Pub Date : 2020-07-24DOI: 10.17650/2222-1468-2020-10-2-30-37
E. A. Shatokhina, S. Potkin, P. Malkov, L. Kruglova, A. Polonskaya
Background. Multikinase inhibitors of angiogenesis are currently the most effective group of drugs in target therapy for cancer. They are associated with a high prevalence of a specific cutaneous adverse reaction, which manifests as a hand-foot skin reaction (HFSR). This side effect is quite prominent in the majority of patients, usually graded as II–III degree, which leads to the dose reduction and even discontinuation of the drug. The study objective is to evaluate clinical, histological and ultrasound characteristics of a HFSR associated with MKI treatment, and to assess the influence of a HFSR on patient’s quality of life. Materials and methods. The study included 46 patients with HFSR, who were previously treated with sorafenib or lenvatinib. Clinical characteristics of HFSR, including severity grading, were evaluated. We also performed ultrasound and histological examinations and assess the Dermatology Life Quality Index. Results. Grade III HFSR was in 5 (10.86 %) patients, grade II – in 25 (54.35 %), and grade I – in 16 (34.79 %). Dermatology Life Quality Index depended on the HFSR severity, with the mean value 24.5 ± 2.4. Pathomorphological examination revealed irregular epidermal proliferation with hypertrophic psoriasiform acanthosis, minimal keratinocyte vacuolization, few apoptotic figures, dyskeratosis, hyperkeratosis and microvessel dilation in the papillary dermis. Ultrasound examination showed increased vascularization in papillary and reticular dermis in affected skin areas, which was more prominent in patients with severe degrees of HFSR. The pronounced enhancement of vascularization was detected in fragmented hypoechogenic sites along the border of papillary and reticular dermis and in similar sites along the border of dermis and hypodermis. Conclusion. The use of multikinase inhibitors leads to pronounced changes not only in the surface layers of the skin, but also in the dermis and subcutaneous fat, which significantly worsens the quality of life of patients. This indicates the need to search for pathogenetically based methods of treatment of HFSR and create practical guidelines for supportive treatment of patients with HFSR taking multikinase inhibitors.
{"title":"Specificity of hand-foot skin reaction induced by multikinase inhibitors: clinical, histological and ultrasound characteristics","authors":"E. A. Shatokhina, S. Potkin, P. Malkov, L. Kruglova, A. Polonskaya","doi":"10.17650/2222-1468-2020-10-2-30-37","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-2-30-37","url":null,"abstract":"Background. Multikinase inhibitors of angiogenesis are currently the most effective group of drugs in target therapy for cancer. They are associated with a high prevalence of a specific cutaneous adverse reaction, which manifests as a hand-foot skin reaction (HFSR). This side effect is quite prominent in the majority of patients, usually graded as II–III degree, which leads to the dose reduction and even discontinuation of the drug. The study objective is to evaluate clinical, histological and ultrasound characteristics of a HFSR associated with MKI treatment, and to assess the influence of a HFSR on patient’s quality of life. Materials and methods. The study included 46 patients with HFSR, who were previously treated with sorafenib or lenvatinib. Clinical characteristics of HFSR, including severity grading, were evaluated. We also performed ultrasound and histological examinations and assess the Dermatology Life Quality Index. Results. Grade III HFSR was in 5 (10.86 %) patients, grade II – in 25 (54.35 %), and grade I – in 16 (34.79 %). Dermatology Life Quality Index depended on the HFSR severity, with the mean value 24.5 ± 2.4. Pathomorphological examination revealed irregular epidermal proliferation with hypertrophic psoriasiform acanthosis, minimal keratinocyte vacuolization, few apoptotic figures, dyskeratosis, hyperkeratosis and microvessel dilation in the papillary dermis. Ultrasound examination showed increased vascularization in papillary and reticular dermis in affected skin areas, which was more prominent in patients with severe degrees of HFSR. The pronounced enhancement of vascularization was detected in fragmented hypoechogenic sites along the border of papillary and reticular dermis and in similar sites along the border of dermis and hypodermis. Conclusion. The use of multikinase inhibitors leads to pronounced changes not only in the surface layers of the skin, but also in the dermis and subcutaneous fat, which significantly worsens the quality of life of patients. This indicates the need to search for pathogenetically based methods of treatment of HFSR and create practical guidelines for supportive treatment of patients with HFSR taking multikinase inhibitors.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67783588","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 : 2020-07-24DOI: 10.17650/2222-1468-2020-10-2-46-53
I. Romanov, А. M. Mudunov, S. Podvyaznikov, А. V. Ignatova, Y. Alymov
The study objective is to perform retrospective analysis of the efficacy and safety of vandetanib for metastatic and non-resectable medullary thyroid cancer in routine clinical practice. Materials and methods. We analyzed treatment outcomes in 46 patients treated with vandetanib. We also evaluated progression-free survival, overall survival, time to progression, and frequency of adverse events. Results. At a median follow-up time of 27.4 months (range: 2.5–106.5 months) and median duration of vandetanib therapy of 21 months, disease progression was registered in 32.6 % of cases, whereas stable disease was observed in 28.3 % of cases and 8.7 % of study participants demonstrated partial response. One patient had complete response to treatment. Almost one-third of patients (28.2 %) died, including 2 individuals whose death was not associated with cancer. The one-year and three-year progression-free survival rates were 67.3 % and 33.3 %, respectively; the two-year and five-year overall survival rates were 82.4 % and 29.4 %, respectively. The efficacy of therapy was confirmed by a 79.4 % decrease in the serum level of calcitonin after treatment initiation. Side effects were observed in 33.9 % of patients (primarily skin and gastrointestinal toxic reactions) and were easily managed in most of the cases. Eight individuals (17.4 %) required cessation of vandetanib due to adverse events. Conclusion. Our findings suggest high efficacy and acceptable safety profile of vandetanib in the treatment of progressive locally advanced non-resectable and disseminated medullary thyroid cancer
{"title":"Analysis of treatment outcomes in patients with progressive locally advanced non-resectable and disseminated medullary thyroid cancer receiving vandetanib outside of clinical trials (Russian experience)","authors":"I. Romanov, А. M. Mudunov, S. Podvyaznikov, А. V. Ignatova, Y. Alymov","doi":"10.17650/2222-1468-2020-10-2-46-53","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-2-46-53","url":null,"abstract":"The study objective is to perform retrospective analysis of the efficacy and safety of vandetanib for metastatic and non-resectable medullary thyroid cancer in routine clinical practice. Materials and methods. We analyzed treatment outcomes in 46 patients treated with vandetanib. We also evaluated progression-free survival, overall survival, time to progression, and frequency of adverse events. Results. At a median follow-up time of 27.4 months (range: 2.5–106.5 months) and median duration of vandetanib therapy of 21 months, disease progression was registered in 32.6 % of cases, whereas stable disease was observed in 28.3 % of cases and 8.7 % of study participants demonstrated partial response. One patient had complete response to treatment. Almost one-third of patients (28.2 %) died, including 2 individuals whose death was not associated with cancer. The one-year and three-year progression-free survival rates were 67.3 % and 33.3 %, respectively; the two-year and five-year overall survival rates were 82.4 % and 29.4 %, respectively. The efficacy of therapy was confirmed by a 79.4 % decrease in the serum level of calcitonin after treatment initiation. Side effects were observed in 33.9 % of patients (primarily skin and gastrointestinal toxic reactions) and were easily managed in most of the cases. Eight individuals (17.4 %) required cessation of vandetanib due to adverse events. Conclusion. Our findings suggest high efficacy and acceptable safety profile of vandetanib in the treatment of progressive locally advanced non-resectable and disseminated medullary thyroid cancer","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67783739","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 : 2020-07-24DOI: 10.17650/2222-1468-2020-10-2-38-45
D. Sashin, Dolgushin Mb, E. Kobyakova, A. Bekyashev, A. Subbotin, E. Nechipay, D. Romanov, N. A. Kozlov
The study objectiveis to assess the possibilities of magnetic resonance imaging (MRI) in SWI (susceptibility weighted imaging) in the differential diagnosis of glial brain tumors and primary brain lymphomas.Materials and methods.Fifty-four patients with brain tumors were studied (men – 27 (50 %), women – 27 (50 %)). Average age 57.9 years. Histological examination of the surgical material revealed the glial nature of tumors in 41 patients (26 of them with glioblastoma, anaplastic astrocytomas – 15), primary brain lymphomas – in 13 patients. Brain MRI was performed using tomographs with a magnetic field of 3 and 1.5 T. A semi-quantitative assessment of the data obtained in the SWI mode based on the classification of ITSS (intratumoral susceptibility signals), reflecting the severity of interstitial vascular architectonics and microbleeding.Results.The degree of ITSS was 3 in glioblastomas (G4 ) in 26 (100 %) cases, in the structure of gliomas (G3 ) the ITSS values were 3 in 3 (20 %) cases, in the remaining 12 (80 %) cases – ITSS 2. In the group of primary brain lymphomas, the ITSS 1 was in 4 (30.7 %) cases, ITSS 0 was in 9 (69.3 %) cases.Conclusion.MRI in SWI mode is a promising technique that allows one to quantify the degree of pathological changes in tumor vascular architectonics and intratumoral hemorrhages and has shown high specificity in the differential diagnosis of malignant gliomas and lymphomas of the brain, accompanied by active accumulation of contrast medium.
{"title":"Possibilities of magnetic resonance imaging in SWI mode in differential diagnosis of brain gliomas (G3–G4) and primary lymphomas","authors":"D. Sashin, Dolgushin Mb, E. Kobyakova, A. Bekyashev, A. Subbotin, E. Nechipay, D. Romanov, N. A. Kozlov","doi":"10.17650/2222-1468-2020-10-2-38-45","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-2-38-45","url":null,"abstract":"The study objectiveis to assess the possibilities of magnetic resonance imaging (MRI) in SWI (susceptibility weighted imaging) in the differential diagnosis of glial brain tumors and primary brain lymphomas.Materials and methods.Fifty-four patients with brain tumors were studied (men – 27 (50 %), women – 27 (50 %)). Average age 57.9 years. Histological examination of the surgical material revealed the glial nature of tumors in 41 patients (26 of them with glioblastoma, anaplastic astrocytomas – 15), primary brain lymphomas – in 13 patients. Brain MRI was performed using tomographs with a magnetic field of 3 and 1.5 T. A semi-quantitative assessment of the data obtained in the SWI mode based on the classification of ITSS (intratumoral susceptibility signals), reflecting the severity of interstitial vascular architectonics and microbleeding.Results.The degree of ITSS was 3 in glioblastomas (G4 ) in 26 (100 %) cases, in the structure of gliomas (G3 ) the ITSS values were 3 in 3 (20 %) cases, in the remaining 12 (80 %) cases – ITSS 2. In the group of primary brain lymphomas, the ITSS 1 was in 4 (30.7 %) cases, ITSS 0 was in 9 (69.3 %) cases.Conclusion.MRI in SWI mode is a promising technique that allows one to quantify the degree of pathological changes in tumor vascular architectonics and intratumoral hemorrhages and has shown high specificity in the differential diagnosis of malignant gliomas and lymphomas of the brain, accompanied by active accumulation of contrast medium.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67783715","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 : 2020-07-24DOI: 10.17650/2222-1468-2020-10-2-54-60
A. Guz, D. M. Fatkullin, A. Garev, A. S. Zakharov, M. I. Sokolova, A. P. Alekseeva
This review analyzes the research data concerning the problem of antibiotic prophylaxis (ABP) of wound infections after various surgeries for head and neck tumors. In patients with clean wounds, ABP should be used in exceptional cases only (for example, if the patient has any risk factors), otherwise it should be avoided. A short ABP course is recommended for patients with clean-contaminated wounds; however highrisk patients may require a prolonged course. There is some evidence of ABP efficacy in patients with non-contaminated wounds after cervical lymphadenectomy. When choosing a drug for ABP, a doctor should consider the site of surgery and the risk of wound contamination. The optimal drugs after head and neck surgeries include first- and second-generation cephalosporins, ampicillin in combination with sulbactam, metronidazole, and clindamycin. First- and second-generation cephalosporins in combination with metronidazole are preferable, but if the wound is infected with gram-positive bacteria, it is necessary to use clindamycin monotherapy. Reconstructive surgeries with a free flap require a short course of ABP with one of the following combinations: cefazolin + metronidazole, cefuroxime + metronidazole, or ampicillin + sulbactam; if the patient is allergic to beta-lactams, clindamycin can be used. Despite the availability of standard ABP regimens, a surgeon must apply a tailored approach when choosing an ABP regimen for each patient, taking into account risk factors and the volume of surgery.
{"title":"Antibiotic prophylaxis for head and neck cancer surgery","authors":"A. Guz, D. M. Fatkullin, A. Garev, A. S. Zakharov, M. I. Sokolova, A. P. Alekseeva","doi":"10.17650/2222-1468-2020-10-2-54-60","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-2-54-60","url":null,"abstract":"This review analyzes the research data concerning the problem of antibiotic prophylaxis (ABP) of wound infections after various surgeries for head and neck tumors. In patients with clean wounds, ABP should be used in exceptional cases only (for example, if the patient has any risk factors), otherwise it should be avoided. A short ABP course is recommended for patients with clean-contaminated wounds; however highrisk patients may require a prolonged course. There is some evidence of ABP efficacy in patients with non-contaminated wounds after cervical lymphadenectomy. When choosing a drug for ABP, a doctor should consider the site of surgery and the risk of wound contamination. The optimal drugs after head and neck surgeries include first- and second-generation cephalosporins, ampicillin in combination with sulbactam, metronidazole, and clindamycin. First- and second-generation cephalosporins in combination with metronidazole are preferable, but if the wound is infected with gram-positive bacteria, it is necessary to use clindamycin monotherapy. Reconstructive surgeries with a free flap require a short course of ABP with one of the following combinations: cefazolin + metronidazole, cefuroxime + metronidazole, or ampicillin + sulbactam; if the patient is allergic to beta-lactams, clindamycin can be used. Despite the availability of standard ABP regimens, a surgeon must apply a tailored approach when choosing an ABP regimen for each patient, taking into account risk factors and the volume of surgery.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67783208","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 : 2020-07-24DOI: 10.17650/2222-1468-2020-10-2-61-68
H. Chen, A. Mudunov, R. I. Azizian, I. Pustynskiy, D. K. Stelmah
This review covers the issues related to the application of radial free forearm flaps for the reconstruction of defects after surgeries for oral squamous cell carcinoma. The advantages of this method include optimal match of the flap to the tissues of the oral cavity, good adaptation to defect edges, and possibility to replace defects of almost any size and locations. Flap survival rate reaches 92.0–98.4 %. The method demonstrated good functional and aesthetic results when used for the repair of extensive defects of the tongue, oral floor, cheeks, as well as total defects of the lips, hard and soft palates. The main disadvantages of the method include aesthetic defects of the donor site and possible forearm dysfunction, but most patients are quite comfortable with these inconveniences. The death rate is 0.09 %; the incidence of complications is 15–24 %. The main cause of graft failure in this case is venous thrombosis. Advanced age is not currently considered as a contraindication for this method. Further studies evaluating free radial flaps are highly relevant, particularly those comparing this method with other ones and determining strict indications for it (such as size and location of the defect, tumor characteristics, and previous treatment).
{"title":"Oral cancer reconstructive surgery using the free radial forearm flap (review)","authors":"H. Chen, A. Mudunov, R. I. Azizian, I. Pustynskiy, D. K. Stelmah","doi":"10.17650/2222-1468-2020-10-2-61-68","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-2-61-68","url":null,"abstract":"This review covers the issues related to the application of radial free forearm flaps for the reconstruction of defects after surgeries for oral squamous cell carcinoma. The advantages of this method include optimal match of the flap to the tissues of the oral cavity, good adaptation to defect edges, and possibility to replace defects of almost any size and locations. Flap survival rate reaches 92.0–98.4 %. The method demonstrated good functional and aesthetic results when used for the repair of extensive defects of the tongue, oral floor, cheeks, as well as total defects of the lips, hard and soft palates. The main disadvantages of the method include aesthetic defects of the donor site and possible forearm dysfunction, but most patients are quite comfortable with these inconveniences. The death rate is 0.09 %; the incidence of complications is 15–24 %. The main cause of graft failure in this case is venous thrombosis. Advanced age is not currently considered as a contraindication for this method. Further studies evaluating free radial flaps are highly relevant, particularly those comparing this method with other ones and determining strict indications for it (such as size and location of the defect, tumor characteristics, and previous treatment).","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67783361","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 : 2020-07-24DOI: 10.17650/2222-1468-2020-10-2-22-29
A. S. Sharapo, V. Ivashkov, А. M. Mudunov, M. Bolotin, M. Bektemirov, A. E. Raportinova
The study objectiveis to analyze the results of the use of free osteomyofascial flaps in the reconstruction of combined post-resection facial defects with an intraoral component.Materials and methods.Fifty-three patients were operated by the proposed method. The muscle portions which were used with free flaps were: m. flexor hallucis longus with the free fibula flap (n = 27), m. vastus lateralis with anterolateral thigh flap (n = 11), m. subscapularis with the scapula free flap (n = 15). An analysis of postoperative complications was performed, as well as an analysis of the timing of dental implantation.Results.The average hospital stay was 15 days. The main complications from the recipient area were: local inflammation in the reconstruction area – 2 (3.8 %) cases, hematoma on the neck – 2 (3.8 %), fistula formation – 1 (1.9 %), full flap necrosis was noted in 1 (3.7 %) case, hypertrophic growths of granulation tissue on the muscle portions of the flaps in 3 (5.7 %). The main complications from the donor zone: hematomas – 0 cases. In 2 (13.3 %) patients after using a chimeric scapular flap, lymphorrea up to 50–70 ml was noted. Dental implantation was performed in 4 (9.5 %) cases. There were no complications or difficulties in performing dental implantation. The average time taken to form the soft tissue contour in the area of implants after installing the gingiva formers in our study was 2.5 weeks, which is 2 weeks faster than using flaps that include a skin paddle.Conclusion.This reconstruction method could be used as a main for the plastic elimination of combined facial defects with an intraoral component.
{"title":"The results of using free osteomyofascial flaps in the simultaneous reconstruction of combined post-resection facial defects with an intraoral component","authors":"A. S. Sharapo, V. Ivashkov, А. M. Mudunov, M. Bolotin, M. Bektemirov, A. E. Raportinova","doi":"10.17650/2222-1468-2020-10-2-22-29","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-2-22-29","url":null,"abstract":"The study objectiveis to analyze the results of the use of free osteomyofascial flaps in the reconstruction of combined post-resection facial defects with an intraoral component.Materials and methods.Fifty-three patients were operated by the proposed method. The muscle portions which were used with free flaps were: m. flexor hallucis longus with the free fibula flap (n = 27), m. vastus lateralis with anterolateral thigh flap (n = 11), m. subscapularis with the scapula free flap (n = 15). An analysis of postoperative complications was performed, as well as an analysis of the timing of dental implantation.Results.The average hospital stay was 15 days. The main complications from the recipient area were: local inflammation in the reconstruction area – 2 (3.8 %) cases, hematoma on the neck – 2 (3.8 %), fistula formation – 1 (1.9 %), full flap necrosis was noted in 1 (3.7 %) case, hypertrophic growths of granulation tissue on the muscle portions of the flaps in 3 (5.7 %). The main complications from the donor zone: hematomas – 0 cases. In 2 (13.3 %) patients after using a chimeric scapular flap, lymphorrea up to 50–70 ml was noted. Dental implantation was performed in 4 (9.5 %) cases. There were no complications or difficulties in performing dental implantation. The average time taken to form the soft tissue contour in the area of implants after installing the gingiva formers in our study was 2.5 weeks, which is 2 weeks faster than using flaps that include a skin paddle.Conclusion.This reconstruction method could be used as a main for the plastic elimination of combined facial defects with an intraoral component.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67783392","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 : 2020-04-11DOI: 10.17650/2222-1468-2020-10-1-73-83
S. Podvyaznikov, A. Mudunov, A. V. Ignatova, D. A. Vasilkin, A. N. Anisimov, P. Shchennikov
Introduction. Basal cell cancer (BCC) accounts for up to 80 % of all types of non-melanoma skin cancers. In 97 % of cases, BCC develops on bare facial skin, especially at the nose-forehead border, nose wings, corners of eyes and lips. Surgery can lead to gross cosmetic defects, therefore more and more specialists prefer conservative methods, among which local drug therapy holds a special place.The study objective is to evaluate the effectiveness and safety of glyciphon ointment for BCC local treatment as well as the economic costs. Materials and methods. The study included 114 patients who underwent BCC local drug therapy with 30 % Glyciphon ointment, where 111 (97.4 %) patients had primary BCC, and 3 (2.6 %) ones – recurrent BCC. Results. The study recorded 115 cases of use of glyciphon ointment in 114 patients. Doctors were fully satisfied with the treatment results in 101 (88.6 %) cases. In 11 (9.6 %) cases, satisfaction was partial due to severe adverse events (edema and hyperemia of the facial skin, pain), and in 2 (1.7 %) cases the treatment was found unsatisfactory. Eighty-six (93.5 %) patients with adverse events continued Glyciphon ointment therapy. The relapse rate after local drug therapy was 4.4 %, indicating its high efficacy and good tolerance. According to the study, most patients required 1 treatment course with 1 package of Glyciphon. Total cost of the treatment is approximately 17,000 rubles. Total budget expenditures are estimated at 1 billion 190 million rubles. Local BCC therapy with Glyciphon comparing to surgery may save more than 1 billion rubles for the state budget.Conclusion. Local chemotherapy with 30 % Glyciphon ointment is an effective and safe method to treat BCC. Its use increases treatment availability for patients and can significantly reduce federal expenditures.
{"title":"Glyciphon ointment for local treatment of basal cell cancer: clinical and pharmacological aspects","authors":"S. Podvyaznikov, A. Mudunov, A. V. Ignatova, D. A. Vasilkin, A. N. Anisimov, P. Shchennikov","doi":"10.17650/2222-1468-2020-10-1-73-83","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-1-73-83","url":null,"abstract":"Introduction. Basal cell cancer (BCC) accounts for up to 80 % of all types of non-melanoma skin cancers. In 97 % of cases, BCC develops on bare facial skin, especially at the nose-forehead border, nose wings, corners of eyes and lips. Surgery can lead to gross cosmetic defects, therefore more and more specialists prefer conservative methods, among which local drug therapy holds a special place.The study objective is to evaluate the effectiveness and safety of glyciphon ointment for BCC local treatment as well as the economic costs. Materials and methods. The study included 114 patients who underwent BCC local drug therapy with 30 % Glyciphon ointment, where 111 (97.4 %) patients had primary BCC, and 3 (2.6 %) ones – recurrent BCC. Results. The study recorded 115 cases of use of glyciphon ointment in 114 patients. Doctors were fully satisfied with the treatment results in 101 (88.6 %) cases. In 11 (9.6 %) cases, satisfaction was partial due to severe adverse events (edema and hyperemia of the facial skin, pain), and in 2 (1.7 %) cases the treatment was found unsatisfactory. Eighty-six (93.5 %) patients with adverse events continued Glyciphon ointment therapy. The relapse rate after local drug therapy was 4.4 %, indicating its high efficacy and good tolerance. According to the study, most patients required 1 treatment course with 1 package of Glyciphon. Total cost of the treatment is approximately 17,000 rubles. Total budget expenditures are estimated at 1 billion 190 million rubles. Local BCC therapy with Glyciphon comparing to surgery may save more than 1 billion rubles for the state budget.Conclusion. Local chemotherapy with 30 % Glyciphon ointment is an effective and safe method to treat BCC. Its use increases treatment availability for patients and can significantly reduce federal expenditures. ","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67782190","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 : 2020-04-11DOI: 10.17650/2222-1468-2020-10-1-65-72
E. Borodavina, P. Isaev, A. Shurinov, P. Rumyantsev, V. Krylov, K. Petrosyan, A. Kaprin, S. A. Ivanov, S. Podvyaznikov, I. Romanov, A. Mudunov, K. Slashchuk, R. Zhikhorev, M. Volkonsky, R. M. Chagova, I. Suslova, A. I. Khryapa, A. K. Lepshokova, N. L. Fadeeva, A. R. Safarova, L. P. Kaleykina, E. V. Lymar, E. Chernyakova, O. A. Snezhko, A. E. Zinkovskaya, F. F. Mufazalov, E. Kuzmina, Y. Druzhinina, S. Musin, M. R. Mukhitova, A. Khasanova, S. Safina, S. L. Kirienko
Background. The implementation of tyrosine kinase inhibitors into clinical practice improved treatment outcomes in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC). Lenvatinib is recommended as a first-line drug for these patients. The study objective is to analyze clinical experience with lenvatinib in patients with RR-DTC in the Russian Federation. Materials and methods. The data from 18 clinical sites in Russia was analyzed for the period December 2015 and September 2019. Seventyseven patients with histologically verified DTC, proven resistance to radioactive iodine therapy, and tumor progression (according to the Response Evaluation Criteria In Solid Tumors 1.1 criteria) were included in the study. Results.Median progression-free survival in patients included into analysis (n = 72) was 26.1 months. In patients who responded to therapy (including those with partial and complete response), median progression-free survival reached 36.2 months, which is higher than that reported in the updated results of the SELECT study (33.1 months). Lenvatinib-associated adverse events (AEs) were observed in 87 % of patients. Severe AEs were registered in 18.2 % of participants. In 6.5 % of cases, AEs lead to lenvatinib cessation; in 74 % of cases, AEs required dose reduction.Conclusion. Our findings suggest high efficacy and good tolerability of lenvatinib in patients with RR-DTC in routine clinical practice in the Russian Federation.
{"title":"Efficacy and tolerability of lenvatinib in patients with radioiodine-refractory differentiated thyroid cancer: results of a multicenter observational study in the Russian Federation","authors":"E. Borodavina, P. Isaev, A. Shurinov, P. Rumyantsev, V. Krylov, K. Petrosyan, A. Kaprin, S. A. Ivanov, S. Podvyaznikov, I. Romanov, A. Mudunov, K. Slashchuk, R. Zhikhorev, M. Volkonsky, R. M. Chagova, I. Suslova, A. I. Khryapa, A. K. Lepshokova, N. L. Fadeeva, A. R. Safarova, L. P. Kaleykina, E. V. Lymar, E. Chernyakova, O. A. Snezhko, A. E. Zinkovskaya, F. F. Mufazalov, E. Kuzmina, Y. Druzhinina, S. Musin, M. R. Mukhitova, A. Khasanova, S. Safina, S. L. Kirienko","doi":"10.17650/2222-1468-2020-10-1-65-72","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-1-65-72","url":null,"abstract":"Background. The implementation of tyrosine kinase inhibitors into clinical practice improved treatment outcomes in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC). Lenvatinib is recommended as a first-line drug for these patients. The study objective is to analyze clinical experience with lenvatinib in patients with RR-DTC in the Russian Federation. Materials and methods. The data from 18 clinical sites in Russia was analyzed for the period December 2015 and September 2019. Seventyseven patients with histologically verified DTC, proven resistance to radioactive iodine therapy, and tumor progression (according to the Response Evaluation Criteria In Solid Tumors 1.1 criteria) were included in the study. Results.Median progression-free survival in patients included into analysis (n = 72) was 26.1 months. In patients who responded to therapy (including those with partial and complete response), median progression-free survival reached 36.2 months, which is higher than that reported in the updated results of the SELECT study (33.1 months). Lenvatinib-associated adverse events (AEs) were observed in 87 % of patients. Severe AEs were registered in 18.2 % of participants. In 6.5 % of cases, AEs lead to lenvatinib cessation; in 74 % of cases, AEs required dose reduction.Conclusion. Our findings suggest high efficacy and good tolerability of lenvatinib in patients with RR-DTC in routine clinical practice in the Russian Federation.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67782125","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 : 2020-04-11DOI: 10.17650/2222-1468-2020-10-1-101-106
G. Tkachenko, S. Podvyaznikov, A. Mudunov, Е. V. Gusakova
The study objective is to assess the effectiveness of psychological support to patients with laryngeal cancer after laryngectomy. Materials and methods.This study included 36 male patients aged between 45 and 62 years with morphologically verified stage II–IV (Т3–4N0–2М0) laryngeal cancer treated in the Department of Head and Neck Tumors, N. N. Blokhin National Medical Research Center of Oncology in 2011–2016. Patients were randomized into two groups. Group 1 included 14 patients who received antitumor therapy alone. Group 2 comprised 22 patients who additionally received psychological support. Patients’ mental state was assessed before treatment and 6 months after its completion using the Hospital Anxiety and Depression Scale and Symptom Check List-90 Revised. Two patients from Group 1 and 1 patient from Group 2 were excluded from the study at the first stage. Results. We found that patients in both groups had severe psychopathological symptoms (including depression, interpersonal sensitivity, and severe distress) six month after treatment completion (according to the Symptom Check List-90 Revised). Patients who received psychological support demonstrated higher level of depression than healthy controls, but it was still significantly lower than that in patients who received no psychological assistance. Similar results were obtained by the Hospital Anxiety and Depression Scale: patients who received psychological support had significantly lower level of depression than patients who had no psychological support (8.3 ± 0.9 vs 10.2 ± 0.6 points respectively). Conclusion. Patients with laryngeal cancer who received psychological assistance (including cognitive behavioral psychotherapy) demonstrated significantly lower level of depression 6 months after treatment completion compared to those who received no psychological support.
本研究的目的是评估心理支持对喉癌患者喉切除术后的效果。材料和方法。本研究纳入2011-2016年在N. N. Blokhin国家肿瘤医学研究中心头颈部肿瘤科治疗的36例经形态学证实的II-IV期(Т3-4N0-2М0)喉癌男性患者，年龄在45 - 62岁之间。患者随机分为两组。第1组14例患者单独接受抗肿瘤治疗。第二组22例患者接受心理支持。采用医院焦虑抑郁量表及症状检查表-90修订版对患者治疗前及治疗结束后6个月的精神状态进行评估。第一组2例患者和第二组1例患者在第一阶段被排除在研究之外。结果。我们发现两组患者在治疗结束6个月后都有严重的精神病理症状(包括抑郁、人际关系敏感和严重的痛苦)(根据症状检查表-90修订版)。接受心理支持的患者抑郁水平高于健康对照组，但仍显著低于未接受心理支持的患者。医院焦虑抑郁量表也得出类似的结果:接受心理支持的患者抑郁水平明显低于未接受心理支持的患者(分别为8.3±0.9分和10.2±0.6分)。结论。接受心理援助(包括认知行为心理治疗)的喉癌患者在治疗结束后6个月的抑郁水平明显低于未接受心理支持的患者。
{"title":"Psychological assistance to patients after laryngectomy","authors":"G. Tkachenko, S. Podvyaznikov, A. Mudunov, Е. V. Gusakova","doi":"10.17650/2222-1468-2020-10-1-101-106","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-1-101-106","url":null,"abstract":"The study objective is to assess the effectiveness of psychological support to patients with laryngeal cancer after laryngectomy. Materials and methods.This study included 36 male patients aged between 45 and 62 years with morphologically verified stage II–IV (Т3–4N0–2М0) laryngeal cancer treated in the Department of Head and Neck Tumors, N. N. Blokhin National Medical Research Center of Oncology in 2011–2016. Patients were randomized into two groups. Group 1 included 14 patients who received antitumor therapy alone. Group 2 comprised 22 patients who additionally received psychological support. Patients’ mental state was assessed before treatment and 6 months after its completion using the Hospital Anxiety and Depression Scale and Symptom Check List-90 Revised. Two patients from Group 1 and 1 patient from Group 2 were excluded from the study at the first stage. Results. We found that patients in both groups had severe psychopathological symptoms (including depression, interpersonal sensitivity, and severe distress) six month after treatment completion (according to the Symptom Check List-90 Revised). Patients who received psychological support demonstrated higher level of depression than healthy controls, but it was still significantly lower than that in patients who received no psychological assistance. Similar results were obtained by the Hospital Anxiety and Depression Scale: patients who received psychological support had significantly lower level of depression than patients who had no psychological support (8.3 ± 0.9 vs 10.2 ± 0.6 points respectively). Conclusion. Patients with laryngeal cancer who received psychological assistance (including cognitive behavioral psychotherapy) demonstrated significantly lower level of depression 6 months after treatment completion compared to those who received no psychological support.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67781656","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 : 2020-04-11DOI: 10.17650/2222-1468-2020-10-1-55-64
H. Chen, A. Mudunov, R. I. Azizian, I. Pustynskiy, O. A. Saprina, M. Bolotin
The study objectiveis to assess immediate and long-term results of replacing complex defects with a free radial forearm flap in the multimodal treatment of patients with locally advanced oral cavity squamous cell carcinoma.Materials and methods.Twenty eight patients (20 women and 8 men aged 23 to 71 years) with locally advanced oral cavity squamous cell carcinoma (including 10 buccal cancers, 8 carcinomas of tongue, 6 carcinomas of the floor of the mouth, 2 retromolar area carcinomas, 1 carcinoma of the hard palate and 1 carcinoma of alveolar region of the lower jaw) underwent tumor surgery with simultaneous plastic reconstruction of the defect using radial forearm free flap at the department of head and neck tumors of N. N. Blokhin National Medical Research Center of Oncology within 2010–2018. Primary tumors were detected in 2 patients and 11 patients had residual (n = 7) or recurrent (n = 4) tumors after radiotherapy or chemoradiotherapy.Results.An overall success rate was 96.4 %. Postoperative histology revealed that there were no tumor cells at the resection edges. Postoperative complications included: complete flap necrosis in 1 patient with severe concomitant diseases, marginal flap necrosis in 2 patients (in both cases after the necrotic tissue had rejected, wounds were healed by secondary intention), sural veins thrombosis in 1 patient, acute peptic ulcer bleeding on the 6th day after surgery in 1 patient treated with emergency endoscopic hemostasis. No lethal outcomes were reported. Postoperative period lasted in average 14 days. Upon subsequent observation tumor relapse in the oral cavity occurred in 4 (14.3 %) patients, relapses of regional metastases – in 2 (7.1 %). Good aesthetic and functional results were noted. Adequate restoration of breathing, chewing, swallowing and speaking resulted in a full patients’ rehabilitation. In all cases, the radial flap adapted well to the oral cavity organs and corresponded to the surrounding tissues in thickness and consistency.Conclusion.Use of a radial forearm free flap makes it possible to successfully reconstruct extensive and complex defects after surgery of locally advanced primary and recurrent forms of oral cavity squamous cell cancer of various locations. Due to flap’s high regenerative capabilities, preoperative radiation therapy does not affect the frequency of local complications. It allows restoring vital functions of the oral cavity and achieving good aesthetic and functional results.
本研究的目的是评估用前臂游离桡侧皮瓣替代复杂缺损在多模式治疗局部晚期口腔鳞状细胞癌患者中的近期和长期效果。材料和方法。局部进展期口腔鳞状细胞癌28例(女20例，男8例，年龄23 ~ 71岁)，其中颊部癌10例，舌部癌8例，口腔底部癌6例，磨牙后区癌2例。2010-2018年，N. N. Blokhin国家肿瘤医学研究中心头颈部肿瘤科采用前臂桡骨游离皮瓣同时进行缺损整形重建的肿瘤手术，其中硬腭癌1例，下颌骨牙槽区癌1例。经放疗或放化疗后发现原发肿瘤2例，残留肿瘤11例(n = 7)或复发肿瘤11例(n = 4)。术后组织学显示切除边缘未见肿瘤细胞。术后并发症包括:皮瓣完全坏死1例伴严重并发症，皮瓣边缘坏死2例(均为坏死组织发生排斥反应后，创面二次愈合)，腓肠静脉血栓形成1例，急诊内镜止血1例术后第6天急性消化性溃疡出血。没有致命结果的报道。术后平均14 d。经随访观察，口腔肿瘤复发4例(14.3%)，局部转移复发2例(7.1%)。良好的美观和功能效果。充分恢复呼吸、咀嚼、吞咽和说话，使患者完全康复。结论:前臂桡侧游离皮瓣可以成功地修复局部晚期和复发口腔鳞状细胞癌术后广泛复杂的缺损。由于皮瓣的高再生能力，术前放疗不影响局部并发症的发生频率。它可以恢复口腔的重要功能，达到良好的审美和功能效果。
{"title":"Free radial forearm flap for reconstruction of postoperative defects in combined and complex treatment of patients with locally-advanced squamous cell carcinoma of the oral cavity","authors":"H. Chen, A. Mudunov, R. I. Azizian, I. Pustynskiy, O. A. Saprina, M. Bolotin","doi":"10.17650/2222-1468-2020-10-1-55-64","DOIUrl":"https://doi.org/10.17650/2222-1468-2020-10-1-55-64","url":null,"abstract":"The study objectiveis to assess immediate and long-term results of replacing complex defects with a free radial forearm flap in the multimodal treatment of patients with locally advanced oral cavity squamous cell carcinoma.Materials and methods.Twenty eight patients (20 women and 8 men aged 23 to 71 years) with locally advanced oral cavity squamous cell carcinoma (including 10 buccal cancers, 8 carcinomas of tongue, 6 carcinomas of the floor of the mouth, 2 retromolar area carcinomas, 1 carcinoma of the hard palate and 1 carcinoma of alveolar region of the lower jaw) underwent tumor surgery with simultaneous plastic reconstruction of the defect using radial forearm free flap at the department of head and neck tumors of N. N. Blokhin National Medical Research Center of Oncology within 2010–2018. Primary tumors were detected in 2 patients and 11 patients had residual (n = 7) or recurrent (n = 4) tumors after radiotherapy or chemoradiotherapy.Results.An overall success rate was 96.4 %. Postoperative histology revealed that there were no tumor cells at the resection edges. Postoperative complications included: complete flap necrosis in 1 patient with severe concomitant diseases, marginal flap necrosis in 2 patients (in both cases after the necrotic tissue had rejected, wounds were healed by secondary intention), sural veins thrombosis in 1 patient, acute peptic ulcer bleeding on the 6th day after surgery in 1 patient treated with emergency endoscopic hemostasis. No lethal outcomes were reported. Postoperative period lasted in average 14 days. Upon subsequent observation tumor relapse in the oral cavity occurred in 4 (14.3 %) patients, relapses of regional metastases – in 2 (7.1 %). Good aesthetic and functional results were noted. Adequate restoration of breathing, chewing, swallowing and speaking resulted in a full patients’ rehabilitation. In all cases, the radial flap adapted well to the oral cavity organs and corresponded to the surrounding tissues in thickness and consistency.Conclusion.Use of a radial forearm free flap makes it possible to successfully reconstruct extensive and complex defects after surgery of locally advanced primary and recurrent forms of oral cavity squamous cell cancer of various locations. Due to flap’s high regenerative capabilities, preoperative radiation therapy does not affect the frequency of local complications. It allows restoring vital functions of the oral cavity and achieving good aesthetic and functional results.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67782654","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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