The study objective is to provide a rationale for the development of an individual treatment plan for patients with locally advanced squamous cell carcinoma of the larynx, hypopharynx, and oropharynx by selecting different regimens of induction chemotherapy according to biological characteristics of the tumor and functional status of the patient.

Materials and methods. We developed an individual treatment plan for a patient with stage IV moderately differentiated oropharyngeal squamous cell carcinoma (cT4N2M0) characterized by extensive local distribution, pronounced clinical symptoms of respiratory failure, and bilateral conglomerates of metastatic lymph nodes. The treatment scheme included paclitaxel (80 mg/m²), carboplatin AUC 2, and ce-tuximab (400 mg/m² loading dose, then 250 mg/m²). The treatment was initially palliative. The patient received 6 injections once a week.

Results. After a six-week course, we observed tumor resorption by more than 50 %, which allowed the second stage of treatment that included radical chemoradiotherapy with cetuximab. After summarizing our own experience, we found that the majority of patients with initially unresectable tumors, but in good overall physical condition responded to docetaxel, cisplatin, 5-fluorouracil (TPF) — based chemotherapy. Approximately half of them had complete tumor resorption, whereas 14.2 % of them had stabilization of the tumor process. Research literature shows that up to 30 % of patients receiving chemoradiotherapy with cisplatin fail to complete the planned treatment due to its toxicity; replacement of cisplatin with carboplatin and 5-fluorouracil results in mucositis and thrombocytopenia. By contrast, chemoradiotherapy with cetuximab significantly increases both 3-year and 5-year survival and demonstrates good tolerability. In patients with .severe nutritional deficiency, concomitant cardiac diseases, polyneuropathy, and impaired liver function, the preference should be given to less toxic treatment regimens.

Medullary thyroid cancer is a rare tumor. Due to variability of its biological behavior, treatment of this tumor often is a complicated problem. Clinicians have difficulties with determination of indications for prescription of tyrosine kinase inhibitors. Prescription should be based on scru-tinous monitoring of the patients and consideration of all factors: level of tumor markers, patient’s state, and data form visual examinations.

The study objective is to investigate the causes of insufficient efficiency of neck lymph node dissection and possibilities of its improvement in cancer of the oral mucosa without clinically detectable metastases.

Materials and methods. A review of literature on surgical methods of affecting regional lymph collectors in cancers of the oral cavity was performed, and preliminary data on possibilities of biopsy of the sentinel lymph node were obtained.

Conclusion. Combination of fluorescent lymph node mapping andflow cytometry allows to identify the sentinel lymph node and detect hidden micrometastases with high sensitivity.

The study objective is to perform the acoustic analysis of voice in patients after open diagonal resection of the larynx.

Materials and methods. A total of 112 patients underwent diagonal resection of the larynx; of them 73 hadfrontolateral resection and 39 had expanded frontolateral resection. Primary laryngeal cancer was diagnosed in 107 patients; five patients had relapses after radiation therapy. Fifty-six participants underwent acoustic analysis of voice before surgery, 52 participants underwent it 1 month postoperatively, and 112 participants had it after completing their rehabilitation (6 months to 10 years postoperatively). To determine normal acoustic characteristics of voice, we examined 80 men with normal voice. We measured voice fundamental frequency (FF), maximum and minimum FF, FF variability, jitter, shimmer, voice intensity, amplitude of fundamental tone’s harmonics and their difference. Speech rehabilitation included breathing exercises according to E. Ya. Zolotareva and speech training according to S.L. Taptapova.

Results. Patients with laryngeal cancer demonstrated significant changes in the acoustic characteristics of their voice (p <0.05) compared to healthy individuals, including increased mean FF (f₀) (up to 143 ± 45 Hz vs 118 ± 18 Hz in controls), decreased voice intensity (from 60 ± 8 to 43 ± 8 dB), and almost 2-fold decrease in the amplitude of fundamental tone’s harmonics (ω₀, 2 ω₀, 3 ω₀). We also found an increased dispersion and variability of acoustic characteristics assessed compared to healthy individuals. The analysis of long-term treatment outcomes demonstrated more significant improvement of voice acoustic characteristics in patients who underwent speech rehabilitation compared to those who had no rehabilitation.

Conclusion. Open resection of the larynx with endoscopic removal of granulations and ligatures and laser restoration of the laryngeal lumen by dissecting the scars complemented by speech rehabilitation allow restoring respiratory function in 91.1 % of patients and restoring voice in 91.8 % of patients (to achieve acoustic characteristics close to normal).

The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma.

Materials and methods. Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps.

Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached.

Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.

Introduction. Inhibitors of the epidermal growth factor receptor cause the heavy dermatological adverse events, which can be the cause of change of the scheme of treatment. Acneiform rash is connected with specific inflammation of hair follicles, its weight depends on a dose of medicine and correlates with the best response to therapy at various options of tumors, in this regard effective correction of this side effect is of particular importance.

Materials and methods. There were 32 patients with acneiform rash for observation; they have been divided into 3 groups. All patients received system antibacterial therapy: doxycycline 100 mg 2 times a day 10 days and topical medicines for external therapy, various on the action mechanism (tacrolimus, metronidazole, betamethasone valerate in a combination with fusidic acid). Acne Dermatology Index and Dermatology Life Quality Index were used for assessment. The received results were assesed on each visit of the patient, the final point of observations was in 3 months.

Results. The significant regression of rash in all groups was in the 1st week when patients accepted doxycycline per os. Further the weakest response to therapy has shown cream with tacrolimus, the patients using gel with metronidazole has shown bigger effect, the fastest regress of Acne Dermatology Index and Dermatology Life Quality Index was observed in the patients used the combined cream with betamethasone and fusidic acid.

Conclusions. The antibacterial therapy by doxycycline 100 mg 2 times a day per os at early stages of development of acneiform rash at the I—II severity gives the expressed effect and prevents deterioration of the .skin process. The combined therapy of acneiform rash of the I—II degree including doxycycline with topical cream containing a betamethasone valerate 0.1 % and fusidic acid 20 % renders the fastest and expressed effect in comparison with other combinations: the doxycycline and cream containing tacrolimus; the doxycycline and gel containing metronidazole.

The study objective is to evaluate the prevalence of Epstein—Barr virus (EBV), herpes virus, human papillomavirus (HPV), and cytomegalovirus (CMV) infection among patients with cancer of the nasal cavity and paranasal sinuses in the Arkhangelsk Region.

Materials and methods. We examined surgical specimens from 100 patients treated in the Arkhangelsk Clinical Oncology Dispensary between 2010 and 2015. Tissue homogenates were used for DNA isolation. DNA amplification with subsequent detection was performed using polymerase chain reaction.

Results and conclusion. The 36 % of study participants were infected with EBV; the second most common viral pathogens were CMV and human herpes virus type 6 (HHV-6), both found in 21 % of cases. Monoinfection was observed in less than one-third of patients (20 % — EBV, HPV type 16 — 6 %), whereas the remaining participants had mixed infections: EBV + HHV-6 (2 %), CMV + EBV (5 %), EBV + herpes simplex virus types 1 and 2 (HSV-1,2) (1 %), EBV + CMV + HHV-6 (3 %), HPV type 16 + HSV-1,2 (3 %), and HPV type 6 + HPV type 16 (7 %). None of the patients with stage I cancer had mixed infections, whereas participants with stage II, III, and IV cancer demonstrated mixed infections in 1 %, 11 %, and 9 % of cases respectively.

After specific treatment, 11 patients (30.5 %) infected with EBV developed regional metastases and 5 patients (13.9 %) had relapses. All patients simultaneously infected with EBV and HHV-6 had distant metastases. Combination of EBV, CMV, and HHV-6 resulted in relapses in 100 % of cases and distant metastasis in 75 % of cases.

The study objective is to report a case of mandibular ameloblastoma.

Materials and methods. A 30-year-oldfemale patient presented with swelling of the right mandibular region that appeared 8 months ago and has been slowly increasing. The patient had no other symptoms, such as pain, anesthesia, paresthesia, difficulty swallowing, mouth opening, speech disorders, fever, chills, or weight loss. Orthopantomography revealed pronounced bone resorption in the right portion of the mandibular body. Computed tomography showed a cystic cavity in this area. After incisional biopsy, the patient was diagnosed with ameloblastic carcinoma. We performed segmental mandibular resection and installed a reconstructive plate to restore mandibular integrity. We also performed selective cervical lymph node dissection (levels Ia and Ib).

Results. One yearpostoperatively, the results were considered aesthetically and functionally satisfactory.

Conclusion. We observed an aggressive disease phenotype with extensive localized bone destruction, typical of ameloblastic carcinoma. Extensive excision of the primary tumor and selective cervical lymph node dissection without radiotherapy ensured a relapse-free period during patient’s follow up.

This article discusses the problem of cognitive function deterioration in patients with oropharyngeal cancer after treatment. We describe the main factors impeding objective evaluation of cognitive functions in these patients, etiologic factors of cognitive disorders, and the impact on the quality of life.