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.
