Treatment of recurrent laryngeal cancer remains challenging for clinicians. Peristomal reccurence is one of the severest complications of laryngeal cancer that occurs in 2–15  % of patients after laryngectomy and has a poor prognosis: the two-year survival rate is 45 % in patients with stage I and stage II recurrence (according to G.A. Sisson) and 9 % among patients with stage III and stage IV recurrence. Stomal recurrence usually occurs within 2 years after surgery. The following factors can influence that: location of the tumor in the subglottic region of the larynx, size of the primary tumor, presence of regional metastases, placement of a tracheostoma before laryngectomy, and submucosal spread of the tumor to the trachea. All these factors should be taken into account in patients» management, including prescription of adjuvant therapy and choosing a treatment strategy in patients with primary disease.

Since there are multiple factors that can influence peristomal reccurence development, the disease requires comprehensive evaluation in order to provide the most adequate treatment and to prevent stomal recurrence.

Patients with head and neck squamous cell carcinoma diagnosed with recurrent tumor or distant metastases usually have the worst prognosis. Chemotherapeutic options are very limited in these patients; there is a probability of drug resistance development. The researchers continue to search more effective and less toxic drugs. In the current article, we analyze the results of the latest randomized clinical trials devoted the assessment of novel antitumor immunotherapeutic drugs – PD-1 inhibitors – in patients with head and neck squamous cell carcinoma. This studies reveal new possibilities for the treatment of these patients.

Objective and status of the guidelines. These Clinical guidelines consolidate opinions of the members of the expert task group on current problems of diagnosis and treatment of skin cancer at the modern stage of Russian clinical practice. The guidelines embody experience in diagnosis and treatment of this pathology of the leading specialists of scientific research institutes and large oncological centers of the Russian Federation. The guidelines were composed considering operation of oncological dispensaries with different bed capacities and diagnostic capabilities, and therefore opinions of some members of the group can differ from the version presented below. At the same time, the proposed for discussion guidelines make no claim to fully represent all aspects of the problem and can’t replace guidelines for doctors, textbooks, and scientific papers in this field.

The main objective of the guidelines is to improve early diagnosis of malignant skin pathology, its treatment, functional and social rehabilitation of patients with this pathology.

The Guidelines are based on analysis of the current state of diagnosis and treatment of malignant skin tumors of the head and neck considering experience of the leading specialists in the field and reports presented at the task group meeting on February 17th, 2017 in Kazan.

Introduction. Currently thyroid nodules are a widespread problem in clinical oncology and head and neck cancer, malignant focal lesions constitute more than 15–20  %. Accurate diagnosis is very important and determines treatment, as well as the volume of surgical intervention.

Objective – determination of the diagnostic value of the method of contrast-enhanced ultrasound in the diagnosis of thyroid cancer. Reference materials were the results of the histological study of surgical specimens.

Method. Performed a retrospective analysis of medical records of 42 patients who underwent surgery at the surgical department of head and neck tumors on the verified thyroid cancer in the N.N. Petrov Research Institute of Oncology at the Ministry of Health of Russia. The number of female patients was 36 persons (85.5 %), the number of men was 6 people (14.5 %). The average age of patients among men was 55.5 years, women – 46 years. All patients underwent surgical treatment in the amount of extirpation of the thyroid gland – 16 patients (37.5 %), hemithyroidectomy – 26 patients (62.5 %).

Results. The sensitivity of ultrasound with contrast in the diagnosis of cancer of the thyroid gland was 94.11 %, specificity was 87.5 %, diagnostic accuracy – 92.8 %.

Conclusions. The technique of ultrasound nodules thyroid with intravenous contrast enhancement has an excellent diagnostic properties, allowing to identify and verify thyroid cancer is 8 % more accurately in comparison with standard ultrasound technique.

Introduction. In clinical practice, differential diagnosis of nodular thyroid diseases poses a serious problem which can be solved by development of new, safe, and specific thyroid tumor markers. Small regulatory RNAs (microRNA, miRNA) are a class of molecules that control gene expression at the post-transcriptional level. miRNAs, both intracellular and secreted into the extracellular space, can be used as markers of various diseases, including cancer. Stability of extracellular miRNAs is determined by binding to proteins and lipoproteins, or by “packing” into membrane microvesicles – exosomes. It is considered that exosomes with specific miRNA content are a result of active and biologically significant secretion, while release of other forms of miRNA is associated with apoptotic or necrotic cell death. This determines diagnostic value of exosomal fraction of circulating miRNAs, which may reflect presence or clinically significant properties of a tumor.

The study objective was to explore a method of exosomal miRNA isolation, identify marker miRNAs, and estimate diagnostic value of their analysis.

Methods. We used serum samples from 57 patients with nodular thyroid diseases and 13 healthy donors. Exosomes were isolated from serum by ultracentrifugation and analyzed by atomic force microscopy, laser correlation spectroscopy, and western blotting. Analysis of exosomal miRNAs was carried out by RT-PCR.

Results. We have identified a specific correlation between certain miRNAs and status of thyroid nodular disease. Expression profiles of three miRNAs (miRNA-21,  miRNA-146a,  and miRNA-181a) exhibited specific characteristics for different forms of nodular thyroid disease and their analysis may have diagnostic value.

Conclusions. Exosomes isolated by ultracentrifugation from serum are a source of RNA suitable for subsequent analysis of miRNA. The levels of different miRNAs in serum exosomes may differ by 1–2 times. «Marker» exosomal miRNAs have specific profiles in circulating exosomes of patients with different thyroid nodules. Clinical significance of testing exosomal miRNAs in patients with benign and malignant nodules of the thyroid gland can be increased by a parallel assessment of several molecules and analysis of the profile of their representation in exosomes. MiRNA-181a, -146a, and -21 form a diagnostic combination of «marker» molecules present in the circulating exosomes, which can be extended and used for diagnosis (differential diagnosis) of thyroid nodules.

Introduction. Cancer of the oral cavity comprises 6 % of all malignant tumors. Recurrences occur in 15–30  % of patients, 50 % have local recurrences, 25–30  % – regional. The choice of treatment depends on the location and stage of the recurrence.

Objective. To choose optimal tactics for surgical treatment in patients with recurrent cancer of the oropharyngeal region.

Materials and methods. The study included 314 patients with recurrent squamous cell carcinoma of the oropharyngeal region, who were treated at the N.N. Blokhin Russian Cancer Research Center and underwent surgical, combination, or conservative treatment.

Results. Survival in respect to the time of relapse was 35,0 ± 2.0 % for early (in the course of a year) relapses and 63,0 ± 7.1 % for late (a year after treatment and longer) relapses. Five-year survival in respect to the type of treatment for early recurrences was 34.2 ± 6 % for surgical treatment, 7.7 ± 3.5 % for combination treatment, and 17.6 ± 4.6 % for conservative approach. For late relapses, it was 62.7 ± 5.9 %, 77.8 ± 10.6 %, and 59.2 ± 8.7 %, respectively. Surgical treatment was performed in the form of removal of recurrent tumors, resection and reconstruction using local flaps, extended combined surgeries, and laser or cryodestruction.

Conclusion. The method of choice for treatment of recurrent tumors of oropharyngeal cancer is surgery in the form of an extended combined surgery with defect reconstruction using musculocutaneous flaps including the pectoralis major.

Introduction. Surgical intervention is the main method of treatment of oral cavity cancer, and at early stages it»s a monomodal treatment. The study objective is to determine oncological effectiveness based on an analysis of surgical treatment of stage I and II oral cancer.

Materials and methods. In the period from April 2009 to December 2014, 52 patients (37 men and 15 women) aged 39–85 (mean age was 60.2 years) with confirmed diagnosis of squamous cell carcinoma of the tongue (36 patients), the floor of the mouth (15), and the retromolar trigone (1) underwent surgery. Half of the patients were stage I, the other half – stage II. Removal of the primary tumor was accompanied by neck dissection in 35 cases (67 %). Dissection was two-sided in 8 patients. Twenty (20) modified radical dissections and 23 selective neck dissections were performed. In the majority of cases (42 patients, 80.8 %), tumors were removed transorally. Primary reconstruction was performed in 31 patients; in others, additional plastic material was used: infrahyoid flap (14 cases), submental flap (1), radial forearm flap (5), anterolateral femoral flap (1). Survival was evaluated using the Kaplan–Meier estimator incorporating patient’ dates of last visits or death. Progression-free survival took into account time to diagnosis of disease relapse in the form of local or regional recurrence. Statistical data analysis was performed using the SPSS v. 23 software.

Results. Mean follow up duration was 37.4 months (1–91  months), and 27 patients (52 %) were monitored for 3 and more years, 34 (65.4 %) patients after surgery for 2 years and longer, and 46 (88.5 %) patients for more than a year. During this time, 8 patients died, and 3-year overall survival was 84.7 %. In 6 patients, disease recurrence was diagnosed, in 2 of them this event was registered twice (local recurrence in 3 cases, regional recurrence in 4 cases, locoregional recurrence in 1 case). Therefore, locoregional control was 88.5 %. Time to recurrence varied from 4 to 43 months. Three-year relapse-free survival was 91.1 %. Second primary tumors appeared 30–70  months after surgery in 4 patients: In 2 patients, they were located in the oral cavity, in 1 – in the larynx, and in 1 – in the laryngopharynx. Statistical analysis of various factors (Т stage, differentiation grade, localization, etc.) has shown that only neck dissection affected overall 3-year survival: it was 96 % in patients with neck dissection, and 64.3 % in patients without neck dissection (р = 0.012). However, these data can be explained by older age of patients who didn’t undergo neck lymph node dissection (65.2 vs. 57.6 years), and presence of a more severe concomitant pathology.

Conclusion. Surgical intervention remains the main treatment method of early stage oral cavity cancer due to its high oncological effectiveness.

Introduction. The issue of selecting treatment strategy for сT2N0M0 cancer of the oral mucosa remains relevant. Induction chemotherapy (applied in order to evaluate the possibility of organ-preserving chemoradiotherapy) is widely used in clinical practice. In this case, surgical treatment is performed only when chemotherapy (CT) is ineffective or a residual tumor is detected after chemoradiotherapy (CRT). However, many specialists recommend surgical treatment on the first stage of treatment.

Objective: evaluation of the induction chemotherapy feasibility in the treatment of T2N0M0 cancer of the oral mucosa.

Materials and methods. A total of 122 patients with primary Т2N0М0 cancer of oral mucosa without regional metastases (according to clinical examination) were included in the study.

Results. In order to determine the best treatment strategy, we have compared treatment outcomes in three groups of patients. The most favorable outcomes were observed in the group of patients receiving combined treatment according to a scheme «surgery + radiotherapy (RT)/ CRT, where the overall 5-year survival rate and the progression-free 5-year survival rate were 70.4 % and 68.5 % respectively. Survival rate in this group was significantly higher (р < 0.05) than that in the group «induction CT (ICT) ± RT ± surgery» where these parameters comprised 42.2 % and 36.2 % respectively.

Conclusion. Combined treatment with a surgery on the first stage followed by RT or CRT ensures better outcomes of the cancer of the oral mucosa than the strategies that include ICT.

Well-differentiated thyroid carcinoma (WDTC) comprises > 90 % of all cases of thyroid cancer. In 10–15 % of patients, distant metastases are detected which significantly worsen the prognosis. Radioactive iodine therapy remains the main type of treatment of this patient group, but for patients with so-called radioactive iodine-refractory WDTC the prognosis is very poor. After successful phase III  studies, several drugs from the group of multikinase inhibitors are being used in clinical practice for treatment of radioactive iodine-refractory WDTC, for example lenvatinib. In this article, we present a group of patients with radioactive iodine-refractory WDTC who received lenvatinib therapy.

Introduction. Facial nerve paralysis disconnects person»s emotions and expression, causes lagophthalmos, disorders of taste, touch, salivation, and lymph efflux in the damaged area. Among causes of consistent facial nerve conduction defects, the most common is iatrogenic injury during extensive surgical interventions for removal of tumors of the parotid gland. Various surgery interventions are used for correction of such disorders. The article objective is to present results of performed static plastic surgeries using polypropylene thread in patients with facial nerve damage caused by radical parotidectomy.

Materials and methods. From 2014 to 2016 in the Department of Microsurgery of the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, 14 patients underwent static correction using polypropylene thread to treat iatrogenic injury of the facial nerve after radical surgery for malignant and benign tumors.

Results. In all patients, optimal results of repair of the esthetic component of the facial nerve were achieved. Postoperative period didn»t exceed 3 days. Effect duration is longer than 3 years.

Conclusions. Use of polypropylene thread in static plastic surgery allows to perform cosmetic facial correction, eliminate gravitational ptosis and lymphostasis in patients with consistent syndrome of complete damage of facial nerve conductance.

Introduction. Currently, a great importance is being attached to improvement of the surgical component of combination treatment of locally advanced laryngeal cancer. New technological capabilities (transoral microsurgery of the larynx and robotic surgery) offer great opportunities for early cancer stages. However, in some cases capabilities of endoscopic laser intervention are limited. Therefore, open laryngeal resection is still relevant as it serves as the only type of radical organ preservation treatment for stages Т2–Т3. But major laryngeal resection is associated with a problem of tissue defect closure.

The article describes data on the use of biocompatible materials, their advantages and disadvantages. The study objective is to present experience of using a Russian allogenic bioimplant for plastic reconstruction of the opening of the larynx after laryngeal resection.

Materials and methods. The authors present their experience of using a Russian bioimplant produced in collaboration with the Samara Tissue Bank of the Research Institute of Experimental Medicine and Biotechnology of the Samara State Medical University. The material was tested in anterolateral laryngeal resection with simultaneous reconstruction in 5 patients with stages Т2–Т3 laryngeal cancer and in a patient with chondrosarcoma.

Conclusion. The Russian biocompatible implant served as a reliable, simple, cheap, and effective variant of plastic material for reconstruction of the larynx.

Introduction. Thyroid surgeries are one of the most common surgical interventions. Duration of hospital stay depends on the risk of postoperative complications, primarily, transient or permanent hypocalcemia, recurrent laryngeal nerve paralysis, bleeding.

Objective: presentation of first-hand results of using a protocol of enhanced recovery after thyroid surgery by us.

Materials and Methods. In the study, results of treatment of 162 patients who underwent surgery in the period from January 2014 to January 2016 are analyzed. In 22 (13.5 %) patients the surgery was performed endoscopically using bilateral axillo-breast approach (ВАВА). Results. No deaths were registered. In 2 patients, intraoperative complications were observed: In one case the recurrent laryngeal nerve was transected in a patient with retrosternal giant (larger than 15 cm) nodular goiter; in the 2nd case, the cricoid cartilage of a female patient was damaged by a harmonic scalpel during endoscopic intervention. Mean surgery duration in the studied group was 69.5 ± 15.7 min. Postoperative complications were observed in 5 (3 %) patients: In 1 it was subcutaneous emphysema after endoscopic surgery, in 2 patients – laryngospasm, in another two – transient hypocalcemia. Mean duration of hospital stay was 2.1 ± 0.5 days.

Conclusions. Based on literature data analysis and results of our study, we can conclude that the use of enhanced recovery protocols after thyroid surgeries is safe with low rate of complications and earlier hospital discharge.

Vascular endothelial growth factor signaling pathway (VSP) inhibitors are drugs for which arterial hypertension (AH) is a class effect, occurring with a frequency of up to 73 % of treated patients. Blockade of vascular endothelial growth factor or its receptor is accompanied by inhibition of the synthesis of nitric oxide, which is considered a major pathogenic mechanism for the development of AH. VSP-inhibitors therapy will be as safe as possible, if the patient prior to treatment will take a minimum assessment, allowing to identify the category of patients with high/very high cardiovascular risk. Risk evaluation is necessary not to abandon an effective therapy of VSP-inhibitors, and to provide a systematic approach to reduce the likelihood of potential cardiovascular toxicity. Blood pressure during VSP-inhibitors therapy is characterized by a rapid rise after the first dose of target therapy, as a rule, in the first cycle of treatment, ranging from no increase to double the systolic blood pressure. Usually iatrogenic AH spontaneously resolves after stopping chemotherapy. Timely prescribed antihypertensive therapy help to avoids dose reduction or interruption of the course of VSP-inhibitors, which significantly improves the survival of patients.

Objective: in paper direct results of investigation the products of tumor makers – CEA (carcino-embryonic antigen), CYFRA 21-1 and SCC and heat shock proteins hsp27, hsp70, hsp90. reflacting the possibility of malignization epithelial cells in chronic hyperpiastic laryngitis.

Materials and methods. There were investigated 36 patients with chronic hyperplastic laryngitis. It was investigated the production of CEA (carcino-embryonic antigen), CYFRA 21-1, SCC and heat shock proteins hsp27, hsp70 in immune-enzyme method. The variation of serum concentration oncomarkers was investigated in dependent on the maximum production of heat shock proteins reflactihg the value of cell stress in chronic hyperplastic laryngitis. Statistics analysis was convey in programs Statistica (version 6,0) and “Biostat 4.03”.

Results. It was shown more prognostic informative in chronic hyperplastic laryngitis the level of CEA, CYFRA 21-1 and SCC on the background of maximum production of heat shock proteins hsp27, hsp70, hsp90. The serum level of CEA was higher in comparison with control. On the maximum of production hsp27, hsp70, hsp90 the concentration of CEA was 2–3 ng/ml, Cyfra 21-1 – 0–1,2 ng/ml and SCC 1–2 ng/ml. Conclusions. Variation of serum oncomarkers level of CEA – 2–3 ng/ml, CYFRA 21-1 – 0–1,2  ng/ml and SCC – 1–2 ng/ml are the prognostic value in the possibility of malignization epithelial cells in chronic hyperpiastic laryngitis. This results is important in clinical practice.

Multiple approaches are currently available for treatment of oropharyngeal cancer. Particular attention is usually paid to preservation of the normal shape of the organ and maintenance of the quality of life in patients. Early-stage oropharyngeal cancer can be treated by both radiotherapy and surgery, including transoral laser microsurgery and robot-assisted surgery.

Early diagnosis and the use of modern technological approaches allow to conduct adequate surgical treatment without significant injury of the surrounding soft tissues and bone structures, which in turn promotes both aesthetic and functional rehabilitation of the patient. The case of robot-assisted surgical treatment of the oropharyngeal tumor described in this article is a good example of this rehabilitation.

Rhabdomyoma of the nasopharynx is an extremely rare disease. Currently, there are only isolated cases of rhabdomyoma of the nasopharynx described in literature. Information on the clinical picture and course of the disease is very poor. The author presents his own clinical observation of a rare localization of rhabdomyoma in the nasopharynx. Analysis of literature data and clinical observation allowed the author to conclude that rhabdomyoma of the nasopharynx has a relatively favorable prognosis given early detection, benign quality of the disease, and availability of radical surgery.