Целью исследования явилось определение места и роли нейтронной лучевой терапии в лечении пациентов с рецидивами высокозлокачественных глиом головного мозга. Материал и методы. Были проанализированы результаты лечения 40 больных, получивших лечение с 2005 по 2015 г. на базе ГБУЗ «Челябинский областной клинический центр онкологии и ядерной медицины» и Центра нейтронной терапии (г. Снежинск). Средний возраст пациентов -45 лет. Соотношение мужчин и женщин -1:1. У 19 пациентов был рецидив глиобластомы, у 21 -анапластической астроцитомы. В 20 случаях проведена нейтронная терапия в самостоятельном варианте, 20 больным проведен курс сочетанной нейтронно-фотонной лучевой терапии. Результаты. Медиана общей выживаемости для всех пациентов с рецидивами высокозлокачественных глиом головного мозга после проведенного лечения составила 50 мес, показатели 1-летней общей выживаемости -94,1 %; 2-летней -77,8 %; 3-летней -66,7 %. Медиана выживаемости после лечения рецидива -27 мес. Основными прогностическими факторами, влияющими на результаты лечения, стали возраст пациентов, гистологическое заключение, а также время до возникновения рецидива. Метод-специфическая выживаемость была достоверно выше у пациентов с проведением сочетанной нейтронно-фотонной терапии: 48 мес против 20 мес при проведении нейтронной терапии в самостоятельном варианте (р=0,05).Ключевые слова: нейтронная лучевая терапия, рецидивы опухолей головного мозга, повторное облучение.
The aim of the study was to determine and analyze the most significant risk factors for developing cardiac, pulmonary and skin toxicities among patients who received concurrent radiation therapy and chemotherapy with trastuzumab.Material and methods. The study included 66 patients with histologically verified invasive intermediate or low-grade breast carcinoma, who received radiation therapy and chemotherapy with trastuzumab from 2018 to 2019. The average age of the patients was 53.1 ± 4.2 years. Locally advanced stage iii a and iii b breast cancer was the most common (52 %) followed by stage ii a and ii b cancer (36 %). The lvef of all patients was ≥50 %. All patients received neoadjuvant chemotherapy with anthracyclines and/or taxanes. Radiation-induced side effects were assessed using the rtog/eortc scoring criteria. Dose-volume histogram (dvh) of radiotherapy planning was matched to the quantec criteria.Results. Radiation-induced pulmonitis was observed in 2 patients within 2 to 6 months after the completion of radiation therapy. A 10 % reduction in lvef was observed in 3 patients, while a 20 % decrease in ef was not found. Long qt syndrome was observed in 3 patients, and it was accompanied by clinical manifestations in 2 patients. When evaluating the echo-cg protocols after treatment, normal lv diastolic function was recorded in 39 patients, moderate diastolic dysfunction (lv dd) in 27, and 1 patient had severe lv dd. When assessing the dose received by the lv myocardium, the excess of the average dose to the myocardium was present both on the left and on the right. Only in 16 % of cases, left myocardial irradiation met criterion v 25. Clinically, arrhythmias, unstable angina pectoris, and other manifestations of coronary artery disease were mostly observed among patients with left-sided breast cancer. Significant factors for the development of cardiotoxicity were left-sided breast cancer, previous chemotherapy with anthracyclines and/or taxanes, as well as myocardial doses. The occurrence of radiation pulmonitis did not show an obvious relationship with any factor, while the body mass index (bmi) of >30 was a significant factor for the occurrence of radiation-induced skin damage.Conclusion. The combination of radiation therapy and trastuzumab was associated with an acceptable risk of cardiotoxicity. Monitoring of the cardiovascular system parameters during treatment and detection of early signs of cardiotoxicity were shown to be of great importance.
Introduction. There is no treatment for recurrence of head and neck squamous cell carcinoma, which significantly increases the overall survival (OS) of patients.The study objective is to analyze the results of treatment of patients with recurrences of squamous cell carcinoma of the head and neck and to assess the impact of risk factors for relapse, as well as different treatment options for relapse on OS. Materials and methods. In the period from 2012 to 2016, 182 patients with relapses of squamous cell carcinoma of the larynx, oral cavity and tongue received treatment in the Chelyabinsk regional clinical center of Oncology and nuclear medicine. The group 1 included 66 patients with resectable relapse who were operated. The group 2 consisted of 25 patients who received a course of radiation therapy. The group 3 consisted of 46 patients who underwent chemotherapeutic treatment of relapse. The group 4 was represented by combined treatment (surgery + radiation therapy), this group included 9 people. The group 5 consisted of those of patients who were not specifically treated for relapse because of the low Karnofsky index in patients (<70 %). Results. OS among patients who received special treatment was significantly higher compared with the group of symptomatic therapy. The median OS in the special treatment group was 40 months, and without it – 18 months. Comparing all types for treating relapse, the highest rates of OS were in the surgical treatment group. OS rates in combined therapy group and radiotherapy group were comparable rate in the radiotherapy. The lowest OS rate was after chemotherapy (only 21 months).Conclusion. Surgery is the optimal method for treating recurrent squamous cell carcinoma of head and neck, if it is resectable. If surgical treatment is not possible, no other method significantly increases the OS. If the overall status of the patient is normal, re-radiation or polychemotherapy may be performed. A limited category of patients can be subjected to combined treatment for relapse.
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