Symptomatology of oncological diseases consists not only of local symptoms caused by the primary malignancy or its metastases, but also by general systemic signs that are not directly connected with the tumor. These symptoms are mostly associated with autoimmunity or endocrine influences. In many cases, the source of paraneoplastic syndromes (PNS) is unknown. Nearly 15% of oncological patients demonstrate these syndromes but it is diagnosed much more rarely. The survey of the numerous PNS is offered. The significance of the PNS differs for oncologists and other physicians who encounter it in their practice. The reason of those differences, as well as the connection between PNS and cancer toxicity is discussed. The experience of antitoxic therapy (hemosorption, lymphosorption, enterosorption) used in our clinic in the previous years is overviewed.

Background: The pattern of postoperative recurrence among patients with stage III/N2 EGFR-mutant non-small cell lung cancer (NSCLC) is seldom reported. Moreover, the clinical value and optimal candidate of postoperative radiotherapy (PORT) for stage III/N2 NSCLC is still controversial. Method: Consecutive patients who underwent curative resection and were pathologically confirmed EGFR-positive stage III/N2 NSCLC at Fudan University Shanghai Cancer Center from January 2007 to December 2017, were retrospectively enrolled. Serial imaging scans of each patient were intensively examined and the initial recurrence sites were categorized into five groups: thoracic recurrence, brain recurrence, neck recurrence, abdominal recurrence, and bone recurrence. Recurrence-free survival (RFS) were estimated by Kaplan-Meier curves. The Cox proportional hazards model was applied to estimate the association between RFS and clinic-pathological parameters (including age, sex, tumor size, TNM stage, tumor differentiation, tumor histology, lymphovascular invasion, visceral pleural invasion, and EGFR mutation subtypes), as well as a panel of routinely used immunohistochemical markers (including Her2, Ki67, TTF-1, CK20, CK7, CK5/6, p53, RRM1, NapsinA, p40, syn, Bcl-2, CDX2, ERCC1 and p63). Result: Ninety-one patients were identified, all of whom received adjuvant chemotherapy and 28 of whom received PORT. After a median follow up of 28 (range, 6-103) months, disease recurrence occurred in 62 patients. Thirty-six (58.1%) patients had thoracic recurrence, 15 (24.2%) had bone recurrence, 14 (22.6%) had brain recurrence, 9 (14.5%) had neck recurrence, and 8 (12.9%) had abdominal recurrence. Nineteen patients had multiple sites of initial recurrence. In terms of thoracic recurrence, initial relapse at the resection margin occurred in 1 patients and relapse in the mediastinal or ipsilateral hilar lymph nodes was observed in 11 patients. Ki6745% and positive expression of ERCC1 were identified as independent predictors of postoperative recurrence in multivariate analysis. Of note, PORT was not significantly associated with RFS in the whole population (p¼0.877). However, among the 62 patients who had at least one of the independent predictors of postoperative recurrence (ie: Ki6745%, expression of ERCC1), PORT (n¼22) significantly prolonged RFS (p¼0.043). Conclusion: The majority of patients with stage III/N2 EGFR-mutant NSCLC developed their initial recurrence in the thorax. Patients with Ki6745% and/or positive expression of ERCC1 have a significant higher risk of postoperative recurrence, who may be the potential candidate for PORT.

Contemporary development of scientific thought is fostered not by separate people but is a purposeful activity of a group of likeminded people armed with progressive ideas and modern technical equipment. Such schools appeared and work actively in the majo rity of research and educational establishments, clinics, and universities. The Lviv school established in 1945 by Professor H.P. Kovtunovych and developed by Professor A.I. Hnatyshak and his disciples can serve as an example of a successful school of oncology that continues its activity and yields scientific results. This school appeared not out of the thin air. Medieval Lviv could boast of the first university on the territory of the present-day Ukraine. Many discoveries and endeavors that made a beneficial impact on the development of medicine in Eastern Europe were made in this city. For historical reasons, the city of Lviv used to belong to different state formations (Austria-Hungary, Poland, the USSR; now it is a part of Ukraine), which could not but reflect on the staffing of doctor-researchers. This process acquired a special intensity in 1939–1945 when the research staff of the university changed substantially. Then, in 1945, H.P. Kovtunovych, the disciple of the prominent oncologist N.N. Petrov, came to Lviv and brought the ideas of St.-Petersburg oncology to the Lviv ground. The Lviv school was influenced by the two times Nobel Prize winner Marie Skłodowska Curie, who facilitated the initiation of oncological radiology in Lviv. The article contains data on research done by the disciples of Professors H.P. Kovtunovych and A.I. Hnatyshak. The first ever teaching chair of oncology in the USSR was founded in Lviv (1966), as well as the first Ukrainian hospice — an institution for palliative care for the oncological patients. The Lviv oncology center is one of the biggest and best-equipped oncology centers in Ukraine. An organic combination of theory and clinical practice has always been the guiding principle of the Lviv school of oncology. Presently, the Lviv school of oncology unites six doctors of sciences, a large collective of educators and researchers, as well as practitioners of the center of oncology. The school maintains close scientific and practical ties with oncologists of Ukraine as well as with leading oncological centers of Europe and America.

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