Recurrence-free Period Research Articles

Transhepatic Antegrade Gastric Variceal Sclerotherapy: Comparing Outcomes with and without Initial Efferent Vein Embolization

PurposeTo compare the efficacies of percutaneous transhepatic obliteration (PTO) with initial afferent vein embolization (PTO-A) and with initial efferent vein embolization (PTO-E) for gastric varices (GVs). Materials and MethodsConsecutive patients undergoing PTO-A or PTO-E for type 1 isolated gastric varices or type 2 gastroesophageal varices between June 2007 and February 2023 were included. PTO-A or PTO-E was indicated when balloon-occluded retrograde transvenous obliteration failed, or there was no portosystemic shunt for the retrograde transvenous approach. PTO-A was performed for patients before March 2009 and for patients with multiple efferent channels from the GVs. PTO-E was attempted for patients after April 2009. Twenty-six patients were included, of whom 18 underwent PTO-A, and 8 underwent PTO-E. In 12 patients, PTO-E was attempted without success, and they underwent PTO-A instead. The primary outcome was successful complete eradication of GVs within 1 week after the procedure. Secondary outcomes were the GV recurrence-free period and overall survival after the procedure. ResultsTechnical success was achieved in all 26 patients, with a complete GV eradication rate of 33.3% in PTO-A and 100% in PTO-E, significantly higher in PTO-E (p = 0.002). The median recurrence-free period was 8.7 months with PTO-A and 75.1 months with PTO-E; PTO-E had a significantly longer recurrence-free period (p = 0.042). Median overall survival was 37.2 months with PTO-A and 49.9 months with PTO-E, with no significant difference (p = 0.955). ConclusionPTO-E had a better complete eradication rate and longer recurrence-free period than PTO-A for GVs.

204. ALTERATIONS IN LOCAL OESOPHAGEAL MICROBIOTA AND OUTCOMES AFTER OESOPHAGECTOMY FOR OESOPHAGO-GASTRIC CANCER: A PILOT STUDY

Abstract Oesophageal cancer is a global health burden, with an estimated 600,000 new cases and 550,000 deaths per year. It is the 9th most common cancer yet is ranked fifth for cancer mortality. The current gold standard curative strategy includes oesophagectomy, which is a morbid procedure. In particular, anastomotic leaks are a feared complication postoperatively that result in significant morbidity. Studies of patients undergoing colorectal cancer surgery show that alterations in the local microbiota can contribute to complications including anastomotic leak. Furthermore, some pathogenic bacterial species have been implicated in shorter recurrence-free survival periods after curative oncologic surgery. Unlike bacterial culture, which requires viable bacteria to be preserved from the time of sampling through to processing, 16S RNA sequencing can be performed on both fresh and fixed tissues. However, there are few studies using either tissue source and to date, none that compare results from the same patient. The aims of this pilot study were to: 1. Assess the feasibility of testing archived histological specimens (i.e. formalin fixed) that in turn facilitates retrospective analysis of patients with known clinical outcomes (i.e. anastomotic leaks) 2. Identify any difference (variance, reduce or over-abundance) between the microbiota of patients who suffered anastomotic leak and those who did not 3. Generate preliminary data to inform sample sizes, statistical methods, workflow and cost of a future prospective trial Using an established Upper GI Cancer Surgery Database, we performed propensity score matching to identify 15 patients who had a clinically evident anastomotic leak to be matched with 15 patients who did not have an anastomotic leak. Known predictors of anastomotic leak (e.g. neoadjuvant radiotherapy, smoking status, COPD, chronic kidney disease, diabetes mellitus, chronic liver disease) have been controlled for. Fresh frozen and formalin-fixed samples for the same patients were available. The formalin-fixed tissue was comprised of the "anastomotic doughnuts" created at the time of the circular stapled anastomosis. This tissue was chosen because of its immediate proximity to the anastomosis. All samples were analysed using 16S RNA sequencing to obtain a full microbial profile. Sequencing data was analysed by scientific investigators blinded to the clinical outcome (i.e. anastomotic leak vs. no leak) using a pre-existing workflow and bioinformatics pipeline.

Comparative analysis of the effectiveness of antibiotic therapy and combined administration of antibiotics, lactobacilli, and proanthocyanidins for asymptomatic bacteriuria in young pregnant women: A randomized prospective study

Background. Asymptomatic bacteriuria in pregnant women is not accompanied by visible symptoms; however, it involves the risk of serious complications, including gestational pyelonephritis and/or preterm labor, thereby threatening the health of both mother and child. This condition raises particular concern in light of the growing global problem of antibiotic resistance causing traditional therapies to be less effective or futile. Therefore, a study into alternative medicine approaches to asymptomatic bacteriuria in pregnant women appears highly relevant in terms of developing new solutions for managing this condition while minimizing maternal and child health risks and preventing the spread of antibiotic resistance.Objectives. To conduct a comparative analysis of the effectiveness of antibiotic therapy and combined administration of antibiotics, lactobacilli, and proanthocyanidins for asymptomatic bacteriuria in young pregnant women.Methods. 50 pregnant women aged 15 to 17 and diagnosed with asymptomatic bacteriuria participated in a randomized prospective study. Patients were randomly divided into two groups depending on the treatment. Group 1 received standard antibiotic therapy; group 2 received a combination of antibiotics with lactobacilli and proanthocyanidins. Treatment was carried out in the Republican Clinical Perinatal Center, the Republic of Bashkortostan. Patients were enrolled in the study from February 2021 to January 2022. The observation period included several stages: 10 days after treatment (first control), 30 days after treatment (second control), and 2 months after delivery (final control). The condition of the urinary tract was assessed depending on bacterial concentration, with the diagnosis of asymptomatic bacteriuria being made in case of a 105 CFE/mL (colony forming units of bacteria per milliliter of urine). The endpoint of the study was considered to be the cure of pregnant women from asymptomatic bacteriuria, which was determined by the absence of bacteria in the urine 10 days after the therapy, as well as a recurrence-free period for two months after delivery. Statistical data processing was carried out using Statistica 10.0 (StatSoft, USA) for Windows and Microsoft Excel (Microsoft, USA). A statistical level with p ≤ 0.05 was considered significant.Results. Treatment outcomes showed a significant reduction in bacteriuria and recurrent infection, especially in the group receiving the combined therapy. No bacteriuria was reported in 36 % of patients in group 1 and 76 % in group 2 (Yates’ chi-squared test, p = 0.011). The incidence of preterm labor appeared lower in the combined therapy group (4 % for group 2 and 12 % for group 1). Complications were recorded in 11 young pregnant women of group 1 (44 %) and in 3 women of group 2 (12 %). Statistical analysis indicated significant differences between the groups in terms of complication rate after treatment (Fisher’s exact test, p = 0.015).Conclusion. Combined therapy including antibiotics, lactobacilli, and proanthocyanidins demonstrates high effectiveness as an alternative to conventional treatments of asymptomatic bacteriuria in pregnant women. Due to this approach, bacteriuria as well as recurrence rate decreases, thereby contributing to a more stable health status.

Possibilities of Postoperative Rehabilitation After Combination Resection of the Pelvis with Acetabulum and Hip Joint Endoprosthesis

The article presents a clinical case of successful surgical treatment of primary chondrosarcoma of the right ilium affecting the acetabulum and hip joint with acetabulum endoprosthesis. Rehabilitation measures aimed at restoration of the affected limb function are also described. After these measures, the patient demonstrated excellent functional results (93.3 % per the Musculoskeletal Tumor Society Score). Recurrence-free period was 49 months. In modern orthopedic oncology, many techniques of organ-preserving surgical treatment in patients with tumors of the periacetabular area with subsequent reconstruction are used but they are technically complex and carry high risks of postoperative complications. In our opinion, only combination of surgical techniques with interdisciplinary approach during perioperative rehabilitation allows to achieve good and even excellent functional results which is confirmed by the presented clinical case.

Glioma of the anterior visual pathway in children. Part II. Current treatment trends

The literature review presents modern treatment aspects for anterior optic pathway gliomas (OPGs), which are low-grade brain tumors accounting for 20%–30% of childhood gliomas, can occur anywhere along the visual pathways and in the development of the surrounding structure, and are predominantly benign. The predominant histological type of tumor in this localization is piloid astrocytoma (PA), less commonly pilomyxoid astrocytoma (PMA). However, the course of anterior OPGs is unpredictable and varies from spontaneous regression to progression with severe visual, neurological, and endocrine disorders, affecting treatment and disease prognosis. Although there have been advances in clinical studies based on histological and molecular genetic analyses, no fundamental changes in survival rates and recurrence-free periods and improvements in functional outcomes have been achieved. Furthermore, no studies have comprehensively analyzed the functional results depending on the management tactics of pediatric patients with anterior visual pathway gliomas. Anterior optic pathway glioma treatment is challenging and complex problem, which depends on the patient’s age, clinical picture, localization, surgical resectability, and histological and molecular genetic study results. It includes surgical treatment, chemotherapy, radiation therapy, the use of targeted therapy drugs, and additional advanced techniques that are still under development and research. Optimal treatment of anterior optic pathway gliomas in children remains a topic of discussion in the current literature.

Utilizing Immunoglobulin G4 Immunohistochemistry for Risk Stratification in Patients with Papillary Thyroid Carcinoma Associated with Hashimoto Thyroiditis.

Hashimoto thyroiditis (HT) is suspected to correlate with papillary thyroid carcinoma (PTC) development. While some HT cases exhibit histologic features of immunoglobulin G4 (IgG4)-related disease, the relationship of HT with PTC progression remains unestablished. This cross-sectional study included 426 adult patients with PTC (≥1 cm) undergoing thyroidectomy at an academic thyroid center. HT was identified based on its typical histologic features. IgG4 and IgG immunohistochemistry were performed. Wholeslide images of immunostained slides were digitalized. Positive plasma cells per 2 mm2 were counted using QuPath and a pre-trained deep learning model. The primary outcome was tumor structural recurrence post-surgery. Among the 426 PTC patients, 79 were diagnosed with HT. With a 40% IgG4 positive/IgG plasma cell ratio as the threshold for diagnosing IgG4-related disease, a cutoff value of >150 IgG4 positive plasma cells per 2 mm2 was established. According to this criterion, 53% (43/79) of HT patients were classified as IgG4-related. The IgG4-related HT subgroup presented a more advanced cancer stage than the IgG4-non-related HT group (P=0.038). The median observation period was 109 months (range, 6 to 142). Initial assessment revealed 43 recurrence cases. Recurrence-free survival periods showed significant (P=0.023) differences, with patients with IgG4 non-related HT showing the longest period, followed by patients without HT and those with IgG4-related HT. This study effectively stratified recurrence risk in PTC patients based on HT status and IgG4-related subtypes. These findings may contribute to better-informed treatment decisions and patient care strategies.

COMORBIDITY IN ONCOLOGY: MODERN CHALLENGES AND THE SEARCH FOR WAYS TO SOLVE THE PROBLEM

Introduction. The article is devoted to the current problem of modern oncology – increasing the treatment effectiveness of cancer patients with comorbidities. Comorbidity is accompanied by higher rates of mortality, disability, side effects of treatment, increased use of the patient's body resources, and lower quality of life. The aim of the study. To develop a method of recurrence prevention after bone lesions resection and bone replacement surgery for malignant primary bone tumors, which would ensure a longer duration of the 1st recurrence-free period in patients with comorbidities. Materials and methods. The study included a control group consisting of 27 patients who underwent bone replacement surgery after removal of primary malignant tumors of the pelvis and lower extremities. The study group included 25 patients who underwent biomin bone replacement surgery after removal of malignant primary tumors of the pelvic bones and lower limbs, as well as neuropeptide therapy with the drug dalargin. Results. The obtained data testify to the effectiveness of the proposed method of treatment with the use of dalargin: compaction of the structure of compact and spongy tissues and an increase in their heterogeneity have been established. Under the influence of dalargin, the structure of the interface, characteristic of intact bone tissue, is reorganized, accordingly, the restoration of strength is observed. 12 months after the operation, the bone density in the patients of the main group practically recovered to the values typical for the intact limb (p<0.01). No such recovery was observed in patients of the control group. Within 11 to 23 months, 10 patients of the control group had tumor recurrences. Instead, in the study group, the analysis of the results revealed the following: within 21 months, only 1 patient had a recurrence of the tumor. Conclusions. Neuropeptide Dalargin helps to increase the duration of the 1st relapse-free period in patients with primary malignant bone tumors with polymorbidity. The proposed treatment method with integration into the therapeutic protocol of the neuropeptide dalargin allows to increase the complex therapy effectiveness and improve the prognosis of the course of the disease.

Indolent triple negative breast cancer

Triple-negative breast cancer (TNBC), while not the most frequent subtype, has a surprisingly aggressive course and low sensitivity to current antitumour drugs. Detection of predictive BRCA-mutation and administration of targeted therapy in the first lines of treatment of metastatic TNRML can significantly affect the life expectancy of patients. The clinical case of patient O. with BRCA-associated bilateral metachronous metastatic breast cancer demonstrates how important it is to implement a personalised approach in time. During the patient’s treatment, it was important to constantly compare the initial morphological profile of the tumour and the clinical course of the disease in order to suspect a discrepancy and to revise the surgical material. The administration of systemic drug therapy, taking into account the genetic and immunohistochemical features of the tumour, made it possible to achieve prolonged recurrence-free periods in two consecutive lines of treatment with preservation of the patient’s decent quality of life.

Progression-free survival after first recurrence in patients with glioblastoma.

Relevance. Despite all the treatment glioblastoma recurs as an aggressive and therapy-resistant tumor, and patients quickly die from these neoplasms. The study of glioblastoma recurrence processes and search for prognostic factors of the disease should lead to the improvement of survival rates of patients with this pathology. Purpose of the study. To study the influence of clinical and molecular-genetic factors on the median second recurrence-free period. Materials and methods. Progression-free survival after first recurrence in 34 patients aged 28 to 81 years with recurrent glioblastoma was analyzed. The diagnosis was established according to the WHO 2021 classification of CNS tumors. In each observation we studied such clinical parameters as patient’s age, functional status according to the Karnovsky scale pre- and postoperatively, peculiarities of neuroimaging picture (prevalence of tumor process, localization of recurrence, tumor volume), conducted treatment and molecular-genetic characteristics of the tumor (determination of mRNA expression level of genes: MGMT, VEGF, PDGFRA, β-tubulin III, ERCC-1, TOP2A). Results. Among the clinical and demographic characteristics, the median of the survival was influenced by the patients’ age and functional status after surgery. The median of the survival was more than 2 times higher in the group of patients under 50 years old, compared to patients over 50 years old (18.5 vs 8 weeks). The dependence of the median of the survival on the post- operative functional status (according to the Karnovsky scale) was determined (p = 0.001). The median of the survival in case of a single brain lobe lesion was more than 5 times higher than in case of widespread tumor process, though without statistical reliability (p = 0.09, 21.5 vs 4 weeks). Survival rates were higher when recurrence was localized within 2 cm of the area of removal of the primary neoplasm. After disease progression, the MGMT gene lost its predictive value. Patients with low expression of the TOR2A gene had a higher survival rate than those with medium and high expression (47.5 vs 3 weeks, p = 0.001; 47.5 vs 22.5 weeks, p = 0.06). The median of survival was higher than at high levels at low and medium PDGFRA gene expression levels (29 vs 0 weeks, p = 0.04; 21 vs 0 weeks; p = 0.05, respectively). Maximum survival rates were recorded in the group of patients after total and subtotal removal of tumor recurrence (22 and 18.5 weeks, p = 0.05). Administration of second-line chemotherapy with temozolomide statistically significantly increased the median of the second BRS (p = 0.01). Conclusion. Recurrent glioblastomas are characterized by an extremely aggressive course. Therefore, such prognostic factors as patient age, degree of tumor resection, tumor process prevalence, degree of tumor resection and 2nd line chemotherapy come to the forefront. It should be noted that the MGMT gene loses its predictive value during disease progression, while the TOR2A gene and PDGFRA gene become prognostic markers.

Abstract 482: Advancing treatment for metastatic triple negative breast cancer: Liposomal oncolytic adenovirus as a novel neoadjuvant therapy

Abstract Introduction: Adenovirus type-5 (Ad) is considered a prominent viral vector in cancer therapy due to its modifiability for the selective lysis of cancer cells. However, challenges are posed in Ad delivery to cancers lacking coxsackievirus and adenovirus receptors (CARs). In response to this limitation, Ad-encapsulated DOTAP-folate liposomes were developed, which improved Ad delivery and heightened therapeutic efficacy through membrane fusion and folate receptor-mediated endocytosis. Methods: The 4T1 mammary carcinoma model, a CAR-negative triple-negative breast cancer (TNBC) cell line (ER-, PR-, HER2-), resistant to adenoviral infection, was utilized for studying the comparative in vitro transduction of green fluorescent protein (GFP)-expressing Ad (Ad-GFP). The study assessed Ad-GFP with and without DOTAP-folate liposomal encapsulation at a multiplicity of infection (MOI) of 50. Additionally, an oncolytic adenovirus, Ad-hTERT, with a human telomerase promoter, underwent liposomal encapsulation. CAR-negative 4T1 GFP-expressing cells and CAR-positive MDA-MB-231-GFP human breast adenocarcinoma TNBC cells were transduced in vitro at MOI 100 with Ad-hTERT, both with and without DOTAP-folate liposomal encapsulation. Results: CAR-negative 4T1 cells exhibited superior Ad-GFP transduction when encapsulated in DOTAP-folate liposomes, compared to the unencapsulated form (p < 0.001). For oncolytic adenovirus Ad-hTERT, encapsulation resulted in 100% cell lysis within 24 hours in 4T1-GFP cells, contrasting with 13% with unencapsulated Ad-hTERT (P < 0.0001). In CAR-positive MDA-MB-231-GFP TNBC cells, encapsulated Ad-hTERT showed enhanced efficacy, resulting in 100% cell lysis within 24 hours compared to 75% with unencapsulated Ad-hTERT (P < 0.001). Discussion: DOTAP-folate liposomal encapsulation enhances the efficacy of oncolytic Ad-hTERT in both CAR-negative and CAR-positive TNBC cells, establishing it as an optimal therapy for tumors with CAR heterogeneity. Ongoing in vivo studies with Balb/C immune-competent mice and the 4T1 tumor model will assess the effectiveness of encapsulation through intratumoral administration. This approach may extend the recurrence-free period post-surgical tumor removal. Citation Format: Jaimin R. Shah, Tao Dong, Abraham Phung, Sarah L. Blair, Omonigho Aisagbonhi, William C. Trogler, Andrew C. Kummel. Advancing treatment for metastatic triple negative breast cancer: Liposomal oncolytic adenovirus as a novel neoadjuvant therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 482.

Risk factors and treatment strategies for cholecystitis after metallic stent placement for malignant biliary obstruction: a multicenter retrospective study

Background and study aimsCholecystitis can occur after self-expandable metallic stent (SEMS) placement for malignant biliary obstructions (MBO). Furthermore, the best treatment option for cholecystitis has not been determined. Here, we aimed to identify the risk factors of cholecystitis after SEMS placement and determine the best treatment option. Patients and MethodsIncidence, treatments, and predictive factors of cholecystitis were retrospectively evaluated in 1,084 patients with distal MBO (DMBO) and 353 patients with hilar MBO (HMBO) who underwent SEMS placement at the 12 institutions from January 2012 to March 2021. ResultsCholecystitis occurred in 7.5% of patients with DMBO and 5.9% of patients with HMBO. The recurrence rate was significantly lower (p=0.043), and the recurrence-free period was significantly longer (p=0.039) in endoscopic procedures than in percutaneous procedures for cholecystitis treatment. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was better in terms of technical success, procedure time, and recurrence-free period than endoscopic transpapillary gallbladder drainage. The cases with obstruction across the cystic duct orifice by tumor (p=0.015) and those with obstruction by stent (p=0.037) were the independent risk factors for cholecystitis in DMBO. The cases with multiple SEMS placements (OR 11, 95% CI 0.68–190, p=0.091) and those with gallbladder stones (OR 2.3, 95% CI 0.92–5.6, p=0.075) had a higher risk for cholecystitis in HMBO. ConclusionsThe incidences of cholecystitis after SEMS placement for DMBO and HMBO were comparable. EUS-GBD is the optimal treatment option for patients with cholecystitis after SEMS placement for MBO.

The comparison of functional status and health-related parameters in ovarian cancer survivors with healthy controls

PurposeThe primary purpose of this study was to evaluate functional status and health-related parameters in ovarian cancer (OC) survivors and to compare these parameters with healthy controls. The secondary purpose of this study was to compare these parameters in early and advanced OC survivors.MethodsThirty-two OC survivors (n = 15 early stage; n = 17 advanced stage) with no evidence/suspicion of cancer recurrence after completing adjuvant local and systemic treatments for at least 12 months and 32 healthy controls were recruited for functional- and health-related assessments. Participants were assessed using the following methods of measuring the following: 6-min walk test (6MWT) for functional exercise capacity, 30-s chair stand test (30 s-CST) for functional fitness and muscle endurance, a handheld dynamometer for peripheral muscle strength, and a handheld dynamometer for lower extremity strength, Medical Micro RPM for respiratory muscle strength, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity level, and Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, Checklist Individual Strength (CIS) for fatigue, Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression level, and the World Health Organization-Five Well-Being Index (WHO-5) for generic quality of life.ResultsAll OC survivors underwent surgery and chemotherapy, and only 9.4% received radiotherapy in addition to chemotherapy. The median recurrence-free period post-completion of adjuvant treatments was 24.00 (12.00–75.00) months. OC survivors had lower 6MWT (m) (p < 0.001, r = 1.50), peripheral muscle strength (p = 0.005, r = 0.72), knee extension (p < 0.001, r = 1.54), and respiratory muscle strength (maximal inspiratory pressure) (p < 0.001, r = 1.90) (maximal expiratory pressure) (p < 0.001, r = 1.68) compared to healthy controls. HADS-A (p = 0.005, r = 0.75) and CIS scores (p = 0.025, r = 0.59) were also higher in the OC survivors. Early-stage OC survivors had better 6MWT (m) than advanced-stage OC survivors (p = 0.005, r = 1.83). Peripheral muscle strength was lower in advanced-stage OC survivors (p = 0.013, r = 0.92). FACT/GOG-NTX scores were higher in early-stage OC survivors (p < 0.001, r = 1.42). No significant differences were observed between early- and advanced-stage OC survivors in other measures (p < 0.05).ConclusionThe findings suggest functional status, and health-related parameters are negatively affected in OC survivors. Additionally, higher levels of fatigue, neuropathy anxiety, and depression were reported in advanced OC survivors.

Investigation of the association between the Toll-like receptor 1 rs4833095 variation and gastric adenocarcinoma recurrence.

Toll-like receptors (TLRs) are a family of transmembrane receptors that play key roles in identifying invading pathogens and activating innate immunity. TLR1 has been reported to be associated with the risk of gastric cancer (GC) but that was based on only a simple statistical analysis. We genotyped the TLR1 in 526 GC patients to investigate the association between the variation and gastric cancer survival by the multiplex polymerase chain reaction and sequencing method. The rs4833095 variation (chr4:38798089 [GRCh38. p14], T>C) in the TLR1 gene was genotyped in 526 patients who underwent GC resection. The associations between genotype, survival, and recurrence were investigated. The potential role of TLR1 in stomach cancer was investigated using clinical data from formalin-fixed, paraffin-embedded tissue samples. Patients with the T/C and C/C genotypes of rs4833095 had a lower risk of recurrence than those with the T/T genotype. Recurrence-free periods were substantially longer in patients with the T/C or C/C genotypes (22.6 and 22.3 months, respectively) than in those with the T/T genotype (20.7 months). Patients with the T/C or C/C genotype, low expression levels of VEGF1, high expression levels of ERBB2 and ERCC1, the absence of cancer nodules, a tumor size of less than 5cm, and poor differentiation had a considerably reduced risk of recurrence. TLR1 rs4833095 was correlated with the postresection prognosis of patients with gastric cancer, suggesting that TLR1 may have a role in the onset or progression of gastric cancer.

Individual approach to metastatic colorectal cancer treatment (clinical cases)

Two patients with metastatic colorectal cancer underwent R0 large bowel resection followed by surgery liver and lungs metastases, retroperitoneal lymph nodes and post-op chemotherapy. The total follow-up period of the first patient was currently 12 years, the recurrence-free period was 5 years. In the second patient, stabilization of the disease was observed for 12 years, and the total follow-up period – 18.5 years. An integrated treatment approach to metastatic CRC with active surgery for removable distant metastases or perioperative use of the most effective drug therapy for potentially resectable metastases can control the disease even with an aggressive course.

Two cases of colorectal liver metastasis with residual liver recurrence after a long recurrence-free survival period

BackgroundThe rate of residual liver recurrence after the resection of colorectal liver metastases is high, and most cases recur within 5 years of the initial hepatectomy. Here, we report two cases of residual liver recurrence after radical resection of colorectal liver metastases after a long recurrence-free survival period.Case presentationCase 1 involved a 62-year-old woman treated for ascending colon cancer in April 2011 who underwent right hepatectomy for synchronous colorectal liver metastasis in April 2012. However, in September 2021, computed tomography revealed residual recurrence in the lateral segment of the liver, and a lateral segmentectomy of the liver was performed. In Case 2, a 52-year-old man treated for cecal cancer in July 2002 underwent lateral segmentectomy of the liver for metachronous colorectal liver metastasis in October 2006. Subsequently, there was no recurrence; however, computed tomography showed residual liver recurrence in the right lobe of the liver in October 2021, and an expanded posterior hepatic segmentectomy was performed.Histopathological findings in both cases were consistent with colorectal liver metastases.ConclusionsWe encountered two cases in which residual liver recurrence was observed after a long period of recurrence-free survival. Although rare, there have been a few cases of late recurrence of liver metastases after radical resection of cancer liver metastases.

Correlation of Heavy Metal Content in the Blood of Patients with Ovarian Cancer by Place of Residence

Introduction. Malignant ovarian tumours are an urgent problem in oncology today. Ovarian cancer (OC) is in the top ten in terms of prevalence, ranking 7th, and in the top five in terms of mortality, ranking 4th. The asymptomatic course of the disease is explained by the progression of ovarian cancer mainly due to peritoneal dissemination; that is the reason why the disease is diagnosed at late stages. The prognosis of the disease depends on its stage, the degree of differentiation of the tumour, the recurrence-free period, the size of the residual tumour after surgical treatment. Taking into account the above factors, this disease is interesting for scientists in terms of finding new factors for predicting its course and trying to influence them. Purpose: increasing the effectiveness of treatment of patients with ovarian cancer by individualizing supportive therapy taking into account the level of heavy metal salts in the blood.&#x0D; Methods. The study is based on the results of observation of 127 patients with ovarian cancer of stages I-IV. The duration of recurrence-free survival was studied and evaluated depending on the place of residence of patients with ovarian cancer. Results. The analysis of the recurrence-free survival of patients by the territorial principle was carried out: higher rates of cumulative survival of patients are recorded in virtually all studied intervals in patients living in Ivano-Frankivsk and Kalush districts (where a higher content of Zn in the blood of patients is recorded). Cox regressions in correlation with Zn variables were constructed for them.&#x0D; The Cox regression was calculated in correlation with the variables of Zn in the blood of patients with OC living in the Ivano-Frankivsk and Kalush districts at minimal values of the metal content in the blood. For the Ivano-Frankivsk district, it is predicted that at the 16th month of observation, the recurrence-free survival rate will be 0%. For Kolomyia district, the projected recurrence-free survival rate is even lower, with no patients remaining at the 9th month of follow-up. The predicted recurrence-free survival in correlation with Zn variables in the blood of patients with OC living in Ivano-Frankivsk and Kalush districts at the maximum values of the metal in the blood was determined. For the Ivano-Frankivsk district, it is predicted that 97% of patients will remain under observation at month 36. For Kolomyia district, the predicted recurrence-free survival rate at the 36th month of observation is 99%. Conclusions. A correlation was found between the zinc content in the blood of patients with OC and the place of residence in Ivano-Frankivsk region; according to the analysis of the obtained data set, the strongest correlation of recurrence-free survival of patients is observed with this element. Increased levels of zinc and copper in the blood of patients resulted in a longer duration of disease-free survival, so patients from Kalush and Ivano-Frankivsk regions have a more favourable prognosis.&#x0D; For chromium and copper, the place of residence of patients doesn’t play any role.

Photodynamic interstitial stereotactic therapy for recurrent malignant glioma

Objectives Stereotactic photodynamic therapy (sPDT) using 5-aminolaevulinic acid (5-ALA) as a cytotoxic photosensitizer may be a potentially prospective treatment option for malignant gliomas. Material and Methods We analyzed data from 10 patients with recurrent malignant gliomas of the brain who were treated with sPDT at the Department of Neurosurgery of the Military-Medical Academy S. M. Kirov, from 2020 to November 2021. Three patients were treated with sPDT again after 3, 7, and 15 months due to relapse. Results The median age of the patients was 55.5 years, range was 30–60 years, there were six men and four women. At the time of sPDT, 7 (70%) patients with recurrent tumors were diagnosed with glioblastomas (WHO grade IV), and 3 (30%) with anaplastic astrocytomas (WHO grade III). Tumors were without IDH mutation in 7 (70%) patients; MGMT gene expression status was evaluated in tumors in 9 (90%) patients. A 1p/19q co-deletion was not detected in any of the patients. The median tumor volume was 5.85 cm3 (min. 3.2 cm3, max. 22.5 cm3). We have found that the median recurrence-free period after sPDT in patients with anaplastic astrocytomas and glioblastomas was 435 and 195 days, respectively. Conclusion This result allows to consider sPDT as one of the perspective methods of treatment of patients with recurrent gliomas of high malignancy in cases when repeated open surgical intervention has high risks of new neurological deficit.

Intralesional Cidofovir: A Systematic Review of Administration Protocols and Long-term Recurrence Rates in Adult and Juvenile Recurrent Respiratory Papillomatosis

This is a systematic review aimed to explore Cidofovir administration protocols, recurrence rates, and long-term effectiveness for severe cases of recurrent respiratory papillomatosis (RRP). The primary goal was to identify current practices, determine the preferred protocol, and assess the adjuvant therapy's ability to prevent long-term papilloma recurrence in juvenile and adult-onset disease. The following databases were searched: Pubmed, Google Scholar (pages 1-10), EMBASE, Scopus, ISI (clarivate), Cochrane Library, and Journal Storage from 1996 to June 2022. Articles that reported the use of intralesional Cidofovir in RRP and reported remission/recurrence rates with follow-up were included in the review. The systematic review was registered through PROSPERO and contains the detailed protocol for the conduction of the review. A total of 389 records were identified, 126 titles and abstracts screened, 45 studies fully read, and 30 studies met the inclusion criteria. Two hundred and fourteen adult-onset RRP (AORRP) and 126 juvenile-onset RRP (JORRP) cases were treated with Cidofovir across the included studies. There was no universal protocol for administering Cidofovir, with variations in concentration, treatment period, number and interval of injections, and follow-up duration. Most lesions showed human papilloma virus types 6 and 11. Recurrence rates varied, and other outcomes reported included remission rates, lesion reduction, surgical intervals, and side effects. Some studies demonstrated significant improvements in disease severity and extended intervals between recurrences after Cidofovir administration. The analysis of 30 studies reveals the need for greater consistency in reporting treatment parameters and outcomes. The use of recurrence-free period as an outcome measure and the potential benefits of a concentration of 7.5mg/mL are identified. Additionally, the importance of viral typing within papilloma lesions is emphasized. To further enhance understanding and establish optimal protocols, future research should focus on uniform reporting, including severity, dosage, interval, treatment duration, functional outcome, and related procedures. PROSPERO CRD42022299549.

Marginal calcification of thymoma: differences in the location of calcification indicate differences in the characteristics of thymomas.

Thymic epithelial tumors (TETs) are the most common tumors located in the anterior mediastinum. Calcification is sometimes observed in thymomas, especially in thymomas, and has been reported to be an indicator of the invasive behavior of thymomas. However, whether or not all calcification indicates invasive behavior is unclear. The present study therefore analyzed the location, size, and patterns of thymoma calcification and the relationships between calcification and clinicopathological factors and prognosis. We conducted a retrospective study among 77 thymoma patients who underwent surgery between January 2012 and May 2022 and analyzed the relationship between the location of calcification and clinicopathological findings. The patients were categorized into three groups: those with inner calcification of the tumor (group I), those with marginal calcification (group M), and those without any calcification (group N). Calcification was identified in 13 thymomas (16.9%) in group I (n=8) and group M (n=5). Group M included significantly more low-risk thymomas than the other groups (P=0.030). In low-risk thymomas, especially type AB thymoma, marginal calcification was observed more frequently than in other lesions. There were significant differences in age (P=0.024) and Masako-Koga stage (P=0.020) among the groups. In group I, younger patients and patients with advanced-stage disease were included. There were no significant differences in the rates of recurrence or the recurrence-free period among the groups. However, recurrence was not recognized in any members of group M. The location of calcification should be a point of focus in thymomas, and differences in the location of calcification indicate differences in the characteristics of thymomas.

Compare the impact of simultaneous integrated boost radiotherapy and conventional radiotherapy with sequential boost to early breast cancer patients

PurposeIn this study, we aimed to evaluate the toxicity and the irradiated volume of the organs at risk (OAR) of two radiotherapy (RT) techniques for breast cancer patients after breast conservative surgery (BCS) for 10 years. Methods140 patients with early breast cancer (T0∼2N0∼1M0, stage Ⅰ∼Ⅱ) participated in this study. Half of the patients received simultaneous integrated boost (SIB) and other half received conventional radiotherapy (CRT). We compared the toxic effects on cosmetic outcome (CO), volume to the OAR and recurrence-free period (RFP) between SIB and CRT. ResultsThe incidence of acute grade 1 skin toxicity (χ2 = 8.400, p = 0.040) and chronic skin reactions (χ2 = 11.020, p = 0.001) were significantly different between the two RT techniques (p < 0.05). All patients were satisfied with the CO (χ2 = 0.714, p = 0.398). There was no serious organ damage during the process of radiotherapy. There was less volume leakage to the lungs with 20Gy volume (p < 0.05). No significant difference in the volume to the lungs at 1000 cGy and heart at 1000/3000 cGy was observed between SIB and CRT (p ≥ 0.05). Patients in the SIB group were hospitalised and treated for a significantly shorter period of time than those in the CRT group (p < 0.05). All patients were alive at the last follow-up. There were no significant differences in RFP between the two techniques (p ≥ 0.05). ConclusionCompared with patients in the CRT group, the SIB group has a shorter treatment duration without increased toxicity, with advantages in terms of dose-limiting capacity and cosmetic results of treatment. The recurrence-free rate in the SIB group is satisfactory and is a recommended treatment.