Surgical resection for proximal gastric cancer remains an important problem of oncology. Personalized surgical management represents one of the main challenges in treating gastric cancer. The aim of the study was to analyze surgical outcomes of proximal gastric cancer depending on the tumor spread, extent of surgery and the presence of intraperitoneal free cancer cells. Material and Methods. The study included 68 patients with morphologically verified locally advanced proximal gastric cancer. The patients were divided into 2 groups. Group I consisted 37 patients, who underwent total gastrectomy of 31 patients; Group II comprised who underwent proximal subtotal gastrectomy. Results. The overall three-year survival was 48.7 ± 16.9 % in Group I and 66.4 ± 13.2 % in Group II patients. The 3-year progressive-free survival rate was 51.5 ± 18.5 % after proximal subtotal gastrectomy and 34.8 ± 25.6 % after total gastrectomy. The presence of tumor cells in the abdominal cavity was proven to lead to early carcinomatosis. Thus, the 2-year overall survival rate was 26.7 ± 42.8 % in patients in whom free cancer cells were found in peritoneal washings and 69.8 ± 9.0 % in patients with negative cytology findings from washings. Conclusion. Proximal subtotal gastrectomy provides better survival rates compared to total gastrectomy in patients with locally advanced proximal gastric cancer. Local spread of the tumor, which is known to significantly increase the risk of lymph node metastasis and contamination of the peritoneal cavity with cancer cells, is one of the main unfavorable prognostic factors.

Nosocomial infections caused by gram-positive organisms, including Staphylococcus aureus and enterococci (Enterococcus faecium and Enterococcus faecalis) are steadily increasing in almost all clinics around the world. Cancer patients have a higher risk of hospital-acquired infections than non-cancer patients. Cancer patients are immunosuppressed due to increased use of broad-spectrum antibiotics and chemotherapy drugs, radiation therapy, surgery and use of steroids. This paper presents an analysis of resistance of gram-positive bacterial pathogens to antimicrobial agents to determine treatment strategy for cancer patients.

The differential diagnosis of solitary pulmonary nodules remains a challenge in oncology. Dynamic contrastenhanced CT is a potentially valuable tool capable of detecting malignancy. The purpose of the study was to evaluate the value of dynamic CT in the differential diagnosis of solitary pulmonary nodules. Material and methods. Fifty two patients with solitary pulmonary nodules underwent CT examination using a GE Optima CT660. The CT protocol included: 1) scan volume from the jugular notch to the end of the diaphragmatic dome; 2) location of the nodule in the lung; 3) scanning time for 30 sec, 1 min, 2 min, 4 min and 6 min following contrast agent injection. The image processing was carried out on an Advantage Workstation for Windows (AW4.5, GE Healthcare). The CT findings were verified by histology after CT-guided transthoracic biopsy of lung lesions and lung surgeries. Results. The sensitivity, specificity and accuracy of dynamic contract-enhanced CT were higher than those without dynamic CT (85, 95 and 92 % versus 71, 95 and 88 %, respectively).

We presented results of monotherapy and combination therapy of transplantable murine tumor models using methionine-gamma-lyase (MGL) and pyridoxine hydrochloride. We studied MGL from Clostridium sporogenes and Citrobacter freundii. We used Lewis lung carcinoma (LLC), melanoma B16, leukemias P388 and L1210 and Fisher lymphadenosis L5178y. Neither monotherapy with MGL nor combination of MGL and pyridoxine demonstrated antitumor activity against P388 and L5178y. In the murine L1210 leukemia model, MGL C. sporogenes injected intraperitoneally in the dose of 2000 U/kg, 11 times with a 12-hour interval increased the life span of mice (ILS=22 %, р=0.035). In the LLC model, the combination of MGL C. sporogenes at a dose of 400 U/kg, i.p., 4 times with a 48-hour interval and pyridoxine at a dose of 250 mg/kg led to tumor growth inhibition (TGI=55 %, р<0.001) on the first day after the completion of treatment. Monotherapy with MGL or pyridoxine in the same regimens resulted in a 24 % TGI (р=0.263) or 21 % TGI (р=0.410), respectively. In a pair-wise comparison of treatments, MGL + pyridoxine was more effective compared to MGL used alone (р=0.061) and MGL + pyridoxine was more effective then pyridoxine alone (р=0.031). MGL from C. freundii at a dose of 200 U/kg, 4 times with a 48-hour interval plus pyridoxine at a dose of 500 mg/kg injected on day 9 after the completion of treatment led to 50 % TGI, whereas MGL monotherapy at a single dose of 400 U/kg or pyridoxine monotherapy in the same regimen showed 5 % TGI (р=0.991) and 4 % TGI (р=0.998), respectively. The pair-wise comparison showed that MGL (200 U/kg) + pyridoxine was more effective than MGL (400 U/ kg) alone (р<0.001) and pyridoxine alone (р=0.003). In the B16 model, the combination of MGL injected i.p at a dose of 2000 U/kg and pyridoxine at a dose of 300 mg/kg showed 56 % TGI on day 1after the completion of treatment (р=0.045) and 35 % TGI on day 3 (р=0.038). Pyridoxine significantly increased the anticancer effect of MGL: MGL 1000 U/kg i.p and MGL 1000 U/kg i.p. + pyridoxine 300 mg/kg led to TGI=45 % (р=0.034) on day 3 after the completion of treatment. Single maximum tolerated dose after multiple i.p. administration was defined as 2000 U/kg, simultaneous administration of pyridoxine did not increase the toxicity of MGL. In conclusion, LLC and B16 are sensitive to MGL treatment, and pyridoxine may increase the efficacy of MGL.

The relative biological effectiveness (RBE) of fast neutrons is an important factor influencing the quality of neutron therapy therefore, the assessment of RBE is of great importance. Experimental and clinical studies as well as different mathematical and radiobiological models are used for assessing RBE. Research is conducted for neutron sources differing in the method of producing particles, energy and energy spectrum. Purpose: to find and analyze the dose-dependence of fast neutron RBE in neutron therapy using the U-120 cyclotron and NG-12I generator. Material and methods: The optimal method for assessing the relative biological effectiveness of neutrons for neutron therapy was described. To analyze the dependence of the RBE on neutron dose, the multi-target model of cell survival was applied. Results: The dependence of the RBE of neutrons produced from the U-120 cyclotron and NG-120 generator on the dose level was found for a single irradiation of biological objects. It was shown that the function of neutron dose was consistent with similar dependencies found by other authors in the experimental and clinical studies.

Currently, the study of the markers of cell differentiation, proliferative regulators, and molecules involved in the development of drug resistance mechanisms in breast cancer is extremely important. The transcription factor GATA3 plays an essential role in the differentiation and proliferative activity of luminal breast cancer cells, being a tumor suppressor. The GATA3 positive expression is most frequently observed in invasive carcinoma of no special type. High expression of GATA3 is associated with low-grade ER-positive cancer with a favorable prognosis. Low GATA3 expression is observed in patients with high-grade and hormone receptor-negative cancer. The study of GATA3 expression is necessary for understanding the development of drug resistance mechanisms and developing approaches to overcome them as well as for determining the response to hormone therapy. Aim. The present study was undertaken to study the expression characteristics of the transcription factor GATA3 in patients with luminal breast cancer and to evaluate their relationship with the parameters of lymphogenous metastasis. Material and methods. The study included 64 patients with stage T1–4N1–3M0 invasive breast cancer. The primary tumor tissue and all removed lymph nodes were morphologically examined. The diagnosis was established according to the WHO criteria (2012). Results. Low GATA3 expression was associated with a high risk of lymph node metastases, while high GATA3 expression was associated with the absence of lymph node metastases. Heterogeneous GATA3 expression was associated with high risk of lymph node metastasis, and as a consequence, with poor prognosis. Conclusion. The relationship between the expression of GATA3 protein and lymphogenic metastasis in patients with luminal breast cancer was found.

The purpose of the study was to evaluate the epidemiological aspects of the three major gynecologic cancers (cervical, endometrial and ovarian cancers) in Tomsk region. Material and methods. The data collected by the population-based cancer registry and the territorial body of the Federal State Statistics were analyzed. The epidemiological situation in Tomsk region between 2007 and 2015 was studied. Results. Gynecologic cancer is one of the most common cancers affecting women in Tomsk region. Cervical cancer is the 4-th most frequent cancer in Siberian Federal District. The incidence of gynecologic cancer has been steadily rising over time. Early diagnosis of endometrial and ovarian cancers remains a significant clinical challenge. The one-year mortality rate is still high. We recognize that unlike cervical cancer, screening benefits have not been shown for endometrial and ovarian cancer. To improve the specialized care for gynecological cancer patients, the screening programs in the region were approved.

Background. Splenic flexure mobilization (SFM) is a difficult step within both conventional and laparoscopic procedures, often associated with intra- and postoperative morbidity. Additional difficulties occur because of the lack of generally accepted methods for performing SFM. Despite many reports, the routine SFM during low rectal resections remains controversial. Aim. This paper presents the strategy for SFM used in our clinic, as well as the surgical treatment outcomes in patients who underwent low rectal resections with or without SFM. Methods. Two retrospective analyzes of the surgical procedures were made. In the first case, the results of all LS operations with SFM (n=120) were analyzed. In the second case, a retrospective analysis of the LS rectal resections was carried out (low anterior resection (LAR) with the SFM (n=32), pull-through rectal resection with the SFM (n=20) and LAR without SFM (n=94)). Results. In the first analysis, patients were divided into 4 groups: LS-left colectomy, LS-low anterior rectal resection, LS-colproctectomy, and LSpull-through rectal resection. There was no significant difference between the groups in terms of intra- and postoperative complications. In the second analysis, the differences in the operation time, blood loss and hospital stay between low rectal resections were not statistically significant. Anastomotic leakage was detected in 2 patients in the LAR with SFM group, in 8 patients (8.5 %, 8/94) in LAR without SFM group, and in 1 patient in pull-through rectal resection group (5 %, 1/20), p=0.17. Conclusions. Using the laparoscopic approach to SFM, optimal surgical outcomes can be achieved. Routine SFM during low anterior rectal resection is not necessary, because it does not lead to decreased incidence of anastomotic leakage and complications. Routine SFM during pull-through rectal resection is necessary.

Recently, there has been a growing interest in the use of active beam scanning proton therapy for re-irradiation of CNS tumors. Although this treatment option for recurrent intracranial tumors is considered effective, however, it is rarely used because of severe radiation-induced neurologic complications. We present 3 case reports of using active beam scanning proton therapy for re-irradiation of intracranial tumors. In the first case, the patient with high-grade glioma was treated with proton beam therapy 1.5 years after the previous conventional external beam radiation therapy. Tumor regression lasting 18 months was achieved. In the second case, the patient received repeated proton beam therapy for recurrent esthesioneuroblastoma. After 1.5 years of follow-up, no evidence of recurrence and late toxicity was observed. The third case was unique, since the patient with recurrent hemangiopericitoma of the orbit received 4 courses of radiotherapy to the same area. A significant regression with no evidence of radiation-induced damage was also seen 12 months after the completion of radiation treatment. Conclusion. Recent advances in proton therapy allow for re-irradiation of CNS tumors in effective total doses, while reducing exposure to surrounding normal tissues. The use of PET-CT for contouring the target allows the localization and volume of the metabolically active tumor tissue to be precisely determined.

The review presents the clinical and morphological characteristics of early gastric cancer. According to the most recent concepts, early gastric cancer is considered as endoscopically resectable cancer with good prognosis. Currently, early gastric cancer is defined as non-invasive high-grade intraepithelial neoplasia (severe dysplasia) and well-differentiated adenocarcinoma with intramucosal (T1a) and/or minor submucosal (T1b1) invasion as well as poorly cohesive carcinoma, including signet-ring cell carcinoma, confined to the gastric mucosa (≤ 3 cm) without ulceration. Most authors consider that early gastric cancer should be characterized by the absence of regional lymph nodes (N0) and distant metastasis (M0). Early gastric cancer should be classified according to the macroscopic criteria proposed by the Japanese Society of Gastroenterological Endoscopy or the revised version of the Paris classification of superficial neoplastic lesions in the digestive tract as well as according to the World Health Organization classification and the recommendations of the Japanese Gastric Cancer Association. It is important to evaluate lymphovascular invasion in all early gastric cancer cases because of high risk of local metastases. Moreover, cases with mixed-type early gastric cancer (differentiated and undifferentiated components) need to be carefully examined, as they are high-metastatic potential lesions. The review considers predictive criteria for assessing the risk of regional metastasis in early gastric cancer. Cases of hereditary diffuse gastric cancer caused by CDHI gene mutations have been also analyzed. A literature review have allowed us to give recommendations on the risk stratification and the choice of an adequate treatment in patients with early gastric cancer

The literature review on the role of cytokine gene polymorphisms in the development of chronic pain in cancer patients was presented using MedLine, PubMed, NEB elibrary.ru, WileyOnlineLibrary, WebofScience, OxfordUniversityPress and SAGEPremier databases for years 1995 to 2016. The role of inter-individual differences based on cytokine gene polymorphisms and their receptors for personalized anesthetic and accompanying treatment in oncology was shown.

The paper analyzes data on kidney cancer incidence and mortality in Russia and Saint-Petersburg, highlights the issues related to the diagnosis and treatment of kidney cancer, depending on the stage of the disease and the age of the patient. The incidence of kidney cancer has been steadily increasing over the last ten years, and this is predominantly related to the advances in imaging technology and because of the growth and aging of the population. In Russia, the kidney cancer incidence is expected to increase rapidly due to increases in proportion of early kidney cancer patients that makes it extremely important to improve the organ-preserving treatment of this disease. Morphological verification must necessarily be done both in patients with metastatic cancer and in patients planning to undergo ablation treatment.

Recently, there has been an increasing use of laparoscopy in the surgical treatment of gynecologic cancer. We aimed to analyze the feasibility of performing laparoscopic pelvic extentaration for stage IVa cervical cancer. Case report. We present the case of a 61-year-old patient diagnosed with stage IVa (T4N0M0) cervical cancer. The examination revealed cervical cancer invading the bladder wall and extending to the mouth of uretersю The patient underwent laparoscopy and bilateral uretherocutaneostomy as the first line treatment. When creatinine and urea blood levels were in the normal range, the patient underwent laparoscopic anterior pelvic exentaration as the second line treatment. After surgery the patient received pelvic external beam radiation therapy. The follow-up period was 6 months. Conclusion. We have shown the feasibility of performing laparoscopic anterior pelvic exenteration for stage IVa cervical cancer complicated by complete obstruction of one kidney and partial obstruction of another kidney

Endometrial cancer is the 6-th most common malignancy in women worldwide, accounting for about 4.8 % of all female cancers. The treatment of recurrent endometrial cancer remains a major challenge. Some endometrial cancer recurrences, for example vaginal stump recurrence, are reported to be effectively treated with surgical resection and radiation therapy. Early recurrence of early-stage well-differentiated endometrial cancer is uncommon. Case report. Herein we report a rare case of recurrent well-differentiated endometrial cancer in a 65-year-old woman. The patient had recurrence 10 months after laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Recurrent endometrial tumor with extension into the rectosigmoid colon, urinary bladder and the right ureter manifested itself clinically with severe pain requiring the use of opioids. The recurrent tumor was removed. Resection of the bladder, left ureter and upper ampular rectum was followed by anastomosis. The patient received multiple cycles of chemotherapy. Conclusion. Compliance with the principles of ablastics during the laparoscopic or laparotomic surgery helps to avoid recurrence in patients with prognostically favorable cancer. In case of recurrence, combined operations are the only possible chance of improving survival of patients with locally advanced or recurrent tumors, which are insensitive to chemoradiotherapy.