Introduction. Urinary tract infections are among the most frequently seen bacterial infections. Worldwide, about 150 million people are diagnosed with urinary tract infections each year, costing the global economy in excess of 3.5 billion US dollars. Urinary tract infections occur more frequently and exhibit more severe symptoms in cancer patients than in patients with other diseases. Material and methods. The paper analyzes the etiology of urinary tract infections in cancer patients during their stay in the hospital. Results. The presented data concern antibiotic-resistant ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species). Comparative data on the sensitivity to different antibiotics were shown. Recommendations for treatment aimed at reducing the selective pressure of certain groups of antibiotics, in particular carbapenems, were given.

The purpose of the study was to analyze the 10-year outcomes after breast-conserving surgery with electronbeam intraoperative radiation therapy (IORT) followed by external beam radiotherapy (EBRT) in patients with breast cancer. Material and methods. The study included 905 patients with stage T1–2N0–1M0 breast cancer, who underwent breast-conserving surgery. Group I consisted of 746 patients who received IORT at a single dose of 10 Gy, biologically equivalent to 24.8 in standard fractionation, followed by EBRT at a total dose of 46 ± 8.1 Gy. A combined IORT and EBRT photon-equivalent dose delivered to the tumor bed was 60 Gy. Group II (control group) comprised 159 who received EBRT at a total dose of 40–44 Gy delivered to the remaining breast tissue and electron therapy delivered to the area of postoperative scar (a single 3–4 Gy fraction, 3 days per week, to the total photon-equivalent dose of 15-18 Gy). The combined photon-equivalent dose was 58 Gy. Results. According to RTOG/EORTC toxicity criteria, grade 1 radiation-induced damage was observed in 413 (55.3 %) patients of Group I and in 71 (44.6 %) patients of Group II (р=0.2); grade 2 radiation-induced damage in 76 (10.1%) and 43 (27 %) patients (p=0.0002) and grade 3 in 18 (2.4 %) and 9 (5.7 %) patients, respectively (р=0.1). Late radiation-induced injuries (grade I and 2) were mostly observed in the control group. Local recurrence was diagnosed in 11 (1.47 %) patients of Group I and in 14 (8.8 %) patients of Group II. The 10-year disease-free survival rates were 97.3 ± 1.08 % and 88.96 ± 2.8 % in Group I and Group II patients, respectively (р<0.05). The metastasis-free survival rates were 94.4 ± 2.7 and 90.46 ± 1.4 %, respectively (р><0.05). Conclusion. In patients with stage T1–2N0–1M0 breast cancer, combination of IORT and EBRT resulted in higher recurrence-free and metastasis-free survival rates than EBRT alone. Key words: breast cancer, combined modality treatment, intraoperative radiation therapy, breast-conserving surgery.><0.05). The metastasis-free survival rates were 94.4 ± 2.7 and 90.46 ± 1.4 %, respectively (р<0.05). Conclusion. In patients with stage T1–2N0–1M0 breast cancer, combination of IORT and EBRT resulted in higher recurrence-free and metastasis-free survival rates than EBRT alone.

Objectives. The purpose of this study was to assess the tolerance and efficacy of accelerated hypofractionated chemoradiotherapy for oropharyngeal cancer. Material and methods. The study included 54 patients with morphologically confirmed primary stage II–IV oropharyngeal cancer. All the patients received neoadjuvant polychemotherapy with the PF regimen followed by radiation therapy alone. Radiation was delivered in daily 2.4 Gy fractions five days per week to high-risk areas up to a total dose of 62.4 Gy and to low-risk areas up to a total dose of 45.6–48 Gy. Results. A response to neoadjuvant chemotherapy was noted in 75.9 % of cases. Stable disease was seen in 24.1 % of patients. After accelerated hypofractionated radiation therapy, 50 (92.6 %) patients demonstrated tumor response and 4 (7.4 %) demonstrated stable disease. A complete response was achieved in 38 (76.0 %) and partial response was achieved in 12 (24.0 %) patients. The one-year overall survival rate was 83.8 %. Grade III and II oral mucositis was observed in 38 (70.4 %) and 16 (29.6 %) of cases, respectively. Therapy had to be interrupted in 33 (61.1 %) patients. On average, the treatment break lasted 14.2 ± 2.4 days. There was no statistically significant difference in survival rates between the patients treated with or without treatment break (p=0.418). The one-year overall survival rates were 88.9 and 70.0 %, respectively. Conclusion. Evaluation of short-term outcomes and our initial experience with accelerated hypofractionated irradiation at 2.4 Gy per fraction in the treatment of oropharyngeal cancer do not still allow us to draw any firm conclusions on these matters. Further follow-up is needed to make an assessment of long-term treatment outcomes and late toxicities.

The purpose of the study was to evaluate the anesthetic effect of the combination of xenon and dexmedetomidine during surgery for gastric cancer. Material and methods. The prospective randomized study included 53 patients with operable II–III stage gastric cancer. The age range was from 26 to 75 years. The patients underwent gastrectomy (n=21) and subtotal distal gastrectomy (n=32). The study group comprised 27 patients who received anesthesia with xenon and dexmedetomidine combined with epidural analgesia. The control group consisted of 26 patients who received anesthesia with sevoflurane in combination with epidural analgesia. Intraoperative patient monitoring was performed according to Harvard intraoperative monitoring standards. Plasma levels of ACTH, STH cortisole, IL-1β, IL-6, and CRP as well as cytokine profile were used to evaluate the effect of two anesthetic methods. Results. In the perioperative period, the combination of xenon and dexmedetomidine in combination with epidural analgesia was characterized by significant inhibition of systemic inflammatory reactions and a lower release of stress hormones as components of a surgical stress response expressed by a lower level of pro-inflammatory cytokines and somatotropic hormone. The frequency of postoperative inflammatory complications was lower in the xenon group than in the control group. Conclusion. The use of the combination of xenon and dexmedetomidine during surgery for gastric cancer provides a more adequate course of the perioperative period.

Germ-line mutations in BRCA1 and BRCA2 genes are the most established risk factors for hereditary breast and ovarian cancers. The purpose of the study was to analyze BRCA1/2 testing in ovarian cancer patients. Materials and methods. We analyzed 222 patients with ovarian cancer (OC) who underwent genetic testing. Results. Recurrent Slavic mutations in these genes were detected in 60/222 (27%) patients.104 patients lacked any clinical signs of hereditary form of the disease, however BRCA1/2 genetic defects were identified among 11 (11%) of these women. BRCA1/2-associated carcinomas were characterized by more advanced stage at diagnosis and predominance of high-grade serous histological tumor subtype. Conclusion. These results emphasize the need for BRCA1/2 testing for all patients with OC. BRCA1/2-associated carcinomas have clinical and pathological cgaracteristics, which should be considered while planning therapy.

Glucocorticoids (GCs) are often used as an adjuvant therapy to reduce the adverse effects of chemotherapy in breast cancer patients. Moreover, GCs can display pro-proliferative or anti-proliferative effects on BC cells depending on their molecular subtype. In addition, long-term use of GCs can induce drug resistance and tumor progression. The biological activity of GCs is mediated by glucocorticoid receptor (GR) via either transrepression or transactivation. The anti-inflammatory effects of GCs are thought to be due to transrepression, while side effects, drug resistance and tumor progression/metastasis are associated with transactivation. We have previously demonstrated that Compound A, a selective GR agonist (SEGRA), has a GR-dependent antitumor effect on blood cancer cells in vitro, not triggering the GR transactivation. This study was focused on the analysis of the CpdA activity in BC models in vitro. We demonstrated the antiproliferative effect of CpdA on BC cells and its ability to induce transrepression of GR-depended genes such as CCND1-3, COX-2, iNOS without the induction of transactivation. A comparative analysis showed that CpdA was an effective and safe alternative to dexamethasone in adjuvant chemotherapy for breast cancer.

Background. Tumor-associated macrophages (TAM) are the main innate immunity cells that regulate the relationship between the infiltrating immunocompetent cells, tumor cells and other components of the microenvironment. TAMs can promote tumor cell proliferation and angiogenesis and can also contribute to tumor response to chemotherapy. The purpose of the study was to assess the prognostic significance of YKL39 and CCL18 gene expression in breast TAMs prior to treatment. Material and methods. A total of 96 patients with histologically verified invasive breast carcinoma of no special type (T1–4N0–3M0) were included into the study. The patients received 2–4 cycles of neoadjuvant chemotherapy. The 5-year metastasis-free survival was analyzed. The YKL39 and CCL18 expression levels were assessed using TaqMan real-time RTPCR. The expression level of >1 (higher than that in the normal tissue) indicated the gene overexpression. Results. There was no association between the YKL39 and CCL18 gene expression levels and the clinical and pathologic features. However, the levels of YKL39 and CCL18 gene expressions were significantly higher in patients having no distant metastases within a 5-year follow-up. Metastasis-free survival was estimated in patients with overexpression of YKL39 and CCL18 genes (YKL39⁺CCL18⁺ ) and in patients with low and high expression levels (YKL39^– CCL18^– , YKL39^– CCL18⁺, YKL39⁺CCL18^– ) using the Kaplan-Meier method. All 100 % of patients (10 out of 10) with YKL39⁺CCL18⁺ macrophage phenotype in a tumor were alive and had no evidence of tumor progression during 5 years of follow-up. In patients with YKL39⁺CCL18^– phenotype, the metastasis-free survival rate was 85 %. In patients with YKL39^– CCL18⁺ and YKL39^– CCL18^– phenotypes, the 5-year survival rates were 71 % and 69 %, respectively. A statistically significant difference in metastasis-free survival between patients with YKL39⁺CCL18⁺ phenotype and YKL39^– CCL18⁺ or YKL39^– CCL18^– phenotypes was found. Data obtained showed the association between TAM marker gene expression and metastasis free survival of breast cancer patients treated with NACT.

Introduction. The choice of adequate treatment for cancer patients and their survival rates signifcantly depend on the precise detection of the primary tumor and the assessment of the extent of cancer involvement. Despite advances in the treatment of laryngeal/hypopharyngeal cancer, many aspects of this problem are still unresolved. The purpose of the study. Diagnostic capabilities of nuclear medicine imaging in the detection and assessment of the spread of laryngeal/hypopharyngeal cancer were studied. Material and methods. The study included 40 patients with histologically verifed laryngeal/ hypopharyngeal cancer, 10 patients with tumor recurrence after completion of therapy and 20 patients with benign laryngeal lesions. Single photon emission computed tomography (SPECT) was performed 20 minutes after the injection of 99mTc-methoxy-isobutyl-isonitrile (MIBI). Sentinel lymph nodes (SLNs) were detected in 26 patients after submucosal injections of 99mTc-Tehneft or 99mTc-Alotech around the tumor. In 18 hours after the injection of 99mTc-Tehneft and 99mTc-Alotech, SPECT was performed. In 24 hours after the injection of 99mTc-Tehneft and 99mTc-Alotech, intraoperative SLN detection was performed using Gamma Finder II. Results. SPECT with 99mTc-MIBI revealed laryngeal and hypopharyngeal tumors in 38 of the 40 patients. The 99mTc-MIBI uptake in metastatic lymph nodes was visualized in 2 (17 %) of the 12 patients. 28 SLNs were detected by SPECT and 31 SLNs were identifed using the intraoperative gamma probe. The percentage of lymphotropic radiopharmaceuticals in the SLN was 5–10 % of the radioactivity in the injection site by SPECT and 12–33 % by intraoperative gamma probe detection. Conclusion. SPECT with 99mTc-MIBI is an effective tool for the diagnosis of laryngeal/hypopharyngeal cancer. The sensitivity, specifcity and accuracy of this technique were 95, 80 and 92 %, respectively. The use of 99mTc-Tehnefte and 99mTc-Alotech for the detection of SLN in laryngeal/hypopharyngeal cancer patients was characterized by high effcacy, while intraoperative detection was more sensitive, being 80 and 100 %, respectively.

The aim of the study was to improve the treatment outcomes for patients with locally advanced recurrent basal cell and squamous cell skin carcinomas of the face. Material and methods. A total of 26 patients with locally advanced recurrent basal cell (n=21) and squamous cell (n=5) skin carcinomas of the skin were treated with radiotherapy (2–2.5 Gy daily fractions to a total dose of 60–70 Gy, 5 days a week) in combination with local freezing of the tumor. Local cooling of the tumor to the temperature of tissue freezing was performed 10–15 minutes before each session of radiation therapy using liquid nitrogen cryo-preservation equipment. Patients with recurrent skin cancer who had received previously radiation therapy were not eligible for cryoradiotherapy. Results. Complete response was achieved in 23 (88.5 %) patients, residual tumors were removed by conventional surgery (n=2) and cryosurgery (n=1). At 2 to 14-year follow up, recurrences of skin cancer occurred in 3 (11.5 %) cases. Good aesthetic and functional results were observed. Conclusion. Cryo-radiotherapy was shown to be effective, providing long-term aesthetic and functional results.

Tamoxifen is a drug of choice for endocrine therapy of hormone receptor- positive breast cancer in women of reproductive age. The metabolic activity of tamoxifen is determined by the activity of the CYP2D6 enzyme encoded by the CYP2D6 gene: under the action of the enzyme, tamoxifen converts into the metabolically active form called endoxifen. Pharmacogenetic testing of the CYP2D6 gene in patients with hormone-positive breast cancer can help to predict response to therapy and assess the risk of side effects with the aim of improving long-term treatment outcomes.

The purpose of the study was a review of available data on the role of autophagy and angiogenesis in the development, progression and prognosis of colorectal cancer. Material and methods. Databases searched were Medline, Cochrane Library and Elibrary. Of 340 studies, 48 were used to write a systematic review. Results. To date, there is a variety of prognostic markers used in the study of pathogenesis, diagnosis and treatment of colorectal cancer. The review describes the molecular mechanisms of the participation of various proteins of autophagy and angiogenesis in the pathogenesis and progression of colorectal cancer, and the potential importance of their use in clinical practice is presented. Conclusion. Many of the existing markers can be used not only in assessing the prognosis, but also sensitivity to chemotherapy. However, the contradictory results of studies with respect to certain proteins require further study, validation, and subsequent introduction into practice.

Astrocytic retinal hamartoma (phacoma, astrocytoma) is a benign tumor, formed through proliferation of glial astrocytes and blood vessels of the sensory part of the retina. For the first time, eye involvement in tuberous sclerosis (TS) was described by J. van der Hoeva, Dutch ophthalmologist in 1921. A characteristic glial tumor is still considered a classic manifestation of this disease, however, retinal astrocytoma can be observed in practically healthy young people or children. We present the case of a 19-year-old woman diagnosed with multiple retinal hamartomas in the right eye. In addition to ophthalmoscopy, we used the additional diagnostic methods to determine the form of hamartomas (calcined or uncalcined) and differentiate astrocytic retinal hamartoma from other tumors of the retina and choroid as well as to exclude pathological changes in the central nervous system.

Advanced well differentiated neuroendocrine tumors (NET) have poor sensitivity to chemotherapy. Biotherapy and targeted therapy are the main treatment options for these patients. Approaches to the 2nd and subsequent lines of treatment have not been developed to date. VEGFR blocker bevacizumab is actively studied in well differentiated NET. For well differentiated NET, it has been shown that an increase in VEGF expression is associated with metastasis and decrease in progression-free survival.

We present the case of a 67-year-old patient diagnosed with retroperitoneal leiomyosarcoma and solitary pulmonary metastasis. The patient underwent left lower lobectomy and retroperitoneal tumor extirpation simultaneously. This surgery resulted in good outcomes and significant shortening of the hospital stay. This case demonstrates the benefits of simultaneous surgeries for patients with retroperitoneal leiomyosarcoma and solitary pulmonary metastasis, providing the 5-year survival of 32 %.

The contents of Siberian Journal of Oncology for 2017.

List of authors of articles published in 2017.