Vol 19, No 2 (2017)

In this article we produce present practice in treatment of advanced stages of non-small cell lung cancer with activating mutations in EGFR genes. Describe opportunities of effective using of target agents in these cases. There are notions about mechanisms of resistance for target therapy, and demonstrate different approach in this field.

Relevance. Breast cancer is the leading oncological disease among female population. In some cases, clinical stage T2N0M0 is contraindication to breast-concerving surgery due to a big size of the primary tumor. Mastectomy is an optimal surgery in this situation. However, removal of the breast is a serious psychological trauma for the patient, causing quality of life decrease. Attempting to perform breast-conserving surgery is quite logical. Due to this we investigated a method of complex treatment of breast cancer using intraoperative radiation therapy, sentinel lymph node biopsy and neoadjuvant systemic drug therapy. Goal: the main goal is to improve the results of early breast cancer treatment, through the introduction into clinical practice of the original method of complex treatment. Materials and methods. 101 patients treated in the State clinical oncology department of St. Petersburg in the period from 2014 to 2016 were included in the study. The main inclusion criteria was a clinical stage T2N0M0. All the patients are not the candidates for breast - conserving surgery. In the experience group were patients (n=51) who received treatment on the method studied. 50 patients were randomized to the control group, where the mastectomy was performed. In the experience group late toxicity was evaluated after radiosurgery using modified LENT-SOMA scale. Quality of life was assessed by questionnaire QLQ-C30 in both groups. Results. 49 (96%) patients of the experience group were treated by breast-conserving surgery (lumpectomy with intraoperative radiation) due to clinical and radiological tumor response to neoadjuvant therapy. After systemic therapy 10 (20%) women were performed axillary lymph node dissection. Quality of life in the experience group was significantly higher. Late toxicity was not significant after application of intraoperative and whole breast radiotherapy. Conclusion. The investigated method of a complex treatment of early breast cancer is safe and effective and is able to provide the same control of locoregional recurrence as modified radical mastectomy. However, the proposed method provides a statistically significant better quality of life.

Tamoxifen is a selective modulator of estrogen receptors and is widely used in receptor-a-positive breast cancer treatment. Adjuvant tamoxifen treatment substantially reduces breast cancer relapse and mortality rates. However, high interindividual variability in response is observed. One of the causes of this variability may be genetic polymorphisms of the cytochrome P450 (CYP) enzymes, which are responsible for the formation of tamoxifen active metabolites. Polymorphisms of genes encoding the enzymes with decreased or absent activity could be associated with lower tamoxifen active metabolites concentration in serum and consequently reduce the effectiveness of treatment. Pharmacogenetic approach is a promising tool of personalized medicine and may help personolize pharmacotherapy of breast cancer in the future. Throughout this review we analyze the up-to-date information on the influence of the gene CYP2C19 polymorphisms that they have on pharmacokinetic and pharmacodynamic of tamoxifen.

The aim of the study is to analyze the characteristics of cervical stump cancer (CSC), identify the clinical and morphological factors influencing prognosis of the disease. Another aim is to study the results of CSC treatment according to the predictive factors. Materials and methods. We have analyzed the treatment results of 150 patients with FIGO stage 0-IIIB metastatic CSC (mCSC). Patients were treated in N.N.Blokhin Russian Cancer Research Center, over the period from 1977 to 2010. Results. We showed that statistically significant predictive factors of mCSC were regional lymph node metastases, stromal invasion greater than 1 cm in depth, stage of disease, the mixed form of tumor growth and the presence of lymph vessel tumor emboli. We also identified that the survival of the patients with histologically verified adenocarcinoma and with the spread of the tumor to the cervical stump was poor. Conclusion. We showed that the risk factors in case of mCSC were the same as in case of cervical cancer.

Purpose: to estimate the rate of locoregional recurrence and distant metastases, and the grade of chemoradiotherapy toxicity when in combination with local hyperthermia for treating squamous cell anal canal cancer T1-4N0,1-3M0-1. Materials and methods. 112 patients with squamous cell anal canal cancer were treated between 2011 and 2015 with chemotherapy, radiation therapy based on 3D CRT, intensity-modulated radiation therapy (IMRT) and volumetric intensity modulated arc therapy (VMAT), and local hypothermia. Staging was based on TNM (7th edition): I - 4 (3.6%) patients, II - 39 (34.8%) patients; IIIA - 33 (29.5%) patients, IIIB - 34 (30.3%) patients and IV - 2 (1.8%) patients. The median of mean follow-up was 32 months (range, 3-63 months). Local hyperthermia was performed in 81 (72.3%) patients. Results. 2-year local control was 73.2%. All recurrences, no matter which chemotherapy was performed, were in patients with advanced disease (IIIA/IIIB stages), from which 22.2% relapses were in group without local hyperthermia vs. 4.7% in group with radiomodification, p=0.038. Distant metastases were found in 9.4% patients with hyperthermia and in 11.1% patients without radiomodification, p=1. Usage of local hyperthermia is associated with increase II grade of dermatological toxicity (p=0.056). Conclusion. The combination of local hyperthermia and modern technologies of conformal radiation therapy has influenced the decrease of locoregional recurrences, but it is associated with lack of influence on distant metastases appearance regardless on chemotherapy regimen.

It is still unknown whether the combination of IFN-α with octreotide has benefit compared with IFN-α alone. We compared efficacy and toxicyty of IFN-α and IFN-α plus octreotide in first line of therapy of patients with NETs. There was trend to longer TTP in lung NETs pts comparing with GEP NETs pts treated with IFN-α. IFN-α may be a therapy of choice in pts with well differentiated lung NETs as first line treatment. IFN-α have a similar toxicity profile comparing with IFN-α combined with octreotide.