No 1-2 (2013)

Objective: to develop and introduce an accelerated partial breast irradiation procedure in patients with early-stage breast cancer after organ-saving operations using three-dimensional conformal teleradiotherapy (3D CRT) and to assess the preliminary results of treat- ment.
Subjects and methods: the trial enrolled 48 patients with verified T1-2N0-1micM0 stage breast cancer who received organ-saving treatment in the N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, in 2008–2012. The median age of the patients was 63 years. All the patients underwent organ-saving operations with subsequent 3D CRT applied to the resected tumor bed with margins. Radiotherapy with a dose of 2.5 Gy was performed twice daily; the daily dose was 5 Gy; the course dose was 40 Gy. Indications for accelerated partial irradiation of the tumor bed were listed; the data of randomized trials were given.
Results. The median follow-up was 27 months; locoregional recurrences or distant metastases were found in no patients. Late radia- tion skin and soft tissue injuries were seen in no cases. All the patients were ascertained to have early-stage grade I radiation cutane- ous injuries according to the RTOG-EORTC classification. Excellent, good, fair, and poor cosmetic results were obtained in 12 (25 %), 34 (71 %), 2 (4 %), and 0 patients, respectively.
Conclusion. The developed accelerated partial breast irradiation procedure in patients with early-stage breast cancer after organ- saving operations at the median follow-up of 27 months showed good results, such as no local recurrences or distant metastases. Excel- lent and good cosmetic results were noted in 96 % of the patients.

The characteristics of the treatment tactics of the non-nodular forms of gynecomastia as mammary gland’s cancer prevention is given in the ar- ticle on the basis of the own observations and the example of the work of domestic and foreign authors. Variants of the mono- and combined drug therapy are analyzed. Treatment results are given. An attempt was made to determine the priority of the treatment variants being used.

Central nervous system (CNS) involvement by endometrial carcinoma is uncommon. Among 1710 patients registered for brain metastases at our institution between 1990 and 2012, 3 (0.18 %) developed brain metastases. All lesions (1 multiple, 2 single) were contrast enhancing on com- puted tomography scans, and were located in the cerebrum (lobus occipitalis) in 2 cases. The CNS was the only site of detectable disease in 1 patient with recurrent disease. One patient received radiotherapy (survival, 3 months) and two underwent surgical resection of solitary metas- tasis followed by radiotherapy (survival = 3 and 5 months and alive to the present). Prognosis of patients with CNS metastases from endometrial carcinoma appears poor; however, in a selected group of patients early diagnosis followed by multimodal treatment may result in a palliation of the disease.

The article covers the problems of optimization of multidisciplinary hospital’s work in modern conditions. The example of the district clinic pres- ents activities for the organization of inpatient and outpatient specialized medical assistance which allow to improve its quality and effectiveness.