Biomedical subjects
Publications and source records attributed to I V Glekov.
X-ray examination is considered to be the most effective procedure for diagnosis of Ewing's sarcoma of the rib. The extent of surgery and sequence of procedures are determined on the basis of its evidence. Treatment of infantile Ewing's sarcoma of the rib should include chemoradiation therapy and compulsory surgery.
New procedures of laser therapy and chemotherapy have extended the scope of application of organ-saving treatment at advanced stages of retinoblastoma in childhood, thus making it possible to preserve the eye fully functional or cosmetic. Not having to perform such mutilating procedures as ophthalmectomy or eye socket exenteration contributes to psychological and physical rehabilitation. At the same time, as a comparison of the results of surgery carried out at initial stages and surgery-free treatment showed that palliative therapy is characterized by impressive rates of 5-year survival. New vistas have opened of in the management of pediatric retinoblastoma, particularly in cases of stage III tumor and bilateral involvement.
The efficacy and toxicity-related results of non-standard irradiation used in the combined treatment of 129 children with solid tumors were evaluated in 1986-1993. Immediate response (complete or partial regression) was registered in 89.3% of cases of sarcoma of Ewing, 76.8%--rhabdomyosarcoma and 76.7%--other tumors. Local recurrence was observed in 4 and late-onset complication of radiation injury in 10 patients. The actuarial 5-year survival was 54.3, 52.1 and 41.2% in Ewing sarcoma, rhabdomyosarcoma and other tumor groups, respectively.
The treatment of nephroblastomas which accounts for 72% of all malignant neoplasms in children is one of the topical problems of pediatric oncology. To detect the tumor at early stages of a tumorous process is one of the main conditions of successful treatment for nephroblastomas. The histological types of nephroblastoma, its international classifications and present-day treatment policy are given. A role of radiation treatment is shown at pre- and postoperative therapeutical stages. Drugs, their combinations, and the efficiency of polychemotherapy regimens in use are outlined. The importance of comprehensive examination of the patient to determine the extent of malignancy and to choose adequate antitumor treatment regimens is emphasized.
A comprehensive programme was developed for the treatment of uni- and bilateral retinoblastoma in children with due regard to the disease stage by the TNM system. The use of the current sources of teletherapy and cyclic polychemotherapy expanded indications for organ-saving therapy at most common stages. Treatment by the program was performed in 202 patients, including 125 children with unilateral damage and 77 with bilateral damage. An attempt made treat 140 (75%) children at the first stage. More than 70% of cases were diagnosed as having disease stage T3 in one or two stage, while such patients underwent ocular enucleation. A complete or partial (more than 50%) tumor regression without signs of its progression for 2 years or more was achieved in 62% of cases. At the first stage of therapy, conservative therapy insignificantly affected the children's longevity in uncomplicated cases, which is particularly important in bilateral involvement, while this preserved the organ of vision in more than half the patients (62%). Five-year survival was 92 and 82% in unilateral retinoblastoma surgically treated and untreated, 83 and 84%, respectively. Adequate multimodality treatment brought about low incidence rates of recurrence and metastasis (10%) in conservative therapy and 7.7% among all patients.
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A method of dosimetric planning of multifield local irradiation of prostatic cancer using a file of optimized dose fields was proposed (the fields were computed for concrete patients). Basic charts were used to choose a necessary dose field, then the time of irradiation is computed in present directions for each concrete patient. The method was tested during the treatment of 19 patients who were given a course of radiotherapy in an outpatient setting. A continuous course of radiotherapy at a dose of 70-74 Gy was delivered. Radiation reactions of the rectum were insignificant, and they were eliminated without discontinuation of a course of irradiation.
The report presents the results of cranial irradiation of 44 small cell lung cancer patients with clinically-identified intracranial metastases and 40 patients for metastatic spread prevention. Whole brain irradiation was carried out with single doses of 2-4 Gy (total dose--30-40 Gy) in both groups 5 times weekly. Patients irradiated for metastasis prevention revealed a 3.3-fold decrease in intracranial metastasis frequency and a good post-treatment tolerance. In the other group, radiation failed to reach tumor lesions in 20%; treatment produced a poor effect in 30%. There was a correlation between survival time, initial expansion of process and tumor response to primary treatment. No relationship was observed between survival time and procedure and duration of cranial irradiation. Prophylactic irradiation may be beneficial in responders to therapy. However, randomized research into the effectiveness of preventive irradiation and possible radiation injury to cranial and brain tissues is required, particularly, in patients responding to primary treatment by complete regression of localized tumor.
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Altogether 31 patients aged 36-66 were given gamma-beam therapy for metastases of small cell pulmonary carcinoma to the brain. Before irradiation 12 patients received chemotherapy alone, 17 chemotherapy and irradiation of a primary focus and 2 surgery followed by chemotherapy. Simultaneously with a primary tumor brain metastases were found in 6 out of 7 patients. Brain involvement in 24 patients occurred 2.5-26.4 mos. after initiation of treatment. The presence of brain metastases was confirmed by the clinical symptoms, the electroencephalography and computerized tomography data. Brain irradiation in most of the patients was done in the presence of dehydration therapy. Twenty-four patients received a complete preplanned therapeutic course, in the other 7 patients treatment had to be interrupted because of the aggravation of symptoms. A complete regression of different brain symptoms was observed in 60-100% of the cases, the improvement of the focal symptoms and the state of the higher nervous activity was observed in a somewhat less percentage of the cases. Six out of 24 patients lived for 1 year and longer after irradiation of brain metastases. The results of this study have shown that brain metastases of small cell pulmonary carcinoma respond to radiotherapy. The dose of 30-40 Gy is sufficient to do away with severe neurological symptoms in most of the patients.
A study on the advantages offered by a "prophylactic" cranial irradiation in cases of localized small cell cancer of the lung has been conducted at the Center since April of 1981. The report deals with preliminary results on tolerance and immediate reactions of the brain obtained on the basis of 25 cases. A good tolerance of doses ranging 25-30 Gy was recorded. Acute reactions followed gamma therapy in 32% which, however, did not prevent the completion of the full course of prophylactic irradiation. Neurologic symptoms developed after cranial irradiation in 3 cases; this was interpreted as a possible post-radiation encephalopathy. Metastasis was found in one case. The results suggest that the study be continued.
Nephroblastoma or Wilms' tumor occurs most frequently in children. New approaches to diagnosis and treatment of this malignancy introduced for the last 15 years are reviewed. Current approaches are characterized by advances in computer noninvasive diagnostic techniques and more aggressive chemotherapy. The first line treatment is polychemotherapy (1 or 2 courses) followed by surgical intervention and postoperative drug or drug+radiation treatment. As shown by follow-up, 40% of patients with nephroblastoma stage III and IV are now free of recurrences and metastases for at least five years. Special investigations are needed to elucidate these children's quality of life, physical, social and mental fitness. Serious problems still remain in perfection of programmed treatment of children with prognostically unfavourable factors.