Every year, about a million electronic devices implanted in the heart are installed worldwide. In the Russian Federation, there are no accurate statistics on pacemakers. Modern pacemakers (pacers) are characterized by their small size, high sensitivity and susceptibility to ionizing radiation (IR), which increases the risk of temporary or irreversible damage to the device. Throughout the world, the number of cancer patients with electronic devices implanted in the heart has increased over the past decade. Despite the development of modern methods of radiation therapy (RT), this method has a certain risk of complications for cancer patients with ECS.We currently use the 2020 update of the JASTRO/JCS guidelines for RT in patients with cardiac implantable devices to guide management of patients with pacemakers. Similar recommendations have not yet been developed in the Russian Federation, as in many other countries, which makes this problem especially relevant.This article demonstrates a multidisciplinary team approach to the management and treatment of patients with esophageal squamous cell carcinoma (ESCC) with an implantable pacemaker.

Staging of cancer of the esophagus and esophagogastric junction (EGJ), presented in the 8th edition American Joint Committee on Cancer (AJCC). Cancer Staging was derived from the Worldwide Esophageal Cancer Collaboration (WECC). The 8th edition of the American Joint Committee on Cancer (AJCC) staging of the esophagus cancers and esophagogastric junction presents separate classifications for clinical (cTNM), pathologic (pTNM), and pathologic after neoadjuvant treatment (ypTNM). In this article changes presented between the 7th and 8th editions of this TNM classification. These changes included separate clinical, pathological and pathological prognostic staging for adenocarcinomas and squamous cell cancer.

Cancer cells can aberrantly express various markers, including transferrin receptor 1 (CD71) and β1-integrin molecules. Their role in invasion, migration and metastasis has been demonstrated. Determination of their expression in breast cancer (BC) may be an important point to characterize the clinical course of the tumor and prognosis of the disease. OBJECTIVE:To study of transferrin receptor 1 (CD71) expression by primary breast cancer cells in correlation with tumor cell phenotype. MATERIAL AND METHODS:Determination of BC phenotype: immunohistochemical staining method (immunofluorescence). Antibodies to ER (estrogen receptors), KL-1 (pancytokeratin), CD71 (transferrin receptor), CD29 (β1-integrins). CD45, CD3, CD4, CD8, CD20 infiltration was also evaluated. ZEISS microscope (AXIOSKOP; Germany), method of G.J. Hammerling et al. Statistical processing: IBM-SPSS Statistics v.21. RESULTS:63% of BC cases had CD71+ phenotype. CD71-mosaic tumors were observed in 14.4%. β1-integrin expression was monomorphic in 51.6% of cases and mosaic in 38.7%. 85% of ER-positive tumors were CD71-positive with a monomorphic type of reaction; p=0.014. Among ER-negative tumors, CD71-negative reactions were 2-fold more frequent and the monomorphic type was less frequent. ER-positive tumors were CD29-positive in 73%; p=0.031. 45.5% of ER+ tumors were CD29-monomorphic. Among ER-negative tumors, the frequency of CD29-monomorphic tumors was 55%. Significant infiltration by CD3+ cells was predominant in CD71-positive tumors; p=0.016. In the CD29-monomorphic phenotype, CD45+ infiltration was 31.3%, and in the mosaic phenotype, 67.1%. CONCLUSION:BC aberrantly expresses transferrin receptors, β1-integrins. CD71 expression is associated with ER expression. ER-positive tumors are often monomorphic for CD71. Prominent CD3+ infiltration was present in CD71+ tumors. Expression of β1-integrins correlated with ER+ status and weak immune infiltration.

Staging of cancer of the esophagus and esophagogastric junction (EGJ), presented in the 8th edition American Joint Committee on Cancer (AJCC). Cancer Staging was derived from the Worldwide Esophageal Cancer Collaboration (WECC). The 8th edition of the American Joint Committee on Cancer (AJCC) staging of the esophagus cancers and esophagogastric junction presents separate classifications for clinical (cTNM), pathologic (pTNM), and pathologic after neoadjuvant treatment (ypTNM). In this article changes presented between the 7th and 8th editions of this TNM classification. These changes included separate clinical, pathological and pathological prognostic staging for adenocarcinomas and squamous cell cancer.

The incidence of primary multiple malignant neoplasms (PMMN) in Russia is steadily increasing due to the increasing frequency of detection of metachronous tumors. A similar trend is observed in esophageal cancer (EC). Advances in the diagnosis and treatment of cancer have led to an increase in the life expectancy of patients after a cured primary tumor and, in turn, to an increase in the detection rate of a second tumor. The longer life expectancy of patients with cancer, the higher the likelihood of developing a second tumor. PMMN of the esophagus is one of the least studied problems in modern oncology, which complicates the choice of treatment tactics, since there are no standards for the management of such patients. This article reflects a multidisciplinary and individual approach to the treatment of a patient with primary multiple metachronous inoperable squamous cell carcinoma of the middle and lower thoracic esophagus. The patient underwent chemoradiotherapy (CRT) with full effect, with no post-radiation damage and improved quality of life.

The generally accepted standard in early breast cancer surgery today is breast-conserving surgery with external beam radiation therapy, which is comparable in results to previously widely performed radical mastectomy and even has an advantage in terms of overall survival and control. Until now, there are areas of discussion and a number of questions remain related to the methodology of irradiation of patients with breast cancer, namely: is it advisable to irradiate the axillary zone after radical resection for early breast cancer? Does irradiation of axillary lymph nodes provide regional control comparable to lymphadenectomy, and whether it can be an alternative to lymph node dissection? Whether provides an irradiation of axillary lymph nodes comparable with regional lymph node dissection the control over patients with a positive sentry lymph node? A lot of studies have been published so far, answers to questions derived from what we present in this work.

Purpose: To compare the quality of irradiation planning for patients with esophageal cancer using Clinac iX (Varian) electron accelerators with external gantry and Halcyon (Varian). Compare quantitative indicators of irradiation plans for different algorithms and versions. Material and methods: A comparative assessment of the quality of irradiation planning for 90 patients with cancer of the esophagus was carried out using the indices of dose homogeneity and conformity within the target according to the data of dose-volume histograms and dose loads on critical organs. The comparison was carried out for two models of accelerators Clinac iX (Varian) with an external gantry and tunnel type Halcyon (Varian). The results of calculations of irradiation plans using different versions and algorithms for calculating planning systems are compared. Results: A comparison of the quantitative characteristics of the exposure plans made it possible to designate the IMRT technology as the preferred one in the treatment of esophageal cancer using accelerators of both types, with external and built-in gantry. At the same time, the influence of calculation algorithms and versions of the SP on the indices of homogeneity, conformity and dose loads on critical organs is not expressed, and the calculation results are comparable within the error.

Introduction : The results of six randomized control trials have been published by 2022, which evaluated the efficacy of adding PD-1 inhibitors to the first-line chemotherapy in patients with metastatic esophageal cancer. However, it still remains unclear which patients derive the most clinical benefit from combined therapy. Therefore, it is necessary to evaluate the efficacy of the combination of anti-PD1 treatment with chemotherapy in different patient subgroups. Materials and methods : We conducted a meta-analysis of randomized controlled trials in patients with stage IV esophageal cancer who received anti-PD1 drugs with different chemotherapeutic regimens in the first-line setting to select patients who benefit the most from the combined therapy. Results : Six randomized trials were included in the analysis for a total of 3,813 patients. Patients who received combination therapy had significantly longer OS (HR = 0.69, 95% CI: 0.63-0.75; p < 0.001), PFS (HR = 0.62, 95% CI: 0.56-0.69; p < 0.001), and better ORR (OR = 2.12, 95% CI: 1.85-2.42; p < 0.001) than those who received chemotherapy alone. Subgroup analyses showed no benefit of adding PD1-inhibitors to chemotherapy in patients with PD-L1 CPS <1 in terms of OS (HR = 0.58, 95 % CI: 0.31-1.1; p = 0.1) as well as in never-smokers (HR = 0.9, 95% CI: 0.67-1.23; p = 0.52). Conclusions : The addition of PD-1 inhibitors to the first-line chemotherapy in patients with metastatic esophageal cancer significantly improves treatment outcomes. Our results could not strongly suggest the selected patients' cohort which would benefit the most from the combination of PD-1 inhibitors and chemotherapy use.

Renal cell cancer accounts for 2% of all cancers. The gold standard for managing patients with no evidence of distant metastasis renal cell cancer remains is complete surgical resection. The clinical data investigating preoperative radiotherapy failed to reveal benefited from this methods. The role of routine postoperative radiotherapy in the management of renal cell cancer is not established in patients with localized disease after complete surgical resection. Renal cell cancer is radioresistant tumor for conventional radiation therapy. Although renal cell carcinoma is related to radioresistant tumors, in recent years new promising directions in radiation therapy have become apparent. To overcome the radioresistance of renal cell carcinoma, the use of modified radiation therapy regimens with high doses per fraction is justified. new technologies of radiation therapy, which include stereotactic radiation therapy allows to accurately deliver doses of ionizing radiation to a tumor, without the risk of damage to neighboring tissues and organs. Recent data showing that with the use of high-precision methods, such as SBRT, unresectable local renal cell carcinoma can successfully be treated with durable local control and low toxicity. Nonetheless, prospective, randomized trials and omparative effectiveness studies are needed to further evaluate this ablative modality in the treatment of renal cell carcinoma.

Esophageal cancer is one of the most aggressive malignancies of the gastrointestinal tract, characterized by high malignancy potential and poor prognosis. Surgical treatment is the standard for localized esophageal cancer, but the results of only surgery for locally advanced tumors remain unsatisfactory. The use of neoadjuvant chemotherapy, as well as neoadjuvant chemoradiation therapy, leads to a downstaging of the tumor, improves its resectability and increases an overall and disease‑free survival rates. The method of choice for unresectable esophageal cancer, as in case of refusal or intolerance to surgical treatment, is definitive chemoradiotherapy. Until recently, adjuvant therapy after R0 resection was not carried out, however, there is evidence that the postoperative use of nivolumab, an immune checkpoint inhibitor, significantly improves progression‑free survival in patients with evidence of residual tumor.This article presents a current review of the treatment for resectable squamous‑cell carcinoma of the esophagus.

The article lists the main inducers of cholangiocarcinogenesis. The main inflammatory mediators (IL-6, nitric oxide, COX2) have been considered. Data on the study of gene mutations in cholangiocarcinomas are presented. The spectrum of genetic mutations depends on the biliary cancer origin (FGFR2 with intrahepatic cholangiocarcinoma, PRKACA, PRKACB with extrahepatic cholangiocarcinoma). Mutations in the KRAS, TP53, ARIAD1A genes are common in extrahepatic bile duct cancer. The role of epigenetic changes such as DNA hypermethylation, histone modifications, chromatin remodeling, as well as disturbances in miRNA expression is presented. A number of epigenetic features, such as the presence of a TP53 mutations with hypermethylation of p14ARF, DAPK, and/or ASC, correlate with a more aggressive course of the disease. The role of the SOX17 gene in the development of drug resistance is highlighted. The study of the molecular genetic features of extrahepatic bile duct cancer can help to better understand the pathogenesis of this type of tumor, to establish new prognostic and diagnostic markers of the disease.

This article highlights the main inducers of cholangiocarcinogenesis. Data are presented on the study of gene mutations, the variations of which depending on the localization of biliary cancer may be different (FGFR2 in intrahepatic PRKACA, PRKACB cholangiocarcinoma in extrahepatic cholangiocarcinoma). Mutations in the KRAS, TP53, ARIAD1A genes are common in extrahepatic bile duct cancer. Epigenetic events such as DNA hypermethylation, histone modifications, chromatin remodeling, and disturbances in miRNA expression are considered. A number of epigenetic features, such as the presence of a TP53 gene mutation with hypermethylation of p14ARF, DAPK, and/or ASC, correlate with a more aggressive course of the disease. The role of the SOX17 gene in the development of drug resistance is highlighted. The study of molecular genetic features of extrahepatic bile duct cancer is an important aspect in understanding the pathogenesis of this type of tumor, reveals new prognostic and diagnostic markers of the disease. It is possible that in the future, as knowledge is accumulated, this will make it possible to individualize approaches to the treatment of this category of patients.

In this study, we described a clinical case of unoperable squamous carcinoma in the thoracic esophagus, demonstrating the effectiveness of induction chemotherapy followed by independent chemoradiotherapy and brachytherapy in patients with metastatic esophageal carcinoma. The patient was treated with induction chemotherapy, concurrent chemoradiation with weekly carboplatin AUC 2 and paclitaxel 50 mg/m2 and brachytherapy. The most characteristic feature of this clinical case is that the use of brachytherapy in the complex treatment of patients with esophageal carcinoma allows increasing the dose in the target without increasing the risk of complications associated with the escalation of the radiation dose. Brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with external beam radiation therapy. In most patients, esophageal carcinoma is diagnosed at stages III–IV of the disease. Squamous cell esophageal carcinoma is an aggressive disease that, depending on the prevalence, requires various treatment methods, the search for the optimal one is still ongoing. The main standard of treatment in inoperable patients with squamous cell esophageal carcinoma is self — chemoradiotherapy. However, in patients with unoperable esophageal carcinoma, it is also possible to use induction chemotherapy followed by independent chemoradiotherapy and brachytherapy. The combined use of these methods of treatment in conditions of impossibility of surgical intervention is the method of choice in patients with stage III–IV of the disease. The standard dose of DLT for squamous carcinoma of the esophagus is 50.4 Gy. In the conducted studies, it was shown that the escalation of the dose to the tumor using remote radiation therapy leads to an increase in severe post-radiation injuries and an increase in the frequency of deaths. Induction chemotherapy plus concurrent chemoradiotherapy and brachytherapy to boost tumor, and improves disease control and survival.

Prostate cancer (PCa) of high risk is one of the crucial problems in urological oncology. Radiation therapy (RT), along with radical prostatectomy, is an important component of the complex treatment of patients with high‑risk PCa. To improve the long‑term oncological results of RT dose escalation is advocated. Currently, dose escalation can be reached via external beam irradiation and interstitial RT techniques. The study included 109 patients with high‑risk PCa who underwent either external beam RT up to 76 Gy, or combined RT (external beam + interstitial RT) using 125I sources with long‑term androgen deprivation therapy. Comparative analysis of long‑term results of patients with high‑risk PCa treatment showed an improvement in 5‑year disease‑free survival rates after combined RT compared with external beam RT. Acute rectal toxicity was decreased in combined RT group compared to patients after external beam RT: 13.2 % and 46.4 %, respectively (p < 0.01).

The article deals with a peculiar group of breast diseases, which belongs to the B3 category according to the BI-RADS classification, the so-called lesions with undefined malignant potential. The basic information concerning their biological behavior and modern tactical approaches to the management of patients with similar changes in the mammary gland are presented. The possibility of conservative management, as well as the minimization of surgical aid, in cases of indications for it, up to vacuum aspiration biopsy is being considered. In addition, the significance of these diseases for the subsequent development of pre-invasive and infiltrative cancer is discussed.

Radiotherapy is one of the radical treatment options used in patients with prostate cancer (PC). Many studies of combined radiotherapy (CRT) for PC have demonstrated good results in respect of response to treatment; however, the sequence of CRT steps and optimal interval between them have not been determined so far. Few randomized studies have been conducted in order to confirm the advantages of brachytherapy at the first or second step or determine the most effective interval between the contact and external beam RT. Therefore, it appears reasonable to evaluate different CRT techniques.Purpose. The goal of the study was to evaluate the outcomes of PC treatment depending on the sequence of CRT steps and the interval between them.Materials and methods. 53 patients with PC received 125I radiation therapy in combination with long-term hormone therapy (HT). Median follow-up was 38 months. Patients’ age varied from 54 to 81 years. All patients were in a high-risk group according to the D’Amico Risk Classification System. The patients were allocated to two groups: in Group 1, brachytherapy was used as the first step (n=31); in Group 2, it was applied after external beam therapy (EBT). The interval between the CRT steps could be less than 4 weeks (n=6), 4 – 7 weeks (n=17) and more than 8 weeks (n=30). Standard fractionation EBT with a total dose of 46 Gy using the VMAT technique was conducted. 125I prostate implants were inserted to reach a total dose of 110 Gy. Neoadjuvant (2 – 4 months) and adjuvant (not less than 24 months) regimens of HT were applied.Results. Five (9.4 %) patients had disease progression; two of them experienced only biochemical recurrence; distant metastases were diagnosed in three patients. Median time to disease progression was 29.9 months. One patient with a biochemical relapse died of acute myocardial infarction (1.9 %). Median five-year disease-free survival was 84.5±11.7 % in Group 1 and 83.5±9.1 (p=0.73) in Group 2. There were no significant differences in the incidence of toxicity depending on the sequence of CRT steps.Conclusion. EBT using 125I radiation sources in combination with long-term hormone therapy is an effective and safe treatment option for high-risk PC patients. No significant increase in the incidence of disease progression was observed when the interval between the CRT steps was increased to more than 8 weeks. Changes in the sequence of CRT steps do not affect response to treatment or incidence of radiation-related complications.

AIM:To study an importance of new 2016 WHO histologic grading system for prostate cancer in evaluating the risk of progressing after conformal external beam radiation therapy, brachytherapy 125I and androgen deprivation therapy.MATERIALS AND METHODS:A total of 53 patients with prostate acinar adenocarcinoma were undergone to conformal external beam radiation therapy, brachytherapy 125I and androgen deprivation therapy. Age of patients was 54-80 years (68.11+/-4.7 years). T3 and T2 prostate cancer was diagnosed in 42 (79.3%) and 11 (20,7%) patients, respectively. Baseline PSA level ranged from 5.5 ng/ml to 311 ng/ml (39.7+/-7.9 ng/ml). According to the new grading system (the WHO classification, 2016), all patients were divided into five risk groups.RESULTS:Median follow-up was 64.9 months. The biochemical progression was seen in two patients, while three patients had metastatic disease. All patients with progressing prostate cancer were from IV and V prognostic groups. The 5-year progression-free survival rates for patients of IV-V and I-III groups were 44, 4% and 100%, respectively.CONCLUSIONS:According to the results of combination treatment (conformal external beam radiotherapy, brachytherapy 125I and hormonal therapy), progression-free survival rate in patients of IV (Gleason 4+4=8) and V (Gleason 4+5=9 or 5+5=10) groups, according to new WHO grading system were significantly lower, in comparison with patients of I (Gleason 3+3=6), II (Gleason 3+4=7) and III groups (Gleason 4+3=7). Our study showed that new WHO classification allows to predict the progression of prostate cancer not only after prostatectomy, but also after conformal external beam radiation therapy, combined with brachytherapy 125I and androgen deprivation therapy.

Along with surgery and chemotherapy, radiation therapy is the main treatment for malignant tumors. This treatment method is often accompanied by various side effects. They are based on damage to the structure of cells by ionizing radiation. At present, criteria for the assessment of radiation injuries have been developed. One of these injuries is radiation pulmonitis, which can adversely affect the quality of life of patients. Thanks to the introduction into clinical practice of modern methods of radiation therapy, radiation diagnostics and the latest drugs, it became possible to minimize the risk of radiation pulmonitis after treatment.

Despite the achievements of modern medicine in the diagnosis and treatment of oncological diseases, skin melanoma remains one of the leading causes of death worldwide: every third case of melanoma ends in death. As you know, one of the main causes of death is the high incidence of melanoma progression. It is important to note that the mechanisms of melanoma progression are diverse and the rapidly developing area of drug therapy for tumors requires a deep understanding of their characteristics. This is primarily due to the fact that these processes lead to the formation of special, minor tumor clones with stem properties. They are highly resistant to therapy. The latter is the mainobstacle to effective treatment of melanoma patients. The epithelial-mesenchymal transition (EMT) plays a leading role in the acquisition of metastatic potential by melanoma cells. An important distinguishing feature of EMT is a change in the level of expression of transmembrane glycoproteins involved in cell adhesion. With EMT, both a decrease in the level of E-cadherin and an increase in the expression of N-cadherin are observed. Such a switch in different classes of adhesion molecules leads to the fact that melanoma cells lose contact with neighboring keratinocytes and begin to interact with fibroblasts and endothelial cells. The key regulator in EMT induction in melanoma is the Notch1 signaling pathway, which accelerates N-cadherin expression when activated. In addition, EMT also regulates many other pathways – RAS/RAF/MEK/ERK, PI3K/AKT/mTOR, Wnt/β-catenin, the dysregulation of which is associated with the development of drug resistance in melanoma. The analysis was carried out in the article of modern literature data on the importance of EMT in carcinogenesis and prognosis of melanoma. The modern mechanisms of EMT, currently known prognostic factors, as well as potential therapeutic targets that affect EMT and, accordingly, inhibit the process of metastasis, are described in detail.

Introduction: Esophageal cancer (EC) is a malignant disease with low survival rates and limited treatment options in the later stages. The epidemiological situation in developed countries tends to improve. However, in most states, including the Russian Federation, the situation remains in critical condition.Epidemiology of EC: Esophageal cancer is one of the most aggressive malignant disease. According to the International Agency for Research on Cancer (IARC), in 2018, 572 thousand new cases of RP were registered in the world (3.2 % of the total number of malignant disease). In 2018, 508.6 thousand deaths from cancer were recorded in the world (5.3 % of the total number of deaths from cancer, 6th place) [1].EC risk factors: The following factors play an important role in the etiology of squamous EC:1. Diet (nitrites, hot food and drinks, insufficient intake of vitamins and minerals with food).2. Tobacco and alcohol use are independent risk factors, but when combined with others, they increasethe risk of the disease.3. Achalasia of the cardia.4. Burns of the esophagus.5. Autosomal dominant diseases characterized by hyperkeratosis of the palms of the hands and feet.The risk of developing EC reaches 37 % [2].6. Human papillomavirus types 16 and 18 causes a risk of EC in 37 % of patients.Diagnostic methods: Traditional methods for the diagnosis of EC are: esophagogastroduodenosocpy with biopsy, endoscopic ultrasound with puncture biopsy of the mediastinal lymph nodes, computed tomography of the chest and abdominal organs (including contrast), magnetic resonance imaging of the chest cavity (including with contrasting), positron emission tomography with 18F-fluorodeoxyglucose (including combined with computed tomography).