Меланома хориоидеи-наиболее распространенная первичная злокачественная внутриглазная опухоль у взрослых. Несмотря на хорошо отработанную тактику лечения первичного очага, данный тип опухоли в большом проценте случаев дает отдаленные метастазы. Лечение таких пациентов требует комплексного подхода, включающего системное воздействие. В настоящее время в России и во всем мире идет активное внедрение локорегионарного лечения при изолированном метастатическом поражении печени. Регионарные методики заключаются во введении препаратов различных классов непосредственно в печень. Этот способ доставки имеет преимущества в том, что происходит лечение как клинически и рентгенографически явных опухолей, так и тех, которые клинически не проявляются (микрометастазы), в то время как нежелательная системная токсичность ограниченна. Данные методы включают в себя как классические хирургические возможности, так и радиочастотную аблацию, печеночную артериальную инфузию, химиоэмболизацию, иммуноэмболизацию, радиоэмболизацию и изолированную перфузию печени в разных вариантах. Печеночная трансартериальная химиоэмболизация-еще один метод, обычно используемый для доставки высоких доз химиопрепаратов непосредственно к опухоли печени, обеспечивает увеличение времени воздействия препарата и выборочную ишемию части печени. Ключевые слова: увеальная меланома, хориоидея, метастазы, печень, химиоэмболизация.
It perdormed the literature data analysis on the criteria and methods for assessing the clinical efficacy of the isolated limb perfusion method in the treatment of soft tissue sarcoma. It is noted that the use of isolated limb perfusion is a rather effective method providing local control of the tumor process in locally advanced forms of soft tissue sarcoma. It has been demonstrated that the use of such a neoadjuvant treatment regimen allows administration of the drug with the achievement of high local concentrations of chemotherapeutic drugs with a relatively low incidence of systemic side effects. Criteria for tumor response to therapy, in particular RECIST (Response Evaluation Criteria In Solid Tumors), Choi criteria, adapted for magnetic resonance imaging, are presented. It is noted that a number of studies have studied the possibility of using positron emission tomography with fluorodeoxyglucose labeled with 18F (18F-FDG) to assess the response to treatment in sarcomas. At the same time, it was shown that the results of studying the metabolic response are superior in accuracy to the method of assessment using the RECIST criteria and the assessment performed by the dynamics of the tumor tissue volume has significant potential in assessing the response to isolated limb perfusion in patients with soft tissue sarcoma. The importance of a one-time assessment of positron emission tomography with 18F-FDG parameters and Magnetic Resonance Imaging for soft tissue sarcoma is confirmed by the results of a combined analysis that takes into account both morphological characteristics and quantitative metabolic parameters of the tumor. The high potential of the combined assessment of metabolic and volume-morphological parameters obtained using these methods was demonstrated; it was noted that the combination of positron emission tomography data with 18F-FDG and Magnetic Resonance Imaging enhances the reliability and efficiency of planning and monitoring of soft tissue sarcoma treatment using the isolated limb perfusion method.
Aim: to study the effectiveness of the use of transarterial chemoembolization (TACE) in the treatment of patients with metastatic uveal melanoma. Material and methods: in N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia in the period from 2000 to 2019 72 patients received treatment (TACE) for metastases of uveal melanoma in the liver. Of these: men – 22 (30,6%), women – 50 (69,4%). Average age 46,28±10,32 years, range 23–84 years. The time of detection of metastatic liver lesions after treatment of the primary tumor ranged from 2 to 252 months, the median was 24 months. The volume of liver damage was up to 25% in 19 patients, from 25% to 50% in 33 patients, from 50% to 75% in 20 patients. A total of 134 TACE interventions were performed. Depending on the volume of the lesion, the nature of the blood supply to the tumors and the response to treatment, patients underwent 1 to 5 sessions of TACE: in 27 patients one TACE, in 35 – two, in 5 – three, in 3 – four, and in 2 – five TACE. As an embolizing component, lipiodol 10 ml was used in 106 cases, microspheres in 16 cases (particle sizes varied from 100 to 500 μm), in 12 TACEs, combinations of the presented embolizing materials were used. Carboplatin, doxorubicin or gemcitabine were used as chemotherapy drugs. Results: 58 patients (80,6%) had a moderate postembolization syndrome, expressed by pain, febrile temperature, nausea, and vomiting. A local response (including complete response, partial response, or stabilization by mRECIST criteria) was observed in 53/72 (73,6%) patients with metastases of uveal melanoma. The duration of observation of patients after TACE was from 2 to 60 months. The median follow-up was 12,5 months. The group that responded to treatment, including stabilization, achieved a 1-year Kaplan-Meier overall survival rate of 72% and a 2-year rate of 45,6%. In patients with continued growth of lesions, the 1-year overall survival rate according to the Kaplan-Meier method was 42,6%, and the 2-year survival rate was not achieved. 48 patients were alive at the time of the study, 24 died from disease progression. Conclusions: the use of TACE in metastatic lesions of the liver by choroidal melanoma in combined treatment or in mono-regimen led to an objective response or stabilization of the process in 73,6% of patients. This method increases the overall survival of patients and is well tolerated.
Radiofrequency thermal destruction (thermoablation) remains one of the most popular methods of local destruction of liver tumors. There are perennial international experience in oncology, numerous trials and practical issues are rarely discussed. However, there are still strategic questions: when, to whom, in what cases. In fact, specialists recognizing effective impact do not always sure when thermoablation potential will be realized as much as possible. In this review the authors summarized world experience of liver malignancies thermoablation and tried to identify key positions in determining treatment strategy using this approach. Interdisciplinary approach is an absolute priority in optimal treatment of these patients.
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