Pub Date : 2019-01-12DOI: 10.17650/2222-1468-2018-8-4-14-20
Л. В. Болотина, А. Л. Корниецкая, Андрей Дмитриевич Каприн, Е. Ю. Карпенко
The study objective is to provide a rationale for the development of an individual treatment plan for patients with locally advanced squamous cell carcinoma of the larynx, hypopharynx, and oropharynx by selecting different regimens of induction chemotherapy according to biological characteristics of the tumor and functional status of the patient. Materials and methods . We developed an individual treatment plan for a patient with stage IV moderately differentiated oropharyngeal squamous cell carcinoma (cT4N2M0) characterized by extensive local distribution, pronounced clinical symptoms of respiratory failure, and bilateral conglomerates of metastatic lymph nodes. The treatment scheme included paclitaxel (80 mg/m 2 ), carboplatin AUC 2, and ce-tuximab (400 mg/m 2 loading dose, then 250 mg/m 2 ). The treatment was initially palliative. The patient received 6 injections once a week. Results. After a six-week course, we observed tumor resorption by more than 50 %, which allowed the second stage of treatment that included radical chemoradiotherapy with cetuximab. After summarizing our own experience, we found that the majority of patients with initially unresectable tumors, but in good overall physical condition responded to docetaxel, cisplatin, 5-fluorouracil (TPF) — based chemotherapy. Approximately half of them had complete tumor resorption, whereas 14.2 % of them had stabilization of the tumor process. Research literature shows that up to 30 % of patients receiving chemoradiotherapy with cisplatin fail to complete the planned treatment due to its toxicity; replacement of cisplatin with carboplatin and 5-fluorouracil results in mucositis and thrombocytopenia. By contrast, chemoradiotherapy with cetuximab significantly increases both 3-year and 5-year survival and demonstrates good tolerability. In patients with .severe nutritional deficiency, concomitant cardiac diseases, polyneuropathy, and impaired liver function, the preference should be given to less toxic treatment regimens. Conclusion. Cetuximab-containing chemotherapy regimens are the most effective treatment option in head and neck squamous cell carcinoma They can be used in patients with different functional status depending on the clinical situation.
{"title":"Первая линия лекарственной терапии плоскоклеточного рака головы и шеи. Оптимальная стратегия","authors":"Л. В. Болотина, А. Л. Корниецкая, Андрей Дмитриевич Каприн, Е. Ю. Карпенко","doi":"10.17650/2222-1468-2018-8-4-14-20","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-4-14-20","url":null,"abstract":"The study objective is to provide a rationale for the development of an individual treatment plan for patients with locally advanced squamous cell carcinoma of the larynx, hypopharynx, and oropharynx by selecting different regimens of induction chemotherapy according to biological characteristics of the tumor and functional status of the patient. Materials and methods . We developed an individual treatment plan for a patient with stage IV moderately differentiated oropharyngeal squamous cell carcinoma (cT4N2M0) characterized by extensive local distribution, pronounced clinical symptoms of respiratory failure, and bilateral conglomerates of metastatic lymph nodes. The treatment scheme included paclitaxel (80 mg/m 2 ), carboplatin AUC 2, and ce-tuximab (400 mg/m 2 loading dose, then 250 mg/m 2 ). The treatment was initially palliative. The patient received 6 injections once a week. Results. After a six-week course, we observed tumor resorption by more than 50 %, which allowed the second stage of treatment that included radical chemoradiotherapy with cetuximab. After summarizing our own experience, we found that the majority of patients with initially unresectable tumors, but in good overall physical condition responded to docetaxel, cisplatin, 5-fluorouracil (TPF) — based chemotherapy. Approximately half of them had complete tumor resorption, whereas 14.2 % of them had stabilization of the tumor process. Research literature shows that up to 30 % of patients receiving chemoradiotherapy with cisplatin fail to complete the planned treatment due to its toxicity; replacement of cisplatin with carboplatin and 5-fluorouracil results in mucositis and thrombocytopenia. By contrast, chemoradiotherapy with cetuximab significantly increases both 3-year and 5-year survival and demonstrates good tolerability. In patients with .severe nutritional deficiency, concomitant cardiac diseases, polyneuropathy, and impaired liver function, the preference should be given to less toxic treatment regimens. Conclusion. Cetuximab-containing chemotherapy regimens are the most effective treatment option in head and neck squamous cell carcinoma They can be used in patients with different functional status depending on the clinical situation.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"8 1","pages":"14-20"},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776376","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 : 2019-01-12DOI: 10.17650/2222-1468-2018-8-4-32-38
А. Л. Кожанов, Л. Г. Кожанов, Вадим Николаевич Сорокин, Е. С. Романова
The study objective is to perform the acoustic analysis of voice in patients after open diagonal resection of the larynx. Materials and methods . A total of 112 patients underwent diagonal resection of the larynx; of them 73 hadfrontolateral resection and 39 had expanded frontolateral resection. Primary laryngeal cancer was diagnosed in 107 patients; five patients had relapses after radiation therapy. Fifty-six participants underwent acoustic analysis of voice before surgery, 52 participants underwent it 1 month postoperatively, and 112 participants had it after completing their rehabilitation (6 months to 10 years postoperatively). To determine normal acoustic characteristics of voice, we examined 80 men with normal voice. We measured voice fundamental frequency (FF), maximum and minimum FF, FF variability, jitter, shimmer, voice intensity, amplitude of fundamental tone’s harmonics and their difference. Speech rehabilitation included breathing exercises according to E. Ya. Zolotareva and speech training according to S.L. Taptapova. Results. Patients with laryngeal cancer demonstrated significant changes in the acoustic characteristics of their voice (p <0.05) compared to healthy individuals, including increased mean FF (f 0 ) (up to 143 ± 45 Hz vs 118 ± 18 Hz in controls), decreased voice intensity (from 60 ± 8 to 43 ± 8 d B), and almost 2-fold decrease in the amplitude of fundamental tone’s harmonics (ω 0 , 2 ω 0 , 3 ω 0 ). We also found an increased dispersion and variability of acoustic characteristics assessed compared to healthy individuals. The analysis of long-term treatment outcomes demonstrated more significant improvement of voice acoustic characteristics in patients who underwent speech rehabilitation compared to those who had no rehabilitation. Conclusion. Open resection of the larynx with endoscopic removal of granulations and ligatures and laser restoration of the laryngeal lumen by dissecting the scars complemented by speech rehabilitation allow restoring respiratory function in 91.1 % of patients and restoring voice in 91.8 % of patients (to achieve acoustic characteristics close to normal).
{"title":"Устранение нарушений голосовой функции при открытых диагональных резекциях гортани","authors":"А. Л. Кожанов, Л. Г. Кожанов, Вадим Николаевич Сорокин, Е. С. Романова","doi":"10.17650/2222-1468-2018-8-4-32-38","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-4-32-38","url":null,"abstract":"The study objective is to perform the acoustic analysis of voice in patients after open diagonal resection of the larynx. Materials and methods . A total of 112 patients underwent diagonal resection of the larynx; of them 73 hadfrontolateral resection and 39 had expanded frontolateral resection. Primary laryngeal cancer was diagnosed in 107 patients; five patients had relapses after radiation therapy. Fifty-six participants underwent acoustic analysis of voice before surgery, 52 participants underwent it 1 month postoperatively, and 112 participants had it after completing their rehabilitation (6 months to 10 years postoperatively). To determine normal acoustic characteristics of voice, we examined 80 men with normal voice. We measured voice fundamental frequency (FF), maximum and minimum FF, FF variability, jitter, shimmer, voice intensity, amplitude of fundamental tone’s harmonics and their difference. Speech rehabilitation included breathing exercises according to E. Ya. Zolotareva and speech training according to S.L. Taptapova. Results. Patients with laryngeal cancer demonstrated significant changes in the acoustic characteristics of their voice (p <0.05) compared to healthy individuals, including increased mean FF (f 0 ) (up to 143 ± 45 Hz vs 118 ± 18 Hz in controls), decreased voice intensity (from 60 ± 8 to 43 ± 8 d B), and almost 2-fold decrease in the amplitude of fundamental tone’s harmonics (ω 0 , 2 ω 0 , 3 ω 0 ). We also found an increased dispersion and variability of acoustic characteristics assessed compared to healthy individuals. The analysis of long-term treatment outcomes demonstrated more significant improvement of voice acoustic characteristics in patients who underwent speech rehabilitation compared to those who had no rehabilitation. Conclusion. Open resection of the larynx with endoscopic removal of granulations and ligatures and laser restoration of the laryngeal lumen by dissecting the scars complemented by speech rehabilitation allow restoring respiratory function in 91.1 % of patients and restoring voice in 91.8 % of patients (to achieve acoustic characteristics close to normal).","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"8 1","pages":"32-38"},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776423","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 : 2019-01-12DOI: 10.17650/2222-1468-2018-8-4-48-55
Е. А. Шатохина, Л. С. Круглова
Introduction. Inhibitors of the epidermal growth factor receptor cause the heavy dermatological adverse events, which can be the cause of change of the scheme of treatment. Acneiform rash is connected with specific inflammation of hair follicles, its weight depends on a dose of medicine and correlates with the best response to therapy at various options of tumors, in this regard effective correction of this side effect is of particular importance. Materials and methods . There were 32 patients with acneiform rash for observation; they have been divided into 3 groups. All patients received system antibacterial therapy: doxycycline 100 mg 2 times a day 10 days and topical medicines for external therapy, various on the action mechanism (tacrolimus, metronidazole, betamethasone valerate in a combination with fusidic acid). Acne Dermatology Index and Dermatology Life Quality Index were used for assessment. The received results were assesed on each visit of the patient, the final point of observations was in 3 months. Results. The significant regression of rash in all groups was in the 1st week when patients accepted doxycycline per os. Further the weakest response to therapy has shown cream with tacrolimus, the patients using gel with metronidazole has shown bigger effect, the fastest regress of Acne Dermatology Index and Dermatology Life Quality Index was observed in the patients used the combined cream with betamethasone and fusidic acid. Conclusions. The antibacterial therapy by doxycycline 100 mg 2 times a day per os at early stages of development of acneiform rash at the I—II severity gives the expressed effect and prevents deterioration of the .skin process. The combined therapy of acneiform rash of the I—II degree including doxycycline with topical cream containing a betamethasone valerate 0.1 % and fusidic acid 20 % renders the fastest and expressed effect in comparison with other combinations: the doxycycline and cream containing tacrolimus; the doxycycline and gel containing metronidazole.
{"title":"Акнеподобная сыпь - кожная токсическая реакция на применение ингибиторов EGFR","authors":"Е. А. Шатохина, Л. С. Круглова","doi":"10.17650/2222-1468-2018-8-4-48-55","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-4-48-55","url":null,"abstract":"Introduction. Inhibitors of the epidermal growth factor receptor cause the heavy dermatological adverse events, which can be the cause of change of the scheme of treatment. Acneiform rash is connected with specific inflammation of hair follicles, its weight depends on a dose of medicine and correlates with the best response to therapy at various options of tumors, in this regard effective correction of this side effect is of particular importance. Materials and methods . There were 32 patients with acneiform rash for observation; they have been divided into 3 groups. All patients received system antibacterial therapy: doxycycline 100 mg 2 times a day 10 days and topical medicines for external therapy, various on the action mechanism (tacrolimus, metronidazole, betamethasone valerate in a combination with fusidic acid). Acne Dermatology Index and Dermatology Life Quality Index were used for assessment. The received results were assesed on each visit of the patient, the final point of observations was in 3 months. Results. The significant regression of rash in all groups was in the 1st week when patients accepted doxycycline per os. Further the weakest response to therapy has shown cream with tacrolimus, the patients using gel with metronidazole has shown bigger effect, the fastest regress of Acne Dermatology Index and Dermatology Life Quality Index was observed in the patients used the combined cream with betamethasone and fusidic acid. Conclusions. The antibacterial therapy by doxycycline 100 mg 2 times a day per os at early stages of development of acneiform rash at the I—II severity gives the expressed effect and prevents deterioration of the .skin process. The combined therapy of acneiform rash of the I—II degree including doxycycline with topical cream containing a betamethasone valerate 0.1 % and fusidic acid 20 % renders the fastest and expressed effect in comparison with other combinations: the doxycycline and cream containing tacrolimus; the doxycycline and gel containing metronidazole.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"8 1","pages":"48-55"},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776995","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 : 2019-01-12DOI: 10.17650/2222-1468-2018-8-4-39-47
A. Karpenko, R. R. Sibgatullin, A. A. Boyko, M. G. Kostova, O. M. Nikolayeva, E. M. Trunin
The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma. Materials and methods . Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps. Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached. Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.
{"title":"Динамика качества жизни у пациентов с раком полости рта, перенесших комбинированное/комплексное лечение, и его клиническая значимость","authors":"A. Karpenko, R. R. Sibgatullin, A. A. Boyko, M. G. Kostova, O. M. Nikolayeva, E. M. Trunin","doi":"10.17650/2222-1468-2018-8-4-39-47","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-4-39-47","url":null,"abstract":"The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma. Materials and methods . Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps. Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached. Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"8 1","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776030","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 : 2019-01-12DOI: 10.17650/2222-1468-2018-8-4-26-31
Г. Марголин, А. М. Мудунов, Израиль Моисеевич Гельфанд, Ю. В. Алымов, А. А. Ахундов, Сергей Подвязников, М. Н. Нариманов, Т. Н. Заботина, Е. Н. Захарова
The study objective is to investigate the causes of insufficient efficiency of neck lymph node dissection and possibilities of its improvement in cancer of the oral mucosa without clinically detectable metastases. Materials and methods. A review of literature on surgical methods of affecting regional lymph collectors in cancers of the oral cavity was performed, and preliminary data on possibilities of biopsy of the sentinel lymph node were obtained. Conclusion. Combination of fluorescent lymph node mapping andflow cytometry allows to identify the sentinel lymph node and detect hidden micrometastases with high sensitivity.
{"title":"Необходимость и преимущества персонифицированной шейной лимфодиссекции при раке слизистой оболочки полости рта T1-2N0M0. Путь к радикальной операции","authors":"Г. Марголин, А. М. Мудунов, Израиль Моисеевич Гельфанд, Ю. В. Алымов, А. А. Ахундов, Сергей Подвязников, М. Н. Нариманов, Т. Н. Заботина, Е. Н. Захарова","doi":"10.17650/2222-1468-2018-8-4-26-31","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-4-26-31","url":null,"abstract":"The study objective is to investigate the causes of insufficient efficiency of neck lymph node dissection and possibilities of its improvement in cancer of the oral mucosa without clinically detectable metastases. Materials and methods. A review of literature on surgical methods of affecting regional lymph collectors in cancers of the oral cavity was performed, and preliminary data on possibilities of biopsy of the sentinel lymph node were obtained. Conclusion. Combination of fluorescent lymph node mapping andflow cytometry allows to identify the sentinel lymph node and detect hidden micrometastases with high sensitivity.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"257 1","pages":"26-31"},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776306","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 : 2019-01-01DOI: 10.17650/2222-1468-2018-8-4-68-70
G. Tkachenko, E. I. Skvortsova
{"title":"Outlooks on neuropsychological rehabilitation of patients with oropharyngeal cancer","authors":"G. Tkachenko, E. I. Skvortsova","doi":"10.17650/2222-1468-2018-8-4-68-70","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-4-68-70","url":null,"abstract":"","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67777101","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 : 2018-11-08DOI: 10.17650/2222-1468-2018-8-3-21-36
H. Breuninger, I. A. Belova
The study objectiveis to describe the available techniques of microscopically controlled surgery for skin cancer with histological control of tumor resection margins (three-dimensional (3D) histology). This approach almost completely eliminates the risk of recurrence and allows preserving healthy tissue. It is a standard treatment for skin cancer in Germany; however, in Russia and other CIS countries, this method is not in use.Materials and methods.We reviewed German standards for skin cancer treatment and currently available research literature on the treatment methods used for skin cancer.Results.Automated subcutaneous tumescent local anesthesia (ATLA). Since ATLA contains a highly diluted (up to 100 times) anesthetic, we can inject a 100-fold larger volume, thus, increasing the anesthetized area. The use of naropin or ropivacaine in ATLA ensures long lasting effect (10 h on average), while the incidence of side effects is two times lower due to mixing of anesthetics and reducing their doses. The anesthetic solution is injected slowly; therefore, the patient has neither pain nor oppressive feeling. Moreover, the sodium chloride solution was replaced by ionosteril, which eliminates burning sensation. Microscopically controlled surgery (MCS). Before excision, the tumor is topographically marked (with indicating the 12 o’clock position) in order to determine the tissues that should be additionally excised after finding a tumor infiltrate in the resection margin. The tumor is excised by circumscribing an ellipse of skin; the scalpel blade should be tilted toward the tumor, making an acute angle with skin surface. The defect is closed by wound closure strips; then a compression bandage is placed over the strips. When the complete removal of tumor infiltrates is histologically confirmed, the wound is sutured or closed with a flap (if necessary). MCS ensures complete removal of the tumor and preservation of healthy tissues, which is particularly important for patients with head and neck cancer. Three-dimensional histology. In the case of small tumor specimens (up to 2 cm), the margins and the basis of the specimen are folded to a one plane by incisions (“Muffin” technique). Larger specimens require the “Tubingen cake” technique: a narrow (2–4 mm) lateral strip is cut vertically around the full perimeter of the tumor border (marginal fragment). Then a narrow section is cut from the bottom of the specimen (basal fragment); the remaining tissue is cut by diameter (medial fragment). The marginal and basal fragments are examined to identify tumor infiltrates, whereas the medial fragment is used for the diagnosis. The 3D-histological examination allows revealing twice as many tumor infiltrates as conventional histology in Germany, tumor recurrence is the lowest in the world. 3D-histology does not require additional labor costs. Defect closure using intracutaneous 3D-sutures for high tension. Absorbable butterfly and double butterfly sutures withstand strong
{"title":"Microscopically controlled surgery with three-dimensional histology, tumescent local anesthesia and intracutaneous sutures for high tension in the treatment of skin cancer","authors":"H. Breuninger, I. A. Belova","doi":"10.17650/2222-1468-2018-8-3-21-36","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-3-21-36","url":null,"abstract":"The study objectiveis to describe the available techniques of microscopically controlled surgery for skin cancer with histological control of tumor resection margins (three-dimensional (3D) histology). This approach almost completely eliminates the risk of recurrence and allows preserving healthy tissue. It is a standard treatment for skin cancer in Germany; however, in Russia and other CIS countries, this method is not in use.Materials and methods.We reviewed German standards for skin cancer treatment and currently available research literature on the treatment methods used for skin cancer.Results.Automated subcutaneous tumescent local anesthesia (ATLA). Since ATLA contains a highly diluted (up to 100 times) anesthetic, we can inject a 100-fold larger volume, thus, increasing the anesthetized area. The use of naropin or ropivacaine in ATLA ensures long lasting effect (10 h on average), while the incidence of side effects is two times lower due to mixing of anesthetics and reducing their doses. The anesthetic solution is injected slowly; therefore, the patient has neither pain nor oppressive feeling. Moreover, the sodium chloride solution was replaced by ionosteril, which eliminates burning sensation. Microscopically controlled surgery (MCS). Before excision, the tumor is topographically marked (with indicating the 12 o’clock position) in order to determine the tissues that should be additionally excised after finding a tumor infiltrate in the resection margin. The tumor is excised by circumscribing an ellipse of skin; the scalpel blade should be tilted toward the tumor, making an acute angle with skin surface. The defect is closed by wound closure strips; then a compression bandage is placed over the strips. When the complete removal of tumor infiltrates is histologically confirmed, the wound is sutured or closed with a flap (if necessary). MCS ensures complete removal of the tumor and preservation of healthy tissues, which is particularly important for patients with head and neck cancer. Three-dimensional histology. In the case of small tumor specimens (up to 2 cm), the margins and the basis of the specimen are folded to a one plane by incisions (“Muffin” technique). Larger specimens require the “Tubingen cake” technique: a narrow (2–4 mm) lateral strip is cut vertically around the full perimeter of the tumor border (marginal fragment). Then a narrow section is cut from the bottom of the specimen (basal fragment); the remaining tissue is cut by diameter (medial fragment). The marginal and basal fragments are examined to identify tumor infiltrates, whereas the medial fragment is used for the diagnosis. The 3D-histological examination allows revealing twice as many tumor infiltrates as conventional histology in Germany, tumor recurrence is the lowest in the world. 3D-histology does not require additional labor costs. Defect closure using intracutaneous 3D-sutures for high tension. Absorbable butterfly and double butterfly sutures withstand strong","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67775761","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 : 2018-11-08DOI: 10.17650/2222-1468-2018-8-3-37-45
A. Karpenko, R. Sibgatullin, A. A. Boyko, N. Chumanikhina, E. Y. Lomteva, M. V. Lavrova, M. Kostova, O. M. Nikolayeva
The study objectiveis to assess the results of this approach and identifications of factors that may influence the effectiveness of such an approach.Materials and methods. Since 2009 through 2016 72 patients with stage III and IV aged between 42 and 77 years underwent upfront surgery.Anatomical sites included 34 (46 %) tonsil, 24 (33 %) base of tongue and 14 (21 %) soft palate cases. Transcervical sparing the mandible,mandibulectomy and transoral approaches were used in 42 (58 %), 11 (15 %) and 7 (10 %) patient, respectively. Total glossectomy was performed in 4 (5.5 %) cases. Tumor extension necessitated extended laryngectomy in 8 patients (11.5 %). Primary closure of the pharyngeal wound was possible in 30 patients (42 %). Reconstruction with distant flaps was performed in the remaining 42 patients. Both free (anterolateral thigh – 19, radial forearm flap – 10) and flaps with axial blood supply (pectoralis major – 9, supraclavicular flap – 4) were used. There were 6 T1, 12 T2, 28 T3 and 20 T4 tumors; 62 patients were N-positive: N1 – 10 cases, N2 – 51, N3 – 1. Positive surgical margins were diagnosed in 13 cases (18 %) including 3 cases of R2 resection. Adjuvant radiation therapy with or without chemotherapy was completed in 45 patients (63.4 %). Survival was calculated according to Kaplan–Mayer method.Results.There was 1 death in early postoperative period. Mean follow-up for the remaining patients (n = 71) was 27 months (1–94). Median survival was 27 months (95 % CI 11.5–42.5); 3-year overall survival was 44 %; 33 out of 34 still alive patients are capable to take food orally. Only 1 (2.9 %) patient is gastrostomy tube dependent. Univariate analysis revealed that positive margins (p <0.0001) and completeness of combined treatment (p <0.01) are the main factors that have statistically significan impact on prognosis.Conclusion.Combined approach with upfront surgery is one of the main treatment modalities for advanced oropharyngeal cancer. Modern reconstructive options and strict adherence to a proper surgical technique give a high chance for a valuable rehabilitation for the vast majority of patients. Scrupulous planning of the resection of the primary tumor based on modern imaging techniques and encouraging patients to complete all prescribed treatments are the main physician-related factors that influence survival outcome.
{"title":"Surgery for advanced oropharyngeal cancer","authors":"A. Karpenko, R. Sibgatullin, A. A. Boyko, N. Chumanikhina, E. Y. Lomteva, M. V. Lavrova, M. Kostova, O. M. Nikolayeva","doi":"10.17650/2222-1468-2018-8-3-37-45","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-3-37-45","url":null,"abstract":"The study objectiveis to assess the results of this approach and identifications of factors that may influence the effectiveness of such an approach.Materials and methods. Since 2009 through 2016 72 patients with stage III and IV aged between 42 and 77 years underwent upfront surgery.Anatomical sites included 34 (46 %) tonsil, 24 (33 %) base of tongue and 14 (21 %) soft palate cases. Transcervical sparing the mandible,mandibulectomy and transoral approaches were used in 42 (58 %), 11 (15 %) and 7 (10 %) patient, respectively. Total glossectomy was performed in 4 (5.5 %) cases. Tumor extension necessitated extended laryngectomy in 8 patients (11.5 %). Primary closure of the pharyngeal wound was possible in 30 patients (42 %). Reconstruction with distant flaps was performed in the remaining 42 patients. Both free (anterolateral thigh – 19, radial forearm flap – 10) and flaps with axial blood supply (pectoralis major – 9, supraclavicular flap – 4) were used. There were 6 T1, 12 T2, 28 T3 and 20 T4 tumors; 62 patients were N-positive: N1 – 10 cases, N2 – 51, N3 – 1. Positive surgical margins were diagnosed in 13 cases (18 %) including 3 cases of R2 resection. Adjuvant radiation therapy with or without chemotherapy was completed in 45 patients (63.4 %). Survival was calculated according to Kaplan–Mayer method.Results.There was 1 death in early postoperative period. Mean follow-up for the remaining patients (n = 71) was 27 months (1–94). Median survival was 27 months (95 % CI 11.5–42.5); 3-year overall survival was 44 %; 33 out of 34 still alive patients are capable to take food orally. Only 1 (2.9 %) patient is gastrostomy tube dependent. Univariate analysis revealed that positive margins (p <0.0001) and completeness of combined treatment (p <0.01) are the main factors that have statistically significan impact on prognosis.Conclusion.Combined approach with upfront surgery is one of the main treatment modalities for advanced oropharyngeal cancer. Modern reconstructive options and strict adherence to a proper surgical technique give a high chance for a valuable rehabilitation for the vast majority of patients. Scrupulous planning of the resection of the primary tumor based on modern imaging techniques and encouraging patients to complete all prescribed treatments are the main physician-related factors that influence survival outcome.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776106","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 : 2018-11-08DOI: 10.17650/2222-1468-2018-8-3-12-20
A. Kugushev, A. Lopatin, S. Yasonov, M. Bolotin, Rogozhin Dv
{"title":"Fibrous dysplasia of the maxillofacial area: a 15-year retrospective study","authors":"A. Kugushev, A. Lopatin, S. Yasonov, M. Bolotin, Rogozhin Dv","doi":"10.17650/2222-1468-2018-8-3-12-20","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-3-12-20","url":null,"abstract":"","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"8 1","pages":"12-20"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49206233","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 : 2018-11-07DOI: 10.17650/2222-1468-2018-8-3-72-76
A. D. Kaprin, S. A. Ivanov, F. Е. Sevryukov, I. S. Pimonova, P. A. Isaev, N. V. Severskaya, A. A. Ilyin, V. V. Polkin, D. Y. Siomin, S. V. Vasilkov, Derbugov Dn, Yu. A. Panaseikin, V. S. Medvedev
The study objective is to evaluate modern-era radiotherapy (external beam radiotherapy, EBRT) and target therapy (TT) outcomes for advanced medullary thyroid cancer (MTC). Materials and methods. Seventy eight consecutive patients with stage IV MTC were evaluated. All of them with relapsing locally advanced or metastatic MTC, 16 had clinically relevant mediastinal involvement, and 59 had distant metastasis; 26 patients received conformal EBRT or intensity-modulated radiotherapy in monomode, 16 patients – conformal EBRT with simultaneous TT with vandenanib, 36 patients – TT in monomode. Median EBRT dose was 60 Gy. Results. Kaplan–Meier estimates of the median overall survival rate was 14 months for radiotherapy in monomode, 48 months – for conformal EBRT + simultaneous TT with vandenanib, 50 months – for TT in monomode. EBRT and TT allows for significantly shorter periods (median 3.8 weeks), to relieve the symptoms of compression-mediated organs and structures of the neck and mediastinum than in the TT (median 10.2 weeks) (p <0.001). Conclusion. EBRT and TT provided durable locoregional disease control with limited morbidity.
{"title":"Эффективность дистанционной лучевой терапии и таргетной терапии вандетанибом нерезектабельного и прогрессирующего медуллярного рака щитовидной железы","authors":"A. D. Kaprin, S. A. Ivanov, F. Е. Sevryukov, I. S. Pimonova, P. A. Isaev, N. V. Severskaya, A. A. Ilyin, V. V. Polkin, D. Y. Siomin, S. V. Vasilkov, Derbugov Dn, Yu. A. Panaseikin, V. S. Medvedev","doi":"10.17650/2222-1468-2018-8-3-72-76","DOIUrl":"https://doi.org/10.17650/2222-1468-2018-8-3-72-76","url":null,"abstract":"The study objective is to evaluate modern-era radiotherapy (external beam radiotherapy, EBRT) and target therapy (TT) outcomes for advanced medullary thyroid cancer (MTC). Materials and methods. Seventy eight consecutive patients with stage IV MTC were evaluated. All of them with relapsing locally advanced or metastatic MTC, 16 had clinically relevant mediastinal involvement, and 59 had distant metastasis; 26 patients received conformal EBRT or intensity-modulated radiotherapy in monomode, 16 patients – conformal EBRT with simultaneous TT with vandenanib, 36 patients – TT in monomode. Median EBRT dose was 60 Gy. Results. Kaplan–Meier estimates of the median overall survival rate was 14 months for radiotherapy in monomode, 48 months – for conformal EBRT + simultaneous TT with vandenanib, 50 months – for TT in monomode. EBRT and TT allows for significantly shorter periods (median 3.8 weeks), to relieve the symptoms of compression-mediated organs and structures of the neck and mediastinum than in the TT (median 10.2 weeks) (p <0.001). Conclusion. EBRT and TT provided durable locoregional disease control with limited morbidity.","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"8 1","pages":"72-76"},"PeriodicalIF":0.0,"publicationDate":"2018-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67776182","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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