Introduction. Laryngopharyngeal cancer accounts for about half of the total number of malignant neoplasms of ENT organs. Despite the availability of examination, in most patients tumors of this localization are detected at late stages, and the long-term results of treatment of locally advanced cancer of the larynx remain unsatisfactory. Clinical case. This article presents two clinical cases of combined organ-preserving treatment of laryngopharyngeal cancer with spread to the cervical esophagus. At the first stage, patients underwent organ-preserving surgical treatment with a reconstructive plastic component according to the methodology developed at the A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology. Then a postoperative course of chemoradiotherapy was carried out. Conclusion. The use of combined organ-preserving techniques using displaced skin-muscle flaps in the treatment of locally advanced laryngopharyngeal cancer involving the cervical esophagus allows in some cases to avoid crippling surgery, preserve the larynx and achieve satisfactory functional results, which significantly improves the quality of life of patients.

Despite recent advances in radiation therapy, osteoradionecrosis remains a common and severe complication of radiation therapy in patients with head and neck cancer. Modern methods of treatment are developed with regard to the disease severity and pathophysiology complexity, as well as theories of the osteoradionecrosis development. The following theories of osteoradionecrosis pathophysiology are currently considered: "radiation-induced osteomyelitis", "hypoxic, hypocellular, hypovascular" and "fibroatrophic". Prior to radiation therapy, the patient is provided with restorative dental treatment and radiation therapy planning. Treatments range from conservative «watch and wait» to more radical surgical interventions. Currently, there is no approved standard for the care of osteoradionecrosis patients, however, the activity in this direction is underway. Currently state-of-the-art treatment strategies are available with limited evidence. The review aims to assess the literature on osteoradionecrosis of the jaw with an emphasis on available treatment options.

This article presents a method of organ-preserving surgical treatment of laryngeal cancer, which has been developed and used since 1991 at the Tsyba Medical Radiological Research Center, Branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia. The indications for this method are tumors affecting the middle part of the larynx, limiting its mobility, extending to the anterior commissure, laryngeal ventricle, vestibular fold, lower larynx and one arytenoid cartilage, but retaining mobility in the scooper-cricoid articulation.OBJECTIVE:To increase the functional safety of the larynx and improve the quality of life of patients with laryngeal cancer by using the developed method of organ-preserving surgical intervention in combined treatment.MATERIAL AND METHODS:The study included 197 patients who were operated on by the same method for a primary tumor or in connection with a relapse of the disease. At the first stage, all primary patients underwent a course of radiation or chemoradiation therapy 40-50 Gy. In 78 patients with recurrent laryngeal cancer who underwent resection of the larynx, the previous treatment was carried out in the form of a full course of radiation or chemoradiation therapy with a above 60 Gy.RESULTS:Wound healing by primary intention in patients with preoperative irradiation was observed in 92.4% of cases. With resections for a primary tumor, restoration of functions was observed in 115 (96.6%) patients, and with resections of recurrent tumors - in 71 (91%) patients. Three-year disease-free survival in these patients was 74.4%.CONCLUSION:The presented data showed the high efficiency of the method. This is evidenced by the course of the postoperative period, functional and oncological results are comparable, and in some cases exceed those of other researchers.

The treatment outcomes of unresectable laryngeal cancer have been presented. The techniques of radiation therapy (RT) alone and concurrent chemoradiotherapy (CRT), as well as the effect of changes in the fractionation regimens on the treatment outcome have been analyzed. No differences in overall survival (OS) and locoregional control (LC) between the RT and CRT techniques were found (p<0.8). There is a trend toward improvement in OS (p<0.1) and LC (p<0.05) in laryngeal cancer patients treated with hyperftactionated radiation therapy.

The comparative analysis of results of conservative and combined treatment was carried out. The study group consisted of 400 patients with stage T3–4N0–3M0 laryngeal cancer who received concurrent chemotherapy and radiation therapy in combination with various physical radiomodifyers. The control group comprised 920 patients treated with the same technique but without systemic polychemotherapy. The 5-year relapse-free and overall survival rates were significantly higher in the study group than in the control group (concervative treatment: 71 % and 86 % versus 37 % and 64.8 %, respectively, р<0,001 and combined treatment: 80 % and 83 % versus 47.4 % and 52 %, respectively(р<0,001). The functional organ was preserved in 71.2 % of locally advanced laryngeal cancer patients treated conservatively compared to 37.0 % of the control group patients. Oprgan-preserving surgeries were performed in 30.5% and 23%, respectively. The total number of patients with the larynx preservation was 50 % of the stydy group and 31.6 % of the control group.

The literature review presents the modern methods of treatment of inoperable recurrent squamous cell cancer of the larynx. The application of radiation and chemotherapy.

13 Рак гортани составляет 60% всех злокачественных новообразований органов головы и шеи. В структуре заболеваемости мужского населения рак гортани занимает 8—10-е место и составляет 2,5% от общей онкологической заболеваемости. В 90—95% случаев морфологической формой является плоскоклеточный рак различной степени дифференцировки [1]. Согласно данным ряда авторов, в большинстве случаев (60—70%) пациенты с раком гортани начинают лечение уже на III—IV стадии заболевания [2, 3]. В последние годы в России количество пациентов с запущенными, нерезектабельными формами (IV стадия) рака гортани составляет 17% [4]. По данным мировой литературы, общая 5-летняя выживаемость пациентов с нерезектабельными формами плоскоклеточного рака органов головы и шеи составляет не более 25% [5]. Лечение нерезектабельных форм рака гортани — одна из сложнейших задач современной онкологии. Единых подходов к лечению в настоящее время не имеется. Наше исследование посвящено изучению возможностей повышения эффективности лучевого лечения нерезектабельных форм рака гортани.

The comparative analysis of results of conservative and combined treatment was carried out. The study group consisted of 400 patients with stage T3–4N0–3M0 laryngeal cancer who received concurrent chemotherapy and radiation therapy in combination with various physical radiomodifyers. The control group comprised 920 patients treated with the same technique but without systemic polychemotherapy. The 5-year relapse-free and overall survival rates were significantly higher in the study group than in the control group (concervative treatment: 71 % and 86 % versus 37 % and 64.8 %, respectively, р<0,001 and combined treatment: 80 % and 83 % versus 47.4 % and 52 %, respectively (р<0,001). The functional organ was preserved in 71.2 % of locally advanced laryngeal cancer patients treated conservatively compared to 37.0 % of the control group patients. Oprgan-preserving surgeries were performed in 30.5% and 23%, respectively. The total number of patients with the larynx preservation was 50 % of the stydy group and 31.6 % of the control group.

Results of chemoradiotherapy for 103 nasopharyngeal cancer patients were studied. The assessment of treatment efficacy showed that beneficial results were obtained in cases of combination of radiation therapy with 2 courses of polychemotherapy including platinum. A radiation therapy regimen of daily dose fractionation according to the schedule 1 + 1,5 Gy allowed the total tumor dose to be increased not increasing the incidence of radiation-induced reactions. Adjuvant polychemotherapy is recommended after 3-4 courses of chemoradiotherapy, thus improving survival.

The study included 102 patients with advanced recurrent laryngeal cancer, who were divided into 2 groups. Group I consisted of 70 patients who underwent surgical treatment, Group II composed of 32 patients who received preoperative radiation therapy at a total dose of 12 Gy in 2 fractions of 6 Gy each administered on the day before surgery and on the day of surgery. The study showed that the intensive preoperative radiotherapy resulted in increase in survival rate due to decrease in the rate of local recurrences and regional metastases. The 3-year survival rate was 41.3 % in Group I patients and 55.2 % in Group II patients. Complications related to postoperative wound healing in Group II patients were not statistically significant and may be explained by the large extent of surgery in these patients.

The purpose of the study was to increase the treatment efficacy for patients with recurrent laryngeal cancer (rТ3N0М0) using intensive preoperative radiation therapy. A total of 190 patients were included into the study and divided into 2 groups. Group I consisted of 131 patients who underwent surgery. Group II comprised 59 patients who received preoperative radiation therapy at a total dose of 12 Gy delivered in 2 fractions (6 Gy single radiation dose on a day prior to surgery and on a day of surgery). Preoperative radiation therapy was shown to significantly increase the recurrence-free survival of patients and effect no on postoperative wound healing. The 3-year survival rate was 70.6 % for Group I patients and 83.6 % for Group II patients.

The study included 217 patients with inoperable histologically-verified squamous cell laryngeal cancer. Three modes of palliative treatment were used: chemotherapy (33 patients), radiation therapy (97 patients) and chemoradiation therapy (87 patients). Additional radiation therapy was performed in conventional regimen of dose fractionation (30 to 60 Gy). The total dose including the previous radiation therapy for the primary tumor ranged between 80 and 120 Gy. Palliative treatment and chemoradiation therapy allowing the 3-fold increase in survival rate were found to be the most effective. The one-year survival rates were as follows: 6.1% after chemotherapy, 26.8% after radiation therapy and 19.5% after chemoradiation therapy (differences with chemotherapy were statistically significant). Palliative chemoradiation therapy resulted in improvement of only short-term treatment results influencing no on the life span of the patients as compared to radiation therapy. Additional radiation therapy at a dose higher than 40 Gy was the most effective, and the incidence rate of local radiation-induced damages was not significant. The mode of palliative treatment for recurrent laryngeal cancer should be defined individually.

A total of 18 patients with histologically verified recurrent squamous cell laryngeal cancer were included into the study. The main reason for re-radiation therapy was the patients' refusal from surgery. Recurrence occurred from 1 to 19 years. All patients were previously treated with radiation therapy only. A total tumor dose of re-radiation therapy was 40-60 Gy and it depended on radiation-induced reactions and treatment tolerance, a total cumulative dose ranged from 9to 130 Gy. Re-radiation therapy allowed larynx-conserving surgery to be performed in 5 cases (28 %). These patients are disease-free at a follow-up of 3 years. Ten patients underwent laryngectomy due to tumor recurrence. The wound healed by first intention in 40 % of cases. The 3-year recurrence-free survival rate was 28 %, the overall survival rate was 72 %. Re-radiation therapy of recurrent laryngeal cancer prevents no from performing surgeries in case of re-recurrence but it adversely effects on postoperative wound healing. However, this method of radiation therapy should not be considered as an alternative to organ-conserving surgery.