V.A.Tarasov, O.I.Kiselev, V.M.Senin, et al.

SURGICAL TREATMENT OF THORACIC AND ABDOMINAL MALIGNANT NEOPLASMS IN STAGES III - IV, FOLLOWED BY IMMUNOTHERAPY / Thoracic Surgery and Particular Questions of Oncology: Materials of Scientific-Practical Conference. - St.Petersburg, 1996. - P. 35 - 36.

130 patients with various thoracic and abdominal malignant neoplasms in stage III - IV underwent surgery in the thoracoabdominal unit of St.Petersburg city hospital No 26. 39 patients had lung cancer, 8 - pancreatic, 6 - oesophageal, 17 - gastric, 18 - colorectal, 5 - renal, 5 - hepatic, 15 - breast cancer, 17 - other malignancies. All of them were previously investigated in other clinics, diagnosed as Stage III or IV, and recommended symptomatic therapy only. All the patients were informed of their disease and insisted on attempt of surgery.

Radical operations were performed in 66 patients (51%), palliative - in 38 (29%), diagnostic - in 26 (20%). Radical operations included complete removal of an organ or tissue invaded by the tumour, as well as nearby and remote metastases. In case of invasion of great vessels, they were resected and reconstructed by autovenous or allograft. In hepatic metastases located in 1 hepatic lobe we performed anatomical hepatic resection; metastases in both lobes were affected by atypical resections. Lung metastases were removed atypically, - simultaneously from both lungs through vertical sternotomy, or in 2 stages through thoracotomies. Palliative operations included usually bypass anastomoses, and always - cytoreduction by partial resection or electric coagulation of neoplastic tissue. In all cases, samples of primary tumour and metastases were obtained for morphological investigation, cytomorphometry etc., and for preparation of autologous vaccines.

47 patients underwent radical operations, 28 - palliative ones, and 25 - diagnostic (sample-obtaining) operations.

10 - 20 days postoperatively, cellular immunity was checked in all patients, and immunomodulative therapy was started, including enforcement of presentation of neoplastic antigens by means of autologous vaccines enforced by SENDAI and NEWCASTLE viral antigens. Simultaneously, cytotoxicity of natural killers was stimulated by "Lymphokinin" drug (containing Interleukin-2). After finishing this adoptive immunotherapy patients were investigated every 3 months, including CT and Lymphocytes cytotoxic activity tests. If the last appeared to decrease, one more cycle of "Lymphokinin" was prescribed.

18 months after surgery, those who were alive were investigated, with the following results:

1. 1. 39 patients of 47 operated radically were alive; 2 of them (1 having been operated for lung adenocarcinoma, 1 - for spindle-cell sarcoma) appeared to develop new metastases. 3 patients died of relapse of the tumour, 3 patients - of other (non-oncological) conditions.
2. 2. 4 patients of 28 were alive after palliative operations: 2 of them had no clinical signs of tumour; 1 patient's condition improved; 1 patient's condition worsened.
3. 3. 2 patients of 25 were alive after diagnostic operations, both having CT-signs of tumour and metastases, but without progress from the moment of the operation; both consider themselves to get rid of the disease.

Thus, of 130 patients with malignancies of thorax and abdomen, considered to be inoperable by usual criteria, we managed to provide surgical aid in 80% cases. 18 months after surgery with adoptive immunotherapy, in 30% cases recidive and metastatic processes were prevented. Long-term results are obviously better if radical operation is performed. In some cases, it is possible to obtain stable remission and significant improvement of life quality even after cytoreductive, palliative and diagnostic operations, by means of autologous vaccination combined with therapy by "Lymphokinin".

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