Search

Background and objectives. During the two past decades, a new therapeutic approach to ovarian cancer (OC) has been developed. This combines cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, almost no data exist regarding the utility of biomarkers of morphological heterogeneity as prognostic factors in such patients. Methods. A retrospective study of the effectiveness of CRS and HIPEC was carried out in 59 patients with ovarian cancer. Biomarkers of morphological heterogeneity of OC were studied as prognostic factors: OC pathogenic types (based on the identification of р53 mutated gene protein expression) and homologous recombination deficit (basing on the identification of BRCA 1 gene expression status). Results. The survival of patients reliably differed with the division into two pathogenetic OC types established by immunohistochemistry: the median disease-free survival of type I OC patients was 14±1.7 months, type ІІ – 8±1.6 months (р = 0.007); the median overall survival of type I OC patients was 23.5±6.7 months, type ІІ – 12±1.9 months (р = 0.017). The median overall survival of patients with the somatic mutation of BRCA 1 gene and complete cytoreduction was 22±4.8 months, and without the somatic mutation of BRCA 1 gene – 12±3.3 months (р = 0.047). Conclusions. These data demonstrate that identification of the pathogenetic type of OC and BRCA 1 status may be useful for the personalized therapy of ovarian cancer patients treated with CRS/HIPEC.

Background and Objectives Clinical experience in Western Europe suggests that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are promising methods in the management of gastric cancer (GC) with peritoneal metastases. However, there are almost no data on such treatment results in patient from Central‐Eastern European population. Methods A retrospective cooperative study was performed at 6 Central‐Eastern European HIPEC centers. HIPEC was used in 117 patients for the following indications: treatment of GC with limited overt peritoneal metastases (n = 70), adjuvant setting after radical gastrectomy (n = 37) and palliative approach for elimination of severe ascites without gastrectomy (n = 10). Results Postoperative morbidity and mortality rates were 29.1% and 5.1%, respectively. Median overall survival in the groups with therapeutic, adjuvant, and palliative indications was 12.6, 34, and 3.5 months. The only long‐term survivors occurred in the group with peritoneal cancer index (PCI) of 0‐6 points without survival difference in groups with PCI 7‐12 vs PCI 13 or more points. Conclusions GC patients with limited peritoneal metastases can benefit from CRS + HIPEC. Hyperthermic intraperitoneal chemotherapy could be an effective method of adjuvant treatment of GC with a high risk of intraperitoneal progression. No long‐term survival may be expected after palliative approach to HIPEC.

Ovarian cancer (OC) represents the most lethal malignancy in gynaecologic oncology practice and shows a high recurrence rate due to its early chemoresistance to first-line chemotherapy. Yet, timely selection of the correct treatment strategy is likely to prolong a patient’s survival. MicroRNAs (miRNAs) are a class of short non-coding RNAs responsible for the expression of 30%–60% of human genes. In numerous studies, miRNAs have been used to provide the overall prognosis for patients and analyse the process’s prevalence and responses to chemotherapy. In particular, miRNAs as markers for predicting the sensitivity of OC to platinum- and taxane-based chemotherapeutics can significantly improve the treatment efficacy. This article highlights two families of miRNAs: miR-200 and let-7, which are promising for further research on OC and its chemosensitivity.

BACKGROUND AND OBJECTIVES Clinical experience suggests that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) play an important role in the management of ovarian cancer. In order to improve patient selection, the peritoneal surface disease severity score (PSDSS) was previously introduced for use in colorectal cancer patients. However, almost no data exist regarding the utility of the PSDSS index in ovarian cancer patients. METHODS A retrospective study of the effectiveness of CRS and HIPEC was carried out in 59 patients with ovarian cancer. The PSDSS was based on three criteria: symptoms, extent of peritoneal dissemination, and primary tumor structure as assessed by histology and biomarker expression. RESULTS The overall survival time for patients with ovarian cancer in PSDSS Stage I was 48 ± 25.3 months. For PSDSS Stage II, the survival time was 26.5 ± 4.7 months. For PSDSS Stage III, it was 15.5 ± 4 months, and for PSDSS Stage IV, it was 6 ± 4.3 months. A multivariate analysis showed that the PSDSS stage was the only independent survival predictor. CONCLUSIONS These data demonstrate that a PSDSS based on two pathogenetic types may be useful for predicting survival outcomes in ovarian cancer patients treated with CRS/HIPEC.

Colorectal cancer is one of the most common types of cancer in Ukraine. Prognosis for patients with peritoneal carcinomatosis is unfavorable, and life expectancy is typically less than 6 months. Cytoreductive surgery was introduced as a new method of treating these patients to prolong their survival time.The objective of the research was to evaluate and compare the efficacy of cytoreductive surgery, chemotherapy and symptomatic treatment of patients with colorectal cancer and peritoneal carcinomatosis.Materials and methods. The research included 93 patients with colorectal cancer and peritoneal carcinomatosis. All patients were divided into 3 groups depending on the method of treatment being used after the detection of peritoneal carcinomatosis: Group I - cytoreductive surgery, Group II - palliative chemotherapy, Group III - symptomatic treatment. Cumulative overall survival in three groups was analyzed using the Kaplan-Meier method.Results. Statistically significant difference in overall survival was observed between patients treated with different methods. The median overall survival of patients of Group I (n=44) was 15.5 months; the median overall survival of patients of Group II (n=27) was 5.9 months; in patients of Group III (n=22) it was 3.1 months (p

Здійснено ретроспективний аналіз результатів лікування 136 хворих на ускладнений рак товстої кишки, оперованих у клініці в 2008–2014 рр. Вік пацієнтів перебував у межах 36–94 років (середній – (68,8±12,1 року). У більшості хворих РТК діагностовано в клініці у зв’язку з виникненням того чи іншого ускладнення – 117 (86 %). Домінуючим ускладненням колоректального раку виявилась гостра обтураційна непрохідність – ізольовано у 105 (77,2 %) хворих, у поєднанні з перфорацією пухлини, перитонітом – у 24 (17,6 %) пацієнтів, кишковою кровотечею – в 1 (0,8 %) хворого. Перфорацію пухлини, перитоніт констатовано у 3 (2,2 %) хворих, гостру кишкову кровотечу – в 3 (2,2 %) пацієнтів. У 81,1 % спостережень перитоніт мав дифузний характер. Радикальні операції виконано у 68 (50 %) хворих, паліативні – у 18 (13,2 %), симптоматичні – в 50 (36,8 %) пацієнтів. Відповідно до класифікацією TNM, І стадію пухлини встановлено у 0,7 % оперованих, ІІ стадію – у 31 % хворих, ІІІ і IV стадії, відповідно, – у 31,4 та 37,0 % пацієнтів. Післяопераційні ускладнення розвинулись у 10 хворих (7,3 %) і мали в основному гнійно-септичний характер. Появу третинного перитоніту було визнано у 17 (12,5 %) прооперованих. Релапаротомії виконано 21 хворому (15,4 %), здебільшого з причини перитоніту, ретракції колостом. Середній ліжкодень склав 16,2±7,7. Померли 23 хворі – післяопераційна летальність – 16,9 %. Третинний перитоніт призвів до летального кінця в 15 пацієнтів (88,2 %). Основною причиною смерті визнано поліорганну недостатність як прояв тяжкого сепсису. Основними аспектами проблеми ускладненого раку товстої кишки (УРТК), які потребують комплексного вирішення, є зростання захворюваності, запізніла госпіталізація пацієнтів, потенційований ризик венозних тромбозів та емболій, третинний перитоніт, підвищення фахової онкологічної підготовки хірургів.

Patients with locally advanced gastric cancer (GC) and/or peritoneal metastases have a poor prognosis despite systemic chemotherapy or palliative surgery. The aim of this retrospective comparative non-randomised study was to evaluate aggressive cytoreduction in combination with hyperthermic intraperitoneal chemoperfusion (HIPEC) as a novel treatment strategy for patients with intraperitoneal disseminated and locally advanced GC.Forty-nine GC patients with serosal invasion (n = 19), limited peritoneal metastases (n = 20), or disseminated peritoneal metastases and tense ascites (n = 10) underwent combination therapy with HIPEC. Three matched control groups undergoing standard therapies were retrospectively identified.Combination therapy for serosa-invasive GC reduced the level of metachronous peritoneal carcinomatosis and increased median survival from 12 months to 22.5 months (p = 0.001). The median and 1-year survival rates for intraperitoneal disseminated GC patients undergoing therapy with the use of HIPEC were 12 months and 68.8% compared with 8 months and 25%, respectively (p = 0.004) for control subgroup patients (palliative chemotherapy). The symptomatic use of HIPEC allows effective elimination of recurrent ascites in GC patients.HIPEC is a well-tolerated and effective method of adjuvant therapy for gastric cancer with high risk of intraperitoneal progression. Cytoreduction followed by HIPEC improves survival in patients with limited peritoneal carcinomatosis of gastric origin.

The amount of lymph node dissection (LD) required during surgical treatment of gastric cancer surgery has been quite controversial. In the 1970s and 1980s, Japanese surgeons developed a doctrine of aggressive preventive gastric cancer surgery that was based on extended (D2) LD volumes. The West has relatively lower incidence rates of gastric cancer, and in Europe and the United States the most common LD volume was D0-1. This eventually caused a scientific conflict between the Eastern and Western schools of surgical thought: Japanese surgeons determinedly used D2 LD in surgical practice, whereas European surgeons insisted on repetitive clinical trials in the European patient population. Today, however, one can observe the results of this complex evolution of views. The D2 LD is regarded as an unambiguous standard of gastric cancer surgical treatment in specialized European centers. Such a consensus of the Eastern and Western surgical schools became possible due to the longstanding scientific and practical search for methods that would help improve the results of gastric cancer surgeries using evidence-based medicine. Today, we can claim that D2 LD could improve the prognosis in European populations of patients with gastric cancer, but only when the surgical quality of LD execution is adequate.

Introduction Adenocarcinoma near the esophagogastric junction is one of the most lethal GI malignancies known. Surgical treatment of these cancers stays determinative factors of patient survival. Older persons often differ from the younger adult population in terms of biological and functional perspectives; as such, they may have particular needs which require an interdisciplinary approach and intervention, especially when faced with a cancer diagnosis. The aim of this study was to detected expression of TGF-s and CD-44 in age specific subgroup. Methods The expressions of TGF-s and CD-44 were evaluated immunohistochemically in 23 patients with adenocarcinoma of gastric cardia who underwent curative surgery (R0) without any neo/adjuvant therapy. Additionally we analyzed control group of patients with non-cancer lesion or normal tissue of upper digestive tract (13 patients). We divided the patients into two groups. Group A consisted of 13 cancer patients and 7 control patients 65 years of age or older, while Group B consisted of 10 cancer and 6 control patients younger than 65 years of age. The two groups were comparable - there were no differences between the two groups regarding tumor stage. Results Elderly patients have statistically significant better survival (median 20.2 month) compared with younger patients (median 15.4 month) (p=0.045). The median survival rate of patients without TGF-s and/or CD-44 expression was significantly lower (7m) than that of patients with positive expression (>15m) (p=0.003). Regardless of patients age, CD-44 was significantly higher in the cancer tissue of elderly patients than in younger (p Conclusion The biology of tumors may be different in elderly patients, leading to a lower rate of tumor-related mortality.