Introduction. Primary hyperparathyroidism is one of the most common diseases of the endocrine system, after diabetes mellitus and thyroid pathologies. Early diagnosis and treatment of primary hyperparathyroidism allow avoiding severe damage to the bones, kidneys, other organs, thereby reducing the incidence of disability and improving the patients quality of life. The only radical treatment for primary hyperparathyroidism is the surgical removal of the pathologically altered, hyperfunctioning parathyroid glands.

The study objective – to increase the efficiency of preoperative topical diagnosis and intraoperative navigation of parathyroid glands.

Materials and methods. 200 patients with laboratory-verified primary hyperparathyroidism, who underwent preoperative topical diagnostics (ultrasound, planar scintigraphy and single-photon emission computed tomography, combined with computed tomography (SPECT / CT), in some cases supplemented with contrast enhanced CT with / or fine needle aspiration biopsy with flushing from a needle on for parathyroid hormone) and received surgical treatment, in period from 2017 to 2020. A single-stage, open-label comparative study was carried out, including clinical, laboratory and instrumental data of patients. The follow-up period after surgery for primary hyperparathyroidism was at least 6 months.

Results. From 200 included patients, surgical treatment in the amount of minimally invasive parathyroidectomy was performed in 189 patients. As a result of the analysis of the diagnostic accuracy, for a combination of ultrasound and SPECT/CT with augmented contrast enhanced CT, the overall accuracy in visualizing of parathyroid glands was 99 % (95 % confidence interval (CI): 97–100), diagnostic specificity 77 % (95 % CI: 54–100), sensitivity 100 % (95 % CI: 98–100), the predictive value of positive and negative results was 98 % (95 % CI: 97–100) and 100 % (95 % CI: 98–100) respectively.

Conclusion. The results allowed us to develop an algorithm for preoperative topical diagnosis of parathyroid glands in patients with laboratory-verified primary hyperparathyroidism and indications for surgical treatmen. We recommend to perform ultrasound of the thyroid and parathyroid glands in all patients at the first stage, in the absence of evident changes in the thyroid gland, at the second stage – scintigraphy and SPECT / CT with ^99mTc-MIBI; in cases with significant concomitant functional or structural pathology of the thyroid gland – contrast enhanced CT; if necessary, supplementing fine needle aspiration biopsy with flushing from a needle on for parathyroid hormone.

Introduction. Surgery at the first stage has always been the gold-standard treatment for locally advanced head cancer of almost all locations. Such patients often have significant postoperative defects that cause serious functional and aesthetic disorders. This requires simultaneous defect repair. The technique of defect repair should be chosen carefully with the consideration of its benefits and potential consequences.

Objective – to evaluate the efficacy of revascularized radial flaps for defect repair after combination extensive surgical excisions of head and neck tumors.

Materials and methods. This study included 67 patients with head and neck cancers of different locations who had undergone surgical tumor excision followed by defect repair using a radial flap.

Results. All patients had their defects repaired using radial autologous grafts. Since this study included primarily patients with oral and oropharyngeal tumors (53 patients), we also analyzed the survival in this cohort. patients were followed-up for 2 to 7 years. fourteen patients (26.4 %) developed progressive disease during this time, including 8 individuals with recurrent primary tumor and 6 individuals with regional metastases. The mean time to nasoesophageal probe removal and restored swallowing was 12.2 days; mean length of hospital stay was 13.5 days.

Conclusion. Thus, radial flap is a reliable and multifunctional material that can be used to repair complex and combination defects in patients with head and neck tumors. In some cases, it is the method of choice, since it helps to achieve satisfactory quality of life. Repair of tongue defects with radial flaps ensures good functional results.

The study objective – to analyze the treatment results and prognostic factors of survival in patients with locally advanced laryngeal cancer who received surgical treatment and chemoradiotherapy.

Materials and methods. The retrospective study included patients with locally advanced laryngeal cancer treated at the N. N. Petrov National medical Research Center of Oncology, Ministry of Health of Russia in the period from 2009 to 2018. The patients included in the study were divided into 2 equal groups (74 patients were included in each group) depending of treatment: surgery with postoperative radiation therapy combined with chemotherapy (group 1) and concurrent chemoradiation therapy and subsequent surgical treatment in case of incomplete response to treatment or disease progression (group 2). The endpoints of the study were general and relapse-free survival.

Results. One hundred and forty-eight patients were included in the study: 74 patients in group 1 and 74 patients in the group 2. The median overall survival in the surgical treatment group was 45 months, in the chemoradiotherapy group – 44.6 months, and the overall 5-year survival for the group 1 and the group 2 were 39.3 (95 % confidence interval (CI) 26.1–59.2), and 59.2 % (95 % CI 45.3–77.2), respectively. The relapse-free 5-year survival rate for the surgical treatment group and the chemoradiotherapy group was 36.8 (95 % CI 25.1–53.8), and 53.9 % (95 % CI 40.7–71.4), respectively.

Conclusion. There were no significant differences in overall and relapse-free survival. Metastatic lesion of the neck lymph nodes (N2–3), invasion of laryngeal cartilage, invasion of the thyroid gland and the spread of the tumor to the larynx are statistically significantly associated with lower overall and relapse-free survival.

Introduction. Surgical treatment of tumors in the maxillofacial region is always accompanied by the involvement of a significant amount of bone structures of the jaws. At the same time, the main method of dental orthopedic treatment of patients is prosthetics with a removable prosthesis. The larger the defect in the maxillofacial region, the more pronounced the subjective feeling of the patient’s rejection of the removable structure.

There is a close relationship between the adaptive ability of a person and oral stereognosy as the anatomical and physiological mobility of the tongue and the synthetic activity of the cerebral cortex.

One of the options for improving adaptability and increasing the activity of the synthetic activity of the cerebral cortex is a special adaptation training, which includes articulatory movements of the tongue. Stimulation of the muscles of the cheeks and lips with the tongue contributes not only to normal pronunciation / improvement of the intelligibility of the speech stream, but also adapts the tongue to the changed conditions after the imposition of removable prostheses.

In connection with the above data, the study objective is to analyze the effectiveness of adaptive training to improve adaptability to removable dentures in patients with acquired defects of the maxillofacial region.

Materials and methods. Dental orthopedic treatment of 39 patients was carried out after surgical treatment, including resection of the upper jaw and simultaneous replacement with a removable dental resection shaping prosthesis of the upper jaw directly on the operating table.

A clinical control group (n = 40) was introduced to identify parameters in determining the synthetic activity of the cerebral cortex. Depending on the assigned adaptive support, the patients were divided into 2 subgroups: Subgroup 1 – the modernized adaptation training complex was prescribed (n = 18), Subgroup 2 – the standard observation of the patient (n = 21).

Stereognostic testing and determination of adaptive capacity before treatment, after 7 / 14 days and 1 / 3 month after the placement of a resection prosthesis.

Results. Adaptive support for patients of Subgroup 1 is represented by adaptation training 1 complex (33.3 %). Repeated stereognostic testing 7 days after surgery showed a decrease in adaptive values in all patients. After 14 days, in Subgroup 2, stereognostic testing of patients remained unchanged. Another 14 days (1 month after the placement of a resection prosthesis) in the Subgroup 1 of patients, the reference test values were found in 2.5 % of cases. The number of patients with high and moderate values increased by 1.3 times, and the number of patients with low test values also decreased by 3 times. 3 months after the placement of the resection prosthesis, the test values in Subgroup 1 approached the values before the surgical treatment. None of the patients of Subgroup I had a low level of adaptability.

Discussion. The training exercises contributed not only to the muscular development of the tongue, but also stimulated the synthetic activity of the cerebral cortex. In 3 months after the placement of a resection prosthesis in the 1^st subgroup of patients, the values of stereognostic testing approached the preoperative level.

Conclusion. Normalization of the tone of the muscles of the oral cavity through functional training changes the stereognostic abilities of the patient. All this together increases the patient»s adaptability to removable dentures. Adaptation support reduced the time of adaptation to new removable dentures, which was confirmed by objective research – stereognostic testing. The influence on the synthetic activity of the cerebral cortex through the exercises of training for the tongue increased the adaptability to the resection prosthesis, changed the quality of life for the better.

Introduction. Unresectable oral cancer is an urgent and complex problem in modern oncology. Annually, the proportion of patients with stage III–IV is 35 %, and the one-year mortality rate for this pathology reaches 32 %. Patients with advanced oral tumors usually have a negative prognosis and treatment tactics are limited to radiation therapy (RT), chemoradiation therapy, or sequential therapy, including induction chemotherapy (CT). Polymodal therapy for oral cancer is of particular interest in the treatment of pathology in this area.

The study objective – to analyze the results of sequential treatment, including induction CT followed by RT and induction CT followed by surgery and RT in patients with unresectable oral cancer (T3–4bN0–3M0).

Materials and methods. This retrospective study included 30 patients (11 women and 19 men) with primary non-resectable squamous cell carcinoma of the oral cavity (T3–4bN0–3M0) who received 2–3 courses of induction chemotherapy (CT) with DCF (docetaxel, cisplatin, 5-fluorouracil). Mean patients’ age was 61.2 years. The first treatment stage included induction CT according to the following scheme: docetaxel (75 mg/m² /day on day 1) + cisplatin (75 mg/m² /day on day 1) + 5-fluorouracil (1000 mg/m² /day on days 1–4) repeated every 21 days. Study participants were divided into 2 groups according to their objective response to CT. Patients with resectable residual tumors have undergone surgery (after induction CT) followed by radical radiation therapy (RT) (induction CT + surgery + RT). Patients with non-resectable residual tumors/no objective response/no complete response after induction CT have undergone radical RT (induction CT + RT).

Results. The objective response rate (ORR) to induction CT was 66.6 % (20 / 30). Five out of thirty patients (16.7 %) received no subsequent therapy: 3 individuals developed grade III–IV adverse events, while 2 individuals had progressive disease. One-third of patients (10 / 30; 33.3 %) had surgery followed by RT. Half of patients (15 / 30; 50 %) received RT after induction CT. The two-year relapse-free survival rates in the groups of induction CT + surgery + RT and induction CT + RT was 14 and 16 %, respectively (p = 0.49). The two-year overall survival rates in the same groups were 44 and 38 %, respectively (р = 0.74).

Conclusion. Resectability was achieved in 33.3 % (10 / 30) of patients with initially unresectable oral cancer after induction CT. A sequential therapy regimen, including a surgical stage after induction CT, did not demonstrate a statistically significant increase in overall and disease-free survival rates. Sequential multimodal treatment of common oral cancers has some potential, but requires further study to assess its significance.

Introduction. Nutritional support is an important component of multimodal cancer therapy. It is well known that proper nutrition supplemented by necessary nutrients can support muscles and their function, reduce the incidence and severity of complications associated with cancer therapy, and facilitate recovery. Proper nutritional support is planned according to patient’s need for energy (30 kcal / kg body weight per day), protein (1.5 g protein / kg body weight per day), and eicosapentaenoic acid (2 g per day).

Materials and methods. We analyzed the dynamics of nutritional status of 632 cancer patients treated in P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia between 2019 and 2021. Study participants were divided into two groups: experimental (n = 316) and control (n = 316). Patients in the experimental group received proper nutritional support. This study included patients with confirmed gastrointestinal cancers (esophageal and gastric), colon cancer, head and neck cancer, and lung cancer.

Results. Nutritional therapy in the process of drug antitumor treatment has improved the trophological status of patients with tumors of the head and neck, lungs, upper gastrointestinal tract. As a result of the work, there was a tendency to increase the body weight of patients in these subgroups, whereas in the control group there was a statistically significant decrease in body weight compared to the initial indicators by 9.4; 9.5; 5.3 and 9.6 kg, respectively. Also, full clinical nutrition contributed to an increase in the level of total protein in patients with cancer of the upper gastrointestinal tract and colon and rectum by 4.0 and 3.7 g/l, respectively, at the level of statistical trend. The level of albumin significantly increased (by 6.6 g/l) only in patients with lung cancer.

Improved nutritional status of patients during their systemic therapy ensured a 6 % reduction in the frequency of intercycle periods, a 0.2–3.4 % reduction in the need for dosage correction, and a 2.9–11.1 % increase in the completeness of cancer therapy stages (trend).

Conclusion. Our findings suggest that additional specialized (oral or enteral) nutritional support during chemotherapy stabilizes body weight and its index, resulting, first of all, in improved tolerability of treatment.

KEYNOTE-048 study results became basis for changing standard of care in the 1^st line treatment of patients with recurrent / metastatic squamous cell cancer of the head and neck (SCCHN). However, there were no significant improvement in the progression free survival for patients receiving pemrolizumab as a monotherapy or in combination with chemotherapy in both group of patients, with PD-L expression (CPS >1) and without it (CPS <1). The latter lead to reassess existing treatment options for patients with progressive recurrent / metastatic SCCHN.

TPExtreme study started in 2014 as an open multicenter randomized II phase trial to assess efficacy of a new chemotherapy regimen for the treatment of inoperable recurrent / metastatic SCCHN. Patients in the experimental arm received TPEx regimen: docetaxel 75 mg / m², cysplatimun 75 mg / m² and cetuximab 400 mg / m² on the 1^st day (further 250 mg / m² weekly). Four cycles of TPEx were planned totally with further cetuximab maintenance every 2 week (500 mg / m²) until progression or unfit toxicity. Control arm received EXTREME regimen. Therapeutical effect assessed every 8 weeks. 541 patients were enrolled in study totally (271 patients TPEx arm and 270 patients ETREME arm). Median follow-up were 34.4 months in the TPEx arm and 30.2 months in the ETREME arm, overall survival 14.5 months (95 % confidence interval (CI) 12.5–15.7) and 13.4 months (95 % CI 12.2–15.4) respectively (hazard ratio (HR) 0.89, 95 % CI 0.74–1.08; p = 0,23). Progression-free survival didn’t differ significantly in both groups (HR 0.9, 95 % CI 0.75–1.07). There was no significant difference in objective response rate in both treatment groups. TPEx regimen had favorable safety profile. Quality of life was better in experimental arm also. Authors made conclusion that TPEx regimen could provide an alternative to standard of care with the EXTREME regimen in the first-line treatment of patients with recurrent or metastatic SCCHN, especially for those who might not be good candidates for up-front pembrolizumab treatment. According to KEYNOTE-048 study results, the rate of progression was much higher in patients who received pembrolizumab as a monotherapy (total population) compared to patients received EXTREME (41 % vs 12 %). As a result, the latter led to worsening of progression-free survival in pembrolizumab arm. Pembrolizumab as a monotherapy gives positive effect only in patients with certain level of PD-L expression (CPS >20) in total population. Post-hoc analysis of TPExtreme study demonstrated the most benefit results until now for patients who received consequently cetuximab contained chemotherapy regimens as a first line followed by immunotherapy for the second line in this patients group (overall survival 19.4 months for EXTREME arm and 21.9 months for TPEx arm).

Thus TPExtreme study results demonstrates opportunity for better disease control in patients receiving cetuximab in first line and immunotherapy as second line treatment in total population for patients with recurrent / metastatic SCCHN.

Introduction. Malignant brain and other central nervous system tumors show a statistically significant increased incidence worldwide (GLOBOCAN, 2018).

The study objective – to estimate the incidence of malignant brain and other central nervous system tumors in Siberia and the Russian Far East.

Materials and methods. Using data from the population-based cancer registry in Siberia and the Russian Far East, we calculated the cancer incidence rates, the age-standardized incidence rates (ASIR), the index accuracy (the ratio of the number of cancer-related deaths to the number of new cases) of malignant brain and other central nervous system tumors during the period 2010 to 2019.

Results. During the period 2010 to 2019, brain and other central nervous system malignances in males were the 14^th most common cancers in Siberian and the Russian Far Eastern region, with the incidence of 1.6 % in 2010 and 1.5 % in 2019. In females, brain and other central nervous system malignances were the 16^th most common cancers, with the equal incidence of 1.3 % in 2010 and 2020. Overall, the incidence rate of malignant brain and other central nervous system tumors in Siberian and the Russian Far Eastern regions increased from 5.1 to 5.6 per 100 000 with rate of increase of 9.8 %, including the territories of the Republic of Kamchatka (238.5 %), Amur (147.8 %), Khakassia (89.1 %), Irkutsk (65,1 %), Krasnoyarsk (37.8 %), and Primorsky (33.3 %) regions. The incidence rate decreased in the Kemerovo region (34.4 %) and the Trans-Baikal Territory (44.4 %). In women of Siberian and the Russian Far Eastern regions, the incidence rate was slightly increased from 3.7 to 4.0 per 100 000, the overall rate of increase being 8.1 %. The highest incidence rate was registered in the Altai Territory (47.8 %), Novosibirsk region (33.3 %), the Republic of Khakassia (25.0 %), Amur region (246.2 %), but the lowest incidence rate was observed in the Kemerovo region (7.0 %) and the Trans-Baikal Territory (61.1 %).

The index accuracy indicated problems with the quality of territorial cancer registries. In males, the reduced the index accuracy was observed in Siberian and the Russian Far Eastern regions as a whole and amounted to 0.81. The index accuracy was also observed in the Krasnoyarsk, Primorsky, Kamchatka, Novosibirsk and Amur regions, as well as in the Republic of Khakassia, whereas the increased index accuracy was observed in the Kemerovo Region, Altai Republic, Khabarovsk and Trans-Baikal Territories. In females, the increased index accuracy was observed Siberian and the Russian Far Eastern regions as a whole, being 0.78 in 2019, and in the Krasnoyarsk, Kamchatka, Tomsk regions, as well as in the Republic of Khakassia. The reduced index accuracy was noted in the Altai, Primorsky Territories and the Amur Region.

Conclusion. The problems of registration and monitoring of malignant brain and other central nervous system tumors in Russia does not make it possible to present the true incidence rate of these tumors. The development and implementation of a Neuro-Oncology Registry in accordance with the international standards will allow full analysis of the epidemiological situation of malignant brain and other central nervous system tumors.

Introduction. Squamous cell carcinoma of the tongue is the most common oral cancer. The tumor microenvironment has a significant impact on tumor progression; therefore, better understanding of its characteristics is crucial for the treatment strategy, since in some cases it modifies the tumor microenvironment resulting in tumor resistance to therapy.

Study objective – to compare the number of CD8+Т-lymphocytes, CD57+NK-cells, and CD20+B-lymphocytes in the microenvironment of tongue squamous cell carcinoma in patients receiving and not receiving neoadjuvant chemoradiotherapy.

Materials and methods. We performed immunohistochemical examination of specimens from 67 patients with tongue squamous cell carcinoma who did not receive neoadjuvant chemoradiotherapy. Eleven patients were diagnosed with well differentiated tumors (G1); 21 patients had moderately differentiated tumors (G2); and 35 patients had poorly differentiated tumors (G3). T1 tumors were observed in 11 individuals, T2 tumors – in 26 individuals, T3 tumors – in 26 individuals, and T4 tumors – in 4 individuals. We also examined 30 patients who had undergone neoadjuvant chemoradiotherapy, including external beam radiotherapy (total dose of 60 Gy) and a cycle of polychemotherapy (cisplatin and 5‑fluorouracil). Of them, 6 patients had T1 tumors, 17 patients – T2 tumors, 5 patients – T3 tumors, and 2 patients – T4 tumors. We measured the areas occupied by CD8+T-lymphocytes, CD20+B-lymphocytes, and CD57+NK-cells in the hot spots in the tumor microenvironment.

Results. The number of CD8+T-lymphocytes in the tumor microenvironment was higher in patients after neoadjuvant chemoradiotherapy than in those who did not receive it (р = 0.000), whereas the number of CD20+B-lymphocytes was lower after neoadjuvant chemoradiotherapy. The area occupied by CD57+NK-cells in the hot spots of the tumor microenvironment did not differ significantly before and after therapy (p >0.05).

Conclusion. Thus, neoadjuvant chemoradiotherapy in patients with tongue squamous cell carcinoma caused an increase in the number of CD8+T-lymphocytes, a decrease in the number of CD20+B-lymphocytes in the tumor microenvironment, and had no effect on the population of CD57+NK-cells.

Introduction. Oral mucositis is one of the earliest and most frequent complications of radiation therapy or chemotherapy in patients diagnosed with oropharyngeal cancer. Because of this pathology, therapeutic interventions are most often used, thereby poor treatment is considered an etiological factor of oral mucositis. Now, this issue is being actively studied in the world, but a unified algorithm for treatment and prevention of oral mucositis has not been formed.

The study objective – is to evaluate the effect of titanium glycerosolvate aquacomplex in reducing the intensity of radiation induced reactions and reducing the frequency of interruptions.

Materials and methods. 52 patients diagnosed with oropharyngeal cancer were included in this study, treated with radiotherapy or chemotherapy. For prophylaxis of severe stages of oral mucositis, 32 patients underwent standard symptomatic therapy (group 1, control group); 20 patients took titanium glycerosolvate aquacomplex in accordance with symptomatic therapy (group 2).

Results. In the group 1 only 61.7 % of patients completed treatment. In the group 2 80 % of patients completely underwent antitumor therapy. At the same time, they developed oral mucositis of the I–II degree. Also, in the group of the studied drug, in 100 % of cases, therapy was performed without interruptions.

Conclusion. Using titanium glycerosolvate aquacomplex for the prophylaxis of severe stages of oral mucositis during radiotherapy or chemotherapy of oropharyngeal cancer is effective and safe. It is also convenient from the medical and economic side, thanks to the ability to use it on an outpatient basis.

A review of accumulated international clinical experience and prognostic significance calculations of metastatic involvement of the lingual lymph nodes is given. Anatomical terminology of lingual lymph nodes and its contradictive aspects are discussed. It is shown that metastatic lesions of the lingual lymph nodes posses high prognostic value, therein a topographic anatomic classification of the lingual lymph nodes is needed to increase the efficiency of diagnosis and augmenting of the oncologic treatment results. This classification should be unified to avoid misunderstanding between researchers.

Epidermal growth factor receptor inhibitors (EGFR) have a high rate of class-specific dermatologic adverse events. Supportive treatment of dermatologic adverse events decreases their severity, minimizes the need for dose de-escalation / discontinuation of targeted therapy, improves commitment to anticancer treatment and patient’s quality of life. Close interdisciplinary cooperation between oncologists and dermatologists is a key to the successful management of patients treated with EGFR. This article highlights current approaches to classification, concepts of pathogenesis and clinical course of EGFR-associated dermatologic adverse events, current and promising prophylactic and therapeutic strategies to manage these adverse events.

Malignant tumors of the sinuses and nasal cavity are rare diseases. Squamous cell carcinoma is the most common histological type (55–70 % of tumors of the sinuses and nasal cavity). The frequency of neuroendocrine tumors reaches 5 %. Currently, there is no generally accepted standard for the treatment of neuroendocrine tumors of sinonasal localization. If surgical treatment is associated with a significant deterioration of the quality of life or poor outcomes, chemoradiotherapy can be recommended. This article describes a clinical case of combined treatment of neuroendocrine cancer of the maxillary sinus and brief review of the literature on malignant tumors of the paranasal sinuses and the nasal cavity.

Radioiodine therapy for differentiated thyroid cancer has been used for a long time, mainly in patients of intermediate and high risk, as well as in the presence of distant metastases. However, about 30–40 % of patients are refractory to radioiodine therapy, which significantly worsens the prognosis. In patients with radioiodine-refractory differentiated thyroid cancer, therapy with targeted agents, primarily tyrosine kinase inhibitors, is indicated.

This review addresses the criteria for refractoriness and criteria for prescription of targeted therapy, and presents the results of clinical studies of the targeted agents used. As of today, lenvatinib is the most well-known targeted agent. In particular. In SELECT trial lenvatinib demonstrated efficacy in terms of progression-free survival and overall survival in patients with radioiodine-refractory differentiated thyroid cancer. As a result, lenvatinib was included in the international and Russian clinical guidelines for the management of this group of patients as a drug of the 1^st line of targeted therapy.