The purpose of the study: to analyze the breast cancer incidence and breast cancer risk factors for the population of the Republic of Sakha (Yakutia) in 2011-2020. Material and Methods. The incidence of breast cancer in the population of Yakutia was analyzed using the data collected from population-based cancer registries of the Russian cancer statistics covering the period 2011-2020. The analysis of breast cancer risk factors was carried out using the data from systematic reviews published over the past 5 years (2018-2022). Results. The age-standardized incidence rates of breast cancer among the indigenous population of the Republic of Sakha (Yakutia) were lower than those in other Siberian ethnic groups and the Slavic population, amounting to 12.7 per 100,000 population. The rise in the breast cancer incidence rates in the region for 2011-2020 was associated with the aging of the population, since the trend in the population growth was not observed in the analysis of age-standardized rates. Conclusion. The breast cancer incidence rates among the indigenous population of the Republic of Sakha (Yakutia) are significantly lower compared to those observed in other ethnic groups living in Siberia. The rise in the breast cancer incidence rates in Yakutia is related to the aging of the population. The low age-standardized breast cancer incidence rates may be explained by a low consumption of hormonal agents and natural reproductive behavior. The search for ethno-specific mutations associated with breast cancer in the Yakut population as endogenous risk factors is of great importance. Further studies are required to elucidate the role of North-adaptive genetic mutations in the development of breast cancer. The assessment of the role of natural polyphenolic compounds, the content of which is high in wild berries (historically, a significant proportion of the food consumed by indigenous people), as a protective factor, is promising.

Cancer of the corpus uteri (CCU) is one of the most common gynecological malignancies in high- and middleincome countries. The objective of the study was to evaluate the factors predicting survival in CCU patients over the period 2000-2021 using the data of population-based cancer registry of the Arkhangelsk region. Material and Methods. Cancer-specific survival (CSS) of patients with CCU for the period 2000-21 was evaluated using life tables and Kaplan-Mayer methods with a log-rank test. The Cox proportional hazards regression model was used to assess the effect of prognostic factors on survival time. Results. A total of 3272 cases were selected for the analysis. The 5-year survival rates improved from 70.6 % in 2000-04 to 75.6 % in 2015-19. In stage I, II, III, and IV CUN, the 5-year survival rates were 90.8 % (95 % CI 89.3-92.0 %), 71.1 (95 % CI 66.3-75.4 %), 46.7 (95 % CI 41.4-51.8 %), and 3.9 (95 % CI 1.5-7.5 %), respectively; p<0.001. In the multivariate regression model, for stage II, III, and IV CCU, the hazard ratios for death from cancer were respectively 2.69 (2.14-3.39), 5.73 (4.66-7.03), and 20.26 (16.13-25.44) compared to stage I. The risk of death from CCU was 2.0-2.7 times higher in patients with aggressive histological subtypes and sarcomas compared to that in patients with endometrioid adenocarcinoma; 2.0-2.8 times higher in patients older than 60 years compared to younger patients, and 1.3 times higher in rural patients compared to urban patients (p<0.05). There was no increase in the risk of death from CCU over the period of COVID-19 pandemic. Conclusion. In this population-based study, we have found that the survival of patients with CCU is significantly affected by age and place of residence, which may indicate a limited access of some patients to effective treatment and requires further analysis. No increased risk of death from CCU during the COVID-19 pandemic was found.

The purpose of the study was to develop and evaluate the technique for volumetric tumor segmentation based on diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting and assessing the response to chemotherapy in patients with bladder cancer (BC). Material and Methods. We examined 26 patients with morphologically verified transitional cell carcinoma of the bladder. The group was characterized by the presence of one or several tumors with a size of 17 to 46 mm. Before planning chemotherapy according to the M-VAC scheme, a study and post-processing of DW-MRI with volumetric segmentation of lesions, assessment of the volume and apparent diffusion coefficient (ADC) in the entire tumor mass were performed. According to the ADC data, shape of the tumor and its relation to the bladder wall, the coefficient (C) for predicting the response to chemotherapy was calculated. Results. In the cases with a coefficient value below 0.51, a high risk of treatment failure was predicted, at C≥0.74, a positive effect of treatment was predicted. With a value of 0.51≤C<0.74, the prognosis was uncertain, stabilization was more likely. The sensitivity and specificity of the method were 92.3 % and 92.4 %, respectively. Conclusion. The method of volumetric segmentation makes it possible to predict and evaluate bladder cancer response to chemotherapy with a sufficiently high accuracy. The advantages of the method are the possibility of assessing the tumor regardless of the degree of filling of the bladder, with non-contrast MRI, and with large lesions.

The purpose of the study was to conduct a comparative analysis and evaluate the functional results and quality of life of patients with head and neck cancer after radical surgery, depending on the reconstruction techniques used and the feasibility of using autografts for the repair of tissue innervation. Material and Methods. From 2014 to 2021a total of 133 patients with oral cavity cancer underwent simultaneous or delayed reconstruction after radical surgery at Clinical Hospital 1 of Sechenov University. All patients were divided into 4 groups: group 1 (n=37, the main group): reconstruction with free flaps “with reinnervation”, group 2 (n=24): reconstruction with free flaps “without reinnervation”, group 3 (n=23): reconstruction with pedicled axial flaps “with innervation”, and group 4 (n=49): reconstruction with pedicled axial flaps “without innervation”. The QLQ-H&N43 questionnaire was taken as the main tool, speech and swallowing functions were assessed by using scales, and sensibility was assessed by the Semmes-Weinstein and Weber tests, as well as by pain and temperature sensation. Results. In the main group, statistically significant best results were achieved in the following main scales of the QLQ-H&N43 questionnaire: total score - Me=21 (Q1-9; Q3-29) (p=0.038); speech -Me=27 (Q1-7; Q3-37) (p=0.05) and body image - Me=22 (Q1-0; Q3-47) (p=0.049). In group 1, significantly better results were obtained in assessing all sensory tests, except for the temperature sensation. In relation to less discomfort on the donor area and greater satisfaction with the cosmetic result, group 1 also gained better scores than other groups. Conclusion. The use of innervated flaps improves the quality of life and patient satisfaction with the treatment results in long-term follow-up.

Background. Despite the improvement in combined modality treatment of early breast cancer (BC), the rate of locoregional recurrence remains in the range of 7-15 %. Therefore, the search for prognostic factors for BC is of great significance. The aim of the study was to estimate the relationship between clinical and morphological parameters and 10-year recurrence-free survival rate in BC patients after combined modality treatment including intraoperative radiotherapy (IOLT). Material and Methods. The study enrolled 383 patients with morphologically verified T1-3N0-1M0 stage breast cancer. The median age of the patients was 53 years (range: 28 to 80 years). All patients underwent breast-conserving surgery with IOLT delivered to the tumor bed at a single dose of 10 Gy (24.8 Gy according to the iso-effect). External beam radiation therapy (EBRT) to the conserved breast was given in the postoperative period. Results. Within the 10-year follow-up, 20 (5.2 %) locoregional recurrences occurred, of which 7 (35 %) developed with a primary tumor size of ≤ 2 cm (T1), and most recurrences - 13 (65 %) were detected with the primary tumor size corresponding to T2-3. In patients with luminal A subtype of BC and in patients with triple negative BC, the recurrence rates were 5 % and 45 %, respectively. The 10-year survival rate of patients after combined modality treatment with IOLT was 94.8 %. Conclusion. The results obtained indicate the relationship between the recurrence rate and clinical/ morphological parameters of the tumor, such as tumor size and molecular subtype. These parameters should be taken into account when planning treatment in patients with early BC.

Background. Radiation therapy for high-risk prostate cancer presents a challenge for cancer radiotherapists. The improvement of treatment outcomes is associated with radiation dose escalation and prophylactic irradiation of lymph nodes, therefore, the development of the new treatment schemes is needed. Simultaneous integrated boost technique based on the volumetric modulated arc therapy is the most efficient treatment option. Material and Methods. The anatomical data of 10 patients with high-risk prostate cancer was used for dosimetry-based treatment planning. Both simultaneous integrated boost and sequential boost technique were considered. The treatment planning goal was to deliver the equivalent dose of 96 Gy at 2 Gy per fraction (EQD₂=96 Gy) (α/β=1.5 Gy) to the prostate, EQD₂=62.5 Gy to the seminal vesicles and EQD₂=50 Gy to lymph nodes avoiding damaging the organs at risk, mainly the bladder and rectum. The irradiation was based on volumetric modulated arc therapy with two partially coplanar arcs and two rotations at each arc. The obtained dose distributions were compared with respect to dose-volume histograms and equivalent uniform doses (EUD). Results. In the case of sequential boost, the minimal dose delivered to the prostate was equal to 95.9 ± 2.1 Gy, EUD=104.9 ± 1.7 Gy. The dose delivered to 2 cm³ (D_2cc) bladder was 97.4 ± 2.0 Gy. Normal tissue complication probability (NTCP) was 1.64 %. The dose delivered to 2 cm3 (D_2cc) rectum was 103.4 ± 9.2 Gy and NTCP was 27.4 %. In the case of simultaneous integrated boost, the minimal dose delivered to the prostate was equal to 90.4 ± 2.3 Gy, EUD=103.9 ± 1.3 Gy. The bladder dose was as high as D_2cc=96.1 ± 5.2 Gy, NTCP=0.176 ± 0.132 %, the rectum dose - D_2cc=81.1 ± 6.0 Gy, NTCP=2.34 ± 1.92 %. Conclusion. Volumetric modulated arc therapy along with simultaneous integrated boost have shown the feasibility of simultaneous irradiation of the prostate, seminal vesicles and lymph nodes up to the prescribed dose values without significant over irradiation of the organs at risk (OARs). Dose values in the tumor as high as EUD=103.9 ± 1.3 Gy along with prophylactic irradiation of lymph nodes may result in higher tumor control probability value and should be considered for clinical trials.

Purpose: to evaluate the crowding-induced morphological changes in invasive breast carcinoma and compare the data obtained with the parameters of the tumor progression. Material and Methods. The study group included 107 patients (mean age: 57.2 ± 11.2 years) who did not receive neoadjuvant chemotherapy. Breast cancer morphological and immunohistochemical images were studied. The histological type of breast cancer was determined according to WHO recommendations (The WHO Classification of Breast Tumors, 5th Edition, 2019). The study included only cases with invasive breast carcinoma of no specific type. Clinical parameters were assessed using the patients' medical history. Statistical analysis was carried out using the Statistica 10.0 program. A p-value of 0.05 or lower was considered statistically significant. Results. The phenomenon of crowding in breast cancer was shown to be associated with lymph node metastases, with intratumoral heterogeneity of particular importance. The phenomenon of crowding was morphologically confirmed in all cases (n=40) with lymph node metastases in solid tumors. In these solid tumor structures, a decrease in the expression level of the proliferative index Ki67 was observed. In tumor sites with the evidence of crowding phenomenon in solid structures with lymph node metastasis, positive expression of integrin β1 was less frequently observed. Conclusion. Te results obtained suggest that the mechanism that initiates the process of tumor cell invasion may be based on crowding and basal cell extrusion, while the patterns found are a manifestation of changes in cell properties with the acquisition of a higher potential for mobility and cell migration.

Background. Current treatment of HER2-positive metastatic breast cancer (BC) is based on the use of anti-HER2 blockers as pathogenic drugs, as well as the search for the optimal combination of anticancer drugs with different mechanisms of action. The potential activity of chlonisol in HER2+ ВС is of great interesting. The aim of the study was to evaluate the antitumor effect of 2-[3-(2-chloroethyl)-3-nitrosouriedo]-1,3-propanediol (chlonisol) on the growth of spontaneous mammary tumors in HER-2/neu transgenic FVB/N mice. Material and Methods. A prospective study used 5-month-old female mice with HER2-positive mammary tumors. Of these animals, ten pairs with almost the same size of tumors were formed (respectively, for the control group and the chlonisol treatment group). Chlonisol was administered at a dose of 20 mg/kg intraperitoneally, once. The animals were followed up for 30 days. Results. In all ten pairs of mice, chlonisol showed a significant antitumor effect, up to a complete temporary regression of the tumor. When summing the comparative results of all ten pairs of animals, the inhibition of tumor growth (ITG) in the chlonisol treatment group was 90-97 % (p<0.0001), and the area under the kinetic curve of tumor growth was 13.6 times less than in the control group (p<0.0001), thus indicating a significant effect. Conclusion. Chlonisol has a high therapeutic activity by inhibiting the growth of spontaneous HER2-positive breast tumors in FVB/N mice.

Shear wave elastometry is important for improving the quality of treatment of patients with postmastectomy edema of the upper limb. Objective: to assess the density of brachial plexus tissues measured by shear wave sonoelastometry in breast cancer patients who received combined modality treatment. Material and Methods. We examined 30 breast cancer patients with postmastectomy edema of the upper limb, who underwent shear wave elastometry of the brachial plexus in the interscalene region. The side where radiation therapy (RT) was delivered was compared with the contralateral (healthy) side in one patient. Results. The median values of tissue stiffness measured by shear wave elastometry were 30.4 (26.2-35.8) and 16.2 (15-19) kPa on the affected and unaffected side, respectively (p<0.001). There was no statistically significant difference in tissue stiffness associated with the age of the patients, right/left side and body mass index. Conclusion. Shear wave elastometry is an alternative method for examining the brachial plexus in radiotherapy for breast cancer. On the RT side, the perineural tissues of the brachial plexus were denser than those on the healthy side. In clinical practice, elastometry can be used to monitor the dynamics of radiation damage and their consequences.

The purpose of the study was to evaluate the outcomes of a series of liver resections performed in a single regional specialized cancer center. Material and Methods. Eighty-nine patients underwent liver and/ or extrahepatic bile duct resections in the Penza Regional Oncology Hospital over the 8-year study period. Malignancies were observed in 81 patients. Extended liver resections (4 segments or more) were performed in 58 (65.2 %) cases. Results. Postsurgical morbidity and mortality rates were 31.5 % (28 of 89) and 6.7 % (6 of 89), respectively. Six of 10 patients with primary liver carcinomas were alive without evidence of disease progression at a follow-up time ranged from 1.0 to 76.7 months. Adjuvant chemotherapy (ACT) was the only predictor (HR=0.40; 95 % CI 0.16-0.98) of overall survival in patients with metastatic colorectal cancer (mCRC). The median survival time after liver resections for mCRC with or without ACT was 54.5 (95 % CI: 14.5-94.5) vs 21.8 months (95 % CI: 14.2-29.4), respectively. In mCRC patients with ACT, the 5-year overall survival rate was 44.8 ± 12.9 %. Conclusion. Primary hepatobiliary carcinomas and colorectal cancer liver metastases are the most common reasons for liver resections. A series of liver resections in a low-volume hospital is feasible with the achievement of good outcomes.

The study objective: the study objective is to examine the use of artificial intelligence (AI) in the diagnosis, treatment, and prognosis of Colorectal Cancer (CRC) and discuss the future potential of AI in CRC. Material and Methods. The Web of Science, Scopus, PubMed, Medline, and eLIBRARY databases were used to search for the publications. A study on the application of Artificial Intelligence (AI) to the diagnosis, treatment, and prognosis of Colorectal Cancer (CRC) was discovered in more than 100 sources. In the review, data from 83 articles were incorporated. Results. The review article explores the use of artificial intelligence (AI) in medicine, specifically focusing on its applications in colorectal cancer (CRC). It discusses the stages of AI development for CRC, including molecular understanding, image-based diagnosis, drug design, and individualized treatment. The benefits of AI in medical image analysis are highlighted, improving diagnosis accuracy and inspection quality. Challenges in AI development are addressed, such as data standardization and the interpretability of machine learning algorithms. The potential of AI in treatment decision support, precision medicine, and prognosis prediction is discussed, emphasizing the role of AI in selecting optimal treatments and improving surgical precision. Ethical and regulatory considerations in integrating AI are mentioned, including patient trust, data security, and liability in AI-assisted surgeries. The review emphasizes the importance of an AI standard system, dataset standardization, and integrating clinical knowledge into AI algorithms. Overall, the article provides an overview of the current research on AI in CRC diagnosis, treatment, and prognosis, discussing its benefits, challenges, and future prospects in improving medical outcomes.

The purpose of the study was to summarize and analyze modern data about non-invasive methods of molecular diagnosis and approaches to the personalized therapy of diffuse midline glioma (DMG). Material and Methods. The search and analysis of publications was carried out using Google Scholar, Pubmed, Elsevier, Web of Science, Elibrary systems. The review includes publications published from 2011 to 2022. Of the 102 articles found, 59 were used to write the review. Results. In this review, we discuss the spectrum of somatic driver mutations present in DMG tumor cells and their relationship with the sensitivity of tumor cells to certain types of therapy - a pharmacogenetic approach to the selection of individual treatments (targeted therapy). We provide examples of new methods of targeted therapy for DMG, which are currently at the stage of preclinical laboratory development. Also, we discuss examples of the use of 3D cell cultures for the development of targeted therapies, including the use of perfusion systems. The review describes the methods of analysis of liquid biopsy, which allow the detection of tumor-specific biomarkers in the non-invasive diagnosis of DMG, including a number of methods that have not yet been tested in the clinic. The following is a list of tumor-specific biomarkers for diagnosing, monitoring, and selecting targeted therapy for DMG. Finally, we discuss the possibility of implementing these methods in the clinic and present the results of several clinical trials. Conclusion. In oncology, new methods of molecular genetics, such as analysis of liquid biopsy, allow diagnosis and monitoring of treatment in cases where classical methods that require tissue sampling are not applicable (for example, the analysis of genetically heterogeneous tumors and tumors of surgically inaccessible localization). These tumors include DMG, a primary brain tumor most common in children. The available data confirm the relevance of the search for new specific tumor biomarkers, as well as targets for targeted therapy of the paediatric-type diffuse gliomas.

Purpose of the study. Analysis of available data on modern methods of diagnosis and treatment of neurofibromatosis type 1 (NF1) and their application in the Russian Federation. Material and Methods. The search for relevant sources was carried out in the Scopus, Web of Science, PubMed, Elibrary systems, including publications from February 1992 to December 2022. Of the 1873 scientific articles found, 48 were used to write a systematic review. Results. Neurofibromatosis type 1 (NF1) is caused by germline heterozygous mutations in the NF1 gene, which encodes the neurofibromin protein, which suppresses mitogen-activated signaling pathways necessary for cell proliferation. Clinical manifestations of NF1 are similar to Peutz–Jeghers, Laugier–Hunziker, Rusalkab–Muret–Smith, Bannayan–Zonnana, LEOPARD syndromes, neurofibromatosis type 2 and lipomatosis; therefore, to confirm the diagnosis, the most important criterion is the detection of a gene mutation by sequencing, since there are no mutagenesis hotspots in the NF1 gene. To detect 17q11.2 locus microdeletions, MLPA method is used. In Russia, such methods of molecular genetic identification of NF1 were carried out in Moscow and in the Republic of Bashkortostan. Surgical interventions using a neodymium laser and therapy with mitogen-activated protein kinase inhibitors are the most effective for the treatment of tumor syndrome. Scientific results of the use of a surgical laser in the treatment of plexiform neurofibromas and extramedullary tumors of the spinal cord have been published in Russia. Treatment of NF1 with selumetinib in Russia was announced by the interregional public organization for assistance to patients with neurofibromatosis “22/17”, which provides the drug to children with inoperable neurofibromas free of charge. Conclusion. In modern medicine, it is necessary to widely use methods for identifying mutations in the NF1 gene by creating universal panels of targeted sequencing. This will allow not only the differential diagnosis of NF1, but also the identification of the cause of chemoresistance of sporadic malignant neoplasms for the introduction of mitogen-activated protein kinase inhibitors in their treatment. Combination of this method with surgical excision of neurofibromas using a neodymium laser is optimal.

The study aimed to summarize the available data on the role of computed tomography in sarcopenia detection in cancer patients. Material and Methods. A literature search was conducted in the Medline, Scopus, Pubmed, and Elibrary systems. More than 100 articles published in 2008-2022 were analyzed. We included 45 articles in this review. Results. According to the European Consensus, sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength due to age-related, neurohumoral changes, malnutrition or muscle catabolism. It is difficult to overestimate the importance of sarcopenia, since this syndrome is one of the five main risk factors for morbidity and mortality in people over 65 years of age. Sarcopenia is mainly observed in inflammatory diseases, malignancy or organ failure. According to most researchers, CT is considered the gold standard method to assess muscle mass and quality. It is a reliable method for quantitative analysis, which was shown in a study based on the comparison of quantitative assessment of various muscle groups based on CT with muscle volume measured on cadaveric tissues. The purpose of this literature review was to highlight the importance of computed tomography for the detection of sarcopenia in clinical practice. Based on the results of the literature analysis, sarcopenia is still a challenge for modern oncology. Sarcopenia negatively affects the prognosis of the disease and quality of life of cancer patients. Sarcopenia may develop due to metabolic changes caused by cancer treatment, as a result of which the degradation of muscle protein begins to prevail over its synthesis. Conclusion. Given the high prevalence and prognostic significance of sarcopenia in oncology, the need for its early diagnosis and active treatment becomes obvious. The use of routine CT examinations for the diagnosis of sarcopenia will allow us to search for possible causes and optimize treatment, determine the likelihood of risks and determine the treatment strategy at an early stage, when therapy can be most effective.

The purpose of the study was to present up-to-date data on the regulation of expression, function in normal tissues and multidirectional activity in the oncogenesis of miR-143/145 microRNAs cluster, as well as to evaluate the possibilities and limitations of the therapeutic use of microRNAs of this cluster in malignant neoplasms. Material and methods. The search for available domestic and foreign literary sources published in PubMed and RSCI databases over the past 10 years has been carried out. 427 articles were found, of which 41 were included in this review. Results. The conservative cluster miR-143/145 is one of the most intensively studied in tumors. Based on the results of the analysis of differential miRNA expression, in vitro experiments in cancer cell lines and in vivo in mouse tumor models, a decrease in miR-143 and miR-145 levels was shown in malignant neoplasms of epithelial origin. Until recently, these miRNAs were considered classical oncosuppressors. The data presented in the review demonstrate that the results of a number of studies taking into account the cellular aspects of microRNA expression contradict this concept. miR-143 microRNA, for example, is known to participate in the metabolic restructuring of the tumor and the activation of neoangiogenesis. It has been shown that the oncosuppressive or pro-oncogenic activity of miR-143 and miR-145 depend on the tissue and cellular context and can be explained by the presence of several regulated targets that have opposite effects on oncogenesis. Taken together, the data obtained suggest the need to exercise caution when choosing the microRNAs of the described cluster for exogenous therapeutic delivery. Conclusion. Further detailed decoding of the mechanisms of miR-143 and miR-145 functioning in various types of tissues and cells, as well as identification of new MRNA targets are necessary for a better understanding of the involvement of these molecules in oncogenesis.

Introduction. Castleman disease (CD) is a rare lymphoproliferative disorder also known as angiofollicular lymph node hyperplasia or giant lymphoid hyperplasia. CD is considered unicentric in the presence of a single focus and if the clinical picture is represented by multiple lymphadenopathy and systemic manifestations, it is considered multicentric. Manifestation of the disease by the occurrence of a focus that mimics a tumor of the meninges or brain is extremely rare, only 20 cases are known including the one presented in our article. The main treatment for localized forms is surgical resection. Our observation is devoted to a rare variant of intracranial CD. Description of the clinical case. Woman, 35 years old, was admitted to the clinic with complaints of recurrent headache of moderate intensity of a diffuse nature and difficulty in counting and writing. A month before hospitalization a single generalized epileptic seizure occurred. In the clinical picture at the time of admission, Gerstmann-Schilder syndrome was noted which topically corresponded to the lesion of the right parietal lobe. MRI of the brain with contrast enhancement showed pathological infiltration in the structure of the right parietal bone, the presence of a massive paraosseous component that spread intracranially with compression of the right parietal lobe, and moderately pronounced perifocal edema. The neoplasm was removed totally with a fragment of the dura mater (DM). The plastic of DM was performed with a vascularized periosteal flap and one-stage plastic of the skull defect with a titanium implant. According to histological and immunochemical studies, as well as additional examinations, a diagnosis of unicentric CD was established. According to the results of the control MRI of the brain with contrast enhancement after 3, 6 and 12 months, data for relapse were not revealed. The patient currently does not report any symptoms of the disease. Conclusion. Intracranial unicentric CD is a benign disease amenable to radical surgical treatment and does not require further adjuvant therapy. Despite the complexity of differential diagnosis between CD and meningiomas, the primary treatment strategy remains the same in all cases: total surgical removal.

Background. Gastric cancer is one of the most common cancers with the highest incidence and mortality rates worldwide. Gastrectomy/distal subtotal resection with D2 lymphadenectomy and perioperative chemotherapy with FLOT is the standard treatment for locally advanced gastric cancer. Currently, the role of chemoradiation therapy in the treatment of gastric cancer has not been well determined. From 2019 to 2021, a prospective phase 2 clinical trial was undertaken at A. Tsyb Medical Radiological Research Centre (MRRC) to evaluate the safety and efficacy of neoadjuvant therapy: induction chemotherapy with FLOT (2 cycles) and chemoradiotherapy (total dose of 46 Gy with the concurrent chemotherapy with capecitabine and oxaliplatin) followed by surgery. The aim of the study was to demonstrate the effectiveness of neoadjuvant therapy for locally advanced gastric cancer with a favorable pathological response, downstaging and more than 2.5-year disease-free survival. Case description. A 48 year-old male patient was admitted to the MRRC with complain of epigastric pains for 2 months. Gastroscopic biopsy revealed gastric cancer. The comprehensive examination revealed proximal gastric cancer involving the abdominal segment of the esophagus (cT3N3aM0, stage III). The patient was invited to participate in the clinical trial. The patient accepted to participate voluntarily and signed an informed consent. He received 2 cycles of FLOT chemotherapy followed by chemoradiotherapy and surgery (gastrectomy with resection of the abdominal segment of the esophagus and D2 lymph node dissection). Histological examination of the surgical specimen revealed grade 1b pathological response (Becker criteria). Histological examination of lymph nodes revealed pathological complete response. The patient is alive after 33 months of gollow-up without the evidence of disease progression. Conclusion. Neoadjuvant induction chemotherapy followed by chemoradiotherapy resulted in a favorable pathological response, downstaging and 2.5-year disease-free survival.

Background. Subungual squamous cell carcinoma (SCC) of thumb is a rare disease. However, it is the most common malignancy affecting the nail bed. Early recognition is crucial and important for prompt diagnosis and effective treatment. Often this tumour needs to be treated surgically with wide local resection, which results in a defect in the thumb. If not handled appropriately, such defects render restriction in functionality of the involved thumb as well as a poor aesthetic outcome. In the worst-case scenario, it may result in a poor function of involved hand. Thus, reconstruction of the involved thumb is necessary. The main aim of reconstruction is to regain the hands' function and preserved the thumbs' sensation. Secondarily, to have an aesthetically pleasing hand. Our hands carry out delegate job and important duty for daily function. Especially, the thumb working together with the other fingers to carry out the hand function as one unit. Loss of thumb function affects the whole performance of the hand. Case descriptions. We report a case of recurrent subungual squamous cell carcinoma of thumb, which had wide local resection and subsequently underwent soft tissue coverage with an islanded first dorsal metacarpal artery (FDMA) perforator flap. One month after surgery, the patient was able to regain a good functional outcome of the hand. In this report, we discussed the procedures that had been done. Conclusion. The patient regained full functional hand after reconstruction with preserved sensation over distal thumb. The aesthetic outcome is satisfactory. The FDMA perforator flap is a very pliable and robust flap for reconstruction of distal thumb defect.