Introduction. Brain metastases – the most common type of intracranial secondary neoplasms in adults – are characterized by high mortality and are the main cause of death in almost 1/5 of all oncological patients. For neoplasms of various locations, it was shown that fibrinolytic system plays a large role in malignant cell invasion.

Aim. To evaluate the level and activity of the main components of the plasminogen activation system in blood and cerebrospinal fluid (CSF) of patients with brain metastases.

Materials and methods. Using enzyme immunoassay, the main parameters of fibrinolytic system functioning were determined in plasma of 38 patients of both sexes aged 59.9 ± 8.9 years with morphologically verified primary pathological tumor and magnetic resonance imaging-confirmed intracranial metastatic lesions without dislocation syndrome. The level and activity of tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor type 1 (PAI-1) and urokinase receptor (uPAR) were measured. The results were compared to data from 18 individuals without oncological pathology (donor group). The levels and activity of uPA and tPA, as well as PAI-1 inhibitor and uPAR were also evaluated in CSF of 16 patients with brain metastases and 14 patients with benign brain tumors. Statistical data processing was performed using the Statistica 10.0 software.

Results. In plasma of patients with brain metastases, tPA activity was increased 2.1-fold while its level was decreased 3.6-fold which increased their ratio 10-fold (p £0.0002). uPA activity did not change but its level, as well as uPAR level, activity and level of PAI-1 inhibitor and tPA and uPA were decreased. In CSF of patients with brain metastases, the levels of urokinase system components were lower compared to CSF of patients with benign brain tumors. For benign tumors, PAI-1 inhibitor level was 3.5 times higher than for brain metastases (p = 0.0000), while there were no differences in tPA parameters in CSF.

Conclusion. In blood of patients with brain metastases, only tPA activation was observed. The results allow to propose that in patients with brain metastases, functional activity of urokinase system is not elevated in blood and, supposedly, in CSF in contrast to patients with primary malignant tumors of some locations.

Introduction. Given the relatively favorable prognosis in highly differentiated thyroid cancer and improvement in diagnosis of the disease, an assessment of patients’ life quality and risk of developing surgical complications comes to the fore. The lack of studies and recommendations regarding the volume of thyroid resection in patients with tumors limited by its isthmus does not allow determining what the surgery volume is optimal, especially for patients at low risk of relapse.

Aim. To determine the advantages and disadvantages of isthmusectomy as a method of treating nodular pathology of the thyroid gland with suspected cancer, as well as indications for such surgery and its limitation on the basis of experience of the National Medical Research Center for Endocrinology and the scientific data available to date.

Materials and methods. The study included 32 patients with nodal formation in the thyroid gland isthmus, who underwent istmusectomy; the postoperative follow-up period for them was 6 months or more.

Results. In the preoperative phase, thyroid cancer was suspected in 19 (56.3 %) cases; all patients were classified as a low risk of relapse. According to a morphological study, the diagnosis of thyroid cancer was confirmed in 22 patients; all of them had the stage I disease. According to the dynamic risk stratification of the American Thyroid Association (ATA), 21 (95.5 %) patients with verified thyroid cancer were assigned to the low risk of recurrence, 1 (4.5 %) to the high risk of recurrence due to presence of vascular invasion and aggressive morphological tumor subtype (the patient underwent a final thyroidectomy). Over the entire observation period, no cases of recurrence were recorded, that indicates a high quality of preoperative examination when selecting patients for isthmusectomy and the effectiveness of the surgical intervention.

Conclusion. The results of the study allow us to consider isthmusectomy as a safe and effective method of surgical treatment of patients with nodal formations of the thyroid gland localized in its isthmus. Further studies with a longer follow-up period are needed to fully analyze effectiveness of this method.

Introduction. At the current stage of reconstructive surgery development, correction of defects of the oral cavity and tongue in oncological patients is an important component of proper surgical treatment. Therefore, the selection of the most appropriate plastic material including a free revascularized autotransplant (flap) remains an important problem. Usually, radial flap is used due to ease of dissection, thinness, plasticity, long vascular pedicle. However, its use has a serious disadvantage: significant damage of the donor area. The use of antriolateral femoral free flap allows to obtain large volume of soft tissues with minimal injury of the donor area. However, it can be too large due to the thickness of subcutaneous fat and cannot be used to correct small and medium sized defects of the oral cavity. Therefore, the use of medial sural artery perforator flap is an excellent alternative due to its thinness, plasticity and minimal damage to the donor area.

Aim. To evaluate the effectiveness of using medial sural artery perforator free flap for reconstruction of defects of the oral cavity in oncological patients.

Materials and methods. The retrospective study included 8 patients with tumors of the oral cavity and tongue (3 men, 5 women) who underwent surgical treatment at the Mariinsky Hospital (Saint Petersburg) between May of 2020 and January of 2022. Mean patient age was 53 years. For single-step defect reconstruction, medial sural artery perforator free flap was used. Mapping of artery perforators of the future flap was performed using Doppler ultrasound.

Results. The flap was successfully used in 7 of 8 cases. Venous ischemia of the flap on day 1 after surgery developed in 2 patients in whom 1 venous anastomosis was used which led to the necessity of vascular anastomosis revision. Flap loss occurred in 1 case due to late diagnosis of ischemia. In 1 case, due to anastomosis revision, flap perfusion was restored. Donor area was sutured without skin grafts which led to satisfactory esthetic results. In 1 case, partial wound dehiscence occurred and the donor area healed under secondary tension.

Conclusion. The use of medial sural artery perforator free flap is an effective technique for reconstruction of defects of the oral cavity in oncological patients with minimal damage of the donor area and good functional results. However, in our opinion, the use of this flap requires two venous anastomoses, accurate and delicate intramuscular perforator dissection due to their small diameter.

Endoscopic ultrasound is a new technique for diagnosis of precancers and tumors of the larynx. This technique proved its effectiveness in identification of pathologies of the gastrointestinal tract. We have adopted the best practices of our colleagues and used endoscopic ultrasound in diagnosis of squamous cell carcinoma of the larynx.

The article describes advantages of endoscopic and ultrasound diagnosis of laryngeal pathology, presents a clinical case of using endoscopic ultrasound.

The patients with progressive metastatic radioiodine refractory differentiated thyroid cancer have a rather unfavorable prognosis. Their life expectancy, according to various authors, does not exceed 3–5 years. To date, tyrosine kinase inhibitors have demonstrated their effectiveness in the treatment of such patients, and in particular, lenvatinib, which is recommended by all leading world communities as the first line of targeted therapy for such patients. The undoubted benefit of targeted therapy with lenvatinib is associated with the development of a fairly large number of adverse events and, accordingly, a decrease in the quality of life of patients. To date, most experts have come to the unambiguous conclusion that there is no need to rush to prescribe targeted therapy without real need. Unfortunately, despite the huge number of different schools and conferences devoted to this topic, most specialists have quite limited experience in the treatment and dynamic observation of patients with progressive radioiodine refractory differentiated thyroid cancer.

In this article, using a clinical example, we will try to shed light on the difficulties encountered in the treatment of patients with progressive metastatic radiodefractive differentiated thyroid cancer.

The ileocolon flap is a promising plastic material for one-stage restoration of the nutrition and voice functions in cancer patients after laryngectomy and laryngopharyngectomy. The advantage of using this flap over alternative visceral flaps is its anatomical and functional features, the presence of its own one-way valve that assists in the passage of air from the trachea to the pharynx, prevents regurgitation of food or saliva into the respiratory tract and thereby ensures the restoration of vocal function without the need for additional devices. This review analyzes the use of ileocolon flap in the reconstruction of the upper aerodigestive tract, its advantages over other methods, as well as thе role of this approach in improving the quality of life of patients. Historical aspects, technical features, factors influencing the choice of technique, and the results of clinical studies confirming the effectiveness and reliability of this reconstruction method are considered.

Despite the achievements in otorhinolaryngology and radiology, the sphenoid sinus has been and still remains to be subject of interest for rhinologists in all over the world. This is primarily is due to the rapid development of endoscopic surgery of the sphenoid sinus, skull base and of endoscopic neurosurgery, which made transphenoidal approach possible for excision of various pathology the sellar and parasellar location. The sphenoid sinus is extremely variable in its development and pneumatization, which often make the surgery difficult to perform. Therefore, it is consider that, both endoscopic sphenotomy and transsphenoidal surgeries are contraindicated in some types of sphenoid sinus pneumatization due to the high risk of complications.

A detailed analysis of sphenoid sinus pneumatization variants, its relationship with neighboring neurovascular structures is presented in our paper. The presented data will allow for a better understanding of its anatomy, which is important for the detailed planning of endoscopic sphenotomy and transsphenoidal operations. This will help increasing the surgical efficiency by avoiding severe complications associated with surgery of the base of the skull region.

The article reviews methods to restore voice function after laryngectomy. Special attention is paid to surgical methods, the history of the development of voice prostheses. The advantages and disadvantages, functional results, complications of each method of voice restoring are also analyzed, and the design of prostheses is described. Authors included clinical observations of the treatment of patients with malignant laryngeal tumors who underwent laryngectomy with tracheoesophageal bypass grafting and installation of domestic vocal prostheses. After surgery all patients have maintained voice function for a long time without replacing prostheses.

Selpercatinib is a novel, highly selective, small-molecule inhibitor of RET kinase that competes with adenosine triphosphate. In experimental models, this drug has demonstrated nanomolar activity against various RET gene alterations, including an acquired resistance mutation in the gatekeeper gene at residue V804, as well as antitumor activity in the brain. Selpercatinib inhibits wild-type and various mutated forms of RET, as well as vascular endothelial growth factor receptors (VEGFR1 and VEGFR3) with half-maximal inhibitory concentrations from 0.92 to 67.8 nM, and fibroblast growth factor receptors (FGFR1, FGFR2, and FGFR3).

The article presents results of clinical studies on the efficacy and safety of selpercatinib in patients with radioiodine refractory differentiated thyroid cancer with alterations in RET gene and in patients with medullary thyroid cancer with a germinal or somatic mutation in this gene.