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Выбор метода лечения у больных с осложненным течением гастроинтестинальной стромальной опухоли. Клиническое наблюдение и обзор литературы
Выбор метода лечения у больных с осложненным течением гастроинтестинальной стромальной опухоли. Клиническое наблюдение и обзор литературы
Неред С.Н., Стилиди И.С., Шаленков В.А. и др. Выбор метода лечения у больных с осложненным течением гастроинтестинальной стромальной опухоли. Клиническое наблюдение и обзор литературы. Современная Онкология. 2017; 19 (1): 64–68.
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Аннотация
Гастроинтестинальная стромальная опухоль (ГИСО) может осложняться желудочно-кишечным кровотечением, кишечной непроходимостью, перфорацией желудка или кишки в зоне опухолевого поражения, разрывом капсулы опухоли с внутрибрюшным кровотечением, формированием полости некроза в опухоли, сообщающейся с просветом полого органа. Общепринятая практика в таких случаях – хирургическое вмешательство с последующей иматиниб-терапией. В статье приведен обзор данных литературы, касающихся частоты и клинических особенностей осложнений при различной локализации опухоли. Представлено клиническое наблюдение, в котором на первом этапе лечения проведена терапия иматинибом у больной с «полостной» формой ГИСО желудка, осложненной желудочным кровотечением. Неоадъювантная терапия позволила существенно уменьшить размеры опухоли, улучшить состояние больной и выполнить хирургическое вмешательство.
Ключевые слова: гастроинтестинальная стромальная опухоль, осложнения, иматиниб, хирургическое лечение.
Key words: gastrointestinal stromal tumor, complications, imatinib, surgical treatment.
Ключевые слова: гастроинтестинальная стромальная опухоль, осложнения, иматиниб, хирургическое лечение.
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Key words: gastrointestinal stromal tumor, complications, imatinib, surgical treatment.
Полный текст
Список литературы
1. Eisenberg BL, Harris J, Blanke CD et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor (GIST). J Surg Oncol 2009; 99: 42–7.
2. Hohenberger P, Langer C, Wendtner CM et al. Neoadjuvant treatment of locally advanced GIST: Results of APOLLON, a prospective, open label phase II study in KIT- or PDGFRA-positive tumors. J Clin Oncol 2012; 30: 10031.
3. Rutkowski P, Gronchi A, Hohenberger P et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol 2013; 20 (9): 2937–43.
4. Sorour MA, Kassem MI, Ghazal AA et al. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surgery 2014; 12: 269–80.
5. Mokhtare M, Taghvaei T, Tirgar Fakheri H. Acute Bleeding In Duodenal Gastrointestinal Stromal Tumor. Middle East J Dig Dis 2013; 5: 47–51.
6. Vilallonga R, Sanchez JL, Armengol M. Gastrointestinal Stromal Tumor: Cause of Gastrointestinal Bleeding. Gastroenterology Research 2010; 3 (2): 93–5.
7. Lee GW, Kim YS, Kim SG et al. Spontaneous Rupture of a Gastric Stromal Tumor Causing Hemoperitoneum. Gut and Liver 2010; 4 (2): 278–82.
8. Mohamed A, Griffiths E, Witkowski M et al. Traumatic rupture of a gastrointestinal stromal tumour with intraperitoneal bleeding and haematoma formation. BMJ Case Reports 2010; DOI: 10.1136/bcr.12.2009.2541
9. Tateno Y, Suzuki R. Spontaneous Hemoperitoneum Because of a Ruptured GIST without Abdominal Pain. Clin Surg 2016; 1: 1004.
10. Agrawal VP, Wasnik N, Yede J, Gupta A. Perforation of gastric gastrointestinal stromal tumor: A rare phenomenon & review of literature. Int J Biomedical Adv Res 2014; 5 (10): 485–7.
11. Paramythiotis D, Panidis S, Papadopoulos V et al. Perforated Gastrointestinal Stromal Tumor of the Small Intestine: A Case Report Presenting With Peritonitis. J Curr Surg 2011; 1 (1): 44–6.
12. Skipworth JRA, Fanshawe AEE, West MJ, Al-Bahrani A. Perforation as a rare presentation of gastric gastrointestinal stromal tumours: a case report and review of the literature. Ann R Coll Surg Engl 2014; 96: 96–100.
13. Osada T, Nagahara A, Kodani T et al. Gastrointestinal stromal tumor of the stomach with a giant abscess penetrating the gastric lumen. World J Gastroenterol 2007; 13: 2385–87.
14. Maeda Y, Shinohara T, Katayama T et al. Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery Case Rep. Gastroenterol 2016; 10: 399–405.
15. Honda K, Mikami T, Ohkusa T et al. Gastrointestinal autonomic nerve tumor with giant abscess. A case report and literature review. J Clin Gastroenterol 1997; 24 (4): 280–5.
16. Altaca1 G, Demiralay E, Kalayci SA et al. Giant malignant gastrointestinal stromal tumor presenting as an intraabdominal abscess. J Gastrointestin Liver Dis 2009; 18 (4): 515–6.
17. Chen HW, Lin TY. Tumor abscess formation caused by Morganella morganii complicated with bacteremia in a patient with gastrointestinal stromal tumor. Clin Res Hepatol Gastroenterol 2012; 36 (2): 29–31.
18. Lee JH, Moon JY, Kim HJ et al. A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding. Korean J Gastrointest Endosc 2007; 35: 337–41.
19. Singhal T, Doddi S, Leake T et al. Upper gastrointestinal bleeding due to gastric stromal tumour: a case report. Cases J 2010; 3 (58): 1–7.
20. Takeuchi N, Nishida Y, Nomura Y et al. A case of bleeding giant gastrointestinal stromal tumor of the stomach who achieved partial response by chemotherapy. GanTo Kagaku Ryoho 2012; 39 (2): 281–4.
21. Roy SD, Khan D, De KK, De U. Spontaneous perforation of jejunal gastrointestinal stromal tumour (gist). Case report and review of literature. W J Emergency Surg 2012; 7: 37.
22. Alessiani M, Gianola M, Rossi S et al. Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Reports 2015; 6: 58–62.
23. Yamashita D, Usami Y, Toyosawa S et al. A case of diffuse infiltrating gastrointestinal stromal tumor of sigmoid colon with perforation. Pathol Int 2014; 64 (1): 34–8.
24. Hohenberger P, Ronellenfitsch U, Oladeji O et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 2010; 97: 1854–9.
25. Steigen SE, Bjerkehagen B, Haugland HK. et al. Diagnostic and prognostic markers for gastrointestinal stromal tumors in Norway. Mod Pathol 2008; 21: 46–53.
26. Misawa S, Takeda M, Sakamoto H et al. Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. W J Surg Oncol 2014; 12: 153.
2. Hohenberger P, Langer C, Wendtner CM et al. Neoadjuvant treatment of locally advanced GIST: Results of APOLLON, a prospective, open label phase II study in KIT- or PDGFRA-positive tumors. J Clin Oncol 2012; 30: 10031.
3. Rutkowski P, Gronchi A, Hohenberger P et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol 2013; 20 (9): 2937–43.
4. Sorour MA, Kassem MI, Ghazal AA et al. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surgery 2014; 12: 269–80.
5. Mokhtare M, Taghvaei T, Tirgar Fakheri H. Acute Bleeding In Duodenal Gastrointestinal Stromal Tumor. Middle East J Dig Dis 2013; 5: 47–51.
6. Vilallonga R, Sanchez JL, Armengol M. Gastrointestinal Stromal Tumor: Cause of Gastrointestinal Bleeding. Gastroenterology Research 2010; 3 (2): 93–5.
7. Lee GW, Kim YS, Kim SG et al. Spontaneous Rupture of a Gastric Stromal Tumor Causing Hemoperitoneum. Gut and Liver 2010; 4 (2): 278–82.
8. Mohamed A, Griffiths E, Witkowski M et al. Traumatic rupture of a gastrointestinal stromal tumour with intraperitoneal bleeding and haematoma formation. BMJ Case Reports 2010; DOI: 10.1136/bcr.12.2009.2541
9. Tateno Y, Suzuki R. Spontaneous Hemoperitoneum Because of a Ruptured GIST without Abdominal Pain. Clin Surg 2016; 1: 1004.
10. Agrawal VP, Wasnik N, Yede J, Gupta A. Perforation of gastric gastrointestinal stromal tumor: A rare phenomenon & review of literature. Int J Biomedical Adv Res 2014; 5 (10): 485–7.
11. Paramythiotis D, Panidis S, Papadopoulos V et al. Perforated Gastrointestinal Stromal Tumor of the Small Intestine: A Case Report Presenting With Peritonitis. J Curr Surg 2011; 1 (1): 44–6.
12. Skipworth JRA, Fanshawe AEE, West MJ, Al-Bahrani A. Perforation as a rare presentation of gastric gastrointestinal stromal tumours: a case report and review of the literature. Ann R Coll Surg Engl 2014; 96: 96–100.
13. Osada T, Nagahara A, Kodani T et al. Gastrointestinal stromal tumor of the stomach with a giant abscess penetrating the gastric lumen. World J Gastroenterol 2007; 13: 2385–87.
14. Maeda Y, Shinohara T, Katayama T et al. Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery Case Rep. Gastroenterol 2016; 10: 399–405.
15. Honda K, Mikami T, Ohkusa T et al. Gastrointestinal autonomic nerve tumor with giant abscess. A case report and literature review. J Clin Gastroenterol 1997; 24 (4): 280–5.
16. Altaca1 G, Demiralay E, Kalayci SA et al. Giant malignant gastrointestinal stromal tumor presenting as an intraabdominal abscess. J Gastrointestin Liver Dis 2009; 18 (4): 515–6.
17. Chen HW, Lin TY. Tumor abscess formation caused by Morganella morganii complicated with bacteremia in a patient with gastrointestinal stromal tumor. Clin Res Hepatol Gastroenterol 2012; 36 (2): 29–31.
18. Lee JH, Moon JY, Kim HJ et al. A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding. Korean J Gastrointest Endosc 2007; 35: 337–41.
19. Singhal T, Doddi S, Leake T et al. Upper gastrointestinal bleeding due to gastric stromal tumour: a case report. Cases J 2010; 3 (58): 1–7.
20. Takeuchi N, Nishida Y, Nomura Y et al. A case of bleeding giant gastrointestinal stromal tumor of the stomach who achieved partial response by chemotherapy. GanTo Kagaku Ryoho 2012; 39 (2): 281–4.
21. Roy SD, Khan D, De KK, De U. Spontaneous perforation of jejunal gastrointestinal stromal tumour (gist). Case report and review of literature. W J Emergency Surg 2012; 7: 37.
22. Alessiani M, Gianola M, Rossi S et al. Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Reports 2015; 6: 58–62.
23. Yamashita D, Usami Y, Toyosawa S et al. A case of diffuse infiltrating gastrointestinal stromal tumor of sigmoid colon with perforation. Pathol Int 2014; 64 (1): 34–8.
24. Hohenberger P, Ronellenfitsch U, Oladeji O et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 2010; 97: 1854–9.
25. Steigen SE, Bjerkehagen B, Haugland HK. et al. Diagnostic and prognostic markers for gastrointestinal stromal tumors in Norway. Mod Pathol 2008; 21: 46–53.
26. Misawa S, Takeda M, Sakamoto H et al. Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. W J Surg Oncol 2014; 12: 153.
2. Hohenberger P, Langer C, Wendtner CM et al. Neoadjuvant treatment of locally advanced GIST: Results of APOLLON, a prospective, open label phase II study in KIT- or PDGFRA-positive tumors. J Clin Oncol 2012; 30: 10031.
3. Rutkowski P, Gronchi A, Hohenberger P et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol 2013; 20 (9): 2937–43.
4. Sorour MA, Kassem MI, Ghazal AA et al. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surgery 2014; 12: 269–80.
5. Mokhtare M, Taghvaei T, Tirgar Fakheri H. Acute Bleeding In Duodenal Gastrointestinal Stromal Tumor. Middle East J Dig Dis 2013; 5: 47–51.
6. Vilallonga R, Sanchez JL, Armengol M. Gastrointestinal Stromal Tumor: Cause of Gastrointestinal Bleeding. Gastroenterology Research 2010; 3 (2): 93–5.
7. Lee GW, Kim YS, Kim SG et al. Spontaneous Rupture of a Gastric Stromal Tumor Causing Hemoperitoneum. Gut and Liver 2010; 4 (2): 278–82.
8. Mohamed A, Griffiths E, Witkowski M et al. Traumatic rupture of a gastrointestinal stromal tumour with intraperitoneal bleeding and haematoma formation. BMJ Case Reports 2010; DOI: 10.1136/bcr.12.2009.2541
9. Tateno Y, Suzuki R. Spontaneous Hemoperitoneum Because of a Ruptured GIST without Abdominal Pain. Clin Surg 2016; 1: 1004.
10. Agrawal VP, Wasnik N, Yede J, Gupta A. Perforation of gastric gastrointestinal stromal tumor: A rare phenomenon & review of literature. Int J Biomedical Adv Res 2014; 5 (10): 485–7.
11. Paramythiotis D, Panidis S, Papadopoulos V et al. Perforated Gastrointestinal Stromal Tumor of the Small Intestine: A Case Report Presenting With Peritonitis. J Curr Surg 2011; 1 (1): 44–6.
12. Skipworth JRA, Fanshawe AEE, West MJ, Al-Bahrani A. Perforation as a rare presentation of gastric gastrointestinal stromal tumours: a case report and review of the literature. Ann R Coll Surg Engl 2014; 96: 96–100.
13. Osada T, Nagahara A, Kodani T et al. Gastrointestinal stromal tumor of the stomach with a giant abscess penetrating the gastric lumen. World J Gastroenterol 2007; 13: 2385–87.
14. Maeda Y, Shinohara T, Katayama T et al. Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery Case Rep. Gastroenterol 2016; 10: 399–405.
15. Honda K, Mikami T, Ohkusa T et al. Gastrointestinal autonomic nerve tumor with giant abscess. A case report and literature review. J Clin Gastroenterol 1997; 24 (4): 280–5.
16. Altaca1 G, Demiralay E, Kalayci SA et al. Giant malignant gastrointestinal stromal tumor presenting as an intraabdominal abscess. J Gastrointestin Liver Dis 2009; 18 (4): 515–6.
17. Chen HW, Lin TY. Tumor abscess formation caused by Morganella morganii complicated with bacteremia in a patient with gastrointestinal stromal tumor. Clin Res Hepatol Gastroenterol 2012; 36 (2): 29–31.
18. Lee JH, Moon JY, Kim HJ et al. A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding. Korean J Gastrointest Endosc 2007; 35: 337–41.
19. Singhal T, Doddi S, Leake T et al. Upper gastrointestinal bleeding due to gastric stromal tumour: a case report. Cases J 2010; 3 (58): 1–7.
20. Takeuchi N, Nishida Y, Nomura Y et al. A case of bleeding giant gastrointestinal stromal tumor of the stomach who achieved partial response by chemotherapy. GanTo Kagaku Ryoho 2012; 39 (2): 281–4.
21. Roy SD, Khan D, De KK, De U. Spontaneous perforation of jejunal gastrointestinal stromal tumour (gist). Case report and review of literature. W J Emergency Surg 2012; 7: 37.
22. Alessiani M, Gianola M, Rossi S et al. Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Reports 2015; 6: 58–62.
23. Yamashita D, Usami Y, Toyosawa S et al. A case of diffuse infiltrating gastrointestinal stromal tumor of sigmoid colon with perforation. Pathol Int 2014; 64 (1): 34–8.
24. Hohenberger P, Ronellenfitsch U, Oladeji O et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 2010; 97: 1854–9.
25. Steigen SE, Bjerkehagen B, Haugland HK. et al. Diagnostic and prognostic markers for gastrointestinal stromal tumors in Norway. Mod Pathol 2008; 21: 46–53.
26. Misawa S, Takeda M, Sakamoto H et al. Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. W J Surg Oncol 2014; 12: 153.
________________________________________________
2. Hohenberger P, Langer C, Wendtner CM et al. Neoadjuvant treatment of locally advanced GIST: Results of APOLLON, a prospective, open label phase II study in KIT- or PDGFRA-positive tumors. J Clin Oncol 2012; 30: 10031.
3. Rutkowski P, Gronchi A, Hohenberger P et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol 2013; 20 (9): 2937–43.
4. Sorour MA, Kassem MI, Ghazal AA et al. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surgery 2014; 12: 269–80.
5. Mokhtare M, Taghvaei T, Tirgar Fakheri H. Acute Bleeding In Duodenal Gastrointestinal Stromal Tumor. Middle East J Dig Dis 2013; 5: 47–51.
6. Vilallonga R, Sanchez JL, Armengol M. Gastrointestinal Stromal Tumor: Cause of Gastrointestinal Bleeding. Gastroenterology Research 2010; 3 (2): 93–5.
7. Lee GW, Kim YS, Kim SG et al. Spontaneous Rupture of a Gastric Stromal Tumor Causing Hemoperitoneum. Gut and Liver 2010; 4 (2): 278–82.
8. Mohamed A, Griffiths E, Witkowski M et al. Traumatic rupture of a gastrointestinal stromal tumour with intraperitoneal bleeding and haematoma formation. BMJ Case Reports 2010; DOI: 10.1136/bcr.12.2009.2541
9. Tateno Y, Suzuki R. Spontaneous Hemoperitoneum Because of a Ruptured GIST without Abdominal Pain. Clin Surg 2016; 1: 1004.
10. Agrawal VP, Wasnik N, Yede J, Gupta A. Perforation of gastric gastrointestinal stromal tumor: A rare phenomenon & review of literature. Int J Biomedical Adv Res 2014; 5 (10): 485–7.
11. Paramythiotis D, Panidis S, Papadopoulos V et al. Perforated Gastrointestinal Stromal Tumor of the Small Intestine: A Case Report Presenting With Peritonitis. J Curr Surg 2011; 1 (1): 44–6.
12. Skipworth JRA, Fanshawe AEE, West MJ, Al-Bahrani A. Perforation as a rare presentation of gastric gastrointestinal stromal tumours: a case report and review of the literature. Ann R Coll Surg Engl 2014; 96: 96–100.
13. Osada T, Nagahara A, Kodani T et al. Gastrointestinal stromal tumor of the stomach with a giant abscess penetrating the gastric lumen. World J Gastroenterol 2007; 13: 2385–87.
14. Maeda Y, Shinohara T, Katayama T et al. Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery Case Rep. Gastroenterol 2016; 10: 399–405.
15. Honda K, Mikami T, Ohkusa T et al. Gastrointestinal autonomic nerve tumor with giant abscess. A case report and literature review. J Clin Gastroenterol 1997; 24 (4): 280–5.
16. Altaca1 G, Demiralay E, Kalayci SA et al. Giant malignant gastrointestinal stromal tumor presenting as an intraabdominal abscess. J Gastrointestin Liver Dis 2009; 18 (4): 515–6.
17. Chen HW, Lin TY. Tumor abscess formation caused by Morganella morganii complicated with bacteremia in a patient with gastrointestinal stromal tumor. Clin Res Hepatol Gastroenterol 2012; 36 (2): 29–31.
18. Lee JH, Moon JY, Kim HJ et al. A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding. Korean J Gastrointest Endosc 2007; 35: 337–41.
19. Singhal T, Doddi S, Leake T et al. Upper gastrointestinal bleeding due to gastric stromal tumour: a case report. Cases J 2010; 3 (58): 1–7.
20. Takeuchi N, Nishida Y, Nomura Y et al. A case of bleeding giant gastrointestinal stromal tumor of the stomach who achieved partial response by chemotherapy. GanTo Kagaku Ryoho 2012; 39 (2): 281–4.
21. Roy SD, Khan D, De KK, De U. Spontaneous perforation of jejunal gastrointestinal stromal tumour (gist). Case report and review of literature. W J Emergency Surg 2012; 7: 37.
22. Alessiani M, Gianola M, Rossi S et al. Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Reports 2015; 6: 58–62.
23. Yamashita D, Usami Y, Toyosawa S et al. A case of diffuse infiltrating gastrointestinal stromal tumor of sigmoid colon with perforation. Pathol Int 2014; 64 (1): 34–8.
24. Hohenberger P, Ronellenfitsch U, Oladeji O et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 2010; 97: 1854–9.
25. Steigen SE, Bjerkehagen B, Haugland HK. et al. Diagnostic and prognostic markers for gastrointestinal stromal tumors in Norway. Mod Pathol 2008; 21: 46–53.
26. Misawa S, Takeda M, Sakamoto H et al. Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. W J Surg Oncol 2014; 12: 153.
Авторы
С.Н.Неред1,2, И.С.Стилиди1,2, В.А.Шаленков*1, П.П.Архири1,2, И.Б.Перфильев1, А.Е.Калинин1, Я.А.Божченко1, Е.В.Глухов1
1 ФГБУ «Российский онкологический научный центр им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 123995, Россия, Москва, ул. Баррикадная, д. 2/1
*do71@yandex.ru
1 N.N.Blokhin Russian Cancer Reseach Center of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*do71@yandex.ru
1 ФГБУ «Российский онкологический научный центр им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 123995, Россия, Москва, ул. Баррикадная, д. 2/1
*do71@yandex.ru
________________________________________________
1 N.N.Blokhin Russian Cancer Reseach Center of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*do71@yandex.ru
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