Опыт работы60 В в е д е н и е. Заболеваемость раком лёгкого (РЛ) в мире достигает 1 300 000 случаев [3,6,8,12,16]. В Российской Федерации РЛ находится на 2-м месте в общей структуре онкологических заболеваний (11,6 %) и на 1-м (20,4 %) среди злокачественных опухолей у мужчин. Число заболевших им ежегодно превышает 50 000 человек, причём умирают от него 90-96 % заболевших, а свыше 50 % из нихуже в год постановки диагноза. Несмотря на бурное развитие диагностических и лечебных технологий, 5-летняя выживаемость при РЛ во всех странах за последние полвека не меняется, не превышая 15-20 %. При этом известно, что эффективность лечения находится в прямой зависимости от распространённости опухоли на момент начала реализации клинических мероприятий. Так, если для I стадии 5-летняя выживаемость может достигать 70-80 %, то для IV -не превышает 5 %. Ранняя диагностика РЛ до настоящего времени остаётся нерешённой проблемой, и более 2 / 3 заболевших начинают специализированное лечение, имея местно-распространённые либо генерализованные формы опухоли [1, 6, 7, 13]. когортное исследоВАние эффектиВности низкодозной коМПьютерной тоМогрАфии и трАнсторАкАльной треПАн-биоПсии В рАнней диАгностике рАкА лёгкогоЦеЛь иССЛедОВАНия. Анализ литературных и собственных данных для повышения эффективности выявления рака л¸гкого (РЛ) с использованием современных методов первичной и уточняющей диагностики. МАтеРиАЛ и МетОды. Проспективные диагностические данные в отношении контингента из 537 человек, состоящего из двух групп: 1) когортных исследований по ранней диагностике РЛ с использованием низкодозной компьютерной томографии (n=369) и 2) трансторакальной трепан-биопсии (n=168). РеЗуЛьтАты. Патологические изменения в паренхиме л¸гких, подозрительные на ранний периферический рак, выявлены у 24 % участников исследования. Эффективность использования в качестве метода уточняющей диагностики трансторакальной трепан-биопсии составила 85,7 %, находясь в прямой зависимости от размеров очагов и их расположения в паренхиме л¸гких. ЗАКЛючеНие. Современные методы диагностики РЛ позволяют обнаружить заболевание на ранних стадиях и получить достаточные по объ¸му образцы патологической ткани с целью индивидуализации алгоритмов лечения. Ключевые слова: рак л¸гкого, низкодозная компьютерная томография, скрининг, трансторакальная стереотаксическая трепан-биопсия Panel study of the effectiveness of low-dose computed tomography and transthoracic core biopsy in early diagnostics of lung cancer 1 st. Petersburg clinical Research center of specialized types of healthcare (oncological); 2 Petrov Research Institute of oncology, Ministry of healthcare of the Russian federation, saint-Petersburg objecTIve. This paper reviews literature and provides results of original trial data on early diagnostics of lung cancer (lc) with primary and work-up diagnostic procedures. MATeRIAl AnD MeThoDs. The pospective diagnostic data of 537 patients divided into 2 groups was analyzed: 1) panel study in early diagnostics of lc using low-dose computed tomography (369 patients) and 2) tran...

Background. According to a report by the International Agency for Research on Cancer (IARC), lung cancer (LC) is among the leading causes of morbidity and mortality worldwide, with an estimated incidence of 14.1                million new cases of the disease and 8.2 million cancer deaths in 2012. Lung cancer is the most common cancer worldwide, accounting for 13 % of all new cancer cases and 19.4 % of deaths.The purpose of the study was to evaluate LC prevalence and to measure the quality of population-based cancer registries by the indices of the proportion of total incident cases.Material and methods. The study material was given from the monograph «Cancer on Five Continents», which included data from the database of the Cancer Registry of PA. Herzen Moscow Research Oncology Institute (St. Petersburg), surveys of morbidity and mortality in the North-West Federal District, estimations of proportion of the true incidence that was registered in population-based registries.Results. The analysis of lung cancer morbidity and mortality in Russia showed a significant improvement in analytical indices over the past 10 years, however, underestimation of primary cases, reduced the overall lung cancer incidence rate.Conclusions. The dynamics of age-specific lung cancer incidence was shown. The loss of primary lung cancer cases was estimated to be 15-20 % annually.

Cancer screening literature was discussed in this review publication. Broad spectrum of studies was used to make conclusion about effectiveness of screening methods in reaching its major objectives, perspective of screening methods for several cancer types were also discussed. Qualitative assessment of studies was done. Cervical cancer, breast cancer and colorectal cancer screening was proved to be effective. Effectiveness of prostate and lung cancer screening as well as population-based stomach cancer prevention is also discussed. Negative and inconclusive results of screening studies of the other cancer types were also mentioned and perspectives for future diagnostics option for cancer screening were given.

This article reviews the literature and summarizes single institution experience of applying different diagnostic algorithms for lung cancer. All diagnostic methods can be divided into three groups: non-invasive; minimally invasive and invasive. The non-invasive methods include clinical examination; imaging methods for anatomical, functional and multimodal visualization; sputum cytological, analysis of the exhaled breath, detection of various blood and sputum markers. Minimally invasive methods include endoscopy, percutaneous fine-needle and core-needle biopsy. Invasive methods include diagnostic thoracoscopy and laparoscopy, mediastinoscopy, parasternal mediastinotomy and diagnostic thoracotomy. While creating an individual diagnostic plan for each patient it is necessary to carefully analyze the effectiveness, safety, sensitivity, specificity and of different methods available among wide range of modern diagnostic techniques. Optimization of lung cancer diagnosis methods, which includes early cancer detection, is one of priority areas of modern oncology. Many aspects of this problem remain unresolved and require further research

In this article we summarize our own experience of lung cancer diagnostics using exhaled breath analysis with a non-selective method using metal oxide chemoresistor gas sensors with cross-sensitivity combined with the sputum cytology. Volatile organic compounds of exhaled breath change the conductivity of the sensor, the resulting pulse is displayed as a peak on the graph, the area of which is used as test results. The combination of two diagnostic techniques in 204 participants demonstrated the possibility of non-invasively detecting the disease at an early stage. The sensitivity, specificity and accuracy of the breath analysis was 91.2%, 100% and 93.4%, respectively. The combination of the breath test and the sputum cytology compared to the breath test alone showed statistically significant (p = 0.03) increase in sensitivity to 96.8% (95% CI: 80.9% -99%) with acceptable decrease in specificity to 93.4% (95% CI: 88% -96%). The convenience of analysis and realtime measurements show some promise for the early detection.

Lung cancer (LC) is a common malignant neoplasm (MN) with high lethality, often detected at late stages. The implementation of lung cancer screening can change the ratio in favor of the early stages. Screening could help diagnose early-stage LC in 60% of patients. Multiple primary LCs occur in 4–10% of patients within five years after treatment. The presence of oligo-metastatic disease only in the lungs (up to 5 nodules) occurs in 6-40% of patients with malignant tumors, and complete resection could increase 5-year survival to 20-40%. Due to functional limitations, surgical treatment can be performed only in 65-70% of patients. Stereotactic radiation therapy gives an opportunity to accurately deliver a high dose of radiation to the tumor with minimal damage to the surrounding healthy tissues. Local control is possible in 85–95% of cases, and 3-year overall survival is about 60–80%. New algorithms for fractionation and dose determination (BED10 ≥ 100 Gy) could improve the treatment results for early-stage lung cancer and oligometastatic lesions. In this non-systematic review, we analyze a recent publication and our own experience. We consider the effectiveness and safety of stereotactic radiotherapy and planning, modeling, fractionation, dose restrictions on critical organs, radiation reactions, and adverse events. We conclude that randomized controlled trials can reveal the stereotactic radiation therapy's potential in patients with primary and oligo-metastatic pulmonary tumors.

In this literature review we analyze the effectiveness of radiotherapy (as an independent method and in combination with surgery and chemotherapy) in the treatment of locally advanced non-small cell lung cancer. The postoperative adjuvant radiotherapy can increase overall survival and reduce the frequency of local recurrences in IIIA / N2 stage of NSCLC, however, its positive effect can be offset by the damage to surrounding structures. Modern high-tech equipment, improved planning systems, methods radiation doses delivery, and the fractionation regimen can improve the outcomes of radiation therapy. No bimodal treatment has shown advantages over other combinations. Some improvement in survival was noted in a number of studies using three-modal treatment, but it was also associated with an increase in the proportion of postoperative complications, especially after pneumonectomies. The heterogeneity of the IIIA / N2 NSCLC group and criteria for their operability present certain difficulties for a correct comparison of the treatment results, which requires further discussion. In most studies, insufficient attention has been paid to the influence of multimodal treatment on the quality of life of patients, which, taking into account comparable results of treatment, can be crucial in determining indications and contraindications.

An active introduction of screening programs potentially leads to a significant increase in the proportion of patients with early forms of non-small cell lung cancer. Surgical treatment, which is the standard of care for localized forms, due to functional limitations can be performed only in 65-70% of patients. The solution to this problem can be found in the improvement of the results of radiotherapy by using modern equipment, the planning systems, improved fractionation schemes and introduction of methods for summing radiation doses. Stereotactic radiotherapy allows high-precision delivery of high radiation dose to tumor with a minimal damage to surrounding healthy tissues. In this literature review based on the analysis of a large number of publications we show that it is not yet possible to make valid conclusions about the effectiveness and safety of stereotactic radiation therapy as an alternative to the surgical methods. It is necessary to plan and conduct randomized trials without further delay taking into account the expected high relevance of the method.