Эндоскопическое стентирование пищевода в комбинации с химиолучевой терапией
Эндоскопическое стентирование пищевода в комбинации с химиолучевой терапией
Иванов А.И., Попов В.А., Бурмистров М.В. Эндоскопическое стентирование пищевода в комбинации с химиолучевой терапией. Современная Онкология. 2021;23(4):645–648. DOI: 10.26442/18151434.2021.4.201156
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Ivanov AI, Popov VA, Burmistrov MV. Endoscopic esophageal stenting in combination with chemoradiation therapy: A review. Journal of Modern Oncology. 2021;23(4):645–648. DOI: 10.26442/18151434.2021.4.201156
Эндоскопическое стентирование пищевода в комбинации с химиолучевой терапией
Иванов А.И., Попов В.А., Бурмистров М.В. Эндоскопическое стентирование пищевода в комбинации с химиолучевой терапией. Современная Онкология. 2021;23(4):645–648. DOI: 10.26442/18151434.2021.4.201156
________________________________________________
Ivanov AI, Popov VA, Burmistrov MV. Endoscopic esophageal stenting in combination with chemoradiation therapy: A review. Journal of Modern Oncology. 2021;23(4):645–648. DOI: 10.26442/18151434.2021.4.201156
Стентирование пищевода является эффективным методом выбора разрешения злокачественной дисфагии на фоне рака пищевода. Тем не менее имплантация пищеводных стентов при злокачественной патологии – лишь способ достижения адекватного перорального питания, который не повышает сроки продолжительности жизни у инкурабельных больных. Ранние исследования, посвященные комбинации химиолучевой терапии и имплантации стентов, сообщают о достаточно высокой частоте осложнений. Поэтому подобные лечебные сочетания не внедрились в широкую практику. Тем не менее на сегодняшний день нет убедительных клинических данных о результатах комбинации методов стентирования и химиолучевой терапии, а также их влияния на частоту возможных осложнений. В последнее время современные исследования демонстрируют очень обнадеживающую перспективу. Благодаря постоянному усовершенствованию материалов и конструкций стентов сочетание этих методов может повысить продолжительность жизни у инкурабельных больных.
Esophageal stenting is undoubtedly an effective method of choice for resolving malignant dysphagia in the presence of esophageal cancer. Nevertheless, the implantation of esophageal stents for malignant pathology is only a way to achieve adequate oral nutrition, which, unfortunately, does not increase the life expectancy in incurable patients. Early studies on the combination of chemoradiation therapy and stent implantation reported a relatively high rate of complications. Therefore, such therapeutic combinations have not been introduced into widespread practice. Nevertheless, to date, there is no convincing clinical data on the results of a combination of stenting methods and chemoradiation therapy, as well as their effect on the incidence of possible complications. Recent research has shown a very encouraging prospect. The combination of these techniques can increase life expectancy in incurable patients through continuous improvements in stent materials and designs.
1. Mocanu A, Bârla R, Hoara P. Endoscopic palliation of advanced esophageal cancer. J Med Life. 2015;8(2):193-201.
2. Sundelöf M, Ye W, Dickman PW, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer. 2002;99:751-4. DOI:10.1002/ijc.10420
3. Adler DG, Merwat SN. Endoscopic approaches for palliation of luminal gastrointestinal obstruction. Gastroenterol Clin North Am. 2006;35:65-82. DOI:10.1016/j.gtc.2005.12.004
4. Katsanos K, Sabharwal T, Adam A. Stenting of the upper gastrointestinal tract: currentstatus. Cardiovasc Intervent Radiol. 2010;33:690-705.
DOI:10.1007/s00270-010-9862-6
5. Stein HJ, Siewert JR. Improved prognosis of resected esophageal cancer. World J Surg. 2004;28:520-5. DOI:10.3748/wjg.v12.i41.6608
6. Dubecz A, Watson TJ, Raymond DP, et al. Esophageal stenting for malignant and benign disease:133 Cases on a Thoracic Surgical Service. Ann Thorac Surg. 2011;92(6):2028-32. DOI:10.1016/j.athoracsur.2011.08.033
7. Madhusudhan C, Saluja SS, Pal S, et al. Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer:impact on quality of life. Dis Esophagus. 2009;22:331-6. DOI:10.1111/j.1442-2050.2008.00906.x
8. Dai Y, Li C, Xie Y, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2014:CD005048. DOI:10.1002/14651858.CD005048.pub4
9. Włodarczyk JR, Kużdżał J. Stenting in Palliation of Unresectable Esophageal Cancer. World J Surg. 2018;42(12):3988-996. DOI:10.1007/s00268-018-4722-7
10. Lai A, Lipka S, Kumar A, et al. Role of esophageal metal stents placement and combination therapy in inoperable esophageal carcinoma: a systematic review and meta-analysis. Dig Dis Sci. 2018;63(4):1025-34. DOI:10.1007/s1062 0-018-4957-z
11. Fazlı Y, Yekta A, Yener Y. Esophageal self-expandable metal stent placement for the palliation of dysphagia due to lung cancer. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27(1):88-92. DOI:10.5606/tgkdc.dergisi.2019.16755
12. Spaander MC, Baron TH, Siersema PD, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48 (10):939-48. DOI:10.1055/s-0042-114210
13. Touchefeu Y, Archambeaud I, Landi B, et al. Chemotherapy versus self-expanding metal stent as primary treatment of severe dysphagia from unresectableo esophageal or gastro-oesophageal junction cancer. Dig Liver Dis. 2014;46(3):283‑6. DOI:10.1016/j.dld.2013.10.012
14. Servagi-Vernat S, Bosset M, Crehange G, et al. Feasibility of chemoradiotherapy for oesophageal cancer in elderly patients aged > or=75 years: a prospective, single-arm phase II study. Drugs Aging. 2009;26:255-62. DOI:10.2165/00002512-200926030-00006
15. Kaneko K, Ito H, Konishi K, et al. Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus. Br J Cancer. 2003;88:18-24. DOI:10.1038/sj.bjc.6600684
16. Hanna WC, Sudarshan M, Roberge D, et al. What is the optimal management of dysphagia in metastatic esophageal cancer? Curr Oncol. 2012;19(2):e60-e66. DOI:10.3747/co.19.1153
17. Javed A, Pal S, Dash NR, et al. Palliative stenting with or without radiotherapy for inoperable esophageal carcinoma:a randomized trial. J Gastrointest Cancer. 2012;43(1):63-9. DOI:10.1007/s12029-010-9206-4
18. Bergquist H, Wenger U, Johnsson E, et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized controlled clinical trial. Dis Esophagus. 2005;18:131-9. DOI:10.1111/j.1442-2050.2005.00467.x
19. Burstow M, Kelly T, PanchaniS, et al. Outcome of palliative esophageal stenting for malignant dysphagia: a retrospective analysis. Dis Esophagus. 2009;22(6):519‑25. DOI:10.1111/j.1442-2050.2009.00948.x
20. Siddiqui AA, Sarkar A, Beltz S, et al. Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy. Gastrointest Endosc. 2012;76(1):44-51. DOI:10.1016/j.gie.2012.02.036
21. Dayyeh BKA, Vandamme JJ, Miller RC, Baron TH. Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model. Endoscopy. 2013;45(1):42-7. DOI:10.1055/s-0032-1325960
22. Bakheet N, Hu HT, Park JH, et al. Clinical effectiveness and safety of self-expanding metal stent placement following palliative chemotherapy in patients with advanced esophageal cancer. Abdom Radiol (NY). 2020;45(2):563-70. DOI:10.1007/s00261-019-02245-3
23. Medeiros VS, Martins BC, Lenz L, et al. Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease. Gastrointestinal Endoscopy. 2017;86(2):299-306. DOI:10.1016/j.gie.2016.12.017
24. Didden P, Reijm AN, Erler NS, et al. Fully vs. partially covered selfexpandable metal stent for palliation of malignant esophageal strictures:a randomized trial (the COPAC study). Endoscopy. 2018;50(10):961-71. DOI:10.1055/a-0620-8135
25. Reijm AN, Didden P, Schelling SJC, et al. Self-expandable metal stent placement for malignant esophageal strictures – changes in clinical outcomes over time. Endoscopy. 2019;51(1):18-29. DOI:10.1055/a-0644-2495
26. Lu YF, Chung CS, Liu CY, et al. Esophageal metal stents with concurrent chemoradiation therapy for locally advanced esophageal cancer: safe or not? Oncologist. 2018;23(12):1426-35. DOI:10.1634/theon colog ist.2017-0646
27. Fuccio L, Scagliarini M, Frazzoni L, Battaglia G. Development of a prediction model of adverse events after stent placement for esophageal cancer. Gastrointestinal Endoscopy. 2016;83(4):746-52. DOI:10.1016/j.gie.2015.08.047
28. Yakami M, Mitsumori M, Sai H, et al. Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer. Int J Clin Oncol. 2003;8:395-8. DOI:10.1007/s10147-003-0356-2
29. Park JY, Shin JH, Song HY, et al. Airway complications after covered stent placement for malignant esophageal stricture:special reference to radiation therapy. Am J Roentgenol. 2012;198(2):453-9. DOI:10.2214/AJR.10.5780
30. Park JH, Song HY, Shin JH, et al. Migration of retrievable expandable metallic stents inserted for malignant esophageal strictures: incidence, management, and prognostic factors in 332 patients. Am J Roentgenol. 2015;204:1109-14. DOI:10.2214/AJR.14.13172
31. Mariette C, Gronnier C, Duhamel A, et al. Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer:impact on oncologic outcomes. J Am Coll Surg. 2015;220:287-96. DOI:10.1016/j.jamcollsurg.2014.11.028
32. Yu FJ, Shih HY, Wu CY, et al. Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma:a comparison of nasogastric tube, esophageal stent, and ostomy tubefeeding. Gastrointest Endosc. 2018;88(1):21-31. DOI:10.1016/j.gie.2017.11.030
33. Prasad NR, Karthigeyan M, Vikram K, et al. Palliative radiotherapy in esophageal carcinoma. Ind J Surg. 2015;77(1):34-8. DOI:10.1007/s12262-013-0817-4
34. Uesato M, Akutsu Y, Murakami K, et al. Comparison of efficacy of self-expandable metallic stent placement in the unresectable esophageal cancer patients. Gastroenterol Res Pract. 2017;2017. DOI:10.1155/2017/2560510
35. Newburger PE, Cassady JR, Jaffe N. Esophagitis due to adriamycin and radiation therapy for childhood malignancy. Cancer. 1978;42(2):417-23.
DOI:10.1002/1097-0142(197808)42:2<417::aid-cncr2820420206>3.0.co;2-a
36. Francis SR, Orton A, Thorpe C, et al. Toxicity and outcomes in patients with and without esophageal stents in locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 2017;99(4):884-94. DOI:10.1016/j.ijrobp.2017.06.2457
37. Iwasaki Н, Mizushima Т, Suzuki Y, et al. Factors that affect stent-related complications in patients with malignant obstruction of the esophagus or gastric cardia. Gut Liver. 2017;11(1):47-54. DOI:10.5009/gnl16172
38. Seaman WB, Ackerman LV. The effect of radiation on the esophagus:a clinical and histologic study of the effects produced by the betatron. Radiology. 1957;68:534‑41. DOI:10.1148/68.4.534
39. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995;31:1213-36. DOI:10.1016/0360-3016(94)00419-L
40. Yoon CJ, Shin JH, Song HY, et al. Removal of retrievable esophageal and gastrointestinal stents: experience in 113 patients. Am J Roentgenol. 2004;183:1437-44. DOI:10.2214/ajr.183.5.1831437
41. Chen YK, Schefter TE, Newman F. Esophageal cancer patients undergoing external beam radiation after placement of self-expandable metal stents: is there a risk of radiation dose enhancement? Gastrointest Endosc. 2011;73:1109-14. DOI:10.1016/j.gie.2011.02.001
42. Li XA, Chibani O, Greenwald B, Suntharalingam M. Radiotherapy dose perturbation ofmetallic esophageal stents. Int J Radiat Oncol Biol Phys. 2002;54:1276-85. DOI:10.1016/s0360-3016(02)03803-8
43. Abu Dayyeh BK, Vandamme JJ, Miller RC, Baron TH. Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model. Endoscopy. 2013;45(1):42-7. DOI:10.1055/s-0032-1325960
________________________________________________
1. Mocanu A, Bârla R, Hoara P. Endoscopic palliation of advanced esophageal cancer. J Med Life. 2015;8(2):193-201.
2. Sundelöf M, Ye W, Dickman PW, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden. Int J Cancer. 2002;99:751-4. DOI:10.1002/ijc.10420
3. Adler DG, Merwat SN. Endoscopic approaches for palliation of luminal gastrointestinal obstruction. Gastroenterol Clin North Am. 2006;35:65-82. DOI:10.1016/j.gtc.2005.12.004
4. Katsanos K, Sabharwal T, Adam A. Stenting of the upper gastrointestinal tract: currentstatus. Cardiovasc Intervent Radiol. 2010;33:690-705.
DOI:10.1007/s00270-010-9862-6
5. Stein HJ, Siewert JR. Improved prognosis of resected esophageal cancer. World J Surg. 2004;28:520-5. DOI:10.3748/wjg.v12.i41.6608
6. Dubecz A, Watson TJ, Raymond DP, et al. Esophageal stenting for malignant and benign disease:133 Cases on a Thoracic Surgical Service. Ann Thorac Surg. 2011;92(6):2028-32. DOI:10.1016/j.athoracsur.2011.08.033
7. Madhusudhan C, Saluja SS, Pal S, et al. Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer:impact on quality of life. Dis Esophagus. 2009;22:331-6. DOI:10.1111/j.1442-2050.2008.00906.x
8. Dai Y, Li C, Xie Y, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2014:CD005048. DOI:10.1002/14651858.CD005048.pub4
9. Włodarczyk JR, Kużdżał J. Stenting in Palliation of Unresectable Esophageal Cancer. World J Surg. 2018;42(12):3988-996. DOI:10.1007/s00268-018-4722-7
10. Lai A, Lipka S, Kumar A, et al. Role of esophageal metal stents placement and combination therapy in inoperable esophageal carcinoma: a systematic review and meta-analysis. Dig Dis Sci. 2018;63(4):1025-34. DOI:10.1007/s1062 0-018-4957-z
11. Fazlı Y, Yekta A, Yener Y. Esophageal self-expandable metal stent placement for the palliation of dysphagia due to lung cancer. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27(1):88-92. DOI:10.5606/tgkdc.dergisi.2019.16755
12. Spaander MC, Baron TH, Siersema PD, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48 (10):939-48. DOI:10.1055/s-0042-114210
13. Touchefeu Y, Archambeaud I, Landi B, et al. Chemotherapy versus self-expanding metal stent as primary treatment of severe dysphagia from unresectableo esophageal or gastro-oesophageal junction cancer. Dig Liver Dis. 2014;46(3):283‑6. DOI:10.1016/j.dld.2013.10.012
14. Servagi-Vernat S, Bosset M, Crehange G, et al. Feasibility of chemoradiotherapy for oesophageal cancer in elderly patients aged > or=75 years: a prospective, single-arm phase II study. Drugs Aging. 2009;26:255-62. DOI:10.2165/00002512-200926030-00006
15. Kaneko K, Ito H, Konishi K, et al. Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus. Br J Cancer. 2003;88:18-24. DOI:10.1038/sj.bjc.6600684
16. Hanna WC, Sudarshan M, Roberge D, et al. What is the optimal management of dysphagia in metastatic esophageal cancer? Curr Oncol. 2012;19(2):e60-e66. DOI:10.3747/co.19.1153
17. Javed A, Pal S, Dash NR, et al. Palliative stenting with or without radiotherapy for inoperable esophageal carcinoma:a randomized trial. J Gastrointest Cancer. 2012;43(1):63-9. DOI:10.1007/s12029-010-9206-4
18. Bergquist H, Wenger U, Johnsson E, et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized controlled clinical trial. Dis Esophagus. 2005;18:131-9. DOI:10.1111/j.1442-2050.2005.00467.x
19. Burstow M, Kelly T, PanchaniS, et al. Outcome of palliative esophageal stenting for malignant dysphagia: a retrospective analysis. Dis Esophagus. 2009;22(6):519‑25. DOI:10.1111/j.1442-2050.2009.00948.x
20. Siddiqui AA, Sarkar A, Beltz S, et al. Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy. Gastrointest Endosc. 2012;76(1):44-51. DOI:10.1016/j.gie.2012.02.036
21. Dayyeh BKA, Vandamme JJ, Miller RC, Baron TH. Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model. Endoscopy. 2013;45(1):42-7. DOI:10.1055/s-0032-1325960
22. Bakheet N, Hu HT, Park JH, et al. Clinical effectiveness and safety of self-expanding metal stent placement following palliative chemotherapy in patients with advanced esophageal cancer. Abdom Radiol (NY). 2020;45(2):563-70. DOI:10.1007/s00261-019-02245-3
23. Medeiros VS, Martins BC, Lenz L, et al. Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease. Gastrointestinal Endoscopy. 2017;86(2):299-306. DOI:10.1016/j.gie.2016.12.017
24. Didden P, Reijm AN, Erler NS, et al. Fully vs. partially covered selfexpandable metal stent for palliation of malignant esophageal strictures:a randomized trial (the COPAC study). Endoscopy. 2018;50(10):961-71. DOI:10.1055/a-0620-8135
25. Reijm AN, Didden P, Schelling SJC, et al. Self-expandable metal stent placement for malignant esophageal strictures – changes in clinical outcomes over time. Endoscopy. 2019;51(1):18-29. DOI:10.1055/a-0644-2495
26. Lu YF, Chung CS, Liu CY, et al. Esophageal metal stents with concurrent chemoradiation therapy for locally advanced esophageal cancer: safe or not? Oncologist. 2018;23(12):1426-35. DOI:10.1634/theon colog ist.2017-0646
27. Fuccio L, Scagliarini M, Frazzoni L, Battaglia G. Development of a prediction model of adverse events after stent placement for esophageal cancer. Gastrointestinal Endoscopy. 2016;83(4):746-52. DOI:10.1016/j.gie.2015.08.047
28. Yakami M, Mitsumori M, Sai H, et al. Development of severe complications caused by stent placement followed by definitive radiation therapy for T4 esophageal cancer. Int J Clin Oncol. 2003;8:395-8. DOI:10.1007/s10147-003-0356-2
29. Park JY, Shin JH, Song HY, et al. Airway complications after covered stent placement for malignant esophageal stricture:special reference to radiation therapy. Am J Roentgenol. 2012;198(2):453-9. DOI:10.2214/AJR.10.5780
30. Park JH, Song HY, Shin JH, et al. Migration of retrievable expandable metallic stents inserted for malignant esophageal strictures: incidence, management, and prognostic factors in 332 patients. Am J Roentgenol. 2015;204:1109-14. DOI:10.2214/AJR.14.13172
31. Mariette C, Gronnier C, Duhamel A, et al. Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer:impact on oncologic outcomes. J Am Coll Surg. 2015;220:287-96. DOI:10.1016/j.jamcollsurg.2014.11.028
32. Yu FJ, Shih HY, Wu CY, et al. Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma:a comparison of nasogastric tube, esophageal stent, and ostomy tubefeeding. Gastrointest Endosc. 2018;88(1):21-31. DOI:10.1016/j.gie.2017.11.030
33. Prasad NR, Karthigeyan M, Vikram K, et al. Palliative radiotherapy in esophageal carcinoma. Ind J Surg. 2015;77(1):34-8. DOI:10.1007/s12262-013-0817-4
34. Uesato M, Akutsu Y, Murakami K, et al. Comparison of efficacy of self-expandable metallic stent placement in the unresectable esophageal cancer patients. Gastroenterol Res Pract. 2017;2017. DOI:10.1155/2017/2560510
35. Newburger PE, Cassady JR, Jaffe N. Esophagitis due to adriamycin and radiation therapy for childhood malignancy. Cancer. 1978;42(2):417-23.
DOI:10.1002/1097-0142(197808)42:2<417::aid-cncr2820420206>3.0.co;2-a
36. Francis SR, Orton A, Thorpe C, et al. Toxicity and outcomes in patients with and without esophageal stents in locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 2017;99(4):884-94. DOI:10.1016/j.ijrobp.2017.06.2457
37. Iwasaki Н, Mizushima Т, Suzuki Y, et al. Factors that affect stent-related complications in patients with malignant obstruction of the esophagus or gastric cardia. Gut Liver. 2017;11(1):47-54. DOI:10.5009/gnl16172
38. Seaman WB, Ackerman LV. The effect of radiation on the esophagus:a clinical and histologic study of the effects produced by the betatron. Radiology. 1957;68:534‑41. DOI:10.1148/68.4.534
39. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995;31:1213-36. DOI:10.1016/0360-3016(94)00419-L
40. Yoon CJ, Shin JH, Song HY, et al. Removal of retrievable esophageal and gastrointestinal stents: experience in 113 patients. Am J Roentgenol. 2004;183:1437-44. DOI:10.2214/ajr.183.5.1831437
41. Chen YK, Schefter TE, Newman F. Esophageal cancer patients undergoing external beam radiation after placement of self-expandable metal stents: is there a risk of radiation dose enhancement? Gastrointest Endosc. 2011;73:1109-14. DOI:10.1016/j.gie.2011.02.001
42. Li XA, Chibani O, Greenwald B, Suntharalingam M. Radiotherapy dose perturbation ofmetallic esophageal stents. Int J Radiat Oncol Biol Phys. 2002;54:1276-85. DOI:10.1016/s0360-3016(02)03803-8
43. Abu Dayyeh BK, Vandamme JJ, Miller RC, Baron TH. Esophageal self-expandable stent material and mesh grid density are the major determining factors of external beam radiation dose perturbation: results from a phantom model. Endoscopy. 2013;45(1):42-7. DOI:10.1055/s-0032-1325960
Авторы
А.И. Иванов1–3, В.А. Попов*4, М.В. Бурмистров2–4
1 ГАУЗ «Республиканский клинический онкологический диспансер Минздрава Республики Татарстан им. проф. М.З. Сигала», Казань, Россия;
2 ФГАОУ ВО «Казанский (Приволжский) федеральный университет», Казань, Россия;
3 Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Казань, Россия;
4 ГАУЗ «Республиканская клиническая больница» Минздрава Республики Татарстан, Казань, Россия
*radzam@mail.ru
________________________________________________
Aleksej I. Ivanov1–3, Vladimir A. Popov*4, Mihail V. Burmistrov2–4
1 Sigal Republican Clinical Oncological Dispensary, Kazan, Russia;
2 Kazan Federal University, Kazan, Russia;
3 Kazan State Medical Academy – branch Russian Medical Academy of Continuous Professional Education, Kazan, Russia;
4 Republican Clinical Hospital, Kazan, Russia
*radzam@mail.ru