Elderly cancer patients represent a very heterogeneous pop ulation not only in chronological age, but also in functional status, concomitant diseases and therapy, geriatric syndromes and, as a consequence, in the tolerability of cancer treatment. The choice of chemotherapy (CT) for metastatic breast cancer in this category of patients is often a challenge for oncologists. Eribulin, a drug with a fairly good tolerance, has proven itself well both in randomized trials and in real clinical practice, including older patient population. Pooled analyzes of several studies have shown that the incidence of hematologic adverse events in elderly patients treated with eribulin does not exceed that in younger patients and does not generally affect the planned volume of treatment. At the same time, the elderly are more likely to experience side effects such as weakness, fatigue and polyneuropathy, which must be taken into account when planning CT. Only a comprehensive multidisciplinary approach with a geriatric assessment will make it possible to maximally individualize the approach to the treatment of this difficult category of patients.

The processes underlying malignant neoplasms and autoimmune diseases are similar in many aspects. Some malignant neoplasms may be similar to autoimmune diseases, which requires doctors of different specialties to observe the principle of cancer vigilance. Malignant neoplasms which are associated with autoimmune processes have their own characteristics, and therefore are of interest to the medical community and require further study.

The aim of this work was to present the results of a retrospective study of 35 patients with morphologically diagnosed diffuse B-cell large cell lymphoma with bone marrow damage from 22 to 82 years old, median 63 years. There were 27 men and 8 women. After histological confirmation, all patients performed positron emission tomography combined with computed tomography with 18F-fluorodeoxyglucose (FDG PET/CT) followed by bone marrow trepanobiopsy. Specific bone marrow lesions were detected in 100% of cases with PET/CT and in 68.6% of cases with trepanobiopsy. Diffuse bone marrow damage was detected in 24 (68.6%) cases, focal – in 10 (28.6%) patients and in 1 (2.8%) patient – a mixed variant. The data obtained indicate the predominance of diffuse damage to the bone marrow. The statistical analysis established the value of the standardized maximum absorption coefficient of FDG SUV_max for bone marrow damage equal more than 3.58. Sensitivity was at 90% and a specificity was at 92%. The sensitivity of the PET/CT method is higher with focal lesions of the bone marrow than with diffuse. SUV_max was 10.26 ± 1.67 and 2.86 ± 0.09, respectively. The differences between them are significant (p < 0.0001). PET/CT is a non-invasive method of metabolic imaging allows you to assess the condition of the bone marrow and other extranodal symptoms
of the disease at the stage of diagnosis, treatment and follow-up. It can replace the traditional method of bone marrow biopsy with diffuse B-cell large cell lymphoma.

Purpose. Determining the diagnostic value of magnetic resonance imaging in the accurate definition of chondrosarcoma of bone grade at the pre-surgery examination. Material and methods. We analyzed examination data (magnetic resonance imaging with no contrast enhancement) of 70 patients with chondrosarcoma (35 patients with low-grade chondrosarcoma and 35 patients with high grade chondrosarcoma). Informative weighted coefficients were determined separately for ‘learning’ and ‘examination’ samples. On the basis of weighted coefficients, the decisive rule was created for differentiation between low-grade and high-grade chondrosarcoma. Results. The sensitivity of the method was 87.0%, specificity was 95.6%, total correct classification was 91.03%. Conclusion. Magnetic resonance imaging is a highly informative method for prediction of chondrosarcoma grade at the pre-surgery examination.

Uterine leiomyosarcoma refers to malignant tumors with an aggressive course, poor prognosis, and unsatisfactory long-term treatment results. The five-year overall survival rate ranges from 52–85% for the first stage of the disease to 10–29% for the fourth stage. The treatment method that determines the prognosis of both localized and disseminated leiomyosarcomas is currently radical surgery. In the case of unresectable leiomyosarcomas, drug therapy is performed. The problem of choosing the optimal treatment method for each patient with leiomyosarcoma is still relevant. We present a case of long-term treatment of a patient with high-grade uterine leiomyosarcoma from our own clinical practice. During treatment, the patient underwent 4 surgical interventions and 9 lines of drug therapy. At the moment, the patient is in the process of 10 lines of treatment. Duration of life from the moment of diagnosis is 108 plus months, and from the moment of dissemination of the disease is 97 plus months. This clinical case shows that timely performance of radical surgical interventions and rational choice of drug therapy regimens can significantly increase the average survival rate.

The continuous evolution of new technologies in the field of molecular diagnostics and genome analysis, the development of new approaches in pharmacogenetics and the emergence of a range of different targeted drugs have expanded the possibilities of clinical practice, resulting in personalized approaches to treatment. The diagnosis and therapy of pediatric oncological diseases are some of the vivid examples of the successful application of a personalized approach in clinical practice. Today, many pediatric neoplastic diseases are successfully treated with targeted drugs, which significantly increases patient survival. Targeted therapy allows to choose a specific drug for each patient, thereby increasing the effectiveness of treatment, reducing the risk of side effects, and also reducing the likelihood of a relapse of the disease.

The goal. To show the variety of manifestations of non-palpable breast cancer, which create difficulties in diagnostics and the choice of treatment tactics, to focus on the need to accelerate the introduction of the latest organ-saving treatment and diagnostic technologies and prevention into the system of mammary cancer screening. The main provisions. The epidemiology of cancer, risk factors, positive trends in mammary cancer screening in Russia are presented. A description is given of the diversity of X-ray sonographic and molecular biological manifestations of non-palpable breast cancer based on the results of the analysis of a complex clinical X-ray sonographic pathomorphological and molecular genetic examination of 1,212 patients with clinically latent breast diseases, including 708 patients with non-palpable cancer of various molecular subtypes, manifested by a variety of options – a nodular growth (40.1%), an accumulation of microcalcifications (17.5%), a site of local heavy rearrangement of the structure (31.2%), cancer accompanied by pathological secretion (6.6%), X-ray negative cancer (4.6%). When distributed by stages, 70.3% had T1N0M0, 25% had TisN0M0 and microinvasive cancer. For differential diagnosis, high-tech radiological techniques were used – 3D X-ray and ultrasound tomosynthesis. Effective preoperative diagnostics allowed for adequate organ-saving treatment, including oncoplastic surgery, high-power radiation therapy and modern targeted drug treatment, timely rehabilitation and prevention. Conclusion. Non-palpable breast cancer has many faces. Knowledge of the variants of its manifestations and the use of modern diagnostic methods are necessary for mammary cancer screening, which creates the preconditions for adequate timely organ-saving treatment that preserves the life of patients and its quality.

Bone is a frequent site of metastasis for a wide range of cancer types. The most common cancers that often spread to bone are prostate cancer, breast cancer and renal cell carcinoma. In this regard, the preferential bone localization of tumor cells is determined by their molecular features and attraction by bone microenvironment. Metastatic niche growth destroys the bone, and as a result, patients are suffering from symptoms also known as skeletal-related events: severe pain, fractures, progressive hypercalcemia, resulting in high rates of cancer-dependent complications. Lack in effective guidelines and management procedures in metastatic cancer therapy highlights the issues of molecular mechanism investigation. Here, we discuss about bone microenvironment and how it impacts to tumor growth, cancer progression and dormancy.

Objective. The aim of this study was to evaluate the efficacy and safety of trastuzumab in combination with the FLOT/FOLFOX regimen in the perioperative treatment of resectable HER2-positive locally advanced gastric cancer. Methods. 15 patients were included in two groups; 4 patients were treated with trastuzumab (Herticad®, BIOCAD) + FLOT and 11 patients were treated with trastuzumab (Herticad®, BIOCAD) in combination with FOLFOX. The primary endpoint was incidence of disease stage reduction, tumor regression rate (TRG), change in HER2 tumor status, disease-free and overall survival. Results. Тrastuzumab in combination with FLOT/FOLFOX has a good therapeutic effect and a safety profile in the perioperative treatment of patients with resectable HER2-positive advanced gastric cancer (complete tumor regression [TRG1] was morphologically confirmed in 20% of patients, no pathomorphosis or minimal manifestations [TRG3/TRG4] in 40% of patients, in 40% of patients it was possible to achieve significant pathomorphological tumor regression [TRG2]). In addition, trastuzumab + FLOT gives better results in terms of tumor regression rate than FOLFOX + trastuzumab (cN+/ypN0 disease stage reduction in the T + FLOT group was 100%, whereas in the T + FOLFOX group it was only 30.0%). The HER2 status of the tumor changes against the background of preoperative PCT with the inclusion of trastuzumab (a loss of HER2/ neu protein overexpression was detected in 60% of patients).