Camrelizumab is a monoclonal antibody against programmed cell death protein 1 (PD-1) which demonstrated clinical efficacy in esophageal squamous cell carcinoma including in combination with 1st line chemotherapy cases of advanced disease. The article describes a clinical case of administration of camrelizumab + capecitabin in combination with local ablative intervention in the form of stereotactic radiation therapy for treatment of oligoprogressing esophageal squamous cell carcinoma. This observation shows clinical advisability of continuing immunomodulating therapy in cases of limited tumor progression with simultaneous local control of the lesions with the highest biological activity.
Introduction. Laryngopharyngeal cancer is one of the most common head and neck cancers and is a socially significant pathology due to development of aphonia, dysphagia, and high rate of deaths and unfavorable outcomes. Currently, treatment of this pathology and fight against complications remain significant problems. The higher the disease stage, the higher mortality. According to the statistical data, the majority of patients with stage III–IV laryngopharyngeal cancer die in the first year after diagnosis due to severe adverse events such as laryngeal stenosis, dysphagia with subsequent dystrophia, as well as hemorrhages from vessel erosion in the larynx or tumor decay. If laryngeal stenosis or dysphagia are not managed by stoma, hemorrhage due to vessel erosion and diffuse bleeding from the pharynx can cause fatal outcomes. Aim. To study the rate and type of complications, outcomes in patient with stage III–IV laryngopharyngeal cancer in the first year during induction chemotherapy. Materials and methods. Data of 69 patients with stage III–IV laryngopharyngeal cancer who received comprehensive treatment between June of 2022 and July of 2024 at the Altai Regional Oncological Dispensary (Barnaul) were analyzed. The study group included 7 patients who developed hemorrhage during 1 course of induction chemotherapy. The comparison group included 62 patients without this complication. Risk of thromboembolic complications per the Khorana scale was low or intermediate: 1–2 points. Risk of hemorrhage per the American College of Chest Physicians (AССP) scale 2016 in the total group (n = 69; 100 %) was high: 4–8 points. The main risk factors, methods and long-term treatment results, as well of causes of death and recurrence-free survival after treatment completion 1 year later were analyzed. The type and rate of hemorrhages and their role in deaths, adverse event prevention measures were evaluated. Results. In 7 (10.1 %) of 69 patients, hemorrhage developed after 1 course of chemotherapy (study group). Two significant risk factors associated with hemorrhagic complications were identified: hemoptysis at diagnosis and presence of an ulcerative defect in the pharynx which increased the risk of this complication 27.8- and 25-fold, respectively. In 3 patients of the study group, diffuse hemorrhage from the tumor of volume 150 mL was observed. In the other 4 patients, profuse bleeding of volume up to 500 mL developed. Two (28.6 %) patients of the study group were at the remission stage. Deaths during treatment were reported in 5 (71.4 %) patients: they occurred 1–6 months after treatment completion. In the comparison group, 15 (24.2 %) patients were in remission, 2 (3.2 %) of which received treatment due to disease progression. During the first year after treatment completion, 41 (66.1 %) patients died. Survival of 3 (4.8 %) patients was above 12 months: 13, 14 and 15 months; 1 (1.6 %) patient died 19 months after therapy completion. Conclusion. In patients with stage III–IV laryngopharyngeal cancer, both the risk of venous thromboembolic complications (per the Khorana scale) and the risk of hemorrhages (per the АССР 2016 scale) should be determined. Hemorrhagic complications develop in 10.1 % of cases. Additionally, significant factors of bleeding from the pharynx are hemoptysis at diagnosis and presence of an ulcerative defect in the pharynx. In every case of bleeding from the tumor, tumor site and blood loss volume should be takin into account. Diffuse bleeding should be managed by short courses of tranexamic acid (for 3 days). Patients with profuse ulcerative hemorrhage require ligation of the external carotid artery on the affected side.
Laryngeal cancer remains one of the most common localizations of malignant tumors of the head and neck. Despite the availability of modern diagnostic methods, the frequency of delayed and erroneous diagnosis remains high, which negatively affects the prognosis and survival of patients. The article presents clinical cases of both standard and non-standard laryngeal cancer, in which it was difficult to diagnose in a timely manner.
Introduction. Sphenoid sinus (SS) is a very rare site of inverted papilloma (IP). Surgery of IP located in the SS is complicated due to close proximity of vital structures and high risk of their damage during the operation. Radical surgery involving resection of the primary site of tumor growth and adherence to oncological principles is very complex due to the risk of severe complications. Some authors consider SS IP to be unresectable. Therefore, there are very few publications on this topic in the scientific literature. Aim. To analyze a case series of treatment of IP located in the SS and resected endoscopically endonasally, as well as compare our data with the results presented in literature. Materials and methods. Literature data and our experience of treating patients with SS IP which previously were considered unresectable were analyzed. In 7 years, between 2019 and 2025, at the Burdenko National Medical Center of Neurosurgery and Center of Head and Neck Surgery of the Ilinskaya Hospital, 12 patients with this pathology (2 (16.7 %) women and 10 (83.3 %) men) received treatment. Mean patient age was 60 (26–76) years. In 2 (16.7 %) patients with multifocal SS IP growth and recurrence, who underwent multiple previous surgeries, with the initial growth sites in the area of the optic canal and posterior SS wall with its destruction in one case and in the area of lateral SS wall in the other case, squamous cell carcinoma was diagnosed. Results. All patients underwent endoscopic IP resection. In 9 (75 %) cases, extended sphenoidotomy with resection of the initial IP growth site was performed, in 3 (25 %) of the cases, surgery was performed in 2 stages. Follow-up of 11 patients was 40.2 (26–68) months; 1 patient was lost to follow-up. Recurrence developed in 2 (18.2 %) patients with multicentric IP growth (with diagnosed squamous cell carcinoma). Both patients died (5 and 1.5 years after the surgery). No recurrences were observed in other patients. Conclusion. Inverted papilloma of the SS is a very rare pathology. Its surgical treatment is complicated and associated with high risk of severe intraoperative complications. These surgeries should be performed by experienced surgeons using intraoperative navigation. The risk of recurrence after SS IP resection is significantly higher (18.2 %) than for IP in other sites. Conversely, high probability of malignant transformation of SS-located IP is present due to impossibility of its radical resection in some cases. For best results, we recommend extended endoscopic access to the SS using intraoperative navigation and multiple-stage surgical intervention in cases when IP cannot be resected in one step. Additionally, regular life-long follow-up of patients after surgery is necessary with frequency of once every 6 months for early detection of recurrence which can be resected endoscopically.
The problem of diagnosis and treatment of malignant neoplasms of the oral cavity is extremely relevant including association with specific postoperative disorders such as problems with breathing, swallowing, pronunciation and voice. Modern studies on therapy of this pathology are aimed both on oncological radicalness and search for innovative solutions for maximal preservation of patients’ quality of life in the framework of interdisciplinary interaction between specialists at medical and psychological stages of rehabilitation. The article presents a clinical case of successful comprehensive rehabilitation of a patient after hemiglossectomy with subsequent surgical reconstruction. Rehabilitation tactics including preoperative preparation, as well as timely and continuous logopedic work with psychological support, promote increased efficacy of recovery of functions damaged during combination treatment of patients with cancer of the oral cavity.
Currently, incidence of skin cancer is growing both in Russia and other countries. Basal cell carcinoma is the most common malignant tumor of this location. Morbidity growth is associated with aging population, as well as excessive insolation and sunburns, especially among white-skinned population. Locally advanced and metastatic basal cell carcinoma is rare, but its treatment is complicated. The article presents a clinical observation of treatment of a female patient with locally advanced basal cell carcinoma on the face and multiple registered recurrences who received several courses of antitumor treatment. This case demonstrates high efficacy and good tolerability of 3D conformal radiation therapy in this pathology.
Introduction. Adenocystic nasopharyngeal carcinoma is a rare but highly aggressive malignancy arising from the tissue of the minor salivary glands. Currently, there is no consensus in the medical community regarding the optimal treatment method. The priority of surgery over radiation therapy, as well as the advisability of monotherapy versus combination approaches, remain controversial. Aim. To summarize the clinical characteristics of adenocystic nasopharyngeal carcinoma based on an analysis of 13 cases from a single institution, with the aim of optimizing therapeutic approaches for treating patients with these rare tumors. Materials and methods. A retrospective analysis of data from 13 patients with nasopharyngeal adenocarcinoma treated at the N. N. Blokhin National Medical Research Center of Oncology from 1989 to 2023 was conducted. All patients underwent conservative chemoradiation therapy: in 6 cases – concurrent chemoradiation therapy, in 7 cases – induction chemotherapy followed by radiation or chemoradiation. Results. A complete clinical effect was achieved in 9 patients, a partial effect in 4. Disease progression was noted in 7 cases: local recurrence in 3 patients, continued tumor growth in 1, distant metastases in 3. The five-year survival rate was 38.5 %. Five patients died during the first two months, another three were lost to follow-up 5–15 months after the start of treatment. The median overall survival was 28 months. Conclusion. Adenoid cystic carcinoma of the nasopharynx is an extremely rare pathology. Although the standard treatment is surgery followed by radiation therapy, when radical surgery is not possible in patients with locally advanced disease, chemoradiation therapy becomes the treatment of choice.
Thyroid cancer is taking a leading position worldwide. This increase can be connected to both environmental factors and improved diagnostic techniques. Surgery remains the primary treatment for thyroid cancer. As a result, researchers are exploring alternative approaches to avoid visible scarring on the anterior neck. It has already been proven that a noticeable scar causes psychological and emotional discomfort in patients, leading to the development of anxiety and depressive disorders, especially in cases with young women and children. Over the past 30 years, minimally invasive thyroid surgery has undergone significant changes. Extracervical endoscopic approaches and their combinations, as well as transoral techniques for thyroid removal, are actively used in many advanced centers in Russia and all over the world. The most modern approach is the hybrid approach, which combines the techniques of transoral and submental thyroidectomy. This article presents the first clinical experience of using transoral endoscopic hemithyroidectomy through a transoral-submental approach in the Russian Federation in a patient with thyroid cancer.
Introduction. Despite the advancements in science and technology, results of antitumor treatment of recurrent oral squamous cell carcinoma (rOSCC) remain unsatisfactory: patient survival is very low. In cases of recurrent disease, single-step glossectomy, subtotal segmental mandibulectomy and laryngectomy are feasible. Aim. To analyze the results of combination surgical treatment of rOSCC using glossectomy, subtotal segmental mandibulectomy and laryngectomy after previous unsuccessful antitumor treatment to improve outcomes of treatment of recurrences and continued growth of locally advanced cancer. Materials and methods. Single-center prospective study was conducted. It included patients with recurrent squamous cell carcinoma of the oral mucosa and larynx with indications for antitumor treatment using multicomponent surgical intervention in the framework of comprehensive treatment. The case of the treatment of recurrent laryngeal cancer served as a prototype for the development of techniques for simultaneous glosectomy, segmental resection of the mandible and laryngectomy. Two patients had malignant neoplasms of the oral mucosa: in one case, stage рT3N0M0 III tongue cancer, condition after hemiglossectomy, level I–II–III cervical lymph node dissection and radiotherapy; in the other case, stage рT3N0M0 III rOSCC after radiation therapy. Results. During surgery, skin resection was performed above the tumor component of the submandibular area due to signs of derma invasion and danger of penetrating growth with intradermal dissemination caused by postradiation edema. For defect reconstruction, in 1 patient with laryngeal cancer and 1 patient with rOSCC, pectoralis major myocutaneous flap was used. In 1 case of rOSCC, due to rapid wight loss during radiation therapy, primary reconstruction with pharyngostomy formation with total defect of the tongue, mandible and larynx was not performed. Local purulent and necrotic postoperative complications were observed in all 3 patients. In the first 30 days after the surgery, 1 patient with rOSCC died at the hospital; 30-day mortality after combination surgeries was 33 %. Another patient with rOSCC died 2.5 months after discharge, a little more than 90 days (3.5 months) after the surgery. The patient with laryngeal cancer is currently alive without signs of disease. Conclusion. The surgical interventions described are life-saving surgeries due to exhausted capabilities of radiation therapy, supposed low efficacy of antitumor drug therapy in the presence of a mass of crumbling tissues.
Introduction. Growing incidence of oropharyngeal cancer is one of the reasons for increased interest in possibilities of surgical treatment of this pathology which currently is associated with not always available robot-assisted interventions. Therefore, study of the efficacy of traditional surgical accesses is of certain interest. Aim. To analyze the effectiveness of transoral access and lateral pharyngotomy in T1–2 squamous cell oropharyngeal cancer. Materials and methods. The study included 74 patients, ages between 34 and 74 years (mean age 55.3 ± 9.1), with squamous cell carcinoma of the palatine tonsils and root of the tongue. In 38 cases, primary tumor was resected through transoral access (group 1); in 36 cases, using lateral pharyngotomy (group 2). Analysis of postoperative period included evaluation of the number and type of complications, number of repeat surgical interventions, duration of tube feeding and hospitalization. Treatment efficacy was determined taking into account the incidence of local and regional recurrences, locoregional control, and overall survival. Results. Complication rate, mean tube feeding and hospitalization times in the 2nd group were significantly higher than in the 1st group: 36 % versus 3 %, 14.3 days versus 10.6 days and 17.0 days versus 10.4 days, respectively. No differences between the numbers of repeat surgeries and cases of salivary fistula formation were found. With median follow-up of 47 (4–122) months, rates of local and regional recurrences in the 1st and 2nd groups were 11 and 11 %, 11 and 13 %, respectively. In group 1, locoregional control was achieved in 84 % patients; in group 2, in 81 %. Distant metastases were diagnosed in 8 and 17 % cases, respectively. There were no statistically significant differences in this parameter between the groups. Five-year overall survival in the total cohort was 71.2 %. Conclusion. The use of transoral access and lateral pharyngotomy in T1–2 oropharyngeal cancer is characterized by relatively high efficacy and acceptable rate of postoperative complications.
Introduction. Altai region has high incidence of thyroid cancer (TC) which served as motivation for development of a multivariable logistic prognostic model based on clinical and amnestic patient data with determination of low, intermediate, and high risks of the disease. The use of the model in clinical practice can promote optimization of examination volume and formation of priority groups for in-depth diagnostics. Aim. To evaluate diagnostic value of a multivariable logistic model for TC prognosis and analyze distribution of a linear predictor in various clinical groups for identification of areas of low, intermediate and high risks. Materials and methods. Single-center retrospective study including 1463 patients with diseases of the thyroid was conducted. The main group consisted of 505 sequentially examined and surgically treated patients with morphologically confirmed TC; the control group included 958 patients without oncological pathology of the thyroid (operated due to suspicion of a tumor with subsequent morphological exclusion and selected during prophylactic examinations). The set of clinical-anamnestic, anthropometric, and phenotypic characteristics was formed based on the results of previously published study on TC risk factors in the Altai population. Using survey patient data, a set of characteristics Х1–X26 was composed. Statistical analysis included descriptive statistics, univariate logistic analysis with categorization of quantitative variables per ROC criteria, as well as development of a multivariate logistic model with stepwise predictor selection. For the final model, χ2 test, area under the ROC curve (AUC), sensitivity and specificity at optimal threshold were assessed; internal validation was performed using the bootsrap method. For clinical interpretation, distribution of a linear predictor z was analyzed in the TC group, non-TC group, as well as in patients with diffuse and nodular diseases of the thyroid and subgroups with stage T1a–4 tumors. Results. The final multivariate logistic model included a limited set of independent demographic, anthropometric, and anamnestic predictors and demonstrated satisfactory discriminating ability with acceptable AUC values per internal validation. Distribution of the linear predictor showed increase in z values in patients with TC. Small range of values of this parameter was predominantly observed in patients without TC, presence of marked "grey area" – in patients with diffuse and nodular thyroid diseases. Comparison of T categories did not show clear correlation between T stage and the value of the linear predictor. Conclusion. The multivariate logistic model developed based in clinical and anamnestic data of the Altai patients allows to identify 3 areas of linear predictor z values corresponding to low, intermediate, and high TC risks. Its application in clinical practice can promote rationalization of examination volume and identification of priority groups for in-depth diagnostics in regions with high TC morbidity.
The article provides a review of the literature on the problems of voice prosthetics that specialists face in real clinical practice. A comparison of this method with other methods of restoring vocal function is presented, and non-standard clinical cases of treating patients with malignant tumors of the larynx who underwent laryngectomy with tracheoesophageal bypass surgery and the installation of a vocal prosthesis are described.
Introduction. Oral mucosal cancer is one of the most complex tumors of the head and neck. most patients seek help with a locally advanced process where the tumor affects surrounding organs and tissues. Surgical treatment in such cases is accompanied by significant functional and aesthetic disorders, and 5-year disease-free survival does not exceed 50 %. In this regard, additional treatments for oral mucosal cancer, such as neoadjuvant chemotherapy, which can improve survival rates, are being actively investigated.Aim. To evaluate the efficacy of neoadjuvant chemotherapy and its impact on survival in patients with locally advanced oral mucosal cancer.Materials and methods. The study included 188 patients with resectable locally advanced stage III–Iv oral mucosal cancer (T2 – T4N0–2c) who were treated at the N. N. Blokhin National Oncology Research medical Center from 2013 to 2023. patients were divided into 2 groups. group 1 (n = 38) included patients who underwent neoadjuvant chemotherapy followed by surgery, group 2 (n = 150) included patients who underwent surgical treatment with adjuvant radiation / chemoradiation therapy. In 55.3 % of cases, the DCf regimen (docetaxel, cisplatin, 5-fluorouracil) was used, in 18.4 % – Cp (carboplatin, paclitaxel), in 26.3 % – pf (cisplatin, 5-fluorouracil). Clinical and morphological responses were assessed by solid tumor response criteria (Response evaluation criteria in solid tumors, RECIST 1.1). Statistical analysis was performed using IBm SpSS Statistics 27 software.Results. In 44.7 % of patients with locally advanced oral mucosal cancer, neoadjuvant chemotherapy provides a clinical response to treatment, in 25 % of patients – with a pronounced morphological tumor response (grade III–Iv). It was found that in the neoadjuvant chemotherapy group, the incidence of disease progression is significantly lower than in the surgical treatment group (34.2 % versus 53.3 %), overall survival rates are better (48.7 % versus 40.4 %). In patients with a pronounced morphological response after neoadjuvant chemotherapy, the recurrence rate was lower than in patients with a worse response: in 12.5 and 29.2 % of cases, respectively. Nevertheless, there were no significant differences in survival rates between the neoadjuvant and surgical treatment groups (p = 0.063).Conclusion. Neoadjuvant chemotherapy contributes to improved treatment outcomes for locally advanced oral mucosal cancer. An increase in the number of patients with a pronounced morphological response can lead to a statistically significant increase in survival rates.
Cancer of the nasal mucosa is a malignant tumor originating from the mucous epithelium of the nasal cavity or paranasal sinuses. Nasal and paranasal sinus cancer accounts for 1.4 % of all malignancies and 3–5 % of head and neck tumors. males are twice as likely to be affected as females, particularly those aged 55 years and older (nearly 80 % of cases). The five-year survival rate is 8 2 % in patients with stage I disease and 43 % in patients with stage Iv disease. Despite the advances in the diagnosis of nasal cancer, over 80 % of new patients are diagnosed with stage III–Iv disease because of nonspecific symptoms in early (I and II) stages. Traditional treatment methods (including surgery, radiation therapy and chemotherapy) often allow us to achieve complete recovery in patients with this disorder. However, in most patients with locally advanced cancer, this approach has a limited effectiveness and is often associated with severe side effects. Considering frequent progression of nasal squamous cell carcinomas on standard regimens, it is necessary to search for new treatment targets to improve outcomes. Extensive molecular testing using multigenic panels based on next-generation sequencing can be helpful in this case. The most common mutations in nasal cancers occur in five genes: TP53 (up to 80 % of cases), EGFR (up to 77 % of cases), IDH2 (approximately 55 % of cases), PIK3CA (14 % of cases), and CDKN2A (9 % of cases). we report a case of successful treatment of a patient with locally advanced, non-resectable, drug-resistant nasal squamous cell carcinoma with a rare driver mutation.
Introduction. A fairly large number of cancer patients with surgical pathology enter a hospital with nutritional insufficiency of varying degrees. According to the international screening study Nutrition Day, weight loss is associated with a higher risk of inpatient death within 30 days in patients undergoing surgery as compared with patients who were not treated surgically. pain syndrome in the postoperative period has a negative effect on all vital systems of the body, increases the wound healing period and creates a risk of adverse hemodynamic events, thromboembolic complications and chronic pain syndrome. Enhanced sympathetic stimulation inhibits peristalsis and enhances the smooth muscles tone of the intestine, which is fraught with the development of postoperative intestinal paresis. Opioid-associated adverse events such as respiratory depression, gastrointestinal disorders (nausea, vomiting, constipation), sleep, endocrinopathies, cognitive impairment, high risk of addiction and drug dependence impair the quality of care providedAim. To compare the effectiveness and safety of the innovative Russian analgesic Tafalgin® and morphine in cancer patients with nutritional insufficiency in the early postoperative period.Materials and methods. The open-label randomized controlled trial included 80 patients who underwent abdominal surgery. patients received multimodal analgesia with either tafalgina or morphine.Results. According to the data obtained during the study, tafalgin provides analgesia comparable to morphine, while contributing to earlier mobilization, reducing the length of hospital stay, reducing the incidence of postoperative complications, hypoxemia, nausea and vomiting. The drug was also associated with lower severity of sedation and daytime sleepiness.Conclusion. Tafalgin has demonstrated high analgesic potential and a better safety profile as compared to morphine allowing its use in multimodal analgesia in cancer patients with nutritional insufficiency after abdominal surgery.
Inflammation of the submandibular region occurs quite often in dental practice. The ethology and clinical manifestations of this pathology are diverse and despite the great possibilities of conservative therapy, in some cases it is necessary to perform surgical intervention. The causes of inflammation in the submandibular region are odontogenic diseases, lymphadenopathies, sialorrhea, neoplasms of submandibular salivary glands and sialolithiases. The odontogenic abscesses (88.9 % of cases) and phlegmon (2.7–3.4 % of cases) of the maxillofacial region account for 88.9 % of oral infections. Odontogenic diseases are accompanied by impaired colonization resistance of the oral cavity and are of a big problem. Lifadenopathies in the submandibular region occur in 70 % of cases, while surgical treatment is required for 4 % of patients with this pathology, intensive postoperative medical therapy – 1.7 %, lethality occurs in 0.12 % of cases. Sialorrhea often develops in patients with mental retardation, cerebral palsy, autism, and neuromuscular or sensory dysfunctions. with low efficacy of anticholinergic drugs or botulinum toxin arministration, the main treatment is submandibular resection. Benign neoplasms of the submandibular salivary glands occur in 13 % of cases and are malignancies more often than tumors of the parotid gland. Neoplastic diseases of the submandibular glands of the maxillofacial region account for 34 to 54 %. The most common pathology of these glands is salivary stone disease which occurs in 80–90 % of cases.Aim. To analyze the main causes of inflammation in the submandibular region, requiring surgical intervention
Introduction. Laryngeal cancer is an important malignancy of the head and neck, with an estimated incidence of 238,000 cases per year. The main risk factors are smoking, human papillomavirus infection, and exposure to occupational carcinogens. Treatment of laryngeal cancer with T1–2 includes surgery and radiation therapy, but both methods have disadvantages: there is a risk of relapse after radiation therapy, and functional impairment after surgery, which necessitates optimization of treatment methods. photodynamic therapy is a promising organ-preserving method based on the targeted destruction of tumor cells by activating the photosensitizer accumulated in them with visible red light.Materials and methods. The study analyzed the results of combined treatment with intraoperative photodynamic therapy in 74 patients with laryngeal cancer from 2017 to 2023. Inclusion criteria: morphologically confirmed squamous cell carcinoma of the larynx, T1–2 tumor extent and absence of distant metastases. patients were administered photosensitizer (chlorin E6) intravenously 3 hours before surgery. Surgical treatment included endolaryngeal or open laryngeal resections followed by intraoperative photodynamic therapy on the bed of the removed tumor. Oncological and functional results were then assessed for 24 months.Results. Local recurrence was recorded in 2 (2.7 %) patients in the 1st year and in 3 (4.17 %) patients in the 2nd year. Overall survival was 100 %, larynx preservation was 95.9 %. In the group with a positive resection margin (n = 11), progression was noted in 2 patients. Respiratory, swallowing and vocal functions were restored in all patients. No complications associated with photodynamic therapy were registered.Conclusion. The high efficiency of a combined approach involving the use of intraoperative photodynamic therapy in early-stage laryngeal cancer has been demonstrated. This method has provided good oncological and functional results. In some cases, it allows you to avoid adjuvant radiation therapy, reduce the risk of complications and shorten the rehabilitation period. further studies of the long-term results of such a combined method will help assess the prospects for its implementation in clinical practice.
Introduction. Squamous cell carcinoma of the nasal cavity and paranasal sinuses is one of the rare malignancies. In about 80 % of cases, this pathology is diagnosed at stage III–Iv, which causes an unfavorable prognosis of the disease.Aim. To evaluate effectiveness of an integrated approach to treatment of stage III–Iv squamous cell carcinoma of the nasal cavity and paranasal sinuses.Materials and methods. The study included 126 patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses who were treated and observed during 2000–2020 at the N. N. Blokhin National medical Research Center for Oncology. Depending on the choice of treatment tactics at the 1st stage, patients were divided into 3 groups. group 1 (n = 55) included patients who underwent conservative treatment (radiation or chemoradiation) therapy in an independent version, group 2 (n = 31) – patients who underwent surgery with adjuvant radiation therapy, group 3 (n = 40) – patients who underwent induction radiation or chemoradiation therapy with subsequent surgery. Results. Overall 5-year survival rates did not differ between the 3 groups (p 0.05). At the same time, 5-year progression-free survival in group 2 (surgery + adjuvant radiation or chemoradiation therapy) was significantly higher (50.5 %) as compared with groups 1 (conservative treatment) (17 %; p = 0.021) and 3 (induction radiation or chemoradiation therapy + surgery) (25.5 %; p = 0.031). The five-year progression-free survival of patients with T3 tumor in group 2 was 59.4 %, which was significantly higher than in groups 1 (17.9 %; p = 0.021) and 3 (27.1 %; p = 0.031). However, there were no between-group differences in progression-free survival in patients with T4 tumor.Conclusion. Local recurrence is the most common cause of disease progression. Surgery with adjuvant radiation therapy, especially in patients with T3 tumor, improves the prognosis of the disease. At the same time, it is advisable to conduct conservative treatment to patients with T4 tumor.
Introduction. Anemia is a common complication of malignancies and anticancer treatment. In this regard, it is of great importance to predict the most likely outcomes in cancer patients with this pathology in the distant and medium periods.Aim. To analyze the factors that determine the prognosis in patients with anemia in malignant neoplasms and develop a methodological approach to predicting adverse, including fatal, outcomes in such patients in 3- and 5-year follow-up periods.Materials and methods. A cohort retrospective study was conducted. A group of patients with anemia in malignant neoplasms who received medical care was identified. To assess the factors that determine the outcome of this pathology, patients are divided according to the binary principle. The minimum sample size was determined using Altman nomograms. methods of non-parametric statistics (χ2-criterium) were used for statistical processing of data. The assessment of factors that cause an unfavorable prognosis in patients with anemia in malignant neoplasms was carried out by calculating the diagnostic coefficient according to A. wald and the informative coefficient according to S. kulbak.Results. It was found that the greatest role in formation of an unfavorable outcome of cancer is played by cardiovascular diseases, diabetes mellitus and cirrhosis of the liver. Among the therapeutic measures, the pathogenetic treatment of anemia with drugs that stimulate erythropoiesis, started during the period of antitumor therapy, has the greatest effect on the favorable outcome, which causes an increase in frequency of favorable outcomes to 5.5 and 4.8 % over 3 and 5 years, respectively.Conclusion. The methodological approach developed by us to assess probabilities of formation of adverse outcomes in patients with anemia in malignant neoplasms can be used to solve expert and clinical problems, determination the risk of an unfavorable outcome and justification the indications for the timely start of therapy.
Ductal adenocarcinoma of the gland is a rare malignancy characterized by high rate of metastasis and poor survival. Immunohistochemical findings indicate that 40 % of patients demonstrate overexpression of the human epidermal growth factor receptor 2 (HER2) (2–3+). In patients with distant metastases, targeted anti-HER2 therapy is the only effective method.This article describes our experience of successful targeted therapy in a patient with HER2-positive ductal adenocarcinoma of the submandibular gland.
