Pub Date : 2022-12-13DOI: 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.
{"title":"The role of nutritional support in treatment of head and neck tumors: clinical case","authors":"A. Mudunov, M. Pak, L. Y. Wolf","doi":"10.17650/2222-1468-2022-12-3-86-94","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-3-86-94","url":null,"abstract":"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.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"196 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73449659","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}
Pub Date : 2022-12-13DOI: 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。
{"title":"Features of epileptiform activity in patients with diagnosed glioblastoma: from genetic and biochemical mechanisms to clinical aspects","authors":"E. E. Tyagunova, A. S. Zakharov, A. Glukhov, V. Z. Dobrokhotova, T. I. Shlapakov, V. V. Kozlov, N. V. Korotkova, T. E. Tyagunova","doi":"10.17650/2222-1468-2022-12-3-102-113","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-3-102-113","url":null,"abstract":"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.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77918122","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}
Pub Date : 2022-12-13DOI: 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。
{"title":"Prognostic factors for overall survival and intracranial progression in patients with renal cancer metastasis into the brain after neurosurgical treatment","authors":"K. E. Roshchina, A. Bekyashev, D. Naskhletashvili, E. Moskvina, I. Osinov, A. N. Savvateev, D. A. Khalafyan","doi":"10.17650/2222-1468-2022-12-3-95-101","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-3-95-101","url":null,"abstract":"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.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90857966","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}
Pub Date : 2022-08-01DOI: 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.
{"title":"Current capabilities of replacement of postresection defects of the orbit and periorbital zone with revascularized grafts in patients with malignant tumors: literature review","authors":"T. R. Andreev, A. Mudunov, V. Z. Dobrokhotova","doi":"10.17650/2222-1468-2022-12-2-116-122","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-116-122","url":null,"abstract":"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.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79259942","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}
Pub Date : 2022-08-01DOI: 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
{"title":"Tafalgin is a Russian innovative tetrapeptide pharmaceutical for subcutaneous injection: review of the results of phase I and II clinical trials","authors":"V. Kosorukov, G. Abuzarova, E. Zakharochkina, O. Gamzeleva, K. A. Yatsenko","doi":"10.17650/2222-1468-2022-12-2-89-107","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-89-107","url":null,"abstract":"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 ","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82752021","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}
Pub Date : 2022-08-01DOI: 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.
{"title":"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","authors":"A. Karpenko, R. Sibgatullin, A. A. Boyko, O. M. Nikolayeva","doi":"10.17650/2222-1468-2022-12-2-25-32","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-25-32","url":null,"abstract":"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.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85554045","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}
Pub Date : 2022-08-01DOI: 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.
{"title":"Multiple primary malignant neoplasms of the mouth and oropharynx","authors":"M. Kropotov, L. Yakovleva, L. G. Zhukova, G. Agabekyan, A. V. Khodos, D. Safarov, P. A. Gavrishchuk, M. S. Tigrov, A. S. Vyalov","doi":"10.17650/2222-1468-2022-12-2-55-62","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-55-62","url":null,"abstract":"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.","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88426564","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}
Pub Date : 2022-08-01DOI: 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
{"title":"Survival analysis of patients with advanced metastatic differentiated thyroid cancer","authors":"E. Borodavina, A. Shurinov, V. Krylov, K. Vasilev","doi":"10.17650/2222-1468-2022-12-2-63-70","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-63-70","url":null,"abstract":"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 ","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82142170","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}
Pub Date : 2022-08-01DOI: 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
{"title":"Algorithm of reconstruction combined midface defects after resection malignant tumors","authors":"M. Bolotin, A. Mudunov, V. Y. Sobolevsky, V. I. Sokorutov","doi":"10.17650/2222-1468-2022-12-2-41-54","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-41-54","url":null,"abstract":"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","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76950803","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}
Pub Date : 2022-08-01DOI: 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.
{"title":"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","authors":"A. Odzharova, A. Pronin, T. G. Gasparyan, Z. K. Kamolova","doi":"10.17650/2222-1468-2022-12-2-123-131","DOIUrl":"https://doi.org/10.17650/2222-1468-2022-12-2-123-131","url":null,"abstract":"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. ","PeriodicalId":12937,"journal":{"name":"Head and neck tumors (HNT)","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84270287","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}