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The role of nutritional support in treatment of head and neck tumors: clinical case 营养支持在头颈部肿瘤治疗中的作用:临床案例
Pub Date : 2022-12-13 DOI: 10.17650/2222-1468-2022-12-3-86-94
A. Mudunov, M. Pak, L. Y. Wolf
The article presents a clinical observation of treatment of locally advanced squamous cell oropharyngeal carcinoma. The problems of nutritional support of patients during primary chemoradiation treatment are considered. The presented clinical case shows that use of sip feeds can significantly improve nutritional condition in patients with head and neck tumors and improve tolerability and results of antitumor treatment.
本文报道局部晚期鳞状细胞口咽癌治疗的临床观察。对初次放化疗患者的营养支持问题进行了探讨。本临床病例表明,使用sip饲料可显著改善头颈部肿瘤患者的营养状况,提高抗肿瘤治疗的耐受性和效果。
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引用次数: 0
Features of epileptiform activity in patients with diagnosed glioblastoma: from genetic and biochemical mechanisms to clinical aspects 胶质母细胞瘤患者癫痫样活动的特征:从遗传、生化机制到临床
Pub Date : 2022-12-13 DOI: 10.17650/2222-1468-2022-12-3-102-113
E. E. Tyagunova, A. S. Zakharov, A. Glukhov, V. Z. Dobrokhotova, T. I. Shlapakov, V. V. Kozlov, N. V. Korotkova, T.  E. Tyagunova
Introduction. glioblastomas multiforme (grade Iv gliomas) are common and the most aggressive primary tumors of the brain with very unfavorable prognosis. In all previously published papers on epileptiform activity in glioblastomas, not enough information on encephalogram results is presented.Aim. To study the features of epileptiform activity in patients with glioblastomas and development of a plan for further study of these patients.Materials and methods. An analysis of articles from Elsevier, Embase, Scopus, The Cochrane Library, global Health, Russian Science Citation Index (RSCI) databases, Scholar, google, web of Science, pubmed search engines and scientific electronic library CyberLeninka was performed. materials were selected considering journal indexing system and citations, scientific novelty of the studies, statistical significance of the results. publications repeating data from previous articles or describing animal experiments were excluded from analysis.Results. During the study, data on mechanisms of epileptiform activity pathogenesis, predisposing factors (tumor location in the temporal, frontal or parietal lobes, IDH-1 and / or IDH-2 gene mutations), treatment options in patients with glioblastomas were systemized. Additionally, and original plan of data accumulation for clinical studied taking into account limitations of the previous studies was developed to increase quality of results interpretation.Conclusion. Epileptiform symptoms in glioblastomas negatively affect patients’ quality of life and lifespan. Currently, researchers actively search for an effective method of treatment of epileptic seizures in patients with glioblastomas. The most effective is combination of temozolomide with valproate and levetiracetam due to good control of seizure frequency, low toxicity, and pharmacological synergy between the drugs.
介绍。多形性胶质母细胞瘤(四级胶质瘤)是常见且最具侵袭性的脑原发肿瘤,预后非常不利。在所有先前发表的关于胶质母细胞瘤癫痫样活动的论文中,没有足够的关于脑电图结果的信息。目的:研究胶质母细胞瘤患者癫痫样活动的特点,并制定进一步研究计划。材料和方法。对来自Elsevier、Embase、Scopus、The Cochrane Library、global Health、Russian Science Citation Index (RSCI)数据库、Scholar、google、web of Science、pubmed搜索引擎和科学电子图书馆CyberLeninka的文章进行分析。材料的选择考虑了期刊的标引体系和引文、研究的科学新颖性、结果的统计显著性。重复先前文章数据或描述动物实验的出版物被排除在分析之外。在研究过程中,对胶质母细胞瘤患者癫痫样活动的发病机制、易感因素(肿瘤位于颞叶、额叶或顶叶、IDH-1和/或IDH-2基因突变)、治疗方案等方面的数据进行了系统整理。此外,考虑到以往研究的局限性,为临床研究制定了原始的数据积累计划,以提高结果解释的质量。胶质母细胞瘤的癫痫样症状对患者的生活质量和寿命产生负面影响。目前,研究人员正在积极寻找治疗胶质母细胞瘤患者癫痫发作的有效方法。替莫唑胺与丙戊酸钠、左乙曲西坦合用治疗效果最好,因其控制癫痫发作频率好、毒性低、药物协同作用强。
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引用次数: 1
Prognostic factors for overall survival and intracranial progression in patients with renal cancer metastasis into the brain after neurosurgical treatment 神经外科治疗后肾癌脑转移患者总生存期和颅内进展的预后因素
Pub Date : 2022-12-13 DOI: 10.17650/2222-1468-2022-12-3-95-101
K. E. Roshchina, A. Bekyashev, D. Naskhletashvili, E. Moskvina, I. Osinov, A.  N. Savvateev, D. A. Khalafyan
Introduction. Treatment of patients with brain metastases is an important problem that should be considered in the framework of combination approach. Introduction of new techniques of drug therapy as well as radiotherapy and neurosurgical treatment allows to significantly increase patient survival. Effective drug therapy and local control of brain metastases are of utmost importance in prediction of overall survival and patient quality of life.Aim. To investigate the prognostic factors for overall survival and intracranial progression (local recurrences, distant metastases) in patients with brain metastases of renal cancer after neurosurgical resection.Materials and methods. Retrospective analysis of the treatment results of 114 patients with metastatic brain lesions due to renal cancer who underwent neurosurgical resection (NSR) at the N. N. Blokhin National medical Research Center of Oncology was performed. Clinical data of 102 (89.5 %) of 114 patients for whom data on survival was available were evaluated. Among them, 80 (78.4 %) of patients died, 22 (21.5 %) are under observation. Extracranial disease status at the time of NSR was known in 82 (71.9 %) patients: 45 (54.8 %) patients had extracranial metastases, and 37 (45.1 %) did not. Total resection of brain metastases with perifocal and perivascular zones was performed in 92 (90.1 %) patients; in other cases, fragmental lesion resection was performed.Results. median overall survival after NSR was 13.8 months (95 % confidence interval 10.3–18.6). per study data, factors affecting overall survival of patients with brain metastases of renal cancer after neurosurgical resection were presence /  absence of extracranial metastases and patient’s functional status. Local recurrences in the postoperative cavity after NSR were observed in 24 (21 %) of 114 patients. median time of local recurrence was not achieved. Statistically significant factor of high risk of recurrence in the postoperative cavity was presence of lesions with maximal diameter ≥2 cm. Development of new (distant) metastases was observed in 31 (27.2 %) of 114 patients. median survival without distant metastases in patients with brain metastases after NSR was not achieved. frequencies of distant metastases at 6, 12 and 24 months were 15.5; 24.1 and 35.8 % respectively. per multifactor analysis, factors affecting development of distant metastases in the brain after NSR are multiple metastatic brain lesions and presence of extracranial metastases.Conclusion. Neurosurgical resection in patients with cerebral metastases of renal cancer in the total group leads to median overall survival of 13.8 months. predictors of better overall survival are absence of extracranial metastases and high functional status.
介绍。脑转移患者的治疗是联合治疗框架中应考虑的一个重要问题。引入新的药物治疗技术以及放射治疗和神经外科治疗可以显著提高患者的生存率。有效的药物治疗和脑转移的局部控制对预测患者的总体生存和生活质量至关重要。目的:探讨肾癌脑转移患者神经外科切除后总生存期和颅内进展(局部复发、远处转移)的预后因素。材料和方法。回顾性分析了在N. N. Blokhin国家肿瘤医学研究中心行神经外科切除(NSR)的114例肾癌转移性脑病变患者的治疗结果。对114例患者中102例(89.5%)的临床资料进行了评估。其中死亡80例(78.4%),留观22例(21.5%)。82例(71.9%)患者在NSR发生时的颅外疾病状态是已知的:45例(54.8%)患者有颅外转移,37例(45.1%)患者没有。92例(90.1%)脑转移灶伴病灶周围和血管周围区行全切除术;其他病例行碎片性病变切除术。NSR后的中位总生存期为13.8个月(95%可信区间为10.3-18.6)。根据研究数据,影响肾癌脑转移患者神经外科切除后总生存率的因素是有无颅外转移和患者的功能状态。114例患者中有24例(21%)出现术后腔内局部复发。局部复发的中位时间未达到。术后腔内存在最大直径≥2 cm的病变是术后腔内复发的高危因素。114例患者中有31例(27.2%)发生了新的(远处)转移。NSR后脑转移患者无远处转移的中位生存期未达到。6个月、12个月和24个月远处转移的频率为15.5%;分别为24.1%和35.8%。多因素分析表明,影响NSR术后脑远处转移的因素是多发转移性脑病变和颅外转移。神经外科切除肾癌脑转移患者的中位总生存期为13.8个月。总生存率较高的预测因素是无颅外转移和高功能状态。
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引用次数: 0
Current capabilities of replacement of postresection defects of the orbit and periorbital zone with revascularized grafts in patients with malignant tumors: literature review 恶性肿瘤患者眼眶及眶周缺损术后血管重建移植的现状:文献综述
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-116-122
T. R. Andreev, A. Mudunov, V. Z. Dobrokhotova
Various techniques for replacement of postresection defects of the orbit and periorbital zone in patients with malignant tumors are known, but clearly defined criteria for selection of the optimal variant have not been developed. This review considers current techniques of reconstruction of these defects using free revascularized grafts. Characteristics of various grafts, their advantages and disadvantages are described. Based on the analysis, algorithm of selection of the optimal methods of reconstruction for individual patients is proposed. The main criterion in selection of defect replacement techniques is the possibility of achieving the maximal functional and esthetic results.
恶性肿瘤患者眼眶和眶周区切除术后缺损的各种替代技术是已知的,但选择最佳变体的明确定义标准尚未制定。本文综述了目前利用游离血管重建移植物重建这些缺陷的技术。介绍了各种接枝的特点及其优缺点。在此基础上,提出了针对个体患者的最佳重建方法选择算法。选择缺损置换技术的主要标准是能否获得最大的功能和美学效果。
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引用次数: 0
Tafalgin is a Russian innovative tetrapeptide pharmaceutical for subcutaneous injection: review of the results of phase I and II clinical trials Tafalgin是俄罗斯创新的用于皮下注射的四肽药物:I期和II期临床试验结果综述
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-89-107
V. Kosorukov, G. Abuzarova, E. Zakharochkina, O. Gamzeleva, K. A. Yatsenko
Introduction. pain syndrome significantly affects quality of life and daily activities of patients with cancer, especially at terminal stages of the disease. Opioid analgesics are considered the “gold standard” of therapy, but their use is associated with bureaucratic difficulties, as well as risk of a number of adverse events and drug dependency. Tafalgin is a Russian innovative tetrapeptide analgesic for subcutaneous injection. phase I and II clinical trials demonstrated its high effectiveness comparable to morphine and favorable safety profile.The study objective is to evaluate the safety, tolerability, and pharmacokinetics of tafalgin after subcutaneous injection in healthy volunteers, as well as effectiveness and safety of varying doses in patients with pain syndrome due to malignant tumors.Materials and methods. Phase I clinical trial included 39 healthy male volunteers. The drug was injected once subcutaneously at doses between 0.05 and 7 mg. plasma samples were obtained in the first 120 hours, and safety profile, tolerability and main pharmacokinetic characteristics of the pharmaceutical were determined. phase II clinical study included 42 patients with severe pain syndrome caused by malignant tumors who previously received morphine. At the 1st stage (10 days), all patients were randomized in groups receiving tafalgin at doses 2, 3, 4, 5, 6 or 7 mg (dosing frequency was determined individually); at the 2nd stage the patients were randomized into tafalgin (with dose determined at the 1st stage) and morphine (with dose determined prior to the clinical trial) groups and received the medications for 7 days. Effectiveness and safety of tafalgin compared to morphine and pharmacokinetic parameters of the studied drug were evaluated.Results. Tafalgin is characterized by fast absorption after subcutaneous administration (less than 30 minutes) which allows for fast clinical effect and absence of accumulation in the body. use of this pharmaceutical in patients with cancer allowed to maintain appropriate pain management achieved earlier through intramuscular morphine administration in 100 % of cases. Dynamics of mean daily pain intensity and necessity of additional analgesics did not differ between the groups. use of tafalgin did not require an increase in the dose or frequency of administration. Comparison of mean daily individual morphine and tafalgin doses showed that equianalgetic potential of the studied pharmaceutical was 1:3. Safety profile of tafalgin was favorable: adverse events during the trial were mild or moderate and not lifethreatening. use of tafalgin was associated with decreased number of opioid-induced adverse effects and improved quality of sleep in patients who previously received morphine parenterally.Conclusion. Data obtained during the first in Russia clinical trial of a new selective pharmaceutical tafalgin with tropism to opioid pl-receptors definitively demonstrates its high effectiveness and safety and shows the necessity
介绍。疼痛综合征显著影响癌症患者的生活质量和日常活动,特别是在疾病的晚期。阿片类镇痛药被认为是治疗的“黄金标准”,但它们的使用伴随着官僚主义的困难,以及一些不良事件和药物依赖的风险。他法金是俄罗斯创新的皮下注射用四肽镇痛药。I期和II期临床试验表明其具有与吗啡相当的高疗效和良好的安全性。研究目的是评估健康志愿者皮下注射他法algin的安全性、耐受性和药代动力学,以及不同剂量他法algin在恶性肿瘤疼痛综合征患者中的有效性和安全性。材料和方法。一期临床试验包括39名健康男性志愿者。该药物皮下注射一次,剂量在0.05至7毫克之间。在最初的120小时内获得血浆样本,并确定药物的安全性,耐受性和主要药代动力学特征。II期临床研究纳入42例既往接受吗啡治疗的恶性肿瘤所致严重疼痛综合征患者。在第一阶段(10天),所有患者随机分为2、3、4、5、6或7 mg剂量的他法algin组(给药频率单独确定);第二阶段随机分为他法金组(第一阶段剂量确定)和吗啡组(临床试验前剂量确定),连续用药7 d。比较了他法algin与吗啡的有效性和安全性,并对其药动学参数进行了评价。他法algin的特点是皮下给药后吸收快(不到30分钟),这使得临床效果快,在体内没有积累。在癌症患者中使用这种药物可以维持早期通过肌肉注射吗啡获得的适当疼痛管理,在100%的病例中。平均每日疼痛强度的动态和额外止痛药的必要性在两组之间没有差异。使用他法algin不需要增加剂量或给药频率。吗啡和他法algin每日平均剂量的比较表明,该药物的等效镇痛电位为1:3。他法algin的安全性是有利的:试验期间的不良事件为轻度或中度,不危及生命。他法algin的使用与阿片类药物引起的不良反应的减少和先前接受过吗啡外注射的患者睡眠质量的改善有关。俄罗斯首次对一种具有阿片样物质pl受体倾向的新型选择性药物他他algin进行临床试验,获得的数据明确地证明了其高有效性和安全性,并显示了在该领域进一步研究的必要性。
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引用次数: 10
Rapid clinical progression of stage III-IV oral and oropharyngeal cancer after upfront surgery and difficulty in the assessment of the effectiveness of adjuvant radiotherapy III-IV期口腔及口咽癌前期手术后临床进展迅速,辅助放疗效果评价困难
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-25-32
A. Karpenko, R. Sibgatullin, A. A. Boyko, O. M. Nikolayeva
Introduction. Surgery with adjuvant radiation is the standard for treatment of advanced oral and oropharyngeal cancer. with the absence of randomized trials the assessment of the role of postoperative radiotherapy is difficult. Such assessments are usually based on retrospective analyses, whereas patient and tumor status during the time period between the operation and planned start of radiotherapy is not addressed.The study objective is to assess the role of adjuvant radiotherapy in the treatment of stage III—IV oral and oropharyngeal cancer not associated with human papillomavirus with regard to rapid clinical disease progression after upfront surgical treatment.Materials and methods. The case histories and outpatient records of 260 patients with oral and oropharyngeal cancer of stage III—IV, not associated with human papillomavirus, from 30 to 82 years old (average age - 56.52 years), operated in 2009-2018, were analyzed. Two groups of patients were identified. group 1 included 152 patients (58 %) irradiated postoperatively and group 2 consisted of 108 patients (42 %) treated surgically only. 22 patients of group 2 experienced rapid clinical disease progression, were deemed unsuitable for adjuvant treatment and formed group 2a. Comparison of the Kaplan-Meier overall survival and locoregional control was made for group 1 and the entire group 2 (formal analysis) and after exclusion from the latter patients of group 2a, based on the hypothesis of inability of radiotherapy to improve oncologic results in patients with such an unfavorable disease course.Results. Mean follow up was 33.2 months (range 2-121 months). Locoregional control and 5 year overall survival were statistically higher in group 1: 70.4 % versus 45.4 % (р = 0.000) and 40.2 % versus 24.9 % (р = 0.000) that may imply a significant advantage of the combined over monomodal approach. After exclusion of group 2a patients from the analysis both differences considerably narrowed and were 70.4 % versus 55.8 % for locoregional control, 40.2 % versus 31.3 % for overall survival and became statistically insignificant (p = 0.067 and 0.111, respectively).Conclusion. Rapid clinical disease progression in the time frame between surgical treatment and adjuvant radiotherapy is not a rare phenomenon with a very poor prognosis. It can be one of the reasons for postoperative treatment refusal. formal retrospective analyses of the role of adjuvant treatment without considering causes for its refusal may lead to the overestimation of the combined approach effectiveness.
介绍。手术辅助放疗是晚期口腔癌和口咽癌的标准治疗方法。由于缺乏随机试验,评估术后放疗的作用是困难的。这种评估通常基于回顾性分析,而在手术和计划开始放疗之间的这段时间内,患者和肿瘤的状态没有得到解决。本研究的目的是评估在术前手术治疗后临床疾病快速进展方面,辅助放疗在治疗与人乳头瘤病毒无关的III-IV期口腔和口咽癌中的作用。材料和方法。分析2009-2018年手术治疗的260例30 ~ 82岁(平均年龄56.52岁)III-IV期口腔和口咽癌患者的病例史和门诊记录,患者与人乳头瘤病毒无关。确定了两组患者。组1包括152例(58%)术后放疗,组2包括108例(42%)仅手术治疗。2组22例患者临床病情进展迅速,认为不适合辅助治疗,组成2a组。基于放疗无法改善这种不利病程的患者的肿瘤结果的假设,对1组和整个2组进行Kaplan-Meier总生存率和局部区域对照(形式分析),并排除2a组的后一组患者。平均随访33.2个月(2 ~ 121个月)。第1组的局部控制率和5年总生存率在统计学上更高:70.4%对45.4% (r = 0.000), 40.2%对24.9% (r = 0.000),这可能意味着联合治疗比单一治疗有显著优势。将2a组患者排除在分析之外后,两者的差异明显缩小,局部对照为70.4%对55.8%,总生存率为40.2%对31.3%,差异无统计学意义(p分别= 0.067和0.111)。在手术治疗和辅助放疗之间的时间框架内,临床疾病的快速进展并不罕见,预后很差。这可能是术后拒绝治疗的原因之一。如果对辅助治疗的作用进行正式的回顾性分析,而不考虑拒绝辅助治疗的原因,可能会导致对联合治疗方法有效性的高估。
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引用次数: 1
Multiple primary malignant neoplasms of the mouth and oropharynx 口腔及口咽部多发原发性恶性肿瘤
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-55-62
M. Kropotov, L. Yakovleva, L. G. Zhukova, G. Agabekyan, A. V. Khodos, D. Safarov, P. A. Gavrishchuk, M. S. Tigrov, A. S. Vyalov
Introduction. Probability of development of multiple primary tumors in patients who received treatment due to head and neck cancers varies between 5.6 and 35.9 % per different sources. moreover, treatment capabilities are severely limited by postoperative anatomical changes and previous radiation therapy, and the second tumor frequently causes death in these patients.The study objective is to identify the epidemiological features of the development of synchronous and metachronous primary multiple tumors in the head and neck.Materials and methods. The article analyzes data on 103 patients with multiple primary tumors who received treatment due to tumors of the head and neck between 1991 and 2020 at the N.N. Blokhin National medical Research Center of Oncology and A.S. Loginov Moscow Clinical Scientific Center.Results. During the study, typical locations of metachronous tumors in patients who received treatment due to primary malignant tumors of the head and neck were determined, duration of development of multiple primary tumors, treatment methods and survival rates were analyzed.Conclusion. Due to high risk of multiple primary tumors in patients who received treatment due to malignant tumors of the head and neck in the next 5 plus years, it is expedient to observe these patients during their whole lifetime. Considering typical locations of metachronous tumors, examination during dynamic observation should include instrumental methods such as panendoscopy. Surgical treatment should involve the whole spectrum of minimally invasive interventions including CO2 laser surgery and transoral robot-assisted interventions.
介绍。因头颈癌接受治疗的患者发生多发性原发肿瘤的概率在不同来源的5.6%至35.9%之间。此外,由于术后解剖改变和既往放射治疗,治疗能力受到严重限制,这些患者的第二肿瘤经常导致死亡。研究目的是确定头颈部同步性和异时性原发性多发肿瘤的流行病学特征。材料和方法。本文分析了1991年至2020年间在N.N. Blokhin国家肿瘤医学研究中心和A.S. Loginov莫斯科临床科学中心因头颈部肿瘤接受治疗的103例多发性原发性肿瘤患者的数据。本研究确定了头颈部原发恶性肿瘤患者异时性肿瘤的典型部位,分析了多发原发肿瘤的病程、治疗方法及生存率。因头颈部恶性肿瘤而接受治疗的患者未来5年以上发生多发原发肿瘤的风险较高,故对患者进行终身观察较为有利。考虑到异时性肿瘤的典型位置,动态观察时的检查应包括仪器方法,如全内窥镜检查。手术治疗应包括全谱的微创干预,包括CO2激光手术和经口机器人辅助干预。
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引用次数: 0
Survival analysis of patients with advanced metastatic differentiated thyroid cancer 晚期转移分化型甲状腺癌患者的生存分析
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-63-70
E. Borodavina, A. Shurinov, V. Krylov, K. Vasilev
Introduction. Current treatment of differentiated thyroid cancer includes surgical resection of the thyroid gland, radioiodine therapy (RIT) followed by hormone therapy with levothyroxine. If a patient has distant metastases, radioiodine therapy gains vital importance, becoming a non-competitive method of treatment. However, with incomplete expressed or lost ability of tumor cells to absorb radioactive iodine (131I), the effect of RIT occurs to be limited or completely lost. Radioactive iodine refractivity develops, in which the disease progresses despite ongoing therapy. Therapy with tyrosine kinase inhibitors for the progressive radioiodine-refractory thyroid cancer is currently the only recognized effective treatment. Based on the results of the SELECT study, in an indirect comparison with the data obtained earlier in the DECISION study, lenvatinib was found to be the most effective drug.The study objective is to provide a comparative analysis of response to treatment and overall survival in two groups of patients with progressive metastatic differentiated thyroid cancer. In group 1, treatment was based on continuing radioiodine therapy in combination with suppressive hormone therapy with levothyroxine; in group 2, with the development of radioiodine refractivity, lenvatinib was prescribed.Materials and methods. The study included two groups of patients treated at different times in the A.f. Tsyb medical Radiology Research Center - branch of the National medical Research Center of Radiology, ministry of Health of Russia. group 1 included patients who continued radioiodine therapy, despite disease progression on treatment (historical control group). This group (n = 191) consisted of patients with differentiated thyroid cancer who received radioiodine therapy until January 2015, when the criteria for radioactive iodine refractivity had not yet been established and there was no unified approach to such patients and no possibility of targeted therapy with tyrosine kinase inhibitors. group 2 (n =71) consisted of patients receiving lenvatinib in the 1st line targeted therapy from January 2015 to march 2022, from the time of radiographically confirmed tumor progression according to Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) and establishing the fact of radioactive iodine refractivity.Results. In the historical control group (n = 19) 18 (9.4 %) patients are alive to date. It should be specifically noted that all of them had a miliary dissemination in the lungs. None of the 191 patients had a complete or partial response to treatment. All patients had either disease stabilization (83 (43.45 %) patients), or disease progression (108 (56.54 %) patients). The number of RIT courses varied from 9 to 27, 13 ± 3.4 on average. The total dose for the entire treatment period varied from 21 to 75 GBq, 39.3 ± 10 on average. Overall survival averaged 80 ± 20.3 months (min 54 months, max 162 months). patients with slow disease progression had the
介绍。目前分化型甲状腺癌的治疗包括手术切除甲状腺、放射性碘治疗(RIT)和左甲状腺素激素治疗。如果患者有远处转移,放射性碘治疗变得至关重要,成为一种非竞争性的治疗方法。然而,由于肿瘤细胞不完全表达或丧失了吸收放射性碘(131I)的能力,RIT的作用有限或完全丧失。发生放射性碘折射,尽管持续治疗,病情仍在恶化。酪氨酸激酶抑制剂治疗进展性放射性碘难治性甲状腺癌是目前唯一公认的有效治疗方法。根据SELECT研究的结果,与DECISION研究早期获得的数据进行间接比较,发现lenvatinib是最有效的药物。该研究的目的是对两组进展性转移分化型甲状腺癌患者的治疗反应和总生存期进行比较分析。在第1组,治疗基于持续放射性碘治疗联合左甲状腺素抑制激素治疗;第二组随放射性碘折光性的发展,给予lenvatinib。材料和方法。该研究包括在俄罗斯卫生部国家放射医学研究中心分支机构a.f. Tsyb医学放射学研究中心接受不同时间治疗的两组患者。组1包括继续放射性碘治疗的患者,尽管治疗期间疾病进展(历史对照组)。该组(n = 191)为2015年1月前接受放射性碘治疗的分化型甲状腺癌患者,当时放射性碘的屈光性标准尚未建立,对这类患者没有统一的治疗方法,也没有酪氨酸激酶抑制剂靶向治疗的可能性。组2 (n =71)为2015年1月至2022年3月期间接受lenvatinib一线靶向治疗的患者,从根据实体瘤应答评价标准1.1 (RECIST 1.1)影像学证实肿瘤进展之时开始,建立放射性碘屈光度事实。在历史对照组(n = 19)中,18例(9.4%)患者存活至今。需要特别指出的是,他们都在肺部有军事播散。191例患者中没有一个对治疗有完全或部分反应。所有患者要么病情稳定(83例(43.45%)),要么病情进展(108例(56.54%))。RIT疗程9 ~ 27次,平均13±3.4次。整个治疗期的总剂量为21 ~ 75 GBq,平均为39.3±10。总生存期平均80±20.3个月(最短54个月,最长162个月)。病情进展缓慢的患者总生存期最长。在lenvatinib组中,停止治疗的患者的中位治疗持续时间达到26.3个月(1-52个月)。对71例患者的肿瘤治疗反应进行了评估。根据RECIST 1.1标准,1例(1.41%)患者的最大缓解为完全缓解,30例(42.45%)患者为部分缓解,23例(32.39%)患者为疾病稳定,13例(18.31%)患者为疾病进展。评估首次治疗反应的中位时间为4(2-8)个月。PFS为17.3个月(95%置信区间为15.1-19.4个月)。对lenvatinib治疗有反应(完全缓解和部分缓解)的亚组患者的中位PFS为32.5个月(95%置信区间30.7-37.7)。数据分析时的中位总生存期未达到。一项对比分析表明,基于持续放射性碘治疗的进展性放射折射分化型甲状腺癌的治疗方法是错误的。当酪氨酸激酶抑制剂治疗分化型甲状腺癌不可用时,这是唯一的选择。目前,大多数进展性放射偏光分化型甲状腺癌患者在一线靶向治疗中接受lenvatinib。目前,这种疗法在治疗放射偏光分化型甲状腺癌患者中的作用正在增加。新的靶向药物的合成前景越来越明显,如需要进一步的研究和比较已经在使用的药物。
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引用次数: 0
Algorithm of reconstruction combined midface defects after resection malignant tumors 恶性肿瘤切除后面中部缺损合并重建的算法
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-41-54
M. Bolotin, A. Mudunov, V. Y. Sobolevsky, V. I. Sokorutov
Introduction. Surgical treatment of malignant tumors of maxilla and midface results to a combined defects of the soft tissues of the face (upper lip, buccal, zygomatic regions), upper jaw, hard and soft palate, retromolar region, orbit, nasoethmoidal complex. This is one of the most difficult localizations in terms of both the possibility of performing radical surgery and reconstruction. The purpose of reconstruction is not only the elimination of cosmetic deformity, but also the restoration of such vital functions as breathing, swallowing, speech and binocular vision. Till that time, no algorithm has been developed for choosing a method for the reconstruction and there is no comparative analysis of the available methods.The study objective is to improve the functional and aesthetic results of treatment patients with malignant tumors of the upper jaw and midface.Materials and methods. For the period from 2014 to 2020 in the Department of Head and Neck Tumors of the N.N. Blokhin National Medical Research Center of Oncology, ministry of Health of Russia microsurgical reconstruction after resections of the upper jaw and midface was performed in 80 patients. most often (25 (31 %) patients) the primary tumor was localized in the maxillary sinus, then hard palate (16 (20 %) patients), soft palate (11 (14 %) patients), retromolar trigone (13 (16 %) patients). primary location at alveolar process of the upper jaw was in 3 (3 %) cases, nasal cavity and cells of the ethmoid labyrinth - in 4 (5 %), frontal sinus - in 5 (6 %), the skin of the cheek and lower eyelid - in 3 (3 %) patients. we defined 4 main types of resection. Type I - combined lower resections of the maxilla and mucosa of the retromolar region, soft palate, lateral wall of the oropharynx (47 (60 %) patients). Type II - total radical maxillectomy (resection of all walls of the upper jaw, including orbital wall) (12 (15 %) patients). In 5 (42 %) cases, the resection was combined and included, in addition to the upper jaw, the skin of the buccal and zygomatic regions. Type III - combined partial resections of the upper jaw (13 (17 %) cases). In 9 (69 %) cases, the block of tissues to be removed included a fragment of the skin of the buccal region, part of the external nose, and lower eyelid. Type Iv - orbitomaxillary resection with orbital exenteration (6 (8 %) patients), including exenteration of the orbit, cells of the ethmoid labyrinth, resection of the frontal bone, medial wall of the orbit, a fragment of the dura mater (4 (67 %) cases), skin of frontal, buccal, zygomatic areas, upper and lower eyelids. for reconstruction of defects in 80 patients we used 82 free flaps. In 76 (93 %) cases, simultaneous resections of the primary lesion and reconstructions were performed, in 6 (7 %) cases, delayed reconstruction after previously performed combined or complex treatment were performed.Results. In type I resection with limited defects excellent functional and aesthetic results were obtained in al
介绍。上颌及中面部恶性肿瘤的手术治疗导致面部软组织(上唇、颊区、颧骨区)、上颌、软硬腭、磨牙后区、眼眶、鼻筛复合体的综合缺损。就根治性手术和重建的可能性而言,这是最困难的定位之一。重建的目的不仅是消除外观畸形,而且是恢复呼吸、吞咽、语言和双目视觉等重要功能。到目前为止,还没有开发出选择重建方法的算法,也没有对现有方法进行比较分析。研究目的是提高上颌及中面部恶性肿瘤患者的功能和美观效果。材料和方法。2014年至2020年,在俄罗斯卫生部N.N. Blokhin国家肿瘤医学研究中心头颈部肿瘤科,对80例患者进行了上颌和中面部切除后的显微外科重建。原发肿瘤最常见于上颌窦(25例(31%)),其次为硬腭(16例(20%))、软腭(11例(14%))、磨牙后三角区(13例(16%))。主要部位为上颌牙槽突3例(3%),鼻腔及筛窦细胞4例(5%),额窦5例(6%),颊部皮肤及下眼睑3例(3%)。我们定义了4种主要的切除类型。I型-联合上颌骨下段切除术及后磨牙区、软腭、口咽侧壁粘膜切除术(47例(60%))。II型-全根治性上颌切除术(切除上颌全部壁,包括眶壁)(12例(15%)患者)。在5例(42%)病例中,联合切除,除上颌外,还包括颊部和颧骨区域的皮肤。III型:合并上颌部分切除(13例(17%))。在9例(69%)病例中,待切除的组织块包括颊区皮肤碎片、部分外鼻和下眼睑。Iv型-眶上颌切除合并眼眶摘除(6例(8%)),包括眼眶摘除、筛迷宫细胞切除、额骨、眼眶内侧壁切除、硬脑膜碎片切除(4例(67%))、额部、颊部、颧部、上下眼睑皮肤切除。在80例患者的缺损重建中,我们使用了82个游离皮瓣。在76例(93%)病例中,同时切除原发病灶并进行重建,在6例(7%)病例中,在先前进行联合或综合治疗后延迟重建。在缺陷有限的I型切除中,所有使用桡骨筋膜皮肤游离皮瓣的病例均获得了良好的功能和美观效果。在硬腭及上颌骨牙槽缘部分缺损和全部缺损的情况下,应用游离肩胛骨尖瓣可获得最佳的美观效果(5- 46%为优,3- 27%为满意)和功能效果(8例为言语质量优)。在II型切除中,6例(55%)患者获得了良好的美学效果。所有病例均采用由肩胛骨尖端、锯肌碎片和肩胛旁区皮肤组成的嵌合游离皮瓣。在缺陷有限的III型切除患者中,5例(71%)具有良好的美学效果,2例(29%)具有满意的美学效果。所有病例均采用桡骨自由皮瓣。上颌半缺损采用股前外侧游离皮瓣和胸背游离皮瓣。所有病例均获得满意的美学效果。在IV型手术中,所有患者均获得满意的美学效果。术前计算机三维建模是规划重建的必要条件。这允许确定缺陷的类型和体积,规划最佳重建方法,建立所需皮瓣几何形状的模型,制作皮瓣收获模板,计算固定钛板的位置和数量,并且,如果必要的话,打印眶下壁的单个网格。
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引用次数: 1
Positron emission tomography combined with computed tomography with 18F-fluorodeoxyglucose and 18F-сholine in meningeal solitary fibrous tumors: short literature review sample and clinical cases 脑膜孤立性纤维性肿瘤的正电子发射断层扫描联合18F-氟脱氧葡萄糖和18F-胆碱计算机断层扫描:简短的文献回顾样本和临床病例
Pub Date : 2022-08-01 DOI: 10.17650/2222-1468-2022-12-2-123-131
A. Odzharova, A. Pronin, T. G. Gasparyan, Z. K. Kamolova
Solitary fibrous tumors of the cerebral membranes are rare brain tumors. meningeal solitary fibrous tumors often metastasize outside the central nervous system, which significantly reduces the life expectancy of patients, while metastases can appear in a distant period after radical treatment of the primary intracranial tumor. The results of positron emission tomography combined with computed tomography with 18F-fluorodeoxyglucose and 18F-choline in 2 patients with different differentiation of solitary fibrous tumors were analyzed. The presented clinical cases demonstrate that clinical morphological variants of solitary fibrous tumors differ in aggressiveness and clinical course of the disease. 
孤立性脑膜纤维性肿瘤是一种罕见的脑肿瘤。脑膜孤立性纤维性肿瘤常转移到中枢神经系统外,这大大降低了患者的预期寿命,而转移可在原发性颅内肿瘤根治后较远的时期出现。分析2例不同分化的孤立性纤维性肿瘤患者的正电子发射断层扫描联合18f -氟脱氧葡萄糖和18f -胆碱计算机断层扫描结果。本文的临床病例表明,孤立性纤维性肿瘤的临床形态变异在侵袭性和临床病程上存在差异。
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引用次数: 0
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Head and neck tumors (HNT)
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