Introduction. In some cases of differentiated thyroid cancer expansion into the main vessels and adjacent organs, surgical intervention is impossible. Not many cases of successful use of targeted therapy as neoadjuvant regimen to treat nonresectable differentiated thyroid cancer were reported, but this approach can be an option in management of such patients.

Aim. To analyze clinical experience of using lenvatinib as neoadjuvant therapy in patients with primary nonresectable differentiated thyroid cancer.

Materials and methods. Retrospective analysis of treatment of 7 patients with primary nonresectable differentiated thyroid cancer with lenvatinib as neoadjuvant therapy at Chelyabinsk Regional Clinical Center for Oncology and Nuclear medicine between 2021 and 2023 was performed.

Results. Treatment response was evaluated in 4 (71.4 %) patients. In 2 (50 %) patients, partial response was observed, in 2 - stable disease. Radical surgical intervention became possible in 2 patients. The other 2 patients could not undergo surgery: in 1 patients time to progression was 17.8 months, therapy was changed to the 2nd line drug cabozantinib; 1 female patient with best response (partial) currently continues lenvatinib treatment, tumor is nonresectable, duration of drug administration is 8.9 months.

Conclusion. Our experience of using lenvatinib in patients with nonresectable differentiated thyroid cancer shows that this therapy can be successfully used as neoadjuvant treatment in this patient group.

Introduction. Chemotherapy in combination with targeted therapy (CT + TT) using a monoclonal antibody against epidermal growth factor receptor (EGFR) cetuximab and subsequent maintenance targeted therapy (CT + TT/TT) is the leading 1^st line therapy of recurrent/metastatic head and neck squamous cell carcinoma to achieve objective response irrespective of programmed cell death-ligand 1 (pD-L1) expression level. However, often in clinical practice patient profile does not match characteristics of patients included in registration studies. Therapy selection is based on massive advancement of the tumor, low performance status of the patient, use of various chemotherapy regimes which often decreases therapy effectiveness. This creates a necessity of identification of clinical markers of effectiveness based on the drug's pharmacodynamics and mechanism of action.

Aim. To analyze the effect of clinical characteristics, peripheral blood markers, and systemic inflammation on long-term results of CT + TT/TT with cetuximab in cancer of the mucosa of the head and neck.

Materials and methods. The prospective observational study performed at the Oncology Department with a course on thoracic surgery of the Kuban State Medical University, included 52 patients with head and neck squamous cell carcinoma receiving CT + TT/TT between 2020 and 2023. Clinical characteristics and results of peripheral blood tests were retrospectively analyzed, indices of inflammatory reaction prior to treatment and 12-16 weeks after CT + TT/TT with cetuximab were calculated. Statistical analysis was performed using the med Calc ver. 20.218 and IBM SPSS Statistics 22 software.

Results. CT + TT/TT with cetuximab significantly increased red blood cell count (RBC), lymphocyte-monocyte ratio (LMR), and decreased systemic inflammatory markers (SIM) (p <0.05) 12-16 weeks after the start of treatment. Statistically significant decrease in progression-free survival for baseline RBC <3.9 x 10¹²/L (area under the ROC-curve, AUC) = 0.780; 95 % confidence interval (CI) 0.616-0.944; p = 0.0008), RBC ≤3.8 x 10¹²/L 12-16 weeks after the start of therapy (AUC = 0.748; 95 % CI 0.554-0.941; p = 0.0120) was observed. Survival was negatively affected by LMR >3.27 after 12-16 weeks of therapy (AUC = 0.685; 95 % CI 0.486-0.885; p = 0.0691). median survival of patients after the start of CT + TT/TT with cetuximab was 28 months (95 % CI 17-48), progression-free survival was 8 months (95 % CI 5-36). For RBC count >3.8 x 10¹²/L 12-16 weeks after the start of therapy, risk of progression decreased by 79 % (hazard ratio 0.21; 95 % CI 0.07-0.62; p = 0.0047). Partial response after 12-16 weeks of CT + TT/TT decreased progression risk more than 4-fold (p <0.05). The model decreasing progression-free survival includes baseline RBC ≤3.9 x 10⁹/L, RBC ≤3.8 x 10⁹/L after 12-16 weeks of CT + TT/TT with cetuximab and absence of partial response per the Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) (AUC = 0.792; 95 % CI 0.706-0.877; p = 0.0079).

Conclusion. for prediction of CT + TT/TT with cetuximab effectiveness in patients with head and neck squamous cell carcinoma, baseline characteristics of the peripheral blood and systemic inflammation can be used. Additionally, correlations between these characteristics 12-16 weeks after the start of therapy and treatment effectiveness were observed. Increased RBC as an anemia marker can be considered an indirect mechanism of EGFR signaling pathway blocking by cetuximab through decreased level of interleukin 6, marker of systemic inflammation, and factor of chronic disease anemias hepcidin. In patients with head and neck squamous cell carcinoma, maximal effectiveness of CT + TT/TT with cetuximab requires not only therapy personalization but also anemia correction.

Introduction. The standard of treatment for patients with single cerebral metastases is surgery and radiosurgery. The use of these methods significantly increases survival rates.

Aim. To compare the results of surgical treatment of patients with single and multiple cerebral metastases.

Materials and methods. The study included 40 patients with single and multiple cerebral metastases who underwent neurosurgical intervention in the neuro-oncology department of the N.N. Blokhin National Medical Oncology Research Center from 2010 to 2022.

Results. All patients are divided into 3 groups. Group A included 15 patients who removed all available cerebral foci (from 2 to 4). Group B included 10 patients with multiple cerebral metastases who underwent removal of one symptomatic metastasis. In group C, 15 patients who underwent removal of a single metastasis. It was noted that the survival of patients after removal of all cerebral metastases is identical to the survival of patients after removal of single metastasis 11.9 and 12.4 months, respectively. And it was significantly higher than the survival of patients who removed not all cerebral metastases 6.2 months (p = 0.03). Also in group A and C, the percentage of local relapses was identical. Improvement in neurological status was noted in all groups, there was only an increase in cognitive-mnestic disorders in group A, where all cerebral foci were removed. However, these disorders were moderate and did not reach the extent of dementia. The work done shows.

Conclusion. Surgical removal of all metastases in patients with multiple brain metastases provides a prognosis similar to that of patients undergoing surgery for single metastasis. Removal of symptomatic metastasis in patients with multiple cerebral lesions in most cases leads to a regression of neurological symptoms and makes it possible to continue treatment with a group of patients whose condition was considered incurable. The percentage of local relapses in the removal of multiple cerebral metastases, subject to oncological principles, is the same as in the removal of single metastases.

Human papilloma virus (HPV), primarily type 16 (less commonly type 18), is associated with oropharyngeal squamous cell carcinoma (OPSCC). According to literature data, between 25 and 70 % of all cases of this cancer are linked to HPV infection. In the USA and some countries of the European Union, HPV-associated OPSCC comprises 60-70 % of all cases of head and neck squamous cell carcinoma. HPV-associated OPSCC is characterized by more favorable prognosis and higher survival compared to HPV-negative OPSCC. These types of this pathology are differently characterized in the 8th edition Tumor, Nodus and Metastasis (TNM). Significant differences in survival and disease prognosis led to studies aimed at deintensification of standard OPSCC treatment to minimize adverse events without the loss of effectiveness. Despite more favorable clinical progression, in 15 % of patients with HPV-associated OPSCC even after standard therapy recurrences and/or regional/distant metastases are observed which lead to unfavorable prognosis. Modern treatment schemes for recurrent/metastatic head and neck squamous cell carcinoma include immunotherapy, results of which also depend on HPV-status of the tumor. While clinical trials studying effectiveness of immune drugs include patients with HPV-positive tumors, data on treatment outcomes are contradictory, and molecular mechanisms of HPV effect on the immune response are not fully understood.

The article summarizes the data on the effect of positive HPV status on the effectiveness of immunotherapy in patients with progressing/metastatic head and neck squamous cell carcinoma.

Diffuse midline glioma of the brain is a rare but very aggressive and resistant glial tumor. This pathology is characterized by impossibility of radical surgical treatment, radioresistance, resistance to drug treatment, high morbidity in children, low quality of life of the patients, frequent complications in the form of neurologic deficit, and unfavorable prognosis. The absence of effective treatment scheme for diffuse midline glioma requires identification of other methods (oncolytic virus therapy, immunotherapy) but there is not enough data on this topic leading to the necessity of its further investigation.

A clinical case of a rare combination of thyroid cancer and aberrant struma is described. unusual intraoperative diagnosis during reoperation is due to the metachronous nature of the occurrence of primary malignant tumors. The complexity of diagnosing the considered combined tumor pathology on the anterior-lateral surface of the neck is associated with the extremely rare detection of lateral aberrant struma with malignancy in clinical practice, especially against the background of recurrence of the disease with synchronous regional metastases of highly differentiated thyroid cancer.

Anaplastic thyroid cancer is the rarest and the most aggressive form of thyroid cancer. It comprises 1-2 % of all cases and is characterized by rapid growth. median survival of patients with this pathology is about 5 months. Clinical manifestations of the disease are rapid deformation in the neck area, progressive respiratory distress, and dysphagia.

The article describes a clinical case of a response of unresectable, BRAF-negative, PD-L1-positive (programmed death-ligand 1) anaplastic thyroid cancer to immunotherapy with pembrolizumab.

Juvenile nasopharyngeal angiofibroma is a benign, highly vascularized tumor that occurs mainly in children and young men of pubertal age 9-19 years old. Often manifested by difficulty in nasal breathing and nosebleeds. We report a 16-year-old boy with complaints of a complete absence of nasal breathing, nosebleeds, snoring, nasality, exophthalmos on the right side, visual impairment. undergoing therapeutic treatment for rhinosinusitis and adenoid vegetations for 5 months and an unsuccessful attempt at adenotomy in history. When contacting the Department of Oncology and Pediatric Surgery Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology according to imaging with contrast enhancement juvenile angiofibroma of the nasopharynx IVA stage to Fisch-Andrews with a 30 % increase in volume in 2 months. The patient was initiated on neoadjuvant therapy Sirolimus as part of a pilot phase of a prospective clinical trial. After 9 months of taking the drug, there is a reduction in the tumor by 37 %, restoration of vision, clinical and radiological improvement.

Sarcoma is a group of rare malignant tumors characterized by aggressive growth, active metastasis, and rapid recurrence of the disease. Localized in any part of the body, mainly in the limbs. Ewing's sarcoma in the head and neck area is a challenge for a multidisciplinary team of specialists. The tumor has little sensitivity to conservative methods of special treatment and it is necessary to apply a large surgical treatment. To preserve the quality of life of the patient during surgical operations on the organs of the head and neck, reconstructive operations are required. The article presents a clinical case of treatment and rehabilitation of a patient with maxillary sinus sarcoma.

The radioiodine therapy is a one of the basic elements at combined treatment of differentiated thyroid cancer and is an alternative method for patients with distant metastases and a potentially high risk of tumor recurrence. It has been used in clinical practice for more than 80 years. The first report on the phenomenon of accumulation of ¹³⁰I/¹³¹I in a metastatic focus of differentiated thyroid cancer was published by A. Keston et al. in 1942, and in 1946, the production of ¹³¹I was established, and the drug became available. In our country, radioiodine therapy has been widely used for the treatment of differentiated thyroid cancer since 1982.

This article presents methodological recommendations for radioiodine therapy of patients with differentiated thyroid cancer, provides a modern examination algorithm, discusses the basic principles of laboratory, instrumental diagnostics and treatment approaches treatment of this disease.