Administration of calcium and vitamin D preparations always requires competent selection of doses, and combinations of drugs from a doctor as well as careful clinical and laboratory monitoring of the patient. Physician should always be aware of the danger of overdose, which can lead to very adverse consequences. An appearance of the first symptoms of overdose requires constant laboratory control and urgent measures to address this condition. One should also remember about other causes of hypercalcemia, which can help in the differential diagnosis. Clinical case presented by us is an example of how the lack of knowledge about the combined treatment of patients with postsurgical hypoparathyroidism can lead to some serious consequences such as hypercalcemic crisis. 

We present rare clinical case of laryngeal paraganglioma. Modern possibilities of the disease diagnostics, determination of the prevalence of tumor process, methods, and assessment of the effectiveness of treatment are shown in this paper. 

The work illustrates main issues of the radial treatment acceptability with the modification of patients with the squamous cell carcinoma of the oropharyngeal area. The spectrum of side effects is given and key issues of the accompanying therapy are concerned. Separately are given approaches to the treatment of patients with radial mucositis and dermatitis. 

Basal cell carcinoma is one of the most common malignancies. Despite a wide range of treatment options and relatively good prognosis of the disease, there may be restrictions on the use of standard methods of treatment because of elderly patients, their physical condition and characteristics of the tumor localization. We provide clinical examples of successful treatment of basal cell carcinoma of the head and neck with Kuraderm BEC5. This is a drug with anti-tumor activity for topical use made on the basis of glycoalkaloids of plants of nightshade family. 

Introduction. Pathologic angiogenesis is typical for angiogenic diseases including tumor growth. Vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), transforming growth factor alpha and beta (which are also known as “triggers” of angiogenesis), and other factors (Gacche, Meshram, 2013; Nijaguna et al., 2015) play a special role in its development. Evaluation of the important mechanisms of angiogenesis in physiological and pathological conditions remains to be a subject of heightened interest for the past 30 years. It is known that VEGF A is the main trigger of growing blood vessels into the tumor tissue. This is specific mitogen signal for endothelial cells that triggers the mechanisms of cell division and migration. VEGF-induced tumor vasculature has a number of structural and functional features that provide growth and progression of tumors, including increased permeability of blood vessels and their chaotic arrangement.

Objective: to study in comparative aspect the level of certain growth factors in the following tissues: glioblastomas, brain metastasis of the breast cancer, meningiomas as well as corresponding peritumoral areas.

Materials and methods. Tissue samples were obtained from 56 patients admitted to the surgical treatment in Rostov Research Institute of Oncology: 24 patients had glioblastomas, 19 patients had brain metastasis of the breast cancer, 13 patients with meningiomas without peritumoral edema. Histological control was carried out in all cases. Age of patients ranged from 35 to 72 years. The level of growth factor was detected in the samples of tumor tissue and regions immediately adjacent to the tumor foci (peritumoral area) by the method of immunoassay and using standard test systems. The following growth factor were detected: VEGF-A and its receptors VEGF-R1 (BenderMedSystem, Austria), VEGF-C and its receptor VEGF-R3 (BenderMedSystem, Austria), EGF (Biosource, USA), IFR-1 and IFR-2 (Mediagnost, USA), TGF-β1 (BenderMedSystem, Austria).

Results. We have found both common and distinctive features in the content of growth factors in neoplastic tissues of different histological structure and corresponding peritumoral areas. Common metabolic features of glioblastomas, brain metastases and meningiomas include various increase in the level of VEGF-A, VEGF-R1, VEGF-C, IFR-1, IFR-2 and VEGF-C/VEGF-R3 index ratio. Differences included the fact that the level of VEGF-R3 and TGF-β1 did not increase in the benign tumor, while the level of EGF and VEGF-A/VEGF-R1 index ratio were below the control values in contrast to the values of malignant tumors.

Conclusions

• In the neoplastic tissues of glioblastomas and peritumoral area there is a strong positive correlation between the level of VEGF-A with the level of EGF, IGF-1, IGF-II and TGF-β1.

• In the metastatic tissue there is a strong positive correlation between the level of VEGF-A with the level of EGF, IGF-1, IGF-II and TGF-β1. However, correlations had a different nature in the peritumoral zone tissues near to metastases: there was a strong positive correlation of VEGF-A level with TGF-β1 only, while there was a strong negative correlation with the level of IGF-1 and IGF-II, there were no correlations with EGF level.

• In meningioma tissues VEGF-A levels correlated only with the level of insulin-like growth factors: there was a strong positive correlation with IGF-1 and IGF-II, correlation has been found with the level of EGF and TGF-β1.

• In descending order VEGF-C was detected in glioblastoma tissue, in metastatic tumors, meningiomas, peritumoral zones of glioblastomas and metastases. However, in all of these samples the level of the studied factor significantly exceeded the value in intact brain tissue. VEGFR-3 level was elevated in glioblastoma tissue only. 

Laryngeal cancer takes the leading position among malignant tumors of head and neck. Currently, endolaryngeal laser resection is the leading treatment option for localized processes (T1-T2). In the period from December 2014 to January 2016 such surgeries were performed in 76 patients in our clinic. Carcinoma in situ was detected in 19 (25 %), T1a in 27 (35 %), T1b in 24 (31 %), T2 in 6 (8 %) patients. As result of the planned histological examination, in all cases surgical procedures had microscopically radical character. Endolaryngeal CO2 -laser resections allow to perform enough large radical surgical interventions with satisfactory functional and cosmetic results, without compromising long-term outcomes. 

Objective – analysis of the results of surgical and conservative treatment of conjunctival melanoma (CM) on the basis of our own experience.

Materials and methods. Retrospective analysis of 25 patients with CM treated with surgery and/or Sr-90-brachytherapy in Ocular Oncology Service of S.N. Fyodorov Eye Microsurgery Federal State Institution. Clinical and histological features and treatment outcomes were analyzed.

Results. Patients mean age was 57.15 years (from 20 to 82). In 9 cases CM arose from acquired melanosis (primary — 8, secondary — 1). In 15 cases tumor involved limbus, in 14 — cornea, in 24 cases — bulbar conjunctiva, in 8 — fornices and in 7 — tarsal conjunctiva. Maximum tumor thickness was up to 28 mm. Ten patients were treated with excisional biopsy (including CO2 -laser or radiosurgery), 4 — with excisional biopsy with subsequent Sr-90-brachytherapy, 8 — with brachytherapy alone with mean irradiation dose 150 Gy to a depth of 1.5–3.0mm, in 1 patient orbital periosteal exenteration was fulfilled and in 2 patients extended enucleation was performed. Seven excised tumors were epithelioid cell, 5 — spindle cell, 5 — mixed cell type. The follow-up was from 3 to 114 months (mean 25 months). Local control was achieved in 21 cases, 1 recurrence was after surgery and 3 after irradiation, all the recurrences were in patients with acquired melanosis, 3 recurrences were successfully treated, one led to exenteration. No recurrences were diagnosed after surgery combined with brachytherapy. One patient had preauricular limph nodes metastasis. Two patients died because of metastasis. No complications were diagnosed after Sr-90-irradiation. Patients underwent extended enucleation are followed up 4 and 22 months with no features of recurrences.

Conclusion. Excisional biopsy especially combining with Sr-90-brachytherapy is a well-tolerated and effective therapy. Larger groups of patient are required for further analysis. 

Objective: improve results of the treatment of patients with malignant salivary gland neoplasm (MSGN).

Materials and methods. Analysis of 417 patients suffering from MSGN treated in the Federal State Budgetary Institution “N.N. Blokhin Russian Cancer Research Center” from 1988 to 2014. All the subjects were divided into 4 main groups according to the treatment assigned: group of the surgical treatment – 27.3 % (n = 114), group of the combined treatment (surgery and radiotherapy (RT)) – 54.0 % (n = 225), group of the complex treatment (surgery, radiotherapy and chemotherapy) – 10.5 % (n = 44), group of conservative treatment (radiotherapy and/or chemotherapy) – 8.2 % (n = 34).

Results. Best 5-year disease-free survival (DFS) was observed in patients with localization of the tumor process in the minor salivary glands (MSG), mucosal tunic (MT) of mouth (73.2 ± 5.5%) and parotid gland (62.3 ± 3.3 %), while the lowest survival rate was observed in tumors of sublingual salivary gland (0%) (median was not achieved, p = 0.07). Depending on the morphological variants the best 5-year DFS was observed in groups of myoepithelial carcinoma, and acinar cell carcinoma: 81.3 ± 9.8 and 79.1 ± 8.4 %, respectively (median was not reached, p > 0.05); the worst survival rate was observed in patients with squamous cell carcinoma, carcinoma of the salivary ducts and adenocarcinoma: 45.7 ± 15.5; 50.3 ± 12.7 and 53.0 ± 5.5 %, respectively (median was not reached). In poorly differentiated tumors (G3 ) 5-year DFS was lowest and was equal to 32.7 ± 4.1 %, while in G1 tumors – 83.6 ± 3.1% (p = 0.000001). In G3 tumors addition of radiotherapy to the surgery significantly reduces the incidence of local recurrence - from 51.4 % (surgical treatment alone) down to 33.8 % (combined treatment) (p = 0.08). There was a significant decrease in 5-year disease-free survival rate from 74.2 ± 2.6 % without any adverse pathological signs down to 37.9 ± 5.4% in the presence of these signs (p = 0.000001). Cervical lymph node dissection is absolutely indicated for tumor localization in submandibular salivary gland, as it reduces an incidence of local recurrence: 15.8 % versus 25.9 % in the group without lymph node dissection, p> 0.05. In case of other MSGN localizations, prophylactic lymphadenectomy does not improve long-term outcomes. Radiotherapy in the post-op period significantly improves long-term results of treatment in comparison with a group of preoperative radiotherapy (local recurrence rates are 29.5 and 9.7 %, respectively, p = 0.0002). The use of chemotherapy can be justified in case of neoplasms with poor differentiation (G3 ) since this significantly reduces an incidence of distant metastases (17.6 and 9.1 % in groups of the combined treatment and in the group of conservative chemoradiotherapy respectively, p > 0.05). 

Introduction. Surgical excision followed by whole-brain radiotherapy (WBRT) is a traditional treatment option for solitary brain metastases (SBM) of renal carcinoma. In the presence of multiple brain metastases of renal carcinoma WBRT remains to be the most common treatment option in this group of patients. However, the effectiveness of WBRT is insufficient due to radioresistance of renal carcinoma. After introduction of the standards in the radiosurgical practice, treatment options of renal carcinoma have been changed, since radiosurgery may overcome WBRT limitations in the treatment of brain metastases of radioresistant tumors

Objective: to study the effectiveness of stereotactic radiosurgery by using “Gamma Knife” device in the treatment of brain metastases of renal carcinoma.

Materials and methods. We have analyzed results of the treatment of 112 patients with brain metastases of renal carcinoma who underwent radiosurgical treatment in Moscow Center “Gamma Knife”. Age median of the patients was 58 (33 –77) years. Total number of irradiated metastatic foci – 444, an average number of brain metastases in 1 patient was 4 (1–30). Twenty eight (25.0 %) patients had a single brain metastasis. A median of cumulative volume of brain metastases for each patient was 5.9 (0.1–29.1) cm3. An average value of the marginal dose for metastatic lesion was 22 (12–26) Gy, mean value of isodose used for treatment planning was 64 (39-99) %.

Results. An overall survival (OS) rate after radiosurgical treatment was 37.7; 16.4 and 9.3 % for 12, 24 and 36 months, respectively. A median OS was 9.1 months (95% confidence interval (CI) 7.1–11.8). New brain metastases (distant recurrences) following radiosurgical treatment occurred in 44 (54.3 %) patients, with a median of 10.1 months (95 % CI:7-18). Local recurrences after radiosurgical treatment were detected in 19 (17 %) patients with a median time of 6.6 months (95 % CI 4.0–9.6). Factors associated with the best OS: Karnofsky score ≥ 80 (p <0.0369), and the total volume of brain metastases ≤ 5 cm3 (p = 0.0131). Local control was achieved in 96 % of metastatic lesions in 87 % patients. Side effects of radiosurgical treatment occurred in 33.8 % of patients (6% of cases – radionecrosis, 23.8 % – increase in perifocal edema).

Conclusion. Radiosurgical treatment alone by using “Gamma Knife” device is an effective treatment option of brain metastases of renal carcinoma, providing a high level of local control of metastatic foci with minimal neurotoxicity. In case of distant recurrence, repeated use of radiosurgery provides a good local control and increase in OS compared with other treatment options.

In the treatment of many unresolved issues, indicating the need for research aimed at finding more effective treatment approaches. The aim of the study is to analyze the results of combined treatment of patients with widespread forms of cancer of the cervical esophagus and hypopharynx with the application of surgical treatment in the amount of pharyngolaryngitis with single-step plastic of the defect. A retrospective analysis of results of combined treatment of 28 patients with a verified diagnosis of cancer of the cervical esophagus and hypopharynx. Combined treatment of patients with cancer of the cervical esophagus and hypopharynx included the following treatments: induction chemoradiotherapy according to the scheme cisplatin/5-fluorouracil, external beam radiation therapy 65 Gy, brachytherapy (7 Gy 1 time per week, 3 sessions), surgical treatment with one-stage plastic of the esophagus. In 7 patients (25 %) was achieved complete regression on the background of induction chemo-therapy, 21 patients (75 %) received the treatment in full. Postoperative mortality rate was of 9.52 %, post-operative complications such as anastomosis dehiscence – 19 %.