Введение Несмотря на совершенствование хирургической техники и успехи комбинированных методов лечения пациентов с раком нижнеампулярного отдела прямой кишки, проблема повышения риска локального рецидива опухоли в группе больных, перенесших брюшно-промежностную экстирпацию прямой кишки, остается во многом нерешенной.
The main treatment for cervical cancer are surgery, radiation and combined (surgery + radiotherapy), the role of chemotherapy in this localization is studied less fully. In recent years the new possibilities of chemotherapy, including neoadjuvant intraarterial chemotherapy, are explored. Theoretical prerequisites for this are the best drug delivery to the tumor by blood vessels, undamaged due to radiation therapy and surgery. This paper describes a clinical case of a patient with primary inoperable cervical cancer. As an alternative to preoperativ e radiotherapy the patient was proposed neoadjuv ant com bination chemotherapy with the use of regional administration of platinum drugs and systemic administration of drugs of taxan series as a stage of preparation for further surgical treatment. According to the prevalence of the tumor process patient underwent 2 courses of neoadjuv ant chemotherapy by a method of superselective intra-arterial administration of cisplatin and paclitaxel intravenously. According to a comprehensive examination after treatment data for the presence of tumor was absent. During the second stage the patient underwent surgical treatment in the volume of nerve-sparing radical hysterectomy with appendages. The next step, according to the histological form of the tumor, stage of disease, was the radiotherapy in the postoperative period on the pelv ic area and routes of lym ph drainage. The patient underwent external beam radiotherapy to the pelvic area of FD = 20 Gr, intracavitary gamma-therapy and external beam radiation on the area of parametrial and lymphopenia FD = 50 Gr.The patient passed the control examinations every 3 months. According to a comprehensive survey a year after the start of treatment — there is no data for the presence of recurrence and spread of tumor process.
Extensive liver resections are the main method of treatment of patients with primary and metastatic liver cancer, which allows the noticeable prolongation of life. In patients with a reduced functional reserve of the liver or a missing volume of the remaining liver parenchyma, these interventions become impossible because of the increased risk of postresectional acute hepatic insufficiency. One of the most modern and promising ways to overcome this obstacle is the use of minimally invasive methods of tumor destruction. This article presents two observations of the clinical application of the laser ablator “Echolaser X4”: open laser ablation of the metastatic focus with subsequent atypical liver resection and percutaneous laser ablation of the metastasis of the neuroendocrine tumor into the liver. The presented experience testifies to the justification of using laser destruction of metastatic malignant liver tumors and demonstrates the possibilities of laser thermoablation therapy in patients who can not perform radical surgical treatment.
Background: 5-fluorouracil (5-FU) is widely used in the therapy of solid tumors, including breast cancer (BC). Toxicity remains a major limitation in the clinical efficacy of 5-FU. Developed approximately 50 years ago, this competitive antagonist of uracil is still not exhaustively studied in terms of its mechanism of action, and the potential of molecular markers in predicting its efficacy and toxicity is not yet fully unravelled. Methods: A modified Reduced Representation Bisulfite Sequencing genome-wide DNA methylation analysis assay, XmaI-RRBS, was applied to 170 BC samples obtained before chemotherapy, and to 10 normal breast tissue samples. Unsupervised hierarchical cluster analysis was used to discern intrinsic DNA methylation BC subtypes; clustering uncertainty was assessed with pvclust R package using bootstrap permutation approach. Results: In a DNA methylation BC subtype enriched in triple-negative breast cancer samples we have identified statistically significant enrichment with the samples nonmethylated at the promoter region of the NME1 gene, compared to all other DNA methylation BC subtypes. Another finding was abnormal methylation of the DPYS gene in a DNA methylation BC subtype enriched in HER2 positive tumors. Conclusions: Most studies of 5-FU resistance have focused on germline status of thymidylate synthase TYMS and DPYD genes, and 5-FU Toxicity and Chemotherapeutic Response Panels for the detection of germline variants in these genes are now widely available. It has also been shown that increased expression in tumor cells of some enzymes from the 5-FU metabolic pathway such as DPYD is correlated with resistance to 5-FU. Here we demonstrate differential methylation of the 5-FU drug pathway mediator genes DPYS and NME1 between the DNA methylation BC subtypes. DNA methylation is easily detected by methylation sensitive PCR and does not require RNA extraction. Thus, we suggest that the existing germline DNA tests may be supplemented with the tumour biopsy DNA methylation analysis in order to provide better prediction of 5-FU response and toxicity.
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