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. References 1. Kaidarova DR. Indicators of the Oncological Service of the Republic of Kazakhstan for 2019 (statistical and analytical materials). Almaty. - 2020. -137 [In Russ]. 2. Kaprin AD, Starinskiy VV, Petrova GV. Malignant neoplasms in Russia in 2016 (morbidity and mortality). - M.: FGBU «MNIOI after named P.A. Herzen» of the Ministry of Health of Russia. - 2018. - 250 [In Russ]. 3. https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf 4. Abdollah MH, Farhad TB, Reza M. Lack of Any Relationship of Stomach Cancer Incidence and Mortality with Development in Asia. Asian Pacific Journal of Cancer Prevention. 2016, 17(8): 3775-3781. https://doi.org/10.14456/apjcp.2016.169 5. Smyth EC, Nilsson M, Grabsch HI, et al. Gastric cancer. Lancet. 2020; 396(10251): 635-648. https://doi.org/10.1016/S0140-6736(20)31288-5 6. Zyryanov BN, Makarkin NA, Tikhonov VI, Tuzikov SA. Combined treatment with intra-arterial regional chemotherapy for locally advanced gastric cancer. Russian Journal of Oncology. 1997; 1: 17-20 [In Russ]. 7. Barone C, Cassano A, Pozzo C, et al. Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer. Oncology. 2004; 67(1): 48-53. https://doi.org/10.1159/000080285 8. Wang J, Shi H, Yang G, et al. Combined intra-arterial and intravenous chemotherapy for unresectable, advanced gastric cancer has an improved curative effect compared with intravenous chemotherapy only. Oncology Letters. 2018; 15(4). https://doi.org/10.3892/ol.2018.8068 9. Song Z, Wu Y, Yang J, et al. Progress in the treatment of advanced gastric cancer. Tumour Biol. 2017; 39(7): 1010428317714626. https://doi.org/10.1177/1010428317714626 10. Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J Gastroenterol. 2015; 21(24): 7343-8. https://doi.org/10.3748/wjg.v21.i24.7343 11. Johnston FM, Beckman M. Updates on Management of Gastric Cancer. Curr Oncol Rep. 2019;21(8): 67. https://doi.org/10.1007/s11912-019-0820-4 12. Ikegame K, Terashima M. Perioperative Chemotherapy for Gastric Cancer. Gan to Kagaku Ryoho. 2020; 47(4): 569-573.
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. References 1. Davydov MI, Aksel' EM. Statistics of malignant tumors in Russia and the CIS countries in 2012. Izdatel'skaya gruppa RONTs. 2014; 4: 226 [In Russ]. 2. Siegel R.L., Jemal А. Cancer statistics. CA. Cancer J Clin. 2018; 68: 7-30. 3. Kaprin AD, Starinsky VV, Petrova GV. Statistics of malignant tumors in Russia 2016 (morbidity and mortality) M.: MNIOI im. PA. Gertsena filial FGBU «NMITs radiologii» Minzdrava Rossii. 2018; 250 p [In Russ]. 4. Alexakis N. Current standards of surgery for pancreatic cancer. Br J Surg. 2004; (11) 91: 1410-27. 5. Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford). 2010; 4(12): 239-43. 6. Yang ZYYuan JQ, Di MY Zheng DY Chen JZ, Ding H, Wu XY, Huang YF, Mao C, Tang J.L. Gemcitabine plus erlotinib for advanced pancreatic cancer: a systematic review with meta-analysis. PLoS One. 2013;8(3):e57528. doi: 10.1371/journal.pone.0057528. Epub 2013 Mar 5. 7. Hidalgo M. Pancreatic cancer. N Engl j med. 2010; 362: 1605-17. 8. Burris H.A. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J ClinOncol. 1997; 2403-13. 9. Popova AS, Pokataev I A, Tyulyandin S.A. Combined chemotherapy regimens for pancreatic cancer. Zhurnal Meditsinskii sovet, Izdatel'stvo «GRUPPA REMEDIUM». 6: 62-70 [In Russ]. 10. Pokataev I A, Bazin I S, Popova A S, Podluzhnyi D V. Efficacy and safety of induction chemotherapy according to the FOLFIRINOX scheme with borderline resectable and unresectable pancreatic cancer. Nauchno-prakticheskii zhurnal po onkologii «Zlokachestvennye opukholi». 2018; 8(1): 38-47[ In Russ]. 11. Conroy T, Desseigne F, Ychou M. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 19(364): 1817-25. 12. Stocken DD. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005; 8(92): 1372-81. 13. Desai N, Trieu V, Yao Z. Increased antitumor activity, intratumor paclitaxel concentrations, and endothelial cell transport of cremophor-free, albumin-bound paclitaxel, ABI-007, compared with cremophor-based paclitaxel. Clin Cancer Res. 2006; 1(4): 1317-24. 14. Dranitsaris G, Yu B, Wang L. Abraxane versus Taxol for patients with advanced breast cancer: A prospective time and motion analysis from a Chinese health care perspective. J Oncol Pharm Pract. 2016; 2: 205-11 15. Giordano G, Pancione M, Olivieri N. Nano albumin bound-paclitaxel in pancreatic cancer: Current evidences and future directions. World J Gastroenterol. 2017; 23(32): 5875-5886. 16. Ottaiano A. Nab-Paclitaxel and Gemcitabine in Advanced Pancreatic Cancer: The One-year Experience of the National Cancer Institute of Naples. Anticancer Res. 2017; 4(37): 1975-1978. 17. Von Hoff DD. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. ClinOncol. 2011; 29(34): 454854. 18. Granov DA, Polikarpov AA, Pavlovskij AV, Moiseenko VE, Popov SA. Evaluation of the safety of intra-arterial chemotherapy with gemcitabine and oxaliplatin in the combined treatment of pancreatic head adenocarcinoma. Annaly khirurgicheskoy gepatologii. 2017; 22 (2): 54-59 [InRuss]. 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 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. References 1. Гаджиева А.К., Маджидов М.Г, Джамалутдинов Ю.А. Факторы риска рака гортани у населения разных климатогеографических зон южного региона Российской Федерации. Материалы XVII съезда оториноларингологов России, 26-28 апреля Санкт-Петербург. 2011;3:327-8. 2. Шаньгина О.В., Сдвижков А.М., Кожанов Л.Г, Финкельштерн М.Р. Факторы риска развития рака гортани в странах восточной и Центральной Европы. Вопр.онкологии. 2007; 53(3):321-8. 3. Пачес А.И. Опухоли головы и шеи. М.: Медицина. 2000; 467с. 4. Brunin F., Rodriguez J., Jaulerry C. Laryngeal cancer and conservative treatment. Place of combined radiotherapy chemotherapy and modified fractionation radiotherapy. Bul Cancer. 1997; 84(2):191-8. 5. Furness S., Glenny A.M., Worthington H.V., Pavitt S., Oiver R. et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev.2010; Sept 8(9): CD006386. 20. 6. Katori H., Tsukuda M., Taguchi T. Analysis of efficacy and toxicity of chemotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin (PFML) and radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother. Pharmacol. 2007;59(6): 789-94. 7. Porceddu S.V. Is induction chemotherapy the new standard in organ preservation treatment for locally advanced head and neck cancer in 2010? Asia Pac. J. Clin. Oncol. 2010;6(2):75-6. 8. Гаспарян С.А., Островерхов Г.Е., Трапезников Н.Н. Регионарная длительная внутриартериальная химиотерапия злокачественных опухолей. М.: Медицина. 1970; 207с. 9. Пачес А.И. Регионарная внутриартериальная химиотерапия в лечении опухолей головы и шеи: Сб. науч. тр. М.: Медицина, 1971; 159с. 10. Lee W.T., Alkureishi, Remco de Bree, Gary L. Ross RADPLAT: An alternative to Surgery? The Oncologist. 2006; 11(5): 469-80. 11. Rapidis A.D., Trichas M., Stavrinidis E., Roupakia A. et al. Induction chemotherapy followed by concurrent chemoradiation in advanced squamous cell carcinoma of the head and neck: final results from a phase II study with docetaxel, cisplatine and 5-fluorouracil with a four-year follow-up. Oral. Oncol. 2006;42(7): 675-84. 12. Van den Broek G.B., Balm A..J, van den Brekel M.W., Hauptmann M. et al. Relationship between clinical factors and the incidence of toxicity after intra-arterial chemoradiation for head and neck cancer. Radiother. Oncol. 2006; 81(2): 143-50. 13. Corry J., Peters L.J., Rischin D. Optimising the therapeutic ratio in head and neck cancer. Lancet Oncol. 2010; 11(3): 287-91. 14. Samant S., Robbins K.T., Kumar P. et al. Bone or cartilage invasion by advanced head and neck cancer: intra-arterial supradose cisplatin chemotherapy and concomitant radiotherapy for organ preservation. Arch. Otolarynogol. Head Neck Surg. 2001; 127: 1451-1456. 15. Арыбжанов Д.Т., Сабуров А.Р. Непосредственные результаты неоадъювантной регионарной химиотерапии больных раком желудка. Диагностическая и интервенционная радиология. 2009; 3(3): 41-44. 16. Balm A.J., Rasch C.R., Schornagel J.H. et al. High-dose superselective intra-arterial cisplatin and concomitant radiation (RADPLAT) for advanced head and neck cancer. Head Neck. 2004; 26:485-93. 17. Nashimura T., Sanada J., Furukawa M. Cervical radiculopathy due to inra-arterial unfusion of cisplatin. J. Laryngol. Otol. 2005; 119(8): 649-50. 18. Madasu R., Ruckenstein M.J., Leake F., Steere E., Robbins K.T. Ototoxic effect of supradose cisplatin with sodium thiosulfate neutralization in patients with head and neck cancer. Arch. Otolaryngol. Head and Neck Surg. 1997; 123(9): 978-
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. References 1. Paches A.I. Opukholi golovy i shei [Head and neck cancer]. Moscow. 2013: 478 [In Russ]. 2. Korytova L.I., Sokurenko V.P., Maslennikova A.V. Sovremennye tendentsii v terapii mestnorasprostranennogo raka rotoglotki i polosti rta [Current trends in the treatment of locally advanced cancers of the oropharynx and oral cavity].Saint 3. Perevodchikova N.I., Gorbunova V.A. Rukovodstvo po khimioterapii opukholevykh zabolevaniy [Guidelines for chemotherapy of tumor diseases] .Moscow. 2015; 154-158 [In Russ]. 4. Alieva S.B., Tkachev S.I., Romanov I.S. et all. Varianty i rezultaty khimioluchevoy terapii bolnykh s mestnorasprostranennym ploskokletochnym rakom glotki [Modifications and results of chemoradiotherapy in patients with locally advanced squamous cell carcinoma of the pharynx]. Meditsinskaya radiologiya i radiatsionnaya bezopasnost. 2012; 57 (3): 32-38 [In Russ]. 5. Pignon J. P, Bourhis J., Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analises of updated individual date. Lancet. 2000. 355(9208):949-55. 6. Browman G.P, Hodson D.I., Mackenzie R.J. et al. Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: A systematic review of the published literature with subgroup analysis. Head Neck. 2001; 23(7):579-89. 7. Granov A.M., Davydov M.I. Interventsionnaya radiologiya v onkologii [Interventional radiology in oncology]. 8. Kovacs A.F. Intraarterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: Long-term result.Br. J. Cancer. 2004. 90(7): 1323-1328. 9. Robbins K. T., Kumar P., Harris J. et al. Supradose intra-arterial cisplatin and concurrent radiation therapy for the treatment of stage IV head and neck squamous cell carcinoma is feasible and efficacious in a multi-institutional setting: Results of radiation therapy. Oncology Group trial 9615. J. Clin. 0ncol.2005;23(7):1447-54. 10. Olshanskiy M.S., Znatkova N.A., Stikina S.A., Redkin A.N., Sukhochev E.N., Zdobnikov V.B., Konstantinova Yu.S. et all. Superselective himioinfuziya and intraarterial chemoembolization of tumor blood vessels with chemoradiation therapy for inoperable cancer of the oropharynx. Trudy XX Rossiyskogo onkologicheskogo kongressa «Zlokachestvennye opukholi» [Proc. XX Ros. Cancer congress «Malignant tumors»]. Moscow. 2016;4: 190-191 [In Russ]. 11. Rhode S., Paul M. C., Martens E. et al. Simulation of haemodynamic flow in head and neck cancer chemotherapy. Biomed. Enq. Online. 2011; 10.1186/1475-925X-10-104. 12. Kumar P., Robbins K.T. Treatment of advanced head and neck cancer with intra-arterial cisplatin and concurrent radiation therapy: the “RADPLAT” protocol. Curr. Oncol. Rep. 2001;3(1):59-65. 13. Robbins K.T., Kumar P., Regine W.F. et al. Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: The Memphis experience. Int. J. Radiat. Oncol. Biol. Phys. 1997; 38(2):263-71. 14. Robbins K.T., Kumar P., Wong FS, et al. Targeted chemoradiation for advanced head and neck cancer: analysis of 213 patients. Head Neck. 2000; 22(7):687-93. 15. Yoshizaki T., Wakisaka N., Murono S. et al. Intraarterial chemotherapy less intensive than RADPLAT with concurrent radiotherapy for resectable advanced head and neck squamouse cell carcinoma: a prospective study. Ann. Otol. Rhinol. Laryngol. 2007;116(10):754-61.
