Background. Planning the organization of medical care for children diagnosed with cancer as well as assessing the quality of care is based on the statistical data analysis.

The purpose of the study was to analyze the main parameters characterizing medical care for children with cancer in the central Federal district.

Material and methods. The reports of the executive authorities in the sphere of health protection of 18 subjects of the Russian Federation included into the central Federal district were analyzed for 2017.

Results. The number of children aged 0–17 years was 6 824 049, the number of pediatric oncology departments was 9, the number of hospital beds for children with cancer was 464, the number of bed-days per year was 319.3. the number of physicians providing pediatric cancer care was 91, of them 64 (70.3 %) had a certificate of a pediatric oncologist. in 11 subjects of the Russian Federation, there were no departments of pediatric oncology, and in 1of them, there were no hospital beds for children with cancer. the number of patients newly diagnosed with cancer was 821. the number of patients who died of cancer was 156, of them 66 were diagnosed with cancer in 2017. the cancer incidence rate was 12 per 100,000 children aged 017 years; the mortality rate was 2.3 per 100,000 children aged 017 years. the one-year mortality rate was 8 %. the mean time taken to establish the diagnosis and the time interval between diagnosis and initiation of treatment was unknown, since the reports did not contain precise information. twelve (1.5 %) patients left the territory of the Russian Federation for receiving treatment outside the Russian Federation.

Conclusion. The information provided in most reports was not statistically reliable. the cancer incidence rates were significantly lower than those in countries with high statistical reliability. For reliable estimation of the number of inpatient beds for children with cancer and the percentage of children referred for the treatment to the federal medical centers, it is necessary to implement a unified database for pediatric oncology in the Russian Federation.

Purpose: to analyze toxicity of combined modality radiotherapy in high-risk prostate cancer patients.

Material and methods. Short-term outcomes after combined modality radiotherapy were analyzed in 88 prostate cancer patients treated at clinic of the a.F. tsyb medical Radiological Research center between april 2016 and February 2018. the median follow-up time was 13 months (range, 3–23 months). the mean age of the patients was 64.8 years (range, 49–80 years). an initial psawas in the range of 3.5–114 ng/ml (mean 16.7 ng/ml). all patients were considered high-risk according to the d’amico classification. the patients were divided into two groups according to the sequence of combined modality radiotherapy. in group 1, the patients (n=45) received conformal EBRtto a total dose of 44–46 gy, and 2–3 weeks later, they underwent high–dose rate ¹⁹²ir- brachytherapy (one single fraction of 15 gy) as a boost to EBRt. in group 2, the patients (n=43) were treated with interstitial brachytherapy followed by EBRtdelivering at total doses of 44–46 gy.

Results. All patients eventually completed the combined modality radiotherapy course planned for them. acute, grade 1 genitourinary (gu) toxicities (Rtog/EoRtc) occurred in 29 (32.9 %) patients. acute gastrointestinal (gi) toxicity was grade 1 in 17 (19.3 %) and grade 2 in 2 (2.3 %) patients. late gutoxicity was grade 1 in 6 (6.8 %) and grade 2 in 3 (3.4 %) patients. an urethral stricture developed in 1 (1.1 %) patient. late gitoxicity was grade 1 in 8 (9.1 %) patients and grade 2 in 6 (6.8 %) patients.

Conclusion. The preliminary results of this study suggest satisfactory tolerability of combined modality radiotherapy by prostate cancer patients. the level of acute toxicity and complications in critical organs is quite acceptable, which maintains high quality of life for patients and does not exceed the published data.

Background. Previous pre-clinical and clinical trials showed that distress experienced by cancer patients can activate the sympathetic nervous system, resulting in the elevation of the level of catecholamines in tumor tissue. catecholamines activate tumor neoangiogenesis via binding to the adrenergic receptors of tumor cells and cells of tumor microenvironment. Vascular endothelial growth factor a(VEgF a) plays a key role in tumor neoangiogenesis.

Objective. To evaluate the correlation between serum VEgF alevel and distress in ovarian cancer patients.

Material and methods. The prospective cross-sectional study included 100 patients with stage i–iV ovarian cancer. the median age of the patients was 56 ± 9,56 years. Enzym-linked immunosorbent assay was used for the assessment of serum VEgF alevel. distress thermometer (validated self-reported questionnaire) was used for distress diagnosis.

Results. The median serum VEgF alevel was 325.77 pg/ml. aclinically significant distress was diagnosed in 54 % of patients. We found the correlation between the serum VEgF alevel and distress level in ovarian cancer patients (spearman’s rho=0.33; 95 % ci, 0.11–0.52; р< 0.004). We also found the correlation between the serum VEgR alevel and disease stage (rho=0.30; 95 % ci0.02–0.53; p<0.05). However, there was no correlation between distress and disease stage. the regression analysis method revealed that distress was an independent factor of serum VEgF aelevation in ovarian cancer patients (p<0.05).

Conclusion. Assessment and early diagnosis of cancer-related distress was shown to be important for the appropriate management of ovarian cancer.

The purpose of the study was to evaluate the frequency of isolation of multi-resistant Pseudomonas aeruginosa and identify the mechanisms of resistance to carbapenems.

Material and methods. We analyzed 866 strains of Pseudomonos aeruginosaisolated from clinical samples from cancer patients in the period 2014–2016. the level of resistance to piperacillin/tazobactam, ceftazidime, cefepime, imipenem, meropenem, ciprofloxacin, amikacin in dynamics was determined. carbapenem-resistant (car-R) strains were examined for the presence of enzymes.

Results. Between 2014 and 2016, the number of strains resistant to piperacillin/tazobactam was 20.1–12.9 %, to ceftazidime – 33.0–32.9 %, to cefepime – 25.6–32.9 %, ciprofloxacin – 36.8–43.8 %, amikacin – 23.8–24.9 %. No statistically significant differences were found (p>0.05). However, an increase in the number of car-R strains from 31.7 to 43.8 % was observed (p<0.05). of 7 strains of P. aeruginosainvestigated for the presence of acquired carbapenemases, the production of metal-beta-lactamase of group Vimwas detected in 2 strains, and class acarbapenemases of the gEs-5 group in one strain.

Conclusion. P. aeruginosaresistance to all antibiotic groups did not exceed 50 % and remained almost unchanged for 3 years, with the exception of the increase in car-R strains. three out of 7 (42.9 %) carbapenem-resistant strains were genetically stable.

A personalized lung cancer risk assessment is important for disease prevention.

The aim of the studywas to estimate a significance of immunoanalysis of antibodies to benzo[a]pyrene, estradiol and progesterone for lung cancer risk prediction in men with respect to age and smoking.

Material and methods. Serum antibodies to benzo[a]pyrene, estradiol and progesterone in the blood serum of 620 healthy men (279 smokers) and 827 lung cancer patients (627 smokers) were studied using semi-quantitative enzyme immunoassay.

Results. The high lung cancer risk was observed in smokers aged over 55 years: oR=15.4 (11.5–20.8 95 % ci). the lung cancer risk in this group of patients was significantly lower when their levels of antibodies to benzo[a]pyrene and to estradiol were lower than those to progesterone: oR=3.2 (2.0–5.0). the lung cancer risk was higher when the personal levels of antibodies to benzo[a]pyrene and to estradiol were higher than the levels of antibodies to progesterone: oR=20.0 (10.5–38.1).

Conclusion. The immunoassay of the blood serum antibodies specific to benzo[a]pyrene, estradiol and progesterone could be useful for determination of the lung cancer risk in men.

The goal of radiotherapy is to maximize the radiation dose to abnormal cancer cells while preventing damage to healthy tissue. in neutron therapy, the optimum regime of treatment is uncertain to date.

The purpose of the study to develop a set of methodological approaches that ensure the permissible frequency and severity of radiation-induced reactions in cancer patients subjected to neutron and neutron-photon therapy (NFt) using u-120 cyclotron.

Material and methods. We used the dependence of the relative biological effectiveness (RBE) of neutrons on the dose and time-dose-fractionation model (tdF). the interaction of neutrons with various types of tissues was analyzed, and the algorithm for summing neutron and photon doses in neutronphoton therapy was developed.

Results. Clinical studies of neutron-photon therapy showed that the developed approaches can predict and prevent serious damage to normal tissue with a satisfactory accuracy. the role of all factors influencing the nature of radiation reactions was taken into account in the computer program, which allowed the main characteristics of the planned courses of neutron-photon therapy to be obtained.

The purpose of the study was to assess the feasibility and safety of using the technique of intraoperative sentinel lymph node (slN) detection guided by indocyanine green dye in endometrial cancer patients.

Material and methods. The study included 10 patients with stage i–ii/g1–2 endometrial cancer. the mean age of the patients was 66.2 years. laser-assisted indocyanine green (icg) fluorescent dye was used for slN mapping. icgwas injected into the uterine cervix immediately before surgery. the concentration used for icgwas 1.25 mg/ml (a 25 mg vial with icgpowder was diluted into 20 cc of aqueous sterile water. icgwas injected intracervically at 3 and 9 o’clock positions: 0.5 ml at 5 mm depth and 0.5 ml at 10 mm depth. the pinpoint endoscopic fluorescence imaging system (Novadaq, canada) was used for slN mapping.

Results. SLNs were identified and removed in all patients. SLNs were located along the external iliac vessels in 6 patients and in the obturator fossa and in the hypogastric vessels in 4 patients. an additional para-aortic lymph node was visualized in one case. Both urgent and planned histological examinations showed no evidence of metastases in all patients. pelvic lymph node dissection was performed in 4 patients. combined pelvic and para-aortic lymph node dissection was performed in one case.

Conclusion. Lymph node involvement is an important prognostic factor in deciding whether neoadjuvant chemotherapy is necessary for endometrial cancer patients. the technique of slN detection using indocyanine green dye appears promising in ensuring adequate intraoperative staging and optimization of the extent and duration of surgery. the use of this algorithm for the treatment of endometrial cancer will significantly reduce the risk of perioperative complications associated with lymphadenectomy, not negatively influencing the disease outcome.

Introduction. Urogenital and anorectal functional disturbances associated with the pelvic autonomic nerve damage are common complications of rectal cancer surgery. the search for methods of intraoperative identification of the autonomic nerve plexus is currently one of the key tasks in modern surgery of rectal cancer. the purpose of our study is to evaluate the role of intraoperative neuromonitoring in rectal cancer surgery.

Material and methods. In 2017 we performed intraoperative neuromonitoring during rectal cancer surgery in two cases. the superior hypogastric plexus and the inferior hypogastric plexus were identified and the pelvic autonomic nerve was preserved in both patients. urogenital and anorectal functional outcomes were assessed in the postoperative period.

Results. Satisfactory functional outcomes in the late postoperative period and at the 12-month follow-up suggest that intraoperative neuromonitoring may be useful in identification and prevention of the pelvic autonomic nerve damage in patients with rectal cancer.

Conclusion. This method would be difficult to use routinely for intraoperative identification of the autonomic nerve plexus but could be especially useful for the study of pelvic physiology. With further development, the method of intraoperative neuromonitoring could help discover a technique that will improve the surgical treatment of rectal cancer. Further research using intraoperative neuromonitoring is needed to more precisely determine its value in the preservation of urinary, anorectal and sexual function.

Background. According to the novel approach to the treatment of patients as persons, the phenomenon of palliation distinguishes modern medicine from the traditional medical paternalism. it means that medical science and practice go beyond physical health, when treatment methods aimed to improving the quality of patient’ life are widely used. man as a phenomenon of culture becomes something much more than his physical body.

The purpose of the study was to analyze the palliative care legislation.

Results. The palliative care was shown not to be a type of medical care, but it refers to the terms used in clinical practice to determine the purposes of specialized treatment aimed at not curing the disease, but rather extending life and controlling symptoms. conclusion. it is necessary to include patients’ relatives and friends to the number of people in need of medical care. The development of the federal state educational standard of higher education in the specialty of a palliative care physician is also of great importance.

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality worldwide. Folate metabolism plays an important role in carcinogenesis through its involvement in the process of dNamethylation and repair.

The aim of our study was to evaluate the relationship between MTHFR С677Т (rs1801133), MTR A2756G (rs1805087), MTRR А66G (rs1801394) gene polymorphisms and lung cancer risk.

Material and methods. Asystematic literature search was conducted in the electronic databases pubmed, elibrary.ru in the time period between 2003 and 2018.

Results. The MTHFR C677Tand MTRR А66G gene polymorphisms were found to be significantly associated with lung cancer. No significant association between the MTR A2756Gpolymorphism and lung cancer risk was found. the variant alleles of MTR 2756A > Gand MTRR 66A > Gpolymorphisms may have a joint effect on lung cancer risk. anumber of factors, such as nationality, smoking, gender, and an accurate diagnosis can influence the results of studies on the role of genes involved in folate cycle in patients with lung cancer.

Conclusion. Future studies are needed to consider gene-gene and gene-environment interactions in lung cancer. Further investigations on MTHFR С677Т (rs1801133), MTR A2756G (rs1805087), MTRR А66G (rs1801394) polymorphisms and lung cancer susceptibility may provide a theoretical basis for lung cancer prevention.

Background. Assessment of hormone receptor status plays a crucial role in treatment of patients with breast cancer. currently, clinicians are limited to determining the expression status of estrogen receptor (ER), progesterone receptor (pR) and HER2 only in primary breast cancer tissues, even in the presence of regional metastases.

The purpose of the study was to review available data on heterogeneity of ER, pR and HER2/neu expressions in primary breast cancer and regional metastases.

Material and methods. We analyzed publications available from pubmed, medline etc. using the keywords «discordance», «breast cancer», «locally advanced», «regional lymph nodes», «ER», «pR», and «HER2».

Results. The clinical and prognostic role in assessing the heterogeneity of the receptor status of primary tumors and synchronous regional metastases, as well as the effect of detected discordance on treatment tactics was assessed.

Conclusion. Data on the frequency of discordance in hormone receptor status between primary and metastatic breast cancer tumors and its effect on the further prognosis in breast cancer are still contradictory. However, the fact of the presence of such heterogeneity suggests that some patients with affected lymph nodes will have significant benefits from determining the status of steroid hormones and HER2 not only in the primary tumor, but also in the lymph nodes, since it will open up new opportunities for subsequent targeted therapy.

Cervical cancer is the second most common cancer after breast cancer and the third most common cause of cancer-related death followed by breast and lung cancers among women worldwide. advances in diagnostic imaging techniques provide better assessment of regional and distant cervical cancer metastasis. the use of contrast-enhanced ultrasound is a revolutionary imaging modality; it has several advantages over ct: no radiation exposure, nephrotoxicity, obtaining real-time information, relatively low cost and ease of use. currently, the contrast agent sonoVue is widely used in ultrasound imaging of liver, kidneys and pancreas lesions, as well as for closed abdominal injuries, multiple organ failure, breast and prostate cancers, etc. However, the role of contrast-enhanced ultrasound in gynecology is not clearly established. one of the most effective tools for the detection of locally advanced cervical cancer is mRi, which is used mainly to determine the local extent of the tumor. However, the use of functional mRitechniques has not yet been included in the standards. cervical cancer tissue has been found to show significantly lower diffusion-weighted imaging (dWi) values than normal cervical tissue, thus facilitating the detection of tumor and its spread. dWiis also used for differentiating changes after biopsy from residual tumor and for identifying small lymph nodes. the pEt/cttechnique combines the metabolic images of pEtwith anatomical images of ctand is more accurate than high resolution ctalone, especially in determining the involvement of regional lymph nodes and distant organs. 18-Fdg-pEt/cthas been successfully used for accurate staging of the disease (especially late stage), assessment of treatment response, radiotherapy planning, and detection of disease progression. in patients with advanced stages of cervical cancer (iiBiV stage), the 18-Fdg-pEt/ ctfindings can determine the treatment strategy in most cases, primarily due to high sensitivity (75–100 %) and specificity (87–100 %) in the detection of lymph node metastases.

Cervical cancer is one of the most common cancers among women of reproductive age. The cytological screening is not always effective and appropriate, therefore the search for new predictive markers of the cervical cancer are of great importance. there are no biomarkers for monitoring patients previously treated for cervical cancer. liquid biopsy is a new option of personalized approach to the detection and monitoring of cervical cancer. it is a set of methods for determining the derivatives of a tumor in biological media, most often in the blood: circulating tumor cells, circulating dNa, RNa, exosomes, etc.

The purpose of the studywas to analyze data on the role of liquid biopsy in the diagnosis and monitoring of cervical cancer.

Material and methods. We analyzed publications available from pubmed, Elibrary over the past 10 years.

Results. Circulating tumor cells, circulating tumor dNa and exosomes are the most studied cancer non-invasive biomarkers. these circulating biomarkers play a key role in the understanding of cervical carcenogenesis, chemo-and radioresistance. currently, liquid biopsy is considered as a promising modern method for the detection and monitoring of cervical cancer. the diagnostic efficiency of this method is good, so it can be used for cervcal cancer screening. However, such statements require further research in this direction. in addition, given the emerging information on the molecular carcinogenesis of cervical cancer, liquid biopsy can also be used as a basis for the development of targeted therapy for locally advanced and generalized cervical cancer.

Conclusion. Liquid biopsy is the non-invasive method of cervical cancer monitoring.

This study aimed to reveal the spectrum of BRca1 and BRca2 genes mutation in various ethnic groups of the Russian Federation. asystematic literature search includes data for the past 10 years and was conducted by using electronic databases of pubmed, eliBRaRY and ect.

Material and methods. The review includes research data on the frequency of mutations of breast cancer-associated genes in various ethnic groups of the Russian Federation.

Results. For «slavic» patients with a family history, the BRca1/2 mutation testing is the standard of care. in addition, the development of new antitumour drugs has resulted in improved survival rates. more than 1000 mutations of the BRca1 gene have been identified. Recent research is focused on the confirmation the beneficial effect of identified mutations. For the indigenous population (mongoloid ethnic groups), there are no standards for the treatment of inherited breast cancer. thus, the advances in molecular oncology for the treatment of hereditary breast cancer are not available for the indigenous population of the Russian Federation.

Conclusion. In this context, the search for markers of early cancer detection and the development of criteria for therapy response are relevant for indigenous people. the development of new predictive and prognostic criteria of breast cancer among mongoloid ethnic groups with a family history will allow the innovative strategies for personalized molecular therapy to be developed.

Pseudomixoma peritonei is a rare type of peritoneal carcinomatosis demonstrating an indolent course and a high rate of recurrence. primary surgical interventions in patients with pseudomixoma peritonei are extensive and traumatic, which worsens the chances for performing re-operation and may increase the rate of postoperative complications. above mentioned circumstances forms a problem in the choice of management for patients with recurrent pseudomyxoma peritonei. in this article we present a clinical case of successful treatment of recurrent disease.

Сlinical case. The 62 years female patient in 2006 first noticed pain in the lower abdomen. the examination revealed a tumor near the right appendages. on 28.12.2006 the uterus was extirpated with appendages, appendectomy, resection of the large omentum; 6 courses of chemotherapy (cap) were conducted. in may 2007 and June 2009, repeated cytoreductive operations were performed with subsequent 12 courses of chemotherapy. in 2012 a patient with a relapse of the disease was re-operated at the N.N. Blokhin NmRcof oncology. Re-operation was performed in the volume of removal of bulk of the tumor in the right and left sub-diaphragmatic spaces with resection of both domes of the diaphragm, splenectomy, removal of the remaining part of the large omentum, with subsequent hyperthermic intraperitoneal chemoperfusion with cisplatin. complications were not noted. after 14 months, ctand ultrasound revealed progression of the disease. in 2013 an attempt was made to re-surgical intervention. during re-operation in the abdominal cavity a massive adhesive process was found. given the palliative nature of the intervention and the high risk of progression, the volume of surgery is limited to a biopsy of the tumor mass. later 4 courses of chemotherapy were conducted. during period of follow-up, relapse of tumor was noted with the development of partial small intestinal obstruction, which did not require emergency intervention. at present, 26 months after the combined treatment, the patient’s condition is satisfactory, with no signs of intestinal obstruction.

Сonclusion. Performance repeated surgical interventions for pseudomixoma peritonei is a rather difficult task for, due to the fact that with continued growth, it is more difficult to achieve optimal cytoreduction. the basic condition for re-operation should be referred to the initial optimal level of cytoreduction and a long-term disease-free period.