Long-term Treatment Outcomes In Patients Research Articles

Long-term treatment outcomes of patients with non-clear cell renal cell carcinoma

Objective: to analyze factors affecting relapse-free and overall survival of patients with non-metastatic non-clear cell renal cell carcinoma (nccRCC) after surgical treatment.Materials and methods. This study included 279 (13.62 %) nccRCC patients from the database containing information on 2049 patients with localized and locally advanced renal cell carcinoma (RCC) without distant metastases who underwent surgical treatment in the Department of Urologic Oncology, P.A. Herzen Moscow Oncology Research Institute between 2002 and 2018. Gender ratio was 1.36:1 (161 men (57.7 %) and 118 women (42.3 %)). Median follow-up time was 34.5 months (range: 1-141 months). Patients had undergone either radical nephrectomy (n = 117; 41.9 %) or kidney resection (n = 160; 57.4 %) or radiofrequency thermal ablation (n = 2; 0.7 %). Standard (open) transperitoneal approach was used in 135 patients (48.4 %) patients, whereas 144 (51.6 %) patients were operated on via laparoscopic approach. Postoperative histological examination demonstrated that 110 participants (39.4 %) had chromophobe RCC, while 79 (28.3 %) and 63 (22.6 %) individuals had type 1 and type 2 papillary RCC, respectively. Twenty-seven patients were found to have rare or mixed variants of nccRCC (they were excluded from the analysis due to their relatively small number). Patients were diagnosed with the following stages of cancer: рТ1а (n = 129; 46.2 %), pT1b (n = 72; 25.8 %), рТ2а (n = 18; 6.5 %), pT2b (n = 8; 2.9 %), рТ3а (n = 31; 11.1 %), pT3b (n = 4; 1.4 %), рТ4 (n = 1; 0,4 %), and pN+ (n = 16; 5.7 %).Results and conclusion. 13 patients (4.7 %) were diagnosed progressive disease; 9 patients (3.2 %) died due to nccRCC progression. The highest relapse-free and overall survival rates were registered in the patients with type 1 papillary RCC and chromophobe RCC.Spearman's correlation analysis showed a significant correlation between the risk of disease progression and tumor size (R = 0.23; p <0.0001), pT stage (R = 0.24; p = 0.0001), vascular invasion (R = 0.36; p <0.0001), pN+ stage (R = 0.4; p <0.0001), surgical resection margin (R = 0.5; p <0.0001), histological variant (R = 0.14; p = 0.02), and Furman differentiation grade (R = 0.16; p = 0.02). The following factors were found to have an impact on relapse-free survival according to multivariate Cox regression: presence of necrosis (p = 0.04), pT stage (p = 0.03), and vascular invasion (p = 0.08), although the last variable failed to reach statistical significance. Cancer-specific survival was significantly affected by pT stage (p = 0.01) and Furman differentiation grade (p = 0.04). None of the factors demonstrated significant associations with overall survival. Thus, the most significant prognostic factor affecting relapse-free, overall, and cancer-specific survival in nccRCC patients was the pT stage (p <0.05).

Evaluation of the long-term treatment effects of intravenous idursulfase in patients with mucopolysaccharidosis II (MPS II) using statistical modeling: data from the Hunter Outcome Survey (HOS)

BackgroundMucopolysaccharidosis II (MPS II; Hunter syndrome) is a rare, life-limiting lysosomal storage disease caused by deficient iduronate-2-sulfatase activity. Enzyme replacement therapy (ERT) with intravenous (IV) idursulfase can stabilize or improve many somatic manifestations, but there remains a need for further analysis of long-term treatment outcomes. Using data from patients with MPS II enrolled in the Hunter Outcome Survey (HOS), mixed modeling was performed to evaluate and predict the effects of IV idursulfase treatment on selected clinical parameters for up to 8 years following treatment start. The modeling population comprised male patients followed prospectively in HOS who had received IV idursulfase for at least 5 years and who had data available for two or more time points (at least one post-ERT). Age at ERT start and time since ERT start were included as covariates.ResultsIn total, 481 patients were eligible for inclusion in at least one model. At 8 years post-ERT start, improvement from baseline was predicted for each age group (< 18 months, 18 months to < 5 years and ≥ 5 years at treatment start) in the following parameters: mean urinary glycosaminoglycan levels (percentage changes of > –75% in each group), mean left ventricular mass index (decreases of ~ 1 g/m2) and mean palpable liver size (decreases of > 2 cm). Improvements in mean 6-min walk test distance (increase of > 50 m) and stabilization in percent predicted forced vital capacity and forced expiratory volume in 1 s (decreases of ~ 4 and ~ 9 percentage points, respectively) at 8 years post-ERT start were predicted for patients aged ≥ 5 years at ERT start (these assessments are unsuitable for patients aged < 5 years). Predicted changes over time were similar across the three age groups; however, overall outcomes were most favorable in children aged < 18 months at ERT start.ConclusionsThese findings suggest that the previously reported positive effects of IV idursulfase on the somatic manifestations of MPS II are predicted to be maintained for at least 8 years following ERT initiation and highlight the value of statistical modeling to predict long-term treatment outcomes in patients with rare diseases.

Impact of radiotherapy on long-term treatment outcomes in patients with breast cancer who have undergone simultaneous one-stage and two-stage reconstructive surgeries. Literature review

The evolution in reconstructive breast surgery in the form of widespread use of implants allows you to abandon the “simple” mastectomy in most patients, provide faster rehabilitation and minimize the psychological trauma due to the absence of a breast. However, in most cases, radiation therapy and/or drug treatment are necessary, as they reduce the risk of relapse, disease progression and mortality. The combined or complex treatment increases the frequency of postoperative complications, such as prolonged wound healing, infection, protrusion/extrusion of the endoprosthesis, the development of capsular contracture, seroma, hematoma, etc. The greatest negative impact on the aesthetic result, both in the early and in the long-term period, is provided by remote radiation therapy. On the other hand, performing reconstructive plastic surgery may complicate radiation therapy. The issues of how long it is necessary to conduct radiation therapy, what type of reconstruction and how to conduct radiation therapy, how to minimize the frequency of complications without compromising the oncological and aesthetic results of treatment of breast cancer patients remain controversial.

Comparative analysis of long-term treatment outcomes in patients with locally advanced prostate cancer

Introduction. The aim of the study was to compare the survival rates of patients with prostate cancer (PC) with lymphogenic metastases (N1) after surgical treatment and after conformal distant radiation therapy followed by adjuvant hormone therapy with analogues of luteinizing-releasing hormone (LHRH).Materials and methods. The patients were divided into two groups. The first group included 36 patients with prostate cancer after posadilonic prostatectomy with extended pelvic lymphadenectomy followed by continuous adjuvant hormone therapy (analogs of LGRH) for up to two to three years. Lymphogenic metastases were detected after histological examination of the operative material. The second group consisted of 42 patients after neoadjuvant hormone therapy for 6 months (LGRH analogues), a course of distant radiation therapy (DLT) in the traditional mode with a single focal dose (ROD) of 2 Gray (Gy), a total focal dose (SOD) of 72 Gy, followed by adjuvant hormone therapy in a continuous mode (analogs of LGRH) for up to two to three years.Results. The duration of follow-up was 60 months, with a median of 38 months. The one-year survival rate after surgery was 86.1%, in the group after DLT — 81.2%, the three-year survival rate in group 1 — 80.1%, in group 2 — 76.3%, the five-year survival rates — 72.3% and 69.1% respectively. The one-year cancer-specific survival rate in group 1 was 96.7%, the three-year survival rate was 83.4%, and the five-year survival rate was 52.8%. In the second group, the oneyear survival rate was 91.9%, the three-year survival rate was 74.1%, and the five-year survival rate was 51.4%. Conclusion. For the treatment of prostate cancer patients with lymphogenic metastases, prostatectomy with extended pelvic lymphadenectomy can be considered as a treatment option not only in clinical trials. The results of cancer-specific and relapse-free survival show the effectiveness of this treatment option

Comparison of long-term surgical outcomes for scleral-fixated versus retropupillary iris-claw intraocular lens.

To compare the clinical features and long-term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral-fixated (SFIOL) versus retropupillary iris-claw IOL (RPICIOL). Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best-corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation. This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (p=0.76) or endothelial cell density (ECD) (p=0.39). Compared with the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, p=0.005) sustained to over 36 months (p=0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, p=0.027), and shorter operation times (52.7 vs. 60.9 min, p=0.015). There was no difference in ECD after 12 months (P=0.282). Over a mean follow-up duration of 33 months (152 cases >3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, p=0.006), suture exposure (7 vs. 0, p=0.045), and redislocation (17.7% vs. 10.1%, p < 0.001). Multivariable regression showed that a final BCVA below 20/40 was associated with SFIOL (P=0.007), older age (p=0.001), intraoperative complications (p=0.002), past history of vitrectomy/glaucoma surgery or uveitis (p=0.046), and surgically induced astigmatism >1D (p=0.029). RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long-term follow-up, comparing favourably against conventional SFIOL.

Voiding dysfunctions in patients with non-Hunner's ulcer interstitial cystitis/bladder pain syndrome do not affect long-term treatment outcome.

The role of urodynamic study in the diagnosis and prognostication of interstitial cystitis/bladder pain syndrome (IC/BPS) is still controversial. This study evaluated the correlation of the baseline voiding dysfunctions and long-term treatment outcome in patients with non-Hunner's ulcer IC (NHIC). A total of 211 NHIC patients were enrolled. All patients underwent videourodynamic (VUDS) examination at baseline to identify their voiding conditions and received subsequent treatments. The primary endpoint was Global Response Assessment (GRA) at the interview. Secondary endpoints included O'Leary-Sant symptom score (OSS), Visual Analogue Scale (VAS) for pain and the rate of IC symptom flare-up. The mean age was 56.8±12.8years, and mean duration of IC was 16.0±9.9years. At baseline, 83 (39.3%) patients had a voiding dysfunction and 132 (62.7%) had 1 to 3 co-morbidities. The duration, co-morbidities, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA and flare-up rate showed no significant difference among different subgroups. When we divided patients by their storage and voiding conditions, patients with non-hypersensitivity bladder (HSB) (n=32) had significantly greater MBC (P=.002) whereas those with HSB with (n=76) or without (n=103) voiding dysfunction had higher glomerulation (P=.021). When we analysed voiding dysfunction subgroups by GRA, patients with a GRA of ≥2 had a significantly shorter duration of disease (13.9±8.6years, P=.021). There were also significant associations between GRA and the changes of OSS (P<.001) and VAS (P<.001). VUDS can disclose voiding dysfunction in 39.3% of NHIC patients. With adequate therapy, the voiding dysfunctions in NHIC patients do not affect long-term treatment outcome.

Evaluation of Diffuse Type 2 Dominant or Eosinophilic Chronic Rhinosinusitis With Corticosteroid Irrigation After Surgical Neosinus Cavity Formation

Eosinophilic chronic rhinosinusitis (eCRS), contemporarily classified as diffuse type 2 dominant chronic rhinosinusitis (CRS), is characterized by eosinophil-dominant mucosal inflammation. Contemporary management of eCRS as an inflammatory airway condition is multimodal with corticosteroid irrigations after the surgical creation of a neosinus cavity. To assess long-term treatment outcomes in patients with primary diffuse type 2 CRS or eCRS receiving multimodal treatment. A prospective cohort study of patients seen in a tertiary rhinology practice recruited from May 2010 to November 2018 was conducted. Follow-up duration was 12 months or more following endoscopic sinus surgery (ESS) with a neosinus cavity formed. Data analysis was performed from August to November 2020. Consecutive adult (≥18 years) patients diagnosed with primary diffuse type 2 dominant CRS or eCRS based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 criteria were included. Type 2 inflammation was defined as more than 10 eosinophils per high-power field obtained from sinus mucosal biopsy and managed with neosinus cavity ESS and ongoing corticosteroid irrigations. Exclusion criteria were less than 12 months of follow-up and secondary CRS. Endoscopic sinus surgery with complete removal of intersinus bony partitions to create a neosinus cavity. Nasal irrigation (240 mL) with betamethasone, 1 mg, or budesonide, 1 mg, daily for 3 to 6 months after ESS and tapered to an as-needed basis (minimum, 2-3 per week). Poor control was defined as polyp recurrence (polyp growth in >1 sinus area on a single side), use of long-term systemic therapy (biologic therapy or ≥3 consecutive months of oral corticosteroids), and revision surgery involving polypectomy. The disease in patients with no poor control criteria was defined as well controlled, and the disease in those with 1 or more criteria was considered poorly controlled. Maintenance medical therapy use and patient-reported outcomes based on the 22-item Sinonasal Outcomes Test for preoperative and last follow-up were collected. Of the 222 participants recruited with primary diffuse type 2 dominant CRS or eCRS and minimum of year of follow-up, 126 were men (56.8%). Mean (SD) age was 54.8 (13.6) years, and median (SD) follow-up was 2.2 (2.2) years. Of the 222 patients, 195 (87.8%) had well-controlled disease, 16 (7.2%) had polyp recurrence, 7 (3.2%) continued to receive long-term oral corticosteroid therapy, 5 (2.3%) received biologic therapy, and 8 (3.6%) underwent a revision polypectomy. Clinically meaningful change on the 22-item Sinonasal Outcomes Test and the nasal subdomain score was maintained at the last follow-up in 134 patients (67.0%). Poor disease control was not associated with poor adherence to irrigation use. The findings of this cohort study suggest that long-term disease control and reduction in symptom burden in patients with primary diffuse type 2 CRS or eCRS might be achieved when managed as an inflammatory disorder. Maintenance corticosteroid irrigations in the population examined appeared to be successfully self-tapered to disease activity.

Long-Term Clinical Results of Use of an Anal Fistula Plug for Treatment of Low Trans-Sphincteric Anal Fistulas.

BackgroundAn anal fistula plug is a sphincter-sparing procedure that uses biological substances to close an anorectal fistula. This study aimed to evaluate the long-term therapeutic effect of an anal fistula plug procedure in patients with trans-sphincteric fistula-in-ano and to determine the risk factors affecting fistula healing.Material/MethodsA single-center retrospective study was performed assessing long-term treatment outcomes of patients with low trans-sphincteric anal fistulas who initially underwent anal fistula plug procedures between August 2008 and September 2012. Risk factors affecting fistula healing were identified using univariate and multivariate analyses.ResultsA total of 135 patients who had low trans-sphincteric anal fistulas and underwent anal fistula plug procedures were analysed. The overall healing rate was 56% (75/135) with a median follow-up time of 8 years (range, 72–121 months). The primary reasons for treatment failure were plug extrusion (n=12, 20%) and surgical site infection (n=9, 15%), occurring within 30 days after surgery. Multiple logistic regression analysis showed that the duration of anal fistula ≥6 months was significantly associated with treatment failure using an anal fistula plug (OR=3.187, 95% CI: 1.361–7.466, P=0.008). Of the patients who failed initial treatment with an anal fistula plug, 6 (9%) had anal fistulas that healed spontaneously after 2–3 years without additional treatment.ConclusionsAs a sphincter-preserving procedure, the anal fistula plug can effectively promote healing of low trans-sphincteric anal fistulas. The long-term efficacy is good and the procedure warrants wider use in clinical practice.

SURGICAL TREATMENT OF SOLITARY ADRENAL METASTASIS FROM NON-SMALL CELL LUNG CANCER

Background . Adrenal glands are the site of solitary synchronous and metachronous metastases in non-small cell lung cancer (NSCLC). The presence of solitary adrenal metastasis from lung cancer provides survival benefit; however, currently, there are no exact treatment algorithms. Objectives of the study : to assess shortand long-term treatment outcomes in patients with adrenal metastases from NSCLC. Material and methods . Treatment outcomes of patients undergoing adrenalectomy for NSCLC were analyzed. Results . From 1993 to 2014, 13 patients (11 males/2 females aged between 44 and 78, median age 58 years) with solitary adrenal metastases (adenocarcinoma (n=7), squamous cell carcinoma (n=4), large cell carcinoma (n=2); synchronous metastases – 5 cases (38.5%) and metachronous metastases – 8 cases (61.5 %), underwent adrenalectomy (one patient was given stereotactic radiation therapy for brain metastasis). Laparoscopic adrenalectomy was performed in 10 (76.9 %) cases, open adrenalectomy was performed in 3 (23.1 %) cases. The average adrenal tumor diameter was 74.6 ± 13.3 mm (25–170 mm). In the early postoperative period, two lethal outcomes were recorded. The median follow-up time after adrenalectomy was 20 months (3 to 267 months), the average follow-up time was 51.5 ± 23.5 months. The 3-year overall survival rates in patients with synchronous and metachronous metastases were 25.0 ± 2.2 % and 57.1 ± 1.9 %, respectively; however, the differences were not statistically significant (p=0.63; LogRank). The extent of surgery, morphological tumor type and status of regional lymph nodes produced no influence on the survival rate (p>0.05). Conclusion . No factors influencing survival in patients with solitary adrenal metastases from NSCLC were identified.

Human umbilical cord-derived mesenchymal stem cell therapy in patients with COVID-19: a phase 1 clinical trial

No effective drug treatments are available for coronavirus disease 2019 (COVID-19). Host-directed therapies targeting the underlying aberrant immune responses leading to pulmonary tissue damage, death, or long-term functional disability in survivors require clinical evaluation. We performed a parallel assigned controlled, non-randomized, phase 1 clinical trial to evaluate the safety of human umbilical cord-derived mesenchymal stem cells (UC-MSCs) infusions in the treatment of patients with moderate and severe COVID-19 pulmonary disease. The study enrolled 18 hospitalized patients with COVID-19 (n = 9 for each group). The treatment group received three cycles of intravenous infusion of UC-MSCs (3 × 107 cells per infusion) on days 0, 3, and 6. Both groups received standard COVID-treatment regimens. Adverse events, duration of clinical symptoms, laboratory parameters, length of hospitalization, serial chest computed tomography (CT) images, the PaO2/FiO2 ratio, dynamics of cytokines, and IgG and IgM anti-SARS-CoV-2 antibodies were analyzed. No serious UC-MSCs infusion-associated adverse events were observed. Two patients receiving UC-MSCs developed transient facial flushing and fever, and one patient developed transient hypoxia at 12 h post UC-MSCs transfusion. Mechanical ventilation was required in one patient in the treatment group compared with four in the control group. All patients recovered and were discharged. Our data show that intravenous UC-MSCs infusion in patients with moderate and severe COVID-19 is safe and well tolerated. Phase 2/3 randomized, controlled, double-blinded trials with long-term follow-up are needed to evaluate the therapeutic use of UC-MSCs to reduce deaths and improve long-term treatment outcomes in patients with serious COVID-19.

The immediate results of combined operations in patients with advanced ovarian cancer: the experience of N. N. Blokhin National Medical research Center of Oncology, Ministry of health of russia

Objective: to analyze intraoperative and postoperative complications in patients who underwent combination surgeries for advanced ovarian cancer.Materials and methods. This retrospective study included patients that underwent primary or interval cytoreductive combination surgeries for advanced (grade III–IV) ovarian cancer at N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia between 2000 and 2017.Results. We analyzed medical records of 144 patients with grade III–IV ovarian cancer who underwent combination surgery at some stage of their treatment. Almost two-thirds of patients (64.8 %) had complete or optimal volume of surgery. Intraoperative complications were registered in 7 % of patients (n = 10), while postoperative complications were observed in 38.2 % of cases (n = 55). The postoperative death rate was 0.7 % (n = 1).Conclusions. Higher frequency of complete and optimal cytoreduction, as well as acceptable level of intra- and postoperative complications confirm the need for combination surgeries in patients with advanced ovarian cancer. Aggressive surgical tactics should be used only in specialized cancer hospitals with the involvement of a multidisciplinary team that includes cancer surgeons and anesthesiologists in order to improve both short-term and long-term treatment outcomes in patients with advanced ovarian cancer.

The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks.

Although the effectiveness of lumbar medial branch radiofrequency ablation (RFA) for the treatment of zygapophyseal joint (z-joint)-mediated low back pain has been characterized, few studies have described outcomes in patients selected using a guideline-concordant paradigm of ≥80% pain relief with dual comparative medial branch blocks (MBBs). We investigated long-term treatment outcomes of patients selected according to this paradigm. Cross-sectional cohort study. The medical records of 111 consecutive patients were reviewed; 85 met inclusion criteria. A standardized telephone survey was used to capture current numerical rating scale (NRS) and Patient Global Impression of Change (PGIC) scores. The primary outcome was the proportion of patients reporting ≥50% reduction of index pain. Binary logistic regression analysis was performed to explore associations between the primary outcome and covariates, including age, duration of pain, presence of scoliosis, degenerative spondylolisthesis, and >75% disc height loss. At six to 12, 12-24, and >24 months, 63.2% (95% confidence interval [CI] = 41-85%), 65.6% (95% CI = 49-82%), and 44.1% (95% CI = 27-61%) of patients reported a ≥50% pain reduction (P = 0.170), respectively. At a minimum of six months, 70.6% of patients reported a pain reduction of two or more points (minimally clinically important change), and 54.1% reported a PGIC score consistent with "much improved" or better. Older age and a smaller Cobb angle were associated with a ≥50% pain reduction (P < 0.05). Lumbar medial branch RFA is an effective, durable treatment for a significant proportion of patients with recalcitrant lumbar z-joint pain when candidacy is determined by the guideline-concordant paradigm of ≥80% pain relief with dual comparative MBBs.

TREATMENT OUTCOMES IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA ACCORDING TO THE RUSSIAN PART OF THE EUTOS POPULATION-BASED STUDY

Background.The European Population Register EUTOS for CML includes data on adult patients (n = 2904) diagnosed with Ph-positive (Ph+) and/or BCR-ABL1-positive (BCR-ABL1+) chronic myeloid leukemia (CML) in 20 European countries during the period from 2008 to December 2012. Russia took part in this study, having contributed 6.8 % of CML patients to the total number of patients in the Register.Aim.To estimate long-term treatment outcomes in patients with newly diagnosed CML in the Russian Federation in comparison with the data obtained for a pan-European population cohort of patients.Patients and methods.The cohort under study consisted of 197 patients from 6 Russia regions, all of whom were diagnosed with a Ph+ / BCR-ABL1 + CML during the period from October, 1, 2009 to December, 31, 2012. The patients’ median age was 50 (18–82) years, with men and women being represented in approximately equal proportions.Results.In the first line, 97 % and 3 % of the patients received Imatinib and 2nd generation tyrosine kinase (TKI) inhibitors, respectively. The response dynamics was as follows: 12 months after the treatment, a complete cytogenetic response and a major molecular response were achieved in 40 % and 20 % of the patients. The overall survival (OS) and progression-free survival rates in patients in Russia following 12, 24 and 30 months were 93 %, 87 % and 84 %, and 92 %, 87 % and 87 %, respectively. In Russia, the study was prolonged. By 80 months of observation, the OS of patients in the chronic CML phase with a low and high risk of the disease progression had been 88 % and 56 %, respectively. In the acceleration phase, the 5-year overall survival rate was 39 %.Conclusion.An analysis of treatment outcomes in CML patients in a population-based non-selected sample indicates an increase in the survival of CML patients. However, problematic aspects of the therapy have been identified, along with a need for intensification of the treatment in patients with an unfavourable CML prognosis.

Long-term treatment outcomes of patients with primary optic nerve sheath meningioma treated with stereotactic radiotherapy

We analysed the long-term outcomes of patients with primary optic nerve sheath meningioma (ONSM) treated with stereotactic radiotherapy (SRT). 26 patients with primary ONSM were treated with SRT between 2004 and 2013 at a single institution. SRT was delivered with image guidance to a median dose of 50.4 Gy in 28 fractions. 4 patients had prior surgical debulking. At a median radiological follow-up of 68 months, the MRI based tumour control was 100%. Visual acuity improved in 10 (38.4%), remained stable in 10 (38.4%) and was reduced in 6 (23.1%) patients following treatment. Stable or improved vision post-treatment was seen in 92.3% of patients with good pre-treatment vision (best corrected visual acuity 6/18 or better), compared to only 61.5% of patients with poor pre-treatment vision (best corrected visual acuity 6/24 or worse). Overall, the treatment was well tolerated with no Grade 2 or greater acute toxicity. Minimal other ophthalmic complications were seen with only one patient developing late onset Grade 3 radiation retinopathy.

Effects of complete revascularization on long-term treatment outcomes in patients with multivessel coronary artery disease over 80 years of age admitted for acute coronary syndrome.

The effects of complete revascularization (CR) on long-term treatment outcomes in patients over 80 years of age with acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD) have not been sufficiently investigated. In this study, we analyzed data obtained in 305 patients over 80 years of age with MVD who were admitted in the period from January 2014 to August 2017 for ACS. The patients were divided into two groups. CR was performed in 131 patients, and 174 subjects had an intervention on the symptomatic artery only [incomplete revascularization (ICR)]. The primary endpoint was one-year occurrence of the major adverse cardiac events (MACE) including death, non-fatal myocardial infarction, stroke. We also recorded cases of repeat coronary artery intervention, major bleeding events, contrast-induced nephropathy and stent thrombosis that occurred within a period of 1 year. The MACE rate in patients undergoing CR was significantly lower during the 12-month observation period. No statistically significant differences were observed in the rates of repeat coronary artery intervention, bleeding events, contrast-induced nephropathy, and stent thrombosis. CR performed in patients over 80 years of age with ACS due to MVD decreases the incidence of MACE without increasing the risk of periprocedural complications.

A COMPREHENSIVE APPROACH TO THE MANAGEMENT OF CRITICALLY ILL

The study of long-term treatment outcomes of patients in the intensive care unit (ICU) is necessary for the rapid recovery of a critically ill patient. Training of ICU staff in basic rehabilitation techniques for early rehabilitation and resocialization of patients allows promoting improvements in postresuscitation immunosuppression, polyneuropathy, polymyopathy, and cognitive dysfunction. The introduction of rehabilitation in the ICU enables avoiding the concept of syndrome-treatment of critically ill patients, solving the problem of “a chronic ICU patient”, reducing the number of complications of the underlying disease and chronic pathologies associated with the patient's critical condition. The algorithms for the recovery of critically ill patients are proposed to be introduced from the first day of the hospitalization, when the first pathophysiological recovery patterns begin to form. The role of resocialization in the framework of this approach to the rehabilitation of critically ill patients, the “open ICU” model and deontological aspects of the communication between medical staff and an ICU patient are put forward. The prevention of delirium after cardiac arrest contributes greatly to the further prevention of post-resuscitation cognitive dysfunction, decreases depression and prevents oversedation. A new phenotype of a chronic critically ill patient, the “patient after a critical condition,” is introduced with the discussion of the pathophysiological patterns involved in its formation. The relevance of this review is confirmed by the growing interest to the integration between ICU staff and patient`s family, thus emerging the role of social aspect of the rehabilitation in critically ill patients. The novelty of this research is imposed by advanced approaches to the early rehabilitation of ICU survivors which are currently neglected from the routine ICU practice.

Long-term treatment outcomes in patients with low rectal cancer

Objective: to assess the effect of preoperative treatment option on the number of sphincter-preserving operations (SPO) in patients with low rectal cancer. Materials and methods . The patients with low rectal cancer (0—6 cm from anocutaneous line) were randomized into 3 groups: in the 1st control group surgery was performed in 0—3 days after completion of short-course radiotherapy (5 х 5 Gy). Patients in the 2nd control group received identical radiotherapy but the interval before surgery was extended to 42 ± 3 days. Patients in the study group received treatment identical to 2nd control group with 2 additional courses of monochemotherapy with capecitabine, starting on the first day of radiotherapy. The primary endpoint was the number of SPO. Complete pathomorphologic response rate, overall survival, tumor-specific survival and event-free 5-year survival were also assessed as secondary endpoints. Results. Data on 129 patients was analyzed: 46 in the 1st control group, 43 in the 2nd control group, 40 in the study group. The proportion of SPO was 41,3 ± 7,3 % in the 1st group, 69,7 ± 7,0 % and 77,5 ± 6,6 % in the 2nd group and study group, respectively. Complete histological response was achieved in 15 % of patients in study group, comparing to 14,3 % of patients in the 2nd group. Overall 5-year survival in this study was estimated to be 77,8 ± 4,5%, tumor-specific survival — 89,7 ± 3,7 %, event-free survival — 90,1 ± 2,9 %, with no significant differences between groups. Conclusion. Short-course radiotherapy (5 х 5 Gy) with 6-week interval before surgery resulted in increase of SPO rate with no affect on oncologic outcome.

Characteristics of ventricular tachycardia and long-term treatment outcome in patients with dilated cardiomyopathy complicated by lamin A/C gene mutations

BackgroundDilated cardiomyopathy caused by lamin A/C gene (LMNA) mutation is complicated with atrioventricular (AV) conduction disturbances, malignant ventricular arrhythmias, and progressive severe heart failure. Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) has been reported to be challenging due to the high recurrence rate in patients with LMNA-related cardiomyopathy. However, electrophysiological and histopathological characteristics of VT substrate remain to be fully elucidated. Methods and resultsWe experienced 6 familial patients with LMNA-related cardiomyopathy in 3 pedigrees (6 males, 43.7±4.5 [SD] years). All patients had first VT attack at 50±6.6 [SD] years of age, and 4 underwent RFCA for incessant VT. Their electrocardiograms during VT showed similar QRS morphologies, characterized by an inferior axis, SR pattern in aVR, and QS pattern in aVL, suggesting the origin of the basal anterior ventricle. Indeed, the VTs had multiple exits around the basal anterior ventricular septum in all RFCA cases. Although we performed multiple RFCA procedures including epicardial ablation and surgical cryoablation, all cases experienced VT recurrences in 4.5±6.4 [SD] months after last procedure. All patients developed end-stage heart failure with frequent VT events, and died at 59.5±3.6 years of age (severe heart failure in 5 and lung disease in 1). In three autopsy cases with RFCA, fibrofatty degeneration was noted in the AV node. In addition, in the deep basal ventricular septum, inhomogenous fibrotic degenerated tissue was noted beyond the reach of RF lesions. ConclusionsThese results demonstrate that patients with LMNA-related cardiomyopathy are characterized by VTs refractory to RFCA probably because of the deep intramural focus at the basal ventricular septum, resulting in poor prognosis with progressive severe heart failure despite all available optimized therapies. Thus, we should consider heart transplantation in their early 50s when several VT events begin to occur.

The effects of unplanned surgical intervention on the long-term treatment outcomes of patients with osteosarcoma

The effects of unplanned surgical intervention on the long-term treatment outcomes of patients with osteosarcoma

RESECTION OF TRACHEAL BIFURCATION IN TREATMENT OF NON-SMALL CELL LUNG CANCER (LITERATURE REVIEW)

Over the past few years, significant advances in surgical and anesthetic techniques as well as appropriate selection of patients have led to an improvement in the immediate and long-term treatment outcomes in patients with non-small cell lung cancer with involvement of tracheal bifurcation. In accordance with the current selection criteria, patients with contralateral lymph node metastases (lung root, aortic window, paratracheal area) require chemotherapy or chemoradiotherapy with subsequent estimation of follow-up and treatment strategy. Surgeries with resection of tracheobronchial bifurcation are considered technically complicated, and they should be performed in carefully selected lung cancer patients and only in specialized centers with extensive experience. It allows the incidence of intra-and postoperative complications to be significantly reduced.