Sentinel lymph node biopsy (SLNB) is a standard component of I and II clinical stage skin melanoma staging. Patients with IIB, IIC, and IIIB stages have similar prognosis, but different tactic. The KEYNOTE-716 study shows a 37,5% reduction in the risk of local recurrence in stage IIB, IIC with adjuvant treatment with pembrolizumab compared with observation. The NCCN recommendations version 2.2023 has already introduced the possibility of SLNB refusing in patients with skin melanoma clinical stage IIB, IIC and prescribing pembrolizumab in the adjuvant treatment. The study included patients over 18 years old with clinical stage IB, IIA, IIB, or IIC skin melanoma – AJCC, 8th edition, 234 males (31%) and 521 females (69%). Metastasis was detected in 17.2% (n = 130). Patients in categories T1a, T1b and T2a were 7.4% (n = 56), 16.5% (n = 125) and 19.6% (n = 148). Metastaticall sentinel lymph node (SLN) was found in 10% of these categories, in 100% it was the only lymph node with metastasis. 585 patients (77.5%) agreed to participate in the survey. All patients are under observation. In 55 (9.4%) cases skin melanoma progression occurred: 27 (4.6%) in the lymph nodes, 8 (1.3%) – satellite and transit metastases, and 20 (3.4%) – distant metastases (lungs – 7, liver – 5, brain – 3, bones, other – 5). A lethal outcome was recorded in 5 cases, the relatives refused to report the cause of death. New information raises the potential issue of de-escalation of surgical treatment and expansion of indications for systemic treatment of patients with clinical stage IB, IIB, IIC skin melanoma

Introduction . Oncological endoprosthesis for tumors of the pelvic bones is rare. It is associated with certain difficulties and is insufficiently investigated. The study objective is to evaluate the results of surgical treatment of patients with tumors of the pelvis performed between 2012 and 2021 at the N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia. Materials and methods . The study included 23 patients with primary and secondary tumors of the pelvic bones who underwent limb-saving surgeries with substitution of the postresection defect with an endoprosthesis between 2012 and 2021. Mean follow-up duration was 19 months. Results . The most common postoperative complication was infection of the postoperative wound (n = 8; 35 %). Mechanical complications associated with the installed metallic prosthesis were observed in 4 (17 %) patients. Function al results were evaluated after 6 months using the Musculoskeletal Tumor Society Score (MSTS). Mean score per this scale was 53 % which corresponds to satisfactory outcome. Conclusion . Patients with malignant tumors of the pelvic bones should undergo treatment only in specialized medical facilities. Patients for organ-saving therapy should be carefully selected.

Introduction. The incidence and mortality of malignant melanoma have increased steadily over the last decades; therefore, the development of novel diagnostic markers for malignant melanoma is of great importance. The purpose of the study was to assess whether the development of melanoma before any treatment is accompanied by the body changes and, in particular, DNA damage in the mononuclear cells of the peripheral blood of patients. Material and Methods. In 93 patients (26 men and 67 women) admitted to the N.N. Petrov National Medical Research Center of Oncology for surgical treatment of stage T1c-2a-b-3a-b4a-bN0-1 cutaneous malignant melanoma, and in 118 healthy people as a comparison group, the level of damage to DNA in peripheral blood mononuclear cells was studied using the “comet” method. All patients were divided into two groups: group 1 included 45 patients (13 men and 32 women) who were examined before a decision on treatment was made and group 2 consisted of 48 patients (13 men and 35 women) who previously underwent excision biopsy for melanoma. Results. The level of DNA damage in peripheral blood mononuclear cells, assessed by the comet assay, was found to be signifcantly higher in patients with melanoma than in the comparison group. Moreover, the increase in the level of DNA damage was similar both in patients with a primary tumor before starting any treatment and in those who previously underwent excision biopsy for melanoma. The relationship between the level of DNA damage in peripheral blood mononuclear cells and the morphological characteristics of the tumor cells was revealed. The Spearman correlation analysis showed that all parameters that determined DNA damage positively correlated with the thickness of melanoma according to the Breslow’s depth, and the percentage of DNA in the comet and the comet tail moment correlated with the stage of the disease. Conclusion. The development of cutaneous melanoma is accompanied by an increase in the level of DNA damage in peripheral blood mononuclear cells. The level of DNA damage in peripheral blood mononuclear cells refects the changes that occur in the patient’s body under the infuence of the tumor process, which may allow using this indicator as an additional criterion for the diagnosis and aggressiveness of melanoma.

Evaluation of sentinel lymph node (SLN) is crucial for cutaneous melanoma staging and treatment in patients with clinically negative lymph nodes. We evaluated patients’ outcome who underwent SLN biopsy (SLNB) in NMRC of N.N. Petrov National Medical Research Center of Oncology for skin melanoma between July of 2018 and March of 2021. SLNB was performed in 310 patients with an average age of 53.6 years. 67.4% of patients were female and 32.6% were male. The stage distribution was following: pT1 – 65 (21%), pT2 – 103 (33.2%), pT3 – 84 (27%), pT4 – 58 (18.8%). SLNB was performed with excision of the primary tumor in 71 cases (22.9%), delayed – 239 (77.1%). Average amount of days between excisional biopsy and re-excision of a postoperative scar with SLNB was 44.8 (range 12 to 190 days). Metastasis was detected in 42 cases (13.5%). In 7 cases SLNB was performed simultaneously with excision of the primary skin melanoma, in 35 cases it was delayed. After detection of metastasis in SLN, 100% of patients receive immunotherapy in various modes. The median follow-up time was 13.1 months (range 1 to 27 months). In ῾negative’ SLN group there were 3 cases of regional lymph node disease (in 6, 8 and 12 months, respectively). In all cases metastasis was recorded in the lymphatic collector, in which the SLN was removed. 5 patients had true scar recurrence. SLNB is an effective method for early diagnosis of regional metastases, which allows to start systemic treatment and improve patient’s outcome.

Preoperative radiotherapy in patients with soft tissue sarcomas characterized by important advantages: high precision of dose delivery, reduction of tumour volume and implantation potential, induction of immunologic response. Postoperative radiotherapy associated with decreased complication rate, delivery of treatment to microscopic disease according to pathologic report. Combination of pre- and postoperative irradiation gives the opportunity to use best of both methods. The aim: analyses of feasibility and safety of radiotherapy protocol that combined pre- and postoperative radiotherapy in patients with soft tissues sarcomas of extremities. Materials and methods: from 06.2018 to 01.2020 ten patients with soft tissue sarcomas of extremities were included in the protocol. Preoperative stereotactic ablative body radiotherapy (SABR) was performed as 5 fraction of 7 Gy on the main tumor volume with dose reduction to 5Gy in 5 fraction on the margins of the field. Postoperative radiotherapy started 5-8 weeks after surgery and was performed as standard compartmental irradiation in 25 fractions of 2Gy. Complications were determined according to CTCAE and wound complication scales. Results: from 06.2018 to 01.2020 10 patients with soft tissue sarcomas of extremities were included in the study. Pre-opeartive SABR and subsequent radical resection with tumor free surgical margins were performed in all 10 cases. Primary wound closure was mentioned in all patients. With relatively short follow-up of 9.1 (3-20) months we didn’t mentioned any case of grade II or more toxicity and no local recurrences. Conclusion: Our preliminary results demonstrate that combination of preoperative SABR and postoperative conventional radiotherapy is feasible and associated with low probability of grade II (and higher) toxicity.

The purpose of the study was to analyze treatment outcomes in prostate cancer patients, who received external radiotherapy combined with high dose rate (HDR) 198 Ir brachytherapy boost of 10 Gy in 2 fractions or 15 Gy in 1 fraction. Material and methods. Between July 2012 and June 2017, 98 patients with prostate cancer received radiation therapy at N.N. Petrov National Medical Research Center of Oncology (St-Petersburg, Russia). Intensitymodulated radiation therapy (IMRT) at a total dose of 46–50 Gy was delivered to the prostate, seminal vesicles and regional lymph outflow areas (RTOG, 2009). The patients were then divided into 2 groups. Group I patients (81 patients, 82.7 %) received HDR brachytherpy boost of 10 Gy in 2 fractions, Group II patients (17 patients, 17.3 %) received HDR brachytherpy boost of 15 Gy in 1 fraction. Inclusion criteria were: high or extremely high risk of relapse according to NCCN (2010), no evidence of distant metastases and no evidence of pronounced urinary tract disorders (residual urine volume less than 50 ml, IPSS less than 17 points, maximum urination rate ≥10 ml / sec). Assessment of radiation-induced complications (toxicity) was carried out in accordance with generally accepted RTOG / EORTC (1995) criteria and taking into account the terminological recommendations of CTCAE v 4.0 (2009). Results. The median follow-up time was 39.2 [30.7; 48.7] (20.3–69.8) months in Group I and 37.0 [30.9; 47.9] (23.7–50.7) months in Group II. The 3-year disease-free survival rate in the study groups regardless of the boost was 77.1 % (75.9 % in Group I and 77.8 % in group II, p=0.7). The 3-year disease-free survival rates in patients with high and extremely high risk regardless of the radiotherapy regimen were 88.6 % and 70.8 %, respectively (р=0.04). Genitourinary early radiation toxicity and rectal intestinal early radiation toxicity of grade 3 were observed in 13.5% and 12.3 % of Group I patients and in 17.6 and 5.9 % of Group II patients. The most significant late complications were the formation of urethral stricture (1 patient of group I) and postradiation rectal stenosis (1 patient of group II). Evaluation of the level of erectile function in both groups showed a significant decrease in satisfaction with the quality of sexual life, which, apparently, can be explained not only by radiation damage to the structures responsible for hemodynamics of the penis, but also by castration syndrome due to prolonged hormonal deprivation in the vast majority of patients. Conclusion . The combination of external beam radiation therapy with HDR brachytherapy boost is an effective method of radical treatment of prostate cancer patients with high and extremely high risk of recurrence.

Учебное пособие используется для аудиторных занятий и самостоятельной работы студентов при изучении профилактики и лечения венозных тромбоэмболических осложнений у пациентов со злокачественными новообразованиями. Содержание освещает основные вопросы определения риска венозных тромбоэмболических осложнений и методы их профилактики и лечения у больных с местно-распространенными и метастатическими злокачественными новообразованиями. Учебное пособие предназначено для обучающихся в системе высшего образования (аспиранты, ординаторы, интерны, студенты) и дополнительного профессионального образования (слушатели циклов повышения квалификации). Учебное пособие утверждено в качестве учебно-методического пособия Ученым советом ФГБУ «НМИЦ онкологии им. Н. Н. Петрова» МЗ РФ (протокол № 10 от 27.09.2016). The textbook is used for classroom studies and independent work of students in the study of prevention and treatment of venous thromboembolic complications in patients with malignant tumors. The content covers the main issues of determining the risk of venous thromboembolic complications and methods of their prevention and treatment in patients with locally advanced and metastatic malignant tumors. The textbook is intended for students in higher education (graduate students, residents, interns, students) and in additional professional education (students of advanced training cycles). The textbook was approved as educating manual by the Scientifi c Council of NMRC of Oncology n. a. N. N. Petrov HM of RF (protocol № 10 from 09.27.2016).

A systematic review of the studies where HIPEC combined with cytoreductive surgery was used in patients with primary advanced ovarian cancer was performed to understand is there a role for this treatment modality not only in recurrent but in primary advanced ovarian cancer. The results are controversial but there is a strong trend for improvement of the long-term outcomes of patients with primary advanced ovarian cancer after HIPEC.

Treatment of advanced soft tissue sarcoma (STS) has passed a difficult and long way of evolution from amputation surgery to complex limb-salvage interventions, but the problem of local recurrence is relevant today as 100 years ago. Tactics of monitoring after treatment of STS depends on the individual risk of recurrence and should be based on simple and effective diagnostic methods. Developing of new individualized approaches to patient follow up after primary treatment of STS is extremely necessary for early detection of local recurrence and improvement of overall survival, which requires close cooperation of clinical, morphological and radiology specialists.

One of clinical and anatomical types of melanoblastoma is melanoma of the glans penis appearing on the skin or mucosa of the penis (external opening of the urethra or ureter, internal or external layer of the foreskin). It's a rare disease, and most of specialists are unfamiliar with it, including oncologists and urologists. Thus, the conducted research has practical importance as it may improve diagnostics and treatment of patients with this oncological pathology.

The purpose of the study was to systematize the data available in the modern literature on the diagnosis and treatment of metastatic melanoma without clinically evident primary tumor. Materials and methods. The results of laboratory-instrumental diagnostics, surgical and drug treatment presented in randomized clinical trials, published over the past 10 years in Medline, Embase and the Cochrane Library were analyzed. Results. Despite continuous improvement in imaging techniques, melanoma accounts for up to 12.6 % of all cases of metastatic cancer with an unknown primary site. Metastatic melanoma without clinical evidence of primary tumor accounts for approximately 1% to 8% of all melanoma cases. Conclusion. Metastatic melanoma without clinically evident primary tumor has not been extensively studied. Until now, only a few reports on metastatic melanoma without clinically evident primary tumor have been available. Therefore, further prospective studies of clinical course and optimization of diagnosis and treatment of patients with metastatic melanoma without clinically evident primary tumor are needed.

Subungual melanoma is a rare malignancy of which practitioners in various fields including oncologists know little; the work, therefore, is of great practical importance, since it could improve the diagnosis of melanoma not only by oncologists, but also by surgeons, general practitioners, dermatologists and other specialists. The article provides full and detailed information on the clinical manifestations of subungual melanoma, especially in the early stages, recommends an algorithm for timely diagnosis, suggests the optimum volume of surgical treatment, outlines prognostic factors for this form of melanoma.

Treatment of advanced soft tissue sarcoma (STS) has passed a difficult and long way of evolution from amputation surgery to complex limb-salvage interventions, but the problem of local recurrence is relevant today as 100 years ago. Tactics of monitoring after treatment of STS depends on the individual risk of recurrence and should be based on simple and effective diagnostic methods. Developing of new individualized approaches to patient follow up after primary treatment of STS is extremely necessary for early detection of local recurrence and improvement of overall survival, which requires close cooperation of clinical, morphological and radiology specialists.

The paper summarizes and analyzes the results of complex treatment of patients with malignant tumors performed in the N.N.Petrov Research Institute of Oncology using perfusion technologies. Safety and efficacy data on various chemoperfusion is presented: intraperitoneal chemoperfusion combined with cytoreductive surgery in patients with locally advanced and disseminated gastric cancer, recurrent ovarian cancer and pseudomyxoma peritonei; isolated lung perfusion combined with metastasectomy in patients with lung metastases; isolated limb perfusion with/without cytoreduction in patients with locally advanced skin melanoma and locally advanced soft-tissue sarcoma. The conclusion is made that both intraperitoneal and isolated chemoperfusions are not associated with higher incidence of intra- and postoperative morbidity. However safety of the procedures could be increased through optimizing tactics of surgical procedures prior to chemoperfusions. The use of perfusion technologies provides significant survival advantage in patients who can’t benefit from conservative treatment.