myocardial infarction in a patient with tongue cancer on the background of chemotherapy. When analyzing the entire array of clinical and laboratory data, the leading initiating factor that played a decisive role in the development of myocardial infarction in this case was, in our opinion, a preoperative course of polychemotherapy with paclitaxel and carboplatin, which have cardiotoxicity. Thus, the category of patients with an initial unfavorable background, due to a common malignant process and the presence of a history of cardiodisfunction, requires more careful preparation for preoperative courses of polychemotherapy, including cardiotropic therapy with mandatory monitoring of the level of the main cardiomarkers. The most significant changes were in the levels of creatine phosphokinase MB, troponin I, and myoglobin, which were recorded in the first hours of myocardial infarction. An association was found between an increase in troponin I concentration and an increase in the ST segment of the electrocardiogram.

Changes in the level of cardiomarkers in the development of acute myocardial infarction on the background of chemotherapy of a patient with tongue cancer

Cancer is one of the leading causes of death and disability worldwide. Timely diagnosis and the introduction of new effective treatments, including intensive radiation and chemotherapy regimens, have significantly improved survival forecasts in recent years. At the same time, the use of these types of treatment increases the risk of complications, one of which includes chemotoxic cardiopathies. In this regard, timely detection and treatment of complications from the cardiovascular system in patients receiving chemotherapy courses in combination with surgical methods of treatment is important. This paper presents an assessment of the significance of the use of cardiomarkers in the early diagnosis of acute myocardial infarction that developed during chemotherapy in a patient with tongue cancer with a complicated cardiac history. Patient M., 45 years old, was admitted for surgical treatment for cancer of the tongue St. IVA, T4aN1M0, cl. gr. 2. Planned laboratory and instrumental studies were performed. Contraindications for surgical treatment were not identified. A preoperative course of chemotherapy was performed, against the background of which the patient's condition worsened with symptoms of acute cardiopathy. A second ECG was urgently performed, as a result of which an increase in the ST segment in III, aVF was established, as well as a study of the concentration of cardiomarkers: highly sensitive troponin I, N-terminal propeptide of natriuretic hormone, creatine phosphokinase MB, myoglobin, the dynamics of changes in the level of which indicated the development of acute coronary syndrome. The complex application of diagnostic procedures, including the determination of the level of cardiomarkers, made it possible to timely diagnose the development of acute type 1 myocardial infarction in a patient with tongue cancer on the background of chemotherapy. When analyzing the entire array of clinical and laboratory data, the leading initiating factor that played a decisive role in the development of myocardial infarction in this case was, in our opinion, a preoperative course of polychemotherapy with paclitaxel and carboplatin, which have cardiotoxicity. Thus, the category of patients with an initial unfavorable background, due to a common malignant process and the presence of a history of cardiodisfunction, requires more careful preparation for preoperative courses of polychemotherapy, including cardiotropic therapy with mandatory monitoring of the level of the main cardiomarkers. The most significant changes were in the levels of creatine phosphokinase MB, troponin I, and myoglobin, which were recorded in the first hours of myocardial infarction. An association was found between an increase in troponin I concentration and an increase in the ST segment of the electrocardiogram.

A Case of Successful Treatment of Gram-Negative Sepsis Associated with Toxic Myelosuppression in a Patient with HIV-Associated Non-Hodgkin’s Lymphoma

This article presents a clinical case of successful treatment of gram-negative sepsis in a patient with HIV-associated non-Hodgkin’s lymphoma. The patient was admitted to the intensive care unit in critical condition after the third course of polychemotherapy according to the ICE scheme. The severity of the condition was due to nosocomial pneumonia, septic shock, multiple organ failure, immunosuppression against the background of PCT and HIV infection, and the lack of specific treatment for HIV infection. Despite the absence of a positive blood culture throughout the entire treatment period, the diagnosis of sepsis was not in doubt, according to the criteria of the 2001 International Consensus Conference on Sepsis. The cause of the septic state was the combined effect of bacteria (Pseudomonas aeruginosa) and fungi (Candida albicans, Candida krusei) against the background of persistent HIV infection. The patient’s pneumonia was destructive and was twice aggravated by spontaneous pneumothorax. At the initial stage, intensive therapy led to positive dynamics. The severity of the systemic inflammatory response decreased, the acute respiratory insufficiency regressed, the X-ray pattern improved, and laboratory parameters stabilized. Despite the continued intensive therapy in the former volume on day 19, a sharply negative dynamics was noted, which led to a re-transfer of the patient to artificial ventilation of the lungs. The replacement of antibiotics and the specific treatment of HIV infection led to the patient’s recovery. In the future, chemotherapy was not carried out. Remission of the disease lasts six years.

Surgical treatment of retroperitoneal neuroblastoma in a 14-month-old child

Introduction. Neuroblastoma is the most common malignant embryonic extracranial solid tumor in childhood having a high mortality rate. While treating neuroblastoma, it is extremely important to follow international protocols with their staging systems and groups of risk. Surgical treatment is a compulsory approach, but in some cases it is extremely difficult, and it involves significant risks. However, in some cases, radical removal of the tumor can cure patients without chemotherapy.Material and methods. The article presents a clinical case of 14-month-old child with neuroblastoma of stage 3 and difficult anatomical location after 2 courses of polychemotherapy by NB-2004 protocol. The child had subradical resection of an extensive tumor in the retroperitoneal space and nephrectomy on the right. The authors also describe specific moments during surgery, problems which their faced during child’s treatment as well as follow-up examinations in the postoperative period.Results. Follow-up examinations did not reveal any signs of disease recurrence. Catamnesis lasted for 56 months. The child is in a good state; she is active, attends a nursery school.Conclusion. The discussed case demonstrates that a successful radical surgical removal of neuroblastoma of difficult anatomic location may have good outcomes without adjuvant postoperative therapy.

ВОЗМОЖНОСТИ НУТРИТИВНОЙ ПОДДЕРЖКИ ПРОБИОТИКОМ «БИОВЕСТИН» В БОРЬБЕ С ГАСТРОИНТЕСТИНАЛЬНЫМИ ОСЛОЖ-НЕНИЯМИ У ОНКОЛОГИЧЕСКИХ ПАЦИЕНТОВ В ПЕРИОД ПРОВЕДЕНИЯ ХИМИОТЕРАПИИ

The incidence of oncological pathology in Russia and throughout the world is steadily growing, and the mortality rate is not decreasing either. A large number of locally advanced and neglected cases of cancer of various location are revealed. Treatment of these forms requires polychemotherapy (PCT). The study included 52 patients with oncological pathology of various location: head and neck, stomach, large intestine, they underwent adjuvant chemotherapy according to the PF, TPF and FOLFOX regimens, which include an infusion of 5-fluorouracil for 2–5 days. The study analyzed gastrointestinal toxicity according to CTCAE, version 4.03, 2010. It was revealed that the addition of the probiotic Biovestin to meal reduces gastrointestinal toxicity by 2 times compared with the control group and reduces the risk of interruption of the PCT course by 19 % due to the development of side effects. Thus, the addition of the probiotic Biovestin has shown its effectiveness, safety and simplicity of use in the prevention of gastrointestinal disorders in cancer patients under conditions of PCT.

Osteosarcoma of III metacarpal bone in a 13-year-old girl (case report)

Osteosarcoma is the most common primary malignant neoplasm of bones in children; this tumor accounts for 50 to 80% of all skeletal sarcomas. Less often, osteosarcoma affects flat bones (scapula, ribs, bones of the skull and pelvis), bones of the foot, hand and spine.
 Description of the observation. A 13-year-old girl, 8 months before admission to the clinic, began to complain of pain in her right hand, six months later, a swelling appeared in this area. After radiography, which revealed a bone tumor of the III metacarpal bone, a trepanobiopsy with histological examination was performed. Conclusion: subperiosteal telangiectatic osteosarcoma G II. The child was admitted to the oncology department in November 2018. Before the operation, the girl underwent 4 courses of chemotherapy, as a result of which the tumor reduced in size, which made it possible to perform organ-preserving surgical treatment extirpation of the third metacarpal bone affected by the tumor, followed by autoplasty from the wing of the right iliac bone with fixation of the graft Kirschner needles. The postoperative period passed without complications. As a result of the operation, it was not only possible to radically remove the tumor, but also to preserve 3 fingers of the right (working) hand with good functionality. After surgery, the child received 5 courses of polychemotherapy and is currently in remission.
 Conclusion. The above observation demonstrates the possibility of performing organ-preserving surgeries using bone autoplasty for rare tumor lesions of the metacarpal bones. This method is more physiological in comparison with the use of allo- or artificial grafts.