Yevchev F. D. The Improvement of the Diagnostics and Treatment for Patients with Recurrent Tumors and Regional Metastases of Malignant Tumor of the Larynx. – Manuscript. Doctoral thesis of Medicine in Subject 14.01.19 – Otolaryngology I. Kolomiychenko Institute of Otholaryngology of Academy of Medical Science of Ukraine, Kyiv, 2007.

Doctoral thesis deals with the questions of improvement, elaboration and introduction of the methods of diagnostics, treatment and introduction of the non-relapse period for patients with recurrent tumors and regional metastasis of malignant tumor of the larynx.

In the Doctoral thesis such problems as the status of the antioxidant system of the organism of the patients; the microenvironment of the tumourous lesion; the content of the copper in the tissues of the tumor; the mechanisms of the medicinal neutralization of aggressive oxidizing radicals; the function of the intoxication agents in the development of the complications and the relapsing of malignant tumor of the larynx were investigated. In the present thesis the information about correction of the homeostasis disbalance for patients with malignant and relapsing tumor of the larynx was demonstrated.

814 patients with the malignant tumor and 300 with the relapse of the tumor of the larynx were examined. The 1st (main) group contains 280 patients; 2nd group (of comparison) – 260; and the 3rd (control) group – 274 patients. The 2nd and 3rd groups were random-measured in comparison with the main group of patients as to homeostasis disbalance; as to the postoperational and radiation complications; as to the supervision during the non-relapsing period. The patients of the main group were received the maintenance therapy in the medical algorithm.

The activity of blood ferments such as: Arginase, Ornitin-decarboxilase, the content of Ceruloplasmin was investigated for 300 patients. There were 180 patients with the tumor of the larynx (Т1-2N0М0 – 60 patients, Т3N0М0 – 60, Т4N1-2М0 – 60) and 180 patients with relapse of the tumor of the larynx.

The laser correlation spectroscopy was made for 180 patients. The radiation investigation: the X-CT and magnetic resonance tomography (MRT) of the larynx was made for 50 patients; the CT with CT-endoscopy of the larynx was made for 80 patients. Endoscopic investigation: larynx-fiberscopy was made for 300 patients; autofluorescent endoscopy of the larynx with photosensitizer (PS) (Fluorescine, 5-amyno-levulin-acid, Ceruloplasmin) was made for 80 patients; ultrasonic-investigation of the neck and the larynx was made for 1100 patients.

The clinical course for the patients with T3, T4 and with the relapse of tumor is characterized by the toxic syndrome that is followed by permanent accumulation of aggressive oxidizing radicals and by development of conditions that favor complications and relapses.

It is investigated that the patients with T3, T4 and with the relapse of tumor have the considerable descent of the activity of the serum arginaze and ornithine-decarboxylase because of growth of the content of Ceruloplasmin in the saliva and blood serum. The derangement of the activity of these characteristics correlates each other. It was proved by the data of laser-correlated spectroscopy of the blood serum of these patients.

The role of the antioxidants was elaborated and estimated: Ceruloplasmin, Erbisolum, Protephlasidum and Acetyl-cysteine in the medical algorithms for patients with the malignant tumor and with the relapse of the tumor of the larynx with marked toxic syndrome. The results were compared with the data of homeostasis of patients with the medical algorithm without the maintenance therapy (MT) (In a comparison group and in a control group).

Examination of the application activity of the group of polyfunctioning agents for patients with the toxic syndrome in the main group in 6 months, in 1—2 years, showed trustworthy approaching (descent, improvement) of these characteristics of patients to the characteristics of the healthy people.

It was established that the main group of patients has the normalization of the biochemical characteristics with trustworthy ascent of the non-relapse period till 5 or more years.

It was established, that in the relapsing tumor of the larynx, after combined treatment (resection of the larynx, radiotherapy) the operation of choice was the extirpation of the larynx with the maintenance therapy (MT). The combined laryngoectomy with the maintenance therapy (MT) was the operation of choice in the cause of localization of the relapsing tumor in posterior parts of the larynx.

The exclusion of the unnecessary reconstructive operations in the relapsing tumors of the larynx is the main advantage of the proposed concept of the non-relapsed treatment that corresponds to the principles of the clinical oncology.

Key words: malignant tumor of the larynx, relapse of malignant tumor of the larynx, toxic syndrome, laser correlation spectroscopy, combined diagnostics, combined treatment, relapse prophylaxis, the maintenance therapy (MT).