Leptomeningeal metastases are lesions of brain and/or spinal cord sheaths by tumor cells. They occur in 5% of patients with solid tumors, although autopsies reveal these lesions much more often (10-20% of cases). Leptomengeal metastases are an unfavorable prognostic factor. Despite the modern NCCN treatment standards, including intrathecal therapy (ITT), such patients receive only irradiation of the entire brain and/or spinal cord in most cases.OBJECTIVE:To evaluate the effectiveness of ITT in patients with leptomeningeal metastases in breast cancer.MATERIAL AND METHODS:Twenty-five patients with breast cancer and leptomeningeal metastases underwent intrathecal administration of methotrexate between 2016 and 2022. Intrathecal chemotherapy was administered through lumbar puncture. We performed an intensive course (intrathecal methotrexate 15 mg 2 times a week for 1 month (8 injections), then intrathecal methotrexate 15 mg 1 time a week (4 injections), and then 15 mg 1 time a month until progression or unacceptable toxicity).RESULTS:The median duration of ITT was 2.5 months. Complete neurological responses were observed in 3 out of 25 (12%) patients, partial neurological response - in 15 out of 25 (60%) patients, progression of neurological symptoms - in 7 (28%) patients. The number of complete cytological responses was observed in 6 out of 25 (24%) patients. The median overall survival after ITT was 6.7 months.CONCLUSION:Effectiveness of ITT is confirmed by higher quality of life (72% of patients), complete cytological responses (24%) and improvement in neuroimaging data. This is an important criterion for severe patients with limited treatment options. First-stage ITT before whole-brain irradiation is preferable, as this approach increases overall survival by 3 months. Undoubtedly, ITT is a treatment option that can be used in routine clinical practice for lesions of brain and spinal cord sheaths.

Introduction. The standard of treatment for patients with single cerebral metastases is surgery and radiosurgery. The use of these methods significantly increases survival rates. Aim. To compare the results of surgical treatment of patients with single and multiple cerebral metastases. Materials and methods. The study included 40 patients with single and multiple cerebral metastases who underwent neurosurgical intervention in the neuro-oncology department of the N.N. Blokhin National Medical Oncology Research Center from 2010 to 2022. Results. All patients are divided into 3 groups. Group A included 15 patients who removed all available cerebral foci (from 2 to 4). Group B included 10 patients with multiple cerebral metastases who underwent removal of one symptomatic metastasis. In group C, 15 patients who underwent removal of a single metastasis. It was noted that the survival of patients after removal of all cerebral metastases is identical to the survival of patients after removal of single metastasis 11.9 and 12.4 months, respectively. And it was significantly higher than the survival of patients who removed not all cerebral metastases 6.2 months (p = 0.03). Also in group A and C, the percentage of local relapses was identical. Improvement in neurological status was noted in all groups, there was only an increase in cognitive-mnestic disorders in group A, where all cerebral foci were removed. However, these disorders were moderate and did not reach the extent of dementia. The work done shows. Conclusion. Surgical removal of all metastases in patients with multiple brain metastases provides a prognosis similar to that of patients undergoing surgery for single metastasis. Removal of symptomatic metastasis in patients with multiple cerebral lesions in most cases leads to a regression of neurological symptoms and makes it possible to continue treatment with a group of patients whose condition was considered incurable. The percentage of local relapses in the removal of multiple cerebral metastases, subject to oncological principles, is the same as in the removal of single metastases.

The article presents a clinical case of atypical teratoid rhabdoid tumor with one of the longest catamnesis described in literature (109 months) and high quality of life. first, a giant tumor of the frontal lobe with advancement into a lateral ventricle was found in a female patient and totally removed. It was histologically diagnosed as primitive neuroectodermal tumor. Combination treatment consisting of radiotherapy, high-dose polychemotherapy and cellular immunotherapy including intrathecal therapy led to 4-year recurrence-free period. Recurrence of the tumor was resected. The period of the 2nd remission was 34 months. Subsequently, multistage metastasis of the tumor through cerebrospinal fluid tracts of the brain and spinal cord was observed. Twice microsurgical treatment with removal of symptomatic metastases in ventricles Iv and III was performed. In repeat morphological examinations, the tumor was verified as atypical teratoid rhabdoid tumor. The presented clinical case shows the role of active surgical tactics in effective long-term combination treatment of this severe pathology.

Introduction. The surgical stage takes an important place in the complex treatment of patients with cerebral metastases of malignant tumors. In general, all efforts during surgical intervention should be aimed at restoring a good functional status, since severe neurological symptoms can deprive patients of the opportunity to continue complex treatment, which will negatively affect overall survival. The most pronounced neurological symptoms are observed in patients with metastases in the motor area. In this article, we tried to substantiate the need for surgery of cerebral metastases in patients with severe motor deficits, evaluate the results of surgical treatment and also to develop optimal surgical removal techniques.The study object – to assess the effectiveness of surgical removal of metastases in the motor cortex by evaluating the dynamics of motor function recovery and regression of paroxysmal symptoms.Materials and methods. An analysis of the surgical treatment of 18 patients with metastases in the motor area was carried out. Tumor localization was verified using magnetic resonance imaging, before surgery, neuronavigation system Brainlab during surgery. Мagnetic resonance tractography made it possible to assess the localization and degree of compression of the fibers of the cortico-spinal tract. Functional monitoring was not performed during the operation. The operations were performed using a ZEISS OPMI PENTERO 800 microscope.Results. Recovery of motor function after surgery was noted in 17 (94.5 %) cases. It was complete or partial. With metastases of a solid, solid-necrotic, solid-cystic structure, regression of pyramidal symptoms developed gradually, starting from 4 days after surgery. As a rule, rehabilitation therapy (therapeutic exercise, massage, electromyostimulation) is carried out on patients from 3 days after surgery, which accelerated the recovery process. The maximum effect developed on the 15th day after the operation. Faster recovery of motor function was observed in patients with large cystic metastases who underwent surgery in the volume of Ommaya reservoir implantation. They began to recover motor function a few hours after awakening. Regression of paroxysmal symptoms was noted in all cases. Although the patients continued to take anticonvulsants. The observation period was 6 months.Сonclusion. Surgical removal of cerebral metastases in the motor area allows achieving complete or partial regression of neurological symptoms. At the same time, the recovery period is short – from several hours to 14 days. It becomes possible to cancel glucocorticoids 7–10 days after the operation. Conditions are being created for the continuation of complex treatment of patients previously considered incurable.

Glioblastoma multiform^ is one of the most aggressive malignancies, wich standard of treatment not changed over the past decade, and the average life expectancy from diagnosis to death does not exceed two years in the most optimistic trials. The review examines the features of the glioblastoma microenvironment, its genetic heterogeneity, the development of recurrent glioblastoma, the formation of drug resistance, the influence of the blood-brain barrier and the brain lymphatic system on the development of immunotherapy and targeted therapy. Molecular subgroups of glioblastomas with an assumed prognostic value were analyzed. It was determined that numerous relationships between glioblastoma cells and the microenvironment are aimed at ensuring tumor progression, and also cause a state of reduced effector function of T cells. Data on the development of future molecular-targeted therapies for four types of cancer cells based on their different properties and response to therapy are summarized: primary GSC, RISC cells, and proliferating and postmitotic non-GSC fractions. The penetration of blood-brain barrier with chemotherapeutic drugs and antibodies currently remains the main limitation in the treatment of glioblastoma. The resulting analysis of the causes is reduced to the following conclusions. A detailed understanding of the evolutionary dynamics of tumor progression can provide insight into the related molecular and genetic mechanisms underlying glioblastoma recurrence. The most promising methods of treatment for glioblastoma are combined therapy using immune checkpoint inhibitors in combination with new treatment methods -vaccine therapy, CAR-T-cell therapy and viral therapy. A deeper study of the mechanisms of drug resistance and acquisition resistance, biology and subcloning clonal populations of glioblastoma and its microenvironment, with active consideration of combined trips to the treatment will increase the survival rate of patients, and may lead to stable remission of the disease.

The spread of female genital tract tumours to the brain is a rare and insufficiently studied pathology. The problems of diagnosis and treatment of this group of patients still remain. The article gives a detail account of the clinical picture, radiological and morphological diagnosis, and the principles of treating patients with brain metastases from gynaecological cancers. Conclusion. A probable cause of a rare occurrence of brain metastases from gynaecological malignancies might be a high resistance of nervous tissue to various kinds of tumours. When local control over a brain tumour is achieved, this might improve the patient’s survival and quality of life in some particular cases. Key words: ovarian cancer, endometrial cancer, cervical cancer, brain metastases

Metastatic damage to the brain is a frequent manifestation in tumors of various localizations, including breast cancer. Until recently, systemic therapy of metastatic brain damage was of limited use; however, with the advent of targeted drugs that are better understood in terms of the specific molecular targets and biological characteristics of metastases, it is now possible to improve treatment results. In an analysis of the results of studies on the problem of metastasis of breast cancer in the brain, a comparison of the use of various targeted drugs in the treatment of metastatic HER2 + breast cancer is presented. The results of a comparison of the degrees of effectiveness of targeted drugs, both in monotherapy and in combination with chemotherapy, were obtained and analyzed.

А. Г. Кедрова1, 2, С. Э. Красильников3, А. Г. Винокуров4, А. И. Беришвили2, Т. А. Греян1, О. П. Крашенков5, Е. С. Половников3 1Отделение онкологии ФГБУ «Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентства России» (ФНКЦ ФМБА России); Россия, 115682 Москва, Ореховый бульвар, 28; 2кафедра акушерства и гинекологии Академии последипломного образования ФНКЦ ФМБА России; Россия, 125371 Москва, Волоколамское шоссе, 91; 3Институт онкологии и нейрохирургии ФГБУ «НМИЦ им. акад. Е. Н. Мешалкина» Минздрава России; Россия, 630055 Новосибирск, ул. Речкуновская, 15; 4нейрохирургическое отделение ФНКЦ ФМБА России; Россия, 115682 Москва, Ореховый бульвар, 28; 5отделение противоопухолевой лекарственной терапии ФГБУ «Центральная клиническая больница с поликлиникой» Управления делами Президента Российской Федерации; Россия, 121359 Москва, ул. Маршала Тимошенко, 15

The article presents a clinical case of long-term complete remission after combined treatment in patient with metastasis of ovarian cancer in the brain. Duration of remission after treatment was more than 7 years.

Improvement in the diagnosis and treatment of cancer patients, increase in frequency of prevalence and detection of metastatic lesions of the brain make the choice of treatment timely and important. The article presents data on the current prognostic scales for patients with cerebral metastases of solid tumors and the analysis of their features. The features of choice of tactics and strategy of treatment of patients with cerebral metastases of solid tumors depending on various prognostic factors are described. The original version of the rating scale for determining treatment options for patients with metastatic brain lesions is proposed. We suggest to consider oncological, neurological (neurosurgical), somatic (functional) groups of factors to choose the tactics of treatment of patients with brain metastases.

Hepatocellular carcinoma ranks 5th in prevalence and 3rd in cancer mortality worldwide. The prognosis of this disease is very poor: the 5-year survival rate was not more than 3-5%. Metastases generally occur in the lung, in the lymph nodes of the abdomen, chest, and neck, in the vertebrae, kidneys, and adrenals. The cases of brain metastasis from hepatocellular cancer are very rare. Overall, the prognosis is very poor for patients with brain metastases from hepatocellular carcinoma. Nevertheless, solitary brain metastases and good hepatic function are favorable survival criteria; thus, the treatment of this group of patients may lead to their better survival. The paper describes a clinical case of brain metastasis from hepatocellular carcinoma in a patient receiving the combination treatment involving neurosurgical treatment and targeted therapy.

Lung cancer is mostly common occurring oncological disease in the developed countries. Currently lung cancers are subdivided into nonsmall-cell (adenocarcinoma, large-cell, squamous cell) and small-cell. The difference in the clinical and morphological picture leads to the necessity of choosing therapeutic approaches to patients of various groups.Lung cancer should be referred to encephalotropic diseases since metastatic lesion of the central nervous system is sufficiently common complication. Successes of complex treatment of primary tumor result in increase of total longlivety currently ther is ageing of patients suffering lung cancer. These factors increase the risk of metastatic lesions of the brain.Interest to the problem of neurosurgical treatment of patients suffering lung cancer is determined by frequency of lesion, varicosity of morphological variants of the disease, requiring various algorithms of treatment and diagnosis.The main role of neurosurgical intervention in cerebral metastases of lung cancer consist in creation of the paled of carrying out combined therapy. Ideally, a neurosurgical operation should be carried out with clearcut observance of oncological principles of ablasty.Adequate comprehensive approach to treatment or patients with cerebral metastases of various forms of lung cancer with the developed of optimal tactics of and stages of treatment would make it possible to increase duration and quality of life of patients.

The article describes a clinical case of successful chemotherapeutic and radiation treatment of a patient with breast cancer and metastases to the brain and meninges and with a pronounced neurological deficit. The patient underwent combined treatment (whole brain radiation with TBD of 30 Gy and local radiation of a metastasis with TBD of 15 Gy associated with capecitabine therapy) with continued administration of capecitabine until improvement. A partial metastasis reduction by 50% and complete regression of the neurological deficit were observed. Disease-free period was 1 year and 10 months, and the overall survival amounted to 2 years.

The use of the oncological principle – en bloc ablastic tumor resection – can expect a breakthrough in the treatment of baseline unfavorable patient groups. In the described case of atypical meningioma, its en bloc resection presents significant technical difficulties when accomplishing the task associated with the giant sizes of a tumor as an iceberg growing outside and into the cranial cavity, its rich vascularization from both the internal and external carotid artery system, with the involvement of the superior sagittal sinus, the presence of a dense bone crown that combines the three-component construction of a neoplasm, which made difficult safe mobilization and scanning in the cranial cavity.In such topographic variants, the criteria for the Simpson radical meningioma resection are inapplicable and only en bloc tumor resection may reflect the oncological principles of surgery. The technologies of en bloc resection of intracranial meningiomas should be more frequently used because preoperative neurovisualization and even histological diagnosis does not always allow the grade of meningiomas to be specified.

The main tasks of the study were to evaluate the efficiency of treatment and to estimate time to progression and survival rates in patients with recurrent glioblastomas receiving combination treatment with irinotecan and bevacizumab. Five (41.7 %) patients achieved partial regression; disease stabilization and progression were observed in 5 (41.7 %) and 2 (16.6 %) cases, respectively. The median time to disease progression was 5.5 months; 6-month and one-year survival rates were 66.6 and 25 %. The median overall survival was 9.0 months. Treatment tolerability was satisfactory. Thus, the preliminary results of our study show the high efficiency of a combination therapy regimen incorporating bevacizumab and irinotecan for patients with recurrent glioblastomas and they are comparable with the data available in the literature on investigations of the efficiency of this treatment regimen. This study is being continued.

Hepatocellular carcinoma ranks 5th in prevalence and 3rd in cancer mortality worldwide. The prognosis of this disease is very poor: the 5-year survival rate was not more than 3–5%. Metastases generally occur in the lung, in the lymph nodes of the abdomen, chest, and neck, in the vertebrae, kidneys, and adrenals. The cases of brain metastasis from hepatocellular cancer are very rare. Overall, the prognosis is very poor for patients with brain metastases from hepatocellular carcinoma. Nevertheless, solitary brain metastases and good hepatic function are favorable survival criteria; thus, the treatment of this group of patients may lead to their better survival. The paper describes a clinical case of brain metastasis from hepatocellular carcinoma in a patient receiving the combination treatment involving neurosurgical treatment and targeted therapy.

Cerebral metastases cancer of the larynx are rare and poorly understood pathology, many questions of diagnostics and treatment of this pathology remain open. In the work presents clinical cases сerebral metastases cancer of the larynx. Special attention is paid to surgical treatment in complex with chemotherapy.

The article reviews the experience of capecitabine application in 65 breast cancer (BC) patients with metastatic brain damage. 35 patients underwent early chemoradiation, (brain irradiation) simultaneously with the start of capecitabine. In 30 patients delayed chemoradiation was conducted, in the first phase - induction chemotherapy with capecitabine, then brain irradiation in patients receiving capecitabine. The effectiveness of the immediate and long-term outcomes in the two groups was analyzed. In the group of early chemoradiotherapy objective effect in the brain was 77.2%. The median time to progression - 15.3 months. The median survival - 22 months. In the group of delayed chemoradiotherapy objective effect was 56.6%. The median time to progression - 12 months. The median life expectancy - 15.1 month. When comparing the time to disease progression in the brain in early chemoradiotherapy group (15.3 months), and the group of delayed chemoradiotherapy (12 months), and also when comparing the median survival in early groups (22 months) and delayed (15, 1 month.) chemoradiotherapy statistically significant differences were found (p = 0.3; p = 0.25, respectively). The reviewed modes of chemoradiotherapy with capecitabine (early and delayed chemoradiotherapy) had comparable effectiveness.

Brain metastases of breast cancer are severe complication of oncological process. Despite the spreading of the process, many patients receive treatment and live for years in contrast to patients with cerebral metastases of other cancers (lung cancer, melanoma, renal cell carcinoma). At different stages of metastatic disease in these patients may be offered different types of treatment: chemotherapy, hormonal therapy, targeted therapy, radiotherapy, radiosurgery, surgical treatment. However, there are no standards that define the indications for surgical treatment of cerebral metastases of breast cancer. This article describes the surgical techniques and defines indications and contraindications for surgical treatment.