Currently, lung cancer is a global problem and public health issue in the world. Chemoradiotherapy remains the optimal method in the treatment of patients with unresectable non-small cell lung cancer (NSCLC). Nowadays, immune response checkpoint inhibitors (monoclonal antibodies) are actively introduced into clinical practice which demonstrated significant improvements in the overall survival for patients with unresectable NSCLC. These drugs block programmed cell death protein (PD‑1) and programmed cell death ligand 1 (PD-L1) that increases regulation on the surface of T-cells and improves the patient's immune system respond to tumor cells. In 2019, durvalumab was introduced into clinical practice for the treatment of patients with unresectable NSCLC (stage III) after chemoradiotherapy. In our study, we’ve summarizes studies investigated the feasibility and safety of radiotherapy with immunotherapy for locally advanced lung cancer.

Mucinous adenocarcinoma is a rare malignant tumor of the lung, which is accompanied by extremely scarce and nonspecific symptoms. This leads to an increase in the timing of its recognition, especially in young women. Given the poor prognosis of the pathlogy, the problem of its early diagnosis with histological and immuno-histochemical studies is extremely urgent. The presented clinical case demonstrates the possibilities of computed tomography with intravenous contrast enhancement in a young woman for the diagnosis of mucinous lung adenocarcinoma.

INTRODUCTION. Chest wall tumors represent a variety of morphological forms and variants of lesions. According to different authors, primary malignant tumors of the chest wall account for 0.2–2 % of all malignant neoplasms. Of them, soft tissue sarcomas constitute about 45 %. Metastatic tumors of the chest wall occur much more frequently and most commonly develop from malignant tumors of the mammary, prostate and thyroid glands, lungs, kidneys and ovaries.MATERIALS AND METHODS. The standard of the treatment of primary and metastatic tumors of the chest wall is combination or comprehensive therapy. In some cases, preoperative care allows to create a more favorable environment for performing surgical treatment being considered the best option for chest wall tumors. The choice of a technique for the replacement of the post-resection chest wall defect is of special importance to preserve the physiological chest volume, to restore chest rigidity, to prevent paradoxical respiration and to seal the pleural cavity.RESULTS. There are different surgical techniques for skeleton reconstruction. A wide range of materials used for a skeleton reconstruction include bone tissues obtained from patient’s own body (bone autoplasty, autografts), polymeric mesh (polypropylene, polytetrafluoroethylene (Gore-Tex), bone cement (polymethyl methacrylate), stainless steel and titanium constructions as well as titanium bars and rib clips (STRATOS). In spite of a large number of techniques for sternal reconstruction described in the literature, searching for new materials and ways of their usage appears relevant.CONCLUSION. Our clinical case studies demonstrate that modern reconstructive techniques combined with careful surgical planning allow to perform radical surgery with a successful outcome preventing serious postoperative complications.

Currently, lung cancer is a global problem and public health issue in the world. Chemoradiotherapy remains the optimal method in the treatment of patients with unresectable non-small cell lung cancer (NSCLC). Nowadays, immune response checkpoint inhibitors (monoclonal antibodies) are actively introduced into clinical practice which demonstrated significant improvements in the overall survival for patients with unresectable NSCLC. These drugs block programmed cell death protein (PD‑1) and programmed cell death ligand 1 (PD-L1) that increases regulation on the surface of T-cells and improves the patient's immune system respond to tumor cells. In 2019, durvalumab was introduced into clinical practice for the treatment of patients with unresectable NSCLC (stage III) after chemoradiotherapy. In our study, we’ve summarizes studies investigated the feasibility and safety of radiotherapy with immunotherapy for locally advanced lung cancer.

Aim: to analyze the quality of life of patients with locally advanced inoperable lung cancer during radiation and photodynamic therapy. material and methods. the study included 59 patients with stage II–III lung cancer. the first group (Rt) included 28 patients, who received radical radiation therapy. they completed questionnaires before starting radiotherapy and 2–3 days before the completion of radiotherapy. the second group (PDt + Rt) included 31 patients, who underwent endoscopic photodynamic therapy followed by radical radiation therapy. they were interviewed three times: before PDt, 10 days after PDt (before radiation therapy), and 2–3 days before the completion of radiation therapy. two types of questionnaires were used: patient lung cancer symptom scale (Lcss) and EuroQol questionnaire (EQ-5D-5L). Results. the student’s t test and Mann-Whitney u test showed no statistically significant differences in symptoms (except for the symptom «blood in the sputum») between two groups. Both treatment options demonstrated improvement in most items assessing symptoms. In the Rt group, no statistically significant improvements in the item assessing pain were found. In the PDt + Rt group, no significant improvements in the item assessing cough were observed. a comparison of the data of the intermediate (after PDt) and the final questionnaire allowed us to establish that the items «appetite», «fatigue», «pain» and «the impact of the disease on life» improved only after the completion of full-course therapy. the improvement in the item assessing cough was observed after PDt; however, the treatment outcomes showed a return (worsening) of the symptom to the level, which was before treatment. the comparison of the data of the intermediate (after PDt) and the final questionnaire showed the improvement of the items, such as «mobility», «self-care», «daily activities» and «anxiety/depression» after PDt; however, the treatment outcomes indicated a return (worsening) of the symptom to the level, which was observed before treatment. Conclusion. Both types of questionnaires provided important information about the patient’s condition. Lcss questionnaires seem to be preferable in terms of the possibility of using parametric criteria and, as a consequence, obtaining quantitative data on changes in the health of patients. the analysis did not allow us to make a conclusion about the difference in the final efficacy Rt and PDt + Rt in terms of subjective assessment of the health status by the patients themselves. the use of questionnaires in the PDt + Rt group showed that after PDt (before starting Rt) patients had positive changes in their health, which were observed in the Rt group after the completion of full-course therapy.

Lung cancer is one of the leading causes of death in the world. Despite improvements in diagnostic procedures, most cases of this disease are diagnosed at common and metastatic stages. In recent years, new approaches to systemic antitumor treatment have been registered, which are the main method of treatment in patients with stage IIIB-IV. The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. It is important to understand how a small amount of biopsy material obtained using minimally invasive techniques is processed and evaluated by pathologists. An important condition is obtaining a sufficient number of cell or tissue substrate, can reliably establish the malignant process, to determine the histologic tumor type (whether it’s adenocarcinoma or squamous cell carcinoma), carry out the immunohistochemical and molecular genetic study to determine indications for the purpose of targeted, immunotherapy and the selection of chemotherapy regimen. It is necessary to conduct a single procedure that is as gentle as possible and provides a sufficiently large amount of tissue. The method of obtaining the material should be selected individually depending on the location of the pathological formation, the patient's condition and the capabilities of the clinic.

Purpose. To assess the effectiveness of various techniques of surgery of pulmonary metastases based on the outcomes of surgery interventions, frequency of postoperative complications and overall survival of patients.Patients and methods. Ninety-seven patients with suspected lung metastases of known primary malignancies (47 men and 50 women, mean age of 46,5 years) were retrospectively included in two study groups between 1 January 2004 and 1 January 2016 and underwent pulmonary surgery with the Nd: YAG laser of the 1318 nm wavelength (Group A, n = 44) or with the electrocautery (Group B, n = 53).Results. A total of 151 operations were performed: 75 in Group A, 76 in Group B. The mean number of resected pul­monary lesions was 8,2 (95% CI: 5,2–11,1) in group A and 4,9 (95% CI: 3,7–6,0, p = 0,047) in group B. Additionally 87 lesions were evaporated due to small sizes (1–2 mm) in Group A. The mean time of surgery was 146 minutes in Group A and 113 minutes in Group B (p < 0,01).Post-surgery complications were diagnosed after 9 and 19 of interventions in Groups A and B, respectively. The most common complications were pneumonia, pneumothorax and subcutaneous emphysema. The number of Grade III com­plications according to Clavien-Dindo classification was 2 and3 inGroups A and B, respectively. The survival rates were computed for all patients: the one-year, three-year and five-year survival rates were 83,7%, 49,7% and 36,7%, respec­tively.Conclusion. The Nd:YAG laser with wavelength of 1318 nm allow extensive parenchymal resections without an increase in post-surgery complications and may have advantages in pulmonary metastasectomy, especially in patients with mul­tiple pulmonary lesions.

48 Рак легкого продолжает занимать лидирующее место по показателю смертности среди онкологических заболеваний в России и в мире [1, 2]. Несмотря на совершенствование диагностических процедур и проведение профилактических мероприятий, большинство случаев рака легкого диагностируют на распространенных стадиях. Для улучшения непосредственных и отдаленных результатов ведется поиск новых методов лечения и их комбинаций. В последнее десятилетие наиболее быстро развивающимся направлением является молекулярно-направленная или таргетная терапия. Лекарственные препараты этой группы у больных немелкоклеточным раком легкого (НМРЛ) с драйверными мутациями селективно блокируют патологические процессы в опухолевых клетках, что позволяет увеличивать эффективность проводимого лечения и повышать общую выживаемость больных [3]. Ингибиторы тирозинкиназы EGFR показали высокую эффективность в клинических исследованиях и повседневной практике, при этом став важным компонентом лечения больных диссеменированным раком легкого. В настоящее время данные литературы и собственный опыт позволяют предполагать грядущее расширение показаний к применению препаратов этой группы у больных НМРЛ. EGFR — трансмембранный рецептор, который связывается с эпидермальным фактором роста, его активация приводит к запуску патологических взаимодействий в опухолевой клетке, вызывая пролиферацию, ангиогенез и метастазирование, поэтому данный сигнальный путь является одним из наиболее привлекательных для поиска лекарственных воздействий [4]. Первыми таргетными препаратами для лечения НМРЛ стали ингибиторы тирозинкиназы EGFR. Изначально, клинические испытаdoi: 10.17116/onkolog20165248-53

The results of 107 CT-guided transthoracic biopsies, conducted during 2005-2010 yy, were analyzed. The authors have shown the advantages of the core biopsy compared with the fine-needle aspiration biopsy (FNAB). Sensitivity of the first for the malignant tumors was 93%, while the FNAB sensitivity was only 75%. Though the core biopsy showed higher complication rates of the procedure. Both methods proved to be easy to use and should be used for the diagnostic purposes in cases of the peripheral lung tumors and mediastinal lymph nodes.