Head and Neck Tumors

Introduction. Sphenoid sinus (SS) is a very rare site of inverted papilloma (IP). Surgery of IP located in the SS is complicated due to close proximity of vital structures and high risk of their damage during the operation. Radical surgery involving resection of the primary site of tumor growth and adherence to oncological principles is very complex due to the risk of severe complications. Some authors consider SS IP to be unresectable. Therefore, there are very few publications on this topic in the scientific literature.

Aim. To analyze a case series of treatment of IP located in the SS and resected endoscopically endonasally, as well as compare our data with the results presented in literature.

Materials and methods. Literature data and our experience of treating patients with SS IP which previously were considered unresectable were analyzed. In 7 years, between 2019 and 2025, at the Burdenko National Medical Center of Neurosurgery and Center of Head and Neck Surgery of the Ilinskaya Hospital, 12 patients with this pathology (2 (16.7 %) women and 10 (83.3 %) men) received treatment. Mean patient age was 60 (26–76) years. In 2 (16.7 %) patients with multifocal SS IP growth and recurrence, who underwent multiple previous surgeries, with the initial growth sites in the area of the optic canal and posterior SS wall with its destruction in one case and in the area of lateral SS wall in the other case, squamous cell carcinoma was diagnosed.

Results. All patients underwent endoscopic IP resection. In 9 (75 %) cases, extended sphenoidotomy with resection of the initial IP growth site was performed, in 3 (25 %) of the cases, surgery was performed in 2 stages. Follow-up of 11 patients was 40.2 (26–68) months; 1 patient was lost to follow-up. Recurrence developed in 2 (18.2 %) patients with multicentric IP growth (with diagnosed squamous cell carcinoma). Both patients died (5 and 1.5 years after the surgery). No recurrences were observed in other patients.

Conclusion. Inverted papilloma of the SS is a very rare pathology. Its surgical treatment is complicated and associated with high risk of severe intraoperative complications. These surgeries should be performed by experienced surgeons using intraoperative navigation. The risk of recurrence after SS IP resection is significantly higher (18.2 %) than for IP in other sites. Conversely, high probability of malignant transformation of SS-located IP is present due to impossibility of its radical resection in some cases. For best results, we recommend extended endoscopic access to the SS using intraoperative navigation and multiple-stage surgical intervention in cases when IP cannot be resected in one step. Additionally, regular life-long follow-up of patients after surgery is necessary with frequency of once every 6 months for early detection of recurrence which can be resected endoscopically.

Introduction. Despite the advancements in science and technology, results of antitumor treatment of recurrent oral squamous cell carcinoma (rOSCC) remain unsatisfactory: patient survival is very low. In cases of recurrent disease, single-step glossectomy, subtotal segmental mandibulectomy and laryngectomy are feasible.

Aim. To analyze the results of combination surgical treatment of rOSCC using glossectomy, subtotal segmental mandibulectomy and laryngectomy after previous unsuccessful antitumor treatment to improve outcomes of treatment of recurrences and continued growth of locally advanced cancer.

Materials and methods. Single-center prospective study was conducted. It included patients with recurrent squamous cell carcinoma of the oral mucosa and larynx with indications for antitumor treatment using multicomponent surgical intervention in the framework of comprehensive treatment. The case of the treatment of recurrent laryngeal cancer served as a prototype for the development of techniques for simultaneous glosectomy, segmental resection of the mandible and laryngectomy. Two patients had malignant neoplasms of the oral mucosa: in one case, stage рT3N0M0 III tongue cancer, condition after hemiglossectomy, level I–II–III cervical lymph node dissection and radiotherapy; in the other case, stage рT3N0M0 III rOSCC after radiation therapy.

Results. During surgery, skin resection was performed above the tumor component of the submandibular area due to signs of derma invasion and danger of penetrating growth with intradermal dissemination caused by postradiation edema. For defect reconstruction, in 1 patient with laryngeal cancer and 1 patient with rOSCC, pectoralis major myocutaneous flap was used. In 1 case of rOSCC, due to rapid wight loss during radiation therapy, primary reconstruction with pharyngostomy formation with total defect of the tongue, mandible and larynx was not performed. Local purulent and necrotic postoperative complications were observed in all 3 patients. In the first 30 days after the surgery, 1 patient with rOSCC died at the hospital; 30-day mortality after combination surgeries was 33 %. Another patient with rOSCC died 2.5 months after discharge, a little more than 90 days (3.5 months) after the surgery. The patient with laryngeal cancer is currently alive without signs of disease.

Conclusion. The surgical interventions described are life-saving surgeries due to exhausted capabilities of radiation therapy, supposed low efficacy of antitumor drug therapy in the presence of a mass of crumbling tissues.

Introduction. Laryngopharyngeal cancer is one of the most common head and neck cancers and is a socially significant pathology due to development of aphonia, dysphagia, and high rate of deaths and unfavorable outcomes. Currently, treatment of this pathology and fight against complications remain significant problems. The higher the disease stage, the higher mortality. According to the statistical data, the majority of patients with stage III–IV laryngopharyngeal cancer die in the first year after diagnosis due to severe adverse events such as laryngeal stenosis, dysphagia with subsequent dystrophia, as well as hemorrhages from vessel erosion in the larynx or tumor decay. If laryngeal stenosis or dysphagia are not managed by stoma, hemorrhage due to vessel erosion and diffuse bleeding from the pharynx can cause fatal outcomes.

Aim. To study the rate and type of complications, outcomes in patient with stage III–IV laryngopharyngeal cancer in the first year during induction chemotherapy.

Materials and methods. Data of 69 patients with stage III–IV laryngopharyngeal cancer who received comprehensive treatment between June of 2022 and July of 2024 at the Altai Regional Oncological Dispensary (Barnaul) were analyzed. The study group included 7 patients who developed hemorrhage during 1 course of induction chemotherapy. The comparison group included 62 patients without this complication. Risk of thromboembolic complications per the Khorana scale was low or intermediate: 1–2 points. Risk of hemorrhage per the American College of Chest Physicians (AССP) scale 2016 in the total group (n = 69; 100 %) was high: 4–8 points. The main risk factors, methods and long-term treatment results, as well of causes of death and recurrence-free survival after treatment completion 1 year later were analyzed. The type and rate of hemorrhages and their role in deaths, adverse event prevention measures were evaluated.

Results. In 7 (10.1 %) of 69 patients, hemorrhage developed after 1 course of chemotherapy (study group). Two significant risk factors associated with hemorrhagic complications were identified: hemoptysis at diagnosis and presence of an ulcerative defect in the pharynx which increased the risk of this complication 27.8- and 25-fold, respectively. In 3 patients of the study group, diffuse hemorrhage from the tumor of volume 150 mL was observed. In the other 4 patients, profuse bleeding of volume up to 500 mL developed. Two (28.6 %) patients of the study group were at the remission stage. Deaths during treatment were reported in 5 (71.4 %) patients: they occurred 1–6 months after treatment completion. In the comparison group, 15 (24.2 %) patients were in remission, 2 (3.2 %) of which received treatment due to disease progression. During the first year after treatment completion, 41 (66.1 %) patients died. Survival of 3 (4.8 %) patients was above 12 months: 13, 14 and 15 months; 1 (1.6 %) patient died 19 months after therapy completion.

Conclusion. In patients with stage III–IV laryngopharyngeal cancer, both the risk of venous thromboembolic complications (per the Khorana scale) and the risk of hemorrhages (per the АССР 2016 scale) should be determined. Hemorrhagic complications develop in 10.1 % of cases. Additionally, significant factors of bleeding from the pharynx are hemoptysis at diagnosis and presence of an ulcerative defect in the pharynx. In every case of bleeding from the tumor, tumor site and blood loss volume should be takin into account. Diffuse bleeding should be managed by short courses of tranexamic acid (for 3 days). Patients with profuse ulcerative hemorrhage require ligation of the external carotid artery on the affected side.

Introduction. Altai region has high incidence of thyroid cancer (TC) which served as motivation for development of a multivariable logistic prognostic model based on clinical and amnestic patient data with determination of low, intermediate, and high risks of the disease. The use of the model in clinical practice can promote optimization of examination volume and formation of priority groups for in-depth diagnostics.

Aim. To evaluate diagnostic value of a multivariable logistic model for TC prognosis and analyze distribution of a linear predictor in various clinical groups for identification of areas of low, intermediate and high risks.

Materials and methods. Single-center retrospective study including 1463 patients with diseases of the thyroid was conducted. The main group consisted of 505 sequentially examined and surgically treated patients with morphologically confirmed TC; the control group included 958 patients without oncological pathology of the thyroid (operated due to suspicion of a tumor with subsequent morphological exclusion and selected during prophylactic examinations). The set of clinical-anamnestic, anthropometric, and phenotypic characteristics was formed based on the results of previously published study on TC risk factors in the Altai population. Using survey patient data, a set of characteristics Х₁–X₂₆ was composed. Statistical analysis included descriptive statistics, univariate logistic analysis with categorization of quantitative variables per ROC criteria, as well as development of a multivariate logistic model with stepwise predictor selection. For the final model, χ² test, area under the ROC curve (AUC), sensitivity and specificity at optimal threshold were assessed; internal validation was performed using the bootsrap method. For clinical interpretation, distribution of a linear predictor z was analyzed in the TC group, non-TC group, as well as in patients with diffuse and nodular diseases of the thyroid and subgroups with stage T1a–4 tumors.

Results. The final multivariate logistic model included a limited set of independent demographic, anthropometric, and anamnestic predictors and demonstrated satisfactory discriminating ability with acceptable AUC values per internal validation. Distribution of the linear predictor showed increase in z values in patients with TC. Small range of values of this parameter was predominantly observed in patients without TC, presence of marked "grey area" – in patients with diffuse and nodular thyroid diseases. Comparison of T categories did not show clear correlation between T stage and the value of the linear predictor.

Conclusion. The multivariate logistic model developed based in clinical and anamnestic data of the Altai patients allows to identify 3 areas of linear predictor z values corresponding to low, intermediate, and high TC risks. Its application in clinical practice can promote rationalization of examination volume and identification of priority groups for in-depth diagnostics in regions with high TC morbidity.

Camrelizumab is a monoclonal antibody against programmed cell death protein 1 (PD-1) which demonstrated clinical efficacy in esophageal squamous cell carcinoma including in combination with 1st line chemotherapy cases of advanced disease. The article describes a clinical case of administration of camrelizumab + capecitabin in combination with local ablative intervention in the form of stereotactic radiation therapy for treatment of oligoprogressing esophageal squamous cell carcinoma. This observation shows clinical advisability of continuing immunomodulating therapy in cases of limited tumor progression with simultaneous local control of the lesions with the highest biological activity.

Currently, incidence of skin cancer is growing both in Russia and other countries. Basal cell carcinoma is the most common malignant tumor of this location. Morbidity growth is associated with aging population, as well as excessive insolation and sunburns, especially among white-skinned population. Locally advanced and metastatic basal cell carcinoma is rare, but its treatment is complicated.

The article presents a clinical observation of treatment of a female patient with locally advanced basal cell carcinoma on the face and multiple registered recurrences who received several courses of antitumor treatment. This case demonstrates high efficacy and good tolerability of 3D conformal radiation therapy in this pathology.

Thyroid cancer is taking a leading position worldwide. This increase can be connected to both environmental factors and improved diagnostic techniques. Surgery remains the primary treatment for thyroid cancer. As a result, researchers are exploring alternative approaches to avoid visible scarring on the anterior neck. It has already been proven that a noticeable scar causes psychological and emotional discomfort in patients, leading to the development of anxiety and depressive disorders, especially in cases with young women and children. Over the past 30 years, minimally invasive thyroid surgery has undergone significant changes. Extracervical endoscopic approaches and their combinations, as well as transoral techniques for thyroid removal, are actively used in many advanced centers in Russia and all over the world. The most modern approach is the hybrid approach, which combines the techniques of transoral and submental thyroidectomy.

This article presents the first clinical experience of using transoral endoscopic hemithyroidectomy through a transoral-submental approach in the Russian Federation in a patient with thyroid cancer.