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Purpose. To study the efficacy and safety of total neoadjuvant chemotherapy (NACT) with the FOLFIRINOX regimen for locally advanced gastric (GC) and cardioesophageal junction (CEJ) cancer.Patients and methods. Patients with histologically confirmed locally advanced gastric adenocarcinoma and CEJ, clinical stage cT3 or higher and/or regional lymph node involvement (cN+), without evidence of distant metastasis were included in our open-label, single-centre, non-randomised study. In the FLOT control group, patients received 4 courses preoperatively and 4 postoperatively with follow-up. I In the FOLFIRINOX group 8 courses of chemotherapy were administered in neoadjuvant mode, followed by surgery and observation. The tumor regression grade was assessed in accordance with Becker, Mandard and G. A. Lavnikova scales.Results. The study included 136 patients, 119 of whom started treatment according to the protocol (ITT population). Fiſty-nine patients were enrolled into the FLOT group and 60 into the FOLFIRINOX group. One-year progression-free survival (PFS) was 67,5 % in the FLOT group and 90,4 % in the FOLFIRINOX group (p = 0,29). The estimated 2-year PFS in the FLOT group was 61,4 % [95 % CI, 48,4–77,9 %]. Median PFS and overall survival (OS) were not reached. The incidence of events (progression or death) was lower in the FOLFIRINOX group (odds ratio [OR] 0,40 [95 % CI 0,16–0,97, p = 0,047]). Adverse prognostic factors regardless of treatment were lymphatic (L1), vascular (V1) and perineural invasion (Pn1), and regional lymph node involvement aſter chemotherapy (ypN+) [p = 0,046; p = 0,014; p = 0,0021; p = 0,04, respectively]. There was no correlation between pathological complete response and survival rates.Conclusion. Total neoadjuvant chemotherapy with the FOLFIRINOX regimen for locally advanced GC/ CEJ demonstrated comparable to the perioperative FLOT one-year PFS rate. No association was found between tumor regression grade and survival outcomes.

The treatment strategy for Paget’s breast cancer (PBC), as for other morphological forms, is determined by the spread of the invasive tumor process, as well as the absence or presence of adverse factors. Significant prognostic factors, e.g. the invasive component of Paget’s cancer, the involvement status of regional lymph nodes, morphological criteria, the grade of malignancy, overexpression of epidermal growth factor Her2/neu, the presence of BRCA 1/2 and CHEK2 gene mutations, as well as age, affect the prognosis of Paget’s disease. According to various sources, PBC in 90–98 % is combined with invasive or non‑invasive breast cancer. For the most part, the lesion is multifocal. There’s high expectation for PBC to form tumor node. A palpable tumor node in the mammary gland is detected in half of the patients. PBC has certain features and specificity in relation to treatment methods. The method of radical surgical treatment of patients is primarily based on performing oncoplastic resections. Sufficient breast volume is a significant criterion for the possibility of performing an organ‑ preserving operation. The organ‑ preserving treatment is oncologically safe in case of PBC. The removal of the nipple‑ areolar complex is mandatory in case of PBC. It is possible to improve survival statistics by analyzing the biological characteristics of the tumor and developing a more accurate approach to the treatment of patients in this category. Determining clear indications for organ‑p reserving operations is the main opportunity to improve the quality of life of patients and their further rehabilitation.

The purpose of the study. Mesenchymal tumors of the esophagus comprise 2 % of all esophageal tumors. Leiomyosarcoma is the most common mesenchymal tumor in the esophagus (up to 80 %). It is located in the lower third of the esophagus. The main treatment modality of leiomyosarcoma is surgery. Due to the low frequency of occurrence, there are no unified approaches to the choice of surgical volume and access. Minimally invasive techniques have advantages over open approaches. However, final treatment approach depends on many factors: localization and location of the tumor around the circumference of the esophagus, as well as size. Endoscopic resection is feasible for small tumors with an intramural growth. In case of large leiomyomas, Lewis operation should be performed. In all other cases, tumor enucleation is the gold standard of treatment. The issue of minimally invasive surgical access is relevant. Thoracoscopic access has limitations for tumors located in the lower thoracic esophagus closer to the esophageal-gastric junction. In this regard, a laparoscopic approach with the possibility of transhiatal mobilization of the esophagus provides an adequate opportunity for tumor enucleation.Clinical case description. We hereby report our case study in which we employ the use of laparoscopic transhiatal enucleation to remove leiomyoma of the lower thoracic part of the esophagus. A 47-year-old female presented to P.A. Herzen Moscow Oncology Research Institute with complaints of pain in the epigastrium, discomfort behind the sternum when taking solid food. R0 resection was performed. During the one year follow-up period no sign of disease recurrence was observed.Conclusion. This approach, in our opinion, is fully justified, with careful selection of patients and compliance with guidelines of cancer surgery. Laparoscopic approach with transhiatal mobilization of the esophagus provides a good opportunity to perform the enucleation of mesenchymal tumors localized in the lower third of the thoracic region, at the level of the supraphrenic and abdominal segments.

Alveolar rhabdomyosarcoma is one of the four subtypes of rhabdomyosarcoma identified by the World Health Organization. This type of malignant neoplasms more often affects deep soft tissues of extremities and occurs in young ages, regardless of gender. According to the medical literature, no more than 45 cases of the development of primary cutaneous rhabdomyosarcoma have been reported in the world. In this report, we describe a clinical case of a 40-year-old woman with primary localization of alveolar radbomyosarcoma in the skin of the mammary gland.

Analysis of treatment results of 165 primary adult patients with diffuse B large-cells lymphoma (DBLCL) treating in Moscow municipal clinics is presented. Study aimed on analysis of efficacy of various dose intensity chemotherapy schedule according to disease molecular genetics variants. 28 adolescents and young adults (median age — 21.7 years) have received treatment according to pediatric BFM-NHL 90m and BFM-NHL 2004M protocols, 46 (median age — 29.0 years) and 91 (median age — 59.5) adults according to courses CHOP and R-CHOP, respectively. It was not randomized study. Germinal and postgerminal variants DBLCL were determined using immunohistochemical technique for 58 (35%) patients with appropriate primary samples. For young patients with germinal DBLCL therapy superiority of intensive BFM-NHL 90m and B-NHL 2004M protocols in relation to postgerminal variants was revealed: 5-years event-free survival (EFS) was 1.0 ± 0.0 (n = 6) versus 0.44 ± 0.15 (n = 9), respectively (p 0.05). Data receiving proves expediency of treatment adolescents and young adults with DBCLC from germinal center cells according to intensity BFM-like protocols.

Gastric cancer (GC) is the fifth most common malignant neoplasm in the world among all malignant tumors. Currently, the “gold” standard of treatment for patients with non‑metastatic cancer of the stomach and esophageal–gastric junction is surgical treatment, which is complemented by perioperative chemotherapy according to the FLOT scheme, which includes four courses of therapy before surgery and four after. However, according to statistics, less than half of patients complete all adjuvant courses of FLOT chemotherapy due to the high toxicity of the regimen and a decrease in the functional status of patients in the postoperative period. In this regard, studies are being conducted to study the tolerability of total neoadjuvant chemotherapy, when all courses are held at the preoperative stage in order to carry out all stages of treatment in full. International studies have shown the results of the use of targeted (ramucirumab, trastuzumab, pertuzumab), immune drugs (pembrolizumab, nivolumab, ipilimumab), S‑1 in combination with chemotherapy as part of the combined treatment of gastric and esophageal‑ gastric junction cancer. The emergence of new therapeutic agents previously studied in metastatic GC may change approaches to the treatment of localized and locally advanced GC.The review presents the features of perioperative therapy regimens in patients with resectable gastric and esophageal‑ gastric junction cancer in order to reduce the frequency of local and long‑term relapses and improve further prognosis.

The purpose of the study was to evaluate the efficacy and safety of laparoscopic transgastric resection for mesenchymal tumors of the proximal stomach.Material and Methods. A retrospective-prospective study was carried out. Surgical techniques of laparoscopic transgastric resection and the history of the development of this surgical method were described in detail. A total of 11 laparoscopic transgastric resections were performed. The course of the postoperative period and the postoperative management of patients were described. The immediate and long-term results of surgical treatment and the quality of life of patients were presented.Results. The assessment of the quality of life of patients after surgery showed that there were no cases of gastroesophageal reflux disease compared to proximal subtotal resection of the stomach or endoscopic tunnel resection. All patients underwent radical resection. In our study, we did not encounter cases of conversion of the surgical approach, as well as serious postoperative complications (Clavien–Dindo>III ). The analysis of long-term treatment outcomes showed that there were no cases of recurrence or disease progression. All patients are alive and followed up.Conclusion. This technique is fully justified, with careful selection of patients and compliance with all the rules of surgical oncology. Transgastric resection of gastric mesenchymal tumors located in the region of the cardioesophageal junction is a justified and safe technique. Surgery is performed under clear visual control, EGDS is not required to detect the tumor. This method allows the reduction of the frequency of contamination of the gastric flora into the abdominal cavity as well as the reduction of the wound area of the anterior abdominal wall.