№72. Breast cancer. New in the last five years
BIOLOGY OF BREAST CANCERE.N. ImyanitovDOI 10.31917/1803221
This review discusses the progress in the studies on fundamental aspects of breast
cancer (BC) development. Biological rationale underlying limited efficacy of early
detection of BC is commented. Studies on mechanisms of BC metastasis are presented.
Advances in endocrine therapy for BC are described. Novel approaches to BC treatment
are illustrated. Recent breast cancer genetic studies are outlined.
Keywords: pathogenesis of breast cancer, metastasis of breast cancer, breast cancer therapy, hereditary breast cancer.
NEW APPROACHES IN BREAST CANCER SURGERYE.M. Bit-Sava, V.V. Egorenkov, A.O. Damenia, O.A. Melnikova, R.M. Akhmedov, M.A. Monogarova, M.G. Anchabandze, V.M. Moiseyenko.DOI 10.31917/1803232
Today compliance with oncological safety in the surgical treatment of breast cancer is inherent in achievement of
the optimal cosmetic result. Over the past century surgical treatment of breast cancer has evolved from an extensive,
crippling mastectomy in Holstead’s way to a tumorectomy and a biopsy of the sentinel lymph nodes. At the same time the
integration of plastic and vascular surgery into oncology of breast made it possible to expand the range of reconstructive
and plastic surgeries. Nowadays a breast conserving surgery with adjuvant radiotherapy remains the «gold» standard in
treatment of patients with early breast cancer. The widespread usage of breast plastic surgery technics allowed to increase
the number of breast conserving surgeries and to introduce the concept of «oncoplastic surgeries». A radical mastectomy
remains a high-demand surgery which is likely determined by the traditional and historical views of patients. In some cases
oncologists also consider this type of surgery as a more radical method of treatment. Nevertheless, according to the new
trends planning and carrying out of mastectomy should be combined with a reconstructive breast surgery. A subcutaneous,
skin-preserving mastectomy with an immediate reconstructive breast surgery allows to significantly improve the quality of
the treatment, i.e. its aesthetic component. The usage of endoscopic methods discovers the alternative versions of minimally
invasive operations. New trends in the breast cancer surgery minimization are common not only for the breast tissue but
also for the axillary lymph nodes. A biopsy of the sentinel lymph nodes has become a standard procedure in the early stages
of breast cancer. Today it expands the range of indications and spreads on patients with a positive sentinel lymph node.
Keywords: breast cancer, breast conserving surgery, oncoplastic surgery, reconstructive-plastic surgery, endoscopic mastectomy, biopsy of sentinel lymph nodes.
RECONSTRUCTIVE AND PLASTIC SURGERY FOR BREAST CANCERV.A. Sobolevsky, V.Ju. Ivashkov, N.I.G. MehtiyevaDOI 10.31917/1803246
According to our clinic for the year 2017, more than 1200 reconstructions have been performed. Every year, the requirements to the quality of life of patients, in particular, to the aesthetic results of treatment, are raised. The active introduction of the methods of reconstructive and plastic surgery into oncological practice makes it possible to solve the task posed. One of the most common methods in our practice is the use of TDL in combination with the implant. In all cases, when it is necessary to conduct radiation therapy, we preferred two-stage methods. When choosing a method of delayed reconstruction, one should take into account the patient’s history of radiation therapy. In most cases, this causes a
marked fibrosis of the tissues in the region of the removed breast, which leads to problems in its expansion. The choice of the method of reconstruction is strictly individual, depending on the stage of the underlying disease, the patient’s constitution, the condition and the number of tissues on the contralateral side, the presence of an excess of tissues in potential donor zones, the wishes of the patient herself. The most stable result with the optimal texture of tissues can be obtained by using
skin-fat flaps, which is their undisputed advantage over synthetic materials.
Keywords: breast reconstruction, breast cancer, skin-fat flap, DIEP.
CHANGES IN NEO- AND ADJUVANT TREATMENT OF BREAST CANCER IN THE LAST 5 YEARSM.B. Stenina, M.A. Frolova, D.Z. Kupchan, S.A. TjulandinDOI 10.31917/1803256
Neo- and adjuvant therapy is an integral component of complex therapy of breast cancer, that brings a considerable contribution to successful treatment of this pathology. Guidelines on treatment of early-stage breast cancer are a subject of regular, not less than 1–2 times per a year, reassessment procedure, considering the latest results of fundamental and clinical oncology researches. The current review examines results of the key investigations devoted to early-stage breast cancer treatment and highlights changes to recommendations on neo- and adjuvant therapy, that were made during the
last 5 years on the basis of these considerations.
Keywords: early breast cancer, neo-adjuvant therapy, adjuvant therapy, radiotherapy, chemotherapy, hormonotherapy, anti-HER2 therapy, ovarian suppression.
PROMISING METHODS FOR THE TREATMENT OF METASTATIC BREAST CANCERA.S. ZhabinaDOI 10.31917/1803265
Progress in the treatment of this disease, metastatic dissemination is still
considered an inclusive condition. In this lecture will be considered questions of
«non-standard» therapy, which may be included in our practice in the future.
Keywords: metastatic breast cancer, high-dose chemotherapy, metronome therapy, vaccine therapy, adoptive therapy.
POSSIBILITIES AND PROBLEMS OF CLINICAL EMBRYOLOGY IN IVF‑PATIENTS WITH ONCOLOGICAL DISEASESN.P. Makarova, A.Yu. Romanov, T.A. Dus, E.A. KalininaDOI 10.31917/1803275
Purpose of the study is a systematic analysis of the current available literature on the possibilities of preserving reproductive function in patients with or after oncological diseases. The review contains data related to this topic from both foreign and Russian articles found in the PubMed database, as well as Russian-language peer-reviewed journals from the past 10 years. Analysis of the literature on the current possibilities of clinical embryology in oncological diseases has shown that this direction of research is of notable social significance. However, many methods remain experimental and require further work and research
Keywords: oncofertility, assisted reproductive technologies, fertility, IVF, ICSI, cancer patients, cryopreservation, vitrification, in vitro oocyte maturation, IVM, ovarian transplantation, embryology.
THE EFFECT OF IPILIMUMAB ON THE SUBPOPULATION STRUCTURE OF LYMPHOCYTES OF PATIENTS WITH METASTATIC MELANOMAZ.G. Kadagidze, T.N. Zabotina, O.V. Korotkova, D.V. Tabakov, A.I. Chertkova, A.A. Borunova, I.O. Panchuk, I.V. Samoilenko, G.Yu. Kharkevich, L.V. DemidovDOI 10.31917/1803285
Using of targeted drugs based on monoclonal antibodies directed against inhibitory receptors on T-cells (called «checkpoint of immunity») is a promising direction in immunotherapy of malignant tumors in our days. One of the first medicine of this group introduced in clinical practice is Ipilimumab (anti-CTLA-4).
The aim of the investigation is the study of the subpopulation structure of circulating lymphocytes of patients with metastatic melanoma in the process of Ipilimumab therapy and it’s relationship with the clinical effect of the treatment.
Materials and methods. Immunophenotyping of circulating lymphocytes was assessed by multiparameter cytometricanalysis using commercial monoclonal antibodies to surface antigens CD45, CD4, CD8, CD19, CD16, CD56, CD25, CD127, CD11b. The study included 120 patients with metastatic melanoma. Immunological tests were performed before and after 4 doses of Ipilimumab (3 mg/kg every 21 days).
Results. The study has identified the correlation of certain populations of peripheral blood lymphocytes with the life expectancy of patients treated with Ipilimumab. The main differences were observed between the group of patients with a maximum life expectancy (over 2 years) and groups of patients with life expectancy less than 2 years. Differences was shown on cells of adaptive and innate immunity, including effector cells (CD8+, CD4+T-cells, NK-cells) and regulatory cells (NKT-cells, CD8+CD28- and CD4+CD25+CD127low/neg T-suppressor cells). Under the influence of Ipilimumab therapy the most significant changes in linear subpopulation structure of circulating lymphocytes was also observed in patients withlife expectancy more than 2 years.
Conclusion. The study found the relationship of the initial amount of effector and regulatory populations of lymphocytes
in the peripheral blood with a life expectancy of patients with metastatic melanoma treated with Ipilimumab.
Keywords: regulatory T-cells, NK-cells, NKT-cells, effector T-cells.
ACCELERATED PROTONS IN THE TREATMENT OF CNS TUMORS IN CHILDREN: A REVIEW OF THE LITERATUREO.I. ShcherbenkoDOI 10.31917/1803298
For the majority of pediatric patients with brain tumors radiation therapy is one
major component in a medical complex. The main problem with its use is the prevention
of remote consequences for potentially curable patients. The use of radiation
therapy with accelerated protons, due to the peculiarities of the distribution of energy
in the tissues, allows for maximum reduction of the radiation load on critical structure
and to reduce the severity of late effects compared with that observed after irradiation
by photons with the equivalent immediate effect. In this regard, proton irradiation is
preferable for patients with potentially curable brain tumors, for which the photon
radiation is associated with risk of development of late complications. The higher cost
of proton irradiation refunded by reduction in the cost of treating the consequences
observed after photon radiation therapy.
Keywords: сhildren, CNS tumors, radiation therapy, accelerated protons, photon radiation, complications, cost of treatment.