Objective: to evaluate the efficacy of first-line systemic therapy administered in real clinical practice to patients >75 years old with prostate cancer (PCa).

Material: the retrospective study included data from 315 patients >75 years old (median age — 84 (75-99) years) with hormone-sensitive PCa (HSPCa) who received antitumor therapy. Non-metastatic HSPCa (nmHSPCa) was observed in 223 (70,8%) patients, while metastatic HSPCa (mHSPCa) — in 92 (29,2%) patients. In 8 (3,6%) cases of nmHSPCa, bicalutamide monotherapy was prescribed, while androgen deprivation therapy (ADT) was administered in 215 (96,4%) cases (intermittently — 164 (73,5%)). All 92 patients with mHSPC received ADT, including in combinations corresponding to current clinical recommendations — in 38 (41,3 %) cases (with docetaxel — 17 (18,4 %), abiraterone acetate — 7 (7,6 %), enzalutamide — 10 (10,9 %), apalutamide — 1 (1,1 %)). The median follow-up time for patients with nmHSPC was 64,2 (2,1-275,7) months, for patients with mHSPC — 48,6 (1,0-234,3) months.

Results: the median duration of the 1st line of therapy for nmHSPC was 40,6 (1,0-243,8) months. In nmHPRPC, PSA reduction by>90% during the first line of therapy was seen in 67,3 % of patients. Five-year survival of patients with nmHPRPC without PSA progression (PFPS) reached 70,8%, progression-free survival (PFS) — 70,8%, metastasis-free survival (MFS) — 85,0%, specific survival (SS) — 97,3% and overall (OS) — 91,5%. Continuous ADT in lowand intermediate-risk nmHPRPC reduced PFS compared to intermittent therapy (p = 0.014), but did not affect MFS, SS and OS. The median duration of the first line of therapy for mHPRPC was 14,3 (1,1-137,7) months. In mHSPC, the frequency of PSA decrease by>90% during the first line of therapy was 38,0%. In patients with mHSPC, the 4-year PFSSA was 50,1%, DFS — 50,1%, DFS — 83,5% and OS — 77,2%. In mHSPC, ADT compared with combination therapy reduced DFS (p = 0.018), DFS (p = 0.053) and OS (odds ratio 3.675 (95% confidence intervals: 1.001-13.489); p = 0.008). No significant effect of the combination drug on the survival of patients with mHSPC was found.

Conclusions: in elderly patients with nmHSPC, intermittent ADT is not inferior to continuous ADT in terms of OS. In patients > 75 years old, combination therapy based on ADT with docetaxel or androgen signal inhibitors provides an increased OS compared to ADT alone.

Introduction: Pheochromocytoma (PC) and paraganglioma (PG) are rare neuroendocrine tumors derived from adrenal chromaffin cells. The main options of systemic therapy for PC / PG are alkylating agent-based chemotherapy (ChT) and targeted therapy with sunitinib. There are no comparative data on the efficacy of these options, which became the purpose of this study.

Materials and methods: This retrospective single-center study included patients over 18 y. o. who received ChT or targeted therapy for the first line treatment for metastatic PC / PG from September 2015 to August 2023.

Results: The study included 33 patients (pts) who were divided into two groups — ChT (N = 18, 54.5 %) and targeted therapy (N = 15, 45.5%). In the ChT group, 12 pts (66.7%) received CVD regimen, 6 (33.3%) — temozolomide. In the targeted therapy group, 10 pts (66.7%) received sunitinib, 4 (26.7%) — pazopanib, and 1 (6.7%) — everolimus. Concurrent somatostatin analogues therapy was prescribed in 12 (66.7%) and 10 (66.7%) pts in the ChT and targeted therapy groups, respectively. Both groups were comparable by all main characteristics. Objective response was achieved in 11.11 % (N = 2) and 6.67 % (N = 1) [p=0.99], disease control > 6 months — 61.11 % and 60% (p = 0.99), biochemical response — 36.36% and 30% (p = 0.9) in the ChT and targeted therapy groups, respectively. Median PFS was 12.7 (2.9-22.3) in the ChT versus 12.9 months (2.3-26.5) in the targeted therapy group (p = 0.55). Median overall survival was not reached in both groups.

Discussion: According to comparable efficacy of both treatment options and the indolent course of PC / PG, most patients do not require ChT in the 1st line of treatment. While choosing the 1st line therapy it is necessary firstly to take into account the safety profile of the drugs.

Background: Nowadays there are no international recommendations regarding the necessity of repeated diagnostic laparoscopy (with cytological examination or without it) after preoperative chemotherapy for resectable gastric cancer Purpose: To determine the indications for the repeated laparoscopic surgery in gastric or gastroesophageal cancer patients

Materials and methods: The information on 449 IB-III stage gastric cancer patients was analyzed. After 4 cycles of chemotherapy 52 patients underwent diagnostic laparoscopy with peritoneal fluid cytology testing.

Results: The multifactorial analysis showed that tumor progression detected on CT scans and gastroscopy, subtotal gastric involvement (p < 0,014), and diffuse Lauren type (p < 0,026) were statistically significant negative prognostic factors after preoperative chemotherapy. The 8 weeks interval after neoadjuvant chemotherapy wasn’t significant.

Results: The repeat staging laparoscopy after neoadjuvant chemotherapy is safe and may be considered for a certain category of patients.

Introduction: Soft tissue sarcomas (STS) of the distal extremities are a rare heterogeneous group of malignant mesenchymal tissue tumors, and the publications are extremely limited. They require a special approach because of their small size and functional significance of the areas in which they are located.

The aim of our research was to analyze the clinical and morphological characteristics of hand and foot soft tissue sarcomas and to evaluate the results of treatment depending on various factors.

Materials and methods: We conducted a retrospective analysis of clinical observations of 50 patients with hand and foot soft tissue sarcomas who were examined and treated from 2004 to 2023 at the Moscow Oncology Hospital № 62.

Results: 50 patients with soft tissue sarcomas of the hand and foot were included in this study. There were 24 men and 26 women with a mean age of 45 years. Of the 50 sarcomas, 12 were localized on the hands and 36-on the feet. The commonest subtypes were epithelioid sarcoma in the hand and synovial sarcoma in the foot. The 5-year overall survival (OS) was 55.9%. There were no significant differences in OS or progression-free survival (PFS) among patients treated at a general hospital. 5-year OS in the group of the phalanx sarcoma was significantly higher (p = 0.025). Phalanx sarcomas were more often 5 cm or smaller in size (p = 0.007), but larger tumor size (> 5 cm) was not associated with lower survival. OS significantly decreased in proportion to increasing stage.

Conclusion: Most hand and foot soft tissue sarcomas were less than 5 cm in size, which is indicating that it should not be used as a diagnostic threshold in the distal extremity region. Five-year OS in patients with soft tissue sarcomas of the phalanges is higher than in patients with sarcomas of more proximal localizations.

Introduction: Recent studies of neoadjuvant therapy for colon cancer indicate a significant percentage of patients’ retreatment, more likely due to the low accuracy of radiation diagnostics. The new Node-RADS lymph node assessment system can allow for more accurate selection of patients for neoadjuvant chemotherapy. Currently, the efficiency of adjuvant chemotherapy has been reliably substantiated for N1 within three months, for N2 within 6 months, for NO-only in the presence of negative prognosis factors. This allows us to study the applicability of neoadjuvant chemotherapy with high reliability of lymph node involvement according to computed tomography data in the preoperative period.

Study objective: To determine the diagnostic efficiency of the Node-RADS system for predicting the risk of metastatic lymph node involvement in colon cancer patients.

Materials and methods: A retrospective comparative analysis of computed tomography and pathomorphological examination data was performed for 75 colon cancer patients operated on at the M. N. A. S. Loginov in the period from 2021 to 2023. The clinical stage was routinely established based on the results of computed tomography of the chest and abdomen with intravenous contrast. Restaging was performed in the same patients according to the Node-RADS system with a lymph node score of 1-5 points. The results of two radiation diagnostic methods were compared with the data of the pathomorphological examination of the surgical material.

Results: The accuracy (AUC) of computed tomography in the routine diagnostic method was 0.69. According to Node-RADS assessment, lymph nodes of 4-5 points were considered involved. Statistical analysis showed that the accuracy of this method increased significantly (AUC0.93). To determine the differences between the results of routine assessment, Node-RADS and the pathomorphological examination results, we found statistically significant (p < 0.0001) differences between the routine assessment and the results of pathomorphology, which corresponded to a low diagnostic value. At the same time, when comparing the results of the assessment according to Node-RADS and the conclusion of the pathomorphological study, no statistically significant differences were found (p = 0.109), which corresponded to sufficient diagnostic value of assessing the metastatic regional lymph nodes according to the Node-RADS criteria.

Conclusions: The Node-RADS system, presented as a universal system for assessing malignant lymph nodes shows a fairly high diagnostic potential.

Breast angiosarcoma is a rare malignancy that accounts for less than 0.5% of all breast cancers. The disease is characterized by rapid growth, aggressive course, active dissemination of the process and poor response to treatment. The peculiarity of the disease lies in the complexity of diagnosing the process, since the clinical picture is not specific and often occurs under the guise of skin diseases such as eczema, atopic dermatitis, rosacea, etc. Also, the complexity of diagnosis is complemented by the lack of specific imaging methods, thanks to which it would be possible to diagnose angiosarcoma with high accuracy. The leading element of treatment is a combined approach, namely a combination of surgical excision, drug therapy and radiation. This article presents our own experience in managing a patient with angiosarcoma of the right breast, which arose 7 years after the treatment of breast carcinoma in the St. Petersburg City Clinical Oncology Center.

Endometrial cancer is the most common gynaecological malignancy in Russia and in the world. Pathological evaluation of lymph nodes is important for staging and adjuvant therapy management. Until recently, systematic lymphadenectomy was the gold standard for staging of endometrial cancer. However, this procedure has been associated with high morbidity and life-long consequences. Sentinel lymph node biopsy is an alternative procedure for staging. We conducted a literature review to evaluate the diagnostic precision, safety and methodology of sentinel lymph node mapping in endometrial cancer.

Background: Cancer patients experience acute pain at various the stages of antitumor therapy, which can reduce the patient's commitment to treatment and trust in the doctor, therefore, rapid relief of acute pain is very important. Objective: The aims of the article is to describe the options for acute pain relief in oncology, to characterize the main groups of analgetics, to present data of clinical trials and clinical cases of the use of Tafalgin — the new generation drug from the group of central analgesics.

Methods: Analysis of the literature on pain therapy in cancer therapy, and own data within the framework of the multicenter study “Observational program for monitoring the effectiveness and safety of Tafalgin® in real clinical practice — NIKITA”.

Results: The classification of acute pain in cancer patients in cancer therapy is proposed, analgesics and the features of their use depending on the intensity of pain are described. The results of Tafalgin use show that in 15 minutes after its subcutaneous administration there was a decrease in the intensity of pain by 59.6 %. The duration of analgesia reached 9.35 ± 6.3 hours. An acceptable level of pain relief was achieved in 84 % of patients. 19 mild and moderate adverse events were detected in 15 patients.

Conclusion: Acute pain in cancer patients continues to be a problem, despite the large number of analgesics, so the introduction into clinical practice of a new effective analgesic Tafalgin might ensure pain control.

There is a cohort of cancer patients with terminal chronic kidney disease (CKD) due to various causes and requiring hemodialysis. Antitumor drug therapy in this concomitant disease is possible, but requires selection of the most optimal modified chemotherapy (CT) regimens to maximize efficacy and minimize treatment toxicity. In this case report we describe our therapeutic approach for a patient on hemodialysis with a metastatic non-seminomatous germ cell tumor (GCT) of the testis of poor prognosis according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. We analyzed the literature datareflecting the use of different drugs and CT regimens used for the treatment of GCT in patients with CKD.

The emergence of immunotherapy has revolutionized the treatment approaches of numerous malignancies. Patients that previously faced a prognosis of only a few months left to live can now enjoy extended lifespans for several years. Nevertheless, it is crucial to acknowledge that immunotherapy carries its own spectrum of adverse events. Notably, the issue of immune-related toxicity is progressively gaining prominence with each passing year. A distinctive feature of these immune-related adverse events is their propensity to transition into chronic conditions, with some manifesting long after discontinuation of immunotherapy. Given the current incorporation of adjuvant immunotherapy regimens in clinical guidelines, it becomes imperative to direct heightened attention towards the challenges associated with chronic and delayed toxicity of immunotherapy.