tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2017-1-52-60tumors-328Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL REPORTSМорфологическое обоснование применения интраоперационной лучевой терапии для профилактики локорегионального рецидива у больных с протоковой аденокарциномой поджелудочной железыMorphological background of intraoperative radiation therapy appliance to prevent locoregional progression in patients with pancreatic ductal adenocarcinomaСЕТДИКОВАГ. Р.SETDIKOVAG. R.

к. м.н., врач патологоанатомического отделения

MD, PhD, pathologist

КАРПОВА. А.KARPOVA. A.

врач-хирург отделения хирургии печени и поджелудочной железы

surgeon, HPB department

ПАКЛИНАО. В.PAKLINAO. V.

д. м.н., заведующая патологоанатомическим отделением

MD, PhD, DSc, professor, head of the Department of Pathology

КНЫШИНСКИЙГ. В.KNISHINSKYG. V.

врач патологоанатомического отделения

pathologist

ТАВОБИЛОВМ. М.TAVOBILOVM. M.

к. м.н., заведующий отделением хирургии печени и поджелудочной железы

MD, PhD, head of the department RMAPS

ШАБУНИНА. В.SHABUNINA. V.

д. м.н., профессор, главный врач

MD, PhD, DSc, chief professor of surgery department RMAPS

ГКБ им. С. П. БоткинаРоссияBotkin Municipal hospitalRussian Federation201705072017015260Copyright © СЕТДИКОВА Г.Р., КАРПОВ А.А., ПАКЛИНА О.В., КНЫШИНСКИЙ Г.В., ТАВОБИЛОВ М.М., ШАБУНИН А.В., 20172017СЕТДИКОВА Г.Р., КАРПОВ А.А., ПАКЛИНА О.В., КНЫШИНСКИЙ Г.В., ТАВОБИЛОВ М.М., ШАБУНИН А.В.SETDIKOVA G.R., KARPOV A.A., PAKLINA O.V., KNISHINSKY G.V., TAVOBILOV M.M., SHABUNIN A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/328Введение

Введение. Протоковая аденокарцинома поджелудочной железы ассоциируется с очень плохим прогнозом, ранней локорегиональной инвазией и быстрым развитием отдаленных метастазов. Одной из причин этого является высокая частота периневральной инвазии. Цель. В данном исследовании показана необходимость комбинированного подхода к лечению больных с протоковой аденокарциномой поджелудочной железы в видеприменения радикального хирургического вмешательства, дополненного ИОЛТ.Результаты. В 14,5% (22/152) можно утверждать об ограничении опухоли в пределах ПЖ, что соответствует рТ 1–2, pN0, extraPn 0, R0. Показатель R1 обнаружен в 32,1% случаев (49/152). Экстрапанкреатическая периневральная инвазия выявлена в 36,8% случаев (56/152). Метастазы в региональных лимфатических узлах  бнаружили в 62,5% (95/152) случаев ПАК ПЖ. При исследовании аутопсийного материалаосновные морфологические параметры динамики опухоли включают локорегионарную прогрессию и/или дистантную прогрессию. Локорегионарный рецидив обнаружен в 85% случаев (29/34), проявляющийся наличием экстарпанкреатической периневральной инвазии в ложе удаленной опухоли. Среднее время от оперативного лечения до локорегионарного рецидива без extraPn – 14 месяцев, с наличием extraPn – 9 месяцев.

Выводы

Выводы. Локорегионарный рецидив у больных непосредственно cвязан с наличием именно экстрапериневральной инвазии. Выявленная субпопуляция больных без дистантной прогрессии, а только с наличием локорегионарного распространения, диктует необходимость применения комбинированного подхода с обязательным использованием ИОЛТ для достижения максимального эффекта от проведенного хирургического лечения и увеличения продолжительности жизни больных с протоковым раком поджелудочной железы.

Background

Background. It is well recognized that pancreatic ductal adenocarcinoma (PDAC) is associated with very poor prognosis, early locoregional invasion and distant metastases. One reason for this is the proliferation of tumor growth through perineural spaces.Aim. To evaluate the efficacy of intraoperative radiation therapy (IORT) for the extrapancreatic perineural invasion (EPPI) in the development of locoregional recurrence in patients with PDAC. Results. In 14.5% (22/152) the tumor was pT1–2, pN0, extraPn 0, R0. R1 detected in 32.1% (49/152). ExtraPn was detected in 36.8% of cases (56/152). Metastases in regional lymph nodes was found in 62.5% (95/152) of cases. In the study of autopsybasic morphological parameters speakers include locoregional tumor progression and / or a distant progression. Locoregional recurrence was found in 85% of cases (29/34), which is manifested by the presence of perineural invasion. The mean time from surgery until locoregional recurrence without extraPn –14 months, with the presence of extraPn – 9 months.

Conclusion

Conclusion. Thus, the absence of regional lymph nodes and/or with positive surgical margin does not preclude the development of locoregional recurrence in patients with PDAC. This is what necessitates a combined approach to the treatment of these patients, including surgery, supplemented by conducting IORT that effectively influences on tissues and reduces the number of local recurrence.

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The authors declare that there are no conflicts of interest present.