Basylaishvili S. Optimization of combined treatment of locally advanced non-small cell lung cancer.

The aim of the dissertation was to improve the results of treatment of patients with IIIA stage locally advanced non-small cell lung cancer by optimizing adjuvant therapies based on biological tumor markers. The dissertation presents the results of the study of 120 patients who underwent combined treatment of various schemes. Sternal puncture were performed to patients of the 3 groups to search isolated tumor cells in bone marrow. The estimate of therapeutic pathomorphism in patients of the 2 group after neoadjuvant chemotherapy was performed. We studied the levels of CYFRA 21-1, VEGF and Ki-67 in the treatment groups. By using light and electron microscopy was studied both the native structure of NSCLC cells and cells after neoadjuvant chemotherapy. It has been established that the 1-3 degree of medical pathomorphosis was detected only in 40% of patients. The results show an improvement in disease-free and overall survival in patients of studied groups. This demonstrates the effectiveness of the applied methods of treatment of patients with IIIA stage NSCLC. In patients of the 2 group with low pathomorphosis the scheme of postoperative chemotherapy was modified and changed on the second line. This allowed increasing two- and three-year survival in this group of patients on 10%. The best results are obtained in 3 groups of patients who received additional postoperative radiation therapy. The three-year survival rate was 67.6% mainly due to the decrease in the number of regional recurrence. The prognostic value of CYFRA 21-1, VEGF and Ki-67 was determined. A treatment algorithm for patients with NSCLC stages IIIA was created.