Background. Analysis of the sequence of HR+ HER2– mBC therapy in routine practice is important for the assessment and optimization of approaches to the treatment of breast cancer. Automatic analysis of electronic medical records (EMR) using artificial intelligence technology makes it possible to collect and analyze a large array of patient data.  

Purpose. Study of drug therapy regimens and schemes in female patients with HR+ HER2– mBC in routine clinical practice in the Russian Federation.  

Methods. The retrospective data of patients who received mBC therapy in routine clinical practice in eight healthcare facilities of the Russian Federation was extracted using machine learning methods. The data were obtained from the EMRs of patients who received drug therapy from February 1, 2018 to May 31, 2021. Main study objectives: to determine the proportion of patients who received various types of pharmacotherapies (chemotherapy [CT], hormone therapy [HT], targeted therapy [TT]); the number of pharmacotherapy lines, the proportion of patients with resistance and sensitivity to HT. Additional objectives included the determination of demographic characteristics, TNM stages. Ki‑67 proliferative activity index, mutations in the PIK3CA gene, and the presence of a visceral crisis.  

Results. The analysis included data from 932 patients diagnosed with HR+ HER2– mBC. The average patient age was 58.9 ± 11.3 years. Primary metastatic breast cancer was diagnosed in 172 (18.4%) patients. The bones were the most common localization of the first metastases (32.6%). Visceral crisis was reported in 29 (3.1%) patients. 21% of patients were sensitive to HT, 11.1% were primarily resistant, and 31.9% of patients had secondary resistance. The 353 (37.9%) patients received one therapy line, 269 (28.9%) patients received two lines, 139 (14.9%) patients received three lines, and 81 (8.7%) patients received four therapy lines. The first-line treatment included mono-regimens of HT (antiestrogens – 22.8%, aromatase inhibitors [AI] – 20.9%), chemotherapy mono-regimens (taxanes – 11.7%, pyrimidine analogs – 4.4%). Among the combined regimens, the most common were combined chemotherapy with cyclophosphamide + anthracyclines (14.3%) and HT + TT: aromatase inhibitors + targeted therapy (5.2%). In subsequent lines, the HT monotherapy remained the most frequently prescribed, and the specific gravity of CT increased with each line. The CDK4/6 inhibitors with Fulvestrant (8.6%) and aromatase inhibitors (5.1%) were most often prescribed as part of the combined regimens.  

Conclusions. The study was the first experience of using AI technology for the retrospective analysis of data of patients with breast cancer in routine practice. The study shows that in routine clinical practice in Russia there are still high frequency of hormone therapy in mono-regime and chemotherapy in the early lines. iCDK4/6 were used in 9.0%, 14.8%, and 10.8% in the first three therapy lines, respectively. The methodology limitations may be associated with the retrospective study design and possible errors when extracting data from the EMR using artificial intelligence. 

The article presents the evolution of the introduction of digital technologies into the oncomammoscreening system, multimodal technologies of interventional radiology, statistics on the growth of malignant breast neoplasms in the world and Russia, shows the advantages of digitalization of radiology, interdisciplinary integration with omix systems biology technologies, which contributes to the development of a new direction of radiogenomics, and also points out the existing problems of introducing the latest technologies of interventional radiology, the need to prepare multimodal specialists.  

The purpose of the study. To show the possibilities of modern digital radiological non-invasive and invasive technologies, as well as the need for interdisciplinary integration and training of multimodal specialists for the early detection and determination of the phenotype of breast cancer, increasing the effectiveness of choosing adequate treatment tactics aimed at increasing the duration and quality of life of patients.  

Materials and methods. There are given literary data on development of radiological digital methods of diagnostics of breast diseases, including technologies of interventional radiology. New data are also presented on the direction of radiogenomics, born due to the interdisciplinary integration of radiological digital systems, interventional technologies and high-tech systems biology.  

Results. The review presents the development of equipment and radiological methods for early recognition of breast diseases, based on technical progress, including the active introduction of digitalization and informatization in medicine. New models of artificial intelligence act as a physician assistant in screening. Advantages of various versions of interventional radiology technologies in oncomammoscreening are shown to increase accuracy of pathomorphological diagnostics and determination of tumor phenotype. The latest data on feasibility of interdisciplinary integration of «computer vision» on signs of medical imaging with capabilities of systems biology in determination of tumor phenotype with correlation validity in 71% are given.  

Conclusions. The undeniable advantages of digitalization and the new capabilities of interventional radiology in detecting the earliest forms of diseases in an interdisciplinary format open the prospect of high-precision diagnostics and an adequate choice of organ-saving therapeutic tactics. The training of a multimodal specialist – radiologist – radiologist-diagnostics and interventional radiologist, who has a wide range of methods of radiological diagnostics, including invasive interventions, requires correction of organizational forms of work, new educational programs not only in the specialty, but also in the basics of digitalization, which will ensure the rational and effective use of modern achievements of science and technology. 

Introduction. The Implementation of immunotherapy in cancer requires a thorough analysis of the biological characteristics of the tumor. Therefore, the study of tumor immunophenotype is the leading scientific direction. Molecules of the major histocompatibility complex are considered as promising markers for evaluating the possibility of using immunotherapy.

Objective. To study the immunophenotype of the primary tumor in molecular subtypes of breast cancer and analyze it depending on the frequency of bone marrow damage.  

Materials and methods. The study included 99 patients with breast cancer. Tumor tissue and bone marrow samples were studied. Stages: T1 (51.5%), T2 (44.4%), T3 (2.0%). Metastatic involvement of lymph nodes (N+) was noted in 39.4% (n = 39) of cases. Immunophenotyping of the tumor was carried out on cryostat sections by immunofluorescence. Antibodies to HLA-I, HLA-II, KL1, FITC-labeled F(ab2) antiserum fragments (Becton Dickinson, USA) were used. The bone marrow was studied by morphological (Zeiss microscope, Axioskop, Germany) and immunological methods (flow cytometry, FACS Canto II, USA), data analysis – Kaluza Analysis v2.1 software. Used monoclonal antibodies: CD45, EPCAM (Becton Dickinson, USA). Statistical data processing was performed using the IBM-SPSS Statistics 21 package.  

Results. The HLA-I antigen is absent or expressed by single tumor cells in 50.8% of cases of luminal breast cancer. Pronounced or partial expression was noted in 36.9% of cases. With the Erb-B2 subtype, all samples had the expression of antigens of the HLA-I class. Loss of HLA-I antigen or weak expression was observed in 30% (3/10) of cases of the triple-negative subtype, in the same percentage of cases the expression of HLA-II molecules was noted. There were no significant differences in the expression of HLA molecules between subtypes. Using flow cytometry, bone marrow involvement was detected in 40% (26/65) of cases. There were no significant relationships between bone marrow damage and the size of the primary tumor, stage, grade of breast cancer, or expression of HLA molecules.  

Conclusions. The expression of HLA molecules does not differ in significant differences depending on the biological subtype. The frequency of bone marrow damage did not depend on the expression of HLA-I, class II molecules. 

Immune checkpoint inhibitors targeting a programmed cell death ligand (PD-L1) have been a major breakthrough in the treatment of many cancers. Nivolumab is an antibody that selectively blocks the PD‑1 receptor on the surface of cytotoxic T-cells to prevent downregulation of the immune response. Immune checkpoint inhibitors can cause immune-related adverse events, including endocrine ones. Type 1 diabetes mellitus is one of the severe rare and potentially lethal immune-related adverse events diagnosed in less than 1% of patients receiving immune checkpoint inhibitors. The total incidence of type 1 diabetes mellitus associated with the PD‑1 inhibitor is relatively low; however, it develops rapidly and is potentially life-threatening without timely diagnosis and treatment. Since PD‑1 inhibitors are widely used in cancer treatment, complications such as type 1 diabetes mellitus should attract medical attention. During treatment, specialists should help patients better recognize the symptoms of hyperglycemia or diabetic ketoacidosis, which requires careful observation, regular monitoring of blood glucose levels, rapid detection and correct diagnosis and treatment of diabetes mellitus. 

Background. Radiation therapy for locally advanced nasopharyngeal carcinoma (NC) has a high incidence of fatal complications, which leads to absolute contraindications to External Beam Radiation Therapy (EBRT). Chemoembolization of a nasopharyngeal tumor significantly reduces these risks and allows for EBRT. The aim of this study was to assess response rate after chemoembolization and EBRT. Objective. To evaluate the response rate in patients with locally advanced nasopharyngeal cancer treated with chemoembolization of tumor vessels and external beam radiation therapy in combination with chemotherapy.  

Methods. Prospective descriptive study was conducted. Patients with cT3–4, N0–2, M0 NC treated in April 2016 – March 2021 were enrolled. All patients had chemoembolization with doxorubicin’s microspheres followed by EBRT administrated once daily (2,0 Gy per fraction). Treatment response rate was assessed according RECIST 1.1 criteria in three weeks.  

Results. Twenty-one patients were identified. The median age was 47 years (IQR: 20–60). Tumors were staged as cT3N0M0 in 1 (4.8%) case, cT3N1M0 in 6 (28.6%) cases, cT3N2M0 in 5 (23.8%) cases, cT4N0M0 in 1 (4.8%) case, cT4N1M0 in 1 (4.8%) case and cT4N2M0 in 7 (33.4%) cases. There were the following histopathology types of NC: WHO type I (n = 1), WHO type II (n = 7) and WHO type III (n = 13). Fourteen (66.7%) patients had EBV-non-associated tumor and 7 patients were EBV-associated. Twenty (95.2%) patients had absolute contraindications to EBRT. All patients had chemoembolization. Complete response (CR) after chemoembolization was achieved in 3 (14.3%) patients, partial response (PR) was in 4 (19%) patients, stabilization was in 12 (57.1%), and progression was in 2 (9.6%) patients. All 21 patients had EBRT (median total dose 66 Gy [IQR: 60–72]).CR after EBRT was achieved in 17 (80%) patients and progression was in 4 (20%) patients.  

Conclusions. Chemoembolization provides acceptable response rate in patients with locally advanced NC and allows for EBRT. Further studies are needed to evaluate local control. 

Relevance. The article is devoted to contrast-enhanced ultrasound in patients at different stages of minimally invasive (radiofrequency ablation, RFA) treatment of a kidney tumor.  

Objective. To increase the effectiveness of minimally invasive treatment of malignant tumors of the kidneys with the use of a contrast agent in ultrasound examination.  

Materials and methods. The group included 32 (100%) patients with malignant tumors of the kidneys who were denied surgical treatment due to the presence of severe concomitant somatic pathology or the presence of one kidney. In 3 patients, an allergic reaction to the contrast used in CT and MRI was observed, therefore, dynamic observation was carried out only on the basis of data obtained during contrast-enhanced ultrasound. Before RFA and at all stages of dynamic control, all patients underwent contrast-enhanced ultrasound examination. In 29 patients, results one month after ablation were compared with contrast-enhanced MRI or CT.  

Conclusions. The work showed that contrast-enhanced renal ultrasound can effectively evaluate the effectiveness of RFA of kidney malignancies in patients who were denied surgical treatment. 

Relevance. Pulmonary lesions of infectious etiology in oncohematological children are common and, in some cases, may be accompanied by a lethal outcome. When pulmonary tissue lesions on the background of hematopoiesis aplasia in the post-chemotherapy period is shown bronchoscopy to determine the genesis of the identified changes.

Aim. To determine the diagnostic value of bronchoscopy with BAL in children with oncohematological diseases.

Materials and methods. 25 bronchoscopies with BAL were performed on the basis of the endoscopic department of the Research Institute of Pediatric Oncology and Hematology.

Results. According to the results of the study in 72% of cases a microbiologic agent was detected. The most frequent pathogens obtained by the results of cultures were Haemophilus parainfluenzae, Streptococcus oralis, Neisseria macacae, Streptococcus peroris and Pseudomonas aeruginosa.

Conclusions. Bronchoscopy with BAL in children with blood system tumors is a highly informative method of pathogen detection and determination of the etiological cause of infiltrative-inflammatory changes in the lungs.

Introduction. Arming gynecological oncology with modern chemotherapy schemes, elements of aggressive oncosurgery, it is possible to achieve an increase in the number of cured patients with locally advanced forms of cervical cancer (CC), providing an improvement in the immediate and long-term results of treatment. The proposed method of surgical treatment is the method of choice for the surgical treatment of patients with locally advanced forms of cervical cancer (stages IIA–IIIB).

Purpose of the study. Introduction into clinical practice of the method of surgical treatment of IIA–IIIB stages of cervical cancer.

Material and methods. Long-term results of treatment of 155 patients with morphologically verified stage IIA–IIIB cervical cancer were studied. The patients underwent neoadjuvant chemotherapy (NACT) (n = 110) and chemoradiotherapy (CRT) (n = 45). When resectability was achieved, the patients underwent surgical treatment using a new technique. Overall survival (OS) and progression-free survival (PFS) outcomes were assessed.

Results. In the period from 2017 to 2020, 155 patients with stage IIA–IIIB cervical cancer after NACT (n = 110) and CRT (n = 45) underwent combinedextended extirpation of the uterus with appendages according to our patented method. The most frequent postoperative complications were urination disorders in 106 (67 [60.9%] and 19 [42.2%]) patients, lymphatic cysts in 30 (20 [18.2%] and 10 [22.2%]) patients and vesicovaginal fistula in 7 patients (5 [4.6%] and 2 [4.4%]), respectively. According to the results of a pathomorphological study, the most frequent tumor response to NACT was III degree of therapeutic pathomorphosis (TP) in 44 (40.0%) patients of group 1 and in 21 patients – IV-degree TP, amounting to 46.6%. The median follow-up was 28.7 (from 3.6 to 51.1) months. During this time, 30 patients died in both groups (17 [15.5%] and 13 [28.9%]) (p = 0.047). Disease progression occurred in 16 (10.3%) patients (6 [5.5%] and 10 [22.2%]) (p = 0.004), respectively. The 3-year OS was 83.8 ± 3.7 and 71.0 ± 6.8 (p = 0.131), PFS – 93.5 ± 2.6 and 77.7 ± 6.6 (p = 0.006).

Conclusions. The proposed method of surgical treatment of IIA–IIIB stages of cervical cancer has a novelty and can be used in practical medicine for the surgical treatment of oncology diseases in cervical cancer