№77. Virus-associated tumors
VIRUS-ASSOCIATED TUMORS IN POINT OF VIEW OF THE MEDICAL ONCOLOGIST: FROM EPIDEMIOLOGY TO TREATMENTV.A. Chubenko
At the present moment viruses are the main etiological factor of 15% of the tumors
in worldwide and more than 25% in the developing countries. The occurrence of the
malignant neoplasms after a long latent period, which can reach up to 30 years, is
the main specialty. The viral epidemiology and transmission are used to distinguish
the groups of risk, resulting in the development of the diagnostic and the screening
programs. The viruses as a prognostic factor are attended in terms of the choice of
the optimal treatment strategies. Our growing knowledge of the role of viruses as a
cause of the tumor has led to the development of vaccines to help prevent certain
Keywords: virus-associated tumors, epidemiology, prognosis, clinical features, vaccination.
PREVENTION OF VIRUS-ASSOCIATED CANCERSА.A. Barchuk
Infections cause more than 15% of all cancers in the world. Viruses are among
the most common infectious causes of cancer. Primary prevention can significantly
reduce the number of virus-associated cancers. Effective vaccines against human
papillomavirus and hepatitis B virus are currently available. Their introduction at the
national level could significantly reduce the incidence and mortality from cervical and
liver cancer. Effective vaccines against other viruses are not available yet. However,
prevention of their transmission and antiviral therapy could also reduce the number
of cancer cases.
Keywords: prevention, vaccination, virus-associated cancers, antiviral therapy, screening.
PROSPECTS FOR IMMUNOTHERAPY OF VIRUS-ASSOCIATED TUMORSI.V. Samoilenko, Ya.I. Zhulikov, L.V. Demidov
Virus-associated malignancies are still common problem worldwide and in Russia
as well. In context of new treatment modalities development such as inhibition of
negative immune regulations or engineering immune cells with artificial receptors
which are capable to recognize viral antigens looks very attractive for billions of
patients worldwide. We reviewed the problem at the end of 2018.
Keywords: virus-associated malignancies, immunotherapy, CAR-T, engineered TCR, anti-PD1.
THE ROLE OF SURGICAL TECHNOLOGIES IN THE TREATMENT OF VIRUS-ASSOCIATED TUMORS ON THE EXAMPLE OF HEPATOCELLULAR CARCINOMAP.V. Balakhnin, A.S. Shmelev, E.G. Shachinov
Hepatocellular cancer (HCC) is the most difficult, but at the same time, the most interesting cancer from the point of view of surgical treatment of virus-associated tumor. In patients with virus-associated HCC, liver cirrhosis should be considered as a competing disease and this fact should be taken into account when determining treatment strategy. HCC is absolutely resistant to chemotherapy and radiation therapy (including stereotactic), therefore surgical (resection and liver transplantation) and IR (transarterial chemoembolization and percutaneous energy-based ablation) treatment methods are the only methods of effective therapy. In the past two decades, dramatic progress has been reached in the development of these technologies, which has significantly increased the survival of patients with very early, early and intermediate stages of HCC according to the BCLC classification.
Keywords: hepatocellular carcinoma, liver cancer, viral hepatitis, liver cirrhosis, virus-associated tumors, HBV, HCV, chemoembolization, ablation.
CHEMORADIOTHERAPY OF VIRUS-ASSOCIATED TUMORS (CANCER OF THE HEAD AND NECK, CERVIX CANCER AND ANAL CANCER)Yu.N. Vinogradova, V.P. Sokurenko, N.Yu. Neklasova, E.A. Maslyukova, A.I. Chumachenko, A.D. Kuznetsov, N.V. Ilyin
The data have been analyzed in the review of the literature on the epidemiology, clinical course, current approaches in the chemo-radiotherapy of patients with virus-associated tumors (head and neck cancer, cervix cancer and anal cancer). The presence of a complex interaction of human papillomavirus, human immunodeficiency virus with the clinical course of the tumors with mentioned localizations and the multidirectional influence of the presence/ absence of the virus on the results of chemo-radiotherapy, has been demonstrated. The perspectives of possible changes in standard treatment protocols of patients with virus-associated tumors, including using new approaches in target- and immunotherapy, are shown.
Keywords: virus-associated tumors, head and neck cancer, cervical cancer, anal cancer, chemoradiotherapy.
A MALIGNANT TRITON TUMOR ASSOCIATED WITH A DISEASE CAUSED BY THE HUMAN IMMUNODEFICIENCY VIRUSD.P. Kovtun, O.G. Polushin, E.V. Ponomaryeva, T.A. Mironov, D.V. Drobyshevsky, S.V. Kolomoytsev, D.A. Alekseev, K.V. Yurina
A description of the rare clinical observation of a malignant triton tumor in a 63-year-old male, aged 8 years with HIV infection and previously operated for testicular angiomyolipoma. The neoplasm up to 14,5 cm was located in retroperitoneum, pushing the cecum forehead, and was radically removed surgically. Because of the multicomponent composition and zonal structure of the tumor, the final diagnosis was possible only on the operating material.
Keywords: malignant peripheral nerve sheath tumor, triton tumor, retroperitoneum, HIV infection, immunohistochemistry.
EVALUATION OF THE EFFECTIVENESS OF USING VIDEOSCOPIC INGUINAL-FEMORAL LYMPHADENECTOMY IN THE TREATMENT OF METASTATIC MELANOMA OF THE SKINV.V. Egorenkov, M.S. Molchanov, A.V. Linetc, V.M. Moiseyenko
Aim. The main goal of the analysis is to evaluate the effectiveness of using the videoscopic method of lymph node dissection for the patients with metastatic lesions of regional inguinal-femoral lymph nodes.
Material and methods. From 2013 to 2016 in Saint Petersburg Scientific and Practical Oncological Center 86 endovideoscopic inguinal-hip lymphadenectomies were performed for the patients with skin melanoma. The average time of operative intervention for standard lymphadenectomy was 100 min. (80–120 min.), using videoscopic equipment –120 min. (100–140 min.). The number of lymph nodes removed using both methods was not significantly different and averaged 11 (9–15). Intraoperative blood loss was comparable in both groups and did not exceed 50-100 ml.
Results. Median duration of the supervision before the interim analysis was 15 months. No local recurrence was obtained in any of the groups. The use of the videoscopic technique allowed to reduce the incidence of postoperative gray formation almost four times: from 28,2% to 6,4%, and also to reduce the duration of the presence of lymphorrhea: from 3 weeks to less than one week for groups of standard and minimally invasive surgery, respectively.
Conclusion. Video endoscopic inguinal-femoral lymphadenectomy is an effective surgical technique that allows achieving results comparable to the open (standard) technique of an operation, corresponding to all levels of oncological radicalism.
Keywords: melanoma, metastatic lesion of regional lymph nodes, video endoscopic lymphadenectomy, lymphadenectomy, Ducken operation.
DUCTAL CANCER OF PANCREATIC HEAD NEOADJUVANT TREATMENT: CLOSE AND END RESULTSR.I. Rasulov, M.V. Zemko, I.V. Ushakova, G.I. Songolov
Aim: study the possibility of neoadjuvant therapy in radical therapeutic regimen of resectable pancreatic head cancer.
Material and methods. 216 patients with ductal cancer of pancreatic head have been treated over the years of 2006–2016. Neoadjuvant treatment was applied in 45 cases, adjuvant treatment – in 101 cases, symptomatic operations – in 70 cases.
Results. Over gastroduodenal artery chemoembolization 11 (18,3%) assessments had complications; they were cut short in the course of conservative treatment in 2–5 days. At the stage of radiation therapy 14 (23,3%) assessments caused radiation injuries; erythema was cut short in 4-10 days, leukopenia – in one day after radiation therapy termination. Remote survival rate with inoperable neoplastic process where gastroduodenal artery chemoembolization and radiation therapy were applied, was: 1 year – 53,9%, 2 years – 10,7%, average-expectancy life – 8,9±1,58 months. Postoperative complications and mortality while neoadjuvant treatment were 40% and 2,2% respectively. Remote survival rate while neoadjuvant and adjuvant treatment of patients with resectable neoplastic process was respectively: 1 year – 63,0% and 51,8% (р=0,1), 2 years – 35,2% and 19,8% (р=0,02), 3 years – 25,2% and 14,4% (р=0,05), 4 years – 11,9% and 7,9% (р=0,3), 5 years – 8,9% and 5,2% (р=0,2), average-expectancy life – 27,8±4,27 и 15,5±1,65 (р=0,03) months.
Conclusion. At pre-operational stage there were some complications and radiation injuries that had been cut short with conservative actions and didn’t extend the duration of this period. Gastroduodenal artery chemoembolization and radiation therapy improved considerably remote survival rate of patients with inoperable neoplastic process. Gastroduodenal artery chemoembolization and radiation therapy didn’t change the character and didn’t increase post-operation morbidity and mortality. Resectable pancreatic head cancer combination therapy improved considerably remote survival rate in cases with metastatic lesions of regional and uxtaregional lymph nodes.
Keywords: pancreatic head cancer, neoadjuvant treatment, gastroduodenal artery chemoembolization, radiation therapy.
OLANZAPINE VERSUS APREPITANT IN PATIENTS RECEIVING HIGH-EMETOGENIC CHEMOTHERAPY: INTERIM ANALYSIS OF RANDOMIZED PHASE II TRIALA.A. Rumyantsev, E.V. Glazkova, R.Yu. Nasyrova, E.O. Ignatova, L.V. Chitia, A.S. Popova, Kh.Kh. Elsnukaeva, I.A. Pokataev, A.S. Tyulyandina, M.B. Stenina, M.A. Frolova, A.A. Bulanov, V.Yu. Fedyanin, O.V. Sekhina, A.A. Tryakin, S.A. Tjulandin
Rationale: optimal management of chemotherapy-induced nausea and vomiting (CINV) remains challenging. Olanzapine might provide several benefits over aprepitant which is current standard of care – particularly in terms of nausea control and cost effectiveness. However, undesired sedation associated with recommended doses of olanzapine precludes its wide use in oncology practice.
Aim of the study: to develop effective, low-toxic and affordable regimen for CINV prophylaxis to be used in daily oncology practice.
Material and methods: this was randomized phase II single center study aimed to compare olanzapine and aprepitant in CINV prophylaxis during high emetogenic chemotherapy (HEC). Key inclusion criteria were: chemo- and radio-therapy naive patients, planned administration of HEC (cisplatin, carboplatin AUC≥4, doxorubicin etc). Patients were randomized in 1:1 ratio in the following arms: olanzapine 5 QD day 0-4 or aprepitant 125 mg day 1, 80 mg day 2, 3. All patients received standard therapy with ondansetron and dexamethasone. Primary endpoint was complete nausea control (absence of nausea and no use of rescue medication) during 0–120 hours after chemotherapy. Nausea was assessed using MASCC Antiemesis Tool. Interim analysis was scheduled after enrollment of 49 patients.
Results: on the time of analysis we enrolled 49 patients. The groups were well balanced. The proportion of patients with no chemotherapy-induced nausea was numerically greater with olanzapine than with aprepitant (45,5% and 25,9%; p=0,228). Complete response was achieved in 63,6% and 48,1% patients, respectively (p=0,241). No differences in rates of undesired sedations were detected.
Conclusion: our data suggests superiority of low-dose olanzapine regimen in terms of nausea control and supports the continuation of this study.
Keywords: olanzapine, aprepitant, chemotherapy, supportive care, CINV, nausea, vomiting.
RE-IRRADIATION THERAPY FOR RECURRENT BRAIN TUMORSO.I. Shcherbenko, O.S. Regentova
Aim. According to the information provided in the Medline system to assess the possibility and effectiveness of repeated courses of radiation therapy for relapses of the most common brain tumors in children and adults.
Material and methods. The analysis of information available in the system Medline, devoted to the analysis of the effectiveness and methods of re-radiation therapy in relapses of medulloblastoma, ependymoma, gliomas and brain stem tumors in childhood and adults.
Results. It is shown that re-irradiation therapy in an independent version or in combination with surgery and chemotherapy for relapses of brain tumors in most cases can improve the quality of life and increase its duration. The resistance of the effect mainly depends on the degree of malignancy of the tumor. The achieved positive effect allows to ignore the hypothetical danger of radiation damage before the risk of progression of the tumor. Tactics of treatment of relapses should be selected individually for each patient, taking into account the characteristics of the tumor, its prevalence, the patient’s condition and life expectancy.
Conclusion. Radiation therapy is currently one of the most realistic means of helping patients with relapses of brain tumors after previous treatment.
Keywords: brain tumors, relapses, radiation therapy, chemotherapy, medulloblastoma, ependymoma, glioma, brain stem tumor, radiation injuries.
СLINICAL CASE. RADIOSURGICAL TREATMENT METHOD OF SOLITARY CONVEXITAL BRAIN METASTASIS USING THE TECHNIQUE OF SKIN INFLATIONA.S. Tokarev, V.A. Rak, O.L. Evdokimova, K.V. Gretskikh
Localization of the pathological focus in functionally significant and radiosensitive zones sometimes limits the use of radiosurgery as a method of single high-dose irradiation of the tumor. In the case of convexital localization of these tumors with a volume of 5 cm3 to achieve effective single-time treatment without radiation damage to the skin is almost impossible.
The article presents a clinical case in which a new method is applied to improve the safety of treatment while maintaining the effectiveness of treatment by reducing the dose to the scalp in the projection of the tumor taking into account the high prescribed dose for the pathological focus. The inventive method is based on using a biodegradable filler to allow inflation of the skin in the projection of the convexital tumors are located and to plan radiosurgical operation, taking intoconsideration its shifting.
Keywords: radiosurgery, convexital localization, skin, metastasis, inflation.
INDICATIONS FOR LYMPH NODE DISSECTION IN PATIENTS WITH VULVAR CANCER. LITERATURE REVIEW AND OWN CLINICAL OBSERVATIONSА.А. Ilin, S.Y. Maximov, А.S. Khadgimba, I.V. Sobolev, S.H. Kaitova
Selection of patients with minimal vulvar cancer characterized by low metastatic rate to regional lymph nodes (LN) will allow to reduce the number of extended surgical interventions, the incidence of complications and lead to prompt rehabilitation of patients.
Aim. Determine the indications to lymph node dissection in vulvar cancer patients.
Material and methods. 252 cases of vulva cancer treatment were analyzed. The distribution by stages was: I – 58, II – 103, III – 79, IV – 12. Histologically squamous cell carcinoma was predominantly 91% (N=229). In most patients (35,5%), vulva cancer was diagnosed at the age of 61–70 years with peak manifestation at 68 years old. The vast majority of patients had therapeutic pathology. Vulvectomy and vulvectomy with lymph node dissection performed in 152 and 100 cases respectively. All patients were observed for 5 years or more.
Results. In subgroup analysis of 45 patients with minimal vulvar cancer (diameter up to 2 cm, invasion up to 5 mm) secondary disease in lymph nodes was recorded only in one (1,4%) observation. In comparison for the group of patients with invasion 5–10 mm and diameter up to 2 cm the incidence of LN metastasis was 8,3% (N=6), significantly increasing with a tumor size of more than two centimeters. In tumors with invasion of more than 5 mm and a diameter of 1,0– 2,0 cm the frequency of LN affection was almost identical – 4,2%. In tumors with invasion of more than 2,0 cm secondary disease in LN was registered significantly more often: up to 5 mm in 20,8% (N=15), 5–10 mm in 23,6% (N=17) and in case of invasion more than one centimeter in 36,1% (N=26) respectively.
Conclusion. Indications for groin lymph node dissection are formulated: 1) tumor size more than 2 cm, 2) invasion more than 5 mm, 3) multifocal tumor growth, 4) low-grade cancer, 5) localization of tumor in the clitoral region.
Keywords: vulvar cancer, metastasis, lymph node dissection, risk factors, vulvectomy.