Genetic factors, immune dysfunction, chronic inflammation, and dysbiosis of the intestinal microbiome (IM) are believed to participate in the pathogenesis of colorectal cancer (CRC). The positive role of IM regulation in the treatment of inflammatory bowel disorders is determined by a reduction in the growth of pathogenic bacteria and an increase in the production of anti-inflammatory factors. Currently, the available data suggests that the IM dysregulates the immune response against the tumor in its microenvironment, thus either slowing down or accelerating the efficacy of antitumor therapy. Clinical studies have reported benefits of CRC therapy selected based on IM in improving immune intestinal homeostasis, epithelial barrier functions, and quality of life. Moreover, the specific IM signature may modulate the sensitivity to chemoand/ or radiotherapy, as well as the prognosis in patients with colorectal cancer. In this article, we presented the general challenges of the CRC therapy based on IM data in combination with immunotherapy, and described the future prospects of this approach.

Background. In 2016, the World Health Organization published an updated version of the Histological Classification for ovarian tumors presenting a new category of endometriosis-associated tumors. The predictors of malignant transformation of endometriosis have not been clearly defined so far.

Purpose. The search for histological and immunohistochemical markers of endometriosis-associated malignancy.

Materials and methods. 28 female patients with endometrioid ovarian cancer and 11 patients with clear cell ovarian carcinoma were enrolled. Histological and immunohistochemical studies were carried out using conventional techniques. Immunohistochemistry was applied to determine the hormone receptor status: expression of steroid hormone receptors, BAF250a (ARID1A), PTEN, P-catenin, MSH6, PMS2, р-53, WT-1, proliferative index (Ki-67). Microsatellite instability (MSI) testing was conducted according to the standard protocol.

Results. In all cases of ovarian cancer, histological examination showed one of the endometriosis features. Atypical endometriosis was found in 39 % (11 / 28) of endometrioid tumors and in 9% (1/ 11) of clear cell carcinomas. Endometrioid ovarian cancer was found to be ER (74±7,8%) — and PR (67±5,4%) — positive; Ki-67 index was 68,2±3,7 %; loss of BAF250a (ARID1A) expression was observed in 14% (4/ 28), loss of PTEN expression in 29 % (8 / 28), nuclear expression of P-catenin in 32% (9/28) of cases. Loss of MMR expression was detected in 7% (2/28) of cases. MSI was found in one case only, which was also associated with loss of expression of BAF250a (ARID1A) and MSH6. Clear cell carcinoma of the ovary showed histological criteria for endometriosis; however, there were no changes immunohistochemical markers expression that were typical for endometriosis-associated malignancies. It could be due to a small number of patients in the group so further research is needed.

Conclusion. Atypical endometriosis may be a morphological precursor of endometrioid and clear cell carcinoma of the ovary. Comprehensive assessment of a marker panel consisting of BAF250a (ARID1A), P-catenin, PTEN, p53, Ki-67 index, PMS2 and MSH6 will allow improving the diagnosis of atypical endometriosis and endometriosis-associated ovarian cancer.

Objective. To evaluate the efficacy of single-photon emission computed tomography combined with computed tomography (SPECT-CT) in the diagnosis of breast cancer (BC).

Materials and methods. We performed 44 SPECT-CT examinations in 40 women with malignant breast neoplasms.

Study Results. The obtained data enabled us to calculate the characteristics of SPECT-CT in the evaluation of the primary tumor. The sensitivity, specificity, and diagnostic accuracy of the method were 88.1 %, 78.3 %, and 88.0 %, respectively. When the method was used to detect nodal and distant metastases, these characteristics were 87.3 %, 76.8 %, 86.9 % and 82.6 %, 73.1 %, 81.4 %, respectively.

Conclusion. SPECT-CT is one of the most accurate methods to assess the primary tumor, lymph node involvement and distant metastases in BC. 

Relevance. Papillary thyroid cancer is often associated with regional metastases to lymph nodes including those of the central adipose tissue of the neck and the deep jugular lymph nodes. Assessment of metastatic involvement of the paratracheal lymph nodes in patients with well-differentiated thyroid cancer T1 and T2 is known to often produce false negative results. Surgical procedures in this region are technically challenging and associated with a certain risk of complications. Therefore, prophylactic removal of the central adipose tissue prevents local cancer recurrence and further metastatic involvement of the regional lymph nodes; moreover, it contributes to proper disease staging and planning of further patient management.

Study goal. Was to determine the optimal extent of surgery for papillary thyroid cancer.

Materials and methods. Sixty patients who underwent surgical procedures for papillary thyroid cancer were enrolled in the study. The study was carried out at SBHI Moscow Clinical Scientific Center named after A.S. Loginov of Moscow City Department of Healthcare from 2015 to 2017.

Results. Regional metastases to the lymph nodes of the central adipose tissue of the neck removed during prophylactic central cervical lymph node dissection were revealed in 41.5% of cases. None of the patients demonstrated regional or distant metastases within 18 months of follow-up.

Conclusions. Papillary thyroid cancer is associated with high incidence of regional metastases to the lymph nodes of the central adipose tissue of the neck, which necessitates central ipsilateral lymph node dissection simultaneously with thyroidectomy, which does not increase the postoperative complication rate.

Background. Locally advanced squamous cell carcinoma of the oral cavity invades the mandible in 13–38 % of cases. Even a small segmental resection of the mandible, for instance, in the chin area, causes significant functional and cosmetic impairment and requires immediate reconstruction of the bone defect. Currently available methods of defect closure require a comparative assessment.

Materials and methods. This article is based on the outcome data from patients with mandibular tumors treated from 1998 through 2018. We identified 471 cases of mandibular surgery including marginal resection and midline mandibulotomy; 203 (43.1 %) patients underwent segmental resection. Of them, we selected 99 patients with an isolated chin defect combined either with a mandibular body defect or with a subtotal defect in the mandible.

Results. In this study, we analyzed the treatment outcomes in patients with primary and secondary mandibular tumors involving the chin as the most difficult for reconstruction from the point of view of the surgeon and the most important for the patient from the functional and aesthetic point of view.

Conclusions. A mandibular defect located in the chin area requires immediate reconstruction. The preferable method of defect closure is the application of a reconstruction plate with a musculocutaneous flap or implantation of vascularized bone grafts. Implantation of a fibular free flap is preferable for the closure of extensive mandibular defects involving the chin area. 

Background. Overall survival (OS) data obtained in patients with metastatic renal cell carcinoma (mRCC) in real-world settings are rarely published. The objective of the RENSUR3 registry study was to collect information on the use of various therapeutic options for mRCC in real-world clinical practice and assess OS in a Russian population.

Methods. Patients were retrospectively identified at 8 cancer centres in different Russian regions and enrolled in the study if the diagnosis of mRCC had been made in the period from January 2015 to December 2016. Anonymous data were collected online, the registry contained demographic characteristics and treatment and outcome data.

Results. The study had 573 subjects included in the analysis. The average age of patients at mRCC diagnosis was 63.1 years; 14.5 % of them were aged > 75 years. 65.6 % of the subjects were men; 72% had received surgical treatment for the primary tumour; clear cell and non-clear cell carcinomas were detected in 84 % and 16 % of the patients, respectively.

Drug therapy was used in 307 patients (54%). The median duration of any line of therapy was 10 months (95% CI 7.6-12.4). The most frequent treatment option was interferon (administered 161 times as part of any line of therapy or at different stages of treatment). Targeted therapy was given to 160 patients (52.1%), 112 of whom received it as first-line therapy. 87 subjects (28.3%) received > 2 lines of therapy. The 3-year OS rate was 21%, and the median OS was 12 months (95% CI 11.1-12.9). The median OS in the therapy and no therapy groups was 15.1 months and 6.9 months, respectively (Р<0.0001). The median life expectancy in patients receiving second-line therapy (median 18.4 months) was significantly higher than in patients treated with first-line therapy only (10.9 months, Р<0.001).

Conclusions: The OS results of the RENSUR3 study are unsatisfactory, which apparently can be explained by the fact that drug therapy was used in only half the patients, the infrequent use of targeted drugs, and the rare administration of targeted therapy for second and subsequent lines of therapy in patients with progressive disease. Introduction of the latest drug therapy options, including checkpoint inhibitors, will help improve patients» life expectancy.

Purpose. To assess the incidence and severity of adverse events; to explore clinical factors associated with grade 3–4 non-hematologic toxicity; to assess the immediate efficacy and progression-free survival during treatment with the FOLFIRI regimen in combination with aflibercept in Russia.

Materials and Methods. A retrospective multicenter study has been conducted with data collected from 20 clinics in 15 regions of Russia. There was no statistical hypothesis. Progression-free survival was the main efficacy criterion. The statistical analysis was performed using IBM SPPS Statistics v. 20 software.

Results. FOLFIRI and Aflibercept combination was administered to 264 patients. The mean number of treatment cycles was 6 (1 to 29). The toxicity of aflibercept was addressed by dose reduction and dosing delay in 10.1 % and 11.4 % of patients, respectively, and dose reductions and dosing delays in any of FOLIFRI components were reported in 20.1 % of participants. The objective response rate was 20.3 %. The median progression-free survival in patients receiving second-line treatment was 6 months (95 % CI: 5.3–6.6 months). Seventy-two percent of patients experienced any grade of adverse events most of which were limited to grade 1–2 (62.1 %). Non-hematologic toxicity was reported in 64 % of patients (grade 3–4 in 17.9 %). Hematologic events were detected in only 17.9 % of patients. Multifactorial analysis has shown that drug therapy for concomitant diseases (OR 1.98, 95 % CI: 1.04–3.78, p = 0.037) and the number of chemotherapy lines prior to aflibercept (ОR 1.5, 95 % CI: 1.06–2.11, p = 0.02) were independent predictors of grade 3–4 non-hematologic toxicity.

Conclusions. Objective response rate, progression-free survival, and frequency of toxicity-related aflibercept discontinuations in the Russian study with patients receiving aflibercept in combination with FOLFIRI regimen as a second-line treatment has shown the results that were comparable with VELOUR study. Comorbidities requiring drug treatment and the number of prior chemotherapy lines appear to be risk factors for grade 3–4 nonhematological toxicity events. 

This paper presents two rare case reports with one common feature. Patients with thyroid nodules, who had undergone a comprehensive clinical evaluation based on standard algorithms according to their preoperative diagnosis of “Multinodular goiter, grade II”, were scheduled for surgical treatment (thyroidectomy). Postoperative morphological examination revealed, however, the extremely rare neuroendocrine tumor paraganglioma that simulated multinodular goiter with tracheal compression. Our analysis of these clinical cases showed common systematic mistakes that were committed during conventional, standardized preoperative examination, resulting in certain difficulties in the treatment of these patients.

The treatment standard for stage IVB cervical cancer is palliative drug therapy combined with cytoreductive surgery used in the presence of resectable lesions. Anticancer therapy is based on two-component regimens that include platinum agents and taxanes. The virus-associated aetiology and pathogenesis of cervical cancer is a predictor of high efficacy of immunotherapy, which made the FDA approve an anti-PD1 agent for use in the treatment of these patients in 2018. The paper presents literature data on the treatment methods for advanced cervical cancer and a case report of indolent disease that was treated with all currently available therapeutic options, including checkpoint inhibitors.