Relevance. Postoperative cognitive dysfunction (POCD) (decreased memory, attention, impaired neurodynamics, etc.) is a common complication especially in elderly patients of cardiosurgical and oncosurgical pathology, which reduces the quality of life and is an actual socially significant problem. Computer electroencephalography (EEG) is an informative method for assessing the functional state of the brain. Patients with cancer and competing cardiovascular pathology have the opportunity to perform staged or simultaneous operations on the heart and lung for further antitumor treatment.

Objective. Based on the literature data, to find out the role of EEG in diagnosis of postoperative cognition dysfunction (POCD) in patients with cardiovascular pathology after cardiac surgery without /under conditions of AC.

Methods. We found and analyzed data in specialized medical data base Pubmed, Scopus, Web of Science about EEG methods in patients after heart bypass with/without AC from 2004 to 2025 years.

Results. Computer EEG is very important for early diagnosis and prognosis for postoperative cognitive dysfunction in patients with coronary heart disease (CHD) after coronary artery bypass with/without AC. However, the studies did not included patients with oncopathology, people over 70 years of age. It opens possibilities for early diagnosis of central nervous system functional conditionin patients with lung cancer and cardiovascular disorders in simultaneous (concomitant heart and lung with/without AC) surgery.

Melanoma of the skin is an extremely aggressive malignancy characterized by high mortality and frequent relapses. In recent years, revolutionary changes have occurred in the treatment of this disease. The introduction of targeted therapy and immunotherapy into clinical practice has significantly changed the traditionally unfavorable prognosis for many patients, including patients with unresectable tumors. However, despite the existing progress, the response to existing therapy is observed not in all cases. Together with the growing incidence, this emphasizes the need for the development of new therapeutic approaches and further studies aimed at assessing their efficacy and safety. This review summarizes the long-term results of large studies that have already influenced clinical guidelines and highlights new promising areas that may change medical practice in the near future.

One of the key tasks in brain tumor neurosurgery is achieving maximum radical resection, which directly impacts patient prognosis. Traditional methods of intraoperative control have limitations, making the implementation of modern imaging technologies, such as intraoperative ultrasound (IOUS), highly relevant.

Objective. To study the capabilities of intraoperative ultrasound in benign and malignant gliomas using modern techniques.

Materials and methods. A prospective study included 58 patients operated on between January 2023 and September 2024. All patients underwent repeat IOUS in B-mode and with contrast enhancement after the main tumor volume was removed to detect residual tumor tissue.

Results. Repeat intraoperative ultrasound scanning allowed identification of residual tumor foci with a minimal size of up to 4 mm in 7 (12.07 %) of 58 patients, leading to renewed resection and achievement of total or subtotal cytoreduction in 100 % of cases. The method provided visualization of tumor boundaries, differentiation from perifocal edema and critical anatomical structures, and also enabled monitoring for the development of intraoperative complications.

Conclusion. Intraoperative ultrasound is a highly informative, cost-effective, and safe method that increases the radicality of neurosurgical interventions through precise intraoperative control and can be recommended for widespread implementation in clinical practice.

Pancreatic cancer remains one of the most aggressive malignancies with an unfavorable prognosis. Over 50 % of patients present with distant metastases at initial diagnosis and the five-year overall survival in this cohort does not exceed 3 % [1, 2]. In contemporary clinical practice the combination regimens mFOLFIRINOX and GemNab have become firmly established as first-line therapy standards in both Russian (RUSSCO) and international (ESMO, NCCN) clinical guidelines [3, 4, 5]. However determining the optimal therapeutic approach upon disease progression remains challenging due to limited evidence-based options highlighting the need to explore new treatment strategies including the reinduction of previously used regimens. A single-center retrospective study conducted at the N. N. Blokhin National Medical Research Center of Oncology analyzed data from 31 patients with locally advanced or metastatic pancreatic adenocarcinoma who received mFOLFIRINOX reinduction following a progression-free interval of at least 3 months after first-line chemotherapy. The study assessed progression-free survival during first-line therapy (PFS 1) and reinduction (PFS 2), as well as overall survival from diagnosis (OS) and from reinduction initiation (OS 2). Median PFS 1 was 13 months (95 % CI: 11.6–14.4), and median PFS 2 was 7.0 months (95 % CI: 5.7–8.3). Median OS reached 23.0 months (95 % CI: 18.5–27.5), while median OS 2 was 8.0 months (95 % CI: 6.2–9.8). The toxicity profile upon retreatment was comparable to initial treatment with a trend toward reduced hematologic toxicity likely associated with optimized supportive care. In conclusion the preliminary data from our study demonstrate that the mFOLFIRINOX reintroduction strategy is a promising approach in the treatment of patients with locally advanced and metastatic pancreatic cancer. The results indicate clinically meaningful efficacy of regimen reuse, warranting further investigation of this approach.

Introduction. Indices calculated from complete blood count parameters are actively investigated as prognostic factors in patients with colorectal cancer, although their role remains incompletely understood.

Methods. A retrospective analysis was performed on 187 patients with colon and rectal cancer (stages I–III) who underwent radical surgical treatment between 2019 and 2023. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII) before surgery and on postoperative days 1, 3, and 5 were assessed, along with postoperative complications (Clavien–Dindo), overall and disease-free survival, and their association with the studied prognostic indices.

Objective. To evaluate the prognostic significance of clinical, morphological and hematological data for key clinical outcomes in patients undergoing radical resection for colorectal cancer.

Results. Three-year overall survival was 85.6 %, and three-year disease-free survival was 78.7 %. Multivariate analysis revealed that none of the hematological indices were independent prognostic factors for overall or disease-free survival. The prognostic factors for overall survival were coronary artery disease (HR 5.176; 95 % CI 1.105–24.246; p=0.037) and pN+ (HR 3.073; 95 % CI 1.251–7.545; p=0.014). The prognostic factors for disease-free survival were female sex (HR 0.019; 95 % CI 0.001–0.451; p=0.014) and CEA level (HR 1.116; 95 % CI 1.022–1.218; p=0.014).

Conclusion. The hematological prognostic indices studied did not demonstrate independent prognostic significance for the risk of postoperative complications or survival in colorectal cancer after radical surgery and may only be considered as part of a comprehensive assessment.

Background. Calcifications are a key ultrasound feature in the risk stratification of thyroid nodules, but their interpretation remains debated due to ambiguous prognostic significance depending on the morphological type.

Objective. To assess the prognostic significance of micro- and macrocalcifications in the differential diagnosis of thyroid nodules of various histological types (colloid goiter, adenoma, carcinoma) based on a comparison of multiparametric ultrasound (US) data and pathomorphological examination.

Materials and methods. A retrospective cohort study included 243 patients with thyroid nodules (102 – colloid goiter, 62 – adenoma, 79 – carcinoma). All patients underwent preoperative multiparametric US (B-mode, color Doppler mapping) with classification of calcifications into micro- (<1 mm) and macrocalcifications (≥1 mm). Correlation analysis (Kendall’s τ), ROC analysis, and logistic regression were performed.

Results. Calcifications were detected in 56.8 % of patients. Microcalcifications were significantly more frequent in thyroid carcinomas (45.7 % vs 1.6 % in goiter; p<0.001) and significantly correlated with high-risk TI-RADS categories (τ=0.327; p=0.020). Macrocalcifications predominated in colloid goiter (48.2 % vs. 24.3 % in carcinoma; p<0.001) and showed no significant correlation with TI-RADS category in malignant nodules (p=0.970). In adenomas, the «calcifications» sign did not reach statistical significance (p=0.465). ROC analysis confirmed high diagnostic value of the sign for differentiating colloid goiter and carcinoma (AUC=0.956) and moderate value for adenomas and carcinoma (AUC=0.860).

Conclusions. Microcalcifications are a highly specific predictor of malignancy and require mandatory fine-needle aspiration biopsy. Macrocalcifications are predominantly associated with benign processes and have no independent prognostic value. In adenomas, calcifications should be interpreted only in conjunction with other ultrasound features.

Current capabilities of endocrine-targeted therapy for HR+HER2-negative metastatic breast cancer (mBC) enable long-term disease control, while the use of CDK4/6 inhibitors in early lines of treatment significantly increases overall survival. Against this relatively favorable backdrop, a distinct subgroup emerges: patients with PIK3CA-associated tumors who progress during adjuvant endocrine therapy (AET) or within 12 months of its completion (primary or secondary endocrine resistance). Standard endocrine therapy and chemotherapy show limited efficacy in this cohort, leading to rapid progression and early mortality. The clinical introduction of a new class of agents targeting the PI3K/AKT/mTOR signaling pathway has expanded therapeutic options, improving progression-free survival (PFS) and objective response rates (ORR). However, significant improvement in overall survival has not been achieved for a long time. The development of a triple-therapy strategy for hormone-resistant PIK3CA-mut luminal HER2-negative mBC (metastatic breast cancer) represents a true breakthrough. It involves the use of fulvestrant in combination with the CDK4/6 inhibitor (iCDK4/6) palbociclib and the novel PI3K inhibitor (iPI3K) inavolisib as first-line treatment. This publication presents data from the phase III randomised clinical trial INAVO120, which demonstrated the efficacy and safety of the triple combination “inavolisib + palbociclib + fulvestrant” compared with the standard approach “palbociclib + fulvestrant” in patients with PIK3CA-associated HR+HER2-negative metastatic breast cancer who experienced disease progression during adjuvant endocrine therapy (AET) or within 1 year after its completion. The addition of inavolisib, compared with the control group, statistically significantly and clinically meaningfully improved all assessed efficacy endpoints, including: progression-free survival (PFS) (median PFS of 17.2 months vs. 7.3 months (hazard ratio [HR] 0.42; 95 % confidence interval [CI] 0.32–0.55); objective response rate (ORR): 62.7 % vs. 28.0 % (p<0.001); overall survival (median OS of 34 months vs. 27 months (HR 0.67; 95 % CI 0.48–0.94; p=0.02)). Inavolisib is the first PI3K inhibitor that has significantly increased the life expectancy of patients with an aggressive type of HR+HER2-negative metastatic breast cancer. The triplet regimen “inavolisib + palbociclib + fulvestrant” represents a new standard of first-line therapy for PIK3CA-mut HR+HER2-negative mBC with early progression after radical treatment.

Introduction. Anorexia-cachexia syndrome (ACS) and associated weight loss are common complications in cancer patients, reducing quality of life and survival. Efforts to prevent the development and correct ACS are relevant for improving treatment outcomes in preoperative chemotherapy for several malignancies. Preventing weight loss may reduce the frequency and severity of complications from chemotherapy and surgical treatment, maintain adequate dose intensity of chemotherapy, and improve patients’ quality of life. Olanzapine, an atypical antipsychotic, has demonstrated potential not only in controlling nausea but also in improving appetite in patients receiving chemotherapy.

Objective. To evaluate the efficacy and safety of prolonged low-dose olanzapine (2.5 mg/day) in preventing significant weight loss (≥5 %) in patients with localized/locally advanced gastric cancer and disseminated ovarian cancer during preoperative chemotherapy.

Materials and methods. The analysis included 30 patients. Of these, 14 were diagnosed with disseminated ovarian cancer and 16 with locally advanced gastric cancer. These tumor types were selected because the treatment plan includes a preoperative chemotherapy block followed by surgery. Preoperative treatment consisted of 3–4 cycles of systemic chemotherapy according to the nosology. A summary of patient characteristics and chemotherapy regimens is presented in Table 1. The experimental group received low-dose olanzapine (2.5 mg orally at night) daily until surgical treatment while maintaining their dietary habits. In the control group, no additional medications were prescribed, and patients adhered to their dietary habits. In both groups, nutritional support and the use of olanzapine as a component of antiemetic therapy were permitted when indicated. In the experimental group, dose escalation to the standard dose (5 mg) on days 1–4 of each chemotherapy cycle was allowed for this purpose. In the control group, olanzapine was administered at a dose of 5 mg orally on days 1–4 of each cycle as antiemetic therapy. Anthropometric parameters (height, weight, body mass index, body surface area) were assessed before the start of chemotherapy and after 3–4 cycles. Adverse events of chemotherapy were evaluated before each cycle, and surgical complications were assessed within 30 days after surgery. The primary endpoint of the study was the proportion of patients with weight loss ≤5 %. Due to the small sample size, descriptive analysis was used.

Results. Among patients who experienced weight loss during preoperative chemotherapy (n=16/30), weight loss of less than 5 % was more frequently observed in the olanzapine group – in 85 % (6 out of 7) – compared to 33 % (3 out of 9) in the control group (p>0.05). Weight stability was associated with a lower incidence of postoperative complications in the olanzapine group (13 % vs. 46.7 %) and prevented a reduction in relative dose intensity to <85 % compared to the control group (13 % vs. 26.7 %).

Conclusion. Preliminary data suggest a potential benefit of prolonged olanzapine administration at 2.5 mg/day in preventing significant nutritional deficiency and improving treatment tolerability.

Neoadjuvant chemotargeted therapy for HER2 positive breast cancer, incorporating two monoclonal antibodies (trastuzumab and pertuzumab), enables achieving the maximum rate of pathologic complete responses (pCR), which significantly improves the prognosis and long term treatment outcomes. According to our data, even in a patient population “enriched” with locally advanced inoperable tumours (T4 or N 2–3), the use of the TCHP regimen ensures a pCR rate exceeding 60 %. Based on the findings of the phase 3 randomized clinical trial KATHERINE, in cases where residual tumour of any size is detected (RCB I, II, and III), administration of post neoadjuvant therapy with trastuzumab emtansine (T-DM1) significantly improves survival. However, in the Russian Federation, the indication for adjuvant therapy with T-DM1 is limited to RCB II and III only. In contrast, for RCB I (minimal residual tumour), adjuvant therapy with trastuzumab – which is part of the NACHTT regimen – is recommended. To assess real-world clinical practice in the Russian Federation and identify trends in physicians’ preferences for adjuvant targeted therapy, the third consecutive survey study “Therapy for HER2-Positive Breast Cancer” (conducted in 2021, 2023, and 2025) was carried out. The survey included questions addressing the post-neoadjuvant phase. Fifty oncology specialists from six regions of the country (Central, Northwestern, Siberia/Far East, Southern, Ural, and Volga regions) participated in the survey. These specialists either independently or as part of a tumor board prescribe treatment for patients diagnosed with HER2-positive breast cancer. This publication presents the results of assessing specialists’ preferences in prescribing adjuvant and post-neoadjuvant therapy. In 2025, neoadjuvant chemotargeted therapy (NACTT) was prescribed/planned for only 75 % of patients with early-stage (M0) HER2+ BC, which is slightly lower compared to previous surveys. According to the respondents, the pCR rate after NACHTT was 49 %; RCB I was reported in another 23 % of cases, while pathological response assessment was not performed in 2 % of cases. Thus, the proportion of patients with moderate to severe residual tumour (RCB II–III) after NACHTT significantly decreased in 2025, reaching only 26 %, compared to 35 % in 2023. The vast majority of patients with RCB II–III (88 %) received post-neoadjuvant T-DM1 adjuvant therapy in 2025, compared to 68 % in 2023 and 24 % in 2021. Additionally, T-DM1 was occasionally prescribed in the Russian clinical practice for RCB I cases as well. Analyzing adherence to the post-neoadjuvant T-DM1 therapy plan, high patient compliance and good drug tolerability were noted: 82.2 % completed the full course of 14 cycles, while another 17.4 % received 7 to 13 cycles. Overall, when selecting a drug treatment regimen for early operable and locally advanced inoperable HER2-positive BC in the Russian Federation, the priority is given to therapy efficacy and safety. The significance of the issue of drug availability is steadily decreasing.