Background. The incidence of female reproductive system cancer, including breast, cervical, ovarian and uterine cancers, is steadily increasing, and therefore it is advisable to conduct an epidemiological analysis and assess the quality of medical care. The purpose of the study was to analyze the epidemiological characteristics of reproductive system cancer in females of the Tyva Republic. Material and Methods. The reporting forms № 7 “Cancer incidence in the Tyva Republic” for 2013–2022 were used. Age-standardized incidence rates were calculated using the “Oncostat” program, and cancer care quality was assessed using “Cancer Care Indicators” program. Results. Reproductive system cancer in the Tyva Republic accounted for 46.3 % of all malignant neoplasms in females during 2013–2022. In 2022, breast cancer was the most common cancer (16.2 %) followed by cervical cancer (13.7 %), ovarian cancer (6.7 %), and uterine cancer (4.0 %). During the study period, none of these cancers showed a statistically significant increase in agestandardized incidence rates (AS R). In 2022, age-standardized incidence rates in the Tyva Republic were higher than those in the Siberian Federal District for cervical cancer (27.5 ± 3.7 vs 16.3 ± 0.4 0/0000) and for ovarian cancer (14.1 ± 2.8 vs 12.7 ± 0.3 0/0000), but lower for breast cancer (32.4 ± 4.1 vs 58.7 ± 0.6 0/0000) and uterine cancer (8.6 ± 2.2 vs 19.7 ± 0.4 0/0000). Overall, cancer care quality indicators for reproductive system cancers had improved. Active detection increased from 22.0 to 29.8 %, p=0.039 (in the Siberian Federal District: from 27.6 to 37.2 %, p=0.001). The detection rate at I–II stages increased from 53.7 to 75.2 %, p=0.004 (in the Siberian Federal District: from 63.0 to 71.3 %, p=0.001). The percentage of advanced stages decreased from 37.4 % to 15.5 %, p=0.001 (from 27.4 % to 23.1 % in the Siberian Federal District, p=0.013). The oneyear mortality rates also decreased from 19.0 to 5.4 %, p=0.013 (in the Siberian Federal District: from 11.8 to 8.5 %, р<0.001). The high incidence of cervical cancer, the absence of noticeable optimal changes in the early detection and the high prevalence of HPV infection among the female population of the Tyva Republic indicate the relevance of mass HPV testing as a part of secondary cancer prevention. Conclusion. The high incidence of female reproductive system cancer and the current status of reproductive cancer care in the Republic of Tyva dictate the need to strengthen primary, secondary and tertiary cancer prevention.

Arthroplasty is the most widely used surgical technique for bone tumors of the upper limbs. However, it should be noted that the functional outcomes after endoprosthetic reconstruction for malignant bone tumors of the upper limb does not always satisfy patients and often lead to impaired working capacity of patients, and their disability. The need to improve functional outcomes determines the practical and socio-economic significance of the research. The purpose of the study was to evaluate the impact of a complex of rehabilitation measures on the quality of life of patients after surgery with endoprosthetic reconstruction for malignant bone tumors of the upper limb. Material and Methods. The treatment and rehabilitation outcomes in 146 patients were analyzed. There were 88 (60 %) men and 58 (40 %) women with an average age of 47 years (range, 19–75 years). The tumor was localized in the proximal humerus in 98 (67 %) patients, in the diaphysis in 18 (12 %), in bones that make up the elbow joint in 16 (11 %) and in the distal radius in 14 (9.6 %) patients. Results. Our rehabilitation technique improved functional outcomes after endoprosthetic reconstruction for all tumor localizations. The musculoskeletal Tumor Society (MSTS) score was improved by 10 % (75 vs 65 %) for arthroplasty of the shoulder joint, for the wrist joint by 8 (80 vs 72 %). The rehabilitation technique allowed significant improvement of MSTS score for arthroplasty of the humeral diaphysis and bones making up the elbow joint (from 76 to 95 % and from 68 to 82 %, respectively). Conclusion. Rehabilitation measures play an important role in optimizing quality of life of patients after surgical treatment of bone tumors of the upper limb with arthroplasty, helping to improve functional outcomes.

Peripheral nerve sheaths tumors (PNST) account for about 8 % of all nervous system cancers. The relapse rate ranges from 17.3 to 26.4 %, showing an upward trend. The causes and provoking factors for the development of relapses of PNST have not been fully studied. Purpose of the study: to establish criteria for predicting recurrence of PNST. Material and Methods. The study included 122 patients who were treated at the Department of Spine and Peripheral Nerve Surgery of A.I. Polenov Russian Research Neurosurgical Institute from 2009 to 2021. Among them, there were 87 (71.3 %) patients with primary PNST and 35 (28.7 %) patients with recurrent PNST. All patients underwent MRI and ENMG both before and after surgery. An immunohistochemical study of Ki67 and SO X10 markers was performed. Results. The majority of relapses occured within 1 year after surgery. In cases with radical removal of PNST, the risk of relapse was: 28.6 % for schwannomas 28.6 %, 37.1 % for neurofibromas and 34.3 % for MP NST 34.3 % (p≥0.05). The risk of developing relapse of PNST was 2.9 times higher in patients aged ≥49 years than in patients aged ≤48 years (p<0.004). The larger the initial size of the tumor, the higher the risk of relapse in the late postoperative period. The risk of developing relapse of MP NST was 8.79 times higher in patients with tumor size of greater than 11.5 cm than in patients with smaller tumor size (p<0.02). The of Ki67 level above 4.85 % in schwannomas and above 5.17 % in neurofibromas can predict relapse of PNST (p<0.05). Loss of SO X10 protein expression was associated with an increase in histological anaplasia of the tumor, which causes a high risk of relapse and an unfavorable clinical course of the disease. Conclusion. Despite radical (total) resection of PNST, the risk of relapse remains high. The pathological type of tumor, its size, levels of SO X10 and Ki67 markers, patient’s age, degree of preoperative neurological deficit and extent of surgery are significant criteria for predicting the development of relapse of PNST.

The aim of this study was to evaluate the feasibility and safety of sequential bilateral anatomical lung resections performed via video-assisted thoracic surgery (VATS) or thoracotomy approaches in lung cancer patients, as well as to identify factors affecting the postoperative period. Material and Methods. Of 534 NSCLC patients undergoing anatomical lung resection in Center for Intensive Pulmonology and Thoracic Surgery from 2014 to 2022, 14 patients with consecutive bilateral anatomical lung resections were included in the retrospective study. The patients were divided into two groups depending on a surgical approach used during the first surgery: group I – 5 patients underwent thoracotomy and group II – 9 patients underwent videoassisted thoracic surgery (VATS). The groups were matched for gender, age, smoking, Charlson Comorbidity Index, lung resection, functional status and stage of the disease. Surgical treatment included anatomical lung resection and ipsilateral systematic lymph dissection. Results. There were significant differences in intraoperative blood loss between the groups. Postoperative complications after surgery on the contralateral lung were observed more often in group 1 patients than in group II patents. The overall 5-year survival rates in patients of groups 1 and 2 were 60 % and 86 %, respectively. Respiratory function indicators three months after surgery corresponded to preoperative prognosis, and their decrease did not depend on the surgical approach used. In comparison with patients who underwent standard unilateral lung resection, bilateral anatomical lung resection was not associated with increased number of “major” complications, however, an increase in the frequency of prolonged air discharge was noted (26 % vs 6 %; p<0.05). Conclusion. Sequential bilateral anatomical lung resections are feasible and safe after thorough preoperative assessment of the functional reserves of the cardio-respiratory system. Mini-invasive technologies make it possible to reduce the frequency of complications in the early postoperative period. The use of the VATS approach makes it possible to safely perform anatomical resection of the contralateral lung.

The purpose of the study was to compare the effectiveness of correction of sound pronunciation in patients after glossectomy without reconstructive surgery and glossectomy with reconstructive surgery. Material and Methods. The study included 56 patients with histologically verified stage III –IV oral cavity and oropharyngeal cancer. All patients were divided into two groups: those undergoing reconstructive surgery after glossectomy and those not undergoing reconstructive surgery after glossectomy. Data on the dynamics of sound pronunciation correction were assessed during the rehabilitation period, as well as 6 and 12 months after completion of speech therapy. The parameters were scored from 0 to 4, where 0 indicated no speech sound disorders, and 4 indicated maximum disorders. Results. All patients showed absolute (4 points) speech sound disorders after surgery. Speech rehabilitation in patients, who underwent reconstructive surgery after glossectomy, resulted in a significant improvement in the pronunciation of posterior lingual sounds: [K], [G], [K’], [G’], whistling (lingual-dental) sounds: [S], [S’], [Z ], [Z’], front-lingual sounds: [T], [Т’], [D], [D’] and hissing sounds: [Sh, [Zh] (p<0.05). In patients, who underwent glossectomy without reconstructive surgery, a statistically significant improvement in sound pronunciation was observed only after correcting posterior lingual hard sounds: [K], [G] (p<0.05). Conclusion. The results obtained highlight the importance of reconstructive surgery after glossectomy to achieve better results of functional restoration and improve the quality of speech function of patients.

The relationship between the tumour and the microenvironment is of great interest because it may determine the efficacy of new agents aimed at targeting the anti-tumour immune response, such as immune checkpoint inhibitors (ICI s), which have been used to treat breast cancer. PD -L1 status in immune cells should be examined when prescribing ICI s for breast cancer. This highlights the importance of studying the characteristics of the tumour microenvironment, the main approach being to uncover its heterogeneity. The aim of this study was to investigate the subpopulation composition of PD -L1-positive lymphocytes in the tumour microenvironment, separately in each luminal subtype of BC, and to compare it according to the PD -L1 status of the tumour. Material and Methods. Fifty-two primary tumour samples were obtained from patients with invasive luminal A, luminal B HER2- and luminal B HER2+ subtypes of breast cancer (T1–2N0–1M0). No drug therapy was administered prior to surgery to any patient in this study. Cytotoxic lymphocytes (CTL s), B lymphocytes, T helper lymphocytes, T regulatory lymphocytes and their PD -L1 expression in tumour tissue samples were assessed by flow cytometry, and tumour PD -L1 status was determined by Ventana SP 142 immunohistochemistry. Results. All of the key lymphocyte populations we identified were present in almost all patients. The number of PD -L1-positive Th2 lymphocytes was significantly higher in the luminal A and luminal B HER2- BC samples compared to the luminal B HER2+ cases (р=0.0240 and p=0.0092, respectively). When the proportion of PD -L1-positive cells was calculated, the proportion of PD -L1-positive Th2 lymphocytes and T regulatory lymphocytes was significantly lower in luminal B HER2-compared to luminal A BC. Cytotoxic lymphocytes, Th2 lymphocytes and T-regulatory lymphocytes represented the predominant PD -L1-positive immune cells in the breast cancer microenvironment and were present in higher numbers in PD -L1-positive luminal B HER2-. Conclusions. Different lymphocyte populations, including those expressing PD -L1, can be found in the breast cancer microenvironment and there are differences in their numbers between different luminal breast cancers. This may explain the discordant prognostic and predictive value of the microenvironment in luminal breast cancer when considered as a single molecular subtype.

The study was aimed to determine the interrelations between levels of serum antibodies specific to estradiol and progesterone (IgA₁-E2 and IgA₁-Pg) and corresponding antiidiotypic antibodies (IgG₂-E2 and IgG₂-Pg) and tumor Ki67 positive cells in breast cancer patients (BCP). Material and Methods. The content of these antibodies in the blood serum of BCP (522 at the I stage and 578 at the II –IV stages) was studied using non-competitive enzyme immunoassay. Ki67 was determined using immunohistochemical method. Statistical analysis of the results was performed using the Statistica 8.0 software. Results. There were no revealed the desired associations in BCP I stage. Tumors with high levels of Ki67 positive cells (>20,0 %) were found more often in BCP II –IV stages with high serum levels of IgA₁-E2 together with IgA₁-Pg than in BCP with low levels of these antibodies (68.8 vs 58.0 %, р=0.02). In contrast, tumors with Ki67>20,0 % were revealed less often in BCP with high levels of IgG₂-E2 together with IgG₂-Pg (49.6 vs 65.2 %, р=0.002). Tumors with high levels of Ki67 positive cells were revealed in 42.9 % BCP I stage and in 77.1 % BCP II –IV stages with high serum levels of IgA₁-E2 and IgA₁-Pg in combination with low serum levels of IgG₂-E2 and IgG₂-Pg (p<0.001). There were no such differences between BCP I and II -IV stages with low levels of IgA₁-E2 and IgA₁-Pg in combination with high levels of IgG₂-E2 and IgG₂-Pg (46.7 vs 48.2 %, accordingly, р=0.985). Conclusion. Antibodies against E2 and Pg synergistically promoted, but corresponding antiidiotypic antibodies synergistically inhibited the tumors proliferation in BCP. Immunoassay of antibodies and anti-antibodies to steroids is recommended for research of human hormone-dependent neoplasms progression.

Aim of the study: to compare the antitumor efficacy and immunogenicity of vaccines with the same antigens but different adjuvants: Ridostin Pro or Poly(I:C); to evaluate the effect of Ridostin Pro and Poly(I:C) on the cytokine profile of serum and the immunophenotype of mouse spleen cells. Material and Methods. To evaluate the antitumor efficacy of vaccines with different adjuvants, two transplantable tumor lines were used: melanoma B16-F10 and EG 7-OVA lymphoma (expressing ovalbumin) for C57BL/6 mice. Against melanoma B16-F10, vaccination with the peptide TRP2 180–188 with the studied adjuvants was performed in a mixed (preventive/therapeutic) and therapeutic regimens. Ovalbumin with adjuvants was vaccinated against EG 7 lymphoma in a therapeutic mode. The immunogenicity of vaccines with different adjuvants in mice without tumors was evaluated by the ELISPOT method. In this case, the peptide TRP2 180–188 and the protein ovalbumin also served as antigens. The cytokine profile of blood serum and changes in the immunophenotype of mouse spleen cells after administration of Ridostin Pro or Poly(I:C) were studied using flow cytometry. Results. In the B16-F10 model, vaccination in a mixed mode protected mice from tumor formation, and the mice lived for more than 100 days. For B16-F10 and EG 7, vaccination in the therapeutic mode led only to inhibition of tumor growth. Ridostin Pro and Poly(I:C) showed a similar ability to develop specific immunity to the peptide TRP2 and ovalbumin. Ridostin Pro increased cytokine levels in the blood serum of mice more strongly than Poly(I:C). Both drugs caused similar changes in the immunophenotype of spleen cells, but Ridostin Pro increased the number of CD 69+ T cells more strongly than Poly(I:C). Conclusion. The comparison of two drugs as adjuvants for antitumor vaccines showed that the domestic drug Ridostin Pro did not inferior in effectiveness to Poly(I:C) on mouse models. In this regard, Ridostin Pro can be considered as a promising adjuvant for antitumor vaccines and deserves further study.

Background. Acute leukemia (AL) is the most common childhood cancer with an incidence rate of about 55–62 cases per 1 million children under 18 years of age. Acute leukemia is difficult to diagnose due to nonspecific symptoms, which are often hidden under the “masks” of other diseases. This problem is especially relevant for regions with a population of up to 100,000 people, where AL in children is diagnosed once every 2–5 years causing too low cancer alertness among pediatricians. Aim: to assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children’s Hospital (RCC H). Material and Methods. The analysis included 35 patients hospitalized in the Department of Oncology and Hematology of the RCC H for the period from 2018 to 2023. The diagnoses were: ALL, C91.0 – 30 (86 %), AML , C92 – 3 (9 %), and AL of unspecified cell type (ALUCL ), C95.0 – 2 (5 %) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76 % and 78 %, respectively. Leukocytosis >20×109/L was observed in 58 %, leukopenia <3.5×109/L in 15 % of patients. In 97 % of cases, blasts (2 % to 95 %) were detected in peripheral blood. In the city of Tver (group 1) and the Tver region (group 2), 16 (46 %) and 19 (54 %) patients were identified, respectively. The mean age of patients in group 1 was 28.6 months and the mean age in group 2 was 72.3 months (p=0.1). Results. In group 1 and 2, ALL was diagnosed in 14 (88 %) and 16 (84 %), AML in 1 (6 %) and 2 (11 %) and ALUCL in 1 (6 %) and 1 (5 %) cases, p=0.6, 0.7 and 0.95, respectively. Delay in diagnosis in the general group (n=35) was observed <2 weeks in 21 (60 %) cases, 2–4 weeks – in 7 (20 %), ≥4–≤8 weeks – in 4 (11 %) and >8 weeks – in 3 (9 %) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed <2 weeks in 7 (44 %) vs 13 (68 %) cases, 2–4 weeks – in 6 (38 %) vs 3 (17 %), ≥4–≤8 weeks – in 1 (6 %) vs 1 (5 %) and >8 weeks – in 2 (12 %) vs 2 (10 %) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care (RCC H) on the time of diagnosis. With the removal of <50 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 36, 36, 21 and 7 %, respectively. With the removal of ≥50–≤100 km, the diagnosis was made in the period of 2–4 weeks in 100 % of cases. With the removal of >100 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 30, 30, 20 and 20 %, respectively (p=0.78). Conclusion. The distance from the third-level hospital did not affect the period of diagnosis of AL in children, which is achieved by holding daily on-line conferences with country hospitals and out-patient departments followed by the rapid hospitalization of children with suspected oncohematological disorders in the specialized department.

Introduction. The esophagus cancer patients needs early diagnosis to achieve better prognosis. The delay barriers increase progression of diseases to higher stages. The aim of work was to identify and explore the barriers in diagnosis of esophagus cancer and chart the time duration in this process. Material and Methods. The study was conducted in Jinnah Hospital Lahore (JHL), a teaching care hospital of Allama Iqbal Medical College, during a period of one year from July 2019 to July 2020. There were 49.42 % female and 50.57 % male patients. Results. Mean age found to be 56 years. Mean Total delay (TD ) time was 206 days and median Total delay (TD ) time in days were 197 days with 25th and 75th (157, 246) percentiles respectively. Longest delays were found in 51–60 age group and age related (r=0.94) significantly to delays (p=0.0004). Initial symptom of weight loss shows maximum delay and symptoms are highly correlated (r=0.94) with delay (p=0.004). The low income group presents maximum delay. Mean patient delay (PD ) time in days were 142 days with 135 Median and (88, 195) 25th and 75th percentile respectively. Mean, Median, 25th and 75th percentiles for Physician delays (PhyD) times were (20, 18, 16, 23) respectively. Treatment delay (TD ) time (Mean, Median) in days were (18, 18.52) with 25th and 75th (14, 22) percentiles. The education significantly reduces the delays with correlation (r=0.91) and significance (p=0.02). Mean system delay (SD ) time were 25 days and median were 24 days with 25th and 75th (20, 31) percentiles. Conclusion. Illiteracy, financial problems, and unavailability of information related to the cancer and health care system, very limited number of health facilities remains the main causes of these delays.

Objective: to study the histological structure of lung cancer, as well as molecular-genetic, gender, demographic and anamnestic characteristics of patients with non-small cell lung cancer in Khanty-Mansiysk Autonomous district – Ugra. Material and Methods. Material for the study consisted of 6725 cases of lung cancer for the period 2001–2020 and 266 cases diagnosed with non-small cell lung cancer for the period 2020–2023. Nonparametric Fisher’s criterion and χ2 test were used to analyze statistical factors. The relative risk of an event in the main group compared to the control group was calculated. Results. Squamous cell carcinoma remained the most common histological form among lung cancers detected for the periods 2001–2010 and 2011–2020 (40.2 and 38.3 %, respectively). During the second decade of the study period, the proportion of lung adenocarcinoma increased by 9.6%, approaching the rates of squamous cell lung carcinoma. It should be noted that in the structure of all histologic subtypes of non-small cell lung cancer, genetic aberrations occurred more frequently in adenocarcinoma than in other histologic forms of lung cancer (33 vs 6 %, respectively). The results of the analysis showed that the relative risk of developing genetic aberrations in EGFR, KRAS, ALK oncogenes was respectively 21.08; 9.04 and 10.84 times higher in lung adenocarcinoma and 15.87; 2.18 and 10.2 times higher among never smokers than in the control groups. The incidence of mutations in the EGFR gene was statistically more frequent in women (p<0.001), and the incidence of translocation in the AL K gene was predominantly diagnosed at age ≥48 years (p=0.002) regardless of gender. The specificity of PD-L1 expression levels (low – 63.2 %, medium – 16.2 %, high – 4.5 %) is consistent with other recent studies. Conclusion. The study of molecular-genetic changes observed in patients with non-small-cell lung cancer in Ugra allows the development of organizational and methodological approaches to diagnosis and treatment of these patients.

Objective. Determination of the optimal machine learning model for the creation of software for screening and early diagnosis of pancreatic neoplasms in the context of centralization of the laboratory service in the region. Material and Methods. The clinical material was based on 1254 patients who were examined in the centralized laboratory of the Volgograd Consultative and Diagnostic Polyclinic No. 2. Of these, 139 were subsequently operated on at the Volgograd Regional Clinical Oncology Dispensary for pancreatic malignancies. In 65 (46.7 %) cases, distal pancreatic resection was performed, and in 74 (53.3 %) cases, pancreaticoduodenectomy was performed. In 28 (20.1 %) cases, at the time of tumor detection, patients did not have clinical symptoms. Statistical processing of the data was carried out using the Python programming language. Five different classifiers were used for machine learning. Results. In the course of factor analysis, 11 parameters were selected from 62 laboratory blood parameters, the dynamics of changes in which should be specifically assessed at the stages of screening and early diagnosis of pancreatic neoplasms. A comparative assessment of machine learning techniques showed that the best option for creating the appropriate software was Hist Gradient Boosting (diagnostic accuracy 0.909, sensitivity 0.642, specificity 0.965, negative predictability 0.928, positive predictability 0.794, F1 0.828, logistic regression loss function 0.352, area under the ROC curve 0.89). Conclusion. The creation of software based on the selected algorithm will make it possible to clarify the real effectiveness of machine learning on a larger population of patients with pancreatic neoplasms.

The study aimed to perform a systematic review of the literature on surgical treatment for right colon cancer (RCC) with complete mesocolic excision (CME) and D2/D3 lymph node dissection (LND). Material and Methods. A literature review was performed for studies published between 2013 and 2023 by the online resources from the official Web sites of the societies/panels and PubMed database. Sources included guidelines, meta-analyses, randomized and nonrandomized clinical studies, guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network, Russian clinical guidelines. Results. CME significantly improved both immediate and long-term treatment results, which was confirmed by numerous meta-analyses. The extent of LND remains one of the most controversial issues in RCC. For many Asian surgeons, D3 LND is the standard procedure for the treatment of RCC, whereas the European approach is more conservative and apical lymph node dissection is not mandatory. There are also large differences in understanding the extent of D3 LND in RCC. Most surgeons understand this term as dissection of adipose tissue along the anterior and lateral surface of the superior mesenteric vein, however, there are authors who perform circular dissection along the superior mesenteric vessels, considering this extent of surgery to be the most radical. Conclusion. It is necessary to standardize methods and effective criteria for quality control of CME for RCC and LND. In this case, external independent assessment of the quality of surgical intervention is important. There is also currently a growing number of studies in which intraoperative fluorescence imaging makes it possible to better visualize the location of the apical lymph nodes and individualize LND.

The aim of the study was to analyze and summarize the available literature data on the modern radiotherapy techniques, indications for radiotherapy (preoperative, radical, postoperative radiation therapy), treatment volumes at different disease stages, and principles of drug and accompanying therapy for patients with vulvar cancer. Material and Methods. The literature review was based on the clinical recommendations of the Ministry of Health of the Russian Federation and National Comprehensive Cancer Network (NCC N), as well as on the search of sources in PubMed and Cochrane Library systems. Literature sources and publications from 2005 to 2023 were included. Results. This contribution outlined the main indications for preoperative, postoperative and radical radiotherapy in patients with vulvar cancer, as well as the basic principles of drug treatment and correction of complications. Potential risk factors for postoperative disease recurrence were identified, the volumes of irradiation at each treatment mode were analyzed, and the feasibility of using brachytherapy in patients with vulvar cancer was discussed. Conclusion. To date, there are recommendations, guidelines for the management of patients with vulvar cancer, as well as clinical trial results. Understanding of the principles of prescribing treatment for vulvar cancer patients can improve local control, overall and recurrence-free survival, and the use of modern radiotherapy techniques will enshure an acceptable quality of life in these patients.

Purpose of the study: to provide current data on pharmacotherapy of hormone-dependent breast cancer (hdBC) and to consider the feasibility of introducing new hormone therapy drugs for breast cancer into clinical practice. Material and Methods. We analyzed 80 publications available Pubmed, Springer, Cochrane Library, etc. concerning the study of pharmacological characteristics of various groups of drugs for the treatment of hdBC, of which 49 were included in this review. Results. Currently, there are several approaches to the treatment of hdBC. Selective estrogen receptor modulators and aromatase inhibitors are the most studied and frequently used drugs. The cyclin-dependent kinase 4/6 inhibitors can be present in both the first- and second-line therapy. Currently, close attention is paid to the development of new drugs based on genomic profiling of the tumor, which is the standard of treatment for hdBC, and contributes to the personalization of therapy. Conclusion. Further development of drugs holds great promise for increasing overall survival and more accurate prognosis, response to conventional systemic therapy, and individualization of pharmacotherapy for hdBC. However, further research and development of new drugs is required. In this regard, the introduction of oral selective estrogen receptor degraders into practice and the development of new drugs that block estrogen-dependent and independent signaling to estrogen receptors are the most promising trends.

Digital papillary adenocarcinoma (DPA ) is a rare malignant neoplasm of sweat glands, which was first described by Helwig in 1979 and then classified by Kao in 1987. This disease most often occurs in men aged 50–70 years and is characterized by a relatively favorable prognosis. In most cases, radical excision of the tumor leads to cure. However, 14–47 % of patients develop distant metastases with predominant lung involvement (70 %). The study of etiology and pathogenesis of this rare cancer and its molecular genetic profile seems to be interesting. Currently, there is no clear approach to the treatment of metastatic DPA , but sporadic cases of using chemotherapy have been reported. Aim of the study: to analyze current data on the pathogenesis of DPA , diagnostic features and treatment methods used, as well as to present the first clinical case of treatment of disseminated digital carcinoma with immune checkpoint inhibitors described in scientific literature. Material and Methods. A search of available literature published in Medline, Pubmed, etc. databases from 1984 to 2023 was performed, 21 sources were included in this review. Clinical Case Description. We present a rare case of metastatic digital papillary carcinoma in a 23-year-old male with disease manifestation at the age of 14 years. Lack of vigilance and awareness of oncologists and morphologists did not allow timely diagnosis of malignancy, even in case of 3 local recurrences of the disease. Only biopsy of a metastatic lung nodule with histological and IHC examination (of archival and new material) made it possible to make a correct diagnosis. This case revealed 2 potential targets that could be used for disease control: androgen receptor positive expression and PD -L1 expression with CPS =20. The use of immune response checkpoint inhibitors (ipilimumab + nivolumab) resulted in partial response followed by stable disease.

Purpose: To demonstrate treatment outcomes in two patients with small cell esophageal cancer. Cases reports. Patient M. was assigned to receive polychemotherapy (PC H) composed of etoposide 100 mg/ m2 intravenously on days 1–3 + cisplatin 80 mg/m2 on day 1, every 21 days for 6 cycles and lanreotide 120 mg subcutaneously, every 28 days, followed by chemoradiotherapy (CRT). The patient received 1 cycle of PCT , which was well tolerated. Then, the patient received a cycle of 3D-conformal radiation therapy concurrently with 2 cycles of chemotherapy: etoposide 120 mg/m2 + cisplatin 80 mg/m2. Chemoradiotherapy was well tolerated. Dysphagia regression to grade I was observed. Currently, the patient continues to receive treatment (etoposide 100 mg/ m2 intravenously on days 1–3 + cisplatin 80 mg/m2 on day 1, every 21 days for 6 cycles and lanreotide 120 mg subcutaneously, every 28 days) and tolerates it well. Patient A. was assigned to receive PCT with etoposide 120 mg/m2 + cisplatin 80 mg/m2. After 4 cycles of PCT , the follow-up CT images revealed disease progression (enlarged retroperitoneal lymph nodes). The patient underwent external bean radiation therapy to the primary tumor. Radiotherapy was relatively well tolerated. The patient underwent the course of radiation therapy relatively satisfactorily. Due to the progression of the disease, symptomatic treatment was assigned. The patient died 9 months after diagnosis. Conclusion. Small cell carcinoma of the esophagus is a rare histological type with poor prognosis. Concurrent platinum-based chemoradiotherapy allows achievement of stable disease and disease control.