The study objective is to evaluate the results of using the Petrov Thyroid Cancer Score (PTCS) in 2018 and assess the diagnostic value of the original PTCS and modified PTCS.

Materials and methods. PTCS, proposed in the N.N. Petrov National Medical Research Center of Oncology in early 2018, was tested in this institution in 310 patients, 99 of whom underwent surgery, mainly due to suspected malignancy of thyroid nodules or at the request of patients.

Results. According to the standard histological evaluation, in 35 cases the process was considered benign (group Д), while in 61 cases — after exclusion of 3 medullary carcinomas — regarded as highly differentiated (according to previous classification) thyroid cancer (group Р). The average values of such components of PCTS as BethesdaScore, TI-RADSScore, ElastoScore and body mass index (BMI) in group Р were significantly higher than in group Д. The sum of the scores of the used four parameters was not only higher in group Р, but also at a magnitude of ≥5.0 (62.3 % of observations in this group) it always corresponded to the diagnosis of thyroid carcinoma. At the same time, a similar histological conclusion was made, in particular, in respect of 14 patients (23 % of the group Р contingent) with the value of the mentioned sum <3.5. Of note, according to the preoperative cytological study, among these 14 cases 11 follicular neoplasms and 3 colloid nodules were found.

Conclusion. A high value (≥5.0) of the sum of four selected parameters (3 from PTCS + BMI_Score) indicates an extremely high probability of detecting a tumor process, while in other cases (and not only under the assumption of follicular neoplasia presence), an additional diagnostic methods of research are needed.

The study objective is to evaluate the utility of ultrasound (US) examination in the diagnosis of laryngeal/hypopharyngeal squamous cell carcinoma and in the assessment of tumor spread.

Materials and methods. We performed US examination in 100patients (7 females and 93 males) with laryngeal/hypopharyngeal cancer aged between 36 and 85 years. We evaluated vocal cord mobility, condition of the laryngeal cartilages, and tumor invasion to the adjacent tissues within the larynx and beyond it. In all patients, the diagnosis was confirmed by histological examination.

Results. Seventy-five patients had primary laryngeal/hypopharyngeal tumors, whereas the remaining 25patients presented with recurrent cancer. Eighty-one participants were found to have laryngeal cancer; of them, 13 patients had tumors in the supraglottis; 67 patients had tumors located in the glottis; and 1 patient had a tumor of the subglottis. Nineteen patients were diagnosed with hypopharyngeal tumors. We have identified the most typical US signs of laryngeal/hypopharyngeal tumors considering their location and compared the results of US examination with histology of surgical specimens. US examination demonstrated a sensitivity of 94.1 %, accuracy of 91.9 %, efficacy of 47.0 %, and positive predictive value of 97.5 %. Specificity was not evaluated since we had no negative results.

Conclusion. US examination is a highly accurate methodfor the diagnosis of both primary and recurrent laryngeal/hypopharyngeal tumors.

The study objective is to develop new approaches to improve the surgical treatment of laryngeal and hypopharyngeal cancer and the detection of cervical lymph node metastasis in the preoperative period by utilizing own clinical experience.

Materials and methods. We conducted a retrospective analysis of 81 patients treated in Department of Otolaryngology in Scientific and Clinical Center of Otorhinolaryngology, Federal Medico-Biological Agency of the Russia. The 39 patients in the experimental group underwent total laryngectomy with neck dissection in our modification. With this proprietary technology modified vertical incision begins from occipital region, continues along the posterior border of the sternocleidomastoid muscle, crosses over this muscle and ends at sternoclavicular joint. The medial part of the sternocleidomastoid muscle was attached to the prevertebral fascia, thus swabbing the carotid neurovascular bundle. The patients in the control group underwent total laryngectomy and conventional neck dissection (42 patients). For morphological verification of cervical lymphadenopathies preoperative diagnostic included a fine-needle biopsy of suspected lymph nodes followed with cytology. The patients with negative cytology underwent harpoon percutaneous biopsy followed with cytological and histopathological examination of the lymph nodes.

Results. Harpoon percutaneous biopsy increased accuracy of preoperative diagnosis from 59.3 to 96.3 % in our study, allowing the most favorable therapy; 3.7 % of lymph node metastases were not diagnosed before surgery. Because of this we believe, that preventive neck dissection is necessary.

Conclusion. Harpoon percutaneous biopsy increased accuracy of histopathological diagnosis by 37 % as compared to fine-needle biopsy. We consider, that anchoring of the medial part of the sternocleidomastoid muscle to the prevertebral fascia allows the reliable separating of larynx and laryngopharynx from the carotid neurovascular bundle.

Surgical resection is one of the standard treatment options for cancer of the larynx, regardless of whether it is combined with postoperative radiotherapy. Reconstruction of the postoperative defect often requires after removal of the tumor. The type of surgery and the reconstructive strategy (selecting recovery methods) depend on the extent of the lesion and the number of departments involved. This article presents a review of the literature on the treatment of cancer of the larynx and the choice of optimal surgical tactics.

This review is devoted to assessing the prevalence of human papillomavirus (HPV) in head and neck tumors (HNC). HPV is recognized as the etiological factor of cervical cancer, but it may be involved in other tumors progression. Of the 28 studies presented, 6 studies showed a low incidence of HPV in HNC tissue (1.6—6.2 %).

Most often, HPV was detected in Singapore (90.6 %), Japan (100 %) and France (94.7 %). Most often found 16 types of virus (82 %) and 18 types (43 %). Low-grade HPV type 11 was most often observed in the Russian Federation (19 %). The frequency of occurrence of HPV in HNC varies, which raises the question about impact HPV and co-infection in HNC progression. It makes further research in this area relevant and promising.

The article discusses main issues relating to abnormal taste and smell, which may an oncologist come across in the treatment practice. It also describes mechanisms of dysgeusia and disosmia development, as well as their relationship with nutritional deficiency. Authors review approaches to assess sensory disorders before treatment, at all the stages and after radiation therapy and chemotherapy. They present the world experience in managing patients with the abnormalities and their possible correction.

Surgical treatment is leading in the treatment of malignant tumors of the salivary glands. The complexity of the anatomical areas, the severity of the tumor process, the close location of the facial nerve branches lead to frequent complications in the postoperative period. The technique of elimination of paresis of mimic muscles with the use of a complex of therapeutic measures, including a course of physiotherapy with the appointment of a magnetolaser and SCENAR therapy developed at the Cancer Research Institute, Tomsk National Research Medical Center of the RAS and the prospect of its use in this pathology. The clinical case of application of this material is described.

The study objective is to demonstrate the difficulties associated with treatment of HPV-negative oropharyngeal cancer.

Material and methods. A 52-year-old male patient visited a doctor in P.A. Herzen Moscow Oncology Research Institute in January 2017 with complaints of pain in the right part of the oropharynx irradiating to the right ear and difficulties with swallowing food and liquids. The patient was diagnosed with stage IVA oropharyngeal cancer (cT3N2bM0).

Results. The patient underwent a course chemoradiotherapy (CRT); as a result, the tumor in the area of the right tonsil became indeterminable 2 weeks later. Three months after completing the course of CRT, the patient underwent modified radical right-sided lymph node dissection. Histological examination revealed metastases from poorly differentiated squamous cell carcinoma in 3 lymph nodes (LNs) with an invasion into adjacent adipose tissue. In October 2017, we received a histological confirmation of ongoing tumor growth in the area of the tongue root and LN metastases in the left side of the neck (yrpT4aN2cM0). We performed resection of the mandible, tongue, soft tissues of the oral floor, and right side of the oropharynx with installation of an oropharyngeal stoma, extended radical left-sided neck lym-phadenectomy with excision of soft tissues (levels I—V), defect repair using an autologous pectoral musculocutaneous flap, and tracheostomy. In March 2018, the patient was found to have continuing tumor growth in the area of the epiglottis and floor of the oral cavity. The patient underwent laryngectomy with oropharyngeal resection and end tracheostomy. In July 2018, we again received a histological confirmation of tumor growth in soft tissues of the anterior neck. We performed resection of the tumor and soft tissues with subsequent plastic reconstruction of the defect. In October 2018, the patient presented with multiple metastases in both lungs. He received a course of immune therapy. Positron emission tomography revealed neoplastic foci with pathological metabolic activity in the area of the alveolar process of the mandible (left side), soft tissues of the neck, lungs, left-sided axillary LNs, and mediastinal LNs. It was decided to continue immune therapy.

Conclusion. HPV-negative oropharyngeal cancer requires an optimized treatment algorithm and, possibly, more aggressive therapeutic measures, such as increased radiation doses. Both overall management strategy and recommended standard scheme of CRT should be revised; the role of surgical and chemotherapeutic components of treatment should also be reassessed. We believe that surgical intervention should be considered regardless of the effect of radiation therapy, while the duration of follow-up after CRT should be reduced.

The study objective: using a clinical example to demonstrate possibilities of single photon emission computerized tomography (SPECT) in combination with computed tomography (CT) in identifying latent bone metastases, taking into account the dynamics growth of serum basal calcitonin.

Materials and methods. Patient S., 60 years old, visited N.N. Blokhin National Medical Research Center of Oncology for consultation on multiple lung metastases of cancer of unknown primary.

Results. Taking into account basal calcitonin level, immunohistochemistry, ultrasound investigation andfine-needle aspiration biopsy of the node in the right thyroid lobe a diagnose of medullary thyroid cancer was made. CT revealed multiple metastases in both lungs. Specialist erformed thyroidectomy with central lymphadenectomy and facial neck dissection on both sides. During next four months basal calcitonin level increased twice. Control contrast CT lung screening showed the growth of previously identified metastases and the appearance of multiple new ones. Bone scan showed focuses of increased radio-pharmaceutical accumulation in the area of 7^h left rib, left iliac wing, in the left bones of cranial vault, in C₇, Th₆, Th₉, Th_I2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th₉, Th_I2 vertebrae and the left iliac wing, and suspicion for metastasis in 7^h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th₉, Th_I2, L₃ vertebral bodies and in the left iliac wing.

Conclusion. Conclusion. In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th₉ and Th_I2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L₃ vertebra. Changes in the 7^h left rib could not be verified using CT, although this changes may be an emerging metastasis. Obviously, extensive use of radiation methods does not guarantee complete identification of all pathological focuses, it therefore allows assessing the prevalence of the pathological process. It is crucially important to control calcitonin level in these patients, since its rapid growth allowed suspecting additional distant metastases.

The study objective is to report a case of successful placement of intraosseous zygomatic implants for functional and aesthetic rehabilitation of a patient with a maxillary defect resulted from maxillary resection for right-sided stage IIB maxillary sarcoma (сT2N0M0, G3).

Materials and methods. A 34-year-old male patient visited a doctor in P.A. Herzen Moscow Oncology Research Institute with complaints of maxillary tumor. During the examination of the oral cavity, we found a dense endophytic tumor in the area of two missing teeth (17 and 18) involving the alveolar process and palatine process of the maxilla. Computed tomography revealed destruction of the alveolar process, lateral, medial, and posterior walls of the maxillary sinus on the right, and tumor invasion into the right iliac fossa, pterygopalatine fossa, and right maxillary sinus. We also observed tumor destruction of the right palatine process of the maxilla. The patient was diagnosed with osteogenic sarcoma.

Results. The patient received 4 courses of polychemotherapy with cisplatin and doxorubicin, which resulted in disease stabilization. Then the patient underwent en-block resection of the fragment of the right maxilla with alveolar and palatine processes, fragments of the zygomatic bone, wings of the sphenoid bone on the right side, and adjacent soft tissues. Simultaneously, we placed two zygomatic implants to provide supportfor the maxillary plate denture. To create an additional supporting point, we extracted tooth 11 and installed an implant with external hexagonal connection. Later, we produced and installed a specially designed palatal obturator.

Conclusion. Installation of removable dentures supported by implants ensures complete and rapid rehabilitation, allowing a patient to chew, swallow, and speak normally. A palatal obturator on implants supports the soft tissues of the medial face, thus ensuring complete aesthetic rehabilitation.

The study objective is to report a case of tracheal chondrosarcoma, which is a very rare malignant tumor. Only 18 cases have been described so far in English medical literature.

Materials and methods. A 74-year-old male patient visited an otorhinolaryngologist in August 2011 with complaints of hoarseness of voice, which have been gradually increasing during the last 3 years. The patient was diagnosed with myxoid chondrosarcoma.

Results. In September 2011, the patient underwent thyroidectomy and circular resection of the trachea at the level of its second ring with the creation of a tracheal anastomosis. This volume of surgery was determined by the presence a thyroid nodule in the right thyroid lobe, which invaded the cricoid cartilage and the first ring of the trachea. In November-December 2011, the patient underwent a course of adjuvant external beam radiotherapy with a total dose of 50 Gy delivered in 2.0 Gy fractions, 5 days per week. No cancer recurrence had been observed during 3 years and 9 months of follow up. In September 2015, the patients was found to have a 24-mm thyroid nodule with an exophytic component in the right thyroid cartilage plate. This finding was considered as recurrent chondrosarcoma. In May 2016, the patient had laryngectomy. We performed margin-negative (R0) resection. The patient has now been in remission for 2 years and 9 months.

Conclusion. We demonstrate successful treatment of a patient with tracheal chondrosarcoma with a long-term remission after surgery for recurrent tumor.

The study objective is to report a case of successful treatment of disseminated nasopharyngeal carcinoma with nivolumab.

Materials and methods. A 22-year-old male patient was admitted to N.N. Blokhin National Medical Research Center of Oncology with a diagnosis of T3N3M1 stage IV nasopharyngeal carcinoma with bone metastasis. After a course of radical chemoradiotherapy, the patient was found to have cancer progression. Between September 2016 and July 2017, the patient received chemotherapy with 3 lines of drugs, but with no effect. We decided to initiate treatment with PD-1 inhibitors. The patient received nivolumab 3 mg/kg every 2 weeks between July 2017 and March 2018.

Results. Positron emission tomography (September 2018) demonstrated no increased uptake of [18F]-fluorodeoxyglucose in earlier identified cancer foci. Since September 2018, the patient has been in persistent remission without any therapy.

Conclusion. This case report demonstrates high efficacy of PD-1 inhibitors in the treatment of disseminated recurrent nasopharyngeal squamous cell carcinoma, resistant to standard radiotherapy and chemotherapy.