Objective. To assess the overall and disease-free survival rates in patients with EGFR-mutated lung adenocarcinoma, who underwent surgery after achieving the objective response to tyrosine kinase inhibitor (TKI) therapy. Material and Methods. The overall and disease-free survival rates were analyzed in 18 patients with EGFR-positive lung adenocarcinoma, which was inoperable at presentation due to locally advanced disease or the evidence of distant metastasis. In accordance with the clinical standards, patients were recommended for TKI therapy. Surgical resection was performed after achieving the objective tumor response to TKI therapy. The control group included 23 patients with EGFR mutation-positive lung adenocarcinoma, who did not undergo surgery after receiving TKI therapy. Results. The study revealed a statistically significant effect of surgical resection on the overall survival (OS) in patients with EGFR mutation-positive stage III–IV lung adenocarcinoma after response to TKI therapy (p=0.004). However, there was no statistically significant effect on the disease-free survival (DFS) (p=0.40). There was a tendency to increase in the median OS in patients of the study group (46 months) compared to that in patients of the control group (26 months). Surgery in the study group was characterized with some technical difficulties associated with severe fibrosis. However, this did not affect the duration of surgery and the volume of blood loss. Conclusion. Tumor resection in patients with EGFR mutation-positive stage III–IV lung adenocarcinoma is feasible and safe, but requires highly qualified team surgeons in well-equipped medical centers. Our study revealed that the combination of EGFR-TKI and tumor resection provided better PFS and OS than EGFR-TKI alone. However, further studies are required.

The pain and pain syndrome remain to be serious problems of clinical medicine and surgery as one of its aspects. The positive correlation was found out between the type of surgery and post-operative pain in abdominal, thoracic and orthopedic surgeries. Materials and methods. Results of a questionnaire survey in 130 patients were analyzed; from 2015 to 2017 all those patients had lobectomies for lung cancer using video-assisted thoracoscopic or open accesses in the Thoracic Department of Petrov National Medical Research Center of Oncology. The intensity of pain and life quality in the post-operative period were assessed using visual analogue scales, the Wong-Baker FACES pain rating scale, verbal rating scales, and McGill pain questionnaire. In order to assess life quality, the non-specific questionnaire of SF-36 was used in the cancer patients and those enrolled in the clinical studies of EORTC QLQ-C30 including the special module of QLQ-LC13 for lung cancer patients. The obtained results were analyzed and it was found out that intensity of pain was statistically significantly lower in video-assisted thoracoscopic access versus thoracotomy (U = 678.00; p < 0.05). When using the questionnaires of SF-36 (U = 8,742.50; p < 0.05) and EORTC QLQ-C30 (U = 3,759.00; p < 0.05) and the special module of QLQ-LC13 for lung cancer (U = 4,243.00; p < 0.05), the obtained data also indicated the better life quality and functions, reduction of pathologic manifestations versus open surgical access. Conclusion: Reduction in the pain intensity and higher life quality were typical of surgeries with use of video-assisted thoracoscopic technologies versus classical open access.

Bronchoplastic surgical operations by means of invaginated method on 1 semicircle in lung malignant tumors were performed in 124 patients. Of them 116 patients (93,5%) had primary and 8 patients (6,5%) metastatic tumors. There were 94 men (75,8%) and 30 women (24,2%). The average age of patients was 56,4. The lesion of the right lung was observed in 78 patients (62,9%), of the left one in 46 patients (37,1%). Bronchoplastic lobectomies were performed in 98 patients (79%), bilobectomies - 17 patients (13,7%), segmentectomy - 4 patients (3.3%), isolated resections of bronchi - 5 patients (4,0%). All operations were radical. In all cases of lung cancer there was carried out extended inpsilateral lymph node dissection. Complications of different severity were observed in 24 patients (19,4%): pneumonia (4,8%), atelectasis (0,8%), insufficiency of bronchial sutures (3.2%), granulation stenosis of the bronchial anastomosis (1,6 %), chylothorax (0,8%), recurrent nerve palsy (2,4%), heart rhythm disorders (2,4%). Postoperative lethality was 4.8%.

Bronchoplastic interventions allow extending indications for radical conserving surgery and, avoiding pneumonectomy, increasing a number of operated patients, reducing the fre- quency complications and postoperative mortality, significantly improving the quality of life as well as the conditions of reha- bilitation of patients and long-term results, which of particular importance for those with limited functional reserves. However some technical aspects of the bronchial reconstructive surgery are still unresolved and require further enhancement.

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.

Immunization with a vaccine prepared from sheep-brain-grown fixed rabies virus inactivated with beta-propiolactone was given to 146 subjects. The vaccine was by 80-90% purified from waste brain tissue substances (protein content less than 2 mg/ml) and showed no neuroallergenicity in guinea pig tests. Simultaneously 86 subjects were vaccinated with commercial Fermi vaccine. Immunization was performed according to the schedules accepted in the USSR. The new vaccine produced much fewer local reactions than Fermi vaccine (in 39.6% and 60.9% vaccinees, respectively) and 5 times as few systemic reactions (in 6.03% and 31.3% vaccinees, respectively). The antigenic potency of the new vaccine was as good as that of Fermi vaccine.

A controlled experiment was carried out to study the epidemiological effectiveness of live mumps vaccine from the L-3 strain, the importance of urgent prophylaxis by vaccination in mumps foci and to evaluate the economic effectiveness of mass prophylaxis of mumps by vaccination. The observations involved 113,967 children of 1 to 12 years. Vaccinations were given to 51,701 subjects and 62,256 subjects were the control group. The groups were formed by random selection. One vaccination dose contained 10(4)HAdU50 of mumps virus. The results attest to high epidemilogical effectiveness of the mumps vaccine. The incidence of mumps among the vaccinees was 29.7-fold lower than among unvaccinated, and the coefficient of protection was 96.6%. The urgent vaccination vaccination prophylaxis carried out in children's institutions during the period of introduction of mumps arrested the outbreak within one month, nad the duration of quarantine was reduced 2-3-fold. As a result of the vaccination the economic effect of 290,000 roubles was achieved.