Pub Date : 2022-09-07DOI: 10.17650/2686-9594-2022-12-3-56-62
T. E. Tikhomirova, A. Tyulyandina, A. A. Rumyantsev, M. E. Abramov, A. Anokhin, A. Lud, S. Tjulandin
Ovarian cancer is a heterogeneous disease and is the leading cause of mortality among all gynecological malignancies. The disease is characterized by a high frequency of germline and somatic mutations in BRCA1/2 suppressor genes, which, according to various sources, occur in 10–27 % of all ovarian cancer cases. Determination of mutations in BRCA1 / 2 genes is a mandatory diagnostic criteria and includes performing next generation sequencing. Knowledge of the disease mutational status is important not only in the case of determining treatment plan, but also in the case of prevention of the other malignant neoplasms. The purpose of this review is to summarize the current data on the disease characteristics, diagnosis and treatment of BRCA-associated ovarian cancer. Also, the article presents data from a non-interventional multicenter OvATAR study to assess the prevalence of germline and somatic mutations in BRCA1 / 2 genes in the Russian patient population.
{"title":"BRCA-associated ovarian cancer: a review of the current literature","authors":"T. E. Tikhomirova, A. Tyulyandina, A. A. Rumyantsev, M. E. Abramov, A. Anokhin, A. Lud, S. Tjulandin","doi":"10.17650/2686-9594-2022-12-3-56-62","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-56-62","url":null,"abstract":"Ovarian cancer is a heterogeneous disease and is the leading cause of mortality among all gynecological malignancies. The disease is characterized by a high frequency of germline and somatic mutations in BRCA1/2 suppressor genes, which, according to various sources, occur in 10–27 % of all ovarian cancer cases. Determination of mutations in BRCA1 / 2 genes is a mandatory diagnostic criteria and includes performing next generation sequencing. Knowledge of the disease mutational status is important not only in the case of determining treatment plan, but also in the case of prevention of the other malignant neoplasms. The purpose of this review is to summarize the current data on the disease characteristics, diagnosis and treatment of BRCA-associated ovarian cancer. Also, the article presents data from a non-interventional multicenter OvATAR study to assess the prevalence of germline and somatic mutations in BRCA1 / 2 genes in the Russian patient population.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44562021","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 : 2022-09-07DOI: 10.17650/2686-9594-2022-12-3-36-42
Y. A. Zhulikov, E. Kovalenko, V. Bokhyan, M. V. Khoroshilov, D. A. Goryainov, A. Roslyakova, S. S. Magamedova, E. Evdokimova, E. Artamonova
Background. Combination of gemcitabine, metronomic capecitabine and mitotane (GemCap + m) is the most studied regimen in second and subsequent lines of therapy for advanced adrenocortical cancer (ACC). Previously published studies do not give a definitive answer to the question- what plays a key role in realizing the response to treatment: chemotherapy or mitotane in therapeutic concentration.Aim. Evaluation the efficacy and safety of GemCap + m combination with the standard dosing regimen of capecitabine in patients with metastatic ACC.Materials and methods. This retrospective single-center clinical study included patients over 18 years of age with histologically confirmed ACC with disease progression after completion of platinum-containing therapy. They received chemotherapy regimen gemcitabine 800 mg/m2 for days 1, 8 and capecitabine 1000 mg/m2 orally 2 times at days 1–14 of the 21-day cycle with mitotane. we evaluated objective response, stabilization of disease, 6-months disease control rate and median progression-free and overall survival. Radiological assessment according to RECIST 1.1 criteria was carried out every 6–8 weeks of treatment.Results. The study included 25 patients. mitotane concentration above 14 ng/mL was achieved in 22 (88 %) patients, of which 21 (84 %) reached therapeutic concentration in previous treatment lines. 80 % of patients received treatment as 2nd line, 20 % as 3rd and subsequent lines. The objective responses and disease stabilization was observed in 1 (4 %) and 11 (44 %) of patients, respectively. Disease control for at least 6 months rate was 24 %. median progression-free and overall survival were 3.2 months and 12.17 months, respectively. Toxicity grade 3–4 was observed in 28 % of patients. gemcitabine dose reductions due to thrombocytopenia grade 1–2 were required in 2 cases (8 %), no capecitabine reductions were necessary.Conclusion. This study demonstrates the effectiveness of a new dose regimen of chemotherapy GemCap + m in the second and subsequent lines of therapy for metastatic ACC. The progression of the disease against the background of previous lines of therapy at a therapeutic concentration of mitotane in the majority of patients indicates the effectiveness of the chemotherapeutic component of gemCap in a cohort of patients resistant to platinum and mitotane.
{"title":"Efficiency of chemotherapy GemCap + mitotane as second and subsequent lines of therapy for metastatic adrenocortical cancer","authors":"Y. A. Zhulikov, E. Kovalenko, V. Bokhyan, M. V. Khoroshilov, D. A. Goryainov, A. Roslyakova, S. S. Magamedova, E. Evdokimova, E. Artamonova","doi":"10.17650/2686-9594-2022-12-3-36-42","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-36-42","url":null,"abstract":"Background. Combination of gemcitabine, metronomic capecitabine and mitotane (GemCap + m) is the most studied regimen in second and subsequent lines of therapy for advanced adrenocortical cancer (ACC). Previously published studies do not give a definitive answer to the question- what plays a key role in realizing the response to treatment: chemotherapy or mitotane in therapeutic concentration.Aim. Evaluation the efficacy and safety of GemCap + m combination with the standard dosing regimen of capecitabine in patients with metastatic ACC.Materials and methods. This retrospective single-center clinical study included patients over 18 years of age with histologically confirmed ACC with disease progression after completion of platinum-containing therapy. They received chemotherapy regimen gemcitabine 800 mg/m2 for days 1, 8 and capecitabine 1000 mg/m2 orally 2 times at days 1–14 of the 21-day cycle with mitotane. we evaluated objective response, stabilization of disease, 6-months disease control rate and median progression-free and overall survival. Radiological assessment according to RECIST 1.1 criteria was carried out every 6–8 weeks of treatment.Results. The study included 25 patients. mitotane concentration above 14 ng/mL was achieved in 22 (88 %) patients, of which 21 (84 %) reached therapeutic concentration in previous treatment lines. 80 % of patients received treatment as 2nd line, 20 % as 3rd and subsequent lines. The objective responses and disease stabilization was observed in 1 (4 %) and 11 (44 %) of patients, respectively. Disease control for at least 6 months rate was 24 %. median progression-free and overall survival were 3.2 months and 12.17 months, respectively. Toxicity grade 3–4 was observed in 28 % of patients. gemcitabine dose reductions due to thrombocytopenia grade 1–2 were required in 2 cases (8 %), no capecitabine reductions were necessary.Conclusion. This study demonstrates the effectiveness of a new dose regimen of chemotherapy GemCap + m in the second and subsequent lines of therapy for metastatic ACC. The progression of the disease against the background of previous lines of therapy at a therapeutic concentration of mitotane in the majority of patients indicates the effectiveness of the chemotherapeutic component of gemCap in a cohort of patients resistant to platinum and mitotane.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48450700","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 : 2022-09-07DOI: 10.17650/2686-9594-2022-12-3-43-50
I. Karasev, A. Stroganova, O. Malikhova, T. S. Davydkina, Z. V. Grigoryevskaya, I. V. Tereshchenko, N. I. Pospekhova, A. V. Semyanikhina
Colorectal cancer (CRC) is one of the leading causes of death from cancer in many countries of the world, both in men and women, and these rates are on the rise. The probability of suffering from CRC is about 4–5 % and the risk for developing CRC is associated with personal features or habits such as age, chronic disease history and lifestyle, but in most cases colorectal cancer develops as a result of the degeneration of adenomatous formations or along the jagged path. Immune dysregulation, dysbiosis, and epithelial destruction contribute to colorectal cancer carcinogenesis. The gut microbiota has a relevant role, and dysbiosis situations can induce colonic carcinogenesis through a chronic inflammation mechanism. Some of the bacteria responsible for this multiphase process include Fusobacterium spp., Bacteroides fragilis and enteropathogenic Escherichia coli. moreover, CRC is caused by mutations that target oncogenes, tumour suppressor genes and genes related to DNA repair mechanisms.Considering that the average time for the development of adenocarcinoma from precancer takes about 10 years, changes in the microbiota can be a prospective marker for screening precancerous conditions of the colon, as well as the detection of changes in DNA.The work will discuss the relationship between changes in the microbial composition of the colon with the genetic mutations identified by molecular genetic sequencing.
{"title":"Endoscopic criteria and promising biomarkers for serrated adenomas of the colon (literature review)","authors":"I. Karasev, A. Stroganova, O. Malikhova, T. S. Davydkina, Z. V. Grigoryevskaya, I. V. Tereshchenko, N. I. Pospekhova, A. V. Semyanikhina","doi":"10.17650/2686-9594-2022-12-3-43-50","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-43-50","url":null,"abstract":"Colorectal cancer (CRC) is one of the leading causes of death from cancer in many countries of the world, both in men and women, and these rates are on the rise. The probability of suffering from CRC is about 4–5 % and the risk for developing CRC is associated with personal features or habits such as age, chronic disease history and lifestyle, but in most cases colorectal cancer develops as a result of the degeneration of adenomatous formations or along the jagged path. Immune dysregulation, dysbiosis, and epithelial destruction contribute to colorectal cancer carcinogenesis. The gut microbiota has a relevant role, and dysbiosis situations can induce colonic carcinogenesis through a chronic inflammation mechanism. Some of the bacteria responsible for this multiphase process include Fusobacterium spp., Bacteroides fragilis and enteropathogenic Escherichia coli. moreover, CRC is caused by mutations that target oncogenes, tumour suppressor genes and genes related to DNA repair mechanisms.Considering that the average time for the development of adenocarcinoma from precancer takes about 10 years, changes in the microbiota can be a prospective marker for screening precancerous conditions of the colon, as well as the detection of changes in DNA.The work will discuss the relationship between changes in the microbial composition of the colon with the genetic mutations identified by molecular genetic sequencing.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46732806","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 : 2022-09-07DOI: 10.17650/2686-9594-2022-12-3-51-55
M. Manukyan, I. Bazin, A. Tryakin
{"title":"Chemotherapy for advanced pancreatic cancer in older patients (literature review)","authors":"M. Manukyan, I. Bazin, A. Tryakin","doi":"10.17650/2686-9594-2022-12-3-51-55","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-51-55","url":null,"abstract":"","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42226874","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 : 2022-09-06DOI: 10.17650/2686-9594-2022-12-3-11-18
I. Stilidi, P. Arkhiri, I. Fainshtein, S. Nered, M. G. Abgaryan, E. Suleymanov, M. Nikulin, A. E. Kalinin, A. Volkov, O. A. Egenov, V. V. Yugai
Currently, with duodenal tumor lesion (duodenum), the possibility of performing economical operations that significantly improve the immediate results and quality of life of patients is increasingly being considered as an alternative to gastropancreatoduodenal resection. using the example of clinical observation, the article presents a new type of economical surgical intervention – duodenectomy with preservation of the peripapillary flap. The operation was performed in a patient with cancer of the resected stomach with a low spread of the tumor along the wall of the duodenum. At the control examination 9 months after the operation, the patient’s condition is satisfactory, without signs of impaired biliodynamics and passage of food through the intestinal tube. The proposed method differs from the existing prototype (papilloservative duodenectomy) by preserving the peripapillary flap of the duodenal wall.The insertion into the jejunum of not the fater papilla, but the surrounding wall of the duodenum eliminates its deformation and violation of patency and provides greater reliability of the formed suture, and the preservation of the small duodenal papilla with an additional pancreatic duct of Santorini can help reduce the frequency of postoperative pancreatitis and pancreonecrosis. In addition to cases of low lesions of the duodenum in gastric cancer, the method can be used in patients with non-epithelial and neuroendocrine tumors, as well as in secondary tumor invasion of the duodenum from the outside. The criterion limiting the performance of this type of operation is the distance from the edge of the tumor to the fater papilla less than 2.0–2.5 cm.Duodenectomy with preservation of the peripapillary flap can be considered as a way to improve the safety and quality of life in the surgical treatment of patients with a tumor lesion of the duodenum.
{"title":"Pancreas-sparing duodenectomy with preservation of peripapillary part of duodenal wall: a new option of surgical treatment for duodenal tumor lesions","authors":"I. Stilidi, P. Arkhiri, I. Fainshtein, S. Nered, M. G. Abgaryan, E. Suleymanov, M. Nikulin, A. E. Kalinin, A. Volkov, O. A. Egenov, V. V. Yugai","doi":"10.17650/2686-9594-2022-12-3-11-18","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-11-18","url":null,"abstract":"Currently, with duodenal tumor lesion (duodenum), the possibility of performing economical operations that significantly improve the immediate results and quality of life of patients is increasingly being considered as an alternative to gastropancreatoduodenal resection. using the example of clinical observation, the article presents a new type of economical surgical intervention – duodenectomy with preservation of the peripapillary flap. The operation was performed in a patient with cancer of the resected stomach with a low spread of the tumor along the wall of the duodenum. At the control examination 9 months after the operation, the patient’s condition is satisfactory, without signs of impaired biliodynamics and passage of food through the intestinal tube. The proposed method differs from the existing prototype (papilloservative duodenectomy) by preserving the peripapillary flap of the duodenal wall.The insertion into the jejunum of not the fater papilla, but the surrounding wall of the duodenum eliminates its deformation and violation of patency and provides greater reliability of the formed suture, and the preservation of the small duodenal papilla with an additional pancreatic duct of Santorini can help reduce the frequency of postoperative pancreatitis and pancreonecrosis. In addition to cases of low lesions of the duodenum in gastric cancer, the method can be used in patients with non-epithelial and neuroendocrine tumors, as well as in secondary tumor invasion of the duodenum from the outside. The criterion limiting the performance of this type of operation is the distance from the edge of the tumor to the fater papilla less than 2.0–2.5 cm.Duodenectomy with preservation of the peripapillary flap can be considered as a way to improve the safety and quality of life in the surgical treatment of patients with a tumor lesion of the duodenum.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42036885","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 : 2022-09-06DOI: 10.17650/2686-9594-2022-12-3-19-25
M. Tikhonovskaya, A. S. Shevchuk
Background. Surgical staging including pelvic and para-aortic lymphadenectomy is recommended in patients with clinical early-stage epithelial ovarian cancer. The therapeutic role of pelvic and para-aortic lymphadenectomy is still under debate, this procedure can increase risk of intra- and post-operative complications. using the sentinel lymph node (SLN) detection in early stage ovarian cancer in very promising and decreases the level of surgical damage. But nowadays the data on effectiveness, safety sensitivity and specificity of SLN are limited and the technique has to be standardized.Aim. To determine the feasibility of the SLN detection procedure using indocyanine green in early stage ovarian cancer.Materials and methods. four patients with clinical stage I epithelial ovarian cancer underwent SLN detection using indocyanine green. The tracer was injected into hilum of the ovary or ovarian ligament stumps in the case of previous adnexectomy. SLN were detected in infrared spectrum. Systemic retroperitoneal lymph node dissection of the pelvic and paraaortic areas was performed after SLN being removed. frozen section of was not performed in this study.Results. SLN were detected in paraaortic area in three of four patients. no one of patients had metastatic disease.Conclusion. The primary experience demonstrates SLN mapping of the ovary being feasible. Prospective study is required to evaluate sensitivity and specificity of SLn detection in early stage ovarian cancer.
{"title":"Sentinel lymph node detection in early stage ovarian cancer: the primary experience in N. N. Blokhin national medical Research Center of Oncology","authors":"M. Tikhonovskaya, A. S. Shevchuk","doi":"10.17650/2686-9594-2022-12-3-19-25","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-19-25","url":null,"abstract":"Background. Surgical staging including pelvic and para-aortic lymphadenectomy is recommended in patients with clinical early-stage epithelial ovarian cancer. The therapeutic role of pelvic and para-aortic lymphadenectomy is still under debate, this procedure can increase risk of intra- and post-operative complications. using the sentinel lymph node (SLN) detection in early stage ovarian cancer in very promising and decreases the level of surgical damage. But nowadays the data on effectiveness, safety sensitivity and specificity of SLN are limited and the technique has to be standardized.Aim. To determine the feasibility of the SLN detection procedure using indocyanine green in early stage ovarian cancer.Materials and methods. four patients with clinical stage I epithelial ovarian cancer underwent SLN detection using indocyanine green. The tracer was injected into hilum of the ovary or ovarian ligament stumps in the case of previous adnexectomy. SLN were detected in infrared spectrum. Systemic retroperitoneal lymph node dissection of the pelvic and paraaortic areas was performed after SLN being removed. frozen section of was not performed in this study.Results. SLN were detected in paraaortic area in three of four patients. no one of patients had metastatic disease.Conclusion. The primary experience demonstrates SLN mapping of the ovary being feasible. Prospective study is required to evaluate sensitivity and specificity of SLn detection in early stage ovarian cancer.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42464468","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 : 2022-09-06DOI: 10.17650/2686-9594-2022-12-3-26-35
M. Stepanova, O. A. Kuznetsovа, P. Shilo, F. Moiseenko, N. Abduloeva, E. Artemyeva, A. Zhabina, M. Kramchaninov, N. Volkov, I. Pokataev, A. A. Rumyantsev, I. Plaksa, M. A. Gairyan, A. A. Isaev, M. V. Ivanov, Yu. F. Sadykova, V. A. Mileiko, V. V. Shamrikova, E. Ledin, A. Tryakin, M. Fedyanin
Background. The use of targeted sequencing panels makes it possible to optimize and personalize the treatment strategy for cancer patients. Given the lack of a clear «portrait of the patient», the role of large panels (200 or more genes) in the treatment of a patient has not yet been determined.Aim. Assessment of the relationship between the results of targeted sequencing of tumor tissue or ctDNA and the treatment carried out after obtaining these data in patients with various solid tumors.Materials and methods. We retrospectively evaluated the NGS results and the treatments, provided to the 184 patients after NGS testing between 06.2016 and 06.2021. For analysis, one of two methods is used: a histological sample or the patient’s blood plasma. Evaluation of the results and determination of treatment tactics were carried out within the framework of a multidisciplinary commission. The frequency of detection of molecular disorders, the number of mutations in each sample, and the frequency of detection of targets for targeted therapy were assessed.Results. Molecular disorders were detected in 88.5 % (n = 163). The average number of mutations in one sample was 6. The maximum was detected in colorectal cancer patients; their average value was 8. The minimum was determined in non-small cell lung cancer and ovarian cancer patients, the average number of mutations was 3 in each localization. The average time from the moment the material was received by the laboratory to the generation of the report was 11 days. Targeted targets were identified in 25 (13.6 %) patients and therapy was started. Therapy with tyrosine kinase inhibitors of the first – third generations were performed in 12 (48 %) patients, PARP inhibitors – in 3 (24 %), BRAF and MEK inhibitors – in 2 (8 %), anti-HER2 therapy – in 1 (4 %). Targeted therapy within international clinical trials was initiated in 4 (16 %) patients. Immunotherapy was recommended in 3 (12 %) patients. In multivariate analysis, the chance of prescribing therapy based on the results of FM1 analysis was influenced by: mRAS (odds ratio 0.08; 95 % confidence interval 0.01–0.65; p = 0.018) and mEGFR (odds ratio 4.8; 95 % confidence interval 1.4–16.3; p = 0.012).Conclusion. The effectiveness of the FM1 test in real clinical practice in the Russian Federation corresponds to international data. In the presence of a mutation in the RAS genes, an additional FM1 test determines a low chance of detecting clinically significant disorders for which personalized treatment can be prescribed. The high frequency of prescription of therapy based on the results of blood plasma tests is due to the cohort of patients with non-small cell lung cancer and the detection of a mutation in the EGFR gene.
{"title":"Personalized therapy in solid tumors: results of a retrospective multicentre study of the clinical applicability of the FoundationOne® Medicine Test","authors":"M. Stepanova, O. A. Kuznetsovа, P. Shilo, F. Moiseenko, N. Abduloeva, E. Artemyeva, A. Zhabina, M. Kramchaninov, N. Volkov, I. Pokataev, A. A. Rumyantsev, I. Plaksa, M. A. Gairyan, A. A. Isaev, M. V. Ivanov, Yu. F. Sadykova, V. A. Mileiko, V. V. Shamrikova, E. Ledin, A. Tryakin, M. Fedyanin","doi":"10.17650/2686-9594-2022-12-3-26-35","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-3-26-35","url":null,"abstract":"Background. The use of targeted sequencing panels makes it possible to optimize and personalize the treatment strategy for cancer patients. Given the lack of a clear «portrait of the patient», the role of large panels (200 or more genes) in the treatment of a patient has not yet been determined.Aim. Assessment of the relationship between the results of targeted sequencing of tumor tissue or ctDNA and the treatment carried out after obtaining these data in patients with various solid tumors.Materials and methods. We retrospectively evaluated the NGS results and the treatments, provided to the 184 patients after NGS testing between 06.2016 and 06.2021. For analysis, one of two methods is used: a histological sample or the patient’s blood plasma. Evaluation of the results and determination of treatment tactics were carried out within the framework of a multidisciplinary commission. The frequency of detection of molecular disorders, the number of mutations in each sample, and the frequency of detection of targets for targeted therapy were assessed.Results. Molecular disorders were detected in 88.5 % (n = 163). The average number of mutations in one sample was 6. The maximum was detected in colorectal cancer patients; their average value was 8. The minimum was determined in non-small cell lung cancer and ovarian cancer patients, the average number of mutations was 3 in each localization. The average time from the moment the material was received by the laboratory to the generation of the report was 11 days. Targeted targets were identified in 25 (13.6 %) patients and therapy was started. Therapy with tyrosine kinase inhibitors of the first – third generations were performed in 12 (48 %) patients, PARP inhibitors – in 3 (24 %), BRAF and MEK inhibitors – in 2 (8 %), anti-HER2 therapy – in 1 (4 %). Targeted therapy within international clinical trials was initiated in 4 (16 %) patients. Immunotherapy was recommended in 3 (12 %) patients. In multivariate analysis, the chance of prescribing therapy based on the results of FM1 analysis was influenced by: mRAS (odds ratio 0.08; 95 % confidence interval 0.01–0.65; p = 0.018) and mEGFR (odds ratio 4.8; 95 % confidence interval 1.4–16.3; p = 0.012).Conclusion. The effectiveness of the FM1 test in real clinical practice in the Russian Federation corresponds to international data. In the presence of a mutation in the RAS genes, an additional FM1 test determines a low chance of detecting clinically significant disorders for which personalized treatment can be prescribed. The high frequency of prescription of therapy based on the results of blood plasma tests is due to the cohort of patients with non-small cell lung cancer and the detection of a mutation in the EGFR gene.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45739113","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 : 2022-06-05DOI: 10.17650/2686-9594-2022-12-2-28-35
S. N. Shchaeva
{"title":"Risk factors for urgent complications of colorectal cancer","authors":"S. N. Shchaeva","doi":"10.17650/2686-9594-2022-12-2-28-35","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-2-28-35","url":null,"abstract":"","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42726858","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 : 2022-06-05DOI: 10.17650/2686-9594-2022-12-2-36-45
M. Fedyanin, A. A. Tryakin
Цель исследования —оптимизация неоадъювантного лечения с учетом токсических реакций и ответной реакции опухоли у больных раком прямой кишки с неблагоприятными факторами прогноза. Материал и методы. В исследование включены 249 больных раком прямой кишки в клинической стадии cT3—4, cN0—2, cM0—1. Пациенты были разделены на четыре группы: 1-я группа (n=45) — лучевая терапия в разовой очаговой дозе 4 Гр через день до суммарной очаговой дозы (СОД) 40 Гр с последующей операцией через 4 нед; 2-я группа (n=64) — лучевая терапия ежедневно фракциями по 2 Гр в течение 5 нед до СОД 50 Гр на фоне 120-часовой инфузии 500 мг/м2 5-фторурацила (5-ФУ) в сочетании с лейковарином, 20 мг/м2 болюсно перед началом лучевой терапии и в конце курса лечения, радикальная операция через 4—6 нед; 3-я группа (n=67) — лучевая терапия по той же методике, что и во 2-й группе, на фоне приема 825 мг/м2 капецитабина 2 раза в день 5 дней в неделю, операция через 6—8 нед; 4-я (n=73) — лучевое лечение по методике для 2-й группы, СОД 50 Гр на фоне внутривенного введения 50 мг/м2 оксалиплатина в 1, 8, 22 и 29-й дни и приема 825 мг/м2 капецитабина 2 раза в день с 1-го по 14-й и с 22-го по 36-й дни лучевой терапии, операция через 8—10 нед после неоадъювантной терапии. Результаты. Токсические проявления в ходе неоадъювантного лечения развились в 1-й группе у 17 (37,6%) больных, во 2-й — у 53 (82,8%), в 3-й — у 20 (29,8%), в 4-й — у 25 (34,2%) больных, различия статистически достоверны (р<0,05). Полная клиническая регрессия по данным магнитно-резонансной терапии отмечена у 3 (4,7%) больных 2-й группы, 12 (18%) больных 3-й группы и 12 (16,4%) больных 4-й группы. Капецитабин и оксалиплатин+капецитабин достоверно увеличили частоту полных и частичных клинических ответов по сравнению с длительной инфузией 5-ФУ (OR 3,929;95% DI 1,900—8,121; p=0,0002). Заключение. Результаты сравнительного исследования позволили при выборе неоадъювантного воздействия у больных местно-распространенным раком прямой кишки отдать предпочтение лучевой терапии на фоне капецитабина, а при значительном поражении регионарных лимфатических узлов — на фоне оксалиплатина+капецитабина.
{"title":"Neoadjuvant therapy for locally advanced rectal cancer","authors":"M. Fedyanin, A. A. Tryakin","doi":"10.17650/2686-9594-2022-12-2-36-45","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-2-36-45","url":null,"abstract":"Цель исследования —оптимизация неоадъювантного лечения с учетом токсических реакций и ответной реакции опухоли у больных раком прямой кишки с неблагоприятными факторами прогноза. Материал и методы. В исследование включены 249 больных раком прямой кишки в клинической стадии cT3—4, cN0—2, cM0—1. Пациенты были разделены на четыре группы: 1-я группа (n=45) — лучевая терапия в разовой очаговой дозе 4 Гр через день до суммарной очаговой дозы (СОД) 40 Гр с последующей операцией через 4 нед; 2-я группа (n=64) — лучевая терапия ежедневно фракциями по 2 Гр в течение 5 нед до СОД 50 Гр на фоне 120-часовой инфузии 500 мг/м2 5-фторурацила (5-ФУ) в сочетании с лейковарином, 20 мг/м2 болюсно перед началом лучевой терапии и в конце курса лечения, радикальная операция через 4—6 нед; 3-я группа (n=67) — лучевая терапия по той же методике, что и во 2-й группе, на фоне приема 825 мг/м2 капецитабина 2 раза в день 5 дней в неделю, операция через 6—8 нед; 4-я (n=73) — лучевое лечение по методике для 2-й группы, СОД 50 Гр на фоне внутривенного введения 50 мг/м2 оксалиплатина в 1, 8, 22 и 29-й дни и приема 825 мг/м2 капецитабина 2 раза в день с 1-го по 14-й и с 22-го по 36-й дни лучевой терапии, операция через 8—10 нед после неоадъювантной терапии. Результаты. Токсические проявления в ходе неоадъювантного лечения развились в 1-й группе у 17 (37,6%) больных, во 2-й — у 53 (82,8%), в 3-й — у 20 (29,8%), в 4-й — у 25 (34,2%) больных, различия статистически достоверны (р<0,05). Полная клиническая регрессия по данным магнитно-резонансной терапии отмечена у 3 (4,7%) больных 2-й группы, 12 (18%) больных 3-й группы и 12 (16,4%) больных 4-й группы. Капецитабин и оксалиплатин+капецитабин достоверно увеличили частоту полных и частичных клинических ответов по сравнению с длительной инфузией 5-ФУ (OR 3,929;95% DI 1,900—8,121; p=0,0002). Заключение. Результаты сравнительного исследования позволили при выборе неоадъювантного воздействия у больных местно-распространенным раком прямой кишки отдать предпочтение лучевой терапии на фоне капецитабина, а при значительном поражении регионарных лимфатических узлов — на фоне оксалиплатина+капецитабина.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45649160","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 : 2022-04-13DOI: 10.17650/2686-9594-2022-12-1-35-40
Z. Dudaev, Dzh. Kh. Khudoerov, Z. Mamedli, V. Aliev, S. Gordeev, V. S. Myshlyakov
Background. Currently available chemoradiotherapy regimens for distal rectal cancer often ensure complete regression of the tumor and lymph node lesions. Therefore, patients with a complete clinical response can be managed with a “watch and wait” (ww) strategy.Objective: to evaluate 2-year overall and progression-free survival in patients with local and locally advanced rectal cancer with a complete clinical response who were managed with the ww strategy.Materials and methods. we performed retrospective analysis of treatment outcomes in patients with newly diagnosed, histologically verified, stage II–III, mrT1–2n1–2m0, T3–4n0–2m0 (within 0–10 cm of the anal verge), and mrT2n0m0 (within 0–5 cm of the anal verge) rectal cancer who had demonstrated complete clinical response to chemoradiotherapy. mandard tumor regression grade (TRg1–2) (assessed using magnetic resonance imaging of the pelvis) and palpatory/visual signs of residual tumor (assessed by digital examination and colonoscopy) were the main parameters evaluated. Overall and disease-free survival was analyzed using the Kaplan–meier method.Results. Twenty-seven patients with a complete clinical response were assigned to the ww group. mRI scans of the pelvis demonstrated that 5 patients (18.5 %) had TRg1, whereas 22 patients (81.5 %) had TRg2. T-downstaging after therapy was observed in 21 participants (77.7 %). n-downstaging was registered in all 14 patients (100 %) with regional lymph nodes affected. median follow-up time was 41 months (range: 25–114 months). Two individuals (7.4 %) developed progressive disease. Both of them had lengthy tumors as demonstrated by digital examination, colonoscopy, and magnetic resonance imaging; they immediately underwent radical surgery. The two-year overall and disease-free survival rates were 100 % and 92.6 %, respectively. Conclusion. The ww strategy with active dynamic follow-up is safe for the management of patients with local and locally advanced middle and lower rectal cancer, provided that inclusion/exclusion criteria are adhered to and patients are carefully followed-up in specialized centers.
{"title":"“Watch and wait” strategy (active dynamic follow-up) in the management of rectal cancer patients with a complete clinical response","authors":"Z. Dudaev, Dzh. Kh. Khudoerov, Z. Mamedli, V. Aliev, S. Gordeev, V. S. Myshlyakov","doi":"10.17650/2686-9594-2022-12-1-35-40","DOIUrl":"https://doi.org/10.17650/2686-9594-2022-12-1-35-40","url":null,"abstract":"Background. Currently available chemoradiotherapy regimens for distal rectal cancer often ensure complete regression of the tumor and lymph node lesions. Therefore, patients with a complete clinical response can be managed with a “watch and wait” (ww) strategy.Objective: to evaluate 2-year overall and progression-free survival in patients with local and locally advanced rectal cancer with a complete clinical response who were managed with the ww strategy.Materials and methods. we performed retrospective analysis of treatment outcomes in patients with newly diagnosed, histologically verified, stage II–III, mrT1–2n1–2m0, T3–4n0–2m0 (within 0–10 cm of the anal verge), and mrT2n0m0 (within 0–5 cm of the anal verge) rectal cancer who had demonstrated complete clinical response to chemoradiotherapy. mandard tumor regression grade (TRg1–2) (assessed using magnetic resonance imaging of the pelvis) and palpatory/visual signs of residual tumor (assessed by digital examination and colonoscopy) were the main parameters evaluated. Overall and disease-free survival was analyzed using the Kaplan–meier method.Results. Twenty-seven patients with a complete clinical response were assigned to the ww group. mRI scans of the pelvis demonstrated that 5 patients (18.5 %) had TRg1, whereas 22 patients (81.5 %) had TRg2. T-downstaging after therapy was observed in 21 participants (77.7 %). n-downstaging was registered in all 14 patients (100 %) with regional lymph nodes affected. median follow-up time was 41 months (range: 25–114 months). Two individuals (7.4 %) developed progressive disease. Both of them had lengthy tumors as demonstrated by digital examination, colonoscopy, and magnetic resonance imaging; they immediately underwent radical surgery. The two-year overall and disease-free survival rates were 100 % and 92.6 %, respectively. Conclusion. The ww strategy with active dynamic follow-up is safe for the management of patients with local and locally advanced middle and lower rectal cancer, provided that inclusion/exclusion criteria are adhered to and patients are carefully followed-up in specialized centers.","PeriodicalId":34449,"journal":{"name":"Tazovaia khirurgiia i onkologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45521802","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}
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