Comparative evaluation of treatment methods of neoadjuvant intra-arterial chemotherapy and chemoembolization by drug-saturated embospheres in II–IVa stages cervical cancer

Objective: comparative evaluation of treatment methods for neoadjuvant intra-arterial chemotherapy and chemoembolization by drug-saturated microspheres followed by surgical treatment in II–IVa stages cervical cancer.Materials and methods. This study presents the results of complex treatment in 209 patients (average age – 40.57 ± 8 years) with II– IVa stages cervical cancer and 384 endovascular interventions as the first stage of complex treatment in the period from 2010 to 2016. The scheme neoadjuvant intra-arterial chemotherapy was carboplatin (AUC6 intra-arterial) + irinotecan (200 mg/m2 intravenously on day 1) every 21 days. Radical surgical treatment was performed basically after 2 cycles of chemotherapy. Patients who did not respond sufficiently to neoadjuvant intra-arterial chemotherapy underwent a radical course of chemoradiation therapy according to the standard scheme.Results. The overall response to neoadjuvant intra-arterial chemotherapy was 84.8 % and 79 % of patients in groups of chemoinfusion and trans-arterial chemoembolization, respectively (p >0.05). Operability was higher in group of chemoinfusion (69 % versus 46.4 %) (p <0.01), and fewer patients with metastases to regional lymph nodes were revealed in this group (30.2 % versus 42 %), p <0.05. Overall and survival rate is statistically significantly better in group of chemoinfusion – 63.9 % and 61 % versus 43 % and 42 %, respectively, p <0.05. At the same time, statistically significant differences between the groups were revealed only at stages III–IVа cervical cancer. Radically operated patients, as expected, had a better prognosis (p <0.001). The age of patients, tumor differentiation and therapeutic pathomorphosis did not affect the prognosis of life.Conclusions. Neoadjuvant intra-arterial chemoinfusion and chemoembolization using irinotecan + carboplatin scheme are relatively safe treatment methods with acceptable toxicity and have a high cytotoxic effect. Patients in chemoinfusion group have a better prognosis compared with patients in chemoembolization group. Selective chemoembolization with subsequent surgical treatment or radiation therapy may be the treatment of choice for stage II cervical cancer complicated by bleeding.

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IMPROVING THE SELECTIVE TREATMENT OF THYMUS TUMORS USING INTRA-ARTERIAL CHEMOEMBOLIZATION

ГРААЛЬ НАУКИ ◽

10.36074/grail-of-science.25.06.2021.063 ◽

2021 ◽

pp. 357-362

Author(s):

Roman Kravchenko ◽

Yu. Avdosjev ◽

O. Luzan ◽

J. Ivashchik ◽

Alexander Dudnichenko

Keyword(s):

Surgical Treatment ◽

Tumor Tissue ◽

Regional Chemotherapy ◽

Thymus Gland ◽

Whole Body ◽

Complex Treatment ◽

Epithelial Tumors ◽

Tumors Of The Thymus ◽

Thymic Carcinomas ◽

Arterial Chemoembolization

Epithelial tumors of the thymus occur in the thymus and include thymomas and carcinomas of the thymus. Thymomas are the most common primary tumor in the anterior mediastinum, but are generally rare (1.5 cases / 1,000,000). Although thymomas can spread locally, they are much less invasive than thymic carcinomas. Patients with thymic carcinomas often have metastases. The 5-year survival of patients with thymoma reaches 90%. At the same time, the 5-year survival rate for thymic carcinoma is approximately 55% (NCCN Guidelines. Version 1.2020).Surgical treatment as an independent method can be used only when there are thymus tumors in encapsulated and minimally invasive tumors in the first degree, rarely in the second degree. In all other cases, patients are subject to combined, complex or conservative treatment. In combined and complex treatment, preference should be given to neoadjuvant methods, which allows to achieve regression of the tumor, reduces its volume, limits the invasion of surrounding tissues, as well as to transform the inoperable process into operability.Endovascular technologies, namely regional chemotherapy, in the preoperative period, as a preparatory stage, will increase the level of ablastics and antiblastics in surgical treatment of thymus and reduce the percentage of cytostatics on the whole body, as in intravenous administration. At patients with a paraneoplastic syndrome it is necessary to increase term of regression of displays of these syndromes.Intra-arterial administration of chemotherapeutics has certain advantages:• cytostatics in the arteries that supply blood to the tumor are injected directly into the affected area, which allows you to significantly increase the concentration of the drug in the tumor itself;• reduces the toxic effects of chemotherapy on the whole body;• longer action of drugs allows long-term contact of the cytostatic with tumor cells at all stages of the cell cycle.Another main detail of treatment is that after the introduction of the cytostatic, it is necessary to introduce special emboli (microspheres) to block the removal of the chemotherapeutic agent.The analysis of treatment is taking into account the stage, anamnestic data, the development of clinical manifestations, the results of laboratory and instrumental methods of examination.According to our evidence, taking into account clinical and anamnestic (complaints), laboratory, instrumental (CT OGK with IV contrast), certain conclusions were made in the treatment of thymic tumors.According to our observations, a method of complex treatment of thymic tumors was developed. In this technique, we used regional chemotherapy (namely intra-arterial administration of chemotherapy-cytostatics) as the main method.Object of study. Epithelial tumors of the thymus gland. Subject of study. Indicators of survival and quality of life of patients with malignant thymoma without surgical treatment. The results of radical surgical treatment after regional chemotherapy. Indicators of ablastic and antiblastic. Indicators of results of patients with paraneoplastic syndrome.The aim of the study. Increase the effectiveness of treatment of patients with epithelial tumors of the thymus by using intra-arterial chemoembolization as a neoadjuvant therapy to create ischemia and high concentrations of cytostatics in tumors for a long period of time to achieve devitalization of tumor tissue and reduce overall toxicity of chemotherapy.Objectives of the study.1. To determine the causes of unsatisfactory results of treatment of patients with epithelial tumors of the thymus using standard methods2. Improve the technique of intra-arterial chemoembolization in epithelial tumors of the thymus gland (technology, choice of cytostatics)3. To study the dynamics of biochemical markers (AFP, HGT) and antibodies to acetylcholine in paraneoplastic syndrome using intra-arterial chemoembolization4. To study pathomorphological changes in tumor tissue using intra-arterial chemoembolization5. To compare the clinical efficacy (increased tumor operability) of intra-arterial chemoembolization in the complex therapy of patients with epithelial tumors of the thymus gland.

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Using Nanotech Radiopharmaceutical for the Visualization of Sentinel Lymph Nodes in Patients with Cervical Cancer

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.1084.540 ◽

2015 ◽

Vol 1084 ◽

pp. 540-544 ◽

Cited By ~ 1

Author(s):

Ivan Sinilkin ◽

Vladimir Chernov ◽

Alena Chernishova ◽

Larisa Kolomiets ◽

Anna Titskaya ◽

...

Keyword(s):

Cervical Cancer ◽

Surgical Treatment ◽

Lymph Nodes ◽

Comparative Evaluation ◽

Invasive Cervical Cancer ◽

Sentinel Lymph Nodes ◽

Stage I ◽

Combined Use ◽

Radiometric Determination

The study of radionuclide determination of SLN and optimization of surgical treatment in organ-sparing treatment of invasive cervical cancer included 26 patients with cervical cancer of stage I. To identify sentinel lymph nodes a nanocolloid was administered one day prior to the planned operation. Sentinel lymph nodes were identified in 26 patients. A comparative evaluation of the sensitivity of techniques for determining SLN, depending on the method, has showed that the SPECT sensitivity was 72%, with radiometry this indicator was 93.3%. The technique of intraoperative radiometric determination of SLN is more efficient in comparison with SPECT. The optimum is the combined use of both techniques, when the probability of SLN detection increases to 91.4%.

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The rationale for the combined use of osteopathic methods of correction and reflexology in the complex treatment of patients with dorsopathy at the cervico-thoracic level

Russian Osteopathic Journal ◽

10.32885/2220-0975-2020-3-82-94 ◽

2020 ◽

pp. 82-94 ◽

Cited By ~ 1

Author(s):

V. O. Belash ◽

L. R. Urazgalieva ◽

R. I. Fayzullina ◽

L. G. Agasarov

Keyword(s):

Drug Therapy ◽

Drug Treatment ◽

Pain Syndrome ◽

Clinical Effectiveness ◽

Complex Treatment ◽

Standard Drug ◽

Treatment Methods ◽

Thoracic Level ◽

Combined Use ◽

Complex Therapy

Introduction. Degenerative-dystrophic changes in the spine are the most common chronic human diseases. Pronounced clinical manifestations of vertebrogenic diseases are observed during active labor activity and represent one of the most frequent causes of temporary disability. It is also known that any pain syndromes are accompanied by the development of psychovegetative disorders, which reduces the effectiveness of treatment. In recent years, there has been a reasonable increase in the interest of the medical community to the non-drug treatment methods. It is caused by the polypharmacotherapy side effects, an increased numbers of allergic reactions, problems with polypragmasia, and a low level of compliance. At the same time, the question of the possibility of various non-drug treatment methods combining is quite acute.The goal of research is to substantiate the clinical effectiveness of the combined application of osteopathic correction and reflexotherapy in the complex treatment of patients with dorsopathy at the cervical-thoracic level.Materials and methods. A prospective controlled randomized study was conducted on the basis of the medical clinics of LLC «Family Health» (Kazan) and ANO «Center for SEB assistance» (Kazan) from April 2018 to May 2019. The study involved 52 people with dorsopathy at the cervical-thoracic level, aged from 25 to 45 years. In accordance with the exclusion criteria, 7 people dropped out of the study. The remaining patients (45 people), depending on the used treatment method, were divided by a simple randomization method using a random number generator into three groups of 15 people. The first group (main group) received osteopathic correction and reflexotherapyon the background of standard drug therapy; the second and the third groups (control groups) received only osteopathic correction orreflexotherapy, respectively, on the background of standard drug therapy. The osteopathic examination was performed for all patients regardless of the group, before and after the course of therapy, with the formation of an osteopathic conclusion.Also there was the estimation of the degree of pain syndrome severity,the asthenia, and the degree of accumulated emotional and energy charge that does not get out in a person.Results. It was found in the course of the study that the inclusion of osteopathic correction and reflexotherapy in the complex therapy of patients with dorsopathy at the cervical-thoracic level is clinically more effective than the isolated use of these methods. Such complex therapy allows to achieve a more significant reduction in the severity of the pain syndrome by VAS (p<0,05), relief of internal emotional tension (p<0,05), and increase the effectiveness of correction of dominant somatic dysfunction. Based on the obtained data, it could be assumed that reflexotherapy potentiates the effects of osteopathic correction.Conclusion. Based on the study, it can be concluded that the combination of osteopathic correction and reflexotherapy in the treatment of patients with dorsopathy at the cervical-thoracic level increases the clinical effectiveness of the standard drug therapy. At the same time, it is worth noting the potentiating effect of the combined use of two non-medicinal methods. The question of combining of various non-drug treatment methods is quite acute today, so this study will be continued.

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Results evaluation of the modern surgical treatment methods for pressure ulsers in patients with the spinal cord injuries consequences

Surgery of Ukraine ◽

10.30978/su2018114 ◽

2018 ◽

Vol 0 (1) ◽

pp. 14-20

Author(s):

Ya. L. Zarutskii ◽

I. B. Plis

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Injuries ◽

Treatment Methods

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RWS Non-Randomized Clinical Trial of Current Surgical Treatment Status in Patients With Early Stage Cervical Cancer

Case Medical Research ◽

10.31525/ct1-nct03955185 ◽

2019 ◽

Author(s):

Keyword(s):

Clinical Trial ◽

Cervical Cancer ◽

Surgical Treatment ◽

Randomized Clinical Trial ◽

Early Stage ◽

Treatment Status ◽

Early Stage Cervical Cancer

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Faculty Opinions recommendation of Results of the GYNECO 02 study, an FNCLCC phase III trial comparing hysterectomy with no hysterectomy in patients with a (clinical and radiological) complete response after chemoradiation therapy for stage IB2 or II cervical cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13996971.15453078 ◽

2012 ◽

Author(s):

David Kushner ◽

Shitanshu Uppal

Keyword(s):

Cervical Cancer ◽

Complete Response ◽

Chemoradiation Therapy ◽

Phase Iii ◽

Phase Iii Trial

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THE ROLE OF SURGICAL STAGE IN COMBINATION THERAPY FOR PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER

Problems in oncology ◽

10.37469/0507-3758-2019-65-5-749-755 ◽

2019 ◽

Vol 65 (5) ◽

pp. 749-755

Author(s):

D. Reyes Santyago ◽

Anzhella Khadzhimba ◽

M. Smirnova ◽

Sergey Maksimov

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Combination Therapy ◽

Lymph Nodes ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Relapse Free Survival ◽

Regional Lymph Nodes ◽

Free Survival ◽

Locally Advanced Cervical Cancer

Objective: to justify the expediency of the surgical stage as a part of the combination treatment for stage IIA-IIIB cervical cancer. Materials and methods. The study included 343 women with stage IIA-IIIB cervical cancer treated from 2013 to 2016 with mandatory follow-up for at least 2 years. Patients were divided into 2 groups. The first group included 214 patients who received a combination treatment. At the first stage, neoadjuvant chemoradiation therapy was performed (remote radiation therapy 5 days a week with radio modification with Cisplatin once a week at a dose of 40 mg/m2). After evaluating the effect, patients were subjected to surgical treatment or continued chemoradiotherapy. The second group (n = 129) received standard combined radiation therapy. Various schemes of combination and complex treatment and standard combined radiation therapy were evaluated using the indices of general and relapse-free survival. Results. The proposed scheme for the combination therapy for patients with locally advanced cervical cancer showed significantly higher survival rates at all the analyzed stages. For the combined treatment group with complete cytoreduction, the two-year overall and relapse-free survival with stage IIA is 94.1% vs. 82.4%, with IIB 90.8% vs. 80.3%, with IIB 87.5% vs. 75%, with IIB with metastatic lesion of regional lymph nodes 85% vs. 70%. For the second group, two-year overall and relapse-free survival with stage IIA 75% vs. 50%, with IIB 70.9% vs. 56.3%, with IIB 59.1% vs. 40.9%, with IIB with metastatic lesion of regional lymph nodes 62.2% and 40.5%. The advantages of this approach are most clearly seen within patients with metastatic lesions of regional lymph nodes (85% vs. 62% accordingly). Conclusion. Cytoreductive surgery in combination with the combination therapy allows to achieve a significant increase in overall and relapse-free survival for patients with locally advanced cervical cancer compared with standard treatment programs.

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