БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
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ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
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ULMASOV Firdavs Gayratovich
JURAEV Mirjalol Dekhkonovich
ESANKULOVA Bustonoy Sobirovna
Samarkand State Medical Institute, Uzbekistan
COMPLEX TREATMENT OF MALIGNANT NON-ORGAN RETROPERITONEAL
SARCOMAS AND THEIR RELAPSES
For citation:
Firdavs Ulmasov, Mirjalol Dzhuraev, Bustonoy Esankulova. COMPLEX
TREATMENT OF MALIGNANT NON-ORGAN RETROPERITONEAL SARCOMAS AND
THEIR RELAPSES. Journal of Biomedicine and Practice. 2021, vol. 6, issue 4, pp. 202-206
http://dx.doi.org/10.26739/2181-9300-2021-4-30
ANNOTATION
The article discusses the analysis of the results of 84 patients with non-organ sarcomas of the
retroperitoneal space, who underwent complex treatment. Tumors of a malignant nature were
histologically verified by trepan biopsy in all patients (100%). The patients were divided into 2
groups - main n = 38 and control n = 46. Neoadjuvant chemotherapy was performed in 45.2% of
preoperative patients who belong to the study group. All patients underwent radical surgical
intervention after 3 courses of PCT. After the operation, they received a course of radiation therapy
(TFD-1.8-2Gy). Preoperative chemotherapy resulted in partial tumor regression in 22 (57.9%)
patients. Stabilization was observed in 9 (23.7%) patients and progression of the process was noted
in 7 (18.4%) patients. Without a relapse period in the main group was 10.2 + 0.4 months, without a
metastatic period 11.4 + 0.5 months.
Key words:
non-organ retroperitoneal sarcomas, non-adjuvant chemotherapy, complex treatments,
radiation therapy, no recurrence.
УЛМАСОВ Фирдавс Гайратович
ДЖУРАЕВ Миржалал Дехканович
ЭСАНКУЛОВА Бустоной Собировна
Самаркандский Государственный медицинский институт, Узбекистан
КОМПЛЕКСНОЕ ЛЕЧЕНИЕ ЗЛОКАЧЕСТВЕННЫХ НЕОРГАННЫХ
ЗАБРЮШИННЫХ САРКОМ И ИХ РЕЦИДИВЫ
АННОТАЦИЯ
В статье обсуждаются анализ результаты 76 больных с неорганными саркомами
забрюшинного пространства, которым произведены комплексные лечения. Опухоли
злокачественной природы были гистологически верифицированы путем трепанбиопции у
всех пациентов (100%). В зависимости от метода лечения больные были распределены на 2
группы- основная=38 и контрольная=46. Неадьювантная химиотерапия произведены 45.2%
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
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больным дооперации которые принадлежат в основной группе. Всем больным после 3 курсов
ПХТ произведено радикальное хирургическое вмешательство. Послеоперации они получали
курс лучевой терапии (РОД-1,8-2Гр). Проведение химиотерапии в дооперационном этапе
привели к частичной регрессии опухоли у 22 (53%) больных. У 9 (23.7%) больных
стабилизация и у 7 (18.4%) отмечалось прогрессирование процесса. Безрецидивный период
в основной группе составил 10,2+0,4мес, безметастатический период 11,4+0,5 мес.
Ключевые слова:
неорганные забрюшинные саркомы, неадьювантная химиотерапия,
комплексные лечения, лучевая терапия, без рецидива.
ULMASOV Firdavs G’ayratovich
JO’RAYEV Mirjalol Dehqonovich
ESANKULOVA Bustonoy Sobirovna
Samarqand Davlat Tibbiyot Instituti, Samarqand, O’zbekiston
NOORGAN RETROPERITONEAL SARKOMALARI VA RESIDIVLARINI KOMPLEKS
DAVOLASH
ANNOTATSIYA
Maqolada retroperitoneal bo'shliqning noorgan sarkomalariga chalingan, kompleks davolanishni
boshdan kechirgan 84 bemorning yaqin va uzoq muddat oralig’idagi natijalari tahlil qilinadi. Yomon
sifatli o'smalar barcha bemorlarda trepan biopsiyasi bilan gistologik tekshirilgan (100Davolash
uslubiga qarab, bemorlar 2 guruhga bo'lingan – asosiy- n = 38 va kontrol- n = 46. Asosiy guruhga
kiruvchi bemorlarda (45.2%) operatsiyadan oldin noadyuvant kimyoviy terapiya o'tkazildi. Barcha
bemorlarga PXTning 3 kursidan so'ng radikal jarrohlik amaliyoti o'tkazildi. Operatsiyadan keyin
ular nur terapiyasi kursini (ROD-1.8-2Gy) olishdi. Operatsiyadan oldin o'tkazilgan kimyoviy
terapiya natijasida 22 (57.9%) bemorlarda qisman o'smaning regressiyasi kuzatildi. 9 (23.7%)
bemorda stabillashuv kuzatilgan va jarayonning rivojlanishi 7 (18.4%) bemorda qayd etilgan.
Residivsiz davr vaqti asosiy guruhda 10,2 + 0,4 oy, metastazsiz davri 11,4 + 0,5 oyga o’zgargan.
Kalit so'zlar:
noorgan retroperitoneal sarkomalar, neoadyuvant kimyoviy terapiya, kompleks
davolash, nur terapiyasi, residivsiz.
Relevance:
The diagnosis and treatment of non-organ retroperitoneal tumors (NRT) is one
of the most important and difficult areas of clinical oncology. NRT make up from 0.03 to 1% of all
human neoplasms, however, they are distinguished by an extraordinary variety of morphological
variants. Existing publications in our country and in the world are based, as a rule, on few
observations or present a description of individual clinical cases. Most foreign researchers consider
NRT in a single complex with soft tissue neoplasms, proceeding only from histogenesis, not taking
into account their localization, however, it is the latter that largely determines the specificity of
diagnostic and therapeutic tactics. The fact that NRTs most often occur between the ages of 40 and
60 gives this problem a particular socioeconomic significance. The anatomical features of the
retroperitoneal space determine the absence of specific clinical symptoms, requiring extraordinary
diagnostic and therapeutic tactics
3
. The main feature of their clinical course is the tendency to
recurrence and the achievement of large sizes, the connection with the surrounding organs and
tissues, including the great vessels, causing significant difficulties and requiring the performance of
combined operations
2
.
Among soft tissue sarcomas, the share of retroperitoneal sarcomas is 10-20%. According to
some data, NRTs constitute 0.03 - 1.0% of all neoplasms of a person
7
. According to various authors,
60 - 80% of tumors of the retroperitoneal space are malignant, and 14 - 40% are benign
1
. Malignant
retroperitoneal tumors are characterized by a high percentage recurrence after surgical treatment (13
- 82%). However, the metastatic potential of NRT is relatively low (19 - 32%)
5
.
Purpose of the study:
To improve the effectiveness of treatment of retroperitoneal sarcomas by
developing an integrated approach using neoadjuvant endoarterial chemotherapy, surgical
intervention followed by radiation therapy.
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Materials and methods:
The research includes an analysis of the results of treatment of 84 patients
in the period from 2017 to 2021 in the Samarkand branch of the Republican Specialized Scientific
and Practical Medical Center of Oncology and Radiology. Histological verification was obtained in
100% of patients by trephine biopsy at the stage of examination. In the group, liposarcoma was
verified in 29 (34.5%) patients, leiomyosarcoma - in 25 (29.8%), fibrosarcoma - in 12 (14.3%),
pleomorphic sarcoma - in 10 (11.9%), angiosarcoma - in 8 (9.5%) patients. With the distribution by
sex, men - 44 (52.4%), women - 40 (47.6%), the average age of patients is 63 + 10.5 years. The
diameter of the formations ranged from 22 to 40 cm in the largest dimension.
The patients were divided into 2 groups depending on the method of treatment.
Group 1
-main-38 (45.2%), who underwent neoadjuvant PCT + radical surgery + RT (SOD-60Gy).
Group 2-
control-46 (54.8%), which underwent radical surgery + adjuvant PCT.
In 38 patients at the preoperative stage, an endoarterial catheter was installed as close as possible
to the vessels feeding the tumor. She received 3 courses of neoadjuvant chemotherapy with an
interval of 21 days according to the CAP scheme. The drugs were administered endoarterially
slowly over 48 hours under strict bed rest at the indicated time. Complications associated with
chemotherapy were not observed. All patients underwent radical surgery after 3 courses of PCT. In
the postoperative period, patients received a course of radiation therapy on the bed of the removed
tumor, split course in the classical dose fractionation mode. Single focal dose was 1.8-2 Gy, Total
focal dose-60 Gy.
To assess the effectiveness of an integrated approach to the treatment of retroperitoneal
sarcomas, the following criteria were selected:
- The effect of chemotherapy on the size of the tumor, the volume and traumatism of the surgical
intervention, and on the prolongation of the relapse-free and metastatic period.
- The effectiveness of postoperative radiation therapy for the duration of the relapse-free period.
Results:
Preoperative chemotherapy resulted in partial tumor regression in 22 (57.9%) patients.
Stabilization was observed in 9 (23.7%) patients and progression of the process was noted in 7
(18.4%) patients. In connection with the regression of the tumor and a decrease in infiltration into
neighboring organs, more favorable conditions arose for carrying out surgery.
The effectiveness of postoperative radiation therapy was assessed in combination with the
treatment methods performed according to the average life expectancy, relapse-free and metastatic
period.
35%
30%
14%
12%
9%
Histological verication
Liposarcoma
Leiomyosarcoma
Fibrosarcoma
Pleomorphic sarcoma
Angiosarcoma
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The relapse-free period in the main group was 10.2 +0.4 months, and in the control group it
was 7.3 +0.3 months (P <0.05), the metastatic-free period was 11.4 +0.5 months and 9.1 +0,
respectively, 4 months (P <0.05).
The study of the average life expectancy of patients, which is the main determining factor,
showed an increase in life expectancy in the main group to 18.2 +0.4 months, and in the control
group 12.4 +0.3 months. (P <0.05).
Discussion:
Retroperitoneal non-organ sarcomas are a heterogeneous group of diseases. One of the
features of NRTs is their slow expansive growth with minimal clinical manifestations. The absence
of pain syndrome allows tumors to reach large sizes (more than 20-30 cm in diameter). Depending
on the type and rate of growth, histological structure, such tumors can either grow into neighboring
organs, or, conversely, shift them to the side, which makes it possible in some cases to perform
organ-preserving operations. According to various authors, liposarcomas are more likely to develop
painless syndrome, they are more difficult to diagnose by ultrasound. Leiomyosarcomas can arise
from small or large veins (inferior vena cava), have a high potential for malignancy and a tendency
to hematogenous metastasis.
The main radical method of treatment of retroperitoneal non-organ tumors, regardless of the
histological structure and localization, is surgical treatment. The surgical method for treating this
pathology was the gold standard. According to many authors, the use of only surgical treatment
cannot provide a long relapse-free and metastatic period. A more effective method of treatment is
the combined use of surgery, chemotherapy and radiation therapy. Combined use of neoadjuvant
endoarterial chemotherapy resulted in partial regression of the tumor process in the studied group
of patients. In connection with tumor regression and a decrease in infiltration into neighboring
organs, more favorable conditions arose for performing surgery. When studying these groups of
patients, an increase in life expectancy, relapse-free and metastatic periods was found.
Thus, neoadjuvant therapies (chemotherapy, external beam radiation, or combination radiation and
chemotherapy) are safe for carefully selected patients and may be considered after careful
consideration by the multidisciplinary sarcoma tumor board when the risk of recurrence is high8.
The preferred method is selected based on the nature of the recurrence, chemotherapy is used in
histological studies with the highest systemic risk (for example, leiomyosarcoma and high-grade
dedifferentiated liposarcoma), and radiation therapy in patients with the highest local-regional risk
(for example, well-differentiated liposarcoma and dedifferentiated low / medium).
Conclusion:
An integrated approach to the treatment of retroperitoneal sarcoma
significantly increases the average life expectancy of patients, as well as the duration of the relapse-
free andmetastatic period. The use of adjuvant long-term endoarterial chemotherapy up to 57.9% of
cases causes a partial effect, and thus creates favorable conditions for surgical intervention.
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