Hormonal therapy is the main treatment for estrogen receptor positive (ER+) HER 2-negative metastatic breast cancer. Cyclin-dependent kinases 4 and 6 (CDK4/6) are regulators of cell transition from G1 phase to S phase of the cell cycle. The activity of CDK4/6 is increased in the cells of the ER+ breast cancer. CDK4/6 are key targets of signal pathways from the estrogen receptors. Palbociclib is a first-in-class oral inhibitor of CDK4/6. The article presents results of two large randomized phase III trials PALOMA-2 and PALOMA-3, including patients with ER+ HER 2-negative advanced breast cancer. Palbociclib in combination with letrozole significantly improved progression-free survival (PFS) compared with letrozole alone as first-line treatment of advanced breast cancer. Adding palbociclib to fulvestrant results in longer PFS than fulvestrant alone in women with advanced breast cancer as second-line treatment.

The article presents methods of treatment of breast cancer. Namely, surgical treatment, combination treatment (combination radiation therapy), drug therapy (chemotherapy, hormone therapy, targeted therapy). Provides information about reconstructive-plastic operations on breast. To detect early stages of breast cancer requires screening program. Currently, the screening test, leading to reduced mortality from breast cancer - mammography.

The well recognized benefits of the concept of enhanced recovery after surgery (ERAS) are reducing of surgical stress, supporting physiologic homeostasis, fast rehabilitation after an operation, decrease of postoperative morbidity rates, length of hospital stay and cost of treatment. One of the most important innovation in the surgery of the gastrointestinal tract is implementation of ERAS techniques. The survey indicates lacks of prospective randomized trials and met-analysis. Now there is no evidence base for wide incorporation of ERAS in surgical treatment of gastric and esophageal cancer. At the same time a notable factor of its implementation is the possibility of high quality surgical treatment to a more number of patients for less money. Therefore it is necessary to prove extended clinical trials for optimization and standardization of perioperative period such technical complicated surgery as gastrectomy, esophagectomy.

The creation of drugs - inhibitors of immune control points has significantly changed the standards for the treatment of common cancer. These drugs not only showed clinical activity against a wide range of solid tumors, but also have a favorable safety profile. A significant increase in overall survival compared to other antitumor approaches is the main advantage of immunotherapy. Nivolumab is an lgG4 antibody that blocks the interaction of the PD-1 receptor with its ligands, thereby negating the inhibition of the antitumor immune response. ln Russia, the drug is approved for the treatment of advanced melanoma, non-small cell lung cancer and kidney cancer.

The aim of the study was to assess the significance of CIN risk factors in pre- and perimenopausal women with the development of an algorithm of management aimed at increasing the effectiveness of treatment, improving the quality of life of patients, preventing the progression of dysplasia. Materials and methods. At the first stage, a retrospective evaluation of treatment of 202 patients with dysplasia in the perimenopause was carried out, in the second stage, a step-by-step algorithm for the maintenance was developed, and in the third stage, the experimental group under this algorithm was treated. Results. One third of women with CIN to 45 years of age had a combination of HPV and HSV, 44.1 % over 45 years of age, no viral DNA fragments were found. A high incidence of combined gynecological pathology in this age group was noted, including up to 45 years in the form of hyperplastic endometrial processes and breast pathology; Over 45 years of age in the form of genitourinary syndrome, endometrial polyps and cervical canal and vulvar diseases. In a group with CIN III, in a number of cases, a combination of dysplasia with atypical endometrial hyperplasia and breast cancer was diagnosed. The study showed a higher efficiency of step-wise treatment of CIN in the perimenopause compared with the traditional management technique. The obtained results stipulate the need for an integrated approach to therapy with the extension of the diagnostic algorithm, stimulation of antiviral immunity, including the method of photodynamic therapy, the inclusion in the treatment of the rehabilitation phase, the use of hormonal and targeted therapy. Complex therapy has increased the effectiveness of treatment, accelerated repair of cervical tissue. Conclusions. Carrying out of stage complex therapy allowed to increase the effectiveness of therapy, to prevent the progression of CIN.

The approaches to the treatment of prostate cancer (PCa) has changed considerably over the last decade. Currently, prostate cancer is one of the most common malignancy and the second leading cause of death among men. The incidence of this disease increases with age, that is why doctors are increasingly facing problems with prostate cancer treatment in older patients. In numerous studies it was shown that carefully selected prostate cancer treatment provides similar survival results of elderly and younger patients. However, in older patients overall health and related diseases can adversely affect the efficacy and safety of different treatment methods. Furthermore, the heterogeneity of the patients population requires a multidisciplinary approach to select proper treatment modality (active surveillance or maintenance therapy) and to determine the use of the conservative and (or) surgical treatment of prostate cancer.

Spinal cord compression syndrome is a serious complication of metastatic lesions of the spine in patients with cancer. No specific treatment or ineffectiveness of such treatment lead to the development of sensory disturbances and motor functions of limbs, pelvic organ dysfunction, severe pain syndrome. Timely conducted course of external beam radiotherapy in separate mode or complex therapy prevents the patient s disability, and significantly improve the quality of life. This article provides two examples of the successful treatment of patients with spinal cord compression syndrome with the use of external beam radiation therapy as part of comprehensive treatment.

Purpose. Chemoradiotherapy in the treatment of anal canal cancer leads to high local control rates, but is associated with significant early toxicity. This article presents the experience of using intensity modulated radiotherapy and its efficacy, and also frequency and severity of adverse side effects in patients with squamous cell carcinoma of the anal canal. Materials and Methods. Between years 2011 and 2015, 112 patients with morphologically confirmed squamous cell carcinoma of the anal canal received chemoradiotherapy using intensity modulated radiotherapy (IMRT); two different chemotherapy regimens were used: cisplatin/bleomycin or mitomycin C. In some patients, the irradiated volumes received a different daily dose of radiation, while maintaining the same number of fractions - the simultaneus integrated boost (SIB) method. Results: Staging of the tumor process was performed according to the TNM-system (7th edition): Stage I - 4 (3.6 %) patients, II - 39 (34.8 %). More than half of the patients had III-A and III-B stages - 33 (29.5 %) and 34 (30.3 %) respectively, and IV in 2 (1.8 %) patients. Median mean follow-up after the end of CRT in 112 patients was 32 months (the range of 7-60 months). The majority of patients were females (n = 94; 83.9 %), the median age was 56 years. The course of treatment without a break was conducted in 65 (58 %) patients. The use of IMRT technology in the SIB variant in comparison with the sequential decrease of the irradiated volume (from total volume including the tumor and lymph nodes up to residual tumor) showed a tendency to decrease the rates of locoregional recurrence: 2 (5.1 %) and 6 (14 %) patients respectively (p = 0.269). It was found that all relapses occurred in patients with advanced disease (III-A and III-B stages). The use of SIB caused a tendency to decrease the rate of distant metastases appearance: from 7 (16.3 %) to 3 (7.7 %) patients (p = 0.318). The combination of radiotherapy and mitomycin C promoted a significant increase in the stage II gastrointestinal toxicity in 33 (53.2%) patients (p = 0.021); haematologic toxicity in 37 (59,7%) patients (p = 0,001); and stage III dermatological toxicity was found in 20 (32,3 %) patients (p = 0,002). Conclusions. The use of improved IMRT-technologies has shown a tendency to reduce locoregional recurrence rate and distant metastases appearance and is an effective part of chemoradiation treatment of anal canal cancer.

In this article, the authors present approaches to the treatment and prevention of complications during operations on the pelvis, regarding malignant neoplasms of various organs. The proposed approach allowed to reduce the number of repeated operations and reduce postoperative complications from 49.1 % to 18.6 %, shortening the time patients stay in a hospital.