Актуальность. Злокачественные опухоли яичников занимают 8 место в структуре заболеваемости и 6 место по смертности среди онкологических заболеваний у женщин. Выживаемость больных раком яичников зависит от объема хирургического вмешательства и величины остаточной опухоли. В настоящее время при лечении злокачественных опухолей яичников принята «агрессивная» хирургическая тактика, направленная на удаление всех макроскопически определяемых опухолевых очагов с последующей региональной химиотерапией. Однако результаты лечения остаются неудовлетворительными, что диктует необходимость поиска новых, альтернативных методов лечения. Одним из таких методов является внедрение в клиническую практику внутрибрюшной гипертермической химиотерапии. Цель исследования. Оценить эффективность гипертермической химиоперфузии в комплексном лечении больных распространенными формами рака яичников после интервальных оптимальных хирургических вмешательств. Материалы и методы. За период с января 2014 по февраль 2019 гг. проведено ретроспективное одноцентровое нерандомизированное исследование на базе ГБУЗ «Челябинский областной клинический центр онкологии и ядерной медицины». Материалом для исследования послужили результаты лечения и наблюдения 61 пациентки с местнораспространённым раком яичников IIIА-С стадии. Распространенность опухолевого процесса оценивалась согласно классификации FIGO и TNM (2009 г.). Перед началом лечения всем пациенткам проводилось обследование, включающее ПЭТ-КТ, определение BRCA мутации. На первом этапе всем больным проведено 3 цикла неоадьювантной химиотерапии (НАПХТ) по схеме: паклитаксел 175 мг / м 2 , карбоплатин AUC 5-6 каждые 3 недели. На втором этапе была выполнена циторедуктивная операция, после чего все пациентки были разделены на 3 группы. Это был последовательный набор больных; в первую группу вошло 15 (24,6 %) пациенток, которым проведена гипертермическая химиоперфузия (HIPEC) с препаратом паклитаксел 100 мг / м 2 , во вторую-20 (32,8 %) больных с HIPEC препаратом цисплатин 100 мг / м 2 , тогда как еще 26 пациенток (42,6 %) оказались в группе контроля без проведения HIPEC. За конечную точку было взята выживаемость без прогрессирования как время от даты постановки диагноза до установления прогрессирования заболевания по данным объективных методов обследования. Результаты исследования. Проанализированы результаты лечения после химиотерапии 1 линии с интервальным хирургическим лечением. Согласно критериям RESIST 1.1, в первой группе зарегистрирован полный ответ у 16 больных (45,7 % случаев), частичный ответ у 12 (34,2 %), стабилизация заболевания у 4 (11,4 %), прогрессирование у 3 пациенток (8,5 % случаев). Во второй группе полный ответ зафиксирован у 13 больных (50 % случаев), частичный ответ-у 7 (26,9 %), стабилизация-у 3 (11,5 %) и прогрессирование также в 11,5 % случаев. Заключение. В настоящее время основным прогностическим фактором, влияющим на продолжительность жизни больных распространенными формами рака яичников, является выполнение полных циторедуктивных операций. Однако HIPEC с препаратом цисплатин,...

e17040 Background: Peritoneal carcinomatosis is a very common by ovarian cancer (OC). Usual treatment`s approaches such as systemic drugs are not very effective. 5-year survival by OC depends of stage and are 15-20% in III stage and only 5% in IV stage. Most part of this patients die with progression of peritoneal disease. Standart treatment`s approach by OC is radical surgery with adjuvant chemotherapy. But in many cases this tactic can`t control peritoneal lesions and, therefore, outcomes. Methods: In our oncology center we are performing retrospective non-randomized prospective study comparing two different treatment options by ovarian`s peritoneal carcinomatosis - photodynamic therapy (PDT) and hyperthermic intraperitoneal chemotherapy (HIPEC). There were 25 patients in PDT-group and 21 patients in HIPEC-group. Treatment in PDT-group included 2-4 cycles of neo-adjuvant chemotherapy (cyclophosphamid+cisplatinum /CP/, n=7 or paclitaxel+cisplatinum /TC/, n=18 ), after which we performed surgery+PDT and then 4-6 cycles same chemotherapy. We used iv. photolon (Russia) as photosensitizer and 630-680 nm diod laser. Time of procedure was 20 minutes. Peritoneal Carcinomatosis Index (PCI) was 4,2 an averege (1-12). Treatment in HIPEC-group included 2-4 cycles of neo-adjuvant chemotherapy (cyclophosphamid+cisplatinum /CP/, n=21), after which we performed surgery+HIPEC and then 4-6 cycles the same chemotherapy. Medium PCI was 5,6 (2-11). We used “closed” HIPEC technique, with 3 inflow and 3 outflow catheters, Performer HT device by RanD and 7 liters of saline solution with 200 mg cisplatunum or 100 mg/m2 taxans were used. Results: There were 11 recurrence in PDT-group (44%) and 10 recurrence in HIPEC-group (38%), t=1,06. Median of time to progression was 11.6 months in PDT-group and 13,5 months in HIPEC-group. Median of overall surviving was 18,4 and 24,1 months respectively. Conclusions: Using of PDT by ovarian cancer with peritoneal carcinomatosis didn`t show increasing of overall survival. We can also notice the non-statistical tendency of increasing time to progression in HIPEC-group. We run our study further and hope to collect more data for analysis.

Background. The survival rate of patients with ovarian malignancies depends on the prevalence of the tumor process, the volume of surgical treatment, and the size of the residual tumor. At the first stage, an «aggressive» surgical tactic of removing all macroscopically determined tumor foci with subsequent antitumor drug therapy is recommended. However, the results of treatment remain unsatisfactory, which dictates the need to search for new methods of treatment.Objective: to evaluate the effectiveness of implantable port systems for intraperitoneal chemotherapy administration in the treatment of patients with advanced stages of ovarian cancer.Materials and methods. 37 cases of stage IIIC ovarian cancer were studied for the period 2018–2019. At the first stage of treatment, a cytoreductive operation was performed. At the second stage, the patients were randomly randomized into three groups: group 1 (n = 9) – installation of a port system + hyperthermic intraperitoneal chemoperfusion followed by intraperitoneal chemotherapy; group 2 (n = 11) – hyperthermic intraperitoneal chemoperfusion followed by systemic intravenous chemotherapy; group 3 (n = 17) – control group, intravenous administration of antitumor drugs. The observation period is 27 months. In the study groups, the indicators of age distribution, the degree of malignancy of the neoplasm, the volume of the residual tumor, and the relapse-free survival were analyzed.Results. Trends towards differences in progression-free survival were found in all study groups. In group 1, there was no relapse in all patients. In group 2, relapses amounted to 18.2 %, in group 3–23.5 %. G3 ovarian cancer (6 (66.7 %) and 6 (54.5 %) cases, respectively) prevailed in groups 1 and 2; G1 ovarian cancer (9 (52.9 %) cases) prevailed in group 3. Discussion. Features of the chemical composition and method of administration of the drug increase the effectiveness of local exposure to tumor cells. The introduction  of cytostatic agents into the abdominal cavity leads to minimal systemic toxicity, which exceeds the results of standard intravenous therapy.Conclusion. An advantage in the relapse-free survival of patients after hyperthermic intraperitoneal chemoperfusion in combination with an implantable port system was found in comparison with standard methods of treatment.

e15501 Background: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a treatment method in patients with gastric cancer having a high risk of development of peritoneal carcinomatosis which can improve treatment results. Methods: HIPEC in a "prophylactic" setting in gastric patients having a high risk of peritoneal carcinomatosis development has been applied in our centre since 2015. This method was used in cases of diffuse type poor-differentiated tumor histology , massive tumor invasion of the stomach serosa and relatively young age of the patient. A “closed” HIPEC technique, with 3 inflow and 3 outflow catheters, RAND HT performer and 7 liters of saline solution with 200 mg cisplatinum was performed. Up to this moment we have treated 8 patients with gastric surgery added by HIPEC. There were 4 men and 4 women. Median age was 48 years. In 2 cases distal subtotal gastric resection was performed, in other 6 cases - total gastrectomy with a D2 lymph nodes dissection. In 2 cases was also performed an edge resection of the pancreas. 2 procedures were performed in cases with ovarian metastases and local diaphragm canceromatosis, with complete cytoreduction. Median surgery time was 4 hours. Results: There was no mortality in early postoperative period, with 25% morbidity. In one case a severe postoperative pancreonecrosis occured which required several re-operations. In one case there has been an acute renal failure, after 3 dialyse sessions the renal function was recovered. Median post-operative hospital stay was 20 days. Two patients are alive without progression on 14 and 23 months respectively. One patient developed a local anastomotic recurrence, no other progression was found, and anastomosis extirpation was performed. Patients having ovarian metastases and local canceromatosis progressed in 6 months, in other cases progression was found in 6 to 12 months. Conclusions: The use of HIPEC doesn't result in elevation of complications or mortality rate. It shows a trend to improve the results of treatment gastric cancer. In cases of already existing canceromatosis the effectiveness of HIPEC is doubtful.

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