Цель обзора: акцентировать внимание на результатах лечения больных с резистентными злокачественными трофобластическими опухолями (ЗТО) и рецидивами, подчеркнуть важность дальнейшего поиска оптимальных путей достижения ремиссии

Early diagnosis of malignant trophoblastic tumors (MTT) and their possible complications is important for the timely and successful treatment of the disease while preserving young women's reproductive function. This article reflects the principles of diagnosis based on an integrated approach, as well as modern methods of treating MTT, primarily chemotherapy, regimens of which have been standardized to date. Unfortunately, having clear algorithms for diagnosis and treatment, we continue to face various kinds of errors, both at the stage of diagnostic search and at the stage of treatment of MTT. The most significant errors allowed by clinicians in the main sections on the way of diagnosis and management of patients are discussed within the framework of the article. The urgency of the problem is obvious, because at the cost of such errors are not only the loss of reproductive potential, but also the unjustified death of young women from a potentially curable disease.

The prevention of cancer of the cervix uteri (CCU) is an interdisciplinary problem that may be solved only via joint efforts of gynecol- ogists, oncologists, virologists, and immunologists. Since there is currently strong evidence for the viral origin of CCU, vaccination is prominent in its primary. The present paper considers and comparatively analyzes 2 different lines of biotherapy for CCU.

Retrospective data of treatment results of 109 patients with rarely observed stage II uterine cancer, admitted to N.N. Blokhin Russian Cancer Research Center from 1980 to 2000 is analyzed. Correlation of overall 5-year survival rates of stage IIA and IIB uterine can- cer patients with a number of tumor morphologic features is studied. The influence of some non-elucidated morphologic features of stage IIA and IIB uterine cancer such as the degree of cellular anaplasia, the depth of tumor invasion into the uterine neck, lymho- vascular invasion into the myometrium and uterine neck, microscopic vessels density in the area of the most extensive invasion, the presence of necrotic areas in the tumor tissue on long-term treatment results are analyzed.

Despite great efforts to publish the 7th edition of the clinical TNM classification, the major aim of the International Union Against Cancer continues to create unified statistical information on the prevalence of disease in each specific case. This information can, in the general context, help specialists evaluate a tumor process, avoid disagreements in the planning of treatment and in the assessment of its results, and make a prognosis, thereby favoring further investigations of malignancies.

The paper characterizes paranoic hypochondriacal development, that is comparable with expan-sive paranoia, in patients with a >5-year history of malignancies at examination. A study sample comprised 8 treated out- and inpatients (mean age 55.7±7.02 years) diagnosed as having repro-ductive organ malignancies. Their examination was made by the clinical catamnestic technique. Psychopathological disorders in the described cases of expansive paranoia are associated with the development of abnormal querulant activity that is aimed at having the medical care volume inadequate to the somatic status of patients with malignancies. The described variant of development of paranoid disorders enables their determination within the framework of cancer-induced chang- es in personality disorders with the formation and further reinforcement of the psychopathological manifestations of mainly the hy- poparanoia type. The constitutional predictors of hypochondriacal development via expansive paranoia type, which include not only certain types of personality disorders (paranoic, 50%; schizoid–expansive pole, 12.5%; icteric, 37.5%; sensitive, 12.5%), but also ac- centuations (segmental depersonalization accentuation) against which the study reactions manifest themselves as a continuation of but ab-normally transformed constitutional properties.

The research has comprised 109 patients suffering from rare endometrial carcinoma of stage II, who were treated at the Blokhin Russian Cancer Research Center from 1980 till 2000 year. Morphological signs of endometrial cancer with spreading to cervix were studied and analysed. We examined morphological signs of endometrial cancer of stage IIA and IIB which hadn't been studied before (the degree of anaplasia, the depth of neoplasma invasion into stroma of cervix, the lymphovascular invasion into the miometrium and stroma of cervix, the microvessels density in the zone of the greatest invasion, the presence of foci of necrosis in the tumor). Data obtained demonstrate that endometrial cancer of stage II has a number of distinguishing morphological peculiarities characteristic for both IIA and IIB stages.

The purpose of this study was to compare receptor status of endometrial tumors and intact ovaries. 85.7% of endometrial tumors and 83.7% of intact ovaries were progesterone receptor positive and 81.6% of endometrial tumors and 26.1% of intact ovaries were estrogen receptor positive. Mean progesterone receptor levels were two-fold and mean estrogen receptor levels were three-fold greater in tumors than in intact ovaries. Steroid hormone receptor concentrations in tumors and intact ovaries depended on disease stage, tumor differentiation and depth of endometrial invasion.

Цель исследования: оценка эффективности и токсичности противовирусного препарата “Изопринозин” в комплексном лечении больных эпителиальными дисплазиями I–III степени (CIN I–III) и преинвазивным раком шейки матки (Ca in situ ШМ), а также больных с рецидивами CIN ШМ или Ca in situ в оставшейся части ШМ, инфицированных вирусом папилломы человека (HPV). Учреждение: отделение гинекологии, отделение амбулаторных методов диагностики и лечения злокачественных новообразований ГУ РОНЦ им. Н.Н. Блохина РАМН.Результаты исследования: у 35(77,8%) пациенток HPV 16 не обнаружен после одного курса лечения изопринозином, при этом HPV 18 не определялся у 4 больных (50%), инфицированных двумя типами вирусов. 9 больным (20%) потребовалось 2 курса лечения с 10-дневным интервалом. У 1 пациентки (2%) HPV 16 и 18 обнаруживался после 2 курсов лечения и операции, что потребовало проведения 3-го курса лечения. Среднее время без рецидива инфекции не менее 4,2±2,1 мес при ежемесячном контрольном обследовании. Заключение: на первом этапе лечения больные с CIN и Ca in situ ШМ должны по показаниям подвергаться электрокоагуляции, криодеструкции, лазеровапаризации, электроконизации ШМ. Противовирусное же лечение должно проводиться на втором этапе обязательно, так как персистенция вируса является ключевым фактором для возникновения рецидива заболевания. Применение противовирусного препарата “Изопринозин” до операции сопровождается значительным снижением активности вируса HPV 16 и 18 типов, определяемых при ПЦР-диагностике. При этом уже после первого курса лечения тест на HPV-инфекцию отрицательный у 77,8% больных.

We analyzed the role of surgery in the treatment for trophoblastic tumors in 70 patients managed at the Gynecology Department of N.N. Blokhin CRC, RAMS, during 1996-2003. Before admission to the CRC 11 patients underwent various surgical procedures, with 4 of them also receiving chemotherapy to follow. At the CRC all the cases started treatment with chemotherapy. All 38 patients having tumors at low to mediate risk of chemoresistance were cured by chemotherapy alone. Ten of 32 high-risk patients underwent surgery. Five operations were performed in 4 cases for refractory primary or metastatic tumors (hysterectomy, removal of a bladder wall metastasis, thoracoscopic pulmonary lobectomy). On completion of line I-II chemotherapy the remaining 6 patients had preservation hysterotomy (2), hysterectomy (3) or dissection of a residual metastasis in the vaginal wall (1). Ten of 11 patients undergoing surgery before chemotherapy presented with distant metastases at admission to the CRC, 3 of them died from disease progression. Of the 4 cases receiving surgery for refractory tumors 2 have been cured and one patient continues treatment. All the 6 patients having surgery after chemotherapy completion are cured. Up-to-date treatment for trophoblastic disease including standard chemotherapy regimens reduces the need in surgery to 16% (vs 43% in previous years) with hysterectomy accounting for only 4.3% (vs up to 40% previously) and prevents bleeding requiring surgery. Surgery is indicated in cases with refractory primary or solitary metastases to improve treatment outcomes.

radiotherapy. We report disease-free and overall survival in 23 high risk endometrial patients treated with paclitaxel and radiotherapy. These patients were surgically staged or referred to our Hospital for adjuvant therapy. 6 patients was in IC G3 stage, without lymphadenectomy or with aneuploid tumor, 4 IIB, 7 IIIA, 1 IIIB, 5 IIIC. Median age was 62.78 years (range 48—74). Patients were treated with Paclitaxel 60mg/m2 onceweekly during the 5 weeks of radiotherapy. Radiation plan consisted of a total dose of 50.4Gy and included the entire pelvis. When lymph-node was positive, patient received irradiation also in the para-aortic field. Other three cycles of Paclitaxel were performed weekly after radiotherapy (dose of 80mg/m2).Median follow-up was 25 months (range 10—45). Twenty-one patients completed radio-chemotherapy. One hundred and fifty-seven cycles of Paclitaxel were performed. Grade 3 hematological and gastrointestinal toxicity was not observed. Neither cardiovascular nor neurological toxicity was registered. Three patients (14.3 % ) presented a relapse of disease, outside the irradiation field. Overall survival was 95.5 % with a disease-free survival of 25 months. This therapeutic regimen is safe and well tolerated; survival and relapse rates appear encouraging, if compared to previous studies.