Background. Currently, low-dose computed tomography (LDCT) is the only screening test that reduces the risk of death from lung cancer. However, there are a number of disadvantages, such as lack of widespread use, high cost, high false-positive rate and the need to conduct studies only in high-risk groups, which significantly limit mass screening. exhaled breath analysis, which uses sensitive breath sensors, is a promising method to improve early diagnosis of lung cancer. Cancer Research Institute of Tomsk National Research Medical Center together with Tomsk State University and Tomsk Polytechnic Research Institute has developed a gas analysis complex capable of analyzing the gas composition of exhaled air with remote sampling from bags. during the study, data obtained by digitizing signals from gas analysis system sensors and patient metadata are recorded in a database for subsequent automated processing and analysis using a neural network. Case description. A 48-year-old female patient with a long history of smoking came to the clinic of the Cancer Research Institute for consultation with suspected pathological infiltration around the celiac trunk detected by abdominal CT. As a clinical trial of the developed gas analytical complex for cancer detection, a sample of exhaled air was taken, and the comparison of the composition of volatile organic compounds (VOCs) with that in the control group (healthy individuals) revealed abnormalities characteristic of lung cancer. the patient underwent a chest CT scan, which revealed stage IIB peripheral cancer of the lower lobe of the left lung. the original sensor gas analysis complex, which has no analogues in Russia, was used for the first time in the detection of lung cancer. the data obtained allowed us to suspect the presence of lung tumor in the patient and perform radical surgical treatment. the composition of VOCs in exhaled air was assessed on day 10 after surgery, and no significant changes in the composition of exhaled air were observed. Conclusion. Machine learning algorithms are actively used to diagnose socially significant diseases. the platforms being developed based on arrays of chemical sensors with data analysis using a neural network are promising candidates for implementation in screening activities.

The healing potential of individual polymer implants for the reconstruction of extensive craniofacial defects after cancer resection is largely determined by the internal architecture of the implant. The architecture of an implant during polymer crystallization could affect the structure and shape of the implant at the micro and macro levels. In this study, the relationship between the internal architecture (triply periodic minimum surface structure (gyroid), cube, grid, and honeycomb) and shape changes of individual implants by 3D printing with a vinylidene fluoride-tetrafluoroethylene copolymer after crystallization is examined at a filling density of 70%. Using the method of differential scanning calorimetry, it is established that crystallization leads to the rearrangement of the crystalline structure of the implant into electrically active (ferroelectric) crystalline phases. Moreover, the type of internal architecture affects the change in the shape of the implant after crystallization. The results of the computed tomography show that structures with a triply periodic minimum surface (gyroid) provide the minimal deformation of the implant during crystallization, which makes such structures optimal for manufacturing implants for replacing bone defects in the zygomatic-orbital complex.

The purpose of the study was to compare the effectiveness of correction of sound pronunciation in patients after glossectomy without reconstructive surgery and glossectomy with reconstructive surgery. Material and Methods. The study included 56 patients with histologically verified stage III –IV oral cavity and oropharyngeal cancer. All patients were divided into two groups: those undergoing reconstructive surgery after glossectomy and those not undergoing reconstructive surgery after glossectomy. Data on the dynamics of sound pronunciation correction were assessed during the rehabilitation period, as well as 6 and 12 months after completion of speech therapy. The parameters were scored from 0 to 4, where 0 indicated no speech sound disorders, and 4 indicated maximum disorders. Results. All patients showed absolute (4 points) speech sound disorders after surgery. Speech rehabilitation in patients, who underwent reconstructive surgery after glossectomy, resulted in a significant improvement in the pronunciation of posterior lingual sounds: [K], [G], [K’], [G’], whistling (lingual-dental) sounds: [S], [S’], [Z ], [Z’], front-lingual sounds: [T], [Т’], [D], [D’] and hissing sounds: [Sh, [Zh] (p<0.05). In patients, who underwent glossectomy without reconstructive surgery, a statistically significant improvement in sound pronunciation was observed only after correcting posterior lingual hard sounds: [K], [G] (p<0.05). Conclusion. The results obtained highlight the importance of reconstructive surgery after glossectomy to achieve better results of functional restoration and improve the quality of speech function of patients.

Introduction. Head and neck tumors comprise about 7 % of all malignant neoplasms. In the head and neck area, tumors are usually located on the tongue (25–40 %) and floor of mouth (15–20 %). In the majority of cases, diagnosis, especially at early disease stages, is based on clinical and histopathological evaluation of tumor process. However, recently development and implementation of non-invasive techniques of early diagnosis of upper respiratory tract tumors through detection of pathognomonic volatile tumor markers in the exhaled air has become topical.Aim. To evaluate diagnostic accuracy of sensory gas analysis device and artificial neural network for examination of exhaled gas samples from patients with oropharyngeal, laryngeal, laryngopharyngeal cancer and to establish the optimal conditions for sampling.Materials and methods. The study included 28 patients with oropharyngeal, laryngeal, laryngopharyngeal cancers and 25 healthy volunteers. The proposed technique is based on analysis of samples of exhaled gas from the studied individuals using a diagnostic device developed by the authors. The device detects volatile compounds in the exhaled air using a set of semiconductor sensors with subsequent analysis by a neural network. The exhaled air was sampled using two methods: in the morning in the fasted state before daily hygienic procedures and physical activity (prepared samples) and in the context of everyday life, nutrition and hygiene without restrictions before sampling (non-prepared samples).Results. Based on the signals from the sensors, the neural network classified and detected patients with malignant tumors. Accuracy of the prepared samples from healthy volunteers and patients with oropharyngeal, laryngeal, laryngopharyngeal cancers was 79.17 %, of non-prepared – 84.09 %.Conclusion. High diagnostic accuracy of the developed technique of non-invasive diagnosis of malignant tumors of the oropharyngeal, laryngeal, laryngopharyngeal areas using exhaled air samples which does not require special preparation of the studied samples was demonstrated.

Introduction. Porous TiNi alloys are widely used in medicine as osteoreplacement implants due to their unique properties of superelasticity and biocompatibility, but their clinical use is severely limited by time-consuming manual fabrication and the inability to create precise geometries. Reconstructive surgery for the replacement of bone defects requires biocompatible endoprostheses of individual shape and complex geometry. The use of porous 3D-TiNi implants can be a solution to many problems in traumatology and bone oncology.Aim: To evaluate the possibility of using porous 3D-TiNi implants in osteoplastic surgery based on a study of the structure and biocompatibility of the material under in vivo conditions.Material and Methods. Porous samples in the form of cones and a single implant for maxillofacial surgery were prepared from TiNi powder by selective laser melting. To print an individual implant for maxillofacial surgery, the personal data of the patient at the Oncology Research Institute were used. The macrostructure, elemental and phase composition of porous titanium nickelide samples were investigated using scanning microscopy and X-ray diffraction analysis. The biocompatibility of porous cone-shaped samples was evaluated in vivo using guinea pigs whose condition was analysed by CT scanning.Results. Structural studies of porous titanium nickelide samples showed that selective laser melting can be used to obtain a continuous porous structure with strong contact bridges between particles of a three-phase powder. In vivo testing of the cone-shaped implants showed no local inflammatory changes, rejection or deformation of the hind limb axes of the experimental animals. The basic feasibility of fabricating a custom implant of complex geometry from TiNi powder using selective laser melting according to a patient’s MSCT data was demonstrated.Conclusions. Porous 3D-TiNi implants obtained by selective laser melting showed high biocompatibility under in vivo conditions. An experimental study confirmed the efficacy and ease of use of 3D TiNi implants, their excellent self-fixation in bone tissue, and bone tissue augmentation at the interface with the implant. The macrostructure, chemical and phase composition of the implant material was found to be close to traditional porous TiNi alloys. It was shown that the method of selective laser melting makes it possible to create complex geometric defects in bone tissue from TiNi.

The immune system, as the main factor in protecting the body from the action of infectious, viral agents, as well as performing anticancer surveillance, undergoes a number of negative changes during surgery. With surgical intervention that causes a stress response and the effects of anesthetics, immunosuppression is formed, which in turn reduces the quality of medical care to patients, increases the duration of hospital stay, as well as the development of a number of complications. The purpose of the study was to evaluate the effect of pre-carbohydrate loading and perioperative administration of dalargin on immunity indicators in patients who underwent surgery for malignant neoplasms of the oropharyngeal region. Materials and methods. 58 patients operated on for malignant neoplasms of the oropharyngeal region were examined. Patients are divided into 2 groups. In the main group (n=29), patients received a carbohydrate load of 400 ml for 12 hours and 200 ml for 2 hours before surgery, used multicomponent general anesthesia with the introduction of dalargin at a dosage of 45-55 mcg/kg/min, at the end of the operation, dalargin was administered 1 mg intramuscularly. In the control group (n=29) was multicomponent general anesthesia. The morphological composition of blood, the content of cytokines (IL-1β, -6, -8, -10, INF-γ and TNF-α) and immunoglobulins (IgA, IgM, IgG) were determined. Results. The level of lymphocytes in the postoperative period up to 7 days was significantly higher in the main group than in the control group, where there was a decrease in this indicator relative to the preoperative level. A significant increase in rod-shaped neutrophils in the control group also persisted up to 7 days after surgery. On the 1st day after surgery, the cytokine content significantly increased in both groups. The values of IL-1ß, IL-6, IL-8, INF-γ, TNF-α were significantly higher in the control group, however, on the 7th day after surgery, significant differences between the groups remained only in the indicators of IL-8, INF-γ. When assessing the level of immunoglobulins, statistically significant differences were revealed between the groups – in the main group, the concentration of IgA on day 1 and IgG on day 7 after surgery was higher. The content of CRP in both groups increased significantly on the next day after surgery, and in the main group the indicators were statistically significantly lower compared to the control group. The level of CRP in both groups remained above the initial values up to 7 days after surgery. Conclusion. The use of enkephalin, dalargin, as a component of anesthetic support in the perioperative period in the surgical treatment of malignant neoplasms of the oropharyngeal region is associated with a lower concentration of pro-inflammatory interleukins, an increase in IgG concentration compared with endotracheal multicomponent anesthesia and may contribute to the activation of an antitumor immune response. Keywords: dalargin, anesthesia, immunity, depression, stress protection.

The progression of head and neck squamous cell cancer (HNSCC) may be influenced by the characteristics of the local and systemic immune response, including the peculiarities of systemic inflammatory response during surgical interventions. The dependence of the prognosis of cancer patients on the preoperative general somatic status and postoperative complications is demonstrated precisely through the prism of a systemic inflammation development promoting the progression of oncological process. It is necessary to study the interaction of a typical inflammatory reaction and the features of reparative processes to understand the correct treatment strategy for patients with oral cancer in the conditions of the existing oncological process. It was found that chronization of inflammation is associated with m2-macrophage polarization which contributes to the tumor progression. And systemic inflammation indices correlate with treatment results. It is also necessary to identify prognostic factors of postoperative complications that affect the chronization of inflammation. They may include the general somatic and nutritional status of patients, concomitant diseases and indices of systemic inflammation. It is obvious that improving the results of surgical treatment of patients with oral cancer can be influenced by various ways of managing the inflammatory response, including the peculiarities of performing the reconstructive interventions and improving the preoperative general somatic and nutritional status.

Material and methods. The prospective study included 155 patients with stage II – IV oropharyngeal cancer, who underwent surgery and speech rehabilitation at the Head and Neck Cancer Department of Cancer Research Institute (Tomsk). The age range of the patients was from 26 to 70 years with a median of 52 years. The patients were divided into 3 groups depending on the extent of surgery. Group I included 70 patients who underwent hemiglossectomy without tongue defect reconstruction. Group II consisted of 70 patients who underwent hemiglossectomy with reconstructive surgery. For the reconstruction of hemiglossectomy defect, the submental, radial forearm free, and medial sural perforator flaps, as well as anterolateral thigh fasciocutaneous flap were used. Group III included 15 patients who underwent glossectomy and reconstruction with pectoralis flaps and musculocutaneous anterolateral thigh flaps. After verification of oropharyngeal cancer and before starting treatment, speech of all patients was recorded using the "OncoSpeech v1.0" computer software. This recording is the basis for further speech diagnostics, as it allows to create a speech standard for each patient. The "OncoSpeech v1.0" computer software can evaluate the pronunciation of six phonemes of the Russian language [К], [S], [Т], [К’], [С’], [Т’]. In our study, we used the OncoLanguage system, which consists of 90 syllables, taking into account the different positions of phonemes in a syllable (at the beginning, in the middle, at the end). All sessions of audio recordings and their current quantitative assessment were automatically uploaded into the program. The second speech recording was performed after surgery when patients were admitted to speech rehabilitation therapy to assess the resulting pronunciation disorders of the studied phonemes. To assess the effectiveness of sound pronunciation correction, the last speech recording was performed after the completion of speech rehabilitation.Results. The speech function correction was performed on days 8 -39 after surgery according to the method developed in the Head and Neck Cancer Department of Tomsk Cancer Research Institute. The program of speech rehabilitation was compiled individually for each patient, depending on the patient’s health condition, age, extent of surgery and the results of speech computer diagnostics using the "OncoSpeech v1.0" computer software. Speech therapy was aimed at restoring the speech function of patients in the shortest time after surgery by activating and coordinating the movement of the lips, cheeks, stump of the tongue, root of the tongue and the lower jaw. The improvement in pronunciation of all six phonemes [К], [S], [Т], [К’], [S’], [Т’] was observed in 100% of patients. The data were expressed in quantitative values in a comparative aspect. The best values for all studied phonemes were observed in group II patients who underwent hemiglossectomy with reconstructive surgery. Speech diagnostics using the OncoSpeech v1.0 software package made it possible to quantitatively express the violation of the pronunciation in patients with oropharyngeal cancer as well as to objectively evaluate the effectiveness of the correction of the sound pronunciation of six phonemes. Материал и методы. Исследование носило проспективный характер и выполнялось на базе отделения опу- холей головы и шеи НИИ онкологии Томского НИМЦ. В исследование были включены 155 больных раком оро- фарингеальной области II–IV стадий опухолевого процесса в возрасте от 26 до 70 лет (Ме=51,6), проходивших хирургическое лечение и речевую реабилитацию в условиях данного отделения. Пациенты были разделены на 3 исследуемые группы в зависимости от объема хирургического вмешательства. В I исследуемую группу мы включили 70 больных с операцией в объеме гемиглоссэктомии без реконструктивно-пластического ком- понента, во II группу – 70 пациентов, которым выполнена гемиглоссэктомия с реконструктивно-пластическим компонентом (пластика подбородочными, лучевыми, медиальными суральными перфорантными лоскутами и кожно-фасциальными переднебоковыми лоскутами бедра), III группа – 15 пациентов после глоссэктомии с реконструктивно-пластическим компонентом (пластикой пекторальными лоскутами и кожно-мышечными перед- небоковыми лоскутами бедра с выполнением сосудистых анастомозов). Всем пациентам после верификации диагноза рака орофарингеальной области до начала комбинированного лечения выполнялась запись речи с использованием компьютерно-программного комплекса «OnkoSpeech v1.0». Данная запись является основой дальнейшей речевой диагностики, т.к. дает возможность создать эталон речи каждого пациента. Компьютерно- программный комплекс «OnkoSpeech v1.0» может оценивать произношения 6 фонем русского языка [К], [С], [Т], [Кь], [Сь], [Ть]. В своей работе мы использовали набор «ОнкоЯзык», который состоит из 90 слогов с учетом различных позиций фонем в слоге (в начале, в середине, в конце). В программу автоматически заносились все сеансы аудиозаписей и их текущая количественная оценка. Вторая запись речи выполнялась после хирур- гического этапа комбинированного лечения при поступлении пациентов на логовосстановительную терапию для оценки возникших нарушений произношения исследуемых фонем. Для оценки эффективности коррекции звукопроизношения выполнялась последняя запись речи после завершения этапа речевой реабилитации. Результаты. Коррекция речевой функции выполнялась по методике, разработанной в отделении опухолей головы и шеи Томского НИИ онкологии. К занятиям приступали на 8–39-й день после операции (Me=23,2). Программу проведения речевой реабилитации составляли индивидуально для каждого больного в зави- симости от его общего состояния, возраста, объема оперативного вмешательства и результатов речевой компьютерной диагностики с использованием компьютерно-программного комплекса «OnkoSpeech v1.0». Логопедические занятия направлены на то, чтобы в оптимально короткие сроки после хирургического лече- ния восстановить речевую функцию пациентов путем активизации и координации движения губ, щек, культи языка, корня языка и нижней челюсти. По оценке, проведенной с помощью «OnkoSpeech v1.0», в результате логовосстановительной терапии у 100% пациентов отмечалось улучшение произношения всех шести фонем [К], [С], [Т], [Кь], [Сь], [Ть], данные были выражены в количественных показателях в сравнительном аспекте. Во II исследуемой группе больных после гемиглоссэктомии с реконструктивно-пластическим компонентом отмечались лучшие показатели по всем исследуемым фонемам.Заключение. Речевая компьютерная диагностика с применением программного комплекса «OnkoSpeech v1.0» позволила количественно выразить нарушение произношения больных раком орофарингеальной области на этапах комбинированного лечения и речевой реабилитации. Применение речевой компьютер- ной диагностики дало возможность объективно оценить эффективность коррекции звукопроизношения 6 фонем в результате логовосстановительной терапии

To identify genetic alterations associated with tongue cancer recurrence in young adults, whole exome sequencing of the primary tumor, recurrence, and whole blood samples from young patients with tongue cancer was performed. A frameshift mutation in the TP53 gene was detected in the primary tumor and recurrence tumor tissue. A mutation in the EPHB6 gene was detected in the recurrence and was absent in the primary tumor. In addition, the primary tumor and recurrence tongue cancer tissue harbored amplification of the 20p13 region containing C20orf96, DEFB125, DEFB126, DEFB127, DEFB128, DEFB129, DEFB132, and ZCCHC3 genes. Thus, genetic alterations have been identified that are associated with tongue cancer recurrence in young adults.

The purpose of the study was to evaluate diagnostic capabilities of the gas analysis sensor device used for the study of exhaled gas samples obtained from patients with oropharyngeal and laryngeal cancers. Material and Methods. Exhaled gas samples from 31 oropharyngeal and laryngeal cancer patients and 31 healthy volunteers were studied using a diagnostic device based on the detection of volatile compounds in inhaled air using semiconductor gas sensors with subsequent neural network analysis. Results . Based on the signals from gas sensors, the neural network classified and identified patients with malignant neoplasms. The sensitivity and specificity of the method were 67.74% and 87.1%, respectively. Conclusion . The gas analysis sensor device and the method for detecting oropharyngeal and laryngeal tumors using the exhaled gas analysis are an accessible and cheap diagnostic tools, and are promising for screening the population in order to select individuals for a comprehensive examination (endoscopic, radiological and morphological) in identifying suspicion of cancer.

Introduction. Squamous cell carcinoma (SCC) of the oral cavity is an aggressive and rapidly progressing disease. The tendency to progression of the tumor process is due to the clinical and pathological characteristics of the patient and the biological characteristics of the tumor. molecular and genetic disorders related with transcriptome level play an important role in tumor progression, which can be used in predicting the outcome of the disease. Aim. To identify markers for assessing the risk of the SCC progression. Materials and methods. Based on the data of the Cancer genome Atlas database, a bioinformatic search for genes associated with the progression of SCC was performed (11 genes were selected). Then we performed a retrospective analysis of clinical data and histological material from 38 patients with SCC treated at the Scientific Research Institute of Oncology of the Tomsk National Research medical Center of the Russian Academy of Sciences from 2018 to 2021. Fixed samples of tumor tissue were examined. The level of gene expression was determined by real-time quantitative polymerase chain reaction. Results. It was shown that decrease in the ST6GAL2 matrix RNA level is associated with presence of lymphogenic metastases and decrease in the CD248 matrix RNA level is associated with the occurrence of relapses. Conclusion. Expression level of the ST6GAL2 and CD248 genes can be used as predictors of an unfavorable prognosis of SCC.

Aim: To study in patients the dependence of the exhaled air composition on pathological processes occurring in the respiratory system, including: lung cancer, community-acquired pneumonia and COVID-19. Material and Methods. The studies were carried out on the basis of a gas analytical complex using the method of neural network data analysis. The gas analytical complex includes semiconductor sensors that measure the concentrations of gas components in exhaled air with an average sensitivity of 1 ppm. Based on signals from sensors, the neural network classifies and identifies patients with certain pathological processes. Results. The statistical data set for training the neural network and testing the method included samples from 173 patients. Our study collected exhaled air samples from groups of patients with lung cancer, pneumonia, and COVID-19. In the case of lung cancer, the parameters of the diagnostic device have been determined at the level of sensitivity – 95.24%, specificity – 76.19%. For pneumonia and COVID-19, these parameters were 97.36% and 98.63, respectively. Conclusion. Taking into account the known value of diagnostic methods such as computed tomography (CT) and magnetic resonance imaging (MRI), the sensitivity and specificity indicators of the gas analytical complex achieved during the study reflect the promise of the proposed technique in the diagnosis of tumor processes in patients with lung cancer, COVID-19 and community-acquired pneumonia.

Aim. To study the effectiveness of modified subtotal laryngectomy with the formation of a tracheopharyngeal shunt in patients with locally advanced cancer of the larynx and laryngopharynx. Materials and methods. We conducted a cohort study on the use of combined treatment (surgical and radiation/ polychemotherapy) in 25 patients: 24 men, 1 woman; median age – 56 years. The subtotal laryngectomy technique that we developed and used included the preservation of one arytenoid cartilage, the posterior third of the vocal fold, and the recurrent nerve on the side not affected by the tumor. We studied postoperative complications, the length and diameter of the tracheopharyngeal shunt, the functioning of the arytenoid cartilage, the frequency of voice recovery and its quality, and overall and relapse-free survival. Results. In the postoperative period, 8 (32%) patients developed a pharyngocutaneous fistula; tracheal stenosis after tracheostomy was observed in 8 (32%) cases. The length of the tracheopharyngeal shunt varied from 16.4 to 25.6 mm, in all cases its course was tortuous, the diameter of the preserved part of the vocal fold varied from 1.1 to 1.5 mm. 24 (96%) patients demonstrated the functioning of the arytenoid cartilage and its work as a valve. Voice function recovered in 24 (96%) patients. Fundamental frequency was 155.3 ± 20.9 Hz, maximum phonation time of the vowel “A” – 3.5 ± 1.0 s, duration of pauses in phrase – 0.24 ± 0.03 s, speech rate – 99.8 ± 8.4 words/ min, number of words in phrase 6.5 ± 0.3. The average value of the Acoustic Voice Quality Index was 6.74, which indicates dysphonia (for the Russian language, the threshold value for dysphonia is 4.86), but this did not interfere with patients’ communication at home and on the phone. Overall and relapse-free survival at 1, 2, and 3 years were 100%, 89%, 78% and 86%, 78%, 72%, respectively. Conclusion. The method of operation proposed by us contributes to the restoration of voice function in the majority of patients with oncological outcomes comparable to total laryngectomy.

In our work, we investigated the immune landscape features of patients younger than 45 years of age with tongue cancer using spatial transcriptomics technology at the single-cell level. The study revealed that tongue cancer in young adults is characterized by immunosuppression.

This study demonstrates the features of oral squamous cell carcinoma microbiome profile in young adults (<45 years) and its association with disease progression.

The article presents a draft of clinical recommendations for the diagnosis and treatment of differentiated thyroid cancer in adult patients, which provides a modern examination algorithm, discusses the basic principles of laboratory, instrumental diagnostics and treatment approaches.

Purpose. To evaluate the effectiveness of intra-arterial chemotherapy alone and as part of combined treatment in head and neck squamous cell carcinoma, as well as to search for new promising directions in this area. Material and methods. The analysis of available literature sources was performed using the Medline, Pubmed, Elibrary, and other databases. The authors found 97 studies, and 31 of them were used to write the literature review. Results. Research is ongoing to optimize and improve the efficacy of the existing, generally recognized methods of treating patients with head and neck tumors. In this aspect, the developed method of intra-arterial chemotherapy (IACT) using high doses of cisplatin with concurrent neutralization (simultaneous intravenous bolus administration) with sodium thiosulfate and radiation therapy (RADPLAT) deserves attention. Three types of access to the arteries are used for conducting IACT in patients with head and neck cancer. IACT has improved oncological results in patients with locally advanced tumors and allowed to achieve the overall and recurrence-free survival of up to 90.0% and 83.3%, respectively. However, this method leads to specific complications in some cases (up to 3.5%): transient ischemic attack, soft tissue necrosis, peripheral neuropathy. Careful patient selection and correct IACT implementation can minimize complication rates. Conclusion. IACT increases the effectiveness of the combined treatment of patients with head and neck tumors, and represents a promising direction in the field of personalized approach to chemotherapy. Цель исследования: оценка эффективности применения интраартериальной химиотерапии (ИАХТ) в составе самостоятельного и комбинированного метода лечения плоскоклеточного рака головы и шеи, а также поиск новых перспективных направлений в данной области. Материал и методы. Проведен анализ доступных источников литературы, опубликованных в базах данных Medline, Pubmed, Elibrary и др. Из 97 найденных исследований 31 было использовано для написания литературного обзора. Результаты. Наряду с существующими общепризнанными методами лечения больных опухолями головы и шеи продолжаются исследования по их оптимизации и повышению эффективности. В этом аспекте можно выделить методику ИАХТ с использованием высоких доз цисплатина с последующей нейтрализацией (одновременное внутривенное болюсное введение) тиосульфатом натрия и лучевой терапии (RADPLAT). При проведении ИАХТ у больных опухолями головы и шеи существует 3 доступа к артериям. ИАХТ позволила улучшить онкологические результаты у больных местно-распространенными стадиями с достижением общей и безрецидивной выживаемости до 90,0 и 83,3% соответственно. Однако данный метод в ряде случаев (до 3,5%) приводит к развитию специфических осложнений: транзиторные ишемические атаки, некроз мягких тканей, периферическая невропатия. Но при тщательном отборе больных и корректном выполнении ИАХТ возможно снизить число подобных осложнений до минимума. Заключение. ИАХТ повышает эффективность проводимого комбинированного лечения больных опухолями головы и шеи и является перспективным направлением в области персонализированного подхода к применению химиотерапии.

Introduction. The surgical stage of treatment is the most important component of the combined method of treatment in cancer patients. However, it is associated with the development of a number of complications caused by stress. In this regard, the modern concept of an anesthesiological manual should also be aimed at protecting the body from surgical stress, which requires the search and development of new gentle methods of anesthesia. Aim. To provide an overview of modern stress protection methods in anesthesia and consider the role of dalargin with carbohydrate loading as a component of stress protection in oncological surgery. Materials and methods. Using the electronic resources of the PubMed and eLibrary search engines, a literary review of 147 scientific papers over the past 30 years has been conducted, which contain an evidence-based experimental and clinical base on the use of dalargin in medical practice. Results. A systematic review of stress protection methods in anesthesiology is presented. The role of dalargin in anesthesiological practice during surgical treatment in cancer patients, including when performing delayed reconstructions, is shown. Conclusion. The use of dalargin in combination with carbohydrate loading in cancer patients is justified and requires further detailed study. The ability to stimulate endogenous opioid receptors and modulate pain perception, its organoprotective and anti-inflammatory properties, as well as a favorable safety profile make dalargin a valuable addition to the tools for anesthesia in oncology.

Introduction. The main treatment option for malignant neoplasms of the head and neck is combined. However, survival rates are still relatively unchanged. The surgical stage of treatment leads to extensive defects that are eliminated through reconstructive technologies. Despite the priority of performing reconstruction at the same time, delayed reconstructions are still being discussed 6–12 months after surgical treatment; therefore, it is necessary to develop new methodological and practical approaches. Aim. To determine the features of the delayed reconstructive-plastic stage in patients with malignant tumors maxillofacial region, evaluation of possible solutions for optimizing the stage. Material and methods. The analysis of available literature sources was taken in the database Medline, Pubmed, eLibrary, etc. The 101 studies were found, 60 were used to write a systematic review. Results. Delayed reconstructive plastic surgery should take into the possibility more complex and larger defects of soft and bone tissues during the reconstructive stage, previous surgery and/or radiation therapy create significant difficulties for the identification of recipient vessels. Computer-aided design (CAD)/computer-aided manufacturing (CAM) technologies allow projecting the design and positioning of reconstructive material at the preoperative stage. Mandibular reconstruction is the most difficult, that isn’t achieve only an aesthetic result, but also to restore the biomechanics of the temporomandibular joint. The development of specific complications hinders the improvement of the patient’s quality of life. In the early postoperative period is may develop necrosis of the flap, thrombosis of vascular pedicle, hematoma; in the late postoperative period plate extrusion is still one of the common complications, planning delayed reconstruction an important aspect is prevention or treatment of osteoradionecrosis. The combination of precarbohydrate loading and dalargin will allow to reduce the frequency of perioperative complications and improve the long-term results of surgical treatment. Conclusion. Reconstructive treatment in patients with defects requiring postponed reconstructive surgeries is a complex problem which requires development of an integrated approach with detailed analysis of the existing defect and previous antitumor therapy.

The review is devoted to the current state and prospects for the treatment of young adults with oral cancer. The article analyzes the possible methods of treatment for this category of patients: immunotherapy, radiation and phototherapy, hyperthermia, surgical treatment, and also discusses the prospects for antibiotic therapy and regulation of the epigenetic landscape of oral cancer in young adults. Обзор посвящен современному состоянию и перспективам терапии молодых пациентов с раком полости рта. В статье дан анализ возможных методов лечения больных данной категории: иммунотерапия, лучевая и фототерапия, гипертермия, хирургическое лечение, а также обсуждены перспективы антибиотикотерапии и регуляции эпигенетического ландшафта рака полости рта у молодых пациентов.