Gastric cancer progression resulting in metachronous peritoneal metastasizing is almost always associated with an adverse prognosis. This review discusses various options of preventing metachronous peritoneal metastases in radically operated gastric cancer patients. Also examined are different hyperthermic intraperitoneal chemotherapy (HIPEC) regimens employed in gastric cancer treatment, postoperative morbidity and mortality rates and long-term treatment outcomes. The authors also review their own experience of using HIPEC based on the combination of cisplatin and doxorubicin in doses of 50 mg/m2 at 42 °C for 1 h to prevent gastric cancer peritoneal dissemination. As a result, progression-free survival rose from 19.6%±5.6% to 47.1%±6.3% (Plog-rank <0.001) and dissemination-free survival—from 22.7%±6.0% to 51.9%±6.3% (Plog-rank <0.001). It is noted that the combination of the described HIPEC regimen with systemic chemotherapy helped raise metastases-free 3-year survival rate to up to 91.0%±9.0% (Plog-rank =0.025) compared with 48.6%±6.4% for patients who underwent only a combined surgery/HIPEC treatment. HIPEC is a promising combined treatment strategy for radically operated gastric cancer patients that can improve patient survival and decrease peritoneal dissemination rate. However, the number of randomized studies on adjuvant HIPEC are still insufficient for a subgroup assessment of efficacy of the given chemotherapy regimens and generation of evidence-based recommendations on the individual use of chemotherapy agents and their combinations, and HIPEC procedural techniques. Further prospective randomized studies are needed to assess the practicability of complementing HIPEC with adjuvant systemic chemotherapies.

ObjectiveTo determine the efficacy of pelvic exenteration (PE) in patients with locally advanced, persistent and recurrent cervical cancer (CC).MethodsA retrospective study was performed of 30 patients with locally advanced, persistent and recurrent CC who underwent PE in 2006–2012. Anterior PE was performed in 24 (80%) patients, posterior PE in 2 (7%) and total PE in 4 (13%).ResultsThe mean operation time was 279.5 min. Urine derivation in 28 patients was performed in the following ways: 7 (25%) patients were subjected to ureterostomy, 21 (75%) had plastic interventions for neocyst formation. Fecal diversion performed in 5 patients by end colostomy (Hartman’s procedure) and in one patient rectum resection was performed. Radical surgery was performed in 70% (21 of 30) of the patients. The median follow-up time of the 28 patients was 76.3 months. During the follow-up period, 19 (68%) patients died of the underlying disease with no deaths of other causes. The median survival was 15.5 months, 5-year survival – 32% (SE 8.8%). The median survival after radical surgery was 37.9 months vs 5.5 months after nonradical one. Five-year cause-specific survival after radical surgery was 74% (SE 10.1%; 95% CI 49–91%), after nonradical one – 33% (SE 15.7%).ConclusionSurgical radicality has been established to be a clinically and statistically significant factor of death risk: the radical surgery enables to reduce the death risk 3.5-fold (95% CI 1.4–9.0; p=0.009), to increase the median survival 6.9-fold, 5-year survival from 11% (SE 10.5%) to 42% (SE 11.3%, 95% CI 20–67%).

Evaluation of the efficacy of the combination of radical surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and adjuvant systemic chemotherapy (ACT) in reducing gastric cancer progression in patients with resectable serosa-invasive gastric cancer in a single institution. In 2015–2016, 19 patients with gastric cancer (stage IIB-IIIC) were included in the trial. The trial protocol comprised radical surgery, HIPEC (cisplatin 50 mg/m 2 + doxorubicin 50 mg/m 2 , 42 °C, 1 hour), and 1–8 cycles of ACT (oxaliplatin 100 mg/m 2 administered on day 1 of each cycle and oral capecitabine 1000 mg/m 2 (or tegafur 10–15 mg/kg) administered twice daily on days 1–14 of each cycle with an interval of 7 days between cycles). Following the ACT treatment, the patients were divided into 2 subgroups—those who underwent up to 6 ACT cycles (1–6 cycles, subgroup ≤ 6–8 patients) and those who underwent 7–8 ACT cycles (subgroup > 6–11 patients). Three-year metastasis-free survival (MFS) for the > 6 subgroup was 91 ± 9%. With a follow-up median of 17 months, 3-year MFS for the ≤ 6 subgroup was not reached − p log-rank = 0.003. The trial showed that in managing advanced gastric cancer patients (pT4a-4bN0-3 M0) by supplementing radical surgery with ACT-enhanced hyperthermic intraperitoneal chemotherapy, ACT proved to be highly effective when administered in its full mode of 7–8 cycles compared with its truncated variant of 1–6 cycles.

INTRODUCTION:This study assesses the efficacy and tolerability of two cycles of adjuvant chemotherapy (AC) with gemcitabine and cisplatin after radical cystectomy in patients with a high risk of progression of muscle-invasive urothelial bladder cancer as compared to chemotherapy at relapse, in a prospective randomized study.MATERIAL AND METHODS:From 2008 to 2013, all patients after radical cystectomy at our institution for primary or recurrent urothelial bladder cancer with stage pT3-4 and/or pN+ on histopathology and without contraindications to combination cisplatin-based chemotherapy, were randomized either to two cycles of gemcitabine and cisplatin chemotherapy or to follow-up and chemotherapy at the time of relapse. The study endpoints were overall, cancer-specific, and disease-free survival.RESULTS:The study included 100 patients, of whom 53 received AC and the other 47 were assigned to the control arm. Out of 53 allocated to AC arm, 16 patients did not start chemotherapy or received only one cycle of AC. The median follow-up for patients in the AC and control arms was 88 and 86 months, respectively. In the AC arm the hazard ratio for death from any cause, death from bladder cancer, and disease relapse were 0.70 (95% CI 0.45-1.11; p = 0.13), 0.84 (95% CI 0.50-1.41; p = 0.51), and 0.77 (95% CI 0.46-1.28; p = 0.31), respectively.CONCLUSIONS:Two cycles of AC with gemcitabine and cisplatin in patients with high-risk urothelial bladder cancer after radical cystectomy does not improve overall, cancer-specific, and disease-free survival. Only 53% of patients randomized to AC received the entire planned treatment.

INTRODUCTION:This paper aims to evaluate the influence of quality of transurethral resection in patients with non-muscle invasive bladder cancer on the benefit of fluorescent cystoscopy-assisted transurethral resection in the post hoc analysis of the single-center randomized controlled trial.MATERIAL AND METHODS:We retrospectively analyzed the results of the prospective randomized study assessing the efficacy of fluorescent cystoscopy-assisted transurethral resection. The quality of transurethral resection was defined on the basis of a separate retrospective study estimating the variability in recurrence risk for the individual surgeon. The subgroup analysis of fluorescent cystoscopy-assisted transurethral resection efficacy depending on surgical experience was performed.RESULTS:Of 377 eligible patients, transurethral resection was performed in 365 (97%) by surgeons with available grading information. Two 'experienced' surgeons performed 238 (63%) of all transurethral resections and three 'less experienced' surgeons completed 127 (34%) surgeries. The two surgical groups were comparable with respect to basic prognostic factors and subsequent therapy. The median follow-up was 56 months.In the total cohort of patients, fluorescent cystoscopy significantly decreased the risk of recurrence with hazard ratio 0.58 (p = 0.004). In the 'experienced surgeons' subgroup the benefit of fluorescent cystoscopy was not significant (hazard ratio 0.81, p = 0.34), whereas the 'less experienced' subgroup showed a marked difference in favor of fluorescent cystoscopy-assisted transurethral resection (hazard ratio 0.31, p = 0.001), with a P-value for interaction of 0.021.CONCLUSIONS:Baseline quality of surgery may be a significant interacting factor affecting the magnitude of the benefit of fluorescent cystoscopy-assisted transurethral resection in patients with non-muscle invasive bladder cancer.

Background: Evaluation of hyperthermic intraperitoneal chemotherapy (HIPEC) in reducing metachronous peritoneal metastases (MPM) risks in patients with resectable serosa-invasive gastric cancer. Materials & methods: Between 2008 and 2016, 154 patients with gastric cancer (stage IIB-IIIC) were randomly assigned to two groups: 76 patients underwent HIPEC (cisplatin 50 mg/m(2) + doxorubicin 50 mg/m(2), 42 degrees C, 1 h) combined with radical surgery (HIPEC group) and 78 patients underwent only radical surgery (control group). Results: Evaluation of HIPEC toxicity showed neither toxic complications of IV-V degree nor haematological toxicity (according to CTCAE v. 4.03). There was no significant difference in the rate of complications between the two groups (p = 0.254). There was a more frequent disease progression in the control group than in the HIPEC group: 42/55 patients (76.4%) vs. 36/68 patients (52.9%), respectively (p = 0.009). At the same time a significant decrease in the rate of MPM was observed after HIPEC administration as compared with surgery alone - 16/68 (12.8%) vs. 39/55 (27.6%) (p < 0.001). 3-year progression-free survival was 47% (95% CI 36-61)) in the HIPEC group and 27% (95% CI 17-43) in the control group - p = 0.0024. The N-stage, HIPEC procedure, type of surgery and interaction between HIPEC treatment and age were independent prognostic factors. Conclusions: HIPEC appears to be helpful in improving treatment results in radically operated gastric cancer patients. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Objectives To conduct the efficacy of radiological endovascular embolization of small pelvis arteries in patients with locally advanced and recurrent uterine cervix cancer (UCC) complicated with hemorrhage. Methods 81 patients were included: 68 (84%) primary patients with locally advanced UCC and 13 (16%) – with UCC recurrences, who underwent radiological endovascular occlusion of small pelvis arteries regarding bleeding from tumor. Results Distribution of primary patients according to FIGO stages: IIB stage – in 4 (6%), IIIB – in 44 (65%), IV – in 20 (29%). In the result of the procedure hemorrhage was stopped in 76 (94%) patients. After successful conduction of radiological endovascular hemostasis in 68% (46 of 68) of primary UCC patients’ antineoplastic treatment was performed, according to the radical program in full – in 43% (29 of 68) of cases. Survival of 22 (32%) patients who was not treated further, and 46 (68%) patients who continued the treatment was significantly differed. 1-year adjusted survival (AS) was 15.2% (SE 8.1%) and 53.5% (SE 7.4%), respectively. No patient survived to 5 years in the first subgroup, in the second subgroup a 5-year AS was 24.0% (SE 6.8%), median AS for the first subgroup was 5.4 months, for the second – 12.8 months (p <0.001). Conclusions Arterial embolization of pelvic vessels is an effective method of arrest of hemorrhage in patients with locally advanced and recurrent UCC in 94% of cases. Conduction of this procedure in primary patients in case of complicated locally advanced UCC allows to perform special antitumor treatment in 68% of cases.

Objectives To investigate the efficacy of low molecular weight heparins (LMWH) on the outcomes of concurrent chemoradiotherapy for locally advanced cervical cancer patients. Methods 85 stage IIB-IVB locally advanced cervical cancer patients were treated at the Gynecologic Oncology Department in 2011–2013 years. Patients were randomized into two arms. The control patient arm received the conventional chemoradiotherapy course, in the study arm it was supplemented with LMWH. Results Hemorrhagic complications associated with the using of LMWH were not detected.The immediate results of chemoradiotherapy in the study and control groups were the same (p=1.0): according to RECIST criteria 47% in each group were recorded in complete regressions, 42% in partial regressions, 11% in the stabilization of the disease, and the progression of the disease to the end treatment was not recorded in any of the studied groups. The 5-year cancer-specific survival of patients in the study arm was 68.2% (SE 7.9%), in the control arm it was 66.4% (SE 7.1%), p=0.80. The 5-year overall survival was 63.3% (SE 8.1%) and 64.4% (SE 7.2%) respectively, p=0.94. The 5-year progression-free survival was 63.3% (SE 8.1%) and 64.4% (SE 7.2%), respectively, p=0.93. Conclusions Thus, despite the theoretical data, as a result of a clinical study, the effect of using LMWH on the primary cure of a tumor has not been established. The analysis of long-term treatment outcomes found no effect of LMWH on the cancer-specific survival, overall survival and progression-free survival in locally advanced cervical cancer patients treated by concomitant chemoradiotherapy.

The objective of this study is to devise a prognostic classification of AKI in the postoperative period based on preoperative factors for patients after partial nephrectomy for renal masses in the solitary kidney (SK). This method will allow identifying patients in a high risk group and reducing this unfavorable postoperative outcome by a careful treatment planning.We present a series of 136 patients with SK tumor who underwent open partial nephrectomy in situ performed at the N. N. Alexandrov National Cancer Centre of Belarus in 2000–2016. During the early postoperative period, AKI occurred in 28 (20.6 %) patients. Three risk factors associated with a risk of developing AKI were included in the multivariate analysis: categorized risk factors such as tumor size and serum potassium and dichotomous – multifocality. On the basis of the multivariant model presented, 3 risk factors were assigned a weighted score. Depending on the score, the cohort of patients was divided into 3 groups. Patients with a score from 0 to 2 were classified as a low-risk group, 3 points – an intermediate-risk group and ≥4 points – a high-risk group with the development of AKI in the postoperative period.The devised prognostic classification allows one during the preoperative period with a predictive accuracy of 82.3 % to determine a risk of development of AKI after partial nephrectomy of SK. In the low-risk group, the probability of developing AKI after surgery is 5.6 %, in the intermediate-risk group – 2.9 %, in the high-risk group – 68.2 % (р < 0.001).

Рак мочевого пузыря (РМП) занимает 9 место в мире среди всех злокачественных новообразований и является второй по частоте опухолью в онкоурологической практике.Ежегодно в мире регистрируется более 430 тыс.новых случаев, Резюме.Мышечно-инвазивный рак мочевого пузыря (МИРМП) с неблагоприятным прогнозом (категории рТ3-4N0 либо pN+) характеризуется высокой агрессивностью течения опухолевого процесса и смертностью.В настоящее время в рамках комплексного лечения данной патологии наряду с радикальной цистэктомией (ЦЭ) используется неоадъювантная (НХТ) либо адъювантная химиотерапия (АХТ), главным образом, на основе цисплатина, характеризующаяся высокой токсичностью и умеренной эффективностью.У пациентов с МИРМП с неблагоприятным прогнозом, которым не проводилась НХТ, после радикальной ЦЭ предлагается применять режимы M-VAC (цисплатин, адриамицин, метотрексат и винбластин), GC (гемцитабин, цисплатин) или CMV (цисплатин, метотрексат и винбластин).Данные исследований, в том числе и проспективного рандомизированного исследования, проведенного в Республиканском научно-практическом центре онкологии и медицинской радиологии им.Н.Н.Александрова, показали, что наибольшая эффективность АХТ отмечается в подгруппе пациентов без метастатического поражения регионарных лимфоузлов.

To determine the efficacy of pelvic artery embolisation (PAE) in patients with locally advanced and recurrent cervical cancer (CC) complicated by haemorrhage, a retrospective study was performed of 81 patients with locally advanced or recurrent CC who underwent PAE for haemorrhage. Of the 81 patients included in the study, 68 (84%) had primary locally advanced CC and 13 (16%) had recurrent disease. Distribution of patients with primary disease according to the International Federation of Gynecology and Obstetrics (FIGO) stages was: IIB (n=4, 6%), IIIB (n=44, 65%), IV (n=20, 29%). The PAE controlled the haemorrhage in 76 patients (94%). After successful embolisation, 46 of 68 (68%) patients with primary CC started antineoplastic treatment a median of 3 days (range 1–17 days) after treatment. Twenty-nine of these women (43%) subsequently completed primary treatment for their disease. During the follow-up period, 67 patients (83%) died of disease and 4 (5%) died of other causes. The adjusted 1-year survival was 41.4% (standard error [SE] 5.6%), 5-year survival was 17.9% (SE 4.5%), and median adjusted survival was 8.4 months. Survival of the 22 patients (32%) who did not receive further treatment and 46 patients (68%) who continued the treatment was significantly different, with a 1-year adjusted survival of 15.2% (SE 8.1%) and 53.5% (SE 7.4%) respectively. None of the patients who did not receive further treatment survived 5 years, whereas in the group undergoing further treatment, the 5-year adjusted survival was 24.0% (SE 6.8%) and the median adjusted survival was 5.4 months and 12.8 months, respectively (p<0.001). Pelvic artery embolisation was effective in controlling haemorrhage in 94% of patients with locally advanced and recurrent CC. Sixty-eight percent of patients were able to undergo further antitumor treatment. Pelvic artery embolisation is a minimally invasive intervention that can be effective at any stage of treatment in patients with CC presenting with haemorrhage.

The analysis of the long-term results of treatment of 1065 radically operated gastric cancer patients was carried out. 103 of them underwent combined operations. A statistically significant effect of the nature of the operation performed on the number of postoperative complications (4.9 % after combined operations, 1.1–3.4 % after standard operations) and the incidence of disease progression (39.8 % after combined operations, 17.8–30.1 % after standard operations). Prevalence in the structure of the progression of peritoneal dissemination was noted, the 4-year cumulative incidence of which after combined operations was 41.1 ± 0.3 % and after standard operations – from 13.26 ± 0.02 to 27.27 ± 0.07 %. The latter testifies to a relative radical surgical treatment when a tumor leaves the gastric wall, which requires the use of adjuvant treatment aimed at preventing the progression of gastric cancer, primarily with disseminated peritoneal lesions.

To assess the efficacy of two treatment options for non-muscle-invasive bladder cancer (NMIBC): (1) transurethral resection (TUR) guided by fluorescence cystoscopy (FC) with the use of 5-aminolevulinic acid (5-ALA) and (2) single early instillation of doxorubicin in a single-center open-label prospective randomized study with a 2 × 2 factorial design.