Introduction. Patients are characterized by locally advanced tumors in 70–80 % of cases at presentation, so possibility of cure and surgical treatment is limited. Total glossectomy, tongue base resection is associated with severe and permanent disability. Such surgical procedures lead to severe dysphagia, alalia and social maladjustment. Enumerated issues motivated us to develop new method of surgical treatment  of locally advanced base of tongue cancer.

Objective is to introduce new opportunities of surgical treatment of locally advanced cancer of the tongue base.

Materials and methods. Glossectomy is accomplished in 5 patients suffering from tongue cancer and admitted to N.N. Blokhin National Medical Research Center of Oncology. Swallowing and speech is preserved in all 5 cases.

Results. The main advantage of the proposed method is that the cut out muscle flap has a different innervation from different cranial nerves involved in the rate of swallowing, so there is not just a mechanical movement of the epiglottis, but also the control of swallowing by the central nervous system. The reduction of injury and operation time in the proposed method is due to the fact that tissues directly contacting with the defect are used to preserve swallowing and speech. The proposed muscle flap has various sources of blood supply, which improves its nutrition and reduces the risk of complications, and healing occurs in a shorter time in comparison with the prototype. All of the above reduces the duration of hospitalization for an average of 7–9 days.

Conclusion. The developed surgical technique allows to achieve early rehabilitation; patients are able to breathe effortlessly, swallow and speak. There is no need in permanent tracheostoma and percutaneous endoscopic gastrostomy tube. All patients remains socially active. 

Radioiodine therapy of metastatic differentiated thyroid cancer is a highly effective method of treatment which makes it possible to achieve the complete cure of the majority of patients, however in some cases radioiodine refractory type develops, it leads to significant deterioration in overall and relapse-free survival. The article presents own experience of the therapy of radioiodine refractory thyroid cancer by the nexavar (sorafenib).

Introduction. Juvenile nasal angiofibroma (JNA) is an aggressively expanding fibro-vascular benign tumor, which occurs in male adolescents. Surgical management of JNA is considered as one of the most difficult in rhinology, because it very often has accompanied with profuse, streaming bleeding. Endovascular embolization has successfully used for reducing the operative blood loss since 2000th. Nevertheless, there is no consensus in the literature about its expediently using because of complications, which may occur.

Objective is to evaluate the effectiveness of selective angiography and endovascular embolization in reducing bleeding when removal of JNA of different stages.

Materials and methods. In the N.N. Burdenko National Medical Research Center of Neurosurgery 134 patients with JNA had been treated surgically.

Results. 110 patients with JNA, who underwent embolization, managed to perform total, subtotal or partial devascularization of the tumor. Total devascularization was achieved in JNA blood supply variant only from the external carotid artery (ECA) system from 1 or 2 sides  (in primary patients or in patients who had not previously been embolized) (n = 39); subtotal devascularization, if the blood supply was carried out from the ECA system, internal carotid artery (ICA) on the 1 side (n = 52) and partial, if there was blood supply from the ECA and significant from the ICA system from 2 sides (in patients with relapse after previous embolization with microspirals or the ECA ligations from 1 or 2 sides, as well as with giant JNA (n = 19). Since the vast majority of patients admitted to our clinic were previously operated on, and JNA blood supply in relapses was more pronounced, we performed the comparison of the degree of tumor devascularization depending on its blood supply in primary patients and patients with relapse. It turned out, as could be expected, that with the primary JNA often managed  to execute a total devascularization than with JNA with continued increase, the difference was statistically significant (p = 0.009).

Conclusion. It accurately proved that embolization decreases intraoperative blood loss and reduce surgical risks even in later stages JNAs  (r = –0,51, p <10–7). Ligation of ECA as well as proximal occlusion of its branches leads to rapid reconstruction blood supply from ICA and inability of its embolization if recurrence of JNA occurs. 

Objective is to identify regularity of metastases distribution of the squamous cell carcinoma (SCC) in the lymph nodes of the neck without revealed primary focus, as well as to evaluate the effectiveness of various methods of treatment.

Materials and methods. Performed the retrospective 45 patients data analysis with metastases of SCC in cervical lymph nodes without  the revealed primary focus treated in different departments of N.N. Blokhin National Medical Research Center of Oncology from 2005  to 2012. The source of information were outpatient studies and medical histories, histological preparations and paraffin blocks.

Results. Metastases of SCC without revealed primary focus are most typical for nodes of a neck and upper part of the body, there are among the patients mostly males aged 50–59 years. To establish the localization of the primary focus, traditional diagnostic procedures are not always effective: in morphological analysis, the primary focus can be hidden behind inflammatory changes, in addition, the tumor lesion can be of a primary focus. Tumors, similar to lymphoepithelioma-like carcinoma, could also simulate metastasis in the lymph node. Tonsil cancer is very often not detected even with repeated biopsies, therefore diagnostic tonsillectomy is justified. Survival depends slightly  on the identification of the source of metastasis. The range of treatment methods for SCC is limited, combined and complex methods demonstrate greater efficiency, chemotherapy is less reasonable. The leading prognostic factor is the degree of distribution of metastatic lesion. Virologic analysis allows only to assume localization of the tumor process in the nasopharynx in patients with human papillomavirus and predict their greater survival, and the number of patients with Epstein–Barr virus is too small for reasonable hypotheses.

Conclusion. With metastases of SCC in the lymph nodes of the neck without the revealed primary focus, the hidden distributing tumor is most often appears in the pharyngeal tonsils and in the root region of the tongue. In some cases, the metastatic node can be the primary focus.  The most effective complex therapy is surgical intervention with followed radiation therapy in combination with chemotherapy. The spectrum (range) of diagnostic procedures can include bilateral tonsillectomy and mucosectomy of the root region of the tongue. 

Head and neck squamous cell carcinoma (HNSCC) is among the 10 most common cancers and demonstrates high mortality rates. Well known for its relation to smoking and alcohol consumption, in within the past 10 years a high number of cases, especially of the oropharynx could  be shown to be based on an infection of human papilloma virus, high risk subtypes, mostly type 16 and 18. Often it is connected to younger age at onset, better outcome and better response to radiochemotherapy.

Next to well established radiochemotherapy schemes, including targeted therapy as cetuximab, in the recent 2 years a complete new therapeutic approach manifested, called checkpoint inhibition. The drugs of this class block a binding of a membranous ligand to a surface receptor  on T-cells. Without blocking, this binding is physiological in antigen-presenting cells or many other normal tissue cells (e.g. heart muscle, trophoblast) inhibiting activation of the cytotoxic T-cells. Research revealed an identical way of tumor cells escaping cell death caused  by patient’s own immune system. By blocking this inhibition, in several carcinoma entities, a very effective disease control was achieved.  So far, 2 pairs of binding are approved for treatment: CD80-CTLA4 and PD1-PDL1. In CD80-CTLA4, it is an inhibitor to CTLA4 (e. g. Ipilimumab), in PD1-PDL1, for both, the ligand an receptor are several inhibitors on the market (e. g. Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab). So far, there could not be found a highly predictive marker for the grade of efficiency of these inhibitors. Next  to very recent and complex markers, tumor mutational burden, the immunohistochemical staining for the ligand, PD-L1 could be established in a few number of carcinoma, incuding adenocarcinoma of the lung. Next to different ways of interpretation of the staining, also different staining procedures used in the trials are hindering an easy establishment of this marker in pathology laboratories. The staining procedures used in trials are not comparable with common immunohistochemistry due to very high costs of reagents (test-kits sold by the involved companies, so called companion diagnostic). To overcome these drawbacks, different studies were performed comparing the different antibody clones  of immunohistochemical stains used in the official trials and antibodies of other companies. These harmonization studies brought to light that most antibodies stain equally, even the antibodies available from other companies thus making this stain more effordable and possible  for introduction in the marker-portfolio of labs of pathology.

In HNSCC there is a better response to checkpoint inhibitors in cases of high PD-L1 expression, but also in negative cases, an effect could  be seen. The actual approval are exclusively for patients in second line without PD-L1 testing. Upcoming approvals for first line treatment  by checkpoint inhibitors are likely to include immunohistochemical testing for PD-L1. 

In this literary review analyzed the possibilities of combination therapy in the treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, compares the frequency and nature of side effects in its different variants, assessed the effectiveness of intra-arterial chemotherapy in comparison with other methods.

Combined treatment with the use of systemic chemotherapy allows not carry out massive surgical operations, but does not improve the long-term results of treatment. Regional intra-arterial chemotherapy has a number of advantages: improves the tumor response to treatment, long-term results, as well as expands the possibilities of organ-preserving treatment performance and, accordingly, improves the quality of life of patients. Another advantage is the possibility of a parallel use of detoxifier, which excludes the toxic effect, which is inherent in systemic chemotherapy. The implementation of this technology in a wide clinical practice is limited by the need for special equipment for interventional radiology and, consequently, the increased cost of treatment. However, the high efficiency of this method in the future is likely to lead to its active implementation in clinical practice.

Chondroradionecrosis of the larynx is a rare and late complication after radiation therapy. The vast majority of patients present the symptoms within 1 year of treatment. However there are described delayed cases up to 25 and even 50 years after treatment. In the article is described a rare clinical case from our own practice. It’s about a patient who developed laryngeal chondroradionecrosis in 63 years after radiation therapy for recurrent respiratory papillomatosis. The case represents the longest in interval between initial treatment and presentation of chondroradionecrosis of the larynx in literature.

We present a clinical case of osteosarcoma of the larynx. It is a rare and aggressive tumor characterized by frequent local recurrence and the appearance of distant metastases. This is the only one case of osteosarcoma of the larynx in N.N. Blokhin National Medical Research Center of Oncology for the period from 1988 to 2017.

The most severe consequences of surgical treatment of malignant neoplasms of the oropharyngeal zone are both violations of the breathing, swallowing, chewing functions, and complete or partial loss of speech. Logopedic rehabilitation of patients with tumors of the oropharyngeal zone plays an important role in the postoperative period, as it is aimed at restoring of all of the above functions.

Restoration of the swallowing function is possible due to the restoration of the motor function of preserved anatomical structures, as well as the mobility of transplanted tissues with adequately performed plastic.

To restore the respiratory function, it is recommended to use the following methods: coordination of inhalation and exhalation; inhalation commission which sufficient for expression; search for the optimal position of the body; the pause function and breathing exercises. Speech skills are restoring by the sound pronunciation correction. To overcome the lockjaw is the tonic spasm of the group of muscles of mastication, which leads to the mobility restriction of the temporomandibular joint, are performing the exercises, which regulate the degree of mouth opening. Also, patients are prescribed the use of the Jaw Motion Rehabilitation System TheraBite (Atos Mediсal, Sweden).