Prostate cancer (PC) is one of the most urgent problems of modern oncourology because of the continuing high incidence of this pathology. The main methods of radical treatment of patients with localized and locally advanced prostate cancer are radical prostatectomy (RP) and radiotherapy – remote (RRT) or brachytherapy.  However, the frequency of biochemical markers of disease progression after curative treatment is high and reaches up to 27–53%. It is extremely important to find the tumor lesion that leads to the increase of the marker. The  palliative hormone therapy (PHT) was the only accepted method in patients with occurrence of distant metastases in recent time. However, a significant number of patients relapse marker may be associated with the so-called oligo-metastatic disease progression, in which the number of detected metastatic lesions is minimal. As the results of the research, the use of surgical or radiological treatment in selected patients of this cohort can significantly increase the length of time prior to the appointment of HT, and in some cases completely abandon its holding.

Purpose. To evaluate the results of the saving pelvic lymphadenectomy in patients with prostate cancer with disease progression after radical therapies.

Patients and methods. The article summarizes the results of surgical treatment of patients who have undergone life-saving lymphadenectomy about oligo-nodal metastatic progression of prostate cancer after treatment in 3 centers – P. Hertsen MORI, the branch of NMRRC; N. Petrov Research Institute of Oncology and Russian scientific center of radiology and surgical technologies. In this multicenter study they evaluated the immediate and remote results of surgical treatment of 57 patients.

Results. The results performed the high efficiency of the method of the saving pelvic lymphadenectomy in patients with prostate cancer with disease progression after radical treatment. So, response to therapy and reduction in the marker level was observed in 47 (82.5%) patients. The decline in PSA level ≥50% from initial level in a month after the operation was in 38 (66,7%) patients. A complete answer in the form of lower marker ≤0.2 ng/ml was observed in 13 (22,8%) patients. For the entire median follow-up period of 12 months, patients with complete response to therapy had received any hormonal treatment.

Conclusion. The saving pelvic lymphadenectomy is an effective method for the treatment of patients with the presence of lymphogenic progression of prostate cancer after a radical treatment with satisfactory oncological results. A significant contingent of patients, SLE is associated with good response to therapy and reduction in PSA levels and long disease-free period. In some patients the removal of nodal metastases allows to postpone or to abandon the HT and hope to increase overall survival of patients.

Malignant adrenal tumors such as adrenocortical cancer (ACC) and malignant pheochromocytoma (MPCC) have a particularly aggressive course, leading to higher mortality in these patients, especially in the later stages of the disease. In this regard, there is a statistically significant difference in survival of patients, depending on the time of detection and initiation of treatment.

Purpose. Analysis of the results of surgical treatment of patients with adrenal tumors.

Patients and methods. 55 patients aged from 17 to 75 years (median 50 ± 13 years) with primary tumor neoplasms of the adrenal gland underwent surgical treatment in the period from 1999 to 2014 in the Department of Onco-urology, P. Hertsen MORI. 18 adrenalectomy (32,7%) completed laparoscopy, 36 (65,5%) – open access, 1 (1,8%) – videoassistance. Among them, retroperitoneal lymph node dissection with ipsilateral hand made in 14 (25.5%), combined operations with resection of adjacent organs – 7 (12,7%), thrombectomy with resection of the inferior Vena cava – 3 (5,5%) cases. The median time was 100 ± 73 minutes in open surgical procedures – 183 ± 55 minutes, laparoscopic – 60 ± 30 minutes. The volume of blood loss – 300 ± 1136 ml. According to the routine morphological studies, 24 (43,6%) patients the tumor were benign, the remaining 31 (56,4%) – malignant.

Results. Long-term results have been traced in 84% of patients in group with ACC. The observation time for patients varied from 2 to 167 months, with a median of 64.5 (IQR 22–111) months. Median survival without progression and 5-year overall and tumor survival was: I stage – 93 months and 67 ± 13%, II stage – 30 months and 75 ± 21%, III stage– 18 months and 67 ± 27%, IV stage – 10 months and 25 ± 21%. The observation time for patients with MPCC varies from 12 to 102 months, with a median of 60 (IQR 18–102) months. Median survival without progression was 26 (IQR 15 to 38) months, 5-year overall and tumor survival was 33 ± 27%.

Conclusion. Currently, the main objective is the identification and operative treatment of malignant tumors of the adrenal glands in the early stages of the disease, which allows to improve the results of relapse-free and  overall survival. In our opinion, it is appropriate extension of the indications for volumes of surgical treatment for primary generalized forms identified with the presence of solitary metastases, and active surgical tactics in the progression of neoplastic process.

Purpose. Assessment of the scope and coverage of the surveys of patients with recurrent pregnancy losses in primary care of Zelenograd administrative district of Moscow.

Materials and methods. Comparison of the frequency of occurrence of miscarriage in Europe, USA, Russia and in Moscow has been held. They performed a retrospective analysis of 221 history for the period 2013–2015 in patients with a history of 2 or more cases of miscarriage. The selection criteria for the study were: completion of pregnancy at term of gestation from 22 to 37 weeks, presence of a diagnosis of “habitual miscarriage” at statement on the account of pregnancy.

Results. The factors predisposing to miscarriage are described, the coverage of the primary care of these patients, timeliness of registration of pregnancy, the completeness of the survey related professionals if patients ‘ comorbidity are estimated. The estimation of the frequency of occurrence of extragenital somatic pathology in patients with HM and the impact of this disease on pregnancy is held. The influence of previously deferred inflammatory diseases of the pelvic organs on a probable miscarriage is estimated, the evaluation of the quality of diagnosis of such diseases at an early stage of monitoring in primary care is held. It is established that pregravid preparation of patients with HM in 80% can be made in surveys provided by the territorial program of medical service. They evaluated the role of costly research conducted in the framework of pregravid training in patients with HM and the feasibility of conducting of these studies.

Conclusion. The recommendations for the prevention of a probable miscarriage and the principles of monitoring of these patients in primary care on the example of Zelenograd administrative district basis are developed, the proposal for the introduction of these techniques in primary health care is formulated.

This is a review of modern literature data of official medications for anti-tumor gene therapy as well as of medications that finished clinical trials.

The article discusses the concept of gene therapy, the statistical analysis results of initiated clinical trials of gene products, the most actively developing directions of anticancer gene therapy, and the characteristics of anti-tumor gene medications.

Various delivery systems for gene material are being examined, including viruses that are defective in  replication (Gendicine™ and Advexin) and oncolytic (tumor specific conditionally replicating) viruses (Oncorine™, ONYX-015, Imlygic®).

By now three preparations for intra-tumor injection have been introduced into oncology clinical practice: two of them – Gendicine™ and Oncorine™ have been registered in China, and one of them – Imlygic® has been registered in the USA. Gendicine™ and Oncorine™ are based on the wild type p53 gene and are designed for treatment of patients with head and neck malignancies. Replicating adenovirus is the delivery system in Gendicine™, whereas oncolytic adenovirus is the vector for gene material in Oncorine™. Imlygic® is based on the  recombinant replicating HSV1 virus with an introduced GM–CSF gene and is designed for treatment of  melanoma patients. These medications are well tolerated and do not cause any serious adverse events. Gendicine™ and Oncorine™ are not effective in monotherapy but demonstrate pronounced synergism with chemoand radiation therapy. Imlygic® has just started the post marketing trials.

Nerve-sparing radical prostatectomy is one of the high-tech operations in urology, and the challenge of the surgeon is not only to remove the prostate tumor, but also to provide a high quality of life. The fact that most questions devoted from patients in a conversation with the surgeon before the operation are devoted to this issue, shows the importance and relevance. At present, the diagnostic methods allow significantly more likely to detect early  prostate cancer, making finding and treatment of these patients more affordable and allows to apply this operation.

Lately, it seems urgent to explore the possibility of water jet dissection in the field of urology, in particular, for nerve-sparing prostatectomy. Preservation of erectile function depends largely on the quality of separating the neurovascular bundle. Standard use of electrocautery is associated with damage to the neurovascular bundle.  When performing operations using water-jet mobilization of prostate the selective dissection of tissue is performed. This avoids injury of neurovascular bundle and further postoperative complications. The use of this technique may allow the surgeon to provide a more accurate mobilization prostate and selectively controlled intersection vessels heading to the prostate from the neurovascular bundle, reduce intraoperative blood loss,  maintaining continence, erectile function.

This literature review is considered by the experience of using nerve-sparing radical prostatectomy using a water-jet dissector, estimated intraoperative parameters using this method.

However, we have the lack of extensive research capabilities of this technique when performing nerve-preserving radical prostatectomy, that does not allow to make a comprehensive presentation on the benefits of this technique and its effects on erectile function and quality of urination, further study of this issue in such a difficult category of patients.

Clinical testing (providing of integrative care) was conducted to determine the methodology for the treatment and rehabilitation of patients who were previously denied in other hospitals. Defined the methodological approaches to the choice of the treatment, causing minimal harm to patients in other health care organizations were offered only symptomatic or palliative therapy.

The purpose of the study:

– improvement the quality of life;

– increasing the terms of survival;

– reduction of depressive state with confirmation of the diagnosis;

– reducing the negative effects of the treatment.

Patients and methods. In clinical trials 47 patients with stage IV of disease were involved, including in the integrative treatment group was 25 patients (16 women and 9 men), the group standard of treatment, 22 patients (15 women and 7 men). The group consisted of the patients with recurrences of the tumours, and patients after primary treatment at a late stage of the disease. The combination of all possible types of treatment (standard methods of treatment, immune therapy with drug “Helixor®  M”, psychological assistance) was performed depending on the disease defined by the overall clinical picture and psychological readiness of patients to one or another form of therapy. The choice of the injection scheme in order to quickly transition to a maximally tolerated doses was carried out using the control functional state.

Results. The use of this method in comparison with the control group showed improvement in the quality of life of patients and increase in terms of survival.

Conclusion. The results that are obtained during clinical testing confirmed the positive effect of integrative treatment of patients with oncologic pathology when choosing the best course and combination of treatments, depending on the needs and course of the disease. Also the immunotherapy with drug “Helixor®  M” showed efficacy in the treatment of viral infections for patients with tumors and without them.

The article is devoted the problem of prevention of perioperative venous thromboembolic complications (VTEC) in cancer patients. The study identifies the causes of thrombosis in this category of patients and describes in details the major and minor risk factors for the development of VTEC. The results of studies on the influence of the morphological characteristics of the tumor, the stage and location of tumor on the risk of development of  VTEC are performed. It is noted that along with the likelihood of thrombosis, cancer patients at the stages of surgical treatment there is an alternative risk factor – bleeding. The frequency of hemorrhagic complications and their risk increases in the presence of disintegration of the tumor, its proximity to the main vessels, extent of surgical aggression, as well as due to the introduction of anticoagulants. The approaches to the selection of the optimal method is specific or nonspecific prevention of VTEC depending on the nature and volume of the intervention, estimated blood loss and patients’ rehabilitation time are described. We show the advantages of  low  molecular weight heparins compared with unfractionated heparin for the prevention of VTEC in Oncology. The article presents long-term experience of employees of one of the leading cancer institutions in Russia – P. Hertsen MORI, whose team took an active part in the development of Russian clinical guidelines for the prevention and treatment of VTEC in Oncology.

 

It is presented the comparative assessment of the quality of the records of patients who died from malignant neoplasms (MN), according to the report of Rosstat used to calculate mortality rates (form No. 5 “the Distribution of deaths by sex, age groups and causes of death”), and according to the report of the Ministry of health (form № 35 “Data on patients with malignant neoplasms”), used to calculate the mortality rate of patients under medical observation. Improving the quality and completeness of information about cancer patients is associated not only with the necessity of improving the accounting system, but with a best option compared with the most used in the world practice, as with any organizational issues.

The following materials will be used. Rosstat data:

• the distribution of deaths from MN by age and sex (form No. 5);

• average annual number of population in administrative territories of Russia. The data of the Ministry of health (form No. 35):

• the number of deaths from the MN from the number taken into account;

• the number of deaths from the MN, not consisting on the account of cancer institution, including:

– with the diagnosis established postmortem, including autopsy;

– consisted on the account in medical institutions of other ministries and departments;

• the number of deaths (from those considered), the cause of death was non-oncological disease;

• the number of deaths from complications related to the treatment (from the number registered during the previous year and died from the MN).

The study was conducted with the use of information and analytical support of the database on Oncology on the basis of state statistical reporting, created by P. Herzen MORI.