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Proton beam therapy in repeat irradiation of recurrent head and neck tumors: analysis of short-term results 质子束治疗复发性头颈部肿瘤重复照射的近期效果分析
Pub Date : 2023-03-09 DOI: 10.17650/2222-1468-2022-12-4-39-47
D. Smyk, I. Gulidov, K. Gordon, D. Gogolin, S. S. Dyuzhenko, A. V. Semenov
Introduction. Recurrence of head and neck tumors occurs in 50 % of cases and usually has locoregional character. Due to the characteristics of dose distribution, proton beam therapy is a promising treatment option for patients with recurrences of tumors in this location who previously underwent radiation therapy.Aim. To evaluate the effectiveness and tolerability of repeat irradiation using active scanning proton beam therapy in patients with recurrent head and neck tumors who previously underwent radiation therapy.Materials and methods. Between November of 2015 and December of 2020, 40 patients with locoregional recurrence of head and neck tumors underwent treatment using active scanning proton beam therapy at the A. F . Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center. Median cumulative dose of primary irradiation was 64.5 Gy. Median time between primary and repeat irradiation was 35.7 months, mean irradiated volume of the repeat course was 94.5 cm3. Proton beam therapy was performed using standard mode (2 isoGy) and accelerated hypofractionation (2.4 isoGy / 3 isoGy) with mean equivalent cumulative dose of 56.4 Gy (α / β = 10). Radiation toxicity was evaluated using the Radiation Therapy Oncology Group European (RTOG) / Organization for Research and Treatment of Cancer (EORTC) scale.Results. Treatment response was achieved in 34 (85 %) patients: in 17 (42.5 %) patients, stable disease was observed; in 10 (25 %) patients, partial response was observed; and in 7 (17.5 %) patients, complete response was observed. In 6 (15 %) cases, disease progression was diagnosed at first follow-up examination. One- and two-year locoregional control, progression-free survival and overall survival were 58.4 / 19.8; 44.5 / 19.8 and 82.3 / 38.8 % respectively with median follow-up duration of 14.2 months. Median survival was 19.5 months. Grade III and above early radiation toxicity was observed in 3 (7.5 %) patients. In total, 6 (15 %) cases of grade III complications and 2 (5 %) episodes of carotid artery rupture leading to death were observed. Overall frequency of complications of grade III and higher was 20 %.Conclusion. Repeat irradiation using proton beam therapy can be considered an effective and safe treatment method for patients with recurrent head and neck tumors. Dosimetric and radiobiological benefits of proton beams allow to achieve balance between high doses and radiation exposure in previously irradiated tissues.
介绍。头颈部肿瘤的复发率为50%,通常具有局部性。由于剂量分布的特点,质子束治疗是一种很有前途的治疗选择肿瘤复发的这一部位,以前接受过放疗。评价主动扫描质子束治疗头颈部肿瘤复发患者放射治疗的有效性和耐受性。材料和方法。2015年11月至2020年12月,40例头颈部肿瘤局部复发患者在a - F接受了主动扫描质子束治疗。医学放射研究中心-国家医学放射研究中心的分支机构。初次照射的中位累积剂量为64.5 Gy。第一次和重复放疗的中位时间为35.7个月,重复疗程的平均放疗体积为94.5 cm3。采用标准模式(2 isoGy)和加速减分(2.4 isoGy / 3 isoGy)进行质子束治疗,平均等效累积剂量为56.4 Gy (α / β = 10)。放射毒性采用欧洲肿瘤放射治疗组织(RTOG) /癌症研究与治疗组织(EORTC)标准进行评估。34例(85%)患者获得治疗缓解,17例(42.5%)患者病情稳定;在10例(25%)患者中观察到部分缓解;7例(17.5%)患者完全缓解。在6例(15%)病例中,疾病进展在第一次随访检查中被诊断出来。1年和2年局部区域对照、无进展生存期和总生存期分别为58.4 / 19.8;分别为44.5 / 19.8%和82.3 / 38.8%,中位随访时间14.2个月。中位生存期为19.5个月。3例(7.5%)患者出现III级及以上早期放射毒性。总共观察到6例(15%)III级并发症和2例(5%)颈动脉破裂导致死亡。III级及以上并发症的总发生率为20%。使用质子束重复照射治疗头颈部肿瘤复发是一种安全有效的治疗方法。质子束的剂量学和放射生物学益处允许在高剂量和先前照射组织的辐射暴露之间实现平衡。
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引用次数: 0
Experience of using a supraclavicular flap in reconstruction of oral cavity defects 锁骨上皮瓣修复口腔缺损的体会
Pub Date : 2023-03-09 DOI: 10.17650/2222-1468-2022-12-4-48-54
M. T. Berdigylyjov, I. Zaderenko, M. Kropotov, S. Aliyeva, D. Stelmakh, V. Z. Dobrokhotova, G. S. Berdigylyjova
Introduction. In case of cancer of the oral mucosa at the first stage, the standard treatment approach is radical surgical intervention, with the formation of extensive defects leading to aesthetic and functional disorders. Taking into account the characteristics of defects, choosing a flap is a difficult task. Currently, there is a wide selection of regional and microvascular free flaps. However, not all flaps meet the requirements. The supraclavicular fasciocutaneous flap, being a regional flap, has a number of advantages: easy to harvest, reliable due to the constancy of the vascular pedicle, primary closure of the donor site, scarcity of hair, the possibility of closing various defects of the oral cavity. Aim. To evaluate the possibility of using a supraclavicular flap in patients with oral cancer to restore the defects after surgical treatment.Materials and methods. The study included 10 patients with malignant tumors of the oral cavity who underwent surgical intervention with defect replacement using supraclavicular flap at the N. N. Blokhin National Medical Research Center of Oncology between February of 2015 and May of 2021. In 4 cases, buccal mucosa was affected; in 3 cases, the retromolar area; in 1 case, oral floor mucosa; in 1 case, mandibular alveolar ridge; in 1 case, mobile tongue. Flap sizes were 5–10 × 5–8 cm. Three (3) patients had history of radiotherapy, and 1 of them had a radical dose.Results. In 4 patients without previous radiotherapy, partial flap necrosis was observed. In 1 patient, sutural diastasis in the oral cavity after partial flap necrosis was diagnosed. There were no cases of total flap necrosis and fistula formation. Suture dehiscence in the donor bed was observed in 1 patient only.Conclusion. Use of supraclavicular flap is an option for oral cavity defect replacement after surgical intervention in patients with malignant tumors of the oral cavity producing satisfactory esthetic and functional results. The advantages of this flap are simple flap dissection, reliability of vascular pedicle, flexibility, possibility of replacing large defects, scant hair coverage.
介绍。对于口腔粘膜癌的第一阶段,标准的治疗方法是根治性手术干预,形成广泛的缺陷,导致审美和功能障碍。考虑到缺陷的特点,选择皮瓣是一项困难的任务。目前,有广泛的选择区域和微血管自由皮瓣。然而,并不是所有的襟翼都符合要求。锁骨上筋膜皮瓣作为一种区域性皮瓣,具有许多优点:易于收获,由于血管蒂的稳定性而可靠,可初步封闭供区,毛发稀少,可封闭口腔各种缺损。的目标。目的探讨口腔癌术后应用锁骨上皮瓣修复口腔癌缺损的可能性。材料和方法。该研究包括2015年2月至2021年5月在N. N. Blokhin国家肿瘤医学研究中心接受锁骨上皮瓣缺损置换手术干预的10例口腔恶性肿瘤患者。4例口腔黏膜受损;3例为磨牙后区;口腔底黏膜1例;1例下颌牙槽嵴;1例为活动舌。皮瓣大小为5-10 × 5-8 cm。3例患者有放疗史,其中1例有根治剂量。4例未接受放疗的患者皮瓣部分坏死。1例患者在部分皮瓣坏死后被诊断为口腔缝合线转移。无皮瓣全坏死及瘘管形成病例。供体床缝线断裂仅1例。锁骨上皮瓣是口腔恶性肿瘤患者术后口腔缺损修复的一种选择,可获得满意的美观和功能效果。该皮瓣的优点是皮瓣剥离简单,血管蒂可靠,柔韧性强,可替代大面积缺损,毛发覆盖少。
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引用次数: 0
Methylation of the tumor associated genes in head and neck squamous cell carcinoma 头颈部鳞状细胞癌中肿瘤相关基因的甲基化
Pub Date : 2023-03-09 DOI: 10.17650/2222-1468-2022-12-4-61-70
S. V. Kurevlev, L. Tskhovrebova, A. Aghajanyan, T. Fatkhudinov, K. Gordon, M. Azova
Introduction. Head and neck cancer is a heterogenous group of malignant tumors of different etiologies, molecular mechanisms of which are still insufficiently studied.Aim. Investigation of DNA methylation status of some tumor associated genes (RASSF1A, RASSF2, RASSF5, CDO1, MEST and WIF1) in patients with head and neck squamous cell carcinoma.Materials and methods. The DNA methylation level of normal and tumor tissues was analyzed using bisulfite conversion and methylation-sensitive high-resolution melting in 25 patients (21 men and 4 women) diagnosed with neck squamous cell carcinoma.Results. There were significant differences in levels of DNA methylation between tumor and normal tissues in the CDO1 and WIF1 genes in all groups and subgroups of patients (larynx and other cancers, squamous cell carcinoma keratinizing and non-keratinizing, primary and recurrent tumor, smokers and non-smokers). The methylation level in the CDO1 gene in tumor tissue was significantly increased in the T4 and T3 stage subgroups compared to T2.Conclusion. The increased level of methylation of the CDO1 and WIF1 genes, as well as changes in their expression are among the molecular mechanisms involved in the neck squamous cell carcinoma development. They can be considered as prognostic and diagnostic markers for this pathology.
介绍。头颈部肿瘤是一种异质性的恶性肿瘤,其病因不同,分子机制研究尚不充分。头颈部鳞状细胞癌患者肿瘤相关基因(RASSF1A、RASSF2、RASSF5、CDO1、MEST和WIF1) DNA甲基化状态的研究材料和方法。采用亚硫酸氢盐转化和甲基化敏感高分辨率熔解法分析了25例(男21例,女4例)颈部鳞状细胞癌患者正常组织和肿瘤组织的DNA甲基化水平。在所有组和亚组患者(喉癌和其他癌症、鳞状细胞癌角化和非角化、原发性和复发性肿瘤、吸烟者和非吸烟者)中,肿瘤组织中CDO1和WIF1基因的DNA甲基化水平与正常组织存在显著差异。肿瘤组织中CDO1基因甲基化水平在T4期和T3期亚组较t2期显著升高。CDO1和WIF1基因甲基化水平的升高及其表达的变化是参与颈部鳞状细胞癌发展的分子机制之一。它们可以被认为是这种病理的预后和诊断标记。
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引用次数: 0
Central airway stenting in oncology 肿瘤中心气道支架植入术
Pub Date : 2023-03-09 DOI: 10.17650/2222-1468-2022-12-4-55-60
M. A. Krylovetskaya, M. Makarova, I. Komarov, O. Malikhova, L. V. Cherkes
Introduction. Malignant central airway obstruction and malignant tracheoesophageal fistula in the context of tumor development are potentially life-threatening conditions which usually require immediate intervention. Airway stenting is one of the safest and most effective methods of airway patency restoration in patients with malignant obstruction of the central airways and restoration of continuity in patients with malignant tracheoesophageal fistula.Aim. To evaluate the significance of self-expandable metal stents in palliative treatment of patients with malignant central airway obstruction and malignant tracheoesophageal fistula.Materials and methods. Between 2017 and 2021 at the N. N. Blokhin National Medical Research Center of Oncology, 55 patients were observed and treated and underwent trachea stenting per the results of bronchoscopy in combination with esophagogastroduodenoscopy. The 1st group included 25 patients with malignant tracheoesophageal fistulas, the 2nd group included 30 patients with malignant central airway obstruction.Results. In the 1st group, stenting was successful in 25 (100 %) cases which allowed to adequately seal the fistula. Stent migration was observed in 1 (4 %) patient with tracheoesophageal fistula in the context of stenosing cancer of the thoracic esophagus. In the 2nd group, stenting was successful in 30 (100 %) cases. Stent migration was not observed in this patient group. In both groups, there were no complications after stent implantation. Installation of tracheal stent allowed to improve patients’ quality of life and provide a possibility for successful special treatment through low-trauma manipulation.Conclusion. According to the obtained data, endoscopic trachea stenting is the most important method of palliative treatment of tumor-related trachea lesions with development of tracheoesophageal fistulas, malignant central airway obstructions and associated sub- and decompensated pulmonary insufficiency.
介绍。恶性中央气道阻塞和恶性气管食管瘘在肿瘤发展的背景下是潜在的危及生命的条件,通常需要立即干预。气道支架置入术是恢复中央气道恶性梗阻患者气道通畅和恢复恶性气管食管瘘患者气道连续性最安全、最有效的方法之一。目的探讨自膨胀金属支架在恶性中央气道梗阻及恶性气管食管瘘患者姑息治疗中的意义。材料和方法。2017年至2021年,N. N. Blokhin国家肿瘤医学研究中心根据支气管镜联合食管胃十二指肠镜检查结果对55例患者进行了观察和治疗,并接受了气管支架置入。第一组25例恶性气管食管瘘,第二组30例恶性中央气道梗阻。在第一组中,25例(100%)支架置入术成功,充分封闭了瘘管。在1例(4%)胸段食管癌狭窄性气管食管瘘患者中观察到支架移位。第二组30例(100%)支架置入术成功。该患者组未观察到支架移位。两组患者支架植入术后均无并发症发生。气管支架的安装提高了患者的生活质量,为低创伤操作的特殊治疗提供了成功的可能性。根据所获得的资料,内镜下气管支架置入术是肿瘤相关气管病变伴气管食管瘘、恶性中央气道梗阻及相关亚代偿性和失代偿性肺功能不全的最重要姑息治疗方法。
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引用次数: 1
Distant metastasis of alveolar rhabdomyosarcoma with pancreatic parameningeal localization in children: clinical case series 儿童肺泡横纹肌肉瘤远端转移伴胰膜旁定位:临床病例系列
Pub Date : 2023-03-09 DOI: 10.17650/2222-1468-2022-12-4-91-101
A. Rodina, V. Polyakov, T. Gorbunova, O. Merkulov, A. L. Kashanina, A. Odzharova, A. Stroganova
Rhabdomyosarcoma is a malignant neoplasm that develops from embryonic mesenchymal cells, with an annual incidence of 4.3 cases per 1,000,000 children. The prevalence of the tumor process is estimated on the basis of data from a comprehensive examination, including magnetic resonance imaging with intravenous contrast, ultrasound examination of the primary focus of regional and distant metastasis zones, computed tomography and radioisotope studies. The overall 5-year survival rate for localized rhabdomyosarcoma reaches 70 %. During the initial diagnosis, distant metastasis to the lungs, bones, and bone marrow is detected, which significantly worsens the prognosis in 20–25 % of patients. The factors of an extremely unfavorable prognosis for the course of alveolar rhabdomyosarcoma are the occurrence of regional and distant metastases before the start of specific treatment, dissemination of the tumor lesion during treatment, and the presence of translocation of the 13q14 sector. Publications contain data on a high (11.2 %) prevalence of metastases of alveolar rhabdomyosarcoma in the pancreas. In the presence of metastatic lesions of the pancreas, surgical treatment is effective only in combination with chemoradiotherapy. Long-term results of treatment of this cohort of children are unsatisfactory due to the high risk of recurrence and dissemination of the tumor.Aim. To study risk factors, evaluate methods and prospects for the treatment of children with metastatic pancreatic lesions in parameningeal alveolar rhabdomyosarcoma. The article considers three clinical cases of such a lesion. We would like to draw the attention of pediatric oncologists and radiologists to the possible association of metastases in the pancreas in children with localization of rhabdomyosarcoma in the head and neck region, which requires improvement of examination protocols in this group of patients.
横纹肌肉瘤是一种由胚胎间充质细胞发展而来的恶性肿瘤,每年的发病率为每100万儿童4.3例。肿瘤进程的患病率是根据综合检查的数据来估计的,包括静脉造影的磁共振成像,局部和远处转移区主要病灶的超声检查,计算机断层扫描和放射性同位素研究。局部横纹肌肉瘤的总体5年生存率达到70%。在最初的诊断中,可以检测到远处转移到肺部、骨骼和骨髓,这明显恶化了20 - 25%的患者的预后。肺泡横纹肌肉瘤的预后非常不利的因素是在特异性治疗开始前发生区域和远处转移,治疗过程中肿瘤病变的播散,以及13q14区易位的存在。出版物包含胰腺肺泡横纹肌肉瘤(alveolar rhabdomyosarcoma)转移率高(11.2%)的数据。在胰腺转移性病变的情况下,手术治疗只有在联合放化疗的情况下才有效。由于肿瘤复发和扩散的高风险,这组儿童的长期治疗结果令人不满意。目的:探讨儿童脑膜旁肺泡横纹肌肉瘤转移性胰腺病变的危险因素、治疗方法及前景。本文考虑了三个这种病变的临床病例。我们希望引起儿科肿瘤学家和放射科医生的注意,儿童胰腺转移与头颈部横纹肌肉瘤定位的可能关联,这需要改进这组患者的检查方案。
{"title":"Distant metastasis of alveolar rhabdomyosarcoma with pancreatic parameningeal localization in children: clinical case series","authors":"A. Rodina, V. Polyakov, T. Gorbunova, O. Merkulov, A. L. Kashanina, A. Odzharova, A. Stroganova","doi":"10.17650/2222-1468-2022-12-4-91-101","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-4-91-101","url":null,"abstract":"Rhabdomyosarcoma is a malignant neoplasm that develops from embryonic mesenchymal cells, with an annual incidence of 4.3 cases per 1,000,000 children. The prevalence of the tumor process is estimated on the basis of data from a comprehensive examination, including magnetic resonance imaging with intravenous contrast, ultrasound examination of the primary focus of regional and distant metastasis zones, computed tomography and radioisotope studies. The overall 5-year survival rate for localized rhabdomyosarcoma reaches 70 %. During the initial diagnosis, distant metastasis to the lungs, bones, and bone marrow is detected, which significantly worsens the prognosis in 20–25 % of patients. The factors of an extremely unfavorable prognosis for the course of alveolar rhabdomyosarcoma are the occurrence of regional and distant metastases before the start of specific treatment, dissemination of the tumor lesion during treatment, and the presence of translocation of the 13q14 sector. Publications contain data on a high (11.2 %) prevalence of metastases of alveolar rhabdomyosarcoma in the pancreas. In the presence of metastatic lesions of the pancreas, surgical treatment is effective only in combination with chemoradiotherapy. Long-term results of treatment of this cohort of children are unsatisfactory due to the high risk of recurrence and dissemination of the tumor.Aim. To study risk factors, evaluate methods and prospects for the treatment of children with metastatic pancreatic lesions in parameningeal alveolar rhabdomyosarcoma. The article considers three clinical cases of such a lesion. We would like to draw the attention of pediatric oncologists and radiologists to the possible association of metastases in the pancreas in children with localization of rhabdomyosarcoma in the head and neck region, which requires improvement of examination protocols in this group of patients.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85766897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Results of complex treatment of patients with locally advanced squamous cell carcinoma of the paranasal sinuses and nasal cavity using induction chemotherapy 诱导化疗综合治疗局部晚期鼻窦及鼻腔鳞状细胞癌的结果
Pub Date : 2023-03-08 DOI: 10.17650/2222-1468-2022-12-4-10-16
T.  . Dеshkina, L. Bolotina, A. Gevorkov, A. Boyko, A. Kornietskaya, A. Polyakov, P. Golubev, R.  S. Sydykova, A. Fedenko
Introduction. About 600 new cases of malignant neoplasms of the paranasal sinuses and nasal cavity are detected annually in Russia. To date, there are no randomized trials to determine the optimal treatment algorithm for this group of patients. Data on the use of induction chemotherapy in squamous cell carcinoma of sino-nasal tract are limited to a small series of clinical observations and, often, are retrospective in nature.Aim. Evaluation of the effectiveness of induction chemotherapy in patients with locally advanced squamous cell carcinoma of the paranasal sinuses and nasal cavity.Materials and methods. Since 2012, 22 patients with locally advanced cancer of the paranasal sinuses and nasal cavity have been treated in our center, who underwent 3-component induction chemotherapy according to the TPF protocol. Evaluation of the effectiveness of treatment was carried out according to the criteria of Response evaluation criteria in solid tumors 1.1 (RECIST 1.1). Patients with a decrease in the tumor size by 30 % or more, were followed by radiation therapy in doses of 66–70 Gy. Patients with a residual tumor underwent surgery after the end of chemoradiotherapy.Results. In 21 patients available for analysis, overall response rate after induction chemotherapy was 71 %: complete response was registered in 3 (14 %) patients, partial response in 12 (57 %), stable disease in 4 (19 %). Progression disease after 3 courses of induction chemotherapy was detected in 2 (10 %) patients.Conclusions. Thus, induction chemotherapy in patients with squamous cell carcinoma of sino-nasal tractseems to be a promising direction for investigation, that can significantly improve the long-term results of treatment of this category of patients and help to avoid of disabling surgery in some of them.
介绍。在俄罗斯,每年约有600例新的副鼻窦和鼻腔恶性肿瘤被发现。到目前为止,还没有随机试验来确定这组患者的最佳治疗算法。诱导化疗用于鼻道鳞状细胞癌的数据仅限于一小部分临床观察,而且通常是回顾性的。鼻窦及鼻腔局部晚期鳞状细胞癌诱导化疗的疗效评价。材料和方法。2012年以来,我中心共收治了22例局部中晚期鼻窦、鼻腔癌患者,均按照TPF方案进行了三组份诱导化疗。根据实体瘤应答评价标准1.1 (RECIST 1.1)进行疗效评价。肿瘤缩小30%或更多的患者随后接受66-70 Gy剂量的放射治疗。放化疗结束后,残余肿瘤患者行手术治疗。在21例可用于分析的患者中,诱导化疗后的总缓解率为71%:完全缓解3例(14%),部分缓解12例(57%),病情稳定4例(19%)。2例(10%)患者在诱导化疗3个疗程后出现疾病进展。因此,诱导化疗在鼻鼻道鳞状细胞癌患者中的应用似乎是一个很有前景的研究方向,可以显著提高该类患者的远期治疗效果,并有助于避免部分患者的致残性手术。
{"title":"Results of complex treatment of patients with locally advanced squamous cell carcinoma of the paranasal sinuses and nasal cavity using induction chemotherapy","authors":"T.  . Dеshkina, L. Bolotina, A. Gevorkov, A. Boyko, A. Kornietskaya, A. Polyakov, P. Golubev, R.  S. Sydykova, A. Fedenko","doi":"10.17650/2222-1468-2022-12-4-10-16","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-4-10-16","url":null,"abstract":"Introduction. About 600 new cases of malignant neoplasms of the paranasal sinuses and nasal cavity are detected annually in Russia. To date, there are no randomized trials to determine the optimal treatment algorithm for this group of patients. Data on the use of induction chemotherapy in squamous cell carcinoma of sino-nasal tract are limited to a small series of clinical observations and, often, are retrospective in nature.Aim. Evaluation of the effectiveness of induction chemotherapy in patients with locally advanced squamous cell carcinoma of the paranasal sinuses and nasal cavity.Materials and methods. Since 2012, 22 patients with locally advanced cancer of the paranasal sinuses and nasal cavity have been treated in our center, who underwent 3-component induction chemotherapy according to the TPF protocol. Evaluation of the effectiveness of treatment was carried out according to the criteria of Response evaluation criteria in solid tumors 1.1 (RECIST 1.1). Patients with a decrease in the tumor size by 30 % or more, were followed by radiation therapy in doses of 66–70 Gy. Patients with a residual tumor underwent surgery after the end of chemoradiotherapy.Results. In 21 patients available for analysis, overall response rate after induction chemotherapy was 71 %: complete response was registered in 3 (14 %) patients, partial response in 12 (57 %), stable disease in 4 (19 %). Progression disease after 3 courses of induction chemotherapy was detected in 2 (10 %) patients.Conclusions. Thus, induction chemotherapy in patients with squamous cell carcinoma of sino-nasal tractseems to be a promising direction for investigation, that can significantly improve the long-term results of treatment of this category of patients and help to avoid of disabling surgery in some of them.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85562220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of transoral and combined approach for surgical treatment of moderately advanced tongue and floor of the mouth cancer 经口入路与联合入路治疗中晚期舌底癌的比较
Pub Date : 2023-03-08 DOI: 10.17650/2222-1468-2022-12-4-25-32
A. Karpenko, R. Sibgatullin, A. A. Boyko, O. M. Nikolayeva
Introduction. Surgical approach for oral cancer treatment is one of the key factors that determines oncologic effectiveness, risk of postoperative complications, need for reconstructive methods etc. Currently, there exists lack of strict criteria for using one or another approaches based on the sound scientific evidence for a primary tumor of given depth of invasion.Aim. The aim of the study is a retrospective comparative analysis of oncologic efficiency of transoral and combined approaches for surgical treatment of tongue and floor of the mouth moderately advanced carcinoma.Materials and methods. 75 patients aged between 30 and 80 years with tongue and floor of the mouth squamous cell carcinoma with depth of invasion from 10 to 20 mm were included into the study. In 29 cases the tumor was resected transorally (Group 1), in 45 – via combined approach (Group 2). Group 2 patients had more advanced tumors both locally and regionally. 13 patients of Group 1 and 27 patients of Group 2 underwent adjuvant radiotherapy. The following parameters were used for comparative analysis: the rate of local and regional recurrence, locoregional control, the rate of distant metastasis and Kaplan–Meyer overall survival.Results. Mean follow up was 33.77 ± 27.72 months (range 14–115 months). The rate of local and regional recurrence was higher in Group 2 (20 % vs 10.3 % and 22.2 % vs 17.2 % respectively). Locoregional control was better in Group 1 (72.4 % vs 62.2 %). The difference for neither of the above-mentioned parameters did not reach statistical significance. Median survival was statistically significantly better in Group 1: 66 ± 17.42 months vs 23 ± 3.85 months (p = 0.030). Poorer treatment results in Group 2 can be explained by a higher proportion of patients with more advanced tumors in this group.Conclusion. The results of the present study do not allow to conclude that combined approach has oncologic advantage over less aggressive transoral approach for tumors with depth of invasion from 10 to 20 mm. It is questionable to recommend the combined approach as a universal one for lesions with such a stage of local invasiveness.
介绍。口腔癌的手术入路是决定肿瘤疗效、术后并发症风险、重建方法需要等的关键因素之一。目前,对于侵袭深度确定的原发肿瘤,缺乏基于可靠科学证据的严格标准。本研究的目的是回顾性比较分析经口入路与联合入路在中晚期舌底癌手术治疗中的肿瘤疗效。材料和方法。75例年龄在30 - 80岁之间的舌底鳞状细胞癌患者,浸润深度为10 - 20mm。经口入路29例(组1),联合入路45例(组2)。组2患者局部和局部肿瘤进展更严重。1组13例,2组27例进行辅助放疗。采用局部和局部复发率、局部区域控制率、远处转移率和Kaplan-Meyer总生存率进行比较分析。平均随访时间为33.77±27.72个月(14 ~ 115个月)。组2的局部复发率和局部复发率均高于组2(分别为20%比10.3%和22.2%比17.2%)。组1的局部控制性较好(72.4% vs 62.2%)。上述参数的差异均未达到统计学意义。组1的中位生存期为66±17.42个月比23±3.85个月,差异有统计学意义(p = 0.030)。第2组治疗效果较差的原因可能是该组肿瘤晚期患者比例较高。目前的研究结果并不能得出结论,对于侵袭深度为10 - 20mm的肿瘤,联合入路比侵袭性较小的经口入路具有肿瘤学优势。推荐联合入路作为一个普遍的病变与这种阶段的局部侵袭是值得怀疑的。
{"title":"Comparison of transoral and combined approach for surgical treatment of moderately advanced tongue and floor of the mouth cancer","authors":"A. Karpenko, R. Sibgatullin, A. A. Boyko, O. M. Nikolayeva","doi":"10.17650/2222-1468-2022-12-4-25-32","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-4-25-32","url":null,"abstract":"Introduction. Surgical approach for oral cancer treatment is one of the key factors that determines oncologic effectiveness, risk of postoperative complications, need for reconstructive methods etc. Currently, there exists lack of strict criteria for using one or another approaches based on the sound scientific evidence for a primary tumor of given depth of invasion.Aim. The aim of the study is a retrospective comparative analysis of oncologic efficiency of transoral and combined approaches for surgical treatment of tongue and floor of the mouth moderately advanced carcinoma.Materials and methods. 75 patients aged between 30 and 80 years with tongue and floor of the mouth squamous cell carcinoma with depth of invasion from 10 to 20 mm were included into the study. In 29 cases the tumor was resected transorally (Group 1), in 45 – via combined approach (Group 2). Group 2 patients had more advanced tumors both locally and regionally. 13 patients of Group 1 and 27 patients of Group 2 underwent adjuvant radiotherapy. The following parameters were used for comparative analysis: the rate of local and regional recurrence, locoregional control, the rate of distant metastasis and Kaplan–Meyer overall survival.Results. Mean follow up was 33.77 ± 27.72 months (range 14–115 months). The rate of local and regional recurrence was higher in Group 2 (20 % vs 10.3 % and 22.2 % vs 17.2 % respectively). Locoregional control was better in Group 1 (72.4 % vs 62.2 %). The difference for neither of the above-mentioned parameters did not reach statistical significance. Median survival was statistically significantly better in Group 1: 66 ± 17.42 months vs 23 ± 3.85 months (p = 0.030). Poorer treatment results in Group 2 can be explained by a higher proportion of patients with more advanced tumors in this group.Conclusion. The results of the present study do not allow to conclude that combined approach has oncologic advantage over less aggressive transoral approach for tumors with depth of invasion from 10 to 20 mm. It is questionable to recommend the combined approach as a universal one for lesions with such a stage of local invasiveness.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88943370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Results of treatment of patients with poorly differentiated carcinoma of the thyroid gland 甲状腺低分化癌患者的治疗结果
Pub Date : 2023-03-08 DOI: 10.17650/2222-1468-2022-12-4-17-24
P. Isaev, V. Polkin, N. Severskaya, A. Ilyin, A. K. Plugar, S. A. Ivanov, A. Kaprin
Introduction. Poorly differentiated carcinoma of the thyroid gland (PDTC) is characterised by aggressive, high rate of tumor growth, massive infiltration, early lymphogenous and hematogenous dissemination. Ways to improve treatment outcomes include developing individual treatment programmes. Given the unsatisfactory results of the treatment, the search for combined treatment options is well founded.Materials and methods. An analysis was made of the treatment of PDTC in patients from May 2014 to July 2021. The study included 24 patients aged 22 to 81 years (9 (37.5 %) men and 15 (62.5 %) women). Surgical treatment was performed in 14 (58.3 %) cases. In 8 (33.3 %) cases, a course of radioiodine therapy with a total dose of 3–4 Gbq was performed in the postoperative period. Seven (29.2 %) patients underwent external beam radiation therapy. In 2 (8.3 %) cases, chemotherapy with carboplatin was performed simultaneously with external beam radiation therapy. Four (16.7 %) patients were prescribed lenvatinib. For one reason or another, 9 (37.5 %) patients did not receive treatment.Results. For patients not treated, the overall survival rate was 5.8 ± 0.5 months, for patients treated – 9.6 ± 1.0 months (p <0.00095). According to the index Lenvatinib showed a significant increase in the general group of patients – up to 15 months.Conclusion. Combined treatment in the form of a combination of surgical, radiation and chemotherapeutic methods at PDTC, allows to achieve much higher survival. In order to achieve longer-term stabilization, further research is needed on new ways to enhance the anti-tumor effect of modern drugs.
介绍。甲状腺低分化癌(PDTC)的特点是侵袭性强,肿瘤生长速度快,大量浸润,早期淋巴和血液播散。改善治疗结果的方法包括制定个人治疗方案。鉴于治疗结果不令人满意,寻找联合治疗方案是有充分理由的。材料和方法。分析2014年5月至2021年7月PDTC患者的治疗情况。该研究包括24例年龄在22至81岁之间的患者(9例男性(37.5%),15例女性(62.5%))。手术治疗14例(58.3%)。在8例(33.3%)病例中,术后进行了一个总剂量为3-4 Gbq的放射碘治疗疗程。7例(29.2%)患者接受了外束放射治疗。在2例(8.3%)病例中,卡铂化疗与外束放射治疗同时进行。4例(16.7%)患者服用lenvatinib。由于这样或那样的原因,9例(37.5%)患者没有接受治疗。未治疗组总生存率为5.8±0.5个月,治疗组总生存率为9.6±1.0个月(p <0.00095)。根据该指数,Lenvatinib在普通组患者中显示出显著的增加-可达15个月。在PDTC进行手术、放疗和化疗相结合的联合治疗,可以获得更高的生存率。为了实现长期稳定,需要进一步研究新的方法来增强现代药物的抗肿瘤作用。
{"title":"Results of treatment of patients with poorly differentiated carcinoma of the thyroid gland","authors":"P. Isaev, V. Polkin, N. Severskaya, A. Ilyin, A. K. Plugar, S. A. Ivanov, A. Kaprin","doi":"10.17650/2222-1468-2022-12-4-17-24","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-4-17-24","url":null,"abstract":"Introduction. Poorly differentiated carcinoma of the thyroid gland (PDTC) is characterised by aggressive, high rate of tumor growth, massive infiltration, early lymphogenous and hematogenous dissemination. Ways to improve treatment outcomes include developing individual treatment programmes. Given the unsatisfactory results of the treatment, the search for combined treatment options is well founded.Materials and methods. An analysis was made of the treatment of PDTC in patients from May 2014 to July 2021. The study included 24 patients aged 22 to 81 years (9 (37.5 %) men and 15 (62.5 %) women). Surgical treatment was performed in 14 (58.3 %) cases. In 8 (33.3 %) cases, a course of radioiodine therapy with a total dose of 3–4 Gbq was performed in the postoperative period. Seven (29.2 %) patients underwent external beam radiation therapy. In 2 (8.3 %) cases, chemotherapy with carboplatin was performed simultaneously with external beam radiation therapy. Four (16.7 %) patients were prescribed lenvatinib. For one reason or another, 9 (37.5 %) patients did not receive treatment.Results. For patients not treated, the overall survival rate was 5.8 ± 0.5 months, for patients treated – 9.6 ± 1.0 months (p <0.00095). According to the index Lenvatinib showed a significant increase in the general group of patients – up to 15 months.Conclusion. Combined treatment in the form of a combination of surgical, radiation and chemotherapeutic methods at PDTC, allows to achieve much higher survival. In order to achieve longer-term stabilization, further research is needed on new ways to enhance the anti-tumor effect of modern drugs.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78247306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Targeted therapy of anaplastic thyroid cancer 甲状腺间变性癌的靶向治疗
Pub Date : 2023-03-08 DOI: 10.17650/2222-1468-2022-12-4-33-38
P. Nikiforovich, A. Polyakov, I. Sleptsov, N. S. Boyko, Yu.  A. Gronskaya, N. Timofeeva, R. Chernikov
Introduction. Anaplastic thyroid cancer (ATC) is a very rare malignant tumor of the thyroid comprising 1–2 % of all thyroid cancers. In this pathology, response rate for standard systemic therapy is less than 15 %, and long-term results remain unsatisfactory. Additionally, there are no data conclusively showing that cytotoxic chemotherapy improves survival or quality of life in patients with ATC.Aim. To improve the results of treatment of patients with ATC through evaluation of the effectiveness of targeted therapy in cases of BRAFV600E mutation.Materials and methods. The multicenter prospective study included 29 patients with ATC IVB–C, T4a–bN1a–bM0–1. The patients were divided into 2 groups. The Group 1 (control) included 15 patients with resectable / nonresectable, metastatic / nonmetastatic ATC (without BRAFV600E mutation), stages IVB–C who received standard types of treatment (surgical intervention, radiation, and chemotherapy). The Group 2 consisted of 14 patients with nonresectable or metastatic ATC, stages IVB–C, who received combination therapy (surgical intervention, radiation, and chemotherapy) with inclusion of inhibitors of BRAF dabrafenib and trametinib in neoadjuvant and adjuvant regimens.Results. The study showed the effectiveness of targeted therapy with inhibitors of BRAF mutations in treatment of locally advanced non-operable metastatic ATC with BRAFV600E mutation. Overall response (complete response + partial response) in the Group 1 was 0 %, in the Group 2 it was 64 %. Therefore, treatment scheme dabrafenib + trametinib is a prmising approach to combination targeted therapy in patients with ATC and BRAFV600E mutation. Conclusion. Dabrafenib + trametinib is a promising combination targeted therapy option for patients with ATC with a BRAFV600 mutation demonstrates a high overall response rate, a prolonged duration of response, and an increase in survival rates with controlled toxicity.
介绍。间变性甲状腺癌(ATC)是一种非常罕见的甲状腺恶性肿瘤,占所有甲状腺癌的1 - 2%。在这种病理中,标准全身治疗的有效率低于15%,长期效果仍不令人满意。此外,没有确切的数据表明细胞毒性化疗可以改善atc患者的生存或生活质量。通过评价BRAFV600E突变病例靶向治疗的有效性,提高ATC患者的治疗效果。材料和方法。这项多中心前瞻性研究包括29例ATC IVB-C, T4a-bN1a-bM0-1患者。患者分为两组。第1组(对照组)包括15例可切除/不可切除、转移性/非转移性ATC(无BRAFV600E突变)、IVB-C期接受标准治疗(手术干预、放疗和化疗)的患者。第2组包括14例不可切除或转移性ATC患者,IVB-C期,接受联合治疗(手术干预,放疗和化疗),在新辅助和辅助方案中纳入BRAF抑制剂达非尼和曲美替尼。该研究表明,BRAF突变抑制剂靶向治疗BRAFV600E突变的局部晚期不可手术转移性ATC的有效性。组1总有效率(完全有效率+部分有效率)为0%,组2总有效率为64%。因此,达非尼+曲美替尼治疗方案是ATC和BRAFV600E突变患者联合靶向治疗的一种很有前景的方法。结论。对于BRAFV600突变的ATC患者来说,Dabrafenib + trametinib是一种很有前景的联合靶向治疗选择,具有高的总缓解率,延长的缓解持续时间,并在毒性控制的情况下增加生存率。
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引用次数: 1
Clinical case of surgical treatment of advanced basal cell carcinoma of the skin on the face 晚期面部皮肤基底细胞癌手术治疗临床一例
Pub Date : 2022-12-14 DOI: 10.17650/2222-1468-2022-12-3-141-148
N. Sharafutdinova, S. Musin, A. V. Sultanbayev, K. Menshikov, V. Ilyin, B. Ibragimov, A. Izmailov, I. Sharifgaliev, F. D. Zainullin
Introduction. Basal cell carcinoma is the most common type of non-melanocytic malignant tumors of the skin. The main treatment methods for this pathology are local methods such as surgery and radiation. In rare cases, basal cell carcinoma can become locally advanced and / or metastatic.Aim. To demonstrate the possibility of reconstructive surgery for large defects after removal of locally advanced tumors of the face and describe a rare case of basal cell carcinoma metastasis into the regional lymph nodes.Clinical case. The article presents a clinical case of treatment of basal cell skin cancer with metastases into the regional lymph nodes. According to the patient, tumor on the skin of the left cheekbone area first appeared in 2007. The patient did not seek medical help. In 2017, the tumor was resected at the local medical facility. In 2018, the patient noted repeat tumor growth. In November of 2021, when the patient first consulted at the Republican Clinical Oncological Dispensary of the ministry of Health of the Bashkortostan Republic, the tumor was 7 × 5 cm. Invasion depth was up to 1.5 cm, infiltration into the temporal and mastication muscles and destruction of the zygomatic bone were observed. On 18.11.2021 at Republican Clinical Oncological Dispensary of the ministry of Health of the Bashkortostan Republic, wide resection of the skin tumor with resection of the zygomatic arch, parotidectomy on the left with defect removal using anterolateral thigh flap was performed. per histological examination, basal cell carcinoma with lymphovascular and perineural invasion and advancement into the masticator muscle and zygomatic bone was diagnosed, as well as carcinoma metastases in 2 lymph nodes with advancement beyond the capsule.Conclusion. Implementation of revascularization flaps significantly widens choices for surgical treatment of this patient group in a regional oncological dispensary and gives satisfactory esthetic results due to removal of large defects after surgical intervention.
介绍。基底细胞癌是最常见的皮肤非黑素细胞恶性肿瘤。这种病理的主要治疗方法是局部方法,如手术和放疗。在极少数情况下,基底细胞癌可以局部进展和/或转移。目的探讨面部局部晚期肿瘤切除后大面积缺损的重建手术的可能性,并描述一例罕见的基底细胞癌转移到区域淋巴结的病例。临床病例。本文报告一例基底细胞皮肤癌转移至局部淋巴结的治疗。据患者介绍,肿瘤首次出现在左颧骨区域的皮肤上是在2007年。病人没有寻求医疗帮助。2017年,在当地医疗机构切除了肿瘤。2018年,患者发现肿瘤重复生长。2021年11月,当患者首次在巴什科尔托斯坦共和国卫生部共和国临床肿瘤诊所就诊时,肿瘤尺寸为7 × 5厘米。侵深可达1.5 cm,颞骨、咀嚼肌浸润,颧骨破坏。2021年11月18日,在巴什科尔托斯坦共和国卫生部共和临床肿瘤诊所,进行了广泛切除皮肤肿瘤并切除颧弓,左侧腮腺切除术并利用大腿前外侧皮瓣切除缺陷。组织学检查诊断基底细胞癌伴淋巴血管和神经周围浸润并进展至咀嚼肌和颧骨,并有2个淋巴结转移并进展到囊外。血管重建术皮瓣的实施大大拓宽了该患者在区域肿瘤诊所的手术治疗选择,并且由于手术干预后切除了大的缺陷,因此获得了令人满意的美学效果。
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引用次数: 0
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Head and neck tumors (HNT)
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