2018.26 (2)

2018, vol XXVI, # 2, page 65

V. S. IVANKOVA1, E. A. DEMINA2, L. V. MATVIEVSKAYA3, Т. V. KHRULENKO1, L. M. BARANOVSKAYA1

1 National Cancer Institute of Health Ministry of Ukraine, Kiev

2 Institute of Experimental Pathology, Oncology and Radiobiology, Kiev

3 Zhytomyr Regional Oncology Dispensary

RADIOBIOLOGICAL ASPECTS IN BRACHYTHERAPY OF SECONDARY METASTATIC VAGINAL CANCER

Abstract. The search for optimal models of contact radiation therapy for the purpose of increasing the effectiveness of chemoradiotherapy for secondary vaginal cancer (metastatic forms) continues to be the subject of extensive discussion.

Materials and methods. The National Cancer Institute, Department of Radiation Oncology conducted complex conservative treatment of 92 patients with metastatic cancer of the vagina II-III stages, T2-3 N0-1 M0 at the age of 28 to 72 years. Depending on the method of HDR (high dose rate – of higher than 12 Gy / h) brachytherapy, 3 groups were formed on the background of chemosensitizing agents (oral fluoropyrimidines, platinum preparations): 2 studies (28 patients who underwent HDR brachytherapy using 192Ir source and 30 patients with 60Co HDR source) and 34 patients of the control group, Which brachytherapy was carried out by 60Co sources with an average medium dose rate (MDR – from 2 Gy / h to 12 Gy / h). The total focal dose from combined radiotherapy was up to 80-90 Gy on the tumor focus and 44-46 Gy on the regions of regional metastasis. Brachytherapy was performed in the 5 Gy regimen 2 times a week.

Results. Analysis of the direct results of the effectiveness of the use of 60Co or 192Ir sources with HDR brachytherapy and dynamic observation data for 3 months showed that the positive tumor response (complete + partial regression) in patients with metastatic vaginal cancer after the course of chemoradiotherapy increased by 20,1 % and 16,6 % application of 60Со МDR at brachytherapy. Toxic effects of treatment by the number and extent of their manifestations in the study groups of patients did not differ from the control group and did not exceed the second degree.

Conclusions. Technologies of high-energy modern brachytherapy with high-dose rate sources of 192Ir and 60Co allow one to concentrate in a short time interval high doses of energy of ionizing radiation in a limited volume of tissues with minimal risks of severe radiation reactions or damage. The clinical effect of chemoradiotherapy is delayed. The use of radio modifiers in the process of combined radiotherapy in patients with metastatic vaginal cancer does not lead to toxic complications that adversely affect the quality of life of patients.

Keywords: brachytherapy, secondary vaginal cancer (metastatic form).

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2018, vol XXVI, # 2, page 70

M.V. SOKOLOVSKA1, V. P. IVCHUK1, T. M. GOVORUKHA2, T. M. VALEVACHINA2, L. V. VINZEVICH2, O. S. CHURIKOVA2, O. V. OVSIENKO2

1 Shupik National Medical Academy of Postgraduate Education

2 Kiev City Clinical Oncological Centre

HDR-BRACHYTHERAPY IN THE MANAGEMENT OF SKIN, ORAL MUCOSA, RECTAL CANCER AND SQUAMOUS CELL CARCINOMA OF THE ANUS: CLINICAL OUTCOMES

The aim. The aim of the study was to evaluate the role of high-dose-rate brachytherapy (HDR-BT) in the definitive and postoperative management of skin, oral mucosa, rectal cancer and squamous cell carcinoma of the anus in terms of clinical outcomes and toxicities.

Methods. 79 patients treated with an applicative or intracavitary (192) Ir HDR-BT on the GammaMed Plus from 2014 to 2017. The treatment management depended on the stage of the tumour. As the definitive course, brachytherapy was used for Tis-T1N0M0 and recurrent tumours. For T2N0M0 HDR-BT was applied with external beam radiation therapy (EBRT) or as the postoperative treatment.

Results. Short-term treatment results allow us to consider the used programs as effective and safe treatment method. The clinical complete response rate after RT completion was 100%. We have seen acute toxicity only Grade 1-2. However, it needs observed a long-term follow-up.

Conclusions. We confirm the excellent results with RT in T1 and T2 lesions of skin, oral mucosa, rectal cancer and squamous cell carcinoma of the anus. Applicative and intracavitary HDR-brachytherapy is effective method of radiotherapy and it may use as the definitive (alone or in combination with EBRT) and postoperative management.

Keywords: high-dose-rate brachytherapy (HDR-BT), skin cancer, oral mucosa cancer, rectal cancer, squamous cell carcinoma of the anus.

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2018, vol XXVI, # 2, page 74

A. A. GRYAZOV

Shupik National Medical Academy of Postgraduate Education

COMPARISON OF DYNAMIC SUSCEPTIBLIRI CONTRAST (DSC) MRI PERFUSION AND NON-INVASIVE ARTERIAL SPIN LABELING (ASL) IN THE DIAGNOSTIS OF GLIOMAS MALIGNANCY

In order to compare the diagnostic value in determining the degree of malignancy with gliomas, data from 30 patients with cerebral glioma diagnosis were analyzed using the data of a non-contrast technique based on arterial spin labeling (ASL) and dynamic susceptibility contrast (perfusion) MRI (DSC). In all patients, the diagnosis was histologically confirmed, either after surgery or after a stereotactic biopsy. High-grade gliomas were detected in 22 patients and low-grade gliomas in 8 patients. Prior to surgery, all patients were examined by MRI with a magnetic field strength of 1.5T, obtaining both standard MP sequences and special perfusion programs: ASL and DSC. The regions of interest in the tumor tissue as well as the brain tissue (cortex and white matter) of the contralateral hemisphere were investigated. We investigated the following parameters: the relative volume and cerebral blood flow, according to the contrast MRI DSC and the ASL-free, non-contrast technique. According to our data, the blood flow increased with the degree of glioma malignancy. The ASL data correlated with the DSC-rCBF data (r = 0.580, P <0.01) and with the rCBV data (r = 0.431, P <0.01).

In the regions of interest (ROC), depending on the gliomas degree, the cerebral blood flow from the ASL data was the highest in the ROC curve (0.844). The regions under the ROC DSC-rCBF and DSC-rCBV curve were analyzed using the Z test; the difference was not statistically significant.

The sensitivity of diagnosis according to the DSC data was 91.3% and according to ASL 95.8%, specificity 77.7 and 89.4%, respectively. The use of a non-invasive MRI sequence based on pulse arterial spin labeling (PASL) compared with dynamic susceptibility contrast (DSC) makes it possible with a high accuracy to determine the degree of malignancy of brain gliomas, with high sensitivity and specificity.

Keywords: magnetic resonance imaging, arterial spin labeling, dynamic susceptibility perfusion, glioma, degree of malignancy.

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2018, vol XXVI, # 2, page 80

M. A. SELEZNEV

Kharkiv Medical Academy of Postgraduate Education

THE EXPERIENCE IN THE INTRODUCTION OF LAPAROSCOPIC TECHNOLOGIES INTREATMENT OF COLORECTAL CANCER

The analysis of 22 patients operated in the period from 2016 to 2018 for colon tumors with the use of laparoscopic technologies, was performed. In ten cases, the laparoscopic stage was changed to open surgical intervention. All patients with a conversion had a tumor of the left colon. The structure of completely laparoscopic surgery included right hemicolectomy, sigmoidectomy, proctectomy, and transanal TME.

The problem of introducing laparoscopic techniques into the surgery of colorectal cancer lies not only in the development of manual skills, but also in solving administrative and organizational issues aimed at ensuring the continuity of the educational process and sufficient surgical activity. The learning curve for performing colorectal resections, even with the use of simulation techniques for the development of manual skills and the use of educational video materials, significantly exceeds 10 operations. Essential assistance in mastering this type of surgical interventions is provided by working with a mentor.

The selection of patients for operations in the rectum and the left colon for such parameters as BMI, tumor size, adhesions in the abdominal cavity — significantly reduce the frequency of conversions.

Keywords: colorectal cancer, laparoscopy, conversion, learning curve.

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2018, vol XXVI, # 2, page 83

V. S. IVANKOVA

National Cancer Institute of Health Ministry of Ukraine, Kiev

ADVANTAGES OF CONTEMPORARY TECHNOLOGIES IN THE RADIATION THERAPY OF ONCOLOGICAL DISEASES

The article shows that malignant neoplasms are one of the most acute medical problems of our time. A gradual increase in oncological morbidity was noted, which continues to occupy the first place in the list of causes of premature mortality. Radiation therapy remains one of the main methods of treatment of oncological diseases. Increasing the effectiveness of radiation therapy in the treatment of cancer patients in our country in recent years is due to the introduction of modern technologies in the planning and implementation of it. However, the maximum use of modern radiation methods depends on the level of technical equipment of oncological institutions and informing society about the role and possibilities of radiotherapy. The successes of radiation oncology in the late 20th and early 21st century are mainly due to the high technologies of therapeutic irradiation. An important part of the technological chain of preparation and conduct of radiation therapy is pre-radial topometric preparation. Modern methods of radiation therapy using different types of high-energy radiation are a new stimulus to the development and introduction of high-precision combined radiation therapy and dosimetric planning into practice. The prospect of further development of radiation oncology consists not only in the introduction of new technologies in radiotherapy, but also in the intensive development of radiation medicine and radiobiology. It is emphasized that for the effective use of radiation therapy and the quality assurance of treatment, the modern department of radiation oncology should be equipped with such a complex of equipment: irradiators — remote and contact gamma machines, accelerators with a maximum photon energy of 5–25 MeV, a device for visualization and accuracy control irradiation, irradiation planning system. It is indicated that the further development of radiation therapy consists not only in the introduction of new technologies in radiotherapy, but also in the intensive development of radiation medicine and clinical radiobiology. The use of new technologies and computer technology, taking into account the principles of radiobiology, ensures that the planned dose is reduced to the target volume with minimal irradiation of healthy tissues while maintaining the quality assurance of radiotherapy.

Keywords: radiation oncology, ionizing radiation, conformal radiation therapy, modern technologies.

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2018, vol XXVI, # 2, page 88

M. I. KHVOROSTENKO, I. N. KIKHTENKO, J. M. KHVOROSTENKO, Y. V. HRABOVSKYI

State Institution «Dnepropetrovsk medical Academy of Health Ministry of Ukraine»

PECULIARITIES OF DIAGNOSIS, COURSE AND TREATMENT OF LATE RADIATION ULCERS

Abstract. The possibility of determining the state of lymphovenous outflow of limb segments with distal edema in cancer patients after combined treatment with pertechnetate 99mТс was revealed.

Keywords: limfovenozny outflow, lymphedema limb, pertechnetate 99mТс.

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2018, vol XXVI, # 2, page 93

N. V. BELOZOR, S. V. ARTYUKH, N. A. MITRYAEVA, V. P. STARENKY, L. V. GREBENIK

SI Grigoriev Institute for Medical Radiology of National Academy of Medical Science of Ukraine, Kharkov

VEGF, COX-2 AND PGE-2 CONTENT IN BLOOD SERUM OF PATIENTS WITH HEAD AND NECK CANCER WITHIN CONFORMAL RADIATION THERAPY OVER TIME

The purpose of the research is to study VEGF, COX-2 and PGE-2 content in blood serum of patients with head and neck carcinoma (HNC) within conformal radiation therapy over time.

Materials and methods. The study enrolled 22 patients with head and neck squamous cell carcinoma aged from 29 to 79. Radiation therapy (RT) was carried out applying the methods of multiple conformal irradiation on Clinac 600C linear accelerators via the classical fractionation regime. The selection of the irradiation area in the planned system (Varian Eclipse 8.9) was conducted according to ICRU 50 & 62 guidelines. To determine the content of angiogenesis factors for VEGF, COX and PGE-2, blood was collected from patients before the beginning of irradiation and after the course of therapy. The level of factors was estimated in blood serum by polarization fluoroimmunoassay using CJSC Vector-Best standard reagent kits (Russia), Invitrogen COX-2 ELISA Kit commercial reagent kits (Great Britain) and Prostaglandin T2 ELISA Kit (Germany).

Outcomes. It has been proved that VEGF, COX-2 and PGE-2 content in blood serum of 91% and 86.4% of patients with HNC before the start of conformal radiation therapy is significantly higher than in the comparison group. After the course of radiation therapy in patients with HNC in tumor regression (77.3%), the level of VEGF decreased was decresed by 1.8 times compared with the indices before treatment, and COX-2 and PGE-2 content remained practically unchanged. At the same time local radiation reactions did not exceed II degree, hematological toxicity – I degree. A high level of VEGF was observed before treatment in the group of patients with progression (22.7%) of the neoplastic process, after treatment they had a high VEGF level against the consistently high values of COX-2 and PGE-2. The analysis of the obtained outcomes showed that the change in VEGF level coincided with an objective response to radiation therapy. When the tumor regressed, there was a significant reduction in VEGF level, which indicates the effectiveness of RT; in the course of progression, a stably high level of VEGF was observed, which is an unfavorable sign and is probably associated with tumor resistance to the therapy.

Conclusions. Dynamic changes in VEGF indices in blood serum of patients with HNC in radiation therapy were determined against an objective response to treatment. It has been  found that the levels of COX-2 and PGE-2 remain high after radiotherapy in patients with HNC.

Keywords: radiation therapy, vascular endothelial growth factor (VEGF), angiogenesis, cyclooxygenase-2 (COX-2), prostaglandin E-2 (PGE-2), head and neck cancer (HNC).

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2018, vol XXVI, # 2, page 99

N. V. KRASNOSELSKYI1, 2, A. N. BELIY1, 2

1 SI Grigoriev Institute for Medical Radiology of National Academy of Medical Science of Ukraine, Kharkov 2 Kharkov National Medical University

PRINCIPLES OF SURGICAL INJURY MINIMIZATION AND RECONSTRUCTION POSSIBILITY IN BREAST CANCER PATIENTS

Breast cancer ranks first among women with oncological diseases. Over recent years breast cancer has affected young women with increasing frequency. One of the most acute and unresolved factors is the problem of psychological and social adaptation of such patients after surgical treatment to the extent of radical mastectomy. The article presents tactical and strategic considerations for minimizing surgical aggression in patients with breast cancer. The own data concerning organ-saving and reconstructive treatment of patients with breast cancer have been presented.

Keywords: breast cancer, surgical treatment, reconstructive surgery.

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2018, vol XXVI, # 2, page 102

V. S. SUKHIN

SI Grigoriev Institute for Medical Radiology of National Academy of Medical Science of Ukraine, Kharkіv

THE ROLE OF THE DOSE OF ADJUVANT RADIATION THERAPY FOR UTERINE SARCOMAS STAGE I–II

Standard treatment for uterine sarcoma is surgical intervention. The influence of any adjuvant therapy has not been proven. Radiation therapy, which reduces the frequency of local relapses but does not affect overall survival, is not used in some centers. This is also due to the difference in dosage given.

The aim of the study. Analysis of the effectiveness of treatment depending on the dose of irradiation in patients with uterine sarcoma І–ІІ stage.

Materials and methods. The postoperative radiotherapy course was performed on 106 patients with uterine sarcoma stage I–II (T1a–2NхM0), which were divided into two groups – radiotherapy alone in TFD 40-50 Gy, and in combination with brachytherapy (boost) in TFD up to 60-70 Gy.

Results. Conducting postoperative irradiation with a dose of 70-80 Gy due to brachytherapy on the tumor bed contributes to a decrease in the incidence of local recurrence: 41.9 versus 24.5 % regardless of the treatment regimen. Conducting radiotherapy in the combined regimen provides the absence of relapse and a reduction in the frequency of metastasis from 66.7 to 11.8 %. An increase in the dose of irradiation in complex treatment is likely to reduce the rate of relapse from 25.0 to 6.3 %, and metastases – from 75.0 to 25.0 %, especially in stage I — from 33.3 to 7.1%.

Conclusions. The dose of adjuvant radiation therapy is a factor that affects the incidence of relapse and metastasis. Keywords: uterine sarcoma, radiotherapy, relapse, brachytherapy, radiation dose, boost.

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2018, vol XXVI, # 2, page 113

D. E. MAKHMUDOV, M. I. PALIY, A. V. GANICH, O. Y. STOLYAROVA, V. V. ZVIRICH, O. O. KOLESNIK

National Cancer Institute of Health Ministry of Ukraine, Kiev

ACUTE BOWEL OBSTRUCTION AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED RECTAL CANCER. CASE REPORT

Summary. Chemoradiation therapy represents a standard neoadjuvant treatment option for locally advanced rectal cancer due to substantial increase of both recurrence free survival and frequency of radical surgery. Tumor regression grade quantitatively represents a positive effect of neoadjuvant treatment. Complete radiological and complete pathological response refers to a superior condition of tumor regression after neoadjuvant treatment. In a current article we present a clinical case of acute bowel obstruction as a manifestation of a near complete response of locally advanced rectal cancer after neoadjuvant chemoradiation therapy.

Keywords: neoadjuvant chemoradiation therapy, locally advanced rectal cancer, acute bowel obstruction.

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2018, vol XXVI, # 2, page 120

N. V. KRASNOSELSKYI1, 2, Y. A. BABALIAN3, E. N. KRUTKO1, A. N. BELIY1, 2, M. V. VERBITSKY1

1 SI Grigoriev Institute for Medical Radiology of National Academy of Medical Science of Ukraine, Kharkiv

2 Kharkiv National Medical University

3 Communal Healthcare Establishment Regional Clinical Hospital — Emergency Care Center and Disaster Medicine, Kharkiv

SURGICAL TREATMENT OF LOCALLY ADVANCED EXTRA-INTRACRANIAL SKIN OF THE OCCIPITAL AREA

The article presents the possibilities of surgical treatment of patients with locally advanced cancer of the skin of the head and neck. The lower trapezoidal flap can be used if there are defects of the face, neck, scalp, head, shoulder, anterior chest wall, especially after radiotherapy. Applying the lower trapezoid flapmakes it possible to achieve acceptable functional and cosmetic results.

Keywords: locally advanced skin cancer, surgical treatment, lower trapezoid flap.

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2018, vol XXVI, # 2, page 124

Y. A. DOLYA2, S. V. HRYHORENKO1, T. M. SHERBATUK1, N. V. VITIUK1, A. P. DIKAYA1, T. V. KONKOVA1, A. G. KORCHINSKIY1, O. I. BOLIUKH1, T. C. NECHIPORUK1

Podilsky regional center of oncology, Vinnitsa

2 National Cancer Institute of Health Ministry of Ukraine, Kiev

CLINICAL CASE SKIN CANCER OF THE NOSE TREATMENT. SURGERY OR RADIOTHERAPY?

Summary. The article presents a clinical cases radiotherapy skin cancer of the nose. Presented the treatment results. It is shown radyotherapy as independent treatment.

Keywords: radiation therapy, skin cancer.

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