Anemia has a noticeable negative impact on the quality of life of cancer patients and determines the prognosis of the disease. The need to treat anemia is determined by its negative impact on life expectancy, since hypoxia caused by anemia can be associated with resistance to chemotherapy, radiation therapy, causes stimulation of genetic mutations and neoangiogenesis in the tumor, which makes it difficult to control it. The methods of correction of anemia are determined by the clinical picture and the antitumor treatment being carried out. The use of blood transfusions is limited and involves a number of risks. Erythropoiesis-stimulating drugs can reduce the need for blood transfusions. The article describes the mechanisms of action, indications and side effects of recombinant erythropoietin (rEPO) drugs. The analysis of the effectiveness of rEPO drugs in the treatment of anemia in oncology based on the historical experience of clinical trials is presented. The recommendations of the leading communities on the use of rEPO drugs in various categories of patients are presented, and the Russian experience of using epoetin alpha in patients receiving chemotherapy is reflected. The use of erythropoietins clearly in accordance with the indications can significantly improve the results of treatment of cancer patients.

Introduction. Patients with metastatic castration-resistant prostate cancer (mCRPC) are a complex and heterogeneous group whose primary treatment goals are to both prolong life and preserve quality of life. Among patients with mCRPC, there is a group with a progressive tumor process in the prostate gland, in which local irradiation along with systemic Ra 223 (Ra223) therapy would lead to improved oncological outcomes.

Purpose of the study. To evaluate the efficacy and safety of Ra223 in patients with mCRPC in routine clinical practice and to assess the feasibility of local radiation therapy of the prostate in patients with mCRPC receiving Ra223 therapy.

Materials and methods. This study included 189 patients with mCRPC who received 1 to 6 injections of Ra223 as part of routine clinical practice. The patients were divided into two groups. Group 1 included patients who received systemic therapy only – 153 (81%), while group 2 consisted of patients who received local irradiation of the prostate gland along with Ra223 therapy – 36 (19%) patients.

Conclusions. The use of radium223 in combination with localized radiotherapy for the treatment of the prostate has shown promising results in increasing disease control rate (DCR) in patients with mCRPC. Concurrent localized irradiation of the prostate against the radium223 therapy background did not show the result in increased hematological toxicity, which favorably affecting the tolerability of the radionuclide treatment. At the same time, localized radiation reactions occurring during localized prostate irradiation did not prevent patients from completing the full course (six injections) of the radionuclide radium223 treatment.

Purpose of the study. The aim of the work was to optimize the prognosis of recurrences of retroperitoneal extraorgan liposarcomas of various degrees of differentiation by detecting microRNAs (miRNAs) of tumor cells with differential expression depending on the course of the malignant disease.

Materials and methods. The study was conducted on 96 patients: 19 patients with lipomas and 77 patients with retroperitoneal extraorgan liposarcomas. Tissue samples were obtained during the operation. Among patients with malignant diseases, highly differentiated liposarcoma (VDLS) was detected in 51 patients, and dedifferentiated (DDLS) in 26 patients. miRNA expression levels in tumor cells were determined using real-time PCR.

Results. During the follow-up period, relapses of malignant disease were detected in 25 (32,5%) people: 13 (25,5%) among patients with VDLS and 12 (46,2%) among patients with DDLS. In DDLS, characterized by a more aggressive course, there was an increased level of expression of miRNA155, -21, -26a2 and a decrease in expression of miRNA15a and -34 compared with patients with VDLS. In patients with recurrent retroperitoneal liposarcomas, the expression of miRNA15a was initially 83% lower in tumor cells of surgical samples (p<0,001), iRNA34 by 79% (p< 0,001), and the expression activity of miRNA155 was 7,54 times higher (p<0,001) and miRNA26a2 by 6,93 times (p<0,001).

Conclusion. The determination of the expression of miRNA155, -26a2, -34, -15a in tumor cells during surgical treatment of patients with retroperitoneal liposarcomas is an effective way to assess the risk of recurrence and is relevant for determining the tactics of further treatment of patients.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of diseases that include well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The increase in the incidence of NETs in recent decades, especially in Russia – from 0.05 to 5.19% per 100 thousand population from 2001 to 2019, determines a significant increase in interest among doctors and scientists in this problem. Existing domestic and foreign recommendations raise a number of controversial issues that require informed decisions in the course of new clinical trials.

The group of patients with stage 4 disease has the worst prognosis and treatment results, with a decaying tumor ulcer forming in 2–5% of cases. Treatment of skin tumor ulceration includes antitumor therapy combined with local treatment of the tumor ulcer. Local treatment of decaying tumors consists of sanitation, washing with antiseptic solutions, and clearing the ulcer of necrotic masses by mechanical, chemical, and enzymatic methods. Bleeding is the most important problem of symptomatic treatment. “Hemostatic collagen sponge with silver” due to the combination of components not only stops capillary bleeding, but also promotes epithelialization of the wound defect against the background of antiseptic action.

Relevance. Approximately 90–100% of patients have skin toxicity, which manifests itself in the form of acne-like rashes (papulo-pustular rash), paronychia, hair changes, xerosis, itching. Skin manifestations cause psychological, emotional and physical discomfort, which may be the reason for dose reduction or discontinuation of treatment, and may reduce the effectiveness of antitumor therapy. The use of modern telemedicine systems, such as online consultations and remote monitoring, are designed to make life easier for patients and are now increasingly available and in demand among the general population.

The aim of the study. Assessment of the quality of life in cancer patients receiving EGFR inhibitors, depending on the use of remote consultations and remote monitoring.

Materials and methods. 140 cancer patients were included in the study. All patients were divided into two groups: in group 1 (study group) n=70, the mobile application «My Health» was used for online-consultation with a dermatologist, in group 2 (comparison group) n=70, offline consultations were used. During the consultations, skin toxicity was assessed using CTCAE scales version 5.0. To analyze the level of quality of life, a questionnaire of the dermatological quality of life index (DLQI) was used, which patients of each group filled out on the day of the start of the study, then after 4 weeks.

Results. In patients of the first group, there was a positive dynamic in the state of the skin process compared with the initial indicators. There was a statistically significant improvement in the quality of life, a decrease in the average score for all indicators. In patients of the second group, the positive dynamics of the skin process was not so obvious, as evidenced by the results of the questionnaire. There was a statistically significant strong direct correlation between the value of the results of DLQI and the severity of the disease (rs=0.721 p <0.001).

Conclusion. Skin toxicity is a complex interdisciplinary problem that requires an integrated approach between oncologists and dermatologists. Remote monitoring is an accessible form of communication between a doctor and a patient, which contributes to the timely control of skin toxicity in cancer patients receiving EGFR inhibitors.

This article is devoted to such a benign acquired condition as postsplenectomy splenosis, which is often incorrectly interpreted as a primary malignant tumor or secondary (metastatic) tumor process. The article provides a modern definition of the concept of «splenosis», examines the main mechanisms of autotransplantation of splenic tissue, indicates the most typical localizations of splenosis foci, provides the timing of the onset of splenosis, considers possible clinical manifestations and potential complications of this condition, discusses modern approaches to diagnostics, differential diagnostics of splenosis, tactics of management and treatment of such patients in detail, and also provides own author’s clinical observation of disseminated spontaneous postsplenectomy splenosis mimicking disseminated malignant tumor process. The feature of this clinical case is the presence of hereditary microspherocytosis (congenital microspherocytic hemolytic anemia, Minkowski-Chauffard disease) in the patient, which served as the reason for splenectomy. The article is illustrated with original computed tomography and magnetic resonance imaging.

Purpose. To evaluate the capabilities of whole-body MRI based on accelerated acquisition sequences in assessing the extent of malignancy.

Material and methods. The study included 30 patients with malignant, solid tumors of various origins and metastatic lesions of various anatomical structures. All patients underwent WB-MRI, based on accelerated data collection sequences, with subsequent clarifying studies, such as CT, PET/ CT, ultrasound to confirm or refute the malignancy of the detected changes.

Results. In 14 out of 30 cases, it was possible to identify additional localizations of metastatic lesions, excluding skeletal bones.

Conclusion. In modern conditions, WB-MRI makes it possible to collect comprehensive information for staging a tumor disease in a relatively short period of time.

Neuroendocrine prostate cancer is a rare and aggressive cancer with a poor prognosis. This type of cancer is often diagnosed at an advanced stage and exhibits rapid resistance to standard therapeutic methods. Taking into account the low occurrence of this phenomenon, a description of poorly differentiated neuroendocrine (small cell) prostate cancer with extremely aggressive forms is given.

Metastatic breast cancer still remains an incurable disease, requiring lifelong treatment. Introduction of targeted therapy into clinical practice has radically changed treatment approaches of HER2-positive breast cancer, making it possible to significantly increase the life expectancy. The treatment algorithm for HER2-positive metastatic breast cancer appears to be quite clear and is reflected in both international and Russian recommendations. To assess actual clinical practice in the Russian Federation, a survey study “Therapy of Her2-positive breast cancer” was conducted. This publication presents results dedicated to the treatment of metastatic HER2-positive breast cancer. 50 specialists from 43 cities took part in the survey. Only heads of departments or their deputies who were personally involved in determining the treatment for patients were allowed to participate. Expertise of this level allows us to reliably assess the actual clinical practice that has developed in the Russian Federation and determine directions for optimizing therapeutic approaches. Despite ongoing questions about the availability of drugs, doctors primarily focus on the effectiveness of treatment. The main first-line therapy in the Russian Federation is the combination of trastuzumab with pertuzumab. However, experts noted that in conditions of unlimited access to drugs, the number of prescriptions for this regimen in the first line would increase by 13%. Doctors also agree that the use of a subcutaneous form of this combination of drugs would optimize the treatment process. Trastuzumab emtansine remains the standard of second-line therapy and, according to the survey results, almost all patients for whom it is indicated receive this type of therapy. Experts predict more frequent use of trastuzumab emtansine in first-line therapy, given the widespread use of neoadjuvant regimens with pertuzumab. The most significant changes are expected in the third line of therapy with the introduction of the new conjugate – trastuzumab deruxtecan. The survey results demonstrate high awareness and commitment of physicians to modern principles of treatment of HER2-positive mBC.