ГУ РНПЦ ОМР им Н.Н. Александрова Minsk, Belarus 2009 State Establishment N.N. Alexandrov National Cancer Centre of Belarus. - презентация

1 ГУ РНПЦ ОМР им Н.Н. Александрова Minsk, Belarus 2009 State Establishment N.N. Alexandrov National Cancer Centre of Belarus

2 ГУ РНПЦ ОМР им Н.Н. Александрова THE COUNCIL OF MINISTERS OF THE BYELORUSSIAN SSR ResolutionOn Intensifying Cancer from May 23, Research Investigations The Council of Ministers of the Byelorussian SSR states that the level of researches on malignant neoplasm diseases is absolutely insufficient in medical and research institutes and establishments of the Byelorussian SSR. There is no material and technical basis for experimental studying the most important problem in the republic. Some oncological dispensaries (Mogilev, Gomel and others) are located in premises, inadequate in area, Vitebsk and Grodno dispensaries have no in-patient departments; there are no hostels-hotels for oncological patients undergoing out-patient treatment. With the aim to create necessary conditions for organizing and conducting broad experimental and clinical researches on cancer problem at an up-to-date level, training highly qualified specialists- oncologists as well as improving prophylactic and medical help to patients with malignant diseases, the BSSR Council of Ministers D e c i d e s: 1. To take into consideration that in the seven-year plan, the BSSR Public Health Ministry forsees constructing a 200-bedded research institute of oncology and medical radiology in a zone out of Minsk; 5 oncological dispensaries with radiological and in-patient departments.

3 ГУ РНПЦ ОМР им Н.Н. Александрова 1960 y. N.N. Alexandrov – the founder and first director near a model of the future institute.

4 ГУ РНПЦ ОМР им Н.Н. Александрова Administration building

5 ГУ РНПЦ ОМР им Н.Н. Александрова Modernized building for oncological mammalogical department

6 ГУ РНПЦ ОМР им Н.Н. Александрова Laboratory building

7 ГУ РНПЦ ОМР им Н.Н. Александрова Recreational pavilions in pedestrian zones on the Centre territory

8 ГУ РНПЦ ОМР им Н.Н. Александрова With the Decree of President of the Republic of Belarus Alexandr Grigoryevich Lukashenko from July 6, 2005 oncology is included into the structure of main trends of scientific and technical activities in the Republic of Belarus in 2006 – 2010

9 ГУ РНПЦ ОМР им Н.Н. Александрова CCH Polotsk Vitebsk Minsk Settl.Lesnoy Vileyka Grodno Мogilev Bobruisk Gomel Mozyr Baranovichy Pinsk Brest SE N.N.Alexandrov NCCB SE COH NCCB 5 regional ODs 6 interdistrict ODs and MCOD Specialized Medical Help to Oncological Patients special beds for oncological patients

10 ГУ РНПЦ ОМР им Н.Н. Александрова Centre Structure At the base of the Centre, the BelMAPO Oncology Department (2 Doctors of Sciences and 2 Candidates of Sciences) functions as well as the Council for dissertation defense Д on specialties – oncology – radiodiagnosis, radiotherapy Research Sector: Clinical Sector: Departments and laboratories– 31 Auxiliary services - 21 Research departments – 13 Auxiliary services -– 3 Staff: 1578 persons, including 270 doctors Doctors of Sciences - 7 Candidates of Sciences – 31 Doctors of Sciences– 16 Candidates of Sciences 22 Staff: 135 persons, including 79 researchers

11 ГУ РНПЦ ОМР им Н.Н. Александрова Research Trends organizing anticancer struggle, studying cancer epidemiology and prophylaxis developing new technologies for diagnosing malignant tumours developing new technologies for managing patients with malignant neoplasms developing new technologies for rehabilitation and bettering quality of oncological patients life carrying out clinical trials of new drugs improving medical and technical basis of the oncological service of the republic

12 ГУ РНПЦ ОМР им Н.Н. Александрова Center Bedding 820 beds 12 beds the Resuscitation Department

13 ГУ РНПЦ ОМР им Н.Н. Александрова Hospitalized Patients Annually more than 200 foreign patients from the USA, France, Russia, India, Iraq, Poland, Azerbaijan, Armenia, Georgia, Kazakhstan, Latvia, Lithuania, Moldova, Uzbekistan, the Ukraine and other countries undergo medical treatment in the Centre.

14 ГУ РНПЦ ОМР им Н.Н. Александрова Diagnostic Base of the Centre

15 ГУ РНПЦ ОМР им Н.Н. Александрова Practically, the whole specter of biochemical, clinical, immunohistological, radioisotopic, molecular and genetic investigations is performed. Laboratory Diagnosis

16 ГУ РНПЦ ОМР им Н.Н. Александрова Laboratory of Molecular Oncogenomics Specter of Performed Investigations Detecting mutations in genes of hemodialysis system Detecting mutations in genes hereditarily associated with breast and ovarian cancer (BRCA1 and BRCA2) development Identifying mutations in genes hereditarily associated with colon cancer (APC, K-ras, MLH1, MSH2, BCL2) development Assessing a residual minimal disease under malignant neoplasms of breast, lung and prostate

17 ГУ РНПЦ ОМР им Н.Н. Александрова Translocation t(11,14) under lymphoma from mantle zone cells Fluorescent microscope Axioskop 40 FISH-Laboratory FISH fluorescent in situ hybridization identifying amplifications of HER-2/neu gene at breast cancer for performing a target (using monoclonal antibodies) therapy; detecting translocations, deletions, inversions in non- Hodgkins lymphomas; detecting chromosomal aberrations in solid tumours (breast and bladder cancer, some soft tissue tumours, brain tumours)

18 ГУ РНПЦ ОМР им Н.Н. Александрова Modern Methods of Molecular and Cytogenetic Investigations Comparative Genomic Hybridization, CGH Spectral Karyotyping, SKY Interspecific chromosomes segmenting, RхFISH Multicoloured human chromosome 5 staining, MCB Laboratory of Molecular Cytogenetics

19 ГУ РНПЦ ОМР им Н.Н. Александрова Morphological Methods of Investigation

20 ГУ РНПЦ ОМР им Н.Н. Александрова Distribution of protein ER in tumour cell nuclei at BC, x40. Immunohistochemical staining MKAT (clone 1D5, DAKO) Distribution of protein PR in tumour cell nuclei at BC, x40. Immunohistochemical staining MKAT (clone PgR636, DAKO) Receptor status: ER, PR Up-to-date immunohistological investigation methods using more than 60 poly- and monoclonal antibodies are introduced and widely used in practical work at present.

21 ГУ РНПЦ ОМР им Н.Н. Александрова Distribution of protein c-erbB-2 in tumour cell nuclei at BC, x40. Immunohistochemical staining MKAT (dilution 1:300, polyclonal, DAKO) Level of Protein c-erbB-2 and Protein BRCA I Expressing Cytoplasmatic distribution of protein BRCA1 in tumour cells at BC, x40. Immunohistochemical staining MKAT (dilution 1:50,clone E30, DAKO)

22 ГУ РНПЦ ОМР им Н.Н. Александрова Telepathology system for giving on-line consultations on morphological preparations Modern equipment for biopsy material automated paraffin covering

23 ГУ РНПЦ ОМР им Н.Н. Александрова Radiodiagnosis The department is equipped with modern, mainly, digital diagnostic instruments securing the use of an advanced filmless technology of getting, transmitting, processing and keeping images. At the base of the department one realizes a big work on training specialists in radiodiagnosis for medical institutions of the oncological profile of the Republic of Belarus (at working places and conducting thematic seminars). The permanent school for advanced training of radiodiagnosticians of Minsk region has been functioning here for 5 years.

24 ГУ РНПЦ ОМР им Н.Н. Александрова Computer roentgen tomographs

25 ГУ РНПЦ ОМР им Н.Н. Александрова Magnetic resonance tomograph

26 ГУ РНПЦ ОМР им Н.Н. Александрова One-photon emission tomograph

27 ГУ РНПЦ ОМР им Н.Н. Александрова Angiographic investigations

28 ГУ РНПЦ ОМР им Н.Н. Александрова Ultrasound investigations USI scanners in the expert class

29 ГУ РНПЦ ОМР им Н.Н. Александрова Intraoperative ultrasound investigation

30 ГУ РНПЦ ОМР им Н.Н. Александрова Diagnosing Bladder Cancer on the Basis of Photodynamic Effect Bladder cancer manifestation after intravesicular introduction of 5-ALA (Alamin): А – white lit; B – blue lit (λ = 400 nm), one can see additionally detected bladder tumours А B

31 ГУ РНПЦ ОМР им Н.Н. Александрова Efficacy of Clinical Use of 5-ALA (Alamin) of the Belarusian Production Additional malignant bladder tumours are detected in more than 18% of patients Obligate precancer is detected in 13% of patients

32 Highly Technological Methods of Treatment

33 ГУ РНПЦ ОМР им Н.Н. Александрова Surgical Activities Totally, there were made operations operations. There were operated patients patients

34 ГУ РНПЦ ОМР им Н.Н. Александрова Highly Technological Medical Interventions Combined operations with resection and prosthetics of arch and chest aorta, vertebrae bodies as well as resection of atrium with alloplasty of its wall using an artificial circulation apparatus in lung cancer patients Bronchoplastic operations with resection and plasty of pulmonary artery and vena cava superior at lung cancer Intrapleural and intra-abdominal thermochemotherapy in patients with pleural mesothelioma and metastatic involvement of abdomen Pancreoduodenal resections at pancreas head cancer, with pylorus being saved

35 ГУ РНПЦ ОМР им Н.Н. Александрова Pancreatectomy under total pancreas cancer, with pylorus constrictor being saved Gastropancreatoduodenal resections under locally spread stomach carcoma (with involvement of pancreas head) Biliary stenting at pancreas head cancer complicated with mechanical jaundice Management of liver and lung metastatic lesions using radiofrequency ablation Extended operative interventions into liver with removing 6 segments Radical cystectomy with forming artificial bladder from intestine

36 ГУ РНПЦ ОМР им Н.Н. Александрова Multicomponent management of patients with primary liver cancer and colorectal cancer with metastases in liver using preoperative chemoembolization of hepatic artery Laparoscopic radical prostatectomy Extracorporeal nephrectomy Operations under brain and skull base tumours Reconstructive and plastic operations using a microsurgical technique Photodynamic diagnosis and therapy using original Belarusian drugs (5-aminolevulinic acid, fotolon)

37 ГУ РНПЦ ОМР им Н.Н. Александрова method of combined and radiation treatment of patients with supratentorial gliomas and a metastatic brain lesion ; pneumoectomy with resection and prosthetics of descending aorta; distal resection of pancreas with resection and angioplasty of celiac trunk; exenteration of pelvis at locally spread cervical cancer; monoblock hystervaginavulvectomy with lymphaden- ectomy; fluorescent diagnosis and photodynamic therapy for precancer cervical diseases; subtotal laryngectomy; High Technologies Introduced in 2008

38 ГУ РНПЦ ОМР им Н.Н. Александрова reconstruction of mandible using titanium implants; use of the navigation system for diagnosing and treating brain and skull base tumours; shunting operations under brain tumours; extraperitoneal videoassisted radical prostatectomy; extracorporeal nephrectomy with autotransplantation; videoassisted nephroablation; subtotal coloproctectomy with forming intestine reservoir and ileoanal anastomosis; intersphincter proctectomy; stenting esophagus and trachea.

39 ГУ РНПЦ ОМР им Н.Н. Александрова Radiofrequency Ablation of Tumours Perfused elecrodes Generator Integra Elektrotom HITT ® 106

40 ГУ РНПЦ ОМР им Н.Н. Александрова Radiofrequency Ablation of Hepatic Tumour Liver CT with bolus contrasting (portal phase) before (A) and after (B) radiofrequency ablation of solitary metastasis of bronchial carcinoid АB

41 ГУ РНПЦ ОМР им Н.Н. Александрова Radiofrequency Ablation of Pulmonary Neoplasm Computer tomograms during the ablation (A) and 1 month afterwards (B) of the patient with a lung cancer metastasis after lobectomy. There is an encysted cavity at the metastasis place. B А

42 ГУ РНПЦ ОМР им Н.Н. Александрова Radiofrequency Ablation of Kidney Neoplasm

43 ГУ РНПЦ ОМР им Н.Н. Александрова Endoscopic Operations Laparascopic: splenectomy,adrenalectomy, nephrectomy, radical prostatectomy, obstructive resection of sigmoid colon and others. Thoracoscopic: lobectomy, thymectomy, removing posterior mediastinum, parasternal lymphadenectomy at breast cancer. Videoassisted mediastinoscopy 100% of morphological verification of pathological changes of mediastinum lymphnodes. 10% of changed diagnoses after mediastinoscopy Complications – 0,32%.

44 ГУ РНПЦ ОМР им Н.Н. Александрова OPERATIONS UNDER HEAD AND NECK TUMOURS

45 ГУ РНПЦ ОМР им Н.Н. Александрова Upper maxilla cancer with growing into the orbit and spreading into the anterior cranial fossa CRANIOFACIAL RESECTION

46 ГУ РНПЦ ОМР им Н.Н. Александрова CRANIOFACIAL RESECTION Cranial and facial stage View of the wound after removing preparation Macropreparation

47 ГУ РНПЦ ОМР им Н.Н. Александрова TECHNOLOGY OF TRACHEOESOPHAGEAL SHUNTING WITH VOCAL PROSTHESIS INSERTING SET FOR INSERTING VOCAL PROSTHESES

48 ГУ РНПЦ ОМР им Н.Н. Александрова ONE-STAGE REPARATION OF VOCAL AND ESOPHAGEAL FUNCTIONS PHARYNGOSTOMA TRACHEOSTOMA

49 ГУ РНПЦ ОМР им Н.Н. Александрова TRACHEOESOPHAGEAL ANASTOMOSIS FORMING The trochar is inserted via pharynx

50 ГУ РНПЦ ОМР им Н.Н. Александрова PROSTHESIS FIXATION IN CONDUCTOR The prosthesis is fixed in a conductor

51 ГУ РНПЦ ОМР им Н.Н. Александрова PHARYNX ANTERIOR WALL FORMING WITH LOCAL TISSUES Vocal prosthesis

52 ГУ РНПЦ ОМР им Н.Н. Александрова THE SKIN DEFECT IS REMOVED WITH SKIN AND MUSCULAR PECTORAL GRAFT

53 ГУ РНПЦ ОМР им Н.Н. Александрова INSERTED VOCAL PROSTHESIS

54 ГУ РНПЦ ОМР им Н.Н. Александрова Plastic Operations in Patients with Breast Cancer

55 ГУ РНПЦ ОМР им Н.Н. Александрова Patient Z, 34 y.o. Diagnosis: left breast cancer T2N0M0G2. The condition after a complex treatment in 1996–1997. DELAYED MAMMAPLASTY

56 ГУ РНПЦ ОМР им Н.Н. Александрова The same patient. The condition after a delayed mammaplasty with a free TRAM-graft in 1999.

57 ГУ РНПЦ ОМР им Н.Н. Александрова The same patient. The condition after the reconstruction of mamillary and areolar complex in 2001.

58 ГУ РНПЦ ОМР им Н.Н. Александрова Right breast cancer Т2N1М0. The condition after bilateral subcutaneous mastectomy and one-stage mammaplasty through a combined method (the broadest back muscle + endoprosthesis)

59 ГУ РНПЦ ОМР им Н.Н. Александрова Postmastectomy Syndrome

60 ГУ РНПЦ ОМР им Н.Н. Александрова Plasty of Soft Tissues

61 ГУ РНПЦ ОМР им Н.Н. Александрова

62 ГУ РНПЦ ОМР им Н.Н. Александрова

63 ГУ РНПЦ ОМР им Н.Н. Александрова Rhabdomyosarcoma of Left Forearm Soft Tissues

64 ГУ РНПЦ ОМР им Н.Н. Александрова The same patient: plasty with a radial fixed vascular pedicle flap

65 ГУ РНПЦ ОМР им Н.Н. Александрова Operations Preserving Organs under Bone Tumours

66 ГУ РНПЦ ОМР им Н.Н. Александрова Modular Endoprostheses

67 ГУ РНПЦ ОМР им Н.Н. Александрова

68 ГУ РНПЦ ОМР им Н.Н. Александрова

69 ГУ РНПЦ ОМР им Н.Н. Александрова Endoprosthetics with saddle-like prosthesis

70 ГУ РНПЦ ОМР им Н.Н. Александрова

71 ГУ РНПЦ ОМР им Н.Н. Александрова Lung Cancer and Mediastrium Tumours

72 ГУ РНПЦ ОМР им Н.Н. Александрова Lung Tumour Invading Left Atrium Lumen

73 ГУ РНПЦ ОМР им Н.Н. Александрова Tumour in Left Atrium Lumen

74 ГУ РНПЦ ОМР им Н.Н. Александрова The lung is removed, the left atrium wall defect is substituted with xenopericardium

75 ГУ РНПЦ ОМР им Н.Н. Александрова MSCT before Operation Tumour Aorta

76 ГУ РНПЦ ОМР им Н.Н. Александрова Detecting Site of Thoracic and Abdominal Aorta with Tumour Esophagus Celiac trunk SMA Left kidney vessels Aorta tumour

77 ГУ РНПЦ ОМР им Н.Н. Александрова Spine Left kidney vessels Aorta The site of aorta with tumour is resected. Celia trunk

78 ГУ РНПЦ ОМР им Н.Н. Александрова Esophagus Left kidney vessels Aorta prosthesis The prosthesis is made to aorta. Celia trunk SMА

79 ГУ РНПЦ ОМР им Н.Н. Александрова Macropreparation

80 ГУ РНПЦ ОМР им Н.Н. Александрова Extracorporeal nephrectomy with autotransplantation

81 ГУ РНПЦ ОМР им Н.Н. Александрова View of reconstructed kidney

82 ГУ РНПЦ ОМР им Н.Н. Александрова Ileocystoplasty according to R. Hautmann (Modified) after Radical Cystectomy due to Bladder Cancer

83 ГУ РНПЦ ОМР им Н.Н. Александрова Operating Block

84 ГУ РНПЦ ОМР им Н.Н. Александрова Resuscitation Department

85 ГУ РНПЦ ОМР им Н.Н. Александрова The apparatus Artificial Kidney Procedure of extracorporeal detoxication using the apparatus «Multifiltrat»

86 ГУ РНПЦ ОМР им Н.Н. Александрова Radiotherapy

87 ГУ РНПЦ ОМР им Н.Н. Александрова Material and Technical Basis of Remote Radiotherapy Title of apparatusMark of apparatus ProducerExploitation start 1.Linear acceleratorTrilogyVarian (USA) Linear acceleratorClinac- 2300СD Varian (USA) Linear acceleratorMevatron KD-2 Simens (Germany) Gamma-therapeutic apparatus TeratronCanada Gamma-therapeutic apparatus Rocus-AMRussia1992

88 ГУ РНПЦ ОМР им Н.Н. Александрова Material and Technical Basis of Short Focus and Contact Radiotherapy Title of apparatusMark of apparatus ProducerExploitation start 1.Apparatus for short focus radiotherapy X-ray-ТА 01Russia Apparatus for contact radiotherapy Microselectron HDR-old Nucletron (Holland) Apparatus for contact radiotherapy Microselectron PDR Nucletron (Holland) X-ray-topometric complex for contact radiotherapy IBU Microselectron HDR Nucletron (Holland) 2008

89 ГУ РНПЦ ОМР им Н.Н. Александрова Material and Technical Basis for Preradiation Preparation Title of apparatusMark of apparatus ProducerExploitation start 1. X-ray simulatorAcquityVarian (USA) X-ray simulatorSimulixNeucletron (Holland) System for planningEclipseVarian (USA) System for planningOncentre Masterplan Neucletron (Holland) System for planningPlatoNeucletron (Holland) System for planningPrazurRussia Computer tomographLightspeedGeneral Electrics (USA) 2005

90 ГУ РНПЦ ОМР им Н.Н. Александрова Material and Technical Basis (Auxiliary Devices and Dosimetry ) Title of apparatusProducerExploitation start 1. System for making individual blocks Holland Fixing appliances and devicesSivco (USA) Set of dosimetric equipmentCanberra Paccard (Austria) 2005

91 ГУ РНПЦ ОМР им Н.Н. Александрова Linear accelerator with 2 photon energies and 6-8 energies of electrons with a many-plane diaphragm, with a mobile system of getting tomographic images through X-ray bundle according to the procedure Cone-beam CT for localizing a target, verifying an irradiation plan and posing a patient (IGRT) Radiotherapeutic Complex

92 ГУ РНПЦ ОМР им Н.Н. Александрова

93 ГУ РНПЦ ОМР им Н.Н. Александрова High Technologies in Radiotherapy Three-dimensional conformal radiotherapy Radiotherapy with modulating dose intensity Stereotaxic radiotherapy / radiosurgery Four-dimensional conformal radiotherapy

94 ГУ РНПЦ ОМР им Н.Н. Александрова Brachytherapy Using an Integrated X-ray and Topometric Complex (IBU) Brachytherapy of prostate tumours with high dose power controlled through TRUZI and planning in the SWIFT- system online

95 ГУ РНПЦ ОМР им Н.Н. Александрова Hyperthermia

96 ГУ РНПЦ ОМР им Н.Н. Александрова Equipment for Photodynamic Therapy and Diagnosis «Metalaz-M» «Kamin-Video» «Lesa-6» «LD-680»

97 ГУ РНПЦ ОМР им Н.Н. Александрова 6 months afterwards Patient C., 34 y.o., CIN III – PDT Before treatment Photodynamic Therapy under Cervical Dysplasia

98 ГУ РНПЦ ОМР им Н.Н. Александрова Dynamics of Malignant Neoplasm Morbidity and Mortality in the Republic of Belarus 194,3 (-3,1%) 329,1 414,1 188,2 (on of population) (+24,8%) Data of the Cancer-Register. Data of the National Committee on Statistics of Belarus Sickened377,4380,2388,9411,2414,1 Died189,7188,5187,3187,9188,2

99 ГУ РНПЦ ОМР им Н.Н. Александрова Region Number of the sickened Number of the died Number of the died/ Number of the sickened % % % (2004) % (2008) Europe Belarus European Union Annals of Oncology 16: , 2005 Belarusian Cancer-Register, 2008 Correlation of the Died due to Malignant Neoplasms to the Number of the Sickened (2004)

100 ГУ РНПЦ ОМР им Н.Н. Александрова