Sukhina O. Role and place of radiotherapy in complex treatment of ovarian cancer 9118

Українська версія

Thesis for the degree of Doctor of Science (DSc)

State registration number

0502U000090

Thesis Registration Form

0502U000090.pdf

Applicant for

Specialization

  • 14.01.23 - Променева діагностика та променева терапія

20-02-2002

Specialized Academic Board

Д 26.560.01

National Cancer Institute

Essay

Dissertation is devoted to development of new methodical approaches to realization of radiotherapy for ovarian cancer. The given research is based on the analysis of the results of treatment of 383 patients with ovarian cancer of I - IV stage (243 patients have received antitumor therapy: surgery and chemotherapy, 118 - additional therapeutic irradiation, among them 2 patients have received only chemoradiotherapy and 22 patients - only chemotherapy). Inclusion of radiotherapy as adjvant course in complex treatment of the patients with ovarian cancer undergone radical surgery has increased the relapse-free survival even at presence of such adverse factors as ascites and commissure process in the patients with Т2N0M0 - Т3N0M0 stages of the disease. Median relapse-free survival in patients with Т2N0M0 stage for 9.0 months has exceeded the given parameter in the control at the average duration 50.3 and 39.4 months in the groups of comparison, respectively, and at Т3N0M0 - for 14.0 months, at the average duration 52.8 months and 37.2 respectively. Five year relapse-free survival at Т1N0M0 was 90.0(9.8 %; at Т2N0M0 - 76.2(4.4 %; at Т3N0M0 - 83.3(7.2%; and in the control group - 82.4(4.6 %; 47.1(2.9 %; 46.2(3.4 %. Frequency of relapses of ovarian cancer with adjuvant radiotherapy in postoperative period has a twice decrease at Т2N0M0 and three-fold decrease at Т3N0M0. At primary non-cured patients with ovarian cancer the addition of the combined treatment with radiotherapy has extended the terms of remission. Median was: at the patients with locally disseminated form (Т2N0M0) in the basic group - 18.0 at the average duration of stabilization of the process 34.1 months, and at dissemination of the process for small pelvis (Т3N0-1M0) - 18.0 and 25.9 months, respectively. In control group - at Т2N0M0 stage - 8.0 and 16.8 months, at Т3N0-1M0 - 6.0 and 11.6 months. The application of therapeutic irradiation in these patients is expedient at the stage III of the antitumour treatment. It has increased the median periodof the remission for about 24.0 months at the average duration of 30.4 months, that is 2.5 and 1.7 times higher than radiotherapy treatment at stage I. Use of therapeutic irradiation for patients with residual tumour has a twice lowered frequency of cases with prolonged disease in the area of small pelvis at locally disseminated forms and 1.2 times - at dissemination of the process on abdominal cavity. Five year survival of the patients with primary non-cured ovarian cancer Т2N0M0 undergone therapeutic irradiation was 38.5(6.9 % and 15.4(3.9 % in the control; at Т3N0-1M0 - 22.5(2.1 % and 15.4(1.9 %. At the dissemination of the process for abdominal cavity the distinction were marked only for first two years of the follow up: 70.0(7.2 % and 40.0(5.3 % in the basic group, and 45.5(3.4 % and 18.2(2.0 % - in the control. The duration of remission between the first and second relapses of ovarian cancer depends on radicality of the operative intervention. At the patients undergone radical surgery the clinicalform and size of the recurrent tumour influences on the given parameter . Median period of the remission at solitary relapse in small pelvic was 18.0 months at the average duration 25.5 months and was reduced with the increase of the size of the a relapse - 10.0 months at average duration of the stabilized process - 9.8 months. At the application of the radiotherapy almost in 42.8 % cases the irreversible changes of ultrastructure of cancer cells are observed in comparison with 22.2 % in case of treatment only with chemoagents. The application of radiosensitization of tumour with low dozes of ionizing irradiation at treatment of recurrent ovarian cancer the period of remission has increased irrespectively with radicality of the program of first line antitumour therapy up to 21.8 and 21.0 months according to an extensive affection of the organs of small pelvis and dissemination of the tumour process on abdominal cavity. The addition of adjuvant antitumour therapy with radiomethod results in stabilization of immune reactivity of the patients with ovarian cancer up to the level close to the referred to the limits of regional physiological norm. At primary non-cured patients the degree of immunological insufficiency does not depend on the mode of the therapy. The high level of Т-suppressors on the background of depressed digestive function of neutrophils and increase of the contents of circulating immune complexes at monitoring of the patients at the stage of remission might related to the adverse predicting factors. The inclusion of radiotherapy in the scheme of the radical antitumour treatment of ovarian cancer results in activization of lipid exchange that is testified by the development of hyperlipidemic reactions. The parameters of clinical efficiency in all cases positively correlated with increase of the level of general cholesterol and low density lipoprotein. Lipograms of the patients in long remission demonstrated 1.5-2 times increase of the investigated parameters in comparison with the relapses of the disease.

Read more

Files

aref.doc

image001.tif

image002.tif

image003.tif

image004.tif

image005.tif

image006.tif

image007.tif

image008.tif

image009.tif

image010.tif

image011.tif

image012.tif

image013.tif

image014.tif

image015.tif

image016.tif

image017.tif

image018.tif

image019.tif

image020.tif

image021.tif

image022.tif

image023.tif

image024.tif

image025.tif

image026.tif

image027.tif

image028.tif

image029.tif

image030.tif

image031.tif

image032.tif

image033.tif

image034.tif

image035.tif

image036.tif

image037.tif

image038.tif

image039.tif

image040.tif

image041.tif

image042.tif

image043.tif

image044.tif

image045.tif

image046.tif

image047.tif

image048.tif

image049.tif

image050.tif

image051.tif

image052.tif

image053.tif

image054.tif

image055.tif

image056.tif

image057.tif

image058.tif

image059.tif

image060.tif

image061.tif

image062.tif

image063.tif

image064.tif

image065.tif

image066.tif

image067.tif

image068.tif

image069.tif

image070.tif

image071.tif

image072.tif

image073.tif

image074.tif

image075.tif

image076.tif

image077.tif

image078.tif

image079.tif

image080.tif

image081.tif

image082.tif

image083.tif

image084.tif

image085.tif

image086.tif

image087.tif

image088.tif

image089.tif

image090.tif

image091.tif

image092.tif

image093.tif

image094.tif

image095.tif

image096.tif

image097.tif

image098.tif

image099.tif

image100.tif

image101.tif

image102.tif

image103.tif

image104.tif

image105.tif

image106.tif

image107.tif

image108.tif

image109.tif

image110.tif

image111.tif

image112.tif

image113.tif

image114.tif

image115.tif

image116.tif

image117.tif

image118.tif

image119.tif

image120.tif

image121.tif

image122.tif

image123.tif

image124.tif

image125.tif

image126.tif

image127.tif

image128.tif

image129.tif

image130.tif

image131.tif

image132.tif

image133.tif

image134.tif

image135.tif

image136.tif

image137.tif

image138.tif

image139.tif

image140.tif

image141.tif

image142.tif

image143.tif

image144.tif

image145.tif

image146.tif

image147.tif

image148.tif

image149.tif

image150.tif

image151.tif

image152.tif

image153.tif

image154.tif

image155.tif

image156.tif

image157.tif

image158.tif

image159.tif

image160.tif

image161.tif

image162.tif

image163.tif

image164.tif

image165.tif

image166.tif

image167.tif

image168.tif

image169.tif

image170.tif

image171.tif

image172.tif

image173.tif

image174.tif

image175.tif

image176.tif

image177.tif

image178.tif

image179.tif

image180.tif

image181.tif

image182.tif

image183.tif

image184.tif

image185.tif

image186.tif

image187.tif

image188.tif

image189.tif

image190.tif

image191.tif

image192.tif

image193.tif

image194.tif

image195.tif

image196.tif

image197.tif

image198.tif

image199.tif

image200.tif

image201.tif

image202.tif

image203.tif

image204.tif

image205.tif

image206.tif

image207.tif

image208.tif

image209.tif

image210.tif

image211.tif

image212.tif

image213.tif

image214.tif

image215.tif

image216.tif

image217.tif

image218.tif

image219.tif

image220.tif

image221.tif

image222.tif

image223.tif

image224.tif

image225.tif

image226.tif

image227.tif

image228.tif

image229.tif

image230.tif

image231.tif

image232.tif

image233.tif

image234.tif

image235.tif

image236.tif

image237.tif

image238.tif

image239.tif

image240.tif

image241.tif

image242.tif

image243.tif

image244.tif

image245.tif

image246.tif

image247.tif

image248.tif

image249.tif

image250.tif

image251.tif

image252.tif

image253.tif

image254.tif

image255.tif

image256.tif

image257.tif

image258.tif

image259.tif

image260.tif

image261.tif

image262.tif

image263.tif

image264.tif

image265.tif

image266.tif

image267.tif

image268.tif

image269.tif

image270.tif

image271.tif

image272.tif

image273.tif

image274.tif

image275.tif

image276.tif

image277.tif

image278.tif

image279.tif

image280.tif

image281.tif

image282.tif

image283.tif

image284.tif

image285.tif

image286.tif

image287.tif

image288.tif

image289.tif

image290.tif

image291.tif

image292.tif

image293.tif

image294.tif

image295.tif

Similar theses

0421U102124

Danylenko Viktoriia V.

Radionuclide therapy with samarium oxabifor 153Sm metastatic bone lesions in malignant tumors of different localization

0421U102125

Ibrahimova Konul Nizami qizi

Ultrasound diagnosis of degenerative changes in the cervical spine in older children

0521U101329

Grebinichenko Ganna O.

Prenatal ultrasound diagnosis of congenital diaphragmatic hernia and anterior abdominal wall defects

0421U101763

Krizhanovskaya Iryna

The role of triplex echography in primary diagnosis, staging and prevalence of gastric cancer

0421U101284

Storozhchuk Yuliia A.

Cone-beam computed tomography, teleradiography, orthopantomography in the diagnosis and planning of orthodontic treatment of anomalies in the ratio of dental arches and the position of teeth