Background. Combination therapy is the main method used for treatment of patients with locally advanced cancer of the oral floor and tongue. Radical surgery is a key stage of this therapy. These surgeries are inevitably associated with extensive defects in the oral cavity and tongue and, therefore, the loss of necessary organism functions. Currently, there is no optimal autotransplant for tongue reconstruction after total or subtotal removal of the tongue and oral floor muscles; it appears to be one of the most significant challenges in modern reconstructive surgery.

Materials and methods. The authors describe a case of successful repair of the oral floor and tongue after total glossectomy using a novel method developed in the Department of Microsurgery at the P. A. Herzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia. This method implies tongue reconstruction using a revascularized, reinnerved, chimeric, thoracodorsal flap with inclusion of a muscular portion from the serratus anterior muscle and a musculocutaneous portion from the latissimus dorsi muscle. We performed tongue reconstruction in a 62-year-old patient diagnosed with stage IVA (Т3N2bМ0) tongue cancer. 

Results. The novel method of surgical treatment of locally advanced tongue cancer with simultaneous repair of defects using a revascularized, reinnerved, chimeric flap with inclusion of the serratus anterior muscle and latissimus dorsi muscle allowed to remove the tumor, stabilize the laryngeal complex, restore the diaphragm of the oral floor, create an adequate volume of neotongue, obtain good functional and cosmetic results, and reduce the length of hospital stay. 

Conclusion. Novel method of surgical treatment of locally advanced tongue cancer facilitates health, employment, and social rehabilitation of patients with oropharyngeal cancer. This method can be considered as an alternative method of choice in the reconstruction of complex post-traumatic oropharyngeal defects. 

The study objective is to study overall survival and the rate of intracranial recurrences in patients with brain metastases after radiosurgery as single treatment.

Materials and methods. The results of radiosurgical treatment of 579 patients with brain metastases (248 men and 331 women) were analyzed. The sources of brain metastases were breast cancer (164 patients), non-small-cell lung carcinoma (162), melanoma (123), kidney cancer (87), colorectal cancer (43). Median cumulative tumor volume, maximal lesion volume, number of brain metastases in the studied patient group were 5.4 cm3, 3.6 cm3, and 4, respectively. Mean marginal dose of ionizing radiation was 22 Gy (15–24 Gy). Mean follow-up duration was 13.4 months.

Results. Overall survival of patients at 12 and 24 months was 42.8 and 24.8 %, respectively, with median overall survival after radiosurgery of 9.8 months (95 % confidence interval: 8.5–11.3). Local control of metastatic lesions was achieved in 81.3 % patients. Survival without local recurrence at 12 months was 66.7 %. Distant metastases developed in 235 (52.4 %) of 449 patients for whom radiological data was available. Survival without distant metastases at 12 and 24 months was 41.5 and 20.9 %, respectively. Multifactor analysis has shown that prognostic factors for long-term survival in patients with brain metastases were presence of breast cancer metastases in the brain, limited (4 lesions or less) number of brain metastases, high functional status, and absence of extracranial metastases. Increased survival duration was also associated with targeted therapy (p = 0.0412) and repeated radiosurgery to treat intracranial recurrences (р <0.0001).

Conclusion. Radiosurgical treatment of patients with brain metastases confers higher median overall survival (up to 9.8 months) than the same criterion (7.1 months) in the 1st class patients (per the recursive partitioning analysis scale) who received irradiation of the whole brain as single treatment. Repeated radiosurgery in cases of intracranial recurrences and targeted therapy confer increased overall survival of patients with brain metastases.

Background. Priority objectives of surgical neurooncology (diagnosis verification, tumor cytoreduction, and preservation of patient’s functional status) can be achieved both through traditional neurosurgical approaches and through the use of keyhole surgery. Keyhole surgery allows to minimize unnecessary, extended resection of the skull base and long-term static brain tissue retraction.

Objective. The authors present preliminary results of the use of supraorbital keyhole craniotomy in intra- and extra-axial brain tumors. 

Materials and methods. In 2014–2016, 45 patients were operated through supraorbital craniotomy to treat intra- and extra-axial tumors. The majority of patients (n = 28) was diagnosed with anterior cranial fossa meningiomas. Gliomas of the frontal lobe were diagnosed in 12 patients. The average tumor size ranged from 3 to 3.5 cm.

Results. Mortality, disability, or serious permanent access-related complications were not observed in our group. In all cases, the transition to the classical craniotomy was not required. Periorbital edema and transient hypoesthesia were observed in all patients. Permanent frontal hypoesthesia was observed in 3 patients (4 %) for a time period up to six months. According to postoperative MRI performed in all patients at the time of discharge, in the group of intra-axial brain tumor gross-total removal was observed in 8 patients (47 %), in 9 patients (53 %) the tumor was near-totally removed (more than 90 % of the tumor), in the group of meningiomas all 28 patients had gross-total removal.

Conclusion. Supraorbital craniotomy can be an effective and safe alternative to classic approaches to treatment of extra-axial tumors of the anterior cranial fossa and intra-axial tumors of the frontal lobe. The approach requires a very careful selection of patients, individualization of surgery, and further critical evaluation. 

The article describes methods for primary reconstruction of defects formed during the removal of malignant hypopharyngeal and cervical esophageal tumors. The possibility of plastic closure with local tissues, regional flaps and free flaps is discussed. The advantages and disadvantages of different types of reconstruction are evaluated.

Introduction. Treatment of oral squamous cell carcinoma is a complex and multicomponent process with obligatory surgical intervention at stage I of treatment. This usually leads to formation of extensive surgical defects during operational treatment and requires their single-step closure. Therefore, a surgeon faces a challenge of treatment optimization and a search for ways to decrease the rate of postoperative complications. Nutritional support plays a significant role in this process. 

The study objective is to evaluate the effect of nutritional support on immediate course of the postoperative period after surgical treatment for oral squamous cell carcinoma in primary patients.

Materials and methods. In the study performed at the N. N. Blokhin National Medical Research Center of Oncology, 43 primary patients with oral squamous cell carcinoma were divided into 2 groups: in one group the patients received nutritional support (1st group), the other group served as control (2nd group). 

Results. In the 1st group local complications were observed in 7 (31.8 %) cases, while in the control group in 9 (42.3 %) cases. Furthermore, severity of local complications in the 2nd group was also higher than in the 1st group. Such severe complications as partial or total necrosis of the flap developed only in the control group: in 3 (14.3 %) and 1 (4.8 %) case, respectively, while in the nutritional support group only 2 (9.1 %) cases of marginal necrosis were observed. Rate of postoperative complications also affects duration of inpatient stay. Thus, after surgical treatment patients in the 1st group stayed at the hospital for 16.6 bed-days (b/d) on average, while in control group they stayed for 21.5 b/d.

Conclusion. Nutritional support allows to improve patients’ quality of life and decrease the rate of postoperative complications, which in turn leads to increased overall survival. 

The article gives an overview of etiological factors promoting oral cancer development and describes its histological classification and international TNM classification (lip and oral cavity). We established the criteria for the evaluation of functional disorders induced by oral cancer or its treatment depending on the severity and developed a system for quantitative estimation of functional disorders in per cents.

Background. Oropharyngeal cancer is the second most frequent cancer among patients with head and neck tumors in the Russian Federation. Patients usually seek medical assistance in the late stages of the disease (stages III–IV). The mortality rate in such patients during the first year after treatment varies from 30 % to 40 %. This makes it necessary to improve the methods of its diagnosis and treatment. Modern laboratory techniques allow predicting patient’s condition before and during the course of treatment; they were implemented into clinical practice for successful treatment correction. An important role is given to assessing the practical experience of related medical institutions.

Objective: to develop an algorithm for the diagnosis and treatment of patients with oropharyngeal cancer using the experience of medical institutions dealing with these patients. We explored the experience of the Rostov Research Institute of Oncology and the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology of the Ministry of Health of the Republic of Uzbekistan.

Materials and methods. The study included 40 patients with oropharyngeal cancer who received treatment in the departments of head and neck tumors of the Rostov and Uzbek Oncology Institutes between 2007 and 2014. Twenty-five patients had stage III (T1–3N0–1) oropharyngeal cancer, seven patients were diagnosed with stage IV (T4N0–1) cancer, and eight patients had a widespread relapse. Before admission to the hospital for surgery, all patients received neoadjuvant radiation therapy (40 Gy). The surgeries included radical removal of the primary tumor; patients with cervical metastases underwent simultaneous cervical lymph node dissection (levels IB, IIA–B, III, and VA). Samples of tumor tissues and pertumoral tissues were collected during the surgery. They were homogenized and used for the assessment of the levels of pro- and antiinflammatory cytokines: interleukins (IL) 1β, 6, 8, 10; IL-1 receptor antagonist; interferons (IF) α, and γ; tumor necrosis factor (TNF) α, and secretory immunoglobulin А. 

Results. Among newly diagnosed patients without regional metastases, the level of proinflammatory cytokines was significantly higher in the tumor tissue compared the peritumoral tissue. Patients with regional metastases had similar differences. In patients with relapses, such difference was observed only for interleukin-6. It should be mentioned that patients with relapses (unlike the participants from the two remaining groups) usually have no difference in the levels of IL-1β, IL-6, and IL-8 between tumor and peritumoral tissues. This may indicate the transformation of visually non-malignant tissue into the malignant one in terms of its immunological characteristics, which is likely to reflect the loss of ability to limit the proliferative potential. In the peritumoral tissue, the levels of tumor necrosis factor α and interleukin 1β were higher in patients with relapses than in newly diagnosed patients without regional metastases. No difference in the level of secretory immoglobulin A between the tumor and peritumoral tissue was observed among patients with or without metastases, whereas patients with relapses were found to have higher levels of secretory immoglobulin A in the tumor tissue compared to the peritumoral tissue. In these patients, the level of secretory immoglobulin A in the tumor tissue was significantly higher than that in patients with metastases who demonstrated its minimal concentrations, which probably indicates the inhibition of its local synthesis. In the peritumoral tissue, this parameter did not vary across the groups. 

Conclusions. 1. Both clinical data and immunological parameters should be evaluated to supplement the objective assessment of the status of patients with oropharyngeal cancer. 2. The increasing level of pro-inflammatory cytokines in the tumor tissue promotes its progression and dissemination, which may be caused either by their production by tumor cells or by the local inflammatory process; the levels of cytokines in the tumor tissue exceed their levels in the peritumoral tissue. 3. The level of secretory immoglobulin A is minimal in the tissue of the metastatic tumor and maximal in the tissue of the recurrent tumor. However, the differences failed to reach statistical significance.

Despite the achieved progress in radiotherapy, chemotherapy, and surgery, head and neck squamous cell carcinoma (HNSCC) still remains the sixth most common cause of death from cancer worldwide. The division of HNSCC into 2 large groups with different survival rates is a significant achievement made during the last decades in cancer research and treatment of head and neck cancer. In 45 % – 90 % of cases, oropharyngeal squamous cell carcinoma is presumably associated with human papillomavirus (HPV). A recent whole-exome sequencing study on HNSCC helped to develop new principles of treatment that will allow to increase the effectiveness of conventional therapy. The study demonstrated that inactivating mutations in the p53 gene trigger carcinogenesis. The majority of tumors have such mutations that inactivate the p53 tumor suppressor gene. According to the results of sequencing, HPV-positive and HPV-negative tumors have completely different mutation profiles. Intratumoral heterogeneity should be taken into account when implementing new treatment approaches. We present an overview of studies published between 1989 and 2014. Current review briefly describes molecular mechanisms of carcinogenesis in HNSCC in the light of genetic and biochemical features of the tumor, paying particular attention to the most significant scientific achievements in this field. Moreover, we outline the advancements of wholeexome sequencing in HNSCC and give an overview of recent studies devoted to new therapeutic approaches. The process of carcinogenesis in HNSCC is often initiated by tumor suppressors. In this case, the development of target-based drugs is problematic. Target therapy focused on the ways of tumor growth suppression is a much more serious challenge than inhibition of oncogenic signals, because it requires reactivation of tumor suppressors and restoration of their functions, which is more difficult than conventional chemical and biological blockage. Poor survival of patients with HNSCC, which is usually associated with a small size of recurrent tumors, their latent growth, and localization in various anatomical areas, shows that there is an urgent need for developing new therapeutic approaches for the disease. 

The study was aimed to analyze specific molecular features of head and neck tumors and to explore the opportunities of providing personalized care for these patients.

Head and neck squamous cell carcinoma (HNSCC) is one of the most common causes of cancer death. More than 50% of patients with locally advanced tumors relapse. Median survival of patients with recurrent HNSCC developed within 6 month after treatment completion does not exceed 6 months. One of the most important biological processes involved in the disease progression is tumor escape from immune response associated with the expression of programmed death receptor-1 (PD-1), which inhibits the anti-tumor immune response. The emergence of cancer immunotherapy made revolutionary changes in cancer treatment. The article presents the results of a randomized clinical trial of nivolumab for the treatment of recurrent and metastatic HNSCC (CheckMate) 141. Nivolumab improved overall survival of patients with progressive HNSCC refractory to standard therapy. It increased the frequency and median duration of objective anti-tumor responses as well as median overall survival regardless of the PD-L1 expression levels and association of cancer with human papillomavirus. Moreover, the majority of patients receiving nivolumab reported no reduction in their quality of life, which enables long-term therapy in such patients.  The results of the CheckMate-141 study appear very promising and require further investigation of nivolumab in patients with primary HNSCC, especially in combination with standard treatment methods (first-line chemotherapy, radiotherapy) or other immunotherapeutic agents.

Medullary thyroid cancer (MTC) is characterized by the most aggressive course among differentiated thyroid carcinomas and is accompanied by early and extensive metastasis. Up to 60 % of patients with MTC already have disseminated forms of the disease (stage III– IV) by the moment of diagnosis. Overall five-year and ten-year survival of patients with MTC is 85–89 and 73–75 %, respectively, whereas five-year survival rate in patients with stage III–IV MTC is significantly lower and does not exceed 5–10 %. Therefore, treatment of disseminated forms of MTC is an extremely important problem in clinical oncology. The article gives an overview of Russian and foreign publications on the effectiveness of radiation and drug therapy for generalized MTC. Particular attention is paid to modern promising treatment strategies used for this category of patients, such as radionuclide therapy of bone metastases and targeted therapy with tyrosine kinase inhibitors.

Highly differentiated thyroid cancer refers to the non-aggressive tumors due to the fact, that it can grow slowly and does not metastasize into surrounding tissues and organs. Modern medicine has the ability to cope with this disease, identify it in the early stages and begin timely treatment, which includes surgery and subsequent radioiodine therapy according to the indications. At the same time, the resistance of distant metastases to radioiodine therapy in patients with highly differentiated thyroid cancer significantly worsens the survival prognosis. Results of the use of chemotherapy do not allow recommend it as a therapy of choice. Today the achievements of antitumoral drug treatment are mainly related to the development of targeted therapy, namely, using individual tyrosine kinase inhibitors, in particular Sorafenib, which became the first registered in Russia drug, proved its therapeutic effectiveness in patients with this pathology, whose treatment options are currently extremely limited or absent.

N.N. Blokhin National Medical Research Oncology Center, Ministry of Health of Russia; 24 Kashirskoe Shosse, Moscow 115478, Russia Positron emission tomography (PET) with 18F-fluorodeoxyglucose is included in the algorithm of examination and monitoring in patients with radioactive iodine-refractory differentiated thyroid cancer. In assessing the effectiveness of targeted therapy, criteria based on the values of SUVmax (standardized uptake value) in metastases are used. The article shows the results of PET studies in a patient with radioactive iodine-refractory papillary thyroid cancer treated with sorafenib. The dynamics of tumor activity of metastases by different quantitative indicators were evaluated.

Meningeal hemangiopericytomas are rare tumors of the meninges developing from pericytes. The main method of their treatment is surgery aimed at total removal of the tumor. Analysis of the literature studies shows high potential of post-operative distant radiation therapy to increase duration of relapse-free survival of these patients. The recommended total radiation dose varies from 50 to 60 Gy (and in some publications, it exceeds 60 Gy). Radiation is applied as classic fractionation and hypofractionation, and different types of radiosurgery and stereotaxic radiotherapy are suitable approaches to treatment of recurrent meningeal hemangiopericytomas in patients with a history of radiation therapy.

Prosthetic material should induce minimal pathological reaction when in contact with the oral mucosa, especially during oral rehabilitation of patients with tumors of the oral mucosa. The article presents monitoring of a patient after surgery for cancer of the buccal mucosa at the stage of orthopedic rehabilitation. Treatment plan proposed complex oral rehabilitation. A maxillary complete removable denture was manufactured as well as metalloceramic and partial mandibular dentures. Plasma chemical modification of the removable dentures was planned after correction of the prosthetics and primary adaptation. Removable dentures were applied at the maxilla and mandibula. Per our recommendations, the patient was examined weekly for a month and monthly for 6 months. No new tumors or pathological elements were observed.

Conclusions. Changes in critical surface tension of the removable dentures made of acrylic plastic improve their biological characteristics as demonstrated by positive clinical dynamics. Prosthetic constructions with hydrophilic surface are recommended in complex clinical cases when patients with tumors of the oral mucosa require dentures.

Background. Differentiated thyroid cancer has a favorable prognosis in terms of relapse-free and overall survival. However, some cases of differentiated thyroid cancer (TC) are characterized by aggressive course with distant metastases and/or radioiodine refractoriness. Identification of histological subtypes of papillary thyroid cancer (PTC) and detection of specific mutations may have some prognostic value in the prediction of the disease course and clinical response to treatment. The severity of the disease depends on multiple clinical characteristics, morphological and molecular features of the tumor. Several histological variants of PTC with varying degrees of malignancy have been described so far: from well-differentiated PTC to radioiodine refractory undifferentiated anaplastic carcinoma with a high mitotic index and high probability of relapses. In this article, we present a case of PTC in a 76-year-old patient. The patient found a formation on the neck and complained of memory impairment. Upon examination, the patient was found to have a thyroid tumor with metastases in lungs, brain, and bones. The patient underwent thyroidectomy and started to receive suppressive doses of thyroxine. Stereotactic radiotherapy was performed to treat brain metastases. We observed a regression of small formations and partial response of larger metastatic foci. The patient received no radioiodine therapy due to his poor somatic status and extensive tumor spread. The patient received target therapy with sorafenib (800 mg/day) and bisphosphonates (BFT) for treatment of bone metastases. After the second cycle of target therapy, the dose of sorafenib was reduced by 50 % due to adverse events; during the next 10 month the patient received sorafenib at a dose of 400 mg/day. After the third cycle of target therapy we observed a stabilization of metastatic foci in the lungs and bones. However, during the treatment, the patient developed visceral metastases to the liver and the adrenal gland, a lytic metastasis in the right side of the mandible, and pain syndrome. A course of radiotherapy to the mandible was conducted along with BFT treatment. The patient received adequate analgesia and symptomatic therapy. The survival from the moment of diagnosis was 2 years. 

Results. We found that in some cases of differentiated TC, the disease has quite aggressive course with a rapid growth of the primary tumor and metastases into the brain and bones. Patients usually seek medical assistance at the advanced stages of the disease, when it is problematic to provide adequate therapy. The use of target therapy should be considered in such cases. There is a need to find new targets for the development of novel drugs for these patients.

Conclusion. The most aggressive forms of PTC include diffuse sclerosing, tall cell, and insular variants of PTC. Various genetic abnormalities, such as BRAF mutation, can be detected in this case. The following clinical prognostic factors are used to determine metastatic potential, probability of relapse, and mortality: age under 15 years or over 45 years, male gender, family history of TC, and exposure to ionizing radiation. Thus, in some cases these markers can help to predict the course of TC and to provide adequate and timely treatment.