Laryngeal cancer occupies a leading place among malignant tumors of the ENT organs, remaining a serious medical and social problem. The main treatment method for locally advanced and recurrent laryngeal tumors is laryngectomy, which leads to loss of voice function and a significant decrease in the quality of life of patients. As a result, restoration of the voice function is an important task of rehabilitation after such surgeries. The article presents a clinical observation of a patient with recurrent laryngeal cancer after combined treatment, who underwent laryngectomy with simultaneous reconstruction using an ileocolic autograft. The rarity of the use of this technique and the satisfactory functional result achieved served as the basis for the publication of this clinical case.
The implementation of the federal project “Fight against oncological diseases”, (2019—2024 year), has become one of the priorities in the field of healthcare organization, both at the Federal and regional levels. Significant financial investments aimed at additional equipping of medical organizations providing primary, specialized, high-tech care to cancer patients and the proper level of modern drug treatment were accompanied by extensive organizational and methodological work. The criterion for the effectiveness of the regional cancer service in the designated time period was the target (indicator) indicators, the achievement of which testified to the correct way to reform the entire system of care for patients with malignant neoplasms. In the Ryazan region, as in many other regions of Russia, the implementation of this project has led not only to the modernization of the existing material and technical base, but also to the formation of a three-tier cancer service system, the commissioning of a new treatment building of an oncological dispensary, and the emergence of a patient routing system within the region. The consequence of these changes was the growth of key statistical indicators and achievement of their target values by the end of 2024. Mortality from malignant neoplasms decreased from 219.5 to 196.5 cases per 100 thousand population. The share of malignant neoplasms detected at stages I—II increased from 56.7% to 63%. The share of patients with malignant neoplasms registered for 5 years and more out of the total number of patients with malignant neoplasms under dispensary supervision increased from 54.9% to 59.5%. One-year mortality of patients with malignant neoplasms decreased from 22.4% to 17.8%.
On February 19, 2026, a satellite symposium, “The Path to Innovation: Therapy for Metastatic Colorectal Cancer (mCRC) Today and Tomorrow,” was held as part of the XII RUSSCO Conference on Gastrointestinal Tumors. This symposium featured a comprehensive discussion of new, promising drug treatments for advanced colorectal cancer. Experts presented the latest clinical trial results, which have significantly influenced changes in mCRC treatment approaches, discussed promising new treatment methods, and focused on key updates to Russian clinical guidelines.
The long-term consequences of cancer treatment for women are becoming increasingly important. Early and premature menopause induced by surgery, chemotherapy, and hormone therapy is associated not only with a significant negative impact on quality of life, but also with the early development of age-associated diseases. The most effective method for their prevention and symptoms relief is menopausal hormone therapy (MHT), but the safety of its use in patients with a history of cancer remains a subject of debate. This article presents a systematic comparative analysis of international recommendations for the use of MHT in women following treatment for tumors of the female reproductive system. The level of expert consensus is assessed and areas of disagreement are identified.
Cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) in combination with endocrine therapy are the standard of care for HR+/HER2- metastatic breast cancer (mBC). However, the comparative effectiveness of different agents within this class in real-world clinical practice (RWCP) is insufficiently studied, particularly in the Russian population. Objective. To analyze the efficacy and safety of various iCDK4/6 (palbociclib and ribociclib) in real clinical practice at the St. Petersburg City Clinical Oncology Dispensary. Material and methods. A single-center retrospective cohort study with elements of prospective data collection was conducted. The analysis included 815 patients who received CDK4/6is in combination with endocrine therapy between January 2019 and March 2023. Progression-free survival (PFS), objective response rate, and univariate and multivariate analyses of various clinical and morphological factors influencing treatment efficacy were assessed. Propensity score matching (PSM) was used to minimize systematic bias when comparing palbociclib and ribociclib. Results. The median PFS in the overall population was 24.0 months (95% CI 20.2—27.8). In multivariate analysis, the presence of liver metastases (HR 1.95; p<0.001) and administration of CDK4/6i therapy in the second and subsequent lines (HR 1.34; p<0.001) were independent unfavorable prognostic factors. After PSM (n=174), the palbociclib and ribociclib groups were comparable in baseline characteristics; median PFS was 22 and 24 months, respectively (log-rank p=0.808). The objective response rate was higher in the palbociclib group (37.9% vs. 9.2%; p<0.001). Conclusion. In real-world clinical practice, CDK4/6 inhibitors demonstrate high effectiveness comparable to the results of registration trials. Palbociclib and ribociclib have similar PFS outcomes. Key factors worsening prognosis are visceral metastases (especially liver involvement) and later lines of therapy.
Malignant neoplasms of the head and neck organs are quite rare, but they are the leading causes of death in cancer patients. High mortality rates are associated with the peculiarities of the clinical course of tumors of this localization, their pronounced effect on the patient’s somatic status, as well as the highly toxic methods of antitumor treatment used. Due to the unique topographic and anatomical features of the structures of the head and neck, malignant tumors in the process of their growth can give a wide range of complications, significantly aggravating the clinical prognosis. Bleeding in the head and neck prevents the initiation or continuation of antitumor treatment, and in some cases is the reason for its complete rejection. The main method of hemostasis in such situations for a long time was open ligation of the branches of the external carotid artery or its trunk, which often led to the development of irreversible ischemic disorders and frequent recurrence of bleeding due to the opening of collateral blood flow. These disadvantages required the development and widespread implementation of new methods of hemostasis, which make it possible to stop bleeding in cancer patients with a lower risk of complications. Vascular embolization is used as one of these methods today. The purpose of this work is to review the scientific literature data on the methodology of vascular embolization of tumors of the head and neck, modern devices used for endovascular embolization and embolizing agents, complications of intraarterial embolization of tumor vessels during tumor bleeding, as well as the clinical significance of this method in the treatment of complications of the course of the tumor process in the head and neck.
Adrenocortical carcinoma (ACC) is a rare malignant tumor of the adrenal cortex, usually characterized by late detection, aggressive clinical course and unfavorable treatment prognosis. In some cases, patients with ACC have tumor invasion into the IVC, which requires vascular resection of varying extent (longitudinal or circular) with or without subsequent reconstruction. In this article, we report a case of a tumor of the right adrenal gland with tumor thrombosis of the IVC. The patient underwent radical nephradrenalectomy on the right with resection of the inferior vena cava and simultaneous vena cava plastic surgery with cryopreserved allograft under conditions of bypass cava-caval shunting. IVC replacement with cryopreserved allograft using parallel circulation is a rare surgical intervention requiring the work of a multidisciplinary team, with a limited number of cases that can be described in the literature, the authors of this article present this case for consideration.
Melanoma is a malignant skin pathology, the treatment of which, in case of resistance to drug treatment, is a challenge for oncologists. Having a number of morphological and radiobiological features, melanoma manifests itself as a disease sensitive to radiation therapy, especially, to hypofractional regimens. We present a literature review and a clinical case of treating a patient with multiple brain melanoma metastases, progressing on drug treatment. However, after radiation therapy, we achieved a pronounced therapeutic effect, with a significant increase in life expectancy.
Objective. To conduct a pharmacoeconomic analysis of capivasertib plus fulvestrant compared with alpelisib plus fulvestrant for the treatment of locally advanced or metastatic HR-positive, HER2-negative breast cancer in the Russian Federation. Material and methods. The cost analysis considered adult postmenopausal women with HR-positive, HER2-negative locally advanced or metastatic breast cancer harboring a PIK3CA mutation after relapse or progression on a treatment regimen including an aromatase inhibitor or after its completion. The comparator was alpelisib plus fulvestrant. As the indirect comparison showed no statistically significant differences in progression-free survival between the alternatives, a cost-minimization approach was used. The time horizon was 10 years. The budget impact analysis considered adult postmenopausal women with metastatic HR-positive, HER2-negative breast cancer with alterations in the AKT pathway (PIK3CA/AKT1/PTEN) after relapse or progression on endocrine therapy or after its completion, for whom chemotherapy was not indicated. Scenario 1 assumed switching patients with a PIK3CA mutation to alpelisib plus fulvestrant, whereas scenario 2 assumed treatment of the entire target population with capivasertib plus fulvestrant. The time horizon was 2 years. Results. The use of capivasertib plus fulvestrant was associated with a reduction in discounted costs of RUB 302.773 (15.0%) per patient compared with alpelisib plus fulvestrant. Treating the entire target population with capivasertib plus fulvestrant resulted in savings of RUB 114.12 million (11.1%) over 2 years compared with the scenario in which patients with a PIK3CA mutation received alpelisib plus fulvestrant, while the remaining patients received treatment according to current clinical practice. Conclusions. The use of capivasertib plus fulvestrant can reduce healthcare costs and expand the use of targeted therapy compared with alpelisib plus fulvestrant.
Endometrial cancer (EC) is a fairly common disease in the female population today. The main treatment is surgery. However, in some cases, patients need combined treatment: surgery in combination with a course of remote radiation therapy, brachytherapy or courses of drug treatment. Adjuvant treatment in these cases is prescribed in the presence of risk factors for disease progression and is necessary to increase overall and disease-free survival in patients with EC. For the correct prescription of adjuvant therapy, radiotherapists should know the risk factors for the progression of endometrial cancer after surgery and follow generally accepted clinical guidelines in the treatment of this pathology. It is unacceptable to currently prescribe adjuvant treatment unreasonably, and at the same time, risk factors for progression cannot be ignored. This article demonstrates possible risk factors for progression in patients with ER after surgical treatment and shows the adjuvant treatment regimens that are necessary for this group of patients.
The diagnosis of malignancy in a pregnant woman is considered as an extremely dramatic situation in which there is a conflict of risks to the health and life of the mother and fetus. In such a situation, it is necessary to take a balanced approach to treatment and compare the potential threats to the fetus from surgery, systemic treatments and radiation therapy with the expected results for the patient. Special attention should also be paid to conducting an instrumental examination using radiation diagnostic methods in view of the negative effect of ionizing radiation on the development of the embryo. Based on international literature data, the article presents the features of instrumental and invasive diagnostics of pregnant patients who were simultaneously diagnosed with musculoskeletal sarcoma. The main approaches to the treatment of this rare group of patients, which are used in modern oncology, are highlighted.
Transarterial embolization (TAE) is an effective method of hemostasis, but the prophylactic use of this procedure in patients with a high risk of bleeding remains poorly studied. Objective. To evaluate the clinical efficacy and safety of the left gastric artery TAE in patients with resectable gastric cancer and a history of gastrointestinal bleeding before neoadjuvant polychemotherapy (NAPCT). Material and methods. A single-center retrospective non-randomized study was conducted. Treatment results were analyzed in 14 patients (mean age 65±9 years) with resectable gastric cancer and a history of tumor bleeding, who underwent prophylactic embolization of the left gastric artery using microcoils or microspheres before NAPCT at the S.S. Yudin City Clinical Hospital from 2022 to 2024. The technical success of the procedure, the presence of bleeding recurrence and the tumor regression grade (TRG) were assessed. Results. TAE was technically successful in 12 patients (85.7%), of which 10 patients did not experience bleeding recurrence during NAPCT. Radical surgery was possible after successful TAE and NAPCT in 8 patients. There were 4 mild complications: post-embolization syndrome — 3, hematoma — 1. TRG according to Mandard classification constituted 1 — 1 case, 3 — 5 cases, 4 — 2 patients. Conclusion. Prophylactic embolization of the left gastric artery before NAPCT in patients with gastric cancer and tumor bleeding history is a clinically effective and safe procedure that can reduce the risk of bleeding recurrence and improve the tolerability of chemotherapy. However, further studies are needed to clarify the indications and evaluate the long-term results.
Remote digital cytology using artificial intelligence is a new approach in diagnostics that allows for real-time cytological examination. Material and methods. The study was conducted from June 2022 to December 2024. The material includes cervical scrapings from 1.473 patients aged 18 to 70 years who consulted a gynecologist. Preparations of traditional cytology (TC), liquid cytology, digital cytology (DC) and a gallery of cells selected by artificial intelligence (AI) were evaluated. Domestic technologies and equipment were used in the work. Results. When the doctor analyzed the cells of the artificial intelligence gallery, the sensitivity was 99.25%, when examining a digital cytology preparations with artificial intelligence — 98.50%. Digital cytology has an adequacy 19% higher than traditional cytology. The average time for a doctor to examine cells in the artificial intelligence gallery was 1 minute 53 seconds; for a comprehensive study of a virtual digital cytology drug with artificial intelligence, it was 18 minutes 45 seconds. Conclusion. The data obtained proves the advantages of the CC method with AI. Its use in a remote format makes it possible to perform QI in real time, which will eliminate low-quality material, prescribe additional research and treatment during the current gynecologist appointment.
Objective. Improvement of treatment results in functionally inoperable patients with multiple pulmonary metastases. Material and methods. This study is based on the treatment outcomes of 64 patients diagnosed with multiple pulmonary metastases. Patients were divided into 2 groups: in the 1st (n=37) stereotactic radiotherapy (SRT) was performed, in the 2nd (n=27) surgical treatment (ST). All patients in the SRT group were deemed functionally inoperable. For metastases located in the peripheral zones of the lung, a total dose of 46-60 Gy with a dose per fraction of 15 Gy was delivered in 78.4% of cases. In patients with centrally located lesions, a total dose of 40-50 Gy with a dose per fraction of 8-10 Gy was administered (21.6% of patients). SRT was performed using Elekta linear accelerators with Active Breathing Control (ABC) and target position verification prior to each fraction using X-ray Volume Imaging (XVI). In the surgical group, 70.4% of patients underwent atypical resections, and 29.6% underwent anatomical resections. Results. Radiation pneumonitis grade 1 (RTOG 1) was diagnosed in 13 patients (35.1%) in the SRT group. In the ST one patient (3.7%) developed postoperative wound infection. Local recurrence following SRT was observed in 1 patients (1.6%), and in 3 patients (4.7%) after surgery. Local control (LC) in the SRT group remained stable at 96.2% over both 1- and 3-year follow-up periods. In the surgical group, LC was 100% at 1 year and declined to 76.4% at 3 years. The 1-year and 3-year overall survival (OS) rates in the SRT group were 91.6% and 57.2%, respectively, while in the surgical group they were 92.0% and 50.5%. Conclusion. The conducted analysis demonstrated that SRT and surgical resection provide comparable efficacy in achieving local control of both solitary and multiple pulmonary metastases.
Capsular contracture is one of the most common complications in reconstructive surgery for breast cancer. After the implant is installed, a capsule is formed, which is a normal protective reaction. When capsular contracture occurs, the capsule thickens and contracts, thereby compressing the implant, leading to deformation, hardening, and pain in the reconstructed breast. Conservative treatment with botulinum toxin type A can reduce these symptoms and improve quality of life. Objective. To determine indications for conservative treatment for capsular contracture grades II and III. Material and methods. The study included 42 patients (study group) with capsular contracture grades II—III according to Baker after reconstructive surgery who underwent conservative treatment with botulinum toxin type A, as well as 42 patients (control group) who underwent surgical treatment without the use of botulinum toxin type A. Results. The study included patients with a mean age of 47.8±6.5 years. Before botulinum toxin type A administration, capsule thickness was determined using ultrasound and averaged 1.82±0.53 mm in Group 1 and 1.8±0.6 mm in Group 2 before surgery. The study noted a longer period of capsular contracture development in Group 2. Patients who received botulinum toxin type A demonstrated a positive effect that persisted 6 months after administration, with the average capsule thickness being 1.46±0.43 mm. The use of botulinum toxin made it possible to delay the need for surgical intervention by an average of 1.2 years. Conclusion. Botulinum toxin type A injections may be used to reduce symptoms and slow the time it takes for capsular contracture to progress.
In recent years, immune checkpoint inhibitors has made a breakthrough and has become an important treatment most metastatic solid tumors, but the safety and efficacy in the perioperative or neoadjuvant regimes of treatment is currently only under study. We analysed available studies of the use of immunotherapy in locally advanced gastric cancer and and gastroesophageal junction (GC/GEJ). Material and methods. We searched PubMed, Embase, Elibrary databases works dedicated to the effects of the addition of immunotherapy at the neoadjuvant or perioperative treatment in patients with locally advanced GC/GEJ. Results. The addition of immunotherapy to the perioperative treatment of patients with locally advanced gastric cancer does not increase the frequency of adverse events. The frequency of a complete pathological response increase in patients receiving immunochemotherapy (31%). In patients with microsatellite instability, this indicator was even higher (up to 70%). The presented results demonstrate promising safety and efficacy from adding immune checkpoint inhibitors to neoadjuvant therapy for locally advanced gastric cancer and and gastroesophageal junction. Conclusion. In patients with microsatellite instability (MSI), neoadjuvant immunotherapy increased frequency of pCR. The number of adverse events of grade 3 or higher did not significantly increase. Neoadjuvant or perioperative ICI for patients with GC and MSI is included in current clinical guidelines.
Limb lymphedema is a chronic debilitating disease that is one of the main postoperative complications after mastectomy with removal of lymph nodes. Lymphedema can be treated conservatively or surgically, including through tissue resection and direct or indirect lymphatic drainage. Lymphatic-venous anastomosis (LVA) is an effective surgical treatment for obstructive lymphedema that is not amenable to conservative decongestant therapy. This technique was developed on the basis of supermicrosurgery, a technique of applying anastomoses to vessels with a diameter of 0.3—0.8 mm. Objective. Evaluation of the effectiveness and significance of ultrasound examination of lymphatic and venous vessels before the formation of lymphovenous anastomosis. Material and methods. In the period from July 2024 to April 2025 at the P. A. Herzen Moscow Research Institute of Oncology 95 patients were examined after breast cancer treatment. The joint work of the departments of ultrasound diagnostics and oncoplastic surgery included ultrasound examination with marking of superficial veins and lymphatic vessels of the upper limb and lymphography with contrast based on indocyanine (ICG). During the study, the lymphatic and venous vessels of the upper limb were examined from the side of the operation. Results. As a result of the work done, we obtained a 100% match of the performed preoperative markings with the anatomical location of the lymphatic and venous vessels during the operation. Conclusion. Preoperative detection of lymphatic and venous vessels, performed using a high-frequency ultrasound sensor, is fast, economical and allows surgeons to reliably navigate during lymphatic drainage surgery.
Objective. To study the effect of temozolomide on subsequent overall survival, depending on the variant of its use at various stages of primary treatment of glioblastoma. Material and methods. According to the 2021 WHO classification criteria, 178 patients with grade 4 glioma were diagnosed with glioblastoma (GBM) without a mutation in the IDH1 gene based on molecular biological data. Of the 178 patients, 134 (75.3%) had radiotherapy with temozolomide (TMZ) at a dose of 75 mg/m2 (TMZ/RT), 44 had radiation therapy without TMZ (RT; 24.7%). Subsequently, standard adjuvant drug therapy of the 1st line with TMZ at a dose of 200 mg/m2 was included in the treatment program in 158 patients (88.8%). Results. There was no significant increase in survival when using TMZ on the background of radiation therapy. The median overall survival in the TMZ/RT and RT groups was 20.08 (95% Cl: 16.2—23.8) and 17.97 months (95% Cl: 13.6—22.4), respectively (p=0.148). However, 21.5% and 4.5% of patients in the study groups survived the 60-month period. Only in the absence of rapid early progression (NonREP), the TMZ/RT program has significant advantages compared with radiation therapy alone and subsequent adjuvant TMZ, the median overall survival was 26.58 months versus 20.99 months (p=0.012). With REP, the differences in survival in the TMZ/RT and RT groups lose their significance, the medians are 14.75 and 17.22 months, respectively (p=0.949). For overall survival, the isoeffective dose level (<59.5≥Gy), calculated using the linear-quadratic model with a/β=7.5 (OR=0.220; p<0.001) and second-line therapy with bevacizumab (OR=0.464; p<0.001) have a greater specific weight. The resection volume ≥70% with microsurgical intervention (OR=0.437; p=0.001), the use of TMZ in the adjuvant regimen (OR=0.532; p=0.046) are statistically significant in terms of overall survival, in contrast to TMZ against the background of RT (OR=0.737; p=0.119). Conclusion. According to our study, the role of temozolomide in combination with radiation therapy is somewhat exaggerated; the adjuvant regimen of taking an alkylating agent is more significant in the primary treatment program for GBM. A protocol with concomitant and sequential use of temozolomide on the background of radiation therapy should remain the standard in the treatment of glioblastomas.
Objective. Retrospective analysis of oncologic effectiveness of transoral approach and en bloc resection for surgical treatment of tongue and floor of the mouth squamous cell carcinoma with depth of invasion from 11 to 20 millimeters. Material and methods. Sixty nine patients aged between 30 and 80 years were included into the study. In 33 cases transoral approach with discontinuous neck dissection was performed (Group 1). En bloc resection was used in 36 cases (Group 2). Group 2 was characterized by a higher prevalence of N positive patients. Adjuvant radiotherapy was performed in 22 patients of Group 1 (67%) and 25 patients of Group 2 (69%). Rates of local, regional recurrences, distant metastases and overall survival according to Kaplan-Meyer were used for comparison. Results. Median follow up was 28±25.2 months (range 4—127 months). The rate of local, regional and distant recurrence was higher in Group 2: 28% vs 21%; 19% vs 18% and 19% vs 12%, respectively. The difference was statistically insignificant for all the parameters. Overall survival for the whole cohort, Group 1 and Group 2 was 46.6%; 49.7% and 34.2%, respectively. The difference in survival probability did not reach statistical significance (p=0.057). Conclusion. Transoral approach and en bloc resection showed similar effectiveness in treatment of oral cancer with depth of invasion from 11 to 20 millimeters.
Objective. To study the immediate and long-term results of surgical treatment of patients with distal neuroendocrine neoplasms of the pancreas. Material and methods. The results of examination and treatment of 39 patients with neuroendocrine tumors of pancreas body and tail who underwent distal resections are presented. The analysis on the nature of operations, morphological structure of masses, postoperative complications is carried out. The main attention was paid to the factors of unfavourable prognosis and their influence on the survival rate. Results. Complications of III A-B degree according to Clavien– Dindo occurred in 6 (15.4%) patients, there was no postoperative lethality. The 5-year cumulative overall and recurrence-free survival rates were 78.6% and 64.3%, respectively. Conclusion. Surgical treatment of patients with neuroendocrine distal pancreatic tumors is justified by low lethality and frequency of serious complications. Long-term results confirm oncological validity of active therapeutic tactics.
