Purpose of the study. Preventive pressurised intraperitoneal aerosol chemotherapy (PIPAC) safety assessment in the combined treatment of gastric cancer (GC).Patients and methods. The study included 48 patients with morphologically confirmed resectable GC and cardio esophageal transition, having at least one criterion that is a predictor of the development of peritoneal carcinomatosis, e. g. tumor spread to the serous layer (≥ T4a), diffuse tumor type, affected regional lymph nodes, large tumor, young age (up to 45 years), subtotally and totally affected stomach. 36 out of those patients received treatment according to the protocol. All patients received 4 cycles of neoadjuvant chemotherapy according to the FLOT scheme, radical surgical treatment in combination with a PIPAC session, 4 cycles of adjuvant chemotherapy according to the FLOT scheme. The safety assessment was carried out according to the classification of surgical complications according to Clavien-D indo and the international scale for toxicity scaling NCI–CTCAE v5.0.Results. Postoperative complications were diagnosed in 25 %, >III grade complications were revealed in 11 % of cases according to the Clavien-D indo classification. The postoperative mortality rate was 0 %.Conclusion. Preventive PIPAC of locally advanced GC and CET in combined treatment is a reproducible and safe method, which is characterized by the absence of an increase in the number of postoperative complications and mortality rate.

Bladder cancer is the 9th most common malignant tumor worldwide. Muscle-invasive bladder cancer is an aggressive malignant neoplasm with a tendency for early metastases. The main approach for muscle-invasive bladder cancer treatment is radical cystectomy with lymph node dissection and polychemotherapy. In recent decades, organ-preserving conservative therapy has been actively investigated. Currently, the most studied approach to organ-preserving treatment of muscle-invasive bladder cancer is the trimodality therapy which includes transurethral resection of the bladder wall with the tumor, chemotherapy, and external beam radiotherapy. The article presents an approach which additionally includes intratumoral radiation therapy. In our study, we have investigated the current state of brachytherapy in bladder cancer treatment and its development.

Advanced chemo- and radiotherapy makes it possible to expand the cohort of patients who can undergo surgical treatment for esophageal cancer. Optimization of perioperative approach, diagnosis and modern options for complications reduced early postoperative mortality after esophagectomy. Conduit ischemia with failure of esophageal-gastric or esophageal-intestinal anastomosis is one of the most serious complications. To minimize the risk of anastomotic leakage and graft necrosis in these patients, various methods of intraoperative assessment of graft viability are being investigated. Near-infrared fluorescence imaging with indocyanine green is valuable for real time assessment of graft perfusion. To date, fluorescence imaging is analyzed regarding perfusion of the gastric stalk after esophagectomy. However, there are still few or no data on this method for analysis of colonic conduit perfusion. The absence of plastic material for gastrointestinal reconstruction is the most dangerous moment in case of ischemia and necrosis of colonic graft. We present our first case of delayed retrosternal esophageal repair using intraoperative indocyanine green fluorescence imaging for assessment of conduit perfusion.

Esophageal cancer (EC) is one of the most aggressive malignant neoplasms, ranking sixth among oncological causes of death. According to GLOBOCAN, more than half a million people die from this disease every year, and by 2040 this indicator is expected to increase almost twice. In most patients, esophageal cancer is diagnosed at stages III–IV of the disease. Currently, the standard of treatment for inoperable patients with EC is simultaneous chemoradiotherapy. One of the main methods of treatment of patients with non-metastatic esophageal lesion remains surgical intervention in the volume of esophagectomy with radical lymph dissection, accompanied by quite frequent serious postoperative complications. However, the results of surgical treatment of locally advanced esophageal cancer alone remain unsatisfactory, and the fiveyear survival rate is less than 20 %. In order to improve the oncological results of treatment, various combinations of drug and radiation therapy are used (preoperative chemotherapy or chemoradiotherapy, independent chemoradiotherapy). To date, recommendations for the treatment of locally advanced esophageal cancer vary from country to country. Trimodal therapy (preoperative chemoradiotherapy up to TFD – 46 Gy with 5 cycles of weekly chemotherapy according to the carboplatin + paclitaxel scheme followed by surgical treatment) is the standard in operable patients with non-metastatic squamous cell carcinoma of the esophagus in our and European countries. In Asian countries, preference is given to neoadjuvant chemotherapy, based on the data of the JCOG1109 (NExT) study, in which it was shown that the addition of docetaxel to neoadjuvant therapy with cisplatin and fluorouracil is accompanied by an improvement in overall survival and acceptable toxicity, compared with the CF regimen and chemoradiotherapy. A separate issue is the place of lifesaving esophagectomy in patients who have received a course of radical chemoradiotherapy. Unfortunately, according to several researchers, recurrent or persistent esophageal cancer remains an urgent problem with a risk of relapse of the disease in up to 60 % of cases. We have studied the data of the Russian and global literature concerning the treatment of squamous cell carcinoma of the esophagus.

Purpose of the study. The study was aimed to investigate the effectiveness of PET / CT with 18 fluoro‑2 deoxy-D-glucose (18F-FDG) in the differential diagnosis of focal lung neoplasms.Materials and methods. Patients (n = 108) with newly diagnosed lung focal lesions were enrolled in the study. All patients underwent PET / CT with 18fluoro‑2deoxy-D-glucose in the "whole body" mode in accordance with the standard protocol. The next step was surgical treatment with morphological verification. According to the results of the morphological conclusion, malignant neoplasm was not diagnosed in 11 (10.2 %) patients, while post-inflammatory changes were detected in 7 patients (SUVmax from 2.3 to 15.15), hamartoma was verified in 3 patients (SUVmax from 1.1 to 4.2) and anthracosis was detected in 1 patient.Results. The median radiopharmaceutical accumulation (SUVmax) was 6.0 (ICR 3.9–8.4, n = 108). In turn, in patients with diagnosed lung cancer this indicator was 7.0 (ICR 5.8–10.9, n = 60), in patients with metastatic lesions 4.3 (ICR 2.5–7.1, n = 37). The threshold for SUVmax was 5.4 for the detection of malignant tumors. PET/CT with 18F-FDG demonstrated high data variability regarding the size of lung focal lesion. An error within 35 % was observed in 76 % of cases, underestimating small lesions (up to 40 mm) but overestimating the major neoplasms. Application of a linear model for adjustment of neoplasm size assessment allows to estimate the actual size of neoplasms with parameters 5.862 + 0,817 × х (х – PET / CT size) in 84.5 % of cases with an error of 50 %. The optimal diagnosing size for metastatic lesions is in the range between 16.4 and 19 mm.Conclusion. Taken together the results of the study show that PET / CT with 18F-FDG gives a relatively accurate estimation of the tumor size. Application of the linear model corrects a radiological size measurements and helps to predict an actual size of a neoplasm in 84.5 % of cases with an error of 50 %. The prospective threshold for SUVmax was at least 5.4 for the detection of malignant neoplasms.

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.

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.

Background. There is currently no information on the results of randomized studies evaluating the surgical treatment outcomes in patients with pulmonary metastases. Therefore, there is a strong need for a staging system that can permit the stratification of patients with intrapulmonary metastasis. Aim: To analyze the overall survival of patients who underwent pulmonary metastasectomy using a new classification taking account the extent of pulmonary metastasis. Material and methods. The study included 568 lung cancer patients who underwent pulmonary metastasectomy. All patients were stratified according to a new classification taking into account the number of metastatic sites and the extent of lymph node involvement. The median age of the patients was 49 years (range: 18 to 81 years). Results. Histological study revealed no evidence of metastases in 72 patients. In patients having no lymph node involvement, better results were observed in patients with a solitary site of metastasis (Ms ), with a median survival of 58 months. In patients with oligometastatic lesions (up to 5 sites) and limited metastatic sites (6–24 sites), the median survival was 36 and 26 months, respectively. In patients with multiple metastatic lesions (more than 25 sites), the median survival was 12 months. Among patients with lymph node metastases, the median survival was 32 months for patients with a solitary metastasis (Ms) and 27 months for patients with oligometastases (Mo ). In patients with limited number of metastatic sites (6–24 sites), the median survival was 12 months. In patients with multiple metastases (Mm), the median survival was 6 months (p=0.00012). Conclusion. A new classification will help to stratify patients into identical subgroups. Its use should be considered as one of the selection criteria in future multicentre randomized trials.

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.

AIM:To analyze pulmonary metastases classifications which are used in Russian and foreign literature at present time.MATERIAL AND METHODS:It is proposed the variant of pulmonary metastases staging depending on quantitative and regional prevalence of the process.RESULTS:The development of pulmonary metastases classification is advisable to determine homogeneous subgroups of patients with metastatic lesion for prospective randomized trials in order to obtain objective results about the results of surgical or other local treatment of patients with intrapulmonary metastases.

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

Introduction. The aim of this study was to analyze the surgical treatment for multiple intrapulmonary metastases sarcomas of bone and soft tissue. Methods. This analysis includes retrospective survival data from 24 patients with soft tissue sarcomas and bone sarcomas who were treated from January 2004 to December 2014 in MRRC and meet the following criteria: the presence of more than four lesions in the lungs, no progression of the primary tumor, no distant metastases and overall satisfactory status (ECOG 0–1). Survival of patients assessed by Kaplan-Meier method. results. In total 49 pulmonary metastasectomy were performed. There were no postoperative deaths. In 4 patients underwent repeated operations. From this cohort 1-year survival has survived 10 patients (41.6 %), 5-year – 3 (12.5 %). 3 patients are alive 28, 62 and 139 months after surgery with no evidence of progression of tumors. conclusion. The detection of lesion in the pulmonary parenchyma is most often regarded as the poor prognosis of the disease. Individually tailored treatment strategy allows you to increase the overall life expectancy and improve quality of life. The surgical method can be considered as a stage of complex treatment, as in the progression of the disease in the lungs, and in synchronous lesions. Surgical repeated resection may be an appropriate treatment for patients with progression and the justified possibility of an operation.

Introduction. The aim of this study was to analyze the surgical treatment for multiple intrapulmonary metastases sarcomas of bone and soft tissue. Methods. This analysis includes retrospective survival data from 24 patients with soft tissue sarcomas and bone sarcomas who were treated from January 2004 to December 2014 in MRRC and meet the following criteria: the presence of more than four lesions in the lungs, no progression of the primary tumor, no distant metastases and overall satisfactory status (ECOG 0–1). Survival of patients assessed by Kaplan-Meier method. results. In total 49 pulmonary metastasectomy were performed. There were no postoperative deaths. In 4 patients underwent repeated operations. From this cohort 1-year survival has survived 10 patients (41.6 %), 5-year – 3 (12.5 %). 3 patients are alive 28, 62 and 139 months after surgery with no evidence of progression of tumors. conclusion. The detection of lesion in the pulmonary parenchyma is most often regarded as the poor prognosis of the disease. Individually tailored treatment strategy allows you to increase the overall life expectancy and improve quality of life. The surgical method can be considered as a stage of complex treatment, as in the progression of the disease in the lungs, and in synchronous lesions. Surgical repeated resection may be an appropriate treatment for patients with progression and the justified possibility of an operation.