Vol 30, No 6/7 (2023)

Primary mediastinal B-cell lymphoma is an aggressive non-Hodgkin’s lymphoma that occupies a borderline position between diffuse large B-cell lymphoma and classical Hodgkin’s lymphoma. Due to the rare occurrence and the small number of prospective clinical studies, uniform standards for the treatment of primary mediastinal B-cell lymphoma have not been defined. The outcome in refractory or recurrent course remains extremely unfavorable, so the choice of the optimal first-line therapy regimen is especially relevant. The first-line therapy is represented by two main regimens: R-CHOP and DA-EPOCH-R, which have proven their effectiveness in retrospective studies. Given the aggressive course of lymphoma, more intensive approaches to therapy remain the most preferred. R-CHOP induction therapy is followed by consolidation with radiotherapy or alternative regimens (R-ICE). The DA-EPOCH-R mode does not require mediastinal consolidation irradiation. After the end of drug treatment, in order to differentiate the residual tumor tissue from fibrous and inflammatory changes in the mediastinum and determine the indications for subsequent radiation therapy, PET-CT is performed, which, however, has a high percentage of false positive results. Initiated clinical trials will provide rationale for consolidation radiotherapy after rituximab-containing regimens with a complete metabolic response, will determine the feasibility of using PET-CT as a differential diagnostic method, the advantage of the DA-EPOCH or R-CHOP regimen, as well as the need for the use of immunoconjugates, inhibitors of immune control points in combination with standard therapy in order to improve long-term results of treatment.

Background. Anticancer therapy is one of the main ways to treat cancer patients. However, little attention is paid to maintenance therapy in this category of patients. One of the main drugs used in the fight against malignant tumors is 5-fluorouracil. But along with a positive cytotoxic effect, 5-fluorouracil-containing regimens have a negative effect on the mucosa of the gastrointestinal tract, which often leads to the need to replace or cancel drugs, thereby reducing the effectiveness of treatment.

Objective. Improvement of understanding of the possibility of toxicity during treatment with 5-fluorouracil in patients with malignant tumors of various localizations and the factors that aggravate their course, as well as to highlight the problem.

Methods. The search for publications by keywords was carried out in the PubMed, Google Scholar, eLibrary.ru databases and Russian specialized journals related to therapy, surgery, gastroenterology, oncology for the period from 2010 to 2022.

Results. An analysis of the literature allowed to conclude that the risk of damage to the gastrointestinal mucosa during the use of chemotherapy with 5-fluorouracil is very high and reaches 30-40%. In addition, there are many factors that can complicate the course of this undesirable phenomenon. These include the advanced age of patients, the presence of serious comorbidity and postoperative complications in patients, as well as Helicobacter pylori infection. The lack of recommendations for the prevention and treatment of damage to the mucous membrane of the stomach and intestines during the use of chemotherapy remains a serious problem in modern medical practice.

Conclusion. Gastrointestinal toxicity in the form of mucositis against the background of the use of 5-fluorouracil by patients with malignant neoplasms of various localizations deserves close attention. The presence of this undesirable phenomenon in a patient requires immediate therapy, because it will improve the long-term results of the treatment of the underlying disease and ensure a high quality of life for the patient.

20–25% of cases of breast cancer (BC) are characterized by an overexpression of HER2, which is associated with a poor prognosis. Treatment with trastuzumab, a humanized monoclonal nti-HER2 antibody, in combination with chemotherapy (CT), significantly improves response rate, time to progression, and overall survival in HER2-positive women with metastatic BC. In women with resectable BC, trastuzumab improves disease-free and overall survival when used for 1 year in combination with or sequentially after chemotherapy. The positive results of trastuzumab therapy have prompted the search for other HER2-targeting drugs that can improve the therapeutic effects of trastuzumab in combination or when used sequentially. Pertuzumab is an experimental humanized monoclonal antibody directed to the dimerization domain of HER2. Because of their different binding pathways, trastuzumab and pertuzumab have complementary mechanisms of action. Pertuzumab is used in neoadjuvant and adjuvant systemic therapy for women with resectable or locally advanced BC, as well as in unresectable cases as palliative care.

Despite the achievements in performing small pelvic exenteration (SPE) in the world oncological practice, it still remains a debatable subject for practicing oncological surgeons. The main reasons for its unpopularity include technical complexity, high incidence of intra- and postoperative complications (60%), high postoperative mortality (30%), and problems in postoperative rehabilitation of patients [1–3]. This article provides an analysis of 20 SPEs (10 anterior; 10 total) in recurrent locally advanced forms of cervical cancer.

Background. Initially, minimal tumors are characterized by high survival rates, which are proved by international and domestic studies. It is required to clarify the survival rates in the presence of a minimal residual tumor (ypT <10mm) after neoadjuvant systemic therapy in patients with breast cancer (BC) and to compare with primary minimal forms of BC (pT1a-b N0M0), characterized by the most favorable prognosis.

Objective. Improvement of the effectiveness of treatment of residual minimal forms (ypT1a-b) of BC after NST.

Methods. The study included 602 patients aged 18–65 years with early and locally advanced I–IIIC stage T1-3N1-3M0 breast cancer, who underwent complex or combined treatment. This study included patients treated at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2021.

Results and discussion. Our data analysis revealed that the survival rates (DFS and OS) of patients with minimal residual tumor after neojuvant systemic therapy were not comparable with those in the group of patients with primary minimal breast cancer.

Conclusion. After reaching a complete pathomorphological response of the tumor to NST (RCB 0), the 5-year disease-free (DFS) and overall (OS) survival rates (DFS – 78.5%; OS – 90.4%) were inferior to the survival rates of patients with primary minimal breast cancer (pT1ab N0M0) [DFS – 86.4%; OS – 98.6%].

Background. Fluoropyrimidines are highly effective and commonly prescribed anticancer drugs that are used in a wide range of chemotherapy (CT) regimens to treat various types of cancer. Their cardiac toxicity is not only a life-threatening complication, but also leads to the rejection of effective chemotherapy, thereby reducing the life expectancy of patients.

Methods. A cohort of 16 patients with various types of solid gastrointestinal tumors, treated with fluoropyrimidines with detected cardiotoxicity was selected. All patients received treatment at the N.N. Blokhin National Medical Research Institute of Oncology from February 2021 to February 2022.

Results. The most common symptoms of cardiotoxicity included dyspnea, retrosternal pain, and short-term loss of consciousness. An increase in the blood troponin I and NTproBNP levels was registered in 4 patients. In 56% of patients, cardiotoxicity was noted during the first course of treatment. In 1 (6.25%) of 16 cases, a fatal outcome was registered: sudden death during the first infusion of fluorouracil (5-FU).

Conclusion. Patients treated with fluoropyrimidines should be closely monitored and 5-FU should be discontinued at the first sign of cardiovascular toxicity. Re-administration of fluoropyrimidines is not recommended unless they significantly improve the prognosis; but after careful examination of the cardiovascular system, prophylaxis under close monitoring against the background of enhanced cardiac therapy, it is worth considering switching to a bolus of 5-FU. Recognition of risk factors for fluoropyrimidine-associated cardiotoxicity even before the start of chemotherapy is necessary, since it allows either to reduce their influence or to enhance control to detect complications at an early stage.

Background. Determining the most effective drug therapy regimens is one of the top priorities in the individualization of the treatment of patients with breast cancer (BC). When studying neoadjuvant systemic therapy (NST) in many domestic and foreign studies, the achievement of pathological complete response (pCR), an important prognostic factor, is use as the surrogate primary end point. According to the literature, the achievement of pCR after NST in breast cancer varies from 30 to 70%. Patients who do not achieve pCR require post-neoadjuvant treatment.

Objective. Determination of the correlation between the schemes of NST and the degree of tumor response based on the results of postoperative pathological findings on the RCB scale.

Methods. We analyzed the data of 455 patients aged 18–65 years with T1-3N1-3M0 I–IIIC stage locally advanced breast cancer, who underwent NST. This study included patients treated at the N.N. Petrova National Medical Research Center of Oncology from 2015 to 2021.

Results. Data analysis revealed the most effective combinations of drugs expressed in the degree of pathomorphological response according to the RCB scale.

Conclusion. Neoadjuvant chemotherapy regimens that allow achieving a pathological complete response in triple-negative and HER2-positive breast cancer have been defined. An assessment of adverse factors that affect the effectiveness of organ-preserving treatment and correlate with a deterioration in overall survival was performed.

Anemia is a frequent complication of the malignant process, negatively affecting the quality of life of the patient, as well as the results of anticancer treatment and the prognosis of the disease in general. The pathogenesis of anemia in a malignant process is quite complex and is attributable both to the presence of the tumor itself and to the ongoing antitumor treatment. This review summarizes current ideas about the causes and mechanisms of anemia in cancer patients, discusses the diagnostic algorithm and key methods for correcting this condition.

The pain relief is one of the most important tasks in the work of a doctor of any specialty. The patient’s pain is associated with physical suffering and negative emotional experiences. Intense acute, especially chronic, pain causes a complex of maladaptive reactions in the body. First of all, this applies to patients with malignant neoplasms, especially with cancer stage III and IV. Today, opium alkaloids and their synthetic analogues remain the most effective painkillers for intense acute and chronic pain in cancer patients. For chronic pain, strong opioids are prescribed for the second (at low doses) and third steps of pain relief. This stepwise approach is recommended by the World Health Organization. Tapentadol has become a new molecule in the opioid group. The drug was created as an alternative to tramadol, taking into account its pros and cons, which have emerged over many years of use in clinical practice. In 2008, tapentadol received FDA approval for clinical use and entered the US market. In 2010, tapentadol was approved for use in Europe. In 2014, the drug was registered in Russia under the commercial name Palexia. The article provides a literature review of the analgesic potential of tapentadol in cancer patients, a comparative assessment of the effectiveness and risks of its use with other opioid analgesics.

Background. Pituitary adenomas are benign neoplasms, which account for up to 15% of intracranial tumors. Most pituitary macroadenomas today are subject to surgical treatment, and therefore information on the natural course of these tumors is scarce.

Description of the clinical case. In patient B., born in 1990, an endosuprasellar tumor was detected on MRI of the brain performed for headache. Given the absence of neurological symptoms, the patient was kept under follow-up. MRI control 2 months after showed a decrease in the size of the tumor, 4 months after - almost complete regression.

Conclusion. Spontaneous regression of pituitary adenomas is considered a rare but potentially possible outcome. In this regard, when planning the surgical treatment of pituitary adenomas, it is necessary to carefully study all preoperative imaging to confirm that the tumor has not regressed spontaneously.