e21179 Background: Monoimmunotherapy for NSCLC is performed in all patients with a high level of PD-L1 expression ( > 50%) or patients with severe comorbidity and contraindications to therapy with platinum drugs with intermediate level of PD-L1 expression (1-49%).Therapy is carried out up to 2 years, disease progression or intolerable toxicity. An important issue is determining the optimal duration of treatment in order to find a balance between effectiveness, toxicity, cost and burden on the healthcare system. To date, there are no prospective studies with sufficient power devoted to this issue. Methods: The analysis included patients with histologically verified inoperable NSCLC who received the first line of therapy in 2018-2020. 25/230 patients received monoimmunotherapy in the first line (16 men, 9 women; mean age 65.4 years; PD-L1 level > / = 50% - 18 patients (72%), 1-49% - 3/25 ( 12%), 0% - 1/25 (4%), not assessed - 3/25 (12%), adenocarcinoma - 13 (52%), squamous cell - 12 (48%); All patients received pembrolizumab therapy 200 mg 1 once every 21 days. Results: The mean follow-up time was 5.3 months (95% CI 3.4–7.2). The average number of immunotherapy injections (min-max) is 6.4 (1–28). The objective response rate (ORR) in 1 line was 16/23 (64%) (complete regression - 2 patients (8%), partial regression - 3 (12%), stabilization - 11 (44%), progression - 3 (12 %), not assessed - 6 (24%), 2 (8%) patients died after the 1st injection of immunotherapy. Before the progression of the disease or until the end of the planned duration, 16 (64%) of 25 patients interrupted therapy: (10/16 (62%) due to the tightening of the requirements of the epidemiological situation, 6/16 (38%) refused to visit medical institutions. Average follow-up after the end of treatment 7.0 (1.3 - 12.2) months (min-max). 11/16 (68%) are observed without progression 9.3 months (4.0 - 12.1) (min-max PD in 4/16 (25%) after a mean follow-up time of 4.4 months (2.9 - 7.9) (min-max), 1 (6%) patient was lost to follow-up. Conclusions: The obtained data indirectly indicate the absence of a tendency towards a decrease in mPFS and mOS in the group of NSCLC patients who received MIT in the first line of treatment, for whom treatment was discontinued unscheduled, and not continued until 2 years or until the progression of the tumor process was recorded.
Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова Минздрава России (Санкт-Петербург, Россия) 2 Военно-медицинская академия имени С.М. Кирова
characteristics of various surgical tactics for the invasion of highly differentiated thyroid cancer into recurrent guttural nerves, larynx and trachea, esophagus have been performed. The advantage of intraoperative neuromonitoring was shown when deciding whether to retain the recurrent laryngeal nerve in the presence of invasion. The systems of staging of laryngotracheal invasion depending on the degree of its spread and surgical tactics used for each degree of laryngotracheal invasion are considered. Kew words: locally invasive thyroid cancer, surgery, invasion For citation: Radzhabova Z.A.-G., Kotov M. A., Artemiev S. S., Radzhabova M. A. Surgical management of locally advanced thyroid cancer (narrative review). Opukholi golovy i shei = Head and Neck Tumors 2018;8(2):62-7.Введение У большинства пациентов с раком щитовидной железы (РЩЖ) выявляют высокодифференцирован-ную опухоль, что коррелирует с хорошими показателя-ми выживаемости. Однако в 6-13 % случаев опухоль распространяется за пределы щитовидной железы, что повышает частоту местных рецидивов, метастази-рования в регионарные лимфатические узлы и отда-ленные органы и сопровождается снижением выжива-емости пациентов [1,2]. Наиболее часто РЩЖ прорастает в короткие мышцы шеи (53 %), возвратный гортанный нерв (47 %), трахею (37 %), пищевод (21 %), гортань (12 %), в 30 % случаев -в другие ткани [3]. Несмотря на то что инвазивный рост в экстратире-оидные структуры характерен для первичной опухоли, он также может наблюдаться и у метастазов [4].Хирургическое лечение инвазивного и местно-рас-пространенного РЩЖ в настоящее время остается единственным способом борьбы с заболеванием, и спорным считается лишь вопрос об объеме резекции.
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