No 3 (2011)

There is now extensive proof that high percentage of mammographic density (MD) is an independent risk factor for breast cance.r Taking this into account, the research data are summarized with regard to relation of MD to anthropometric, as well as hormonal, genetic and genotoxic factors. There is a negative correlation between MD and such risk factors as age, number of deliveries, BMI and waist-hip ratio. Most inves- tigations show a direct connection between MD and prolactin level or insulin-like growth factor in blood, mostly in premenopaus al women. Relations of MD with blood estrogens, testosterone, sex hormone binding globulin prove to be too diverse to be taken in account of. It is pos- sible that the action of hormones, especially estrogens, is mediated through their metabolites catecholestrogens and / or reactive oxygen spe- cies. There is certain evidence that a genetic component plays a role in MD. It refers to COMT Val158Met, IGF-I rs6220 A> G and UGT1A1 in premenopausal women, and to ESR1 (XbaI и PvuII) in menopausal cases.
Although it is obvious that the risk of breast cancer related to MD is brought about by many factors, there is a necessity for studying addi- tional criteria modifying the process, as well as for searching means for preventing it.

Objective: to improve the results of neoadjuvant chemotherapy (CT) in patients with locally advanced (L A) inoperable breast cancer (BC) at baseline, by using the intensified combination CT at the interval being reduced between the administration of cytostatic dru gs to 2 weeks to give a chance to the patients to be surgically treated.
Subjects and methods. The study enrolled 26 patients aged 33 to 75 years with L A BC. Paclitaxel was administered intravenously (IV) over 3 hours at a dose of 175 mg/m2 on day 1, followed by gemcitabine, 2000 mg/m2, given by 30-minute IV infusion on day 1 every 2 w eeks. If the cytostatics were well tolerated and their effect increased, the treatment was continued up to 6 courses.
Results. Eighteen (69.2%) out of the 26 patients achieved the objective effect of treatment; of them 17 (65.4%) had a partial remission and 1 (3.8) had a complete remission.
The therapeutic pathomorphism of a tumor w as rated in 22 patients; fourth-degree tumor pathomorphism w as found in 2 (9%) patien ts. The follow-up of patients w as 11 to 28 months (median, 20 months). The median time to progression w as not reached in the entire group of patients.
Conclusion. A combination of paclitaxel and gemcitabine in intensive dose-dense scheduling has a marked antitumor activity in BC and
is characterized by its good tolerability without a pronounced myelosuppressive effect. This therapy regimen may be used as neoadjuvant CT.

The author analyzes an algorithm for identifying and treating w omen with cervical intraepithelial neoplasias (CIN) and microinv asive cancer of the cervix uteri in cases of the hidden area of transformation and in the absence of visible cervical changes. There are excep- tional difficulties of making the diagnosis of epithelial damages due to the incomplete reproducibility of cytological abnormal ities and the low informative value of a histological study of scrapes from the cervical canal. To avoid hypodiagnosis, it is justifiable to prefer human papillomavirus testing (Hybrid Capture 2 (HC2)) to repeat smears for the choice of a management tactic. Conization is recommend ed as a diagnostic and/or therapeutic procedure when the viral load is high in over 35-year-old patients with abnormal smears anda hidden transformation area.

Metastatic involvement of the central nervous system (CNS) is very rarely observed in gynecological cancer . Ten case histories were analyzed in patients with malignancies of the cervix uteri, endometrium, and ovaries concurrent with metastatic involvement of the brain and spine. The CNS involvement was metachronous in all the patients. The mean interval between the detection of a primary tumor and the emergence of metastases was 3.1, 4.5, and 2.3 years for cervix uteri, corpus uteri, and ovarian cancers, respectively. All patients with gynecological cancer are indicated to undergo a follow-up including neurological examination and X-ray or magnetic resonance imaging of the brain and spine. When meat static CNS involvement is detected, multimodality treatment involving surgery followed by chemoradiation therapy is recommended.

The results of observation of 22 patients with refractory ovarian cancer were analyzed. The usefulness of chemotherapy the second and  subsequent lines of treatment is shown. Sequential treatment by not cross-resistant chemotherapy allows increase median survival up  to 12.5 months in general group. In 36 % of patients with good performance status prolonged stabilization of disease with median overall survival of 22.3 months was achieved.

Examine changes in the parameters reflecting the activation of humoral immune system, the severity of the destructive processesand autoimmune reactions in patients with endometrial cancer . The findings suggest that the significance of activation of autoimmune reac tions and destructive processes in pathogenetic mechanisms of development of malignant tumors of the corpus uteri.