Представлены данные по определению рецепторов эстрадиола (РЭ) и прогестерона (РП) в цитозольной фракции опухолей и окружающем неопухолевом эпителии при мультицентрическом раке молочной железы (МЦ РМЖ). Процент выявления РЭ/РП– статуса при МЦ РМЖ выше, чем при уницентрическом РМЖ: РЭ – 42,7%, РП – 45,7% (при уницентрическом РМЖ РЭ/РП– выявляется примерно в 20%). Обнаружена корреляционная зависимость уровня РЭ/РП от стадии заболевания МЦ РМЖ: с увеличением стадии опухолевого процесса наблюдается рост средних уров- ней РЭ/РП в большей опухоли. Уровни РЭ/РП в большей опухоли при МЦ РМЖ не коррелируют с количеством опухолевых узлов и различиями в их гистологическом строении. Уровень РЭ в большей опухоли в 2 раза выше, чем в неопухолевом эпителии, а уровни РП в опухоли и неопухолевом эпителии практически равны. При выявлении отрицательного фенотипа большей опухоли при МЦ РМЖ необходимо определять рецепторный статус во второй опухоли, который в 20% случаев бывает отличным от первой. Ключевые слова: рак молочной железы, мультицентрический, рецепторы эстрогена, рецепторы прогестерона. The authors have presented their findings on determining levels of estrogen receptors (ER) and progesterone receptors (PR) in tumor cytosole fraction and in the surrounding nontumoral epithelium in multicentral breast cancer (MC BC). ER/PR status is better revealed in MC BC than in unicentral BC: ER – 42.7%, PR – 45.7% (in unicentral BC ER/PR can be revealed only in about 20%). A correlation dependence has been found out between ER/PR levels and MC BC stage: the higher is the stage of the tumor process, the more is the increase of average ER/PR levels in a large tumor. ER/PR levels in large MC BC tumors do not correlate with the number of tumoural nodes and differences in their histological structure. EP levels in a large tumor are twice higher than in nontumoural epithelium, while PR levels in a tumor and in nontumoral epithelium are practically the same. If a negative phenotype of large MC BC tumor is registered, a receptor status in the second tumor must be found as well out bearing in mind that in 20% of cases the receptor status of the first tumor may be different than that of the second one. Кey words: breast cancer, multicentral , estrogen and progesterone receptors.

В статье представлен анализ результатов обследования и лечения 2075 больных первично-выявленным раком мо- лочной железы за 1985–2008 годы. Средний возраст заболевших составил 59,2 года. Система скрининга РМЖ по- зволяет выявлять больных на ранних стадиях заболевания, так 79,6% пациенток получали лечение по поводу РМЖ I–II стадии, 13,5% –III и лишь 4,3% – IV стадии. Из 2075 пациентов у 232 были выявлены метастазы рака молочной железы в кости, что составляет 11,2%. Лечение больных с метастатическим РМЖ должно быть комплексным и основываться на рациональном применении системной терапии и локальных воздействий, которые должны использоваться в такой последовательности, чтобы до- стичь максимальной ликвидации симптомов при наименьшей токсичности. Основная задача лучевой терапии заключа- ются в достижении обезболивающего эффекта. Уменьшение болевого синдрома наблюдается более чем у 70% больных на срок 5–7 месяцев, полное исчезновение болей у 36% больных. Трехлетняя выживаемость больных после диагностики и лечения костных метастазов составила в целом около 25%, пятилетняя – около 20%. Ключевые слова: рак молочной железы, метастазы в кости. The paper analyzes results of examination and treatment of 2075 patients with primary-revealed breast cancer who were admitted to the hospital during 1985–2008. Average age was 59.2 years. The system of breast cancer (BC) screening allows to reveal patients with BC at early stages; that is why 79.6% of women were treated for BC of stages I–II; 13.5% – stage III and only 4.3% – stage IV. Out of 2075 patients 232 had metastases into the osseous tissue (11.2%). The approach to treating patients with metastatic BC must be complex and based at a reasonable application of systemic and topical therapy. This combination must be organized in such a way so as to get maximal eradication of symptoms with a minimal toxicological effect. The main goal of radial therapy is to produce a pain-killing effect. The reduction of pain syndrome is usually seen in more than 70% patients for 5–7 months; a complete pain control – in 36%. Three-year survival after diagnostics and treatment of osseous metastases was about 25%; five Key words: breast cancer, metastases into the osseous tissue

In this literature review we present analysis of various aspects of the problem of cardiotoxicity of antracyclines used for the treatment of the breast cancer. We consider mechanisms of their cardiotoxic action, role of risk factors, clinical manifestations of acute and chronic cardiotoxicity, and dependence of their severity on treatment duration and drug dose. We give data on contemporary methods of diagnostics of early toxic cardiac effects of antracyclines from the side of cardiovascular system. We also conducted assessment of possibility of prevention of toxic action of antracyclines with the use of combination of different methods including dose sparing regimens and schemes of treatment, combinations of drugs, use of cardioprotectors as well as novel preparations from the antracycline group, possessing lesser cardiotoxicity. Clinical and experimental data on the treatment of manifestations of cardiotoxicity with consideration of pathogenetic mechanisms of their development are given.

The paper analyses surgical treatment outcomes in 62 patients having primary or metastatic tumors of the spine with severe paresis and paralysis. Early decompression-stabilization operations for cervical tumors are found superior to procedures via posterior incision. Two-stage procedures may be reasonable for tumors located in other spinal regions. The first stage (decompressive laminectomy) provides for spinal marrow and radicular decompression with tumor biopsy. Basing on histological findings it is decided whether operation via anterior incision is reasonable to achieve spinal stabilization.

Results of surgical treatment of 105 patients with vertebral body tumors are presented. Depending on the tumor type, manifestation of spinal disorders and patients general condition different decompression and stabilizing operations were performed. Forty seven patients underwent decompressive laminectomy. The choice of that surgical intervention was stipulated by the severity of patients condition and impossibility to perform more radical operation. The outcome of that operation was determined to be of short duration and did not prevent the spinal complications. In 58 patients decompressive-stabilizing operations were performed. In 31 out of those patients the anterior approach was used. Results showed the advantages of the later operations not only in benign tumors, but in malignant ones or metastatic vertebral body lesions. Operations by anterior approach with spine stabilization using carbon implants are the most perspective for the treatment of patients with metastatic lesions.