The study objective is to evaluate the capacity of contrast-enhanced ultrasound in the diagnosis of head and neck squamous cell carcinoma.

Materials and methods. We examined 34 patients with head and neck tumors (or suspected of having a tumor) using contrast-enhanced ultrasound imaging with sulfur hexafluoride.

Results. Contrast enhancement of primary and recurrent tumors (developed within 3 months since the end of treatment) was characterized by rapid wash-in (including peak enhancement) and wash-out of contrast agent. However, recurrent tumors (developed within 3 months after treatment) demonstrated slightly slower wash-in than primary tumors. In patients with suspected relapse, which was not confirmed by histological examination, contrast agent accumulated only in the surrounding tissues and did not penetrate into the fibrous infiltrate; there were no wash-in and wash-out phases (although this did not exclude the presence of small tumors in the infiltrate). By contrast, tumors demonstrated rapid achievement of peak enhancement and fast wash-out. Laryngeal and laryngopharyngeal tumors accumulate and release contrast agent like any other oropharyngeal squamous cell carcinomas. Laryngeal cartilages have high echogenicity and don’t accumulate contrast agent. Tumor-altered vocal cords accumulate contrast agent, which significantly improves the visualization. Intact vocal cords appear as hyperechogenic symmetric structures on B-scans. Contrast-enhanced ultrasound imaging allows better visualization of the vocal cords. Contrast-enhancement can significantly improve the diagnostic value of ultrasound examination of the larynx, especially when B-scanning is hindered by some anatomical features (such as large Adam’s apple) or ossification of laryngeal cartilages.

Conclusion. Contrast-enhanced ultrasound imaging of the head and neck is a highly promising diagnostic tool, although it requires further evaluation. Improved visualization with contrast-enhancement increases the diagnostic value of the method for the differentiation between various tumors and fibrotic changes and detection of tumor spread to the laryngeal cartilages, which is important for surgical treatment and planning anticancer therapy.

The study objective is to analyze the efficacy of a hedgehog signaling pathway inhibitor in locally advanced and recurrent basal-cell carcinoma (BCC) of the head and neck.

Materials and methods. We compared the information from international clinical guidelines and two clinical trials (ERIVANCE and STEVIE). We also provide two case reports of a hedgehog signaling pathway inhibitor (vismodegib) use.

Results. In the ERIVANCE trial, the objective response rate was 48.5 % in patients with metastatic BCC and 60.3 % in patients with locally advanced BCC. The median progression-free survival was 9.3 and 12.9 months in participants with metastatic and locally advanced BCC respectively. The overall survival reached 33.4 months in patients with metastatic BCC and was not reached in patients with inoperable BCC. According to the results of the STEVIE  trial, vismodegib ensured disease control in 93 % of patients with locally advanced BCC and 72 % of patients with metastatic BCC. The median progression-free survival was 24.5 and 13.1 months in participants with locally advanced and metastatic BCC respectively. The majority of vismodegib-realted adverse events in both ERIVANCE BCC and STEVIE trials were grade I/II adverse events. In the two clinical trials, vismodegib at a dose of 150 mg per day during 3 months caused visual reduction of the bone destruction focus, which was confirmed by computed tomography. Patients were recommended to continue therapy with vismodegib.

Conclusion. Until recently, there were no treatment standards for late-stage BCC. Currently, hedgehog signaling pathway inhibitors, such as vismodegib, can be considered as a method of choice for patients with inoperable and metastatic BCC, since this therapy demonstrated high efficacy.

The study objective is to compare short-term results of reconstruction of a full-thickness defect of the cheek using pectoral and trapezoidal flaps.

Materials and methods. Examination and treatment of 21 patients with locally advanced buccal cancer were performed at the Nizhny Novgorod Regional Clinical Oncologic Dispensary in 2007–2018.

Results. Flap necrosis developed in 7 (33 %) patients: in 3 patients total, in 4 – marginal. No postoperative mortality was observed. For pectoral flap reconstruction, necrosis was observed in 2 cases (marginal necrosis of the skin graft). For trapezoidal flap buccal reconstruction, necrosis was observed in 5 patients (total in 3, marginal in 2).

Conclusion. Use of a trapezoidal flap is limited due to its anatomical characteristics and is associated with higher rate of necrosis despite better esthetic characteristics compared to a pectoral flap. Despite its larger volume compared to trapezoidal flap, pectoral flap has better blood supply which leads to low rate of necrosis.

The study objective is to evaluate the possibility of determining the signaling lymph node (SLN)  in oral cancer (T1–2N0M0) with lymphoscintigraphic method.

Materials and methods. In 2016–2018,  SLNs were determined for 23 patients with oral cancer (cT1–2N0M0): for 15 patients with cancer of the tongue, for 8 patients with cancer of the floor of the mouth cavity. SLNs were determined by radiolymphoscintigraphic method by peritumoral administration of Tehnefit radiopharmaceutical in a dose of 40 to 80 MBq, depending on the timing of the signal lymph node biopsy. Visualization of the signaling lymph node was carried out by planar scintigraphy and single-photon emission computed tomography combined with x-ray computed tomography. Intraoperative SLN was detected using intraoperative radiometry using a gamma probe.

Results. In cancer of the floor of the mouth, SLNs were identified only in 2 (25 %) of 8 cases. In cancer of the language, SLN were identified in 14 (93.3 %) of 15 cases. In total, SLNs were diagnosed with cancer in 17 patients. In 4 (26.7 %) of 15 patients, cancer metastases in SLNs were identified. False negative results were obtained in 6.7 % of cases.

Conclusion. A biopsy of the SLN by the lymphoscintigraphic method has a high diagnostic value for staging the early stages of cancer of the tongue.

The study objective is to demonstrate the necessity of individual selection of radiation plan in patients with locally advanced squamous-cell oropharyngeal cancer after multicomponent operation to decrease radioreactions and radiation injuries.

Materials and methods. The study included data on 64 patients with primary locally advanced oropharyngeal cancer after combination treatment at the Nizhny Novgorod Regional Clinical Oncological Dispensary in 2013–2018.  Radiation treatment was performed after surgeries. The 1st group included 30 patients who underwent conformal radiation using linear accelerators. The 2nd  group included 34 patients who underwent conventional radiation.

Results. For conformal radiotherapy, grade I mucositis was observed in 2 (6.6 %) patients, grade II – in 25 (83.4 %) patients, grade III– IV – in 3 (10 %) patients. In the 1st group, radioreactions developed at dose 30 Gy, in the 2nd group at 20 Gy. In the 2nd group, radioreactions were more severe. Grade II mucositis after conventional radiation were observed in 21 (61.7 %) patients, grade III–IV – in 13 (38.3 %) patients, among them 8 (23.5%) received split-course radiotherapy. Partial necrosis of the flap was detected in 1 (3.3 %) patient in the 1st group and in 4 (2.9 %) patients in the 2nd group.

Conclusion. Conformal radiotherapy, including modulated intensity, is characterized by better isodose distribution with minimal effect on the surrounding healthy tissue and vascular pedicle of the transplant after multicomponent operations. This type of radiation allows to decrease the risk of radioreactions and complications requiring expensive accompanying therapy or even split-course treatment.

Currently, intraosseous dental implantation is one of the most widely used methods to eliminate various defects of the dentition. Despite the achievements of modern medicine, the frequency of inflammatory complications, such as peri-implantitis, in patients after dental implantation remains relatively high. Some authors suggest the presence of similarity of peri-implantitis with squamous cell carcinoma of the oral cavity at the level of pathogenesis, as well as cases of mimicry of these different nosological units are described. In this review, we study the pathogenetic mechanisms of the emergence and development of chronic inflammatory processes on the example of dental peri-implantitis, squamous cell carcinoma of the oral cavity and periodontitis, as well as the comparison of pathogenetic patterns of these processes with the study of the possible relationship. The objective of the review was to provide readers with knowledge about the common pathogenetic mechanisms of different nosological units. First of all, the data are necessary for dentists, who must remember the principle of cancer alertness, carefully carry out differential diagnosis, change the tactics of treatment of peri-implantitis with suspected tumor process.

The study objective is to present the experience of performing extensive cranioorbital resection with subsequent arthroplasty of the hard palate and the dentition of the alveolar process of the maxilla.

Materials and methods. In 2018, in the Department of Microsurgery of the P.A. Hertzen Moscow Oncology Research Institute, extensive cranioorbital surgery for recurrent sarcoma of the upper jaw was performed, after the treatment in other clinics. The extensive intervention included the exposure of the dura and the single-stage reconstruction of tissue defect, bone defect of the skull base by using the displaced aponeurotic flap of scalp and microsurgical reconstruction of the soft tissues of the face and mouth left free of the gastro-omental flap. In the early postoperative period, the patient underwent endoprosthesis replacement of the hard palate and alveolar process with a dentition.

Results. Extensive intervention with resection of the structures cranioorbital zone and the skull base with a single-stage reconstruction with free gastro-omental flap with subsequent arthroplasty of the hard palate and the alveolar process dental arch allowed to rehabilitate the patient.

The study objective is to report a case of successful treatment of recurrent unresectable squamous cell carcinoma of the head and neck using pembrolizumab (selective inhibitor, preventing the interaction between the programmed death receptor 1 (PD1) and its ligands PD-L1 and PD-L2).

Materials and methods. A 72-year-old male patient was admitted to the Clinic of Head and Neck Tumors, N.N. Blokhin Russian Cancer Research Center with the following diagnosis: primary metachronous malignant tumors: 1) oropharyngeal cancer T2N3M0 (after chemoradiotherapy, no relapse or metastases), 2) skin cancer of the left ear (T2N0M0,  stage II, after combination treatment); relapse. After multiple surgeries for repeated relapses and external beam radiotherapy in March 2017, the patient was found to have new metastatic lesions in the retropharyngeal lymph nodes and paravertebral soft tissues of the neck (left side). The tumor was considered unresectable. The patient had high level of PD-L1 expression in the tumor (50 %), therefore, it was decided to initiate treatment with PD-1 inhibitors. The patient received pembrolizumab (keytruda) 200 mg once every three weeks (7 courses).

Results. Positron emission tomography performed in February 2018 demonstrated no increased uptake of radiopharmaceutical in the retropharyngeal lymph nodes and paravertebral soft tissues of the neck, which were earlier affected. Since that time, the patient demonstrates sustained remission without any therapy.

Conclusion. This case not only shows high efficacy of PD-1 inhibitors for aggressive recurrent head and neck squamous cell carcinoma, but also opens new opportunities for the treatment of weakened patients after chemotherapy and radiation exposure.

Introduction. Chemoradiation therapy with a competitive regimen allows to avoid laryngectomy and increase patients’ quality of life. However, it’s highly toxic and this limits the use of this approach in patients with severe concomitant disorders. The alternative to systemic chemotherapy is infusion of high doses of chemotherapy drugs directly into a vessel supplying the tumor through a microcatheter.

The study objective is to present a clinical case of using intra-arterial chemotherapy for treatment of locally advanced laryngopharyngeal cancer in a patient with a solitary functioning kidney.

Materials and methods. Patient K., 55 years old, applied to the Head and Neck Tumors Clinical of the N.N.  Blokhin National Medical Research Center of Oncology with laryngopharyngeal cancer and bilateral metastases in the lymph nodes (T3N2M0,  stage IV). Use of systemic chemotherapy for this patient was limited because he had only 1 functional kidney. Three (3) courses of intra-arterial chemotherapy with docetaxel and cisplatin 60 mg/m² (with detoxification with sodium thiosulfate) and subsequent radiation therapy, systemic infusion of 5-fluorouracil were performed.

Results. The main side effect of the treatment was edema of the pharyngeal and laryngeal mucosa but without severe respiratory distress. The symptoms were corrected with inhalations of oxygen-hydrocortisone mixture. Laboratory and instrumental control during treatment didn’t show any deterioration of the state of the solitary functioning kidney.

Conclusion. Regional intra-arterial chemotherapy demonstrated a satisfactory effect in a patient with severe concomitant pathology and absolute counterindications for systemic chemotherapy.

The study objective is to analyze mental state of patients with laryngeal cancer after laryngectomy.

Materials and methods. The study included 38 patients at various stages of laryngeal cancer treatment. To assess mental state, we used the Hospital Anxiety and Depression Scale (HADS) and the Symptom Checklist-90-R (SCL-90-R).

Results. In general, preoperative mental state of study participants was close to that in healthy individuals (described in literature), although there was a slight increase in their levels of depression and anxiety and higher distress severity indices. Six months after laryngectomy, a high level of distress was found; all patients had higher scores in all primary symptom dimensions; however, a significant increase was registered only for anxiety, depression, somatization, hostility, and interpersonal sensitivity. Six months postoperatively, mean anxiety score reduced, but was still higher than preoperative one and normal one. There was a significant increase in depression score and interpersonal sensitivity score. Conclusion. Our findings suggest the need for special programs of psychological rehabilitation for patients with laryngeal cancer to teach them the skills needed for self-regulation of mental state in order to increase their stress resistance.