Венозные тромбоэмболические осложнения (ВТЭО) — собирательное понятие, объединяющее тромбоз поверхностных вен, тромбоз глубоких вен, венозную гангрену и тромбоэмболию легочной артерии. ВТЭО развиваются у 10–20% онкологических больных при жизни и выявляются при аутопсии в 30–50% случаев.

Неитропения – частое гематологическое осложнение химиотерапии (ХТ). Ряд исследовании показал, что недовыполнение программы лечения в связи с развитием данного вида гематологическои токсичности приводит к снижению эффективности терапии и увеличению онкологическои смертности. Инфекции, которые возникают в результате длительнои неитропении, чрезвычаино опасны. Наиболее тяжелым проявлением неитропении 4-и степени является фебрильная неитропения (ФН), которая может привести к смерти от серьезных инфекции. Такие пациенты нуждаются в немедленнои госпитализации и проведении эмпирическои терапии антибиотиками широкого спектра деиствия. Затраты, связанные с госпитализациеи по поводу ФН, увеличивают общую стоимость лечения онкологических больных. Внедрение в клиническую практику рекомбинантных форм природного белка гранулоцитарного колониестимулирующего фактора (Г-КСФ) позволило решить ряд важных проблем в этом направлении. В клинических исследованиях и повседневнои практике показано, что первичная и вторичная профилактика с использованием рекомбинантных Г-КСФ снижает риск развития ФН и улучшает результаты лечения злокачественного новообразования. В представленном обзоре приведены современные данные о фармакологических своиствах, клиническои эффективности и рациональности использования пролонгированных форм Г-КСФ для профилактики ФН у пациентов с солидными опухолями при проведении 2-недельных режимов ХТ. Уделено внимание режимам ХТ с включением 5-фторурацила, оксалиплатина, иринотекана при лечении колоректального рака (КРР). Применение неоадъювантного лечения у таких пациентов позволяет добиться резектабельности опухоли и выполнения радикальной операции. Сохранение интенсивности дозы препаратов на протяжении всех курсов ХТ играет немаловажную роль в достижении успеха лечения. Поэтому профилактика тяжелой нейтропении и ФН, индуцированной ХТ, особенно важна у пациентов, которые являются кандидатами для хирургического лечения. Результаты некоторых исследований подтверждают целесообразность использования Г-КСФ пролонгированного действия при 2-недельных схемах ХТ у пациентов с КРР.

Aromatase inhibitor (AI) combined with Gonadotropin-releasing hormone agonist (GnRH-a) have been recognized as an effective approach to adjuvant endocrinotherapy for breast cancer (BC) in premenopausal patients with adverse predictive factors. However, the risk of non-optimal suppression of the ovaries due to the mechanism of action of aromatase inhibitors has been proven. Recently published SOFT-EST studies showed that the blood estradiol (E2) level in 37% of patients was above the level that was permissible for the purpose of this group of drugs. And although today there is no enough scientific justification to interpret this result, the introduction of aromatase inhibitors in adjuvant therapy in young women requires the search for tactics to reduce the risk of mediated increase in estradiol against the background of such therapy. Alertness occurs when the E2 serum level exceeds the menopause limit by the time the aromatase inhibitors are prescribed. Objective of the study. Determine the tactics for minimizing the risk of increasing estradiol against the background of aromatase inhibitors in combination with GnRH-a in adjuvant therapy for breast cancer in premenopausal patients. Material and methods. 47 patients of ≤ 50 years old with GR + HER2- Stages I-III Breast Cancer and a regular menstrual cycle before the start of neo-/adjuvant chemotherapy were studied. E2 and FSH levels were assessed at the stage prior to chemotherapy and immediately prior to administering adjuvant endocrinotherapy. After the completion of chemotherapy, only 7 out of 47 women had the menstrual cycle - patients without clinical and biochemical suppression of ovarian function (SOF). 86% of cases had cytostatic amenorrhea (n = 40), of which 23 cases (58%) showed that this condition was not combined with the biochemical response of sex hormones, i.e. there was no biochemical SOF. Thus, the study group included 30 patients, who were supposed to be treated with aromatase inhibitors + GnRH analogues, and had no clinical or biochemical menopause by the time adjuvant endocrinotherapy was prescribed. In order to reduce the risk of mediated increase in estradiol, even with pharmaceutical “switching off” ovarian function, the patients were prescribed the GnRH analogue (Buserelin Depot) before starting aromatase inhibitors therapy. Results and conclusion. A progressive decrease in E2 level was determined after each subsequent administration of Buserelin Depot. The median values remained low only after the third injection. Following the chemotherapy, a decrease in estradiol was accompanied by a physiological increase in the FSH levels in 73% of women. The administration of Buserelin Depot led to a significant decrease in FSH median (p <0.01) in 90% of patients. Aromatase inhibitors and continuing GnRH-a were prescribed to 97% of patients. The results indicate that the achievement of ovarian function suppression prior to the administration of IA, can be considered as a reliable tactics for adjuvant endocrinotherapy in patients of reproductive age. The dynamic assessment of reproductive hormones (E2, FSH) is recognized useful when choosing or correcting therapy in such patients.

For a long time, cachexia has been considered one of symptoms of cancer progression. The word cachexia is of Greek origin (kakos bad and hexis condition). This disorder is associated with a decrease in physical activity, reduced effectiveness of anticancer therapy, and decreased survival rates. The study of dissemination of malignancies demonstrated that cachexia is caused not only by the malignancy itself, but also by development of anorexia (loss of appetite) due to changes in humoral regulation of metabolic processes. Therefore, such condition of cancer patients should be called an anorexia-cachexia syndrome.

The study of 581 patients with multiple primary malignant neoplasms of reproductive system including their genealogical data revealed that the risk of developing malignancies significantly increases in the presence of congenital defects of mismatch repair system. Mutations in mismatch repair genes (MSH2, MLH1 and MSH6) were detected in patients with multiple primary malignant tumors of the colon and reproductive system in 13 (37%) observations. It is feasible to perform DNA-diagnosis in patients with multiple primary cancers of the colon and endometrium starting with identification of mutation inMSH6 gene. All women with colorectal cancer, especially in cases where mutations in genes of mismatch repair system are present, should undergo simultaneous preventive surgery during preand menopause periods: hysterosalpingo-oophorectomy. The decision regarding the greater omentum should be based on each particular situation.

Methylation of the regulatory sites of RASSF1A and MGMT genes in 58 samples of breast cancer patients from the Moscow region was studied. A high frequency of promoter region methylation of MGMT in breast cancer (21%, 12/58) was shown for the first time. It was revealed that the frequency of methylation of RASSF1A and MGMT genes in the basal breast cancer were strongly increased (33% vs. 19% and 40% vs. 21%, respectively). A significant correlation between the frequency of methylation of both genes with the progression of breast cancer (P≤0.05, by Fischer) was established. All these data allows considering these genes as significant molecular markers which carry information for choose of treatment and prognoses of disease.

A 5-year survival of patients with Stage III colon cancer with prophylactic panhysterectomy in anamnesis was 83.3%, significantly higher than that of patients with Stage III colon cancer without panhysterectomy (69.3%) and than in colon cancer patients with metachronous ovarian metastases (42%). In families of patients with primary multiple malignant tumors (PMMT) of colon, endometrium and/or ovaries as well as in cases of accumulation in the same family of solitary tumors of the above locations it is necessary to carry out genetic testing to identify mutations in genes MSH2, MLH1, MSH6. Carriers of mutations in genes of mismatch repair MSH2, MLH1, MSH6 should be assumed to the high-risk group for the development of malignancies both PMMT of colon and organs of the female reproductive system and solitary tumors of the above locations. All women suffering from colon cancer, especially in the presence of mutations in genes of mismatch repair, in pre- and menopause should be undergone simultaneous prophylactic surgery: panhysterectomy. The question about the greater omentum should be decided situationally.

Complex measurements of tumor markers help to improve the diagnosis of multiple primary neoplasms (MPN) significantly. For breast- ovarian MPN CA-125 was increased in 92.6 % and CA-153 — in 81.6 %. In patients with ovarian-colorectal MPN CA-125 was increased in 79.0 % and carcinoembryonic antigen — in 90.0 %.

The research conducted the first comprehensive studv of the methvlation status of tumor suppressor genes RASSF1A, RARB2 and SEMA3B in breast and ovarian carcinoma tissue samples, as well as in adjacent histologically normal tissue. For the first time it was found out that abnormal methylation of RASSF1A gene promoter region could be detected at the preclinical stage of breast and ovarian cancer, that would help to use this method in clinical practice as a noninvasive technique for early diagnosis.

Malignant peritoneal effusions often arise in patients with ovarian carcinoma. They are a hazardous complication of cancer. Systematic intraperitoneal chemotherapy is not necessarily followed by long-term remission and may even induce untoward side effects. Intraperitoneal interleukin-2 (IL-2) and IL-2/lymphokine-activated killers (LAK) biotherapy showed high efficacy in treatment of ovarian carcinoma patients suffering from peritoneal effusions. The objective effect was 80.1% and 82.6%, respectively. Our results suggest that intraperitoneal biotherapy may be extended to dealing with malignant peritoneal effusions in ovarian carcinoma.