Vol 15, No 4 (2025)

Introduction. Human papilloma virus (HPV) – associated oropharyngeal squamous cell carcinoma is identified as a separate nosological entity of head and neck squamous cell carcinoma. This pathology is often associated with metastases with unknown primary origin. If they are located in the cervical lymph nodes, the primary lesion can be located in the nasopharynx. Considering that keratinizing and nonkeratinizing nasopharyngeal cancer is often accompanied by coexistence of HPV and Epstein–Barr virus (EBV), a theory was proposed that EBV can promote HPV infection.

Aim. To determine the role of EBV in determination of the primary lesion in patients with squamous cell metastases of unknown origin.

Materials and methods. For determination of the supposed link between metastases in the cervical lymph nodes from unknown primary origin and EBV DNA, we examined 151 patients with metastases of squamous cell carcinoma in the cervical lymph nodes from unknown primary origin. Surrogate EBV DNA marker was found in 33 patients.

Results. An association between EBV DNA in serum and nasopharyngeal squamous cell carcinoma was found. Rare incidence of metastases from unknown primary origin is supposedly results from small size of the primary lesion and submucosal tumor location in combination with early lymphatic metastasis.

Conclusion. To not miss clinically hidden nasopharyngeal cancer, interdisciplinary interaction and quantitative measurement of serum EBV DNA are necessary.

Introduction. Laryngeal cancer is an important oncological problem. The vocal fold is most commonly affected. The main treatment modalities for localized laryngeal cancer are organ-preserving surgery or radiation therapy. Recently, more specialists have been giving preference to endolaryngeal laser resections as the primary treatment method.

Aim. To analyze the oncological outcomes of endolaryngeal laser resections in patients with localized forms of laryngeal cancer.

Materials and methods. The study included 172 primary patients with squamous cell laryngeal cancer cT1–T2 who were treated in the head and neck tumor department of N. N. Blokhin National Medical Research Center of Oncology from 2015 to 2025. The extent of tumor process was assessed as cT1a in 71 (41 %) patients, cT1b in 30 (18 %) patients, and cT2 in 71 (41 %) patients.

Results. The overall 2- and 5-year survival rates were 97.7 % and 94.7 %, respectively. Disease-free 2- and 5-year survival rates were 95.9 % and 92.4 %, respectively. Local recurrence developed in 12 % (n = 21) of patients. Among all patients included in the study, laryngectomy was performed in 4 % (n = 7) of patients.

Conclusion. Endolaryngeal laser resections are the treatment of choice for localized squamous cell carcinoma of the larynx. Radiation therapy should be considered as an alternative when surgery is not possible or the patient refuses surgical treatment.

Introduction. Camrelizumab is a high-affinity monoclonal antibody targeting programmed cell death protein 1 (PD-1) that has demonstrated strong clinical activity across multiple solid tumors. Emerging evidence suggests that camrelizumab can bind not only PD-1 but also the stress-induced ligand ULBP2 which activates natural killer (NK) and CD8⁺-T cells.

Aim. To experimentally verify specific camrelizumab binding to ULBP2 (in contrast to reference anti-PD-1 antibodies pembrolizumab, nivolumab, and prolgolimab), compare anti-PD-1 antibodies binding profiles, and explore the potential immunological implications of camrelizumab dual specificity to PD-1 and ULBP2 in the context of antitumor immune response.

Materials and methods. Binding interactions between ULBP2 and the four anti-PD-1 antibodies (camrelizumab, pembrolizumab, nivolumab, and prolgolimab) were assessed using surface plasmon resonance and flow cytometry.

Results. Among all the tested antibodies, only camrelizumab exhibited specific binding to ULBP2 (K_D (equilibrium dissociation constant) = 2.79 × 10^–7 M). This interaction was confirmed by two independent methods.

Conclusion. Camrelizumab displays a unique dual specificity for PD-1 and ULBP2 maintaining activity of effector lymphocytes and potentially decreases the dependence of therapy efficacy of PD-1 ligand (PD-L1) expression level. These findings expand our understanding of the biological features of camrelizumab and support its potential as an immunomodulator with broadened activity.

A summary of clinical cases describing lesions of lingual lymph nodes in cancer of the tongue and the floor of the mouth is presented. For the first time, a revision of special anatomical terminology was performed on such material. Topographic and anatomical information on the intermuscular fascial spaces of the tongue and the floor of the oral cavity throughout which subgroups of lingual lymph nodes are distributed is provided.

Introduction. Betterment of techniques and methods of treatment of oncological diseases promotes improved patient rehabilitation. Improvement of biopsychosocial status of these patients significantly depends on determination of rehabilitation potential. Due to increased survival of oncological patients, problems associated with the quality of life have become more urgent.

Aim. To determine the possibility of using a non-specific questionnaire Short Form-36 (SF-36) for evaluation of quality-of-life characteristics and rehabilitation potential of patients with malignant head and neck neoplasms during different schemes of radical radiation therapy.

Materials and methods. The study included 68 patients with malignant head and neck neoplasms who underwent chemo / radiotherapy with accompanying symptomatic treatment and nutritional support between 2019 and 2021 (treatment group). In 32 (47.08 %) patients, the tumor was located in the larynx, in 8 (11.76 %) in the pharynx, in 6 (8.82 %) in the parotid gland, in 13 (19.11 %) in the oral cavity, in 9 (13.23 %) in the paranasal sinuses and nasopharynx. A course of radical photon therapy as monotherapy was administered to 59 (86.76 %) patients, a course of chemoradiation treatment to 9 (13.24 %) patients. Control group consisted of healthy people (n = 679) who at the time of questioning did not have a diagnosis of malignant neoplasms. Mean age of the participants was 64 years. Quality of life characteristics associated with rehabilitation potential were determined using a non-specific questionnaire for quality of life evaluation SF-36.

Results. In patients of the treatment group, significant decrease in such quality-of-life characteristics as bodily pain and role-physical functioning was observed. In general, quality of life characteristics in this group were lower than in the control group. It was shown that patients with head and neck malignant neoplasms are prone to limiting social contacts which can be caused by their physical and emotional condition, and have significant pain syndrome. Role functioning is based on the effect of physical condition on daily role performance (work, daily chores) (р = 0.001). On the other hand, every characteristic reflecting various aspects of quality of life of patients with malignant head and neck tumors such as pain intensity, role-physical functioning can be corrected using symptomatic rehabilitation medicine and psychological support.

Conclusion. Data obtained using the SF-36 questionnaire can form a basis for early patient rehabilitation during in-hospital treatment. Th use of various quality of life questionnaires in oncological patients positively affects treatment outcomes. The identified deviations of quality-of-life characteristics from normal values in patients with malignant head and neck neoplasms can be considered psychotherapeutic targets for psychologists, treatment physicians, rehabilitation specialists forming an interdisciplinary team. Collection of information about the patient prior to outpatient appointment promotes improved communication between the patient and the doctor, increases awareness about patient needs after treatment in medical specialists, increases quality of medical care and implementation of personalized medicine principles.

Introduction. Osteoradionecrosis (ORN), a severe and potentially deadly bone complication arising from radiation therapy in the head and neck region, is defined by exposed, irradiated bone that fails to alleviate within three months, with no signs of remaining tumor or cancer recurrence. Research into more effective, less invasive, and safer treatments for ORN is of great importance, highlighting the need for Maxillofacial surgeons and oncologists to carefully select the most suitable treatment plan based on the disease’s advancement. Considering the central role of the RANKL-RANK system in the remodelling and resorbing processes of the bone, new therapies with denosumab and bisphosphonate have been used recently with promising results.

Aim. To evaluate modern conservative and surgical methods in treatment of ORN in the maxillofacial region, based on literature review.

Materials and methods. This study employed a retrospective review of articles and publications from 2018 to 2024, utilizing databases such as Google Scholar, PubMed, Springer Link, and Science Direct. A comprehensive search, utilizing the keywords such as: “jaw osteoradionecrosis”, “head and neck cancer”, “radiotherapy”, “denosumab”, “bisphosphonates”, yielded 318 articles. These articles were then meticulously screened based on their conclusions, and those deemed irrelevant to the research topic were excluded such as experiments conducted on non-human subjects, as well as treatments with unfavourable prognoses and recovery rates. Following a comprehensive analysis of the remaining publications, 47 articles were selected for inclusion in this review.

Conclusion. The management of ORN is dependent on the severity and progression stage of the condition. Early stages of ORN have demonstrated responsiveness to treatments such as PENTOCLO and ozone therapy. In contrast, stages II and III of ORN require more invasive surgical approaches. The integration of surgical methods with non-invasive therapies has been associated with enhanced patient outcomes.

Biopsy of the sentinel lymph nodes is a modern technique of surgical staging of head and neck tumors. It allows to determine advisability of cervical lymph node dissection in patients with early-stage oral cancer.

The article presents a literature review on the history, methodology, and clinical efficacy of sentinel lymph node biopsy. It is shown that technological development and implementation of new indicators increase method efficacy, minimizing unnecessary surgical interventions and decreasing the risk of complications.

Introduction. Despite favorable prognosis for differentiated thyroid cancer, 5–10 % of the cases are radioiodine-refractory form of this pathology characterized by aggressive course. Molecular and genetic causes of the resistance are genetic mutations, primarily in the BRAF (V600E mutations), TP53, TERT, RAS, NTRK and RET genes, oligoclonality, and somatic tumor heterogeneity. These cell events can affect response to targeted therapy, promote the «evasion» effect, development of radioiodine resistance, and underlie the possibility of tumor re-differentiation when treatment affects these targets.

Clinical case. The article describes a clinical case of combination treatment of differentiated thyroid cancer with lung metastases. In 2016–2022, the female patient received 3 courses of radioiodine therapy which did not achieve any significant effect. Due to this, targeted therapy with sorafenib at the place of residence was initiated. Considering development of medication intolerance and disease progression (local metastasis of BRAF-positive tumor and laryngeal stenosis), targeted therapy was switched to BRAF / MEK-specific with subsequent course of radioiodine therapy and achievement of stable disease for 1 year. Genetic examination of the primary tumor and metastasis showed presence of the BRAF^V600E mutation. Variant allele frequencies (VAF) in metastasis and recurrent tumor were 12 and 6 %, respectively. In the recurrent tumor, H1047L mutation in the PIK3CA gene was found (VAF 8 %). Previous examinations in two other laboratories did not show BRAF gene mutation in this tumor which did not correspond to primary partial response to targeted therapy with BRAF / MEK inhibitors. That said, our analysis identified this mutation.

Conclusion. The obtained data highlight significant diagnostic difficulties of analysis of formalin-fixed and paraffin-embedded samples: preanalytical degradation of nucleic acids, fixation artefacts, low VAF, non-representative biopsy sampling increase the risk of false negative results. The presented clinical case demonstrates the necessity of routing of patients with aggressive tumors into specialized centers, and that treatment and diagnostic tactics should be determined by a qualified multidisciplinary team.