Background. Over the past 10–15 years, there has been a clearer understanding of the processes occurring in cells of the primary glioblastoma. However, the change in MGMT gene expression and its role after disease relapse remain understudied.

Purpose: to study changes in MGMT gene expression in case of recurrent primary glioblastoma after the standard therapy; to determine influence of  clinical factors and MGMt gene expression on relapse-free survival of patients.

Materials and Methods. We carried out a prospective analysis of clinical and molecular genetic characteristics of 21 patients aged from 28 to 63 with primary glioblastoma before and after recurrence. Relative mRna expression of MGMT gene and mutations in IDH1/IDH2 genes were determined in surgical biopsies using PCR techniques. after the first surgery, all patients received radiation therapy (60 Gy) and chemotherapy with adjuvant temozolomide (2–18 cycles). the second-line chemotherapy was performed in 17 (80.9 %) patients, and 8 patients received (47 %, 8/17) temozolomide.

Results. the relationship between the progression-free survival (PFs) and mRna expression of MGMT gene (73.5 vs 33 weeks, p=0.013) and objective response to therapy (88 vs 36 weeks, p=0.046) was found. The number of cycles of first-line chemotherapy with temozolomide influenced the duration of the first PFs (65 weeks vs 21.5 weeks, p=0,07). the first PFs was not affected by patients’ age (p=0.64), sex (p=0.17), Karnofsky performance scale index (p=0.43), extent of brain damage (p=0.41) and extent of the resection (p=0.27). after onset of relapse, mRna expression of MGMT gene remained  the same, being 66.7 % (14/21). The increased expression was observed in 23.8 % (5/21) of cases, and decreased gene expression was observed in 9.5 % (2/21) of cases. the second PFs was affected by the extent of tumor resection, although there were no statistically significant differences (p=0.52). the effect of mRna expression of MGMT gene on the median second PFs was not revealed (p=0.39). no objective response to therapy was found in patients with a low mRna expression of MGMT gene.

Conclusion. Recurrent glioblastoma becomes more resistant to further therapy. With the development of tumor recurrence, the predictive value of MGMT gene is lost and the role of the extent of cytoreductive surgery increases. 

Purpose: to conduct a preliminary analysis of the safety and effectiveness of hifu-therapy with a lowenergy hifu-2001 device (shenzhen Huikang Medical apparatus Co., ltd) performed concurrently with chemotherapy in pancreatic cancer patients who are not suitable for surgery or chemoradiotherapy.

Material and Method. The study included 24 pancreatic cancer patients who were treated at the Hertsen Moscow Oncology Research institute in the period from 2016 to 2019. There were 17 (71 %) women and 7 (29 %) men. The percentage of patients in the elderly group was 79 %. Stage iia pancreatic cancer was diagnosed in 3 (12.5 %) patients, stage ii in 5 (21 %) patients, stage iii in 9 (37.5 %) patients, and stage iv in 7 (29 %) patients. All patients received combination therapy, including systemic chemotherapy and hifu-therapy. 

Results. The most frequent adverse events of treatment were skin burns (n=6), with third-degree burns occurring in 2 (8.3 %) patients. Local sclerosis of subcutaneous adipose tissue was observed in 4 (17 %) patients; development of asymptomatic pancreatic pseudocysts in the area of hifu exposure was observed in 1 (4 %) patient. Pain control was achieved in 17 (85 %) patients, and local tumor control was achieved in 19 (79.2 %) patients. The follow-up time ranged from 5 to 30 months with a median time of 14.5 months. The median total life expectancy of patients was 16 months, and the median time to progression was 9 months. The overall 6-month survival rate was 100 %. The 1- and 1.5-year survival rates were 75.0 % and 41.7 %, respectively. The 2-year survival rate was 17.2 %. The 6-month and 1-year disease-free survival rates were 62.5 % and 12.5 %, respectively.

 Conclusion. The short- and long-term outcomes were consistent with those described in other studies, which indicated that a combination of systemic drug therapy and hifu-therapy is an appropriate approach for the treatment of patients with pancreatic cancer.

Introduction. The high incidence of cancer of the upper aerodigestive tract, impairment of breathing, speech, and swallowing functions accompanied by prolonged and often persistent disability put the rehabilitation and the quality of life of patients among the most important social problems.

Material and methods. We have gained experience in reconstructing the pharynx and esophagus with various fragments of the gastrointestinal tract in 121 cancer patients. Based on our own clinical experience, the most important criteria of selecting patients after laryngectomy for reconstruction of the upper aerodigestive tract with visceral flaps were identified. Visceral autografts formed from different parts of the patient’s gastrointestinal tract were full-layer fragments of the abdominal organs, which included the mucous membrane of the stomach, small intestine, or large intestine. In some patients, the choice of flap was limited by a large omentum.

Results. In 9.9 % of cases, flap necrosis was observed. Oral nutrition was restored in 93.9 % of patients. In 90.5 % of cases, speech function was restored after the installation of avoice prosthesis. The method of autologous transplantation of the ileo-colonic flap made it possible not only to remove the organs affected by the tumor, but also to simultaneously restore the lost nutrition and vocal functions without resorting to artificial prostheses, but using only their own tissues. The 5-year survival rates were 36.4 % and 67.3 % in patients with simultaneous reconstruction and in patients with delayed reconstruction, respectively.

Conclusion. The use of visceral flaps in the reconstruction of the upper aerodigestive tract allows patients to restore both the nutrition and voice functions after laryngectomy.

Background. The majority of tumors of the nasal cavity and paranasal sinus are diagnosed at an advanced stage, requiring invasive and mutilating surgery, and therefore, the reconstruction of post-surgical craniofacial bone defects using various implants is necessary.

Purpose of the study: to evaluate the effectiveness of the use of the thin-profile implants made of titanium nickelide in the surgical treatment of nasal cavity and paranasal sinus cancers.

Material and Methods. From 2002 to 2020, a total of 60 patients with stage Т3–4n0–1M0 nasal cavity and paranasal sinus cancer were treated at the Cancer Research institute (tomsk). All patients received radiation therapy followed by surgery with reconstruction of bone structures of the subcranial region and orbital walls. In the study group (n=30), the orbital walls were restored with individual thin-profile shape memory titanium nickelide implants. In the control group (n=30), typical porous and tissue titanium nickelide implants were used. They required adjustment during surgery and complicated reparative processes in the postoperative period due to their thickness. Tissue implants did not allow accurate restoration of the orbital walls due to their structure.

Results. Surgical rehabilitation with orbital wall reconstruction using thin-profile titanium nickelide implants makes it possible to shorten the duration of surgery and improve the precision of surgical repair. Features of the architectonics of implants do not interfere with the growth of tissues of the recipient zone, thus preventing the development of inflammation in the implantation site. The technique allows adequate restoration of the natural position and function of the eye.

The purpose of the study was to optimize treatment of patients with prostate cancer at high risk of disease progression using a quantitative assessment of risk factors and the treatment method.

Material and methods. Immediate outcomes were analyzed in 107 patients with pt3a-bn0m0g2–4 prostate cancer, who were treated in samara regional clinical oncological dispensary between 2010 and 2012. All patients were divided into 2 groups. Group i patients underwent surgery alone and group ii patients underwent surgery followed by radiation therapy. All patients were at high risk of disease progression according to the d’amico classification. Only
one risk factor was identified in 64 patients, two risk factors in 37 patients, and three risk factors in 6 cases. The overall survival, cancer-specific survival and disease-free survival were analyzed.

Results. In cases with one and two risk factors, the overall, disease-free and cancer-specific survival rates were statistically higher than in cases with three risk factors in the entire cohort (p<0.05). In the subgroups with one, two, and three risk factors, there were no statistically significant differences in overall and cancer-specific survival rates (p>0.05). Disease-free survival rates in the presence of one factor were not statistically different (p=0.920). In the presence of two and three factors, the relapse-free survival rates were statistically higher in group ii patients (surgical with adjuvant radiation therapy, p=0.049, p=0.025).

Conclusion. The presence of three risk factors significantly increased the likelihood of a poor prognosis compared with one or two factors. Adjuvant radiation therapy improved survival rates in prostate cancer patients.

Introduction. Boron neutron capture therapy (bnct) is a promising method for treating tumors, in particular, infiltrative malignant tumors, due to the selective destruction of tumor cells without damaging the surrounding normal tissues. This type of therapy is based on nuclear reaction of neutron capture by stable 10b isotope. For the successful implementation of bnct, boron delivery drugs that must be selectively accumulated in malignant cells in a sufficient amount, and a neutron source with the energy required for the neutron capture reaction are needed. At the budker institute of nuclear physics, the accelerator-based neutron source was designed with flux parameters allowing studies on bnct to be conducted.

Objective: to assess the effect of bnct on tumor and normal cell lines using borphenylalanine (bpa), borcaptate (bsh) and liposomal borcaptat as boron delivery drugs.

Materials and methods. Human cell cultures: glioblastoma (u87), colorectal human adenocarcinoma (sw-620), human melanoma (sk-mel28) and primary embryonic cell lines were irradiated with a neutron flux at the presence of bpa, bsh and liposomal bsh with a concentration of 10b 40 μg/ml. The short-term cytotoxic effect of irradiation was evaluated using trypan blue. Cell survival 96 hours after irradiation was determined using mtt test, and survival fraction was evaluated using the clonogenic test.

Results. Early cytotoxic effects of irradiation were not observed for all 4 cell lines. According to mtt and clonogenic tests, the most pronounced effect of bnct was noticed for sw-620 and u87 lines, regardless of boron delivery drug used. For sk-mel28 line, the best effect was achieved after irradiation with liposomal borocaptate. For the primary transplanted embryonic line, high toxicity was revealed when bnct was performed with borphenylalanine and borcaptate.

Conclusion. The data obtained indicate that the accelerator-based bnct using boron delivery drugs, such as borphenylalanine, borcaptate and liposomal borcaptat, has a positive effect on tumor lines of glioblastoma, colorectal adenocarcinoma and melanoma.

Since B16/F10 melanoma demonstrated gender differences in its growth in the presence of chronic neuropathic pain (cnp) and changes in the system of proangiogenic growth factors, the aim of the study was to analyze levels of components of the no-system in male mice during the growth of transplantable B16/F10 melanoma in the presence of cnp.

Material and Methods. 66 male mice С57Вl/6 were used in the experiment. A model of subcutaneous growth of B16/F10 melanoma (during 3 weeks) was created in the cnp presence (sciatic nerve ligation). Concentrations of nos-2, nos-3, l-arginine, citrulline, total nitrite, nitrotyrosine and adma were determined by elisa in intact and tumor tissues.

Results. A significant increase in levels of no-synthases was revealed in the skin and tumor tissues in the tumor growth with cnp from week 1, as well as a decrease in the level of total nitrite in the skin, multidirectional dynamics of adma and arginine levels, a steadily increased level of citrulline in the skin and tumor in the dynamics of tumor growth with cnp.

Conclusions. Male mice with B16 melanoma growing in the presence of cnp demonstrated a more active functioning of the no-system already from week 1, compared to standard tumor growth, which might result in a greater rate of growth of melanoma with cnp. Significantly higher skin and tumor levels of citrulline in males were a distinctive feature, in contrast to melanoma with standard growth, which could be the result of inhibition of arginine synthesis and formation of a tumor auxotrophic for arginine.

Objective: to determine the level of growth factors in the blood serum of patients with left-sided colon cancer and to assess the feasibility of using these findings in the tumor detection.

Material and Methods. The study group included 63 patients aged 20 to 75 years who underwent surgery for left-sided colon adenocarcinoma (descending, sigmoid, rectosigmoid) with stage i (t1–2n0m0), ii (t3–4an0m0), and iii (t1–2n1m0). Only 5 patients developed metastases in one regional lymph node. The remaining patients had no regional metastases. In all patients, before hospitalization, the tumor was confirmed by colonoscopy followed by histological examination. The group of comparison consisted of 25 patients with chronic hemorrhoids without exacerbation, who underwent colonoscopy. In patients of the study group, blood tests were drawn on the day of surgery before its starting. In patients of the comparison group, blood was taken after excluding colon cancer (after colonoscopy). Blood tests were carried out using a test system (Biolegend): multiplex set for determining growth factors (angiopoietin-2, (ang-2), egf, epo, FGF-basic, G-csf, GM-csf, HGF, M-csf, pdgf-aa, pdgf-BB, scf, tgf-α, vegf).

Results. In cancer patients, the levels of egf, HGF, M-csf, pdgf-aa, and pdgf-BB were several times higher than in the control group (p <0.05). The level of pdgf-aa was 10 times higher in cancer patients than in controls. In addition to quantitative changes, statistically significant differences were observed between the vegf level and sex of the patients; angio protein-2, G-csf, epo, M-csf, pdgf-aa, pdgf-BB, vegf levels and the age of the patients; tgf-α, HGF levels and the histological grade of the tumor.

Conclusion. It was found that changes in the level of biologically active substances that occur in colon cancer can serve as additional diagnostic markers for cancer detection.

The aim of the study was to evaluate the five-year survival rate in patients with stage ib2–iiib cervical cancer treated with neoadjuvant chemotherapy and radical surgery.

Material and Methods. Long-term treatment outcomes were studied in 173 patients with histologically-verified stage ib2–iiib cervical squamous cell carcinoma. The patients underwent neoadjuvant chemotherapy using intravenous infusion of cytostatic drugs (n=106) and intra-arterial infusion of cytostatic drugs in combination with embolization of tumor-feeding arteries (n=67). Patients with resectable tumors underwent radical surgery. Disease-free survival was assessed.

Results. The median follow-up time was 66 months, and the maximum follow-up period was 144 months. 160 (92.5 %) patients underwent radical surgery after chemotherapy. 55 (34.4 %) patients did not receive adjuvant radiation therapy. The five-year disease-free survival rate was 79.6 %.

Conclusion. For the group of patients with locally advanced cervical cancer, who achieved respectability following neoadjuvant chemotherapy, radical surgery could be performed. Chemotherapy followed by radical surgery can improve disease-free survival rates in patients with stage ib2–iiib cervical cancer.

Background. Pneumonectomy is one of the most traumatic thoracic surgeries, leading to a significant decrease in the patient’s functional status. Despite numerous questionnaires, there is no standard approach to the study of the quality of life of patients who have undergone radical surgery for lung cancer.

The purpose of the study was to conduct a retrospective analysis of the quality of life of patients who underwent pneumonectomy during the period 2017–2018, taking into account the extent of surgery, presence of concomitant disease and adjuvant antitumor treatment.

Material and Methods. Changes in the quality of life (qol) during combined modality treatment were evaluated in 40 patients with non-small cell lung cancer. To assess the functional status, the criteria adopted for determining the surgical risk were used. The st. George`s Respiratory Questionnaire (sgrq) and Quality Outcomes study short-Form 36 (sf-36) were used to assess the respiratory system of patients. Data collection was carried out 12 months after surgery using a questionnaire method based on a direct survey of respondents.

Conclusion. Postoperative special treatment significantly worsens both the functional parameters of patients and the quality of life. Thus, a multidisciplinary approach to the management of patient with participation of an oncologist, pulmonologist, physiotherapist, and rehabilitologist is required.

Purpose of the study: to analyze characteristics of cancer-testis antigens (Ctas) as potential biomarkers for dissemination of primary human skin melanoma (sm).

Material and Methods. Recent publications from Pubmed, scopus and elibrary databases were analyzed for the available appropriate literature review. In total, 176 papers reported the description of Ctas and encoding genes and their potential for prognosis of primary sm dissemination. The authors included 52 of them in the given review.

Results. Two sections of the paper comprise clinically significant characteristics of Ctas and their genes, including overexpression, which is selective for the heterogeneous tumor cell populations and mediated by humoral and/or cellular immune reactions; the association of tumor process and activation of Cta genes by demethylation of promotor sites, which is correlated with tumor progression; and the conditions required for effective immunotherapy involving Ctas and/or their genes.

Conclusion. At present, there are no standards or clinical recommendations for the Cta-based prognosis of the early dissemination of primary skin melanoma. Therefore, it is important to study and analyze the Cta and encoding gene characteristics that reveal the connection between primary sm progression and tumor genesis including the role of circulating tumor cells (ctc), similar to stem cells, which have epithelial-mesenchymal transition (emt) phenotype, for clinical diagnostics of early sm dissemination. As a result of the study, the following Ctas could be considered as significant biomarkers of the early sm dissemination: mage-a1, mage-a4 and ny-eso-1, which expression correlates with the clinical pathological description of the disease progression, as well as with the relapse-free period and overall survival of the patients; magea3, which expression correlates with spag5 activation and Cd8+ t-cell abundance; ssx, a marker for stem cell migration including identification of the cells with emt and/or ctcs; and prame, signaling marker for dissemination of the uveal melanoma.

Purpose of the study: to review the available data on the heterogeneity of colon cancer and to assess the prognostic significance of colon cancer subtypes.

Material and Methods. Medline, PubMed, Cochrane library, elibrary databases were used to identify studies that characterized the current view on the problem of choosing the optimal postoperative treatment for colon cancer.

Results. the review showed the results of international studies of colon cancer subtypes based on complex multomics characteristics. Particular attention was paid to the description of modern studies on the search for prognostic markers for colon cancer. The relevance of the study of immunohistochemical markers was confirmed by the analysis of the world literature. the outcomes will make it possible to classify colon cancer into molecular subtypes in real clinical practice and, as a consequence, significantly improve the effectiveness of adjuvant therapy.

Purpose of the study: to present current data regarding challenges in treatment of castration-resistant prostate cancer (CRPC) and the relationship between CRPC and the expression of prostate-specific membrane antigen (psma).

Material and Methods. The search for relevant sources was carried out in the Pubmed, elibrary, Medline databases. The review included 43 publications, most of which were published over the past 5 years.

Results. Currently, prostate cancer (PC) is one of the most common cancers in men. Moreover, over time, most patients develop resistance to therapy, which significantly worsens the prognosis of the disease. Psma is one of the molecular markers of prostate cancer; a number of studies have demonstrated a direct correlation between the level of psma expression and the tumor grade, stage and aggressiveness. Numerous studies indicate that psma represents an excellent target for radionuclide therapy of prostate cancer. ⁶⁸Ga or ¹⁸F-psma Pet/Ct is the most common method for diagnosing PC. It should be noted that modern trends in the development of nuclear medicine are closely related to theranostics; therefore, the creation of highly specific theranostic pairs for diagnosis and subsequent therapy of malignant tumors is of great significance. The data obtained indicate that ¹⁷⁷lu demonstrates the most optimal radiation and physical characteristics for therapeutic radionuclides, while psma-617 is one of the most studied ligands for radionuclide therapy.

Conclusion. Currently, there are several studies covering radionuclide therapy with various psmacompounds labeled with ¹⁷⁷lu. Radionuclide therapy with ¹⁷⁷lu-psma has been shown to be recommended for patients with metastatic CRPC, who have no benefits from alternative therapies or have contraindications to them.

Recently, minimally invasive treatment modalities based on the application of various physical factors have been widely used in anticancer therapy. Electrochemical lysis is a method in which tumor cells are destroyed by local exposure to a constant low voltage electric current.

Purpose: to present the current results of using electrochemical lysis in the treatment of various tumors, to describe the mechanism of tumor destruction and methods of delivering electric current to the tumor, as well as to evaluate the electrical parameters and positioning of the electrodes.

Material and Methods.aliterature search included the Medical literatureanalysis and Retrieval system Online (Medline), the excerpta Medica data Base (embase), Web of science, scopus, Russian citation index. All articles were published before december 2019. The review included studies on the investigation electrochemical lysis in vitro, in vivo, as well as clinical observations and clinical studies in which electrochemical lysis has been used as an independent treatment, or in combination with other methods of anticancer treatment since 1984.

Results. This review provides information regarding the electrochemical mechanisms of tumor destruction, anti-tumoral effects of electrochemical therapy, methodology for planning and distributing the dose of electrical lysis and positioning of electrodes. We have evaluated complications and oncological results. Electrochemical lysis is a safe, simple, effective, and relatively non-invasive method of antitumor treatment.

Conclusion. The electrochemical lysis is a promising minimally invasive method which can be used for the treatment of tumors. However, long-term data are needed to validate this treatment before it can be included into clinical recommendation for the treatment of cancer patients.

Purpose of the study: to review in vivo studies on the relationship and role of various molecular genetic components of the circadian rhythm system in the initiation and development of malignant neoplasms. in contrast to clinical and epidemiological studies, animal models, including transgenic animal models, can model various changes and disturbances in the activity of clock genes and track the results of these changes.

Material and Methods. the review includes data from studies carried out over the past 10 years in animal models, studying the mechanisms and effects of disturbances in the system of circadian rhythms related to the formation and development of tumors. the data sources for the review were the Medline, embase and scopus databases.

Results. analysis of the literature has shown that interference with the work of the «biological clock» by changing the light cycle, disrupting the expression of clock genes and other manipulations is a factor predisposing to the development of tumors. in tumors of various types, the expression of clock genes is often mismatched, and it is unclear at what stage of their formation this occurs. in addition, the development of tumors disrupts the circadian homeostasis of the body. there are three key areas of research aimed at studying the role of circadian rhythms in tumor development: disturbance of circadian rhythms as a carcinogenic factor, disturbances in the clock gene system in a tumor, disturbances in the clock gene system of the whole organism, provoked by tumor development.

Conclusion. the results of studies on animal models demonstrate that the relationship between the disturbance of circadian rhythms and the tumor process is complex since the causal relationship has not yet been studied. in this regard, the prospect of targeted pharmacological correction of circadian rhythms in clinical practice in cancer patients does not seem to be the nearest one.

Introduction. Skin cancer is one of the most common malignancies, however melanoma accounts for only 1.8 % of all skin cancers. Melanoma is rare but aggressive tumor. Early detection and appropriate treatment of the tumor are critical and result in improved overall and recurrence-free survival rates. Histopathological reporting plays a critical role in guiding the surgical oncologist’s treatment plan for melanocytic lesions. The experience and knowledge of the pathomorphologist are decisive in the future fate of the patient.

Case description. We report a case of a 36-year-old female patient who presented with a pigmented lesion on the skin of the trunk. In the regional cancer center at her place of residence, she underwent surgical removal of this lesion with a surgical margin of about 1 cm. The histological diagnosis was reported as melanoma. Diagnosis of melanoma was also confirmed in another medical center that did not specialize in the treatment of patients with skin tumors, but the tumor thickness was changed to a smaller one. However, in the federal cancer center that specialized in the treatment of patients with skin melanoma, the diagnosis of melanoma was not confirmed. The patient was diagnosed with nevus. The paper discusses in detail the reasons for the erroneous diagnosis of a malignant neoplasm, indicating the stages of differential diagnosis.

Conclusion. This clinical case demonstrates that a reference analysis of borderline melanocytic lesions under conditions of specialized cancer centers with experienced pathologists is required. We have described objective difficulties in pathomorphological diagnosis, which can additionally be aggravated by the absence of important clinical and instrumental information, artifacts during excision biopsy, macroscopic examination, and orientation of tissue fragments in the embedding paraffin block.

Introduction. Currently, there is no global consensus regarding the management of breast cancer patients with implant-associated infections. Some studies clearly recommend their removal and surgical debridement with consecutive antimicrobial treatment, while others prefer long-term antibacterial therapy (at least 1 month) with the effectiveness of such conservative approach of 36–73 %.

Case description. A 43-year-old patient suffering from brca1-positive right breast cancer t2n0m0 (invasive carcinoma of non-specific type g3, er – 8, pgr – 0, her-2/neu – 0, ki67 (%) – less than 20 %), underwent radical skin-preserving mastectomy on the right with simultaneous implant reconstruction and preventive subcutaneous mastectomy on the left with simultaneous implant reconstruction. Peri-implant infection in the left breast was observed on the 21st day after surgery.

Results. The patient received empirical therapy with cefepim. Microbiological examination of the punctate revealed the causative agent of infection – methicillin-resistant staphylococcus aureus (mrsa) (1×105cfu/ml). Daptomycin 6 mg/kg/day was added to therapy. After 8 weeks, the patient received oral moxifloxacin 400 once daily, for another 3 weeks. A complete response was achieved. The patient has no signs of infection for 3 years.

Conclusion. Long-term etiotropic antibacterial therapy with daptomycin followed by oral moxifloxacin resulted in a stable clinical effect.

Background. Breast cancer ranks as the second most common cancer (14.9 %) and the most common female cancer (20.9 %) in Russia. at the time of diagnosis, 11.0 % of patients have already developed metastases, and 10.3 % of patients die within the first year of diagnosis from disease progression. distant metastasis is the leading cause of death from breast cancer, and brain metastasis is a significant prognostic factor for poor survival.

Case description. We report the case of a long-lasting control of advanced breast cancer with brain metastases in a 32-year-old woman. low grade tubular breast carcinoma was histologically confirmed. immunohistochemical study: eR-ts-4 points, PR-ts – 3 points, Her-2 positive, Ki67 – 35.0 %. BRCa1 5382ins C mutation was not detected. the long-term use of therapy with lapatinib and capecitabine was described.

Conclusion. this case demonstrates the feasibility of long-term (31 months) control over Her-2 positive disseminated breast cancer with multiple metastases to the brain and bones, while maintaining the quality of life and social activity of a young patient. despite the risks associated with whole brain radiotherapy, no cognitive impairment was observed. therapy with lapatinib and capecitabine was effective for 28 months with good tolerance.