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Background. A combination of different types of lung cancer and chronic obstructive pulmonary disease (COPD) is very common. COPD, accompanied by ventilation disorders and, often, respiratory failure, is a significant additional risk factor for mortality in these patients. Identification of risk factors for mortality in patients with lung cancer and COPD can potentially be associated with better long-term outcomes.Materials and methods. Using a Cox regression model based on information about the outcome of the disease and life expectancy after treatment initiation, a survival analysis was performed with an assessment of the contribution of various clinical and anamnestic factors for a group of 118 COPD patients with primary diagnosed lung cancer. These patients received treatment at the Cancer Research Institute in Tomsk in 2013–2019.Results. The study included 118 patients (87.3% men and 12.7% women). Among them, 77.97% of patients were active or former smokers with smoking index (SI) ≥ 10 pack-years, and 22% of patients had never smoked or had SI < 10 pack-years but had other risk factors for COPD. Peripheral lung cancer was detected in 45.8% of cases. Squamous cell carcinoma was noted in 54.2% of cases, adenocarcinoma – in 34.7%, large cell carcinoma – in 1.7%, small cell carcinoma – in 5.9%, and carcinoid tumors – in 2.5% of cases. Patients were characterized by varying degrees of severity of ventilation disorders in accordance with the GOLD classification: stage 1 was observed in 44% of patients, stage 2 – in 38.1 % of patients, stage 3 – in 16.9 % of patients, and stage 4 – in one patient. Threeyear mortality was 28.12%.Conclusion. According to the results of the Cox regression analysis, factors that significantly reduced the survival rate of patients with lung cancer in combination with COPD were more severe stages in terms of the size of the primary tumor and its localization, the prevalence of metastasis (according to TNM classification), more severe dyspnea (mMRC scale), lower oxygen saturation values, atelectasis, and episodes of pneumonia, including paracancrotic pneumonia, over the previous 12 months. The presence of certain types of metastases, such as metastatic lesions of the pleura, adrenal glands, distant non-regional lymph nodes, and bones should also be noted as negative factors for survival. It is worth noting that surgical treatment of the primary tumor was associated with an increase in the survival rate in patients with lung cancer in combination with COPD.

Introduction. Lung cancer (LC) is one of the leading causes of mortality in Russia and in all other the world. Late detection of LC is a healthcare system issue because of most of patients are asymptomatic. Aim. The aim of the study was to analyze the structure of healthcare resources in the group of patients with non-small cell LC (NSCLC) in St. Petersburg. Materials and methods. The database of electronic medical records was created by combining the information from National cancer register and governmental medical insurance system, which included the patient with NSCLC diagnosed between 2011 and 2020 years. The data about the high technology medical services received by patients was added in the database as well. Results. None of the existing electronic medical records system is able to make visible all the medical services received by a specific patient. The combined database gives the possibility to follow-up the history of around 8000 patients with NSCLC in St. Petersburg. Conclusions. When building the hospital model of the NSCLC patient aiming the rational planning of healthcare resources the stage of the disease is the most important because it is strongly linked with the healthcare resources provided to the patient.

An application of geometric mixed additive-multiplicative models for lung cancer risk modeling under combined action of radon and smoking is justified in this paper. The geometric mixed model allows: 1) to reduce the discrepancies between estimates of the lung cancer risk for males and females, 2) to predict the population risk under condition of the varying smoking prevalence and changing average indoor radon concentration level. Using the geometric mixed model, the calculation of the lung cancer risks for the Russian Federation population was carried out for different percentages of smokers among the population, an increase in life expectancy, and a change in the average radon concentration level in residential buildings. Assuming that currently rounded average indoor radon concentration in Russia is 50 Bq/m3, the contribution of radon to total mortality in 2009 was 0.46% and 0.20% for male and female, respectively. Modeling has shown that the effect of lung cancer mortality reducing due to the predicted decrease in the proportion of smoking population will partly be offset by an increase in the realization of lung cancer risk with the life expectancy increase. For a hypothetical situation, when the entire population maintain a healthy lifestyle and mortality from cardiovascular, oncological, infectious diseases, diseases of the respiratory tract and from external causes has significantly decreased, the contribution of radon exposure to total mortality will increase to about 0.8%. If the average level of radon in buildings will increase due to energy-efficient technologies widespread implementation in building construction, the contribution of radon to total mortality will be even more noticeable.

Aim. To study the ventilation function of the lungs in patients with varying degrees of severity of chronic obstructive pulmonary disease (COPD) and in patients with COPD combined with lung cancer (LC), as well as to establish the features of its disorders using spirography and body plethysmography.Materials and methods. A clinical and functional study of 57 individuals was carried out with 10 healthy patients (control group), 30 patients with COPD and 17 patients in whom LC was combined with COPD using the Masterlab Pro diagnostic complex (Erich Jaeger, Germany).Results. In patients with early COPD, a decrease in MEF75 (a ventilation parameter characterizing small airway patency) is the most informative. With the progression of bronchial obstruction, both restrictive and obstructive disorders, characterized by a decrease in FEV1, VC, a change in the structure of the total lung capacity in the form of an increase in the RV/TLC ratio such as an increase in the RV/TLC ratio and an increase in bronchial resistance were recorded. In patients with LC and mild COPD, pulmonary volumes, capacities, flow-volume loop and bronchial resistance parameters did not differ from patients with COPD with a similar bronchial obstruction. In patients with LC and more severe COPD, in contrast to patients suffering from a similar severity of COPD, a decrease in the patency of large, medium and small diameter bronchi (PEF, MEF25, MEF50, MEF75) was detected, which indicated development of generalized bronchial obstruction.Conclusion. Modern diagnostics of pulmonary ventilation disorders in patients with LC and COPD should be aimed at identifying the disease, and drug therapy should target maximum leveling of reversible components of bronchial obstruction in order to increase the functional reserve of the respiratory system and reduce the risk of postoperative complications caused by COPD.

The diagnostic accuracy of the artificial intelligence algorithm aimed to detect lesions on low-dose computer tomograms has been independently assessed. The dataset formed as part of the lung cancer screening program in Moscow was used. The following indicators have been defined: sensitivity – 0.817%, specificity – 0.925%, accuracy – 0.860%, area under the characteristic curve – 0.930. High accuracy rates demonstrated through the independent assessment indicate a good reproducibility of the results by artificial intelligence using independent data about the population of Moscow

Malignant tumors of the trachea, bronchi, lungs represent a serious medical and social problem. Most cases of cancer of the trachea, bronchus, and lung are detected at stage IV, and therefore, to improve the survival of patients, a new treatment strategy is proposed based on modern data on mutagenesis and receptor status of tumor cells, which has a personalized approach for each specific case. To make managerial decisions about the introduction of innovative drugs, a forecast of expected results is required which should be improved indicators of the State Program On Healthcare Development. It has been found out that the transition to a new strategy for lung cancer chemotherapy will reduce mortality from malignant tumors by 1.2-0.7%, including lung cancer by 3.9%, as well as one-year case fatality by 3% for all malignant tumors, including 15% for lung cancer. At the same time, within 5 years after the introduction of the new strategy for lung cancer treatment, the indicator reflecting the proportion of patients with malignant tumors registered for 5 years or more is expected to decrease, which is related to specific parameters of the calculation method.The authors state that they have no conflict of interests.

The purpose of the study was to analyze the world experience in the objective assessment of the functional state of the bronchopulmonary system in lung cancer patients with chronic obstructive pulmonary disease (COPD) using modern diagnostic tools and techniques as well as correction of ventilation disorders in the perioperative period using long-acting inhaled bronchodilators. Material and methods. A literature search was conducted using the Medline, Elibrary etc. databases. Out of 112 publications concerning the study of the incidence of lung cancer and COPD, external respiration function and rehabilitation of patients, 37 were included in this review. Results. COPD was shown to be the major cause of postoperative non-surgical complications and the main predictor of perioperative mortality in lung cancer patients. Modern techniques for studying the function of external respiration, such as bodyplethysmography, spirography, high-resolution computed tomography, ventilation and perfusion lung scintigraphy, were highlighted. It was shown that preoperative correction of obstructive syndrome and postoperative pulmonary rehabilitation, including drug therapy with long-acting bronchodilators in combination with smoking cessation, eradication of foci of chronic infection and respiratory gymnastics were necessary to detect functional respiratory disorders in lung cancer patients with COPD. Conclusion. To date, there are no standards clinical practice guidelines for diagnostic testing and the correction of ventilation disorders in lung cancer patients with COPD in the pre- and postoperative periods. Therefore, further studies aimed at developing a diagnostic algorithm to improve the accuracy of detecting bronchial obstructive syndrome, especially in the early stages of COPD, as well as compensation for respiratory disorders using modern bronchodilator therapy are needed.

The aim of this work is the development and demonstration of the method of simultaneous detection of several biomarkers of lung cancer in the blood plasma of patients using a multiplex electrochemical testing system based on DNA aptamers. DNA aptamers are a new class of synthetic affinity probes obtained by in vitro or in vivo selection procedure by the systematic evolution of ligands by exponential enrichment (SELEX).Materials and methods. A set of aptamers obtained previously by selection for postoperative lung cancer tissue was used to create a multiplex electrochemical biochip. Identification of aptamer target proteins was performed using a modified affinity enrichment method (AptaBID). Molecular targets for the used set of aptamers to lung cancer were defined as vimentin, defensin, a light chain of myosin, tubulin alpha 1-B, neutrophil elastase and A1 elongation factor 1.Measurements of the presence of these biomarker proteins in blood plasma were carried out using electrochemical detection. The difference between peak heights before and after plasma deposition on the electrodes modified by aptamers was considered as a response of the system to the presence of protein onco-markers in blood plasma. Blood plasma of healthy volunteers was used as control.Results. Research showed that in the blood plasma of all the patients with lung cancer the content of biomarker proteins that bind to aptamers on electrode surfaces was increased. The increased content of these proteins in the blood plasma of patients suggests the presence of invasiveness and metastasis of tumors and their chemo-resistance.

The authors investigated features of diagnostics and surgical treatment of lung cancer which was complicated by purulent destructive process. The possibilities of radical operative intervention were considered after preliminary adequate treatment of purulent complications in 226 patients. It was noted, that the diagnostic thoracotomy should be used in doubtful cases in order to estimate the resectability of lung cancer.

The patients (11 cases) with massive invasion in the thoracic aorta have been operated in the period from 2002 till 2010. The tumor of left lung was diagnosed in 9 cases and tumor of the mediastinum — in 2 cases. Prosthetics of the arch of aorta was performed under condition of artificial circulation in 6 cases. The prosthetics of the descending aorta was performed in 5 cases. A condition of artificial circulation was partially used in 1 case, fully used in one and the assist circulation was applied in 3 cases. The hospital lethality consisted of 4 patients. The common number of patients with severe hospital complications was 5. The survival of one-, two- or three — year estimated 36,4±14,5%, 18,2±11,6% and 0% respectively. A median of survival was 1,63 months. The remaining 7 patients died in a long-term period. The cause of death was a progress of tumor process in vast majority of cases.

An analysis of modern methods of diagnostics such as morphological, immunohistochemical and spectral, which included the bronchoscopy and spectrometry by using reflectance and autofluorescent regime, was made. The data involved the results of prospective follow-up study of 167 patients (620 biopsies). An obligatory spectrometry of suspicious area was carried out before the forceps biopsy. The microslides, which met the requirements of criteria of one of the carcinogen steps (n=201), were subjected to the in-depth morphological and immunohistochemical investigations. The tendency of angiogenesis (CD31 and CD34), proliferative activity (Ki-67), level of apoptosis (P53), EGFR expression were estimated. The sensitivity of combined endoscopic method was 94,74% by specificity 79,95% and high prognostic value of negative endoscopic diagnosis — 99,4%.

Objectives: Studying the influence of the method of selecting a control group in the radon case-control study on assessment of dose-effect dependence. Study the effect of additional additive or multiplicative risk factors on the results of the study. Materials and Methods: Simulation of a large-scale radon epidemiological case-control study. Analyzing of the influence of the representative value of the comparison subgroup on the results of calculating the odds ratio of the incidence of radiation-induced lung cancer. Analysis of different variants of standardization of the control group on the correctness of the dose-effect dependence. Development of methods for identifying risk factors that affect the incidence of lung cancer and determining the mechanism of their influence (additive or multiplicative). Results: It is shown that the insufficient representativeness of the comparison subgroup used in calculating the odds ratio can significantly distort the estimates of dose-effect dependence. In the presence of factors (sex, smoking, etc.), correlating both with the incidence of lung cancer and of radon concentration, complete standardization of such factors is necessary. Multiplicative risk factors without such correlation do not require additional standardization in the selection of a control group. Calculation of the odds ratio for various risk factors in subgroups differing in the levels of spontaneous cancer incidence allows to determine the significance of this factor for the incidence of lung cancer, and to establish the preferential mechanism of the influence of this factor (multiplicative or additive). Conclusions. When carrying out the radon case-control study, it is necessary to identify risk factors that correlate both with the incidence of lung cancer, and with the radon concentration, to assess the mechanism of action of these factors and to made the complete standardization of the control group for them.

The aim of the study: to analyze the risk of lung cancer caused by exposure to indoor radon using an environmental study, taking into account recent data on the possible effect of Human Papillomavirus, based on lung cancer mortality and radon exposure in the Russian regions.Materials and methods: in the analysis, linear dependencies of lung cancer against influencing factors were used. The average radon concentration for the regions of Russia was earlier reconstructed on the basis of the annual reports of the form 4-DOZ. Information on morbidity and mortality from malignant neoplasms in Russia was obtained from annual reports issued by the Р. Hertsen Moscow Oncology Research Institute. As a surrogate of the level of infection with Human Papillomavirus, the incidence of cervix cancer was used. The smoking prevalence was estimated applying data on the incidence of tongue cancer.Results: taking into account smoking and infection with Human Papillomavirus, it is possible to obtain estimates of lung cancer excess relative risk when induced by radon in dwellings consistent with the results of case-control studies.Conclusion: the analysis of regionally aggregated data on deaths from lung cancer in Russia, the average level of indoor radon concentrations and significant risk factors for lung cancer confirms the linear threshold-free concept of radiation-induced carcinogenesis.

Objective – lung cancer (LC) and stomach cancer (SC) morbidity in Kemerovo region (KR) from 1996 to 2015 years. Methods. Analysis of standardized indexes of LC and SC morbidity. Comparison of morbidity levels and tendency in two 10 years periods: 1996-2005 and 2006-2015. Results. Lung cancer morbidity in Kemerovo region reduced from 49,0 to 36,7 cases on 100000 inhabitants from 1996 to 2015 years, and stomach cancer morbidity – from 36,4 to 20,5 accordingly. The part of inhabitants living on territories with high levels of lung cancer morbidity in 1996-2015 years brought down from 58,8 % to 7,2 % in 2006-2015 years. The same reduction of stomach cancer morbidity was from 52,4 % to 7,6 %. The cities and districts of Kemerovo region had the local peculiarity according to combined estimation of cancer morbidity levels and tendency in two 10-years periods. Conclusions. Evidently the lowering of lung cancer and stomach cancer morbidity is a result of decrease of carcinogens air and water pollution in Kemerovo region.

Objective: A simulation of a large-scale epidemiological case-control study to identify the relationship between exposure to radon and lung cancer in the presence of factors that distort the results of the assessment of exposure to radon in homes. Materials and Methods: Analysis of sources of uncertainties arising during radon epidemiologic case-control studies. Evaluation of the uncertainties caused by the errors of the measurements of the long-term variations in the radon concentration, exposure to radon in other places of the human habitat, except dwellings, etc. Simulation by Monte Carlo technique of radon epidemiologic study, comparable to the combined European radon study, and assessment of uncertainties, which affect the evaluation of dose-effect dependence. Results: The multiplicative error in the assessment of individual exposure based on the radon concentration is shown generally caused by the combined effect of long-term variations of the radon concentration and the differences in the levels of the radon concentration in living houses and other places of the human habitat. The logarithmic standard deviation of this errors σerr is from 0,70 to 0,90. The estimated value of this error is 2,0 times higher than the value used for correction of the results of the combined European radon study. It is shown that for the σerr

The article is devoted to computer tomographical (CT) and gistotopographical comparisons in different subtypes of lung cancer. The study includes 39 cases of patients who undergone lung resection about cancer. Cross-sections of lungs on the level of most cancer spread were subjected to investigation. The data were comparised with CT data of the same patients before operation. These results allow to detalise CT research data of different anatomical subtypes of lung cancer.

The article presents data on the epidemiology of lung cancer among the population in some areas of the Republic of Bashkortostan, differing in antropogenic loads on the atmosphere. The expressed association between degree of ecological trouble and incidences of the population of lung cancer is revealed.

The review deals with computer-tomographic diagnosis of diseases of bronchopulmonary system and pleura, many of the issues highlighted in the literature not clearly or not covered at all. The introduction into clinical practice of modern methods of diagnosis increases the possibility of detecting disease at an early stage when there is possible to use radical methods of treatment. Despite the high level of modern technologies in the field of visualization of respiratory system, problem early and accurate diagnosis of disease remains highly relevant. Improved results of treatment dependent on the timely and accurate diagnosis. Modern methods of CT is one of the most accurate in radiodiagnostic, allows quickly to obtain significant information about the organs state and tissues of the chest. The work demonstrates the potential of CT in clinical decision making when observing patients with diseases of bronchopulmonary system and pleura.

Goal of the study: to investigate the structure of patients referred with the suspicion of tuberculosis to the differential diagnostics department of TB dispensary.Materials and methods. The analysis included investigation of medical documents of 990 patients admitted to the hospital in 2012-2014 with the suspicion of tuberculosis to the diagnostic department of TB dispensary.Results. No active tuberculosis had been confirmed in 506 (51.1%) patients out of 990. Out of those patients 29.4% of cases had pneumonia or other inflammatory disease, in 18.9% – post-tuberculous changes, 12.7% – lung cancer, 6.5% – respiratory tuberculosis. The time of diagnosis for each nosology without invasive methods of sample obtaining was analyzed.

The article summarizes and analyses the results of research work conducted by the authors collective on high radon concentration effects on mine workers from the tungsten ore mine and population of the Akchatau settlement located in the Dzhezkazgan region of Kazakstan around this mine. Heightened morbidity rate for lung cancer, respiratory tract diseases is being revealed. Clinical examination found out pathological changes among the population of settlement, which can be linked with the radiation exposure: cataracts, abnormal gestation courses. Immunological investigations revealed some causes of discovered pathological changes: tissue immunodepression ofrespiratory tract, autoimmune processes to the lung antigens at respiratory system pathology.

The work is devoted to computed tomography (CT) and ultrasound (US) diagnosis of the thoracic cavity diseases, which highlights many of the issues in the literature clearly or not covered at all. Advances in the CT and US technologies have demanded reconsideration of the scientific data about value of these methods in diagnostics of diseases of lungs and pleurae. Now US is widely used in the diagnosis of diseases of the organs and tissues of the abdominal cavity, retroperitoneal space, pelvic organs, cardiovascular system and is insufficiently used for the study of pathological changes of lungs and pleura. The analysis of possibilities of US and CT in diagnosis of parietal thoracic cavity formations and indications for ultrasound are presented, the US technique as well as US semiotics of revealed pathological changes are described. Implementation into clinical practice of modern methods of diagnosis increases the chance of early detection of the disease when it is still possible to use the radical methods of treatment

Рентгеноэндоваскулярная эмболизация (РЭЭ) бронхиальных артерий (БА) осуществлена у 419 больных по поводу легочного кровотечения (ЛК) и кровохарканья при различных заболеваниях легких. Осложненные формы рака легкого диагностированы у 237 больных. Положительный клинический эффект РЭЭБА отмечен в 89,8% наблюдений. Рецидив кровохарканья возник у 10,2%, умерли 11 (2,6%) больных. Опыт применения РЭЭБА позволяет сделать вывод, что метод является одним из наиболее эффективных в лечении ЛК.

Представлен случай лечения пациента 54 лет с диагнозом: центральный рак верхней доли левого легкого (гистологически – плоскоклеточный). T4N0M0. IIIB стадия. С учетом инвазии опухоли в ствол легочной артерии выполнена расширенно-комбинированная верхняя лобэктомия слева с резекцией общего ствола левой легочной артерии и бронхоциркулярной резекцией левого главного бронха. Формирование анастомоза артерии по типу «конец в конец». Формирование анастомоза бронха по типу «конец в конец». В послеоперационном периоде осложнений со стороны сосудистого и бронхиального анастомозов не отмечалось. Обследован в отдаленном послеоперационном периоде. Данных о рецидиве опухоли нет.

The study investigated the distribution of polymorphous variants of genes regulating cellular cycle – p53 G215C, Bax G248A and Bcl-2 C938A in lung cancer patients and healthy donors with the purpose of obtaining new fundamental knowledge on the role of above polymorphisms in the lung cancer development. The statistically significant di|erences were found out in the distribution of polymorphous variants of genes regulating cellular cycle in the compared groups; relative risks of cancer development were calculated for those carrying of polymorphous variants of genes of p53 G215C, Bax G248A and Bcl-2 C938A.

The articles presents a rare clinical case of the lung cancer with metastases into skin and soft tissues which was initially diagnosed as disseminated pulmonary tuberculosis with two-fold bacillary excretion; it shows the opportunities for rapid diagnostics of the lung cancer in a peripheral TB dispensary.

Objective: comparative evaluation of carcinogenic risk inMoscowfrom radon in indoor and atmospheric pollutants.Materials and methods: the lung cancer incidence in Moscow; radiation-hygienic passport of the territory; .U.S. EPA estimated average age at all and radon induced deaths, years of life lost; Report of UNSCEAR 2006 and WHO handbook on indoor radon, 2009. Trend analysis of incidence; evaluation of the excess relative risk; assessment of ratio radon-induced population risk and published values оf total population carcinogenic risk from chemical carcinogens.Results: it is shown that the 304 cases of lung cancer per year (1. 85 10-3) on average from 2006 to 2011 (21280diseases for 70 years in addition to background level) induced by radon; the differences in average trends of all lungcancer incidence in the districts can exceed 25%.Conclusion. The potential of risk reduction by measures of mitigation radon concentration exceeds 5 times the cost efficiency to reduce emissions from vehicles and can reduce cancer incidence, on average 236 cases per year; population risk 16520 cases over 70 years or save not less than 2832 person-years of life per year. The annual effect of reducing losses from not-survival of 12 years as a result of radon-induced lung cancer deaths exceeds 14160000 dollars. The evaluating of the carcinogenic risk from radon in accordance with the definition of population risk increases the predictive evaluation of the effectiveness of preventive measures more than twice.

Intensive worldwide researches of the public exposure to radon are carried out for over 30 years. According to numerous studies being performed in many countries, radon and its progenies contribute significantly in total dose to the public. At that, dose due to inhalation of radon and its progenies is higher than that induced by other radiation sources, including sources used in medicine and those occurring in the environment due to the nuclear fuel cycle activities. Prolonged internal exposure to the human‘s body induced by the radon decay products is one of the key factors in the development of the lung cancer pathology. The recent results of global epidemiological studies, aimed at the risk assessment of indoor radon-induced lung cancer, have initiated the need to improve approaches to the regulation of this problem. International organizations (such as WHO, IAEA, ICRP) proposed a strategy of the public radiation protection against radon exposure and adapted this strategy to the up-to-date realities. The recent recommendations not only correct the radon activity concentration being limited in dwellings, but also change its status through converting the action level to the reference one. The strategies for limitation of the public exposure due to this component of natural radiation should be revised at the national level and an action plan for their implementation in the long term perspective should be developed. This paper deals with the key provisions of the recent international recommendations including approaches to regulate the public protection against radon exposure.

The hypertrophic osteoarthropathy (HOA) may occur as isolated finding or is often part of the syndrome which is characterized by periostosis of the long bones and occasional painful joint enlargement. The majority of cases of HOA are due to malignant thoracic tumors. The authors present a case of hypertrophic osteoarthropathy as a paraneoplastic syndrome in a patient with peripheral lung cancer.

The proinflammatory activity of bronchoalveolar lavage fluid (BALF) was investigated using the biological test system (donor blood) in 71 patients with lung cancer and inflammatory disease of respiratory organs (lung abscess, infiltrative tuberculosis, tuberculoma, fibrocavernous tuberculosis). The supernatant of BALF was purified by filtration through millipores and added to blood, and a nitroblue tetrazolium recovery test (HBT) was carried out. Hank’s balanced salt solution was used in the control. The proinflammatory effect of BALF was defined as a diformazan-positive neutrophil count ratio in the experimental and control samples (stimulation index). The inflammatory process developing in lung cancer was active, as suggested by the accumulation of neutrophils in the lung and by the high proinflammatory activity of BALF, which were comparable with the similar indicators in lung abscess and fibrocavernous tuberculosis.

The paper shows problems in the differential diagnosis of malignancies of the lung and pleura in 55 patients. It characterizes the duration of a diagnostic period in patients with lung cancer identified at all diagnostic stages in tuberculosis hospitals. The clinical manifestations of lung malignancies are shown. The predictors of delay in the verification of diagnosis are found.

Disseminated lung diseases are still a difficult diagnostic problem. Modern endoscopic techniques for minimally invasive diagnostics allow to verify the diagnosis in more than 3/4 of patients. However, the incidence of diagnostic errors at initial evaluation without biopsy remains high. The reasons for errors are the actual complexity of differential diagnosis of disseminated processes, failure to properly examine the patients, late or insufficient use of high-resolution computed tomography and bronchoscopy with releveant biopsies.

В обзоре рассмотрены основные цитохромы, синтезируемые в лёгких, их связь с различными заболеваниями лёгких и участие в метаболизме лекарственных средств (ЛС). Показано, что измененная активность местных цитохромов, таких как CYP1 A1, CYP2 A6, CYP3 А5 и некоторых других, может приводить к более активному окислению проканцирогенов, в том числе содержащихся в табачном дыме, а значит, увеличивать риск развития лёгочных заболеваний. Продемонстрировано, что полиморфизмы CYP1 A1 связаны с повышенной чувствительностью к раку лёгкого, ХОБЛ, эмфиземе. С другой стороны, у «медленных метаболизаторов» по CYP2 A6 и CYP3 А5 предрасположенность к раку лёгкого может снижаться. Активность изоферментов цитохрома Р450 может вносить определённый вклад в биотрансформацию различные лекарственных средств. Так, снижение активности CYP3 A5 в лёгких, увеличивает концентрацию ингаляционных глюкокортикостероидов в ткани лёгких и в системном кровотоке, а CYP2 A13 способен изменять метаболизм теофиллина. Таким образом, интерес к системе цитохрома Р450 в лёгких связан с её высокой значимостью для патогенеза заболеваний лёгких и фармакокинетики ряда лекарственных средств.

This work is devoted possibilities to use the intraoperative photodynamic therapy in treatment of nоn-small lung cancer. Studied the problem of calculate light-doses necessary for inactivation tumor-cells in pleural cavities.

The life quality of patients with lung cancer after the intraoperative irradiation with a dose 15 Gy during the surgery (loband pneumonoectomies) for the period of two years has been studied. The form developed by the European Organization for Research and Treatment of Cancer EORTC QLQ-C 30 and the QLQ-LC 13 module were used. It is shown that the life quality of patients with lung cancer after combined therapy is determined mainly by the volume of surgery made, rather than by the adjuvant therapy conducted. Of great importance for patients was the period needed for the adaptation of the organism to new living conditions. In general, no significant differences in the main life quality indices were revealed among patients of both groups. Based on the results obtained, one can say that the addition of surgery with intraoperative radiotherapy with a total focal dose 15 Gy does not lead to the considerable worsening of life quality of patients and can be recommended for clinical application.