Keyword: Chemotherapy

ABSTRACT: Background: Adjuvant chemotherapy is the standard of care after radical resection of stage III colon cancer. Key process quality indicators include the use of standard regimens, timely treatment initiation, treatment completion, and documentation of reasons for deviations. In Kazakhstan, data on these indicators and regional patient pathways remain limited.
Objective: To assess process quality indicators of adjuvant chemotherapy after radical surgery, taking into account subsequent treatment provided at the patients’ place of residence.
Materials and Methods: This single-center retrospective cohort study included 45 patients aged ≥18 years with morphologically confirmed stage III colon cancer who underwent radical resection at the National Scientific Oncology Center between January 9, 2021, and December 5, 2023. Patients with distant metastases at surgery, prior neoadjuvant chemotherapy, or rectal cancer were excluded. Subsequent treatment was mainly provided at the patients’ place of residence, and data were retrieved from medical records. We assessed treatment administration, reasons for non-initiation, use of standard regimens, time to treatment initiation, proportion of planned cycles completed, and reasons for non-completion. Descriptive statistics were performed using IBM SPSS Statistics. Interregional comparisons were not performed due to small and uneven subgroup sizes.
Results: Adjuvant chemotherapy was administered to 36/45 patients (80.0%). Among nine untreated patients, one had medical contraindications, one refused treatment, and the reason was undocumented in seven. Standard regimens were used in 34/36 patients (94.4%). Among 34 patients with available timing data, median time to treatment initiation was 5.4 weeks (range, 1.0–11.7), and 31 (91.2%) started within 8 weeks. Among 34 patients with data on planned cycles, the median proportion of completed cycles was 70.8% (range, 25.0–100.0%); 15 (44.1%) completed the full course and 17 (50.0%) received ≥75% of planned cycles. Among 19 patients who did not complete treatment, reasons included progression in seven, toxicity in three, and coronavirus infection, drug unavailability, and death due to stroke in one case each; the reason was undocumented in six. Patients represented 12 regions, with subgroup sizes of 1–18 patients.
Conclusions: Most patients received standard adjuvant chemotherapy and initiated treatment within the recommended timeframe; however, fewer than half completed the full planned course. Reasons for non-completion were heterogeneous and should not be interpreted as a single marker of inadequate quality of care. Incomplete documentation and interregional patient pathways limited the assessment. Expansion of the registry and standardized data exchange are required for further analysis.

ABSTRACT: Introduction: Hyperthermic intrapleural chemotherapy combined with cytoreductive surgery is used for malignant pleural neoplasms and tumors with pleural dissemination. Anesthetic management is complicated by prolonged one-lung ventilation, surgical trauma, blood loss, fluid loading, hyperthermia, and the potential nephrotoxicity of cisplatin.
Objective: To evaluate the characteristics of anesthetic management and major perioperative complications associated with cytoreductive thoracic surgeries with hyperthermic intrapleural chemotherapy.
Materials and Methods: A retrospective analysis was conducted on 15 patients who underwent the aforementioned procedures between 2024 and 2025. General anesthesia included intubation with a double-lumen endobronchial tube and one-lung ventilation with a tidal volume of 4–6 mL/kg of ideal body weight and positive end-expiratory pressure of 5–8 cm H₂O. Non-invasive blood pressure, temperature, urine output, acid-base status, and venous blood lactate were monitored; central venous access was used. Perfusion was performed in a closed circuit at 42 °C for up to 60 minutes with cisplatin at 125 mg/m². Descriptive statistics were used.
Results: Patient age ranged from 35 to 68 years, with a mean age of 56.6 years. The median duration of anesthesia was 8 hours and 13 minutes, blood loss – 500 mL, fluid therapy – 5500 mL, and urine output – 900 mL. Respiratory and pleural complications were recorded in 9 (60.0%) patients, acute kidney injury – in 2 (13.3%); one patient required 10 sessions of hemodialysis. One case each (6.7%) of thrombotic complications and atrial fibrillation was observed. The median length of stay in the intensive care unit was 2 days. All patients were discharged from the hospital; two late deaths were recorded during follow-up.
Conclusions: Cytoreductive thoracic surgeries with hyperthermic intrapleural chemotherapy are associated with significant perioperative burden and a risk of respiratory, pleural, and renal complications. Our experience highlights the need for protective one-lung ventilation, adequate fluid and hemodynamic support, monitoring of acid-base status, temperature, and urine output, as well as early detection of renal dysfunction.
Funding: This study was financially supported by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan, Grant No. BR24992950 "Creation and implementation of innovative methods for the treatment of oncological diseases."

ABSTRACT: Introduction: Given the difficulties in assessing response of the primary tumor and metastatic lesions in gastric cancer patients using standard RECIST 1.1 criteria, there is a need to search for new biomarkers to evaluate treatment efficacy, especially at early stages after therapy initiation. Perfusion computed tomography is a functional imaging technique that provides qualitative and quantitative information about tumor microcirculation and can serve as a tool for predicting or assessing treatment response, helping to optimize and individualize subsequent patient management.
Objective: To evaluate the role of perfusion CT (PCT) in monitoring response to neoadjuvant chemotherapy in patients with locally advanced gastric cancer.
Materials and Methods: The results of PCT in 28 patients aged 36 to 76 years with histologically confirmed gastric cancer who received combined treatment at the A.F. Tsyb Medical Radiological Research Center between June 2023 and June 2026 were analyzed. Baseline CT, supplemented by perfusion imaging, was performed before treatment initiation to assess tumor extent and obtain baseline perfusion parameters. Follow-up PCT was performed before surgery to evaluate treatment efficacy and changes in perfusion parameters.
Patients were divided into 2 groups: 12 of 28 patients with regression grade 1a/b according to the scale established by K. Becker (2003) were considered "responders" to neoadjuvant chemotherapy, and 16 of 28 patients with regression grade 2/3 were considered "non-responders." Quantitative PCT analysis was based on interpretation of perfusion parameter values automatically calculated from the region of interest (ROI) placed within the tumor. The following PCT parameters were analyzed: blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface area (PS).
Results: The obtained perfusion data were subjected to both qualitative and quantitative analysis. Qualitative analysis included interpretation of parametric perfusion maps automatically generated by the software for each perfusion parameter. For each group, the significance of changes in each parameter was assessed using the paired Wilcoxon test. In patients who responded to treatment, a statistically significant decrease in BF, BV, and PS perfusion parameters was observed (p < 0.05). In patients who did not respond to treatment, none of the parameters changed significantly (p > 0.1 for all). Differences in BF and BV dynamics between groups were highly significant (p < 0.01), with significantly greater changes in responders. For PS, the difference was also significant (p = 0.04), although less pronounced. When assessing the prognostic value of baseline PCT parameters, none of the parameters reached statistical significance (p > 0.05); only PS showed a weak trend toward lower values in the responder group.
Conclusion: CT perfusion parameters reflect tissue vascularization and can serve as objective quantitative biomarkers of tumor response to neoadjuvant treatment. Baseline low PS values are associated with a likelihood of clinical response to preoperative chemotherapy in gastric cancer. Further studies with larger sample sizes are needed to clarify the prognostic role of PCT.