MD36Y - Method of differentiated treatment of non-invasive ductal carcinoma of the mammary gland - Google Patents
Method of differentiated treatment of non-invasive ductal carcinoma of the mammary glandInfo
- Publication number
- MD36Y MD36Y MDS20080031A MDS20080031A MD36Y MD 36 Y MD36 Y MD 36Y MD S20080031 A MDS20080031 A MD S20080031A MD S20080031 A MDS20080031 A MD S20080031A MD 36 Y MD36 Y MD 36Y
- Authority
- MD
- Moldova
- Prior art keywords
- case
- comedocarcinoma
- radiotherapy
- postoperative period
- noncomedocarcinoma
- Prior art date
Links
- 210000005075 mammary gland Anatomy 0.000 title claims abstract description 12
- 238000000034 method Methods 0.000 title claims abstract description 8
- 206010073094 Intraductal proliferative breast lesion Diseases 0.000 title abstract description 10
- 201000011050 comedo carcinoma Diseases 0.000 claims abstract description 23
- 238000001959 radiotherapy Methods 0.000 claims abstract description 20
- 230000002980 postoperative effect Effects 0.000 claims abstract description 19
- 238000002271 resection Methods 0.000 claims abstract description 13
- 238000011065 in-situ storage Methods 0.000 claims abstract description 9
- 238000001794 hormone therapy Methods 0.000 claims description 4
- 208000006402 Ductal Carcinoma Diseases 0.000 claims description 3
- 239000003814 drug Substances 0.000 abstract description 2
- 208000028715 ductal breast carcinoma in situ Diseases 0.000 description 4
- 201000004933 in situ carcinoma Diseases 0.000 description 4
- 238000011835 investigation Methods 0.000 description 4
- 208000004434 Calcinosis Diseases 0.000 description 3
- 208000037396 Intraductal Noninfiltrating Carcinoma Diseases 0.000 description 3
- 206010028980 Neoplasm Diseases 0.000 description 3
- 239000002537 cosmetic Substances 0.000 description 3
- 230000003211 malignant effect Effects 0.000 description 3
- 230000000877 morphologic effect Effects 0.000 description 3
- 210000000056 organ Anatomy 0.000 description 3
- 238000004321 preservation Methods 0.000 description 3
- NKANXQFJJICGDU-QPLCGJKRSA-N Tamoxifen Chemical compound C=1C=CC=CC=1C(/CC)=C(C=1C=CC(OCCN(C)C)=CC=1)/C1=CC=CC=C1 NKANXQFJJICGDU-QPLCGJKRSA-N 0.000 description 2
- 201000007273 ductal carcinoma in situ Diseases 0.000 description 2
- 230000035755 proliferation Effects 0.000 description 2
- 201000009030 Carcinoma Diseases 0.000 description 1
- 208000035211 Heart Murmurs Diseases 0.000 description 1
- 208000037656 Respiratory Sounds Diseases 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 206010000496 acne Diseases 0.000 description 1
- 210000002469 basement membrane Anatomy 0.000 description 1
- 210000000481 breast Anatomy 0.000 description 1
- 201000011510 cancer Diseases 0.000 description 1
- 210000004027 cell Anatomy 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 230000002380 cytological effect Effects 0.000 description 1
- 210000002249 digestive system Anatomy 0.000 description 1
- 210000002919 epithelial cell Anatomy 0.000 description 1
- 230000002349 favourable effect Effects 0.000 description 1
- 230000002489 hematologic effect Effects 0.000 description 1
- 230000009545 invasion Effects 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 210000004185 liver Anatomy 0.000 description 1
- 210000004072 lung Anatomy 0.000 description 1
- 238000009607 mammography Methods 0.000 description 1
- 210000004115 mitral valve Anatomy 0.000 description 1
- 230000017074 necrotic cell death Effects 0.000 description 1
- 238000002559 palpation Methods 0.000 description 1
- 230000007170 pathology Effects 0.000 description 1
- 238000009527 percussion Methods 0.000 description 1
- 230000002062 proliferating effect Effects 0.000 description 1
- 230000000069 prophylactic effect Effects 0.000 description 1
- 208000020016 psychiatric disease Diseases 0.000 description 1
- 210000002345 respiratory system Anatomy 0.000 description 1
- 230000001020 rhythmical effect Effects 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 210000000952 spleen Anatomy 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 229960001603 tamoxifen Drugs 0.000 description 1
- 230000005740 tumor formation Effects 0.000 description 1
- 230000004580 weight loss Effects 0.000 description 1
Landscapes
- Apparatus For Radiation Diagnosis (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la oncologia glandei mamare şi poate fi utilizată pentru tratamentul diferenţiat al carcinomului ductal in situ neivaziv al glandei mamare. The invention relates to medicine, especially to mammary gland oncology and can be used for the differentiated treatment of non-invasive ductal carcinoma in situ of the mammary gland.
Este cunoscută metoda de tratament pentru carcinomul ductal in situ (CDIS), care constă în efectuarea mastectomiei cu radioterapie în perioada postoperatorie. Multicentricitatea adevărată a CDIS s-a dovedit a fi foarte rară. Dat fiind faptul că CDIS nu reprezintă o singură entitate independentă, ci un grup de tumori heterogene, iar fiece caz are anumite particularităţi, ce trebuie luate în consideraţie la alegerea tratamentului, este evident că o singură metodă nu va fi potrivită pentru toate formele de CDIS sau pentru toate pacientele [1]. The treatment method for ductal carcinoma in situ (DCIS) is known, which consists in performing mastectomy with radiotherapy in the postoperative period. True multicentricity of CDIS has been shown to be very rare. Given the fact that CDIS does not represent a single independent entity, but a group of heterogeneous tumors, and each case has certain particularities, which must be taken into account when choosing the treatment, it is obvious that a single method will not be suitable for all forms of CDIS or for all patients [1].
Dezavantajele metodei cunoscute constau în aceea că nu toate formele de carcinom ductal necesită efectuarea mastectomiei, care provoacă dereglări estetice şi psihice la pacientele tinere. The disadvantages of the known method are that not all forms of ductal carcinoma require mastectomy, which causes aesthetic and psychological disorders in young patients.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de tratament diferenţiat al carcinomului neinvaziv ductal in situ al glandei mamare pentru tratarea eficientă a fiecărei forme de cancer în parte, pentru a micşora numărul de recidive în formele cu o rată înaltă de apariţie a recidivelor, pentru un tratament cosmetic eficient în unele forme care permit păstrarea organului, pentru eficientizarea triajului femeilor primar stabilite cu carcinom neinvaziv pentru un tratament eficient şi pentru micşorarea cheltuielilor şi a timpului pentru investigaţii suplimentare, ceea ce duce la micşorarea termenului de spitalizare. The problem that the invention solves consists in developing a method of differentiated treatment of non-invasive ductal carcinoma in situ of the mammary gland for the effective treatment of each form of cancer separately, in order to reduce the number of recurrences in the forms with a high rate of occurrence of recurrences , for an effective cosmetic treatment in some forms that allow the preservation of the organ, for streamlining the triage of primary women diagnosed with non-invasive carcinoma for an effective treatment and for reducing the expenses and time for additional investigations, which leads to the reduction of the hospitalization period.
Esenţa invenţiei constă în aceea că se determină morfologic prezenţa de comedocarcinom sau de necomedocarcinom şi se efectuează examenul mamografic, unde se determină prezenţa unui singur focar, sau forma multifocală cu focare în acelaşi cadran cu o distanţă de 4…5 cm între ele, sau forma multicentrică cu focare în diferite cadrane sau cu o distanţă mai mare de 5 cm între ele, şi în cazul comedocarcinomului cu un singur focar se efectuează rezecţie sectorială cu radioterapie în perioada postoperatorie, în cazul comedocarcinomului multifocal se efectuează mastectomie cu radioterapie în perioada postoperatorie, în cazul comedocarcinomului multicentric se efectuează mastectomie cu radioterapie şi hormonoterapie în perioada postoperatorie; în cazul necomedocarcinomului cu un singur focar se efectuează rezecţie sectorială, în cazul necomedocarcinomului multifocal se efectuează rezecţie sectorială cu radioterapie în perioada postoperatorie şi în cazul necomedocarcinomului multicentric se efectuează mastectomie. The essence of the invention is that the morphological presence of comedocarcinoma or non-comedocarcinoma is determined and the mammographic examination is performed, where the presence of a single focus is determined, or the multifocal form with foci in the same quadrant with a distance of 4...5 cm between them, or the form multicentric with foci in different quadrants or with a distance greater than 5 cm between them, and in the case of comedocarcinoma with a single focus, sectoral resection with radiotherapy is performed in the postoperative period, in the case of multifocal comedocarcinoma, mastectomy is performed with radiotherapy in the postoperative period, in in the case of multicentric comedocarcinoma, mastectomy with radiotherapy and hormone therapy is performed in the postoperative period; in the case of noncomedocarcinoma with a single focus, sectorial resection is performed, in the case of multifocal noncomedocarcinoma, sectorial resection is performed with radiotherapy in the postoperative period, and in the case of multicentric noncomedocarcinoma, mastectomy is performed.
Rezultatul invenţiei constă în eficientizarea tratamentului pentru fiecare formă de carcinom neinvaziv ductal in situ, micşorarea numărului de recidive în formele cu o rată înaltă de apariţie a recidivelor, efectuarea unui tratament cosmetic eficient în unele forme care permit păstrarea organului, eficientizarea triajului femeilor primar stabilite cu carcinom neinvaziv cu efectuarea tratamentului eficient şi micşorarea cheltuielilor şi a timpului pentru investigaţii suplimentare, ceea ce duce la micşorarea termenului de spitalizare. The result of the invention consists in making the treatment more efficient for each form of non-invasive ductal carcinoma in situ, reducing the number of recurrences in the forms with a high rate of occurrence of recurrences, performing an effective cosmetic treatment in some forms that allow the preservation of the organ, making the triage of primary women established with non-invasive carcinoma with efficient treatment and reduction of expenses and time for additional investigations, which leads to a reduction of the hospitalization period.
Avantajele prezentei invenţii constau în determinarea rapidă a tacticii de tratament a fiecărei forme de carcinom neinvaziv ductal in situ, ceea ce duce la micşorarea numărului de recidive în formele cu o rată înaltă de apariţie a recidivelor, pentru unele forme care permit păstrarea organului se efectuează un tratament cosmetic eficient, efectuarea unui triaj eficient al femeilor primar stabilite cu carcinom neinvaziv cu stabilirea rapidă a tacticii de tratament şi micşorarea cheltuielilor şi a timpului necesar pentru investigaţii suplimentare, ceea ce duce la micşorarea termenului de spitalizare. The advantages of the present invention consist in the rapid determination of the treatment tactics of each form of non-invasive ductal carcinoma in situ, which leads to the reduction of the number of recurrences in the forms with a high rate of occurrence of recurrences, for some forms that allow the preservation of the organ, a effective cosmetic treatment, performing an effective triage of primary women established with non-invasive carcinoma with the rapid establishment of treatment tactics and the reduction of expenses and the time required for additional investigations, which leads to the reduction of the hospitalization period.
Carcinomul ductal in situ CDIS (carcinom intracanalicular, carcinom intraductal) este proliferarea celulelor maligne în interiorul ducturilor glandei mamare fără afectarea membranei bazale. CDIS este o patologie destul de heterogenă, care constă din leziuni proliferative caracterizate prin atipii celulare de la minime la majore şi aspecte arhitecturale foarte variate. După clasificarea europeană au fost diferenţiate trei categorii de CDIS: puţin diferenţiat, moderat diferenţiat şi bine diferenţiat. Ductal carcinoma in situ CDIS (intracanalicular carcinoma, intraductal carcinoma) is the proliferation of malignant cells inside the ducts of the mammary gland without damage to the basement membrane. CDIS is a rather heterogeneous pathology, which consists of proliferative lesions characterized by minimal to major cellular atypia and very varied architectural aspects. According to the European classification, three categories of CDIS were differentiated: slightly differentiated, moderately differentiated and well differentiated.
Din punct de vedere morfologic avem două tipuri de bază de CDIS: From a morphological point of view, we have two basic types of CDIS:
I - comedocarcinom (cu evoluţie nefavorabilă), I - comedocarcinoma (with unfavorable evolution),
II - necomedocarcinom (cu evoluţie favorabilă). II - non-comedocarcinoma (with favorable evolution).
Subtipuri: Subtypes:
1) micropapilar, 1) micropapillary,
2) papilar, 2) papillary,
3) solid, 3) solid,
4) cribriform. 4) cribriform.
Aceste forme rar se întâlnesc de sine stătător, de obicei sunt prezente minimum 2 subtipuri. Cea mai frecventă formă histologică este comedocarcinomul. These forms rarely occur alone, usually at least 2 subtypes are present. The most common histological form is comedocarcinoma.
Particularitatea comună a tuturor tipurilor morfologice este proliferarea celulelor epiteliale maligne în limita lumenului ducturilor fără invazie în stroma glandei mamare. Tipul comedo- are un aspect citologic mai malign, corespunde cu o necroză centrală ductală, care este prezentă în mai mult de jumătate de canale afectate, iar în 50% afectează un singur duct. The common feature of all morphological types is the proliferation of malignant epithelial cells within the lumen of the ducts without invasion into the stroma of the mammary gland. The comedo-type has a more malignant cytological appearance, corresponds to a central ductal necrosis, which is present in more than half of the affected ducts, and in 50% it affects only one duct.
Metoda se efectuează în modul următor. The method is performed as follows.
La pacientele cu suspecţii de carcinom neinvaziv in situ se determină morfologic prezenţa de comedocarcinom sau de necomedocarcinom şi se efectuează examenul mamografic, la care se determină prezenţa unui singur focar, sau forma multifocală cu focare în acelaşi cadran cu o distanţă de 4…5 cm între ele, sau forma multicentrică cu focare în diferite cadrane sau cu o distanţă mai mare de 5 cm între ele, şi în cazul comedocarcinomului cu un singur focar se efectuează rezecţie sectorială cu radioterapie în perioada postoperatorie, în cazul comedocarcinomului multifocal se efectuează mastectomie cu radioterapie în perioada postoperatorie, în cazul comedocarcinomului multicentric se efectuează mastectomie cu radioterapie şi hormonoterapie în perioada postoperatorie; în cazul necomedocarcinomului cu un singur focar se efectuează rezecţie sectorială, în cazul necomedocarcinomului multifocal se efectuează rezecţie sectorială cu radioterapie în perioada postoperatorie şi în cazul necomedocarcinomului multicentric se efectuează mastectomie. In patients with suspected non-invasive carcinoma in situ, the presence of comedocarcinoma or non-comedocarcinoma is determined morphologically and a mammographic examination is performed, in which the presence of a single focus is determined, or the multifocal form with foci in the same quadrant with a distance of 4...5 cm between them, or the multicentric form with foci in different quadrants or with a distance greater than 5 cm between them, and in the case of comedocarcinoma with a single focus, sectoral resection with radiotherapy is performed in the postoperative period, in the case of multifocal comedocarcinoma, mastectomy is performed with radiotherapy in the postoperative period, in the case of multicentric comedocarcinoma, mastectomy with radiotherapy and hormone therapy is performed in the postoperative period; in the case of noncomedocarcinoma with a single focus, sectorial resection is performed, in the case of multifocal noncomedocarcinoma, sectorial resection is performed with radiotherapy in the postoperative period, and in the case of multicentric noncomedocarcinoma, mastectomy is performed.
Radioterapia se efectuează în doză de 45...50 Gy pe parcursul a 5...6 săptămâni (câte 8 Gy în săptămână). Radiotherapy is performed in a dose of 45...50 Gy during 5...6 weeks (8 Gy per week).
Pentru efectuarea hormonoterapiei în formele necesare în perioada postoperatorie se utilizează Tamoxifen. Tamoxifen is used to carry out hormone therapy in the necessary forms in the postoperative period.
Exemplu de realizare Example of realization
Pacienta D., în vârstă de 43 ani, la examenul profilactic a fost depistată o tumoare în glanda mamară pe stânga. La mamografie s-a depistat carcinom ductal în glanda mamară stângă, forma unifocală, microcalcifieri 10...15 cm2. Starea generală a pacientei la internare este satisfăcătoare. Anamnestic, se consideră bolnavă de aproximativ 7 luni, cu o scădere ponderală de aproximativ 6 kg în ultimele 3 luni. La examenul obiectiv general: aparatul respirator - stare normostenică, sunet pulmonar la percuţie, auscultativ - murmur vezicular prezent în ambele câmpuri pulmonare; cordul - limitele absolute şi relative ale matităţii cardiace în normă, auscultativ - zgomote cardiace ritmice cu suflu diastolic la auscultaţia valvulei mitrale; aparatul digestiv - ficat, splină nepalpabile, abdomenul moale, indolor la palpare. Patient D., 43 years old, during the prophylactic examination, a tumor was detected in the mammary gland on the left. On mammography, ductal carcinoma was detected in the left mammary gland, unifocal form, microcalcifications 10...15 cm2. The general condition of the patient at admission is satisfactory. Anamnesis, she considers herself ill for about 7 months, with a weight loss of about 6 kg in the last 3 months. At the general objective examination: respiratory system - normosthenic state, lung sound on percussion, auscultatory - vesicular murmur present in both lung fields; the heart - the absolute and relative limits of normal heart dullness, auscultatory - rhythmic heart sounds with diastolic murmur when auscultating the mitral valve; digestive system - liver, spleen not palpable, abdomen soft, painful to palpation.
Investigaţie paraclinică - indicii hematologici în limitele normei. Paraclinical investigation - hematological indices within the norm.
Status localis: formaţiune tumorală palpabilă la nivelul sânului stâng, ce atinge dimensiuni de aproximativ 4x3 cm, localizată în cadranul inferior-lateral, nedureroasă. La examenul ultrasonografic se depistează fibroadenomatoză localizată, microcalcifieri. La examenul mamografic s-au depistat microcalcifieri 10...15 cm2 , după clasificarea Le Gal de gr. III. Pacienta a fost supusă unei rezecţii sectoriale cu efectuarea radioterapiei în perioada postoperatorie. Status localis: palpable tumor formation in the left breast, measuring approximately 4x3 cm, located in the lower-lateral quadrant, painless. The ultrasonographic examination reveals localized fibroadenomatosis, microcalcifications. During the mammographic examination, microcalcifications 10...15 cm2 were detected, according to the Le Gal classification of gr. III. The patient underwent a sectoral resection with radiotherapy in the postoperative period.
La examenul histopatologic: carcinom ductal neinvaziv in situ, comedocarcinom. Pacienta a fost externată în stare satisfăcătoare şi monitorizată pe parcursul a 5 ani. Recidive nu s-au depistat. At the histopathological examination: non-invasive ductal carcinoma in situ, comedocarcinoma. The patient was discharged in satisfactory condition and monitored for 5 years. Recurrences were not detected.
1. Robert E. Mansel. Ductal carcinoma in situ: surgery and radiotherapy. 2003, №12, p. 447-450 1. Robert E. Mansel. Ductal carcinoma in situ: surgery and radiotherapy. 2003, №12, p. 447-450
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Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20080031A MD36Z (en) | 2008-12-02 | 2008-12-02 | Method for differential treatment of noninvasive ductal carcinoma in situ of mammary gland |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20080031A MD36Z (en) | 2008-12-02 | 2008-12-02 | Method for differential treatment of noninvasive ductal carcinoma in situ of mammary gland |
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| Publication Number | Publication Date |
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| MD36Y true MD36Y (en) | 2009-06-30 |
| MD36Z MD36Z (en) | 2010-01-31 |
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| Application Number | Title | Priority Date | Filing Date |
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| MDS20080031A MD36Z (en) | 2008-12-02 | 2008-12-02 | Method for differential treatment of noninvasive ductal carcinoma in situ of mammary gland |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD3860G2 (en) * | 2008-04-02 | 2009-11-30 | Институт Сельскохозяйственной Техники "Mecagro" | Cavitation generator with centrifugal pump |
Family Cites Families (21)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD106C2 (en) * | 1993-11-12 | 1995-06-30 | Онкологический Институт Республики Молдова | Method of treatment for mamma cancer |
| MD446G2 (en) * | 1995-07-07 | 1996-11-30 | Онкологический Институт Республики Молдова | Method for mamma cancer treatment |
| US6107090A (en) * | 1996-05-06 | 2000-08-22 | Cornell Research Foundation, Inc. | Treatment and diagnosis of prostate cancer with antibodies to extracellur PSMA domains |
| CZ341297A3 (en) * | 1996-10-30 | 1998-05-13 | Eli Lilly And Company | Method of enhancing treatment of prophylaxis of mastocarcinoma |
| MD798G2 (en) * | 1996-11-15 | 1998-05-31 | Онкологический Институт Республики Молдова | Method of the mamma cancer treatment |
| MD962G2 (en) * | 1997-07-24 | 1998-12-31 | Онкологический Институт Республики Молдова | Method for radical mastectomy |
| TR200000532T2 (en) * | 1997-08-29 | 2000-11-21 | Biogen, Inc. | Methods and compositions for therapies using genes encoding secreted proteins. |
| EP1040847A4 (en) * | 1997-11-28 | 2005-09-14 | Masayuki Matsuura | Method of wave therapy and apparatus therefor |
| US6333348B1 (en) * | 1999-04-09 | 2001-12-25 | Aventis Pharma S.A. | Use of docetaxel for treating cancers |
| MD1630G2 (en) * | 1999-06-04 | 2001-09-30 | Онкологический Институт Республики Молдова | Method of radical mastectomy in breast cancer |
| UA74798C2 (en) * | 1999-10-06 | 2006-02-15 | Байоджен Айдек Ма Інк. | Method for treating cancer in mammals using polypeptide interfering with interaction between april and its receptors |
| MD1569G2 (en) * | 1999-12-17 | 2001-06-30 | Онкологический Институт Республики Молдова | Method of treatment of breast canceeeer in the preoperation period |
| GB0005257D0 (en) * | 2000-03-03 | 2000-04-26 | Pharmacia & Upjohn Spa | Breast cancer hormonal therapy |
| GB0015446D0 (en) * | 2000-06-23 | 2000-08-16 | Pharmacia & Upjohn Spa | Combined therapy against tumors comprising substituted acryloyl distamycin derivates,taxanes and/or antimetabolites |
| GB0015447D0 (en) * | 2000-06-23 | 2000-08-16 | Pharmacia & Upjohn Spa | Combined therapy against tumors comprising substituted acryloyl derivates and alkylating agents |
| GB0015444D0 (en) * | 2000-06-23 | 2000-08-16 | Pharmacia & Upjohn Spa | Combined therapy against tumors comprising substituted acryloyl distamycin derivatives and topoisomerase I and II inhibitors |
| US6576612B1 (en) * | 2000-10-02 | 2003-06-10 | Pharmacia Italia S.P.A. | Antitumor therapy comprising distamycin derivatives |
| MD2849G2 (en) * | 2005-05-16 | 2006-04-30 | Василе ЖОВМИР | Method of mammary cancer treatment to patients of old age |
| MD3248G2 (en) * | 2006-06-30 | 2007-09-30 | Василе ЖОВМИР | Method of mammary cancer treatment |
| MD3671G2 (en) * | 2007-11-02 | 2009-09-30 | Онкологический Институт Республики Молдова | Method of subtotal mastectomy in the mammary upper dial cancer |
| MD3772G2 (en) * | 2008-05-12 | 2009-07-31 | Общественное Медико-Санитарное Учреждение Онкологический Институт | Method for treating mammary cancer with metastases |
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2008
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD3860G2 (en) * | 2008-04-02 | 2009-11-30 | Институт Сельскохозяйственной Техники "Mecagro" | Cavitation generator with centrifugal pump |
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| Publication number | Publication date |
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| MD36Z (en) | 2010-01-31 |
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