Highlights on the morphology, prognostic factors, diagnostics, and treatment (chemotherapy, chemotherapy + radiation, targeted therapy, immunotherapy, and surgery) in small cell lung cancer

The article present a review and experience from a a single institution on the morphology, diagnostics, and treatment (chemotherapy, radiation, targeted therapy, and immunotherapy)) of small cell lung cancer (SCLC). The characteristic molecular, genetic, histological, and immunohistochemical features of NSCLC and SCLC are compared. An important issue of SCLC histogenesis is highlighted, taking into account its neuroendocrine characteristics. Paraneoplastic syndromes associated with SCLC and other clinical features of SCLC are discussed. The algorithm of examination of a patient with histologically or cytologically confirmed SCLC, staging schemes, and main prognostic factors are presented. The following aspects of chemoradiotherapy of localized SCLC are considered: features of early, late, simultaneous, and sequential therapy, and the need for whole brain radiotherapy in patients with localized and extensive SCLC. The article discusses the treatment algorithm for extensive disease SCLC, taking into account the recent success of chemoimmunotherapy in the first-line treatment of SCLC. As is known, the combinations of atezolizumab, etoposide, carboplatin and durvalumab, etoposide, cisplatin, or carboplatin showed a real benefit compared to chemotherapy alone. Although the second line treatment has not changed, it is now possible to prescribe a third line therapy because of the proven effectiveness of immunotherapy. Targeted therapy, although not shown to be effective in SCLC, is discussed in terms of the key features of genetic alterations as a possible target for therapy. An important issue in the treatment of patients with superior vena cava syndrome is considered separately. The tasks of future prospective research in SCLC are described.

Targeted therapy in the treatment of HER-2 positive breast cancer with brain metastases

Metastatic damage to the brain is a frequent manifestation in tumors of various localizations, including breast cancer. Until recently, systemic therapy of metastatic brain damage was of limited use; however, with the advent of targeted drugs that are better understood in terms of the specific molecular targets and biological characteristics of metastases, it is now possible to improve treatment results. In an analysis of the results of studies on the problem of metastasis of breast cancer in the brain, a comparison of the use of various targeted drugs in the treatment of metastatic HER2 + breast cancer is presented. The results of a comparison of the degrees of effectiveness of targeted drugs, both in monotherapy and in combination with chemotherapy, were obtained and analyzed.

Influence of plastic surgery for melanoma on progression-free survival in patients with skin melanoma according to the degree of tumor lymphoid infiltration

The aim of the study was to analyze the effect of plastic methods for closing the defect after excision of primary skin melanoma according to the degree of lymphoid infiltration of the tumor. Material and methods. Patients with primary skin melanoma (SM) treated in 2013 (n = 337) were studied; these patients were randomized into 2 groups using the method of blind selection to the main (n = 182). In these groups, the tumor removal operation in patients ended with plastic tissue defect and the group comparisons (n = 155) (after removal of the tumor, simple linear wound closure was performed). Results. It was found that pronounced lymphoid tumor infiltration in patients with primary skin melanoma as a predictor of a favorable prognosis (in terms of the occurrence of locoregional recurrence) is realized in patients with plastic defect replacement significantly 2 times more often than in patients without plastic surgery in the period from 12 to 60 months of observation. Discussion. The dependence of the occurrence of locoregional relapses in patients on lymphoid infiltration of the tumor and the performance of plastic surgery was revealed. In general, all patients who underwent plastic surgery have an advantage in terms of the occurrence of locoregional relapses in the long term for a period of up to 5 years by 12.5%. In patients with severe lymphoid infiltration and plastic surgery, locoregional relapses occur almost 2 times less often than in patients without plastic surgery, starting from a follow-up period of 1236 months by 20.6% (22.9% and 43.5%, respectively; p = 0.008), and in the period from 36 to 60 months of observation by 24.7% (25.3% and 50.0%, respectively; p = 0.002). Conclusion. The use of plastic techniques for closing a wound defect in patients with skin melanoma with pronounced lymphoid tumor infiltration reduces the risk of gross scarring and halves the risk of locoregional metastasis as compared to linear suturing of the postoperative defect.

Results of the surgical treatment of primary skin melanoma depending on the method of tumor excision and options for closing the surgical defect

The aim of the study was to analyze the results of the surgical treatment of patients with primary skin melanoma (SM) according to the location of the primary tumor, the type of incision, and the method of suturing the postoperative defect. Material and methods. Patients with primary SM, treated in 2013 (n = 337) were studied; these patients were randomized into two groups using the method of blind selection to the main (n = 182) comparisons (n = 155) (after removal of the tumor, simple linear wound closure was performed). Results. In patients with localized forms of SM, it was found necessary to perform a round incision when the tumor is localized on the trunk and an elliptical incision when localized on the extremities, followed by plastic replacement in all cases. In stage III patients with any tumor localization, the type of incision and suturing of the defect was not of fundamental importance. Discussion. It was revealed that patients with tumor on the trunk after rounded incision and plastic surgery had an advantage in progression-free survival (PFS) at all stages before an elliptical incision without plastic surgery during the entire observation period (123660 months) by 18.8%23%, 8%26.5% (p ˂ 0.050). Patients with localized forms of melanoma from stage 0 to IIc over the entire follow-up period of 123660 months had the greatest benefit in PFS from a round incision with plastic before conventional suturing without plastic surgery: from stage 0 to IIa by 22.0%31.8%32.0%, from stage IIb to IIc by 35.6%28.5%34.8%. In overall survival (OS), only patients with a rounded incision and plastic surgery in the initial stages of the disease stage 0 to IIa up to 36 and 60 months benefited by 24.4% and 29.3%, respectively. Compared with patients who underwent simple excision on the trunk, patients with stage IIbIIc with elliptical incisions and plasty had an advantage in PFS in the long term up to 3660 months of follow-up by 25.7% and in IDS with stages 0-IIa in the period 1236 months by 24.4%. With the localization of the primary tumor on the extremities, a statistical difference was revealed with the best indicators in patients with an elliptical incision and plastic surgery in the OS compared to patients with a rounded incision and plastic surgery in the period of 3660 months by 18.6% and 26.7%, respectively, as well as over patients with a conventional incision without plastic surgery in PFS as a whole in the subgroup at periods up to 36 and 60 months by 26.4% and 29.4% with a tendency to improve this indicator in the long term, as well as better SOS in the long term in these patients with a difference in OS of 19.3% (3660 months of observation). Conclusion. In patients with localized stages (0IIc), with the localization of the primary SM on the trunk, it is necessary to perform a round excision followed by plasty of the defect with displaced tissues; in addition, it is advisable to have an elliptical incision along the axial line for the limbs, followed by plasty of the defect. In patients with stage III, the shape of the incision and the method of suturing do not play a significant role in PFS and OS.

Evolution of surgical treatment of vulvar cancer: a literature review

In the structure of gynecological oncological pathology, vulvar cancer is located after cancer of the body of the uterus, cervix, and ovaries. The first publications on the surgical treatment of vulvar cancer date back to the second half of the 19th century. In the works of surgeons F. J. Taussig (1949) and S. Way (1960), radical vulvectomy with regional lymphadenectomy became a method of treating patients with invasive squamous cell carcinoma of the vulva. With this aggressive approach, sufficiently high levels of five-year survival of patients with vulvar cancer were achieved up to 90% in a localized process, and up to 50% in the presence of metastases in regional lymph nodes. In the 1980s and 1990s, the transition from ultra-radical operations to economical, sparing ones became possible because of factors such as the introduction of the sentinel lymph node determination method. Ramon M. Cabanas in the 1960s first coined the term sentinel of signal lymph node. Surgical treatment for vulvar cancer has evolved over time, from extended, ultra-radical surgeries to a more individualized, conservative surgical approach, including widespread local excision with sentinel lymph node (SLN) detection instead of extended surgeries for early vulvar cancer. The evolution of the surgical treatment of vulvar cancer over the years is undoubtedly associated with the developments of the surgical technique, understanding of the biology of tumor growth, and radiation medicine along with the possibilities of drug therapy. The transition from simple tumor excision to extended, ultra-radical operations with inguinal-femoral, retroperitoneal, and pelvic lymphadenectomy made it possible to achieve good survival rates for this group of patients. In any case, further research is required to understand the adequate scope of surgical treatment for vulvar cancer.

Correlation analysis of interleukin-10 indicators and tumor necrosis factor-alpha as clinical indicators of rehabilitation treatment of postmastectomy lymphedema in patients after complex breast cancer treatment

Background. Cellular immunity and cytotoxic agents are involved in the inflammatory process and tumor cell apoptosis resolution.Background. Cellular immunity and cytotoxic agents are involved in the inflammatory process and tumor cell apoptosis resolution. Endothelial cell apoptosis violation, imbalanced cytokines are considered as one of the contributory factors for postmastectomy lymphedema development. Aim. To assess the correlation between the interleukin profile (interleukin-10 and tumor necrosis factor-alpha) and clinical indicators of postmastectomy lymphedema in the rehabilitation treatment course after complex breast cancer treatment Materials and methods. The study involved 50 people aged 4065 years. The main group consisted of 40 females who underwent a rehabilitation treatment course for postmastectomy lymphedema. The control group consisted of 10 females with a verified breast cancer diagnosis who were preparing for surgical treatment. The statistical analysis determined the differences between the mean values of indicators using the Mann-Whitney U-test and the Wilcoxon T-test. Spearmans nonparametric correlation analysis was used to determine the relationship between the studied characteristics. Differences between indicators were considered statistically significant at p 0.05. Results. The indices of the studied interleukins in the control group are significantly higher than that of the main group. Interleukin-10 remained unchanged in the course of restorative treatment, whereas tumor necrosis factor-alpha increased from 43.72 10 pg/l to 118.94 14.74 pg/l. After the course, a statistically significant correlation (p 0.05) was found between the levels of the studied interleukins. A positive trend was observed as a result of rehabilitation treatment of postmastectomy lymphedema: the average excess volume in patients of the main group decreased by 38.5%. Conclusion. Evaluation of interleukin-10 and tumor necrosis factor-alpha in patients with postmastectomy lymphedema allows not only the restorative treatment results assessment and determination of the immune status parameter and damage degree of the vascular endothelium of a particular patient but also prognosis formation of malignant neoplasm development.

Histopathological examination of surgical breast cancer specimens after neoadjuvant chemotherapy using digital radiography

The article provides a literature overview on significance, pathologic assessment of residual disease problems, and digital radiography (DR) potential in breast cancer (BC) after neoadjuvant therapy (NAT). Within the framework of the paper, the authors carry out an analysis of the Russian and English-language publications from PubMed, Google Scholar, ClinicalTrials.gov, eLibrary, and Cyberleninka. The comparison of the Russian clinical guidelines for BC diagnosis and the European and American guidelines revealed a lack of information on DR usage in the morphological assessment. The review showed the international experience in DR usage and demonstrated the relevance of the solution of morphological assessment problems in BC regression degree after NAT due to necessary clinical trial protocol standardization and increased predictive residual tumor class significance. The DR facilitated the morphological identification of metal markers implanted into the tumor bed, microcalcifications, altered foci, and improved tumor bed visibility, which is important for further objective status assessment of the resection margins and residual cancer burden class. The authors consider it necessary to conduct a study to optimize the residual tumor assessment using DR.

Digital technologies in prostate cancer prevention and early diagnosis

Background. Prostate cancer is one of the most common malignant neoplasms in males. The Russian Federation observed the same patterns: the incidence of prostate cancer is steadily growing, without the tendency to decrease. Currently, no effective methods are available for prostate cancer early diagnosis and screening. Aim. To improve the effectiveness of prostate cancer prevention and early diagnosis with new digital technologies for high-risk cancer group formation Material and methods. Data from the Cancer Registry population in the Altai regional cancer center, Barnaul City was used. The Cancer Registry includes information about 253,000 patients with malignant neoplasms, including 14,482 males suffering from prostate cancer. Based on the targeted prevention method of A.F. Lazarev, Method for determining the risk of prostate cancer (Patent 2692987) and Automated program for early diagnosis of prostate cancer (certificate of state registration of the computer program No. 2019663514) was developed, which simplifies the stage of forming groups of precancerous high oncorisk and increases prostate cancer detection, as well as develops personalized targeted preventive measures for each patient. Results. The study formed a group of 328 patients with precancerous high oncorisk for prostate cancer in the Cancer Registry, wherein an in-depth examination revealed 26 patients with prostate cancer, which was 7.9%. Stages I and II were established in 97.8%. Conclusion. The web application Automated program for early diagnosis of prostate cancer allows the group formation of high-risk patients who are a targeted search for prostate cancer. The testing process allows a large number of patients to be examined in a short time. The automated program for the early diagnosis of prostate cancer allows a statistically significant increased prostate cancer detection, as well as personalized preventive measure suggestions for each patient.

Systemic chemotherapy for primary cutaneous b-cell lymphoma, leg-type: a case report

Primary cutaneous lymphomas are a group of extranodal B-cell non-Hodgkins lymphomas. Primary cutaneous diffuse B-large cell lymphoma, leg-type, is an extremely rare and aggressive variant of primary cutaneous lymphoma. Due to the contradictory nature, poor prognosis, and high frequency of recurrence of this disease, the treatment of patients is multidisciplinary, based on an accurate histological and immunohistochemical classification as well as risk factor assessment. In this report, we present a clinical case of primary cutaneous B-large cell skin lymphoma, leg-type, with a positive response to chemotherapy. Clinical case. A clinical observation of chemotherapy of a patient with primary B-large cell skin lymphoma, leg-type, is presented. The patient underwent 6 R-CHOP chemotherapy courses and achieved an uncertain complete disease remission. Conclusion. The results obtained confirm the limited literature data on the need for timely administration of systemic chemotherapy in the management of this pathology.

Uncommon case of the acral melanoma with chondro-osseous metaplasia

Aim. This study aimed to improve the diagnostics of acral melanoma and investigate tumor morphological features of the chondroid and osseous matrix. Materials and methods. The article presents a clinical case of metastatic acral melanoma with chondroid and osseous metaplasia in a 60-year-old patient. Cytological, histologic, immunohistochemical, and molecular genetic studies were performed. Results. A conglomerate of lymph nodes was noted in the inguinal region of the patient. Oxyphilic chondroid masses and tumor cells with morphological features of sarcoma were revealed using thin-needle aspiration biopsy. On physical examination, pink-colored subcutaneous neoplasm was discovered in the skin of the heel. Histological examination of the primary neoplasm and inguinal lymph node was performed. Melanoma with chondro-osseous metaplasia was diagnosed. Immunohistochemical examination of the tumor revealed some pronounced diffuse expressions of S-100 protein, HMB-45, and focal expression of Melan A in tumor cells. The sample was tested to detect BRAF mutation, and no mutations were found. Conclusion. Morphological diagnostics of acral melanoma with chondro-osseous metaplasia is characterized by a high risk of diagnostic error. Therefore, additional immunohistological, molecular, and genetic studies should be used in the diagnostics of acral melanoma with chondro-osseous metaplasia.