1 Кафедра радиологии и хирургических технологий ФПО ГБОУ ВПО Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова МЗ РФ; 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8, Российская Федерация 2 ФГБУ Российский научный центр радиологии и хирургических технологий МЗ РФ; 197758, Санкт-Петербург, п. Песочный, ул. Ленинградская, д. 70, Российская Федерация Ïîäaeåëóäî÷íàÿ aeåëåçàЦель. Оценка безопасности периоперационной регионарной полихимиотерапии в комбинированном лечении больных протоковой аденокарциномой головки поджелудочной железы. Материал и методы. Неоадъювантная регионарная химиотерапия, радикальная операция R0 и курсы адъювантной регионарной химиотерапии проведены 53 пациентам. Регионарную химиотерапию проводили введением гемцитабина в суспензии липиодола в желудочно-двенадцатиперстную артерию, дополняли инфузией оксалиплатина. После процедуры выполняли клинический и биохимический анализы крови, коагулограмму. Токсичность оценивали согласно Common Toxicity Criteria. Сравнивали послеоперационные осложнения, сроки пребывания в стационаре больных, перенесших комбинированное лечение (группа А), и пациентов, подвергнутых только оперативному вмешательству (группа Б). Результаты. Осложнений лечебно-диагностической ангиографии и катетеризаций не было. Пост эмболизационный синдром развился у 10 (18,8%) пациентов, гематологическая токсичность отмечена у 13 (24,5%) больных и составила 1-2 балла по Common Toxicity Criteria. Анемия выявлена у 5 (9%) больных, нейтропения -у 2 (4%), тромбоцитопения -у 1. Тошнота отмечена у 11 (20,7%) пациентов, рвота -у 10 (18,8%). Послеоперационные осложнения в группе А развились у 20 (38%) пациентов, в группе Б -у 20 (37%). Число послеоперационных осложнений в группе А не превысило число таковых в группе Б. Средняя продолжительность пребывания в стационаре больных группы А составила 18 сут, группы Б -16 сут. На этапе адъювантной химиоинфузии токсические проявления отмечались редко и не требовали уменьшения дозы или отмены препарата. Заключение. Регионарную химиотерапию гемцитабином и оксалиплатином можно считать безопасным этапом комбинированного лечения больных аденокарциномой головки поджелудочной железы. Для оценки эффективности лечения необходимы дальнейшие исследования.Клю че вые сло ва: поджелудочная железа, протоковая аденокарцинома, панкреатодуоденальная резекция, регионарная химиотерапия, токсичность, комбинированное лечение. Aim. To evaluate safety of perioperative regional chemotherapy in combined treatment of ductal adenocarcinoma of the pancreatic head. Material and Methods. 53 patients underwent neoadjuvant regional chemotherapy, R0-surgery and adjuvant regional chemotherapy courses. Regional chemotherapy was performed by administration of gemcitabine in a suspension of lipiodol into gastroduodenal artery that was supplemented by oxaliplatine infusion. After that complete blood cell count, biochemical and coagulation examination were made. Toxicity evaluation was conducted according to Common Статья поступила в редакцию журна...
Aim. To analyze influence of perioperative intra-arterial selective chemotherapy on terms of recurrent ductal adenocarcinoma of pancreatic head after pancreaticoduodenectomy.Material and methods. 111 patients underwent combined treatment. Surgical stage included conventional pylorussparing pancreaticoduodenectomy in all groups. The main group consisted of 52 patients who received combined treatment: neoadjuvant chemoembolization with gemcitabine (400 mg/m2) and oxaliplatin (50 mg/m2), surgical treatment and 6 courses of regional chemotherapy – infusion of gemcitabine (800 mg/m2) and oxaliplatin (45 mg/m2) into celiac trunk in adjuvant mode. The control group was presented by 59 patients who underwent perioperative regional chemotherapy (neoadjuvant chemoembolization and adjuvant infusion of gemcitabine (800 mg/m2). Progression-free survival (PFS) and terms of recurrence were analyzed in all groups. In case of progression and recurrence we applied regional chemotherapy alone. Systemic chemotherapy was not used in the study.Results. Annual PFS in the main and the control groups was 80%. Three-year PFS in the main group was 37%, in the control group – 14% (p < 0.01). Five-year PFS was 11% in the main group and absent in the control group. Median survival was 26 months in the main group and 22.6 months in the control group. Overall annual, 2-year and 5-year survival in main group was 80%, 57% and 15%, respectively.Conclusion. Regional intra-arterial chemotherapy decreases incidence of recurrences and improves PFS after surgical treatment of pancreatic head adenocarcinoma.Further multi-center studies are necessary to assess the effectiveness of regional chemotherapy.
Morbidity and mortality from pancreatic cancer is an urgent medical and social problem. Evaluation of statistical indicators in dynamics makes it possible to identify organizational and clinical problems in providing care to patients with malignant neoplasms of the pancreas. Medical and statistical indicators of incidence of malignant pancreatic neoplasms in St. Petersburg residents are evaluated. The assessment of medical and statistical indicators of the incidence of malignant neoplasms of the pancreas in residents of St. Petersburg. Statistical data were studied for the period from 2014 to 2019. The increase in the "rough" indicator of primary morbidity changed from 417.99 per 100 thousand population in 2014 to 505.6 in 2019. In the structure of primary cancer incidence, the indicator of active detection of pancreatic cancer glands in 2014 amounted to 3.6%, in 2019 3.8%. The proportion of patients with diagnoses confirmed morphologically increased from 48.9% to 61.4%. The proportion of patients with newly diagnosed stage IV of the disease changed from 39.5% in 2014 to 51.4% in 2019, and in patients with stage III in 2019 it was 33.3% (a decrease in comparison with 2014 15.3%). In 2019, the disease was diagnosed at stage II in 15.2% of patients. The proportion of patients with stage I in 2019 was 6.6%, this indicator in 2014 was registered at the level of 19.2%. From 2014 to 2019, the one-year mortality rate did not change and amounted to 67.9 and 67.4%, respectively (the decrease was 0.7%). Over the past 5 years, there has been no significant downward trend in the "rough" incidence and mortality rates from pancreatic cancer. However, in the dynamics, there was an increase in the number of patients registered for 5 or more years, and an increase in the accumulation index of the contingent of patients with pancreatic cancer.
Pancreatic cancer is the 12th most common malignant neoplasm and the 7th most common cancer related death worldwide. Early diagnosis of pancreatic cancer is complicated, since the disease proceeds for a long time without pronounced clinical symptoms, and the identification and screening of the so-called risk groups of patients is difficult, since the etiology of pancreatic cancer is currently a matter of scientific debate. Early diagnosis of pancreatic cancer can be based on the anamnestic analysis of the psychoemotional status of patients. Back in the early 20th century, based on an analysis of the results of a survey of patients with pancreatic cancer, researchers described a triad of affective signs, including depression, anxiety and a sense of impending death, which worried patients in the early stages of development of the disease. According to literature, the psychiatric symptoms of pancreatic cancer can appear 43 months before the somatic symptoms and occur in more than 50 % of patients. To date, there are a number of concepts in the literature that point to a significant contribution of affective disorders to the development of pancreatic cancer. The aim of this review is to analyze the literature data on the relationship between affective disorders and the development of pancreatic cancer.
Background. Pancreatic malignancies pose a challenging medical and social problem. The assessment of oncology care requires an in-depth analysis of morbidity and lethality. At a relatively improved prevalence and lethality in other-locale malignancies, pancreatic cancer remains a disappointing situation. Medical statistics in pancreatic malignancy can be used for the specialty care prediction and implementation of measures to advance diagnostic algorithms and population screening.Objectives. An assessment of the pancreatic malignancy incidence and mortality in the adult population of Russian Federation over a six-year period.Methods. A retrospective descriptive cohort trial included statistical data on morbidity and mortality in pancreatic cancer patients (C 25.0-C 25.9) according to the ICD of 10th edition. A comparison cohort sampled patients with all-locale neoplasms (C00-C96) according to the ICD of 10th edition, excluding nosologies C25.0-C25.9. Information was sourced in the Federal Statistical Abstracts for the period of 2014-2019. Inclusion criteria: the study cohort included pancreatic cancer patients diagnosed at the age of 18 years on, and comparison cohort — malignancy patients diagnosed with at 18 years on. The main study indicator were the pancreatic cancer morbidity and mortality figures in Russia.Results. Pancreatic cancer was shown to co-increase main morbidity figures in 2014-2019 compared to malignant neoplasms of other localities. Other-locale malignancies decreased mortality over the study period, which was not the case with pancreatic cancer. The period exhibits more frequent morphologically verified diagnoses and higher population numbers registered with specialty dispensaries. Registered pancreatic cancer figures are significantly higher in the female population. The proportion of advanced pancreatic malignancies at primary diagnosis exceeds that of early stages.Conclusion. The findings expose a demand for improving the system of early pancreatic cancer detection via intensifying preventive measures to capture the patient’s predisposition and screening techniques for early disease diagnosis. An active outpatient surveillance is prerequisite to an effective population involvement in dispensary screening.
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