Maltseva, E.A. Gafarova, G.Ch. Garipova

the role of melatonin in regulation of ovary function and opportunities of melatonin in treatment of symptoms of pathological climacterium

Kazan State Medical Academy, Department of obstetrics and gynecology №1, 11 Mushtary, Kazan 420012,

Tatarstan Republic, Russia

Pathological current of climacterium leads to significant decrease in quality of life of women. Hormone therapy has a number of contra-indications. With the purpose of optimization of treatment of patients with a climacteric syndrome search of new and more perfect approaches to therapy of climac­teric frustration is necessary. Melatonin production in a human body decreases with the years and its production in old age makes only half from its level. Age decrease of melatonin synthesis leads to pro­gressive decrease of woman fertility. In this connection the research of a level of melatonin in women with a climacteric syndrome depending on current of disease was carried out. The opportunity to use the Мelaxen in treatment of symptoms of pathological climacterium both in the form of monotherapy, and in combination with replacement hormone therapy was estimated. The greatest efficiency of ap­plication of Мelaxen in combination with hormone replacement therapy has been established.

Key words: melatonin, climacteric syndrome, pineal gland, pituitary hormones, katekcholamines, lipids of blood, Melaxen.

74

УСПЕХИ ГЕРОНТОЛОГИИ • 2007 • Т. 20, № 4

© Коллектив авторов, 2007 г Adv. Gerontol.-2007.-Vol. 20, № 4.-P. 75-78

УДК 616.351-006.6-085-053.9

D.P. Milosevic^[10], M. Kreacic^[11], N. Despotovic^[12], P. Erceg^[13], P. Milanovic^[14], G. Mihajlovic^[15],

S. Mitic^[16], M. David ovic^[17]

the principles of chemotherapy of colorectal cancer

in elderly

The prevalence of colorectal cancer (CRC) increases significantly with age, with 40% of patients in Europe being older than 74 years of age at the time of initial diagnosis. The individualized management of the older-aged patient with cancer is based on the answers to the following questions: 1) will the patient die of cancer or with cancer; 2) will the patient suffer cancer-related morbidity; and 3) is the patient able to handle the toxicity of treatment? More than chronological age, the following parameters are important when elderly patients are to be treated with antineoplastic agents: general condition, liver function, kidney function and bone marrow status. Frail elderly with malignant disease should not be treated with cytostatic therapy. In the case of fit elderly, the standard chemotherapy (i.e. FOLFOX) regimen could be administered. In elderly ineligible for combination chemotherapy, the capecitabine used orally, as a single-agent therapy, is an important therapeutic option for colorectal cancer.

Key words: colorectal cancer, frail and fit elderly patients, chemotherapy.

Incidence of malignant diseases in elderly

Malignant diseases are frequently encountered in el­derly. More than half of all malignant tumors in overall population are encountered in people 65 years of age or older. Possible explanations for this phenomenon are: age related altered hormonal regulation, altered immunoregula-tion allows malignant cell clone proliferation, and increased exposure to environmental cancerogenesis. Lung cancer occurs more frequently in men, while breast cancer is the most frequent malignant tumor in women. Most commonly encountered neoplasms in geriatric practice are colorectal (CRC), stomach, bladder, prostate, skin and cervical can­cer [6]. The prevalence of CRC increases significantly with age, with 40% of patients in Europe being older than 74 years of age at the time of initial diagnosis.

Given this frequency of malignant diseases, chemo­therapy is not infrequent in elderly. Experience from clinical practice indicates that the principles of antineoplastic treat­ment in elderly population are not defined. Also, there is widespread belief that elderly are infrequently suitable for chemotherapy. General purpose of chemotherapy is de­struction of malignant tumor if possible (complete remis­sion) or decreasing tumor burden (partial remission), where the primary goal is slowing of disease progression, improving quality of life and increasing survival. Interestingly, in octo­genarians the incidence of CRC is decreasing [8-10].

Incidence of CRC

Colorectal cancer is the leading cancer in developed countries in Europe and USA. Approximately 3000 new cases are registered in Serbia every year (incidence 60/100 000) [14]. The incidence of it is proportional to age with peak incidence between 6^th and 7^th decade. Only 20% of all cases occur in population younger than 50 years [11]. Most of the cases are localized in rectum (40%) and descendent colon (35%), but V3 of cases are localized proximal of lienal flexure [22]. Almost 95% of CRC are adenocarcinomas and they almost always originate from ad-enomatous polyps, except in rare cases of ulcerative colitis and Crohn‘s disease [22].

Etiology of CRC includes: 1) environmental factors: diet - high intake of lipids and proteins of animal origin, low intake of diet fibers; 2) genetic propensity, inherited or acquired (1% of all CRC originate from familiar polyposis and 5% from the Lynch syndrome; almost 15% of relatives of the CRC patients develop CRC); 3) ulcerative colitis and Crohn‘s disease; and 4) CRC has the best prognosis of all malignant tumors in digestive tube because it is slow growing. The problem is early detection since asymptomatic phase can last up to 5 years.

General principles of chemotherapy in elderly

The individualized management of the older-aged pa­tient with cancer is based on the answers to the following questions: 1) will the patient die of cancer or with cancer; 2) will the patient suffer cancer-related morbidity; and 3) is the patient able to handle the toxicity of treatment? Although chronological age is a poor reflection of physiologic age, two age landmarks have been identified: age 70, beyond which the incidence of age-related changes increases sharply [4], and age 85, when the last stage of life (frailty) begins

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