Vol 22, No 4 (2020)

CLINICAL ONCOLOGY
Multiple myeloma
Mendeleeva L.P., Votiakova O.M., Rekhtina I.G., Osmanov E.A., Poddubnaya I.V., Grivtsova L.I., Falaleeva N.A., Baikov V.V., Kovrigina A.M., Nevol’skikh A.A., Ivanov S.A., Khailova Z.V., Gevorkian T.G.
Abstract

Multiple myeloma

Journal of Modern Oncology. 2020;22(4):6-28
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Differentiated thyroid cancer
Bel’tsevich D.G., Mudunov A.M., Vanushko V.E., Rumiantsev P.O., Mel’nichenko G.A., Kuznetsov N.S., Podvyaznikov S.O., Alymov Y.V., Poliakov A.P., Fadeev V.V., Bolotin M.V., Sevriukov F.E., Krylov V.V., Fedenko A.A., Bolotina L.V., Zharov A.A., Falaleeva N.A., Filonenko E.V., Nevol’skikh A.A., Ivanov S.A., Khailova Z.V., Gevorkian T.G.
Abstract

Differentiated thyroid cancer

Journal of Modern Oncology. 2020;22(4):30-44
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The virtual forum on the diagnosis and treatment of PIK3CA-mutated metastatic breast cancer. October 16th, 2020. Event review
Poddubnaya I.V., Gligorov J., Zhukova L.G., Kovalenko E.I., Frolova M.A.
Abstract

The virtual forum on the diagnosis and treatment of PIK3CA-mutated metastatic breast cancer was held on 16th October 2020. The French and Russian oncology experts shared information and exchanged experience concerning the application of the first PI3K inhibitor – alpelisib.

Journal of Modern Oncology. 2020;22(4):47-55
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The consensus on the prevention and correction of hyperglycemia in patients with HR+ HER2- metastatic breast cancer treated with alpelisib
Mazurina N.V., Artamonova E.V., Beloyartseva M.F., Volkova E.I., Ganshina I.P., Troshina E.A., Tjulandin S.A., Chubenko V.A.
Abstract

The consensus on the prevention and correction of hyperglycemia in patients with HR+ HER2- metastatic breast cancer treated with alpelisib was developed by the experts of the Russian Association of Endocrinologists and the Russian Society of Clinical Oncology. The consensus contains recommendation on risk assessment, prophylaxis and correction of hyperglycemia regarding the baseline metabolic status of the patients.

Journal of Modern Oncology. 2020;22(4):56-59
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Novel therapeutic strategies for patients with metastatic triple-negative breast cancer
Ganshina I.P., Gordeeva O.O., Manukian M.S.
Abstract

Triple-negative breast cancer (TNBC) remains the most aggressive subtype of breast cancer. In the presence of distant metastases, the median overall survival does not exceed 14 months. TNBC is an extremely heterogeneous group of tumors, it includes both tumors extremely sensitive to chemotherapy and tumors that require targeted or immunotherapy for the best treatment outcomes. Such subtype features make it difficult to develop a single treatment strategy for all patients. Current perceptions of resistance mechanisms and molecular drivers’ progression have increased therapeutic opportunities for metastatic TNBC (mTNBC). For example, in the last few years, checkpoint inhibitors and PARP inhibitors have entered into clinical practice in the Russian Federation. This review presents clinical trial data, as well as an algorithm for choosing therapy for patients with TNBC, based on the results of recent clinical studies. The review focuses mainly on drugs registered at the territory of the Russian Federation, that allows to apply these options in everyday clinical practice. Promising directions therapy of mTNBC not registered at the territory of the Russian Federation yet will be showed in a separate review in the next issue in the Journal of Modern Oncology.

Journal of Modern Oncology. 2020;22(4):60-65
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Gene polymorphisms role of blood coagulation in myocardial infarction development in patients with malignant tumors of thoracoabdominal localization
Korolyova A.A., Gerasimov S.S., Kononets P.V., Lyubchenko L.N.
Abstract

Aim. To evaluate the role of polymorphic variants of blood coagulation genes (F2, F5, F7, F13, FGB, ITGA2, ITGB3, PAI-1) in the development of myocardial infarction in patients with malignant tumors of thoracoabdominal localization.

Materials and methods. The study included 143 patients with thoracoabdominal tumors operated in the oncological Department of surgical methods of treatment No.11 (thoracic Oncology) of the thoracoabdominal Department of the Blokhin National Medical Research Center of Oncology in 2018–2019. The study group (n=62) consisted of patients with a history of myocardial infarction or in the perioperative period. The control group (n=81) included patients who did not have severe concomitant cardiovascular diseases, including a family history. Molecular genetic study to determine the gene polymorphisms of blood coagulation were performed in the laboratory of clinical oncogenetic of the Blokhin National Medical Research Center of Oncology with use of reagents “Cardiogenetic Thrombophilia” (LLC “DNA-Technology”, Russia, RU No. FSR 2010/08414 from 22.11.2016).

Results. In the study group, 90.3% (n=56) of cases showed polymorphism -675 5G>4G of the PAI-1 gene (SERPINE1, a plasminogen activator inhibitor) associated with a decrease in the activity of the fibrinolytic system and an increased risk of thrombosis. In the control group, this mutation was observed significantly less frequently – in 67.9% (n=55) of cases (p<0.001). In the group of patients with myocardial infarction, polymorphism 807 C>T of the ITGA2 (integrin a2) gene responsible for platelet aggregation was detected in 66.1% (n=41) compared to 19.8% (n=16) in the control group (p<0.0001). Polymorphism 1565 T>C of the ITGB3 gene (platelet-derived fibrinogen receptor) responsible for fibrinogen-induced platelet aggregation was observed in 25.8% (n=16) of cases in the group of patients with myocardial infarction and in 12.4% (n=10) of cases in the group of patients without concomitant severe cardiovascular pathology (p<0.05). In 48.4% (n=30) of patients of the study group, genetic disorders of the FGB gene (fibrinogen, missense mutation -455G>A) were also registered, which resulted in the development of dysfibrinogenemia, leading to increased blood thrombogenicity; in the control group, this mutation was 2 times less common – 25.9% (n=21) of cases (p<0.01). Polymorphism 1691 G>A of the F5 gene (coagulation factor V, Leiden factor), which is considered one of the most significant genetic risk factors for thrombosis in Caucasians, was detected in 4.8% (n=3) of cases in the study group, while this mutation was not found in the control group. Polymorphism 20210 G>A of the F2 gene (coagulation factor II prothrombin), which is a key protein of the coagulation cascade associated with increased blood levels of prothrombin, was observed in 3.2% (n=2) of patients after myocardial infarction; in the control group, the carrier of this polymorphism was not found in any case. Disorders in the genes that promote hypocoagulation were also noted. Among patients who had a myocardial infarction, polymorphism 10976 G>A of the F7 gene (coagulation factor VII) was detected in 17.7% (n=11) of cases, polymorphism 103 G>T of the F13 gene (coagulation factor XIII) – in 41.9% (n=26) of cases. In patients of the control group, these genetic aberrations were found: in 18.5% (n=15) of cases – a mutation in the F7 gene (p>0.05) and in 45.7% (n=37) – in the F13 gene (p>0.05), respectively.

Conclusion. Based on the results of a molecular genetic study of factors associated with thrombogenic risk, a statistically significant difference in the frequency of occurrence of polymorphisms of genes involved in the process of thrombosis (polymorphisms: -455 G>A of the FGB gene, 807 C>T of the ITGA2 gene, 1565 T>C of the ITGB3 gene, -675 5G>4G of the PAI-1 gene) in patients who had a myocardial infarction, compared with patients without severe concomitant cardiovascular diseases. The frequency of 1691 G>A polymorphism of the F5 gene, one of the most significant genetic risk factors for thrombosis, reached 4.8%. The obtained data on the use of molecular genetic markers of thrombophilia in patients with malignant tumors of thoracoabdominal localization allow us to identify a group of patients with a high risk of developing perioperative myocardial infarction and take additional measures for the prevention and treatment of thrombotic complications.

Journal of Modern Oncology. 2020;22(4):66-70
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Surgical treatment for pelvic bone metastases
Buharov A.V., Derzhavin V.A., Erin D.A., Yadrina A.V., Aliev M.D.
Abstract

Bone metastases are one of the important problems of modern orthopedic oncology. Because of the improvement of the methods of systemic drug treatment of malignant tumors, the overall duration of life expectancy of patients with generalized cancer, including bone metastases, can be up to 12–18 months and more. Metastases, including pelvic bone metastases, reduce the quality of life of patients, not only causing pain syndrome (PS), but also significantly placing restrictions on patients’ movement, often leading to disability. The possibilities of surgical correction of modern oncoortopedia can prevent pathological fractures, reduce PS and, as a result, stabilize or improve the functional status of patients.

The aim is to evaluate the results of treatment of patients with metastases of various solid tumors in pelvic bone.

Materials and methods. The analysis of the treatment of 67 patients who underwent various types of surgery for pelvic ring metastases. The average age of patients was 55.5 years (from 23 to 75 years). 51 (76.12%) patients with multiple metastases underwent minimally invasive palliative surgery. Radical surgery was performed in16 (23.88%) patients with solitary mass.

Results. The average blood loss during radical surgery was 1969 ml (from 150 to 4000 ml). The edges of resection during all surgeries are negative (R0). Six patients showed progression after the treatment of the disease. It was noted that 46 (90%) patients had a significant reduction in PS, up to complete disappearance, that allowed 42 (82%) patients to reduce the intake of analgesic drugs or completely abandon them, after minimally invasive palliative surgery.

Conclusion. In case of solitary pelvic bone metastases is necessary to perform radical surgery to achieve maximum oncological and functional results. In patients with multiple metastases in order to reduce PS and improve the quality of life rationally should be performed minimally invasive surgery, this will allow to start systemic drug treatment as soon as possible.

Journal of Modern Oncology. 2020;22(4):72-76
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Interim results of a multicenter retrospective-prospective observational post-marketing study of Extimia® BIOCAD (INN: empegfilgrastim) to evaluate safety and efficacy in patients with lymphoproliferative diseases receiving cytotoxic therapy
Nesterova E.S., Klitochenko T.Y., Glonina N.N., Fadeeva N.V., Sannikova T.A., Lyalina I.S., Shelekhova T.V., Sherstnev D.G., Voloshin S.V., Sarzhevskii V.O., Hofman A.A., Ichshanov D.G., Poddubnaya I.V.
Abstract

Aim. To assess the efficacy and safety of using the drug Extimia® BIOCAD (international nonproprietary name – INN: empegfilgrastim) in order to reduce the frequency and duration of neutropenia, the frequency of febrile neutropenia (FN) and infections manifested by FN in patients with lymphoproliferative diseases receiving myelosuppressive therapy.

Materials and methods. This publication presents the interim results of a multicenter retrospective – prospective observational post-marketing study of the safety and efficacy of the drug Extimia® BIOCAD (INN: empegfilgrastim) in patients with lymphoproliferative diseases receiving cytotoxic therapy (LEGERITY). The interim data analysis included 40 patients with lymphoproliferative diseases (Hodgkin’s lymphoma, diffuse large B-cell lymphoma, multiple myeloma, primary mediastinal large B-cell lymphoma, follicular lymphoma, chronic lymphocytic leukemia, splenic marginal zone lymphoma), who were treated in ten research centers of the Russian Federation (Moscow, St. Petersburg, regional clinics). The median age of patients was 48 (21–72) years, 13/40 (32.5%) patients belonged to the older age group (≥60 years). Patients had functional status on the ECOG scale of 0–2 and received at least 2 chemotherapy injections against the background of prophylaxis with empegfilgrastim. Empegfilgrastim was administered at a dose of 7.5 mg subcutaneously once 24 hours after the end of the administration of cytotoxic chemotherapeutic agents. Primary endpoint: frequency of neutropenia 3–5 degrees of severity; secondary endpoints: frequency of FN; frequency of severe infections (3–4 stages); frequency of antibiotic prescription; relative dose intensity of therapy of the conducted chemotherapy courses; the incidence of all adverse reactions in patients who received at least one dose of the study drug empegfilgrastim; the incidence of all serious adverse reactions in patients who received at least one dose of the study drug empegfilgrastim; the incidence of CTCAE 5.0 grade 3–4 HP in patients who received at least one dose of the study drug empegfilgrastim; discontinuation rate of study drug empegfilgrastim due to adverse reactions.

Results. The results of this study demonstrate that the incidence of neutropenia of 3 degree of severity after the 1st cycle of chemotherapy developed in 2/40 patients (5%) and as a result of high-dose therapy (R-DHAP). Neutropenia of any severity was reported in 5/40 patients (12.5%). Cases of FN development have not been registered. Severe infections (mucositis, enteropathy, pneumonia, etc.), as well as the use of antibacterial and antifungal drugs during 1 cycle of chemotherapy and in the inter-course period after 1 cycle of therapy were not recorded in any patient. The next course of myelosuppressive therapy was not delayed due to the development of neutropenia in any of the patients during the study. Adverse events, according to the researcher, associated with the use of empegfilgrastim, were registered in 2/40 patients (5%): moderate generalized pain syndrome (“diffuse” pain) of 1 severity and in one case – ossalgia of 2 severity. No serious adverse reactions were reported.

Conclusion. The results of the interim analysis of the study demonstrate the high efficacy of the first Russian original pegylated granulocyte colony-stimulating factor empegfilgrastim after a single administration of a fixed dose in the treatment of patients with aggressive and indolent lymphomas. The drug has a favorable tolerance profile in any age group of patients, especially in elderly patients. Administration of empegfilgrastim as a prophylaxis of neutropenia in patients with lymphoproliferative diseases receiving myelosuppressive therapy of varying intensity can reduce the burden on medical personnel, improve patient adherence to treatment, and contribute to the implementation of the therapeutic plan.

Journal of Modern Oncology. 2020;22(4):77-84
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Improving early breast cancer treatment: the role of granulocyte colony-stimulating factor
Ganshina I.P., Ivanova K.A., Lubennikova E.V., Arkhipov A.V., Zhukova L.G.
Abstract

Breast cancer is still the leading cause of death in patients with malignant tumors. Among women with breast cancer, standard combination chemotherapy with anthracyclines and taxanes reduces mortality from this disease by about one third compared to patients not receiving chemotherapy and is the standard for neoadjuvant or adjuvant chemotherapy of breast cancer. Understanding the patterns of tumor growth has made it possible to improve the current paradigms of the treatment of early forms of breast cancer and to use dose-dense chemotherapy regimens to achieve better treatment results. Nowadays, chemotherapy in a dose-dense regimen for breast cancer is the preferred option in all world and Russian clinical guidelines. However, the use of such chemotherapy regimens significantly increases the incidence of side effects, primarily febrile neutropenia. The appearance of more effective methods of supportive care, particularly short-acting and long-acting granulocyte colony-stimulating factor, in clinical practice has made it possible to use dose-dense chemotherapy regimens to increase the effectiveness of the treatment.

Journal of Modern Oncology. 2020;22(4):86-90
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Differential diagnosis and treatment of primary peritoneal cancer and mesothelioma
Abdullaev A.G., Kozlov N.A., Schakhpazyan N.K.
Abstract

Primary peritoneal cancer and mesothelioma belong to one nosological structure namely primary malignant neoplasms of the peritoneum. Such pathologies, regardless of their morphological differences, have the following in common: low incidence, the absence of pathognomonic signs, similarity of radiological signs and lack of knowledge regarding prognostic factors. Considering the low incidence, reliable differential diagnostic indicators are not currently set up, which makes it substantially more complicated to timely formulate the diagnosis. On the contrary, more often we could reveal the cases where the wrong treatment strategy has been chosen, the absence of unified maintenance algorithm, when in fact a history of a patient`s present illness represents an individual “creation” of a particular doctor. On the other hand, the independent experience of a number of clinics does not exceed a few observations, which does not allow doctors to confidently navigate the problem. Thus, the relevance of conducting multicenter and perhaps prospective randomized scientific research studies with the aim of unified algorithm elaboration of the management of patients with primary peritoneal neoplasms has become imminent. The traditional algorithms for this pathology treatment embrace surgical step and systemic or intracavitary chemotherapy, where treatment sequence could be varied and foremost depends on a disease spread. In order to determine the extent of intraperitoneal dissemination the Sugarbaker peritoneal carcinomatosis index (PCI) is currently used, it also has been proved that one of the main prognostic factors is the degree of cytoreduction completeness. In the article below, we have tried to provide modern concepts of primary peritoneal cancer and peritoneal mesothelioma diagnosis, treatment and prognosis.

Journal of Modern Oncology. 2020;22(4):91-95
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Avapritinib: a new tyrosine kinase inhibitor for treatment of advanced gastrointestinal stromal tumors. The literature review and clinical case
Filonenko D.A., Medvedeva B.M., Meshcheryakov A.A.
Abstract

We have three drugs for treatment of gastrointestinal stromal tumors (GIST): imatinib, sunitinib and regorafenib. Avapritinib (Ayvakit, BLU-285) is one more drug that was approved in January 2020. Avapritinib is a new selective tyrosine kinase inhibitor of PDGFRA and KIT mutations. Based on NAVIGATOR trial avapritinib was approved by FDA for treatment of PDGFRA exon 18 mutant GIST including D842V. Avapritinib was included in NCCN guidelines in the first line therapy PDGFRA D842V mutant GIST. There are only several cases describe imatinib and regorafenib efficacy in D842V mutation in the literature. Avapritinib is the first drug with high efficacy in D842V mutant GIST. Avapritinib has high efficacy against second mutations that explain its activity in ≥4 lines of treatment. This article summarizes the results of NAVIGATOR trial and describes a clinical case of the patient with advanced GIST who received avapritinib in 6th line of treatment. Partial response was achieved that lasted 9 months. The earliest side effects were periorbital edema and increased lacrimation. Three months later the dose of аvapritinib was reduced because of hematological toxicity.

Journal of Modern Oncology. 2020;22(4):96-100
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Modern possibilities of radiological diagnosis of bladder cancer
Suchilova M.M., Nikolaev A.E., Shapiev A.N., Mukhutdinova G.Z., Tkacheva P.V., Nikiforova M.V., Gombolevskiy V.A., Morozov S.P.
Abstract

Bladder cancer is one of the most severe and common diseases of genitourinary organs. According to WHO statistics, bladder cancer is the tenth in cancer morbidity structure and the 13th in cancer mortality structure in the world. In Russia, bladder cancer is 11th in cancer morbidity structure and 16th in cancer mortality structure. In most cases, bladder cancer is diagnosed at 65–74 years of age. The 5-year survival rate for stage IV bladder cancer is about 15%. Early detection, correct staging, and management of the patient influence the prognosis and further quality of life. This review shows detection and staging methods of bladder cancer, staging categories based on multiparametric magnetic-resonance imaging with the use of Vesical Imaging-Reporting and Data System (VI-RADS). Illustrations and a brief overview of alternative visualization methods of bladder lesions, and new approaches in assessment of digital medical images, radiomics and radiogenomics, are presented. In the future, these methods should help to determine the biological characteristics of the tumor without taking a biopsy.

Journal of Modern Oncology. 2020;22(4):101-108
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The role of radiation therapy in the treatment of patients with pleural mesothelioma
Borisova T.N., Tkachev S.I., Ivanov S.M., Alieva S.B., Trofimova O.P., Glebovskaya V.V., Breder V.V., Laktionov K.K., Marinov D.T., Abdullaev A.G.
Abstract

Pleural mesothelioma (PM) remains a disease with a poor prognosis, despite the use of the newest achievements of multimodal treatment. Radiation therapy for PM is traditionally used in some directions: in radical treatment as a part of a three-modal approach, for reducing the risk of chest metastasis in areas of invasive interventions and during palliative treatment. The lack of reliable randomized trials has led to an absence of consensus about the optimal radical treatment strategy. Mordern global recommendations for the treatment of PM are controversial regarding the use of adjuvant radiotherapy in multimodal treatment. Although the role of radiation therapy in the treatment of PM remains unclear, significant successes in planning and conducting radiotherapy are showing that long-term survival can be achieved for these patients, for whom, until recently, only palliative treatment was considered as appropriate treatment. For many years, preventive irradiation of areas of invasive interventions has been used as a method to prevent implantation metastasis. However, a number of randomized trials and recent meta-analysis have not demonstrated the benefits of this treatment approach. Due to the rarity of PM, the severe state of patients and tumor localization, the importance of radiation therapy in the palliative treatment of patients with pleural mesothelioma remains controversial. Recent completed and planned studies allow to commend the role of palliative radiation and recommend it in order to reduce pain.

Journal of Modern Oncology. 2020;22(4):109-114
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Cancer of an ectopic parathyroid gland: from diagnosis to treatment (clinical case)
Allakhverdiev A.K., Malkina N.A., Noskova K.K., Grinevich V.N., Feidorov I.Y., Ketsba A.F., Bystrovskay E.V., Embutniex Y.V., Putova M.V., Synkova D.A.
Abstract

The article presents a clinical case of a prolonged course of gastrointestinal ulcer disease, followed by dysphagia. During the examination, severe hyperparathyroidism was revealed, which subsequently prompted a diagnostic search for a parathyroid adenoma, which is the cause of hyperathyroidism in 80–85% of cases. With instrumental methods of research, the cause of the main complaint is dysphagia, a formation in the posterior upper mediastinum up to 5 cm, compressing the esophagus. With transoesophageal aspiration biopsy (EUS-TYPE). The cytological picture is similar to the thyroid epithelium with part of the oncocytic differentiation. In an immunological study, lavage for parathyroid hormone showed high expression. Scintigraphy with Tc-99m pertechnetate revealed the exact topic of the formation of the parathyroid gland in the posterior mediastinum – an atypical location. Surgical treatment was performed in the amount of thoracoscopic removal of the mediastinal tumor. The radical nature of the surgical intervention was confirmed by laboratory. Serum PTH levels decreased significantly. Upon receipt of the morphological conclusion, reliable data on malignant damage to the parathyroid gland were obtained. Subsequent treatment of the patient consisted in the correction of severe hypercalcemia in the postoperative period by prescribing denosumab, which led to the stabilization of the patient’s condition.

Journal of Modern Oncology. 2020;22(4):115-119
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Radiation therapy in treatment of Rosai–Dorfman disease: literature review and report of a patient with cutaneous form
Potapenko V.G., Belousova I.E., Vinogradova J.N., Kelehsaeva K.A., Ulitin A.M., Smirnova I.O., Petunova Y.G., Ilyin N.V.
Abstract

Rosai–Dorfman disease (RDD) is a rare variant of the nonlangergans histiocytosis. Various presentation, systemic and localised forms and limited publications make diagnostics and prompt management difficult.

Aim. Literature review and presentation of the patient with cutaneous form of RDD.

Results. The patient is a 56 y.o male. In October 2019 he noticed a tumour in the left temporal area. After 3 weeks the tumor was removed. During the next two weeks the tumour recurred within the post-operative scar. After the review of the specimen and staging the skin form Rosai–Dorfman disease was diagnosed. Irradiation (total dose 36 Gr) was conducted. The tumor lessened. Through the next 4 months response is stable.

Сonclusion. Radiation therapy as a second line of treatment of the skin RDD led to a stable response.

Journal of Modern Oncology. 2020;22(4):120-124
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Recurrent desmoid-type retroperitoneal fibromatosis: clinical observation
Budurova M.D., Fainshtein I.A., Turupaev K.A., Kalinin A.E., Kozlov N.A.
Abstract

This article deals with the rare clinical observation of the patient with recurrent desmoid-type fibromatosis, who have achieved long-term stability after surgical treatment. A 24-year-old patient was diagnosed with retroperitoneal tumor which size was 8.8×5.6×13 cm in 2013, infiltrating the left psoas muscle, left kidney, left common and left external iliac arteries, descending colon and sigmoid colon. The patient underwent surgery in the volume of the tumor removal, resection of the left common iliac artery and prosthetics using GORE-TEX prosthesis, left hemicolectomy, left nephrectomy at Blokhin National Medical Research Center of Oncology. The first recurrence of the tumor was detected nine months after the surgery. Due to the subsequent growth of tumor mass, located along the left external iliac artery and in the inguinal canal, the repeated surgery was performed. Then the patient had a second relapse, and underwent surgery again. The third recurrence was detected seven months after the last surgery. During the multidisciplinary discussion, according to the absence of complaints and the small size of the recurrent tumor, as well as the absence of the risk of life-threatening complications, it was decided to stop on the observation. The patient was examined once every six months – there were no data concerning recurrent tumor growth. Today, the patient is alive, does not have any complaints and is able-bodied. Our clinical observation demonstrates that active surgical tactics in case of the retroperitoneal fibromatosis recurrence not always can lead to long-term progression-free survival time and several patients can stay under the observation, using Look and Stay tactic.

Journal of Modern Oncology. 2020;22(4):125-129
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Vulvar cancer: brain metastases. Clinical observation
Ognerubov N.A., Antipova T.S., Kamneva N.A.
Abstract

Introduction. Brain metastases can occur in almost all gynecological malignancies and, despite modern therapeutic options, have a poor prognosis. Brain metastases from vulvar cancer are considered to be rare. In the literature, the reports on these cases have identity character.

The aim is to show clinical observation of the patient with vulvar cancer with brain metastases.

Results. Patient S., 60 years old, with stage I р T1N0M0 vulvar cancer underwent vulvectomy in January 2018. During the histological study – in the subepithelial layers were the areas of kraurosis with the growth of squamous cell keratinous carcinoma. Taking into account the prevalence of the tumor process, adjuvant treatment was not carried out. Two years later, in January 2020, there were focal symptoms in form of weakness in the left upper and lower limbs, an unsteady gait, a generalized weakness. During magnetic resonance imaging (MRI) of the brain in the occipital lobe paraventricular with intensive perifocal edema to the right was determined cystic-solid formation with rough edges which size was 29×33×65 mm without clinically significant mass-effect. The middle structures were not displaced. Positron emission tomography-computed tomography (PET/CT) was performed to detect the prevalence of the tumor process. Data on the presence of the active specific process at the time of study were not received. Taking into account the absence of other indicators of generalization process, whole brain radiation therapy (single fraction dose of 3 Gy, total radiation dose of 30 Gy) was carried out, followed by the application of Temodal. The patient was examined in 6 months. There were no signs of progression.

Conclusion. Brain metastases from vulvar cancer are considered to be rare. This clinical case is interesting because brain metastases have been the only manifestation of the progression of the tumor process in the absence of regional lymph nodes damage. The main diagnostic method is MRI of the brain. The use of PET/CT helps to detect the prevalence of the tumor process. The metastases have been detected after 36 months from the date of the initial diagnosis of the cancer. Radiation therapy is a method of choice of brain metastases treatment.

Journal of Modern Oncology. 2020;22(4):130-133
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Squamous cell breast cancer: description of a rare clinical case
Zikiryakhodjaev A.D., Khakimova S.G., Rasskazova E.A., Saribekian E.K., Omarova D.F., Surkova V.S., Khakimova G.G.
Abstract

Squamous cell carcinoma of the breast is a rare, aggressive tumor with a poor prognosis. To date, due to the low incidence of morbidity, there is no single concept in the complex treatment of this pathology. The article describes the case of a 49-year-old patient after surgical treatment of squamous cell carcinoma of the left breast from 2019 on the anamnesis. A year later after the progression of the disease the patient underwent removal of a chest wall tumor with resection of III–V ribs, allo- and autoplasty, axillary lymphadenectomy on the left. In most cases, the treatment of squamous cell carcinoma of the breast is surgery, but the role of adjuvant chemotherapy, radiation therapy and endocrinotherapy are still unambiguous.

Journal of Modern Oncology. 2020;22(4):134-138
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Ifosfamide/cyclofosfamide-induced methemoglobinemia in pediatric patients with hemoblastoses
Valiev T.T., Korkina Y.S.
Abstract

Rare side effects of already known chemotherapy drugs are a difficult case for clinician. In this article, there is a description of 15 cases of the development of methemoglobinemia after the use of ifosfamide and cyclophosphamide in the therapy of acute lymphoblastic leukemia and Burkitt lymphoma. And when ifosfamide-induced methemoglobinemia is already described in the world literature as a form of isolated cases, cyclophosphamide-induced one is presented for the first time in this article in our (domestic) clinical practice. Both pathophysiological basis and inducer drugs are described in the article in detail. Special attention is paid to hereditary variants of methemoglobinemia and to possible combinations of hereditary and drug-induced variants. Clinical and laboratory criteria for the methemoglobinemia diagnosis and corresponding treatment recommendations are provided by the authors.

Journal of Modern Oncology. 2020;22(4):139-142
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