Abstract:

Introduction: currently, chemoradiation therapy is widely used as the main method of specific treatment for locally advanced head and neck cancer. Previously it was believed that radiation damage of carotid arteries occurs only several years after treatment.

Material and methods: article presents two case reports of internal carotid artery stenosis which arose directly during the course of chemoradiation of head and neck malignant tumors. In the first case, patient K., 54 years old, had laryngeal cancer (stage III: T3N1M0), in the second case, patient M., 40 years old, had tongue cancer (stage I: T1N0M0).

Conlusion: article presents angiographically confirmed carotid artery stenosis arisen directly during chemoradiation and in early stages after its completion. The discussion presents data on the incidence of stenosing lesions of carotid arteries, cerebrovascular events among patients undergoing radiation therapy. It is necessary to draw attention of specialists to the problem of early stenosis of carotid arteries during radiation and chemoradiation therapy of head and neck tumors.

Abstract:

Currently, the results of diagnostics and treatment of gastric cancer (GC) are still not satisfactory. With the advent of modern catheters and angiographic devices, regional intra-arterial chemotherapy in patients with gastric cancer has become more often used in clinical practice.

Aim: was to improve results of treatment of patients with gastric cancer using regional intra-arterial chemotherapy (RIACT).

Material and methods: the immediate and long-term results of complex treatment of 110 patients with stomach cancer for the period 2005-2020 were analyzed. The average age of patients was 59,2 + 4,3 years. The prevalence of the tumor process according to the TNM classification was as follows: T3N0M0 - 37(33,63%) patients, T3N1M0 - 41 (37,27%) patients, and T3N2M0 - 32 (29,1%) patients. Histologically, all patients showed various forms of adenocarcinoma. At the first stage, all patients underwent neoadjuvant RIACT according to the DPF scheme (Docetaxel 75mg/m² + Cisplatin 75mg/m² + Fluorouracil 1000mg/m² on the 1st day) for 2 courses with an interval of 28 days, then surgery.

Results: the immediate results of RIACT showed the effectiveness of treatment after 2 courses of neoadjuvant intra-arterial regional chemotherapy in 93 (84,5%) patients, partial regression was noted, in 17(15,5%) patients, stabilization of the process was noted. These patients underwent a radical operation with the second stage of complex treatment - extended gastrectomy with D2 lymphadenectomy. The drug pathomorphosis of the 1-2 degree was noted in 34 (30,9%) patients, the third degree was noted in 38 (34,5%), the pathomorphosis of the fourth degree in 9 (8,1%) patients. With dynamic follow-up of patients 9(8,1%) patients lived 6 months, 63 (57,2%) patients lived 12 months, 59 (53,3%) patients lived 18 months, 57(51,8%) patients lived 24 months, 47 (42,7%) patients lived 36 months, 41 (37,2%) patients lived 48 months and 35 (31,8%) patients 60 lived months and still are alive. The median survival rate was 51,8 + 1,5 months.

Conclusions: results of neoadjuvant intra-arterial chemotherapy in the treatment of gastric cancer patients proved to be effective in 84,5% of patients. In 42,6% of patients, grade 3-4 therapeutic pathomorphosis was noted. The 3- and 5-year survival rates were 42,7% and 31,8%, respectively. The median survival rate was 51,8 + 1,5 months.

Preoperative intra-arterial chemotherapy may be the method of choice for improving the survival and quality of life of patients with gastric cancer.

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Abstract:

Cervical cancer (CC) is one of the most common oncological disease in the world. There are lots of methods to treat it. Often we use radiation therapy (RT), chemotherapy (CT), surgical treatment. However, when on one hand we have successes, on the other hand we have a number of unsolved problems. To solve them, we study the method of chemoembolization of uterine arteries (CUA). This treatment option is being studied as one of promising methods in the complex or combined radiation treatment of primary and recurrent cervical cancer. This allows, with minimal trauma and relapse rate, to stop bleeding and reduce the size of the tumor. In this article a number of literature sources about using embolization or chemoembolization and results of treatment with CUA has been analyzed.

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Abstract:

Aim: was to analyze the first experiment and estimate the tolerability of intra-arterial use of the Abraxane in oil chemoembolization in patients with pancreatic adenocarcinoma.

Material and methods: for the period January 2018 - August 2018 г on the basis of the FSCU RIS RHT named after academician A.M. Granov, 19 patients with histologically verified ductal adenocarcinoma of the pancreas received treatment: intra-arterial oil chemoembolization with the use of the Abraxane.

Results: in 14 (73.6%) patients appeared mild pain syndrome that was not accompanied by marked laboratory changes, against the background of standard conservative prophylaxy. In 5 (26.4%) cases, patients had clinical and laboratory signs of postembolization syndrome, which was regarded as adverse events of grade 3 antitumor therapy, manifested by clinical and laboratory signs of mild acute pancreatitis, treated in all cases conservatively

The treatment of the postembolization syndrome lasted up to 7 days, until complete laboratory markers normalization, consisting in reducing the activity of blood amylase and urinary diastase to normal values. In all cases, postembolization syndrome was stopped conservatively In described 5 (26.4%) patients, adverse events of intra-arterial oil chemoembolization were regarded as mild postembolization pancreatitis. After treatment, a decrease in the tumor marker CA 19-9 was observed in 9 (90%) patients.

At the next stage, all patients with localized forms of the tumor underwent surgical treatment in the volume of pylorus-preserving pancreatoduodenal resection (n = 13) from 7 to 15 days after intra- arterial oil chemoembolization.

Conclusion: the procedure of oil chemoembolization with Abraxane can be considered as safe if dosages of the oil radiopaque drug Lipiodol are adeqate. There was a tendency to a decrease in the level of the tumor marker CA 19-9 in the blood of patients after the procedure. 

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19.    Granov DA., Pavlovskij AV, Suvorova JuV, Gulo AS, Popov SA, Shapoval SV, Tlostanova MS. Neoadjuvant intra-arterial oil chemoembolization and adjuvant regional chemoinfusion in combined treatment of pancreatic cancer. Voprosioncologii. 2008; 54(4): 501-503.

Abstract:

Since 2001 to 2006 38 patients with inoperable cancer of the pancreas have been treated. They had pancreatic cancer of stage T2-4 N1 MO-l(HEP). Patients with mechanical jaundice (n=28) had beforehand undergone transdermic transhepatic external- internal drainage of the bile ducts. Patients with cancer, which gets its basic source of blood supply out of gastroduodenal artery, got cathete-rization of the celiac trunk with the following intravascular chemotherapy within 2 days. If the basic source of blood supply to pancreas was the inferior pancreatoduodenal artery, then its selective catheterization was carried out together with bolus injection of cytostatics. Chemotherapy was carried out with the help of Gemzar (1 g), Cisplatin (1 OOmg), 5- FU (4g). The level of bilirubin normalized in the blood of the patients with mechanical jaundice due to transdermic endobiliary intervention. As a result of regional chemotherapy, the intensity of the patients' pain syndrome reduced considerably and resumed only in case of the tumor progression.

The best treatment results were achieved in the group of patients with the programmed injections of regional chemotherapetic drugs that enabled to prolong survival of patients up to 19 months and more. Conclusion. The transfemoral selective catheterization of the pancreatic arteries is a simple, non-traumatic and safe operation. The use of programmed regional endarterial chemoinfusion in patients with inoperable pancreatic cancer is a promising method of treatment of these pathology. 

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Abstract:

Aim. Was to describe the efficiency of conservative treatment of retinoblastoma (RB) by an association of local chemotherapy (LCT) as an alternative method for external beam radiation (EBR) therapy and enucleation. Also to reduce the local and systemic side effects of chemotherapy.

Materials and methods. Seven children (11 eyes) had intraocular RB. All of them underwent LCT at the Institute of pediatric oncology and hematology of the N.N. Blokhin Russian Cancer Research Center between February and 2011. There were two methods of LC -selective intra-arterial chemotherapy (Institute of clinical oncology of the N. N. Blokhin Russian Cancer Research Center) and intravitrea chemotherapy by melphalan.LCT was made after systemic chemotherapy in4of8 patients with advanced RB with clinica stages T2a or group С (n = 1), T2b or group D (n = 3), T2c or group E (n = 3) as an alternative to EBR therapy Other 4 of 8 patients were treated with LCT as alternative to enucleation because of new retinal, subretinal tumors and vitreous seeding after initial treatment - systemic chemotherapy with laser treatment or in combination with brachytherapy and/or EBR therapy. LCT was combined with brachytherapy (106Ru + 10^о) in one case (S. Fyodorov Eye Microsurgery Complex)

Results. Due to using of alternative conservative RB treatment we have saved 8 children with 10 of 11 eyes with indications for EBR therapy or enucleation. There were not systemic side effects of LCT. Ophthalmic complications were minimal, including lid and face hyperemia after intra-arterial chemotherapy.

Conclusion. LCT with melphalan has shown high effectiveness as a method of globe-conserving treatment of locally spread RB with a minimum of immediate complications. A small number of observations and the maximum period of observation 7 months do not allow to reliably estimate the long-term results of treatment that requires further research.  

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Abstract:

Aim. Was to evaluate technicalfeasibility and safety of the internalmammary artery redistribution embolization during intra-artena chemotherapy in breast cancer

Materials and methods. Between 2000 and 2010 years 42 patients with inflammatory form of local-spread breast cancer received 48 courses of combined treatment, including systemic and arterial chemotherapy plus radiotherapy In 6 patients, blood flow redistribution n the internal mammary artery was performed to avoid undesirable extra-breast perfusion with possible complications such as neuralgia necrosis of the skin, organ dysfunction. Coil embolization of the internal mammary artery was made distally from branches supplying breast tumor. After that, infusion of chemotherapeutic drug-in-iodized oil was performed

Results. Technicalsuccess rate was 100%.There was no complication of embolization and intra-arterialtherapy During further repeated researches, a giography showed persistent occlusion of the embolized branches and compensatory dilation of tumor-feeding arteries.Survivalrate of patients starts from 2-22 months,with continuation of combined treatment.

Conclusion. Redistribution of blood flow in the internal mammary artery is safe and may be used to avoid complications of ntra-arterial chemotherapy in breast cancer. 

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3.    Таразов П.Г., Рыжков В.К. Эмболизация гастродуоденальной артерии при рентгеноэндоваскулярных вмешательствах по поводу цирроза и опухолей печени. Вестник хирургии. 1988; 140 (1): 83-85.

4.    Таразов П.Г., Павловский А.В., Гранов Д.А. Химиоэмболизация при раке головки поджелудочной железы. Вопросы онкологии. 2001; 47 (4): 489-491.

5.    Таразов П.Г. Эмболизация печеночной артерии при нетипичных анатомических вариантах ее строения у больных злокачественными опухолями печени. Вестник рентгенологии. 1990; 2: 28-32.

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9.    Таразов П.Г., Корытова Л.И., Шачинов Е.Г Внутриартериальная терапия рака молочной железы (обзор литературы). Вопросы онкологии. 2011; 57 (1): 126-131.

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Abstract:

Purpose: South Kazakhstan Regional Cancer Clinic presents the immediate results of hepatic artery chemotherapy infusion and chemoembolization in patients with hepatic tumors. 

Material and methods: hepatic artery chemoembolization and chemotherapy infusion was performed in 70 patients (47 males, 67,1%) with hepatic tumors since 2004-2008. There were all in all 42 cases (60%) of primary hepatic carcinoma, and in 28 patients (40%) the procedure was done for liver metastatic malignancies. Hepatic artery chemotherapy infusion (HACI) was performed in 50 cases, including 32 patients (45,7%) with primary hepatic carcinoma, and 18 patients (25,7%) with metastatic foci. Hepatic artery chemoembolization (HACE) performed in 20 patients, including 10 patients (17,1%) with primary hepatic carcinoma, and 8 cases (11,4%) of metastatic malignancies. 

Results: significant regression of primary cancer foci and uneventful 3 years follow-up were seen in 2 patients (4,76%), partial regression of the lesion - in 6 (14,3%) of cases, tumor stabilization - in 16 (38%), and tumor progression were found in 8 (19%) of patients. 12 months survival with tumor stabilization was 33,3% (14 patients), 18 months survival - 7,14% (3 patients). Post-procedure mortality in terms of 4 to 8 months made up as high as 30,9% (13 patients). HACE procedure resulted with tumor regression in 8 of 10 patients; the effect sustained for 3-5 months already. For the present moment, 2nd and 3d HACE session is scheduled for this group of patients.

Conclusions: HACI is shown to be effective in treatment of primary and to improve the quality of life in 45,2% of cases. Thus, wide use of the method could be recommended in such a complicated category of patients. HACE procedure results are also hopeful, tumor stabilization starting after the first session.

References

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Abstract:

Aim. Improvement of results of treatment sick of a stomach cancer a by application intraarterial regional chemotherapy.

Materials and methods. Direct results of treatment of 50 patients a cancer stomach are analyzed, middle age has made 58,1+0,8 years. Histologycal at 45 (90,0%) by patients it is revealed adenocarcinoma, at 5 (10,0%) skirrous cancer. All sick first stage leads neoadjuvant intraarterial chemotherapy under scheme ТРF (tаxoter 75 m2 + cisplatin 75 m2 + ftoruracili 1000 m2 in one day) 2 rates with an interval of 28 days, then operation.

Results. After 2 rates neoadjuvant intraarterial regional chemotherapy at 42 (84%) patients: partial regress is noted at 29 (58%) by patients and significant regress of process is noted at 13 (26%) by patients. This sick second stage of complex treatment leads radical operation - expanded gasterectomy with lymph node dissections D3.

Conclusions. Neoadjuvant intraarterial regional chemotherapy of a stomach cancer has appeared effective at 84% of patients. Thus radical surgical intervention was possible to lead all of them. At 54% of patients it is noted medical phathomorphosis 3-4 degrees. Neoadjuvant intraarterial regional chemotherapy at a cancer of a stomach is a method of a choice for increase of operability of process and improves direct results of treatment of patients. 

References: 

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5.      Щепотин И.Б., Югринов О.Г., Галахин К.А. и др. Десятилетние результаты применения предоперационной суперселективной внутриартериальной химиотерапии в комбинированном и паллиативном лечении рака желудка. Практическая онкология. 2001; 7 (3); 67-71.

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Abstract:

Since December 2010 till September 2012, 24 patients with III stage laryngeal carcinoma (T3_4NxxM0) underwent chemoradiation therapy Intra-arterial chemotherapy via both superior thyroid and laryngeal arteries with intermitting in 30-45 minutes infusions of cisplatin and 5-fluorouracil was done. Average doses of cisplatin consist 75mg/m2, and 5-fluorouracil dose was1000mg/m2. In 48 hours multifractional radiotherapy started (1,1Gy x 2 per day, 5 days per week) with planned total dose 74-78Gy Then total dose was 26-30Gy and 50Gy pauses for 2 or 3 days in radiotherapy established for repeated same intra-arterial chemotherapy In 21 patients (87,5%) total regress of the tumor was marked. In 3 patients (12,5%) sclerosis of residual volume developed without tumor cells in control biopsies. In the only patient (4,2%) after 6 months reoccurrence was marked and dissection laryngectomy managed. Stability of positive results we observe during 12 months following such chemoradiation therapy.

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Abstract:

Aim: was to estimate the diagnostic value of MRI (qualitative and tumor size analysis) in the evaluation of preoperative chemotherapy in patients with soft tissue sarcomas on different stages of examination.

Material and methods: we analyzed data of 74 patients with soft tissue sarcomas. All patients underwent MRI. Patients were examined before, in the middle and at the end of the course of the preoperative chemotherapy

Results: the sensitivity (predilection of Grade III-IV pathologic response) of qualitative MRI signs in the middle of the neoadjuvant chemotherapy (after 2-3 cycles) was 73%, the specificity (predilection of Grade I-II pathologic response) was 88%; 69% and 100% for maximum tumor size evaluation, correspondingly At the end of the preoperative treatment, values of the sensitivity and specificity of qualitative MRI signs decreased to 50% and 78%, respectively, the sensitivity of maximum tumor size estimation decreased to 31%, while specificity remained the same -100%.

Conclusion: MRI with qualitative and tumor size analysis is an informative method in assessment of preoperative chemotherapy of soft tissue sarcomas.

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Abstract:

Good response to neoadjuvant chemotherapy is a favorable prognostic factor in patients with breast cancer. Early response evaluation might spare unnecessary chemotherapy in bad responders. Clinically mammography and ultrasound are used to evaluate response to treatment while being bac predictors of early response. MRI is getting wider acceptance but still lacks necessary accuracy to the absence of functional evaluation. Thus novel methods are being evaluated in early response prediction. Diffusion-weighted MRI, MR-spectroscopy, mammoscintigraphy PET as well as diffusion optic tomography are discussed in the review as potential ways to improve early prediction of response in breast cancer patients undergoing neoadjuvant chemotherapy.

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Abstract:

Aim: was to proceed comparative analysis of immediate and long-term results of chemoradiation treatment of unresectable local-spread oropharyngeal cancer with use of standart chemoradiatior therapy with intravenous chemoinjection and individual volume-controlled superselective intraarterial chemotherapy.

Materials and methods: 43 patients with unresectable oropharyngeal cancer were included in trial comparing intra-arterial (IA) and intravenous (IV) chemoradiation. IV chemoradiation (n=19 patients) comprised 3-4 times of 100 mg/m2 cisplatin infusion on days 1, 22, 43 combined 2Gy x 5 days fractions with total radiation dose 72Gy The IA chemoradiation group (n=24) comprised 3 or 4 x 90 mg/m2 cisplatin administered in the tumor-feeding artery by personified volume- controlled targeted perfusion. The induction IA chemotherapy was given one day before radiation. Then IA chemotherapy conducted regularly 22, 43, 64 days followed radiation.

Results: we made 86 IA procedures and had no IA-related death or procedure related complications. Five patients of IA group were excluded from long term analysis because of non-comleted protocol. The median follow-up was 21±2.3 months in IA group and 36 months in all patients in IV therapy group. In 19 patients received IA chemoradiotherapy protocol - 100% complete response (CR) and in IV chemoradiotherapy - only in 10 (53%) of 19 patients (ф = 6,820, р<0.05). CR was noted in 8 patients with N1 lymph-nodes and in 9 of 10 patients with N2 lymph nodes in IA therapy group. Initial lymph nodes regress more than 80-90% was observed and follow up improvement was confirmed by PET-CT. One-year overall survival (OS) rates were 95% and 79%, respectively in IA and IV groups (not significant OR = 4,8; ф = 1,51; р = 0,05), but two year OS rates were 90% and 58%, respectively (р<0,05). These data are encourage but further follow-up results need to be investigated. 

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