Biomedical subjects
Publications and source records attributed to V S Datsenko.
702 patients with breast cancer were followed-up after, sparing and radical operations combined with radiation and polychemotherapy. Of adjuvant treatments, radiation therapy showed to be more effective than chemotherapy. Methods of operative treatment combined with radiation are not essential in the treatment of early stages of breast cancer.
The following conclusions were made on the basis of long-term follow-up of 3680 breast cancer patients receiving various irradiation modalities as component of combined or complex treatment. Surgery may be recommended as single or starting procedure for stage I tumors only. Otherwise, preoperative large-fraction irradiation in combination with microwave hyperthermia, if available, should be preferred for operable tumors whereas inoperable cases call for application of standard fraction radiotherapy of primary tumor and regional lymph node areas.
The authors give a brief description a ROKUS-M + Altai-MT system, its software ASPECT-1, stages of radiotherapy design and implementation of optimized programs. They gave examples of optimum computerized design of irradiation in tumors of the nasopharynx, breast, female genitals, esophagus, lungs, bladder, and rectum. The paper is illustrated with charts of isodoses and distributions corresponding to optimized programs of irradiation.
The late results of treatment of operable patients with breast carcinoma are analysed. The frequency of local recurrences and metastases in the subclavicular lymph nodes and distal organs are compared according to the method of operative intervention. It is emphasized that purposeful exposure to radiation makes it possible to achieve similar results in Patey's, Halsted's, and Urban-Holdin's operations. From the functional standpoint, however, conservative radical mastectomy surpasses radical and extended radical mastectomy considerably. All this allows Patey's operation in combination with irradiation to be recommended for wide introduction into therapeutic practice at oncological institutions of the Soviet Union.
A many-year-old study of 3680 breast cancer patients receiving different types of radiation therapy as part of combined or multimodality treatment led to the following conclusions. Surgical intervention used alone or the first stage of combined treatment was found appropriate for stage I only. The most preferable modality in all cases was preoperative irradiation provided in large fractional regimens for operable tumors and, when possible, in combination with UHF-therapy; the use of common fractions with the incorporation of a primary focus and all zones of regional metastatic spreading in the zone of radiation exposure was found appropriate for inoperable tumors.
A method to determine TDF values by standard tables with account of RBE of low-energy x-radiation and a small area of irradiation fields was proposed. Corresponding formulas confirmed by the authors' clinical data, were developed. The authors outlined ways of using these data for assessment and design of courses of brachytherapy to minimize the risk of development of skin radiation damages.
The authors have summed up the experience accumulated over 20 years at the Chair of Clinical Radiology of the Central Order of Lenin Institute of Advanced Medical Training. Doctors majoring in this field, usually become radiologists at the age over 35 when their creative initiative is on a decrease. Therefore the authors have proposed numerous measures aimed at the improvement of the system of training in radiology and an increase in the number of young specialists.
A total of 93 patients were assigned to receive either radiation treatment alone (group 1) or in combination with local microwave-induced hyperthermia (group 2) prior to mastectomy. The treatment results were compared. Within a two-year follow-up period, all patients of group 2 remained free of relapse, metastases being registered in 2 (6.2%) cases. In group 1, relapse was observed in 1 case, whereas metastasis--in 7 (11.5%). The study failed to establish drug-induced tumor pathomorphosis in 12.5% in group 2 and 73.8% in group 1. The procedure did not interfere with surgery, nor was it followed by an increased postoperative complication rate.
The 5- and 10-year results of treatment of 1,377 breast cancer patients were analysed with reference to the type of surgical procedure. On the basis of the similarity of the end results, similar rates of recurrence incidence and distant metastases and the absence of metastasis in the subclavicular area after Patey's operation coupled with radiotherapy, a high effectiveness of the latter treatment was established. It contributed to a radicality comparable to that of a radical mastectomy.
The authors described a method of two-stage UHF-hyperthermia combined with single irradiation of the breast prior to operation. At the 1st stage the temperature was 39 degrees C, duration of exposure 30 min directly before irradiation, irradiation at a dose of 13 Gy. The 2nd stage followed 2 h after irradiation, the temperature was 42 degrees C, duration 90 min. The above therapy did not deteriorate the conditions of surgical intervention, nor did it complicate a postoperative course. Local and general reactions were of transient nature. No recurrences were noted after 1 year of follow-up. A study of tumor pathomorphosis showed injuries of I degree in 30.8%, II degree in 46.2%, III degree in 5.6%, in single irradiation in 18, 8.4 and 2.8%, respectively.
An ultrastructural study of breast cancer cells from 102 female patients after combined therapy with preoperative radiation therapy was conducted. The ultrastructural method made it possible to supplement results obtained by means of the histological method of assessment of tumor radiation pathomorphosis, and in some cases it was even more informative and permitted a comparative assessment of various methods of preoperative radiation therapy using intensively concentrated and large dose fractionation followed by immediate operation.
Coefficients Kv and Ks for determination of the influence of a volume and area of irradiated tissues in the assessment of DMF factors were presented. The above coefficients were derived on the basis of calculations and a retrospective analysis of the authors' clinical data on radiation complications in the subcutaneous fatty tissue in teleradiotherapy of malignant tumors. The use of the coefficients will make it possible to predict with greater reliability the probability of radiation complications in designing radiation therapy.
Proceeding from radiobiological data, the TDF concept and a cumulative radiation effect the authors proposed a new variant of preoperative radiotherapy in operable breast cancer patients. Single doses for the breast and axillary-subclavicular zone that were 15 and 12.5 Gy, were determined. Observation over 72 patients showed that single irradiation did not influence the course of operation and the postoperative period. Good functional and short-term results of treatment make it possible to recommend single large fraction preoperative irradiation for trials in special oncological and radiological institutions.
New methods of the fractionation of preoperative gamma-beam therapy for breast carcinoma and intracavitary irradiation of cervical cancer patients with 252Cf fast neutron sources have been devised and tested on the basis of the concept of a cumulative radiation effect (CRE) and the system of TDF factors at the Chair of Clinical Radiology, Central Institute for Advanced Medical Training. In the selection of regimens of the fractionation of intracavitary irradiation of cervical cancer with 252Cf fast neutrons using the system of TDF factors one should take into account the RBE of the type of radiation that would be equal to 5 by the criterion of a direct response of a tumor within the range of dose rates between 20-30s Gy/hr. Taking account of a short period of half-life of 252Cf sources fractionation schemes should be corrected from the view-point of the system of TDF factors not less than once in 2-3 mos.
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The authors present an analysis of the causes of radiation induced complications in 383 patients referred to the Chair of Clinical Radiology from different medical institutions of the country. It was found that under distant gamma therapy, to prevent the development of complications the value of TDF-factor should not exceed 105--110, for the associated radiotherapy--130--140, and that for close focal roentgenotherapy--130--150. In vast majority of patients (95.3%) the complications resulted from surpassing the normal tissue tolerance. To prevent radiation injuries it is suggested to take into consideration the TDF-factor values, while in planning radiotherapy to choose such schedules of irradiation, which preclude any surpassing of the tolerance of normal tissues and organs adjacent to the tumor.
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