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Introduction. Neoplasms of the orbit and periorbital region are usually represented by tumors of the eyelid skin skin of the periorbital region and paranasal mucosa. The most common histological types of this pathology are squamous cell and basal cell carcinomas. The main indications for orbital exenteration are tumor lesions in the extraocular muscles and orbital apex and irreversible vision loss in the affected eye at the time of surgery planning. In the absence of these pathologies organ-sparing surgery is recommended. Resection of orbital and periorbital tumors (including orbital exenteration) leads to cosmetic and functional defects therefore surgical treatment of this area should be performed only if other methods are impossible or ineffective.Aim. To analyze the experience of resection of orbital and periorbital tumors and to evaluate short- and long-term results of surgical treatment of this pathology.Materials and methods. Retrospective analysis of patients with tumors of the orbit and periorbital region who underwent organ-sparing and exenteration surgeries between 2003 and 2023 was performed.Results. Overall 5-year survival was 55 %. It varied depending on a number of factors. The best 5-year survival rates were observed for basal cell carcinoma of the eyelid skin and periorbital region (83 %) the worst for squamous cell carcinoma (34 %) and melanoma (41 %). For localized tumors (Т1) overall survival was 76 % for locally advanced (Т4) – 43 %.Conclusion. Orbital and periorbital neoplasms are characterized by a variety of tumor morphological types and locations which requires multidisciplinary approach to treatment and rehabilitation of patients with this pathology. more...

The larynx is a vital and socially important organ performing respiratory, vocal, and protective functions. Therefore, organ-preserving approaches are the preferred methods in treatment of patients with laryngeal cancer.The article presents a possibility of performing organ-preserving surgical treatment of locally advanced laryngeal cancer, describes a clinical case of extended resection of the larynx, demonstrates options for defect reconstruction stages. The goal of the presented technique is to improve patients’ quality of life. more...

Introduction. Treatment with the initial stage of the disease causes a high need for the use of organ-preserving treatment methods, which are actively developing and improving. One of the modern and promising methods is endolaryngeal resection of the larynx.Aim. To evaluate oncological effectiveness and functional results of endolaryngeal laser resections in cancers of the voice box.Materials and methods. The study included 139 patients with squamous-cell carcinoma of the voice box between the ages of 26 and 81 years who received treatment at the Department of Head and Neck Oncology of the federal medicalBiological Agency of the Russian federation between 2015 and 2020. All patients underwent standard examination to diagnose oncological diseases and were diagnosed in accordance with the Tumor, Node and metastasis (TNm) international system. In 90 (64.7 %) of 139 patients, squamous-cell laryngeal cancer T1N0m0 was diagnosed, in 49 (35.3 %) patients – T2N0m0. All patients underwent surgical treatment in the form of endolaryngeal laser resection according to the plan developed during an oncological council.Results. After endolaryngeal laser resections, 3-year recurrence-free survival for cancer of the voice box, stages т1 and т2, was 92 and 84.2 % respectively. Temporary disruption of separating function of the larynx in patients with stage T2N0m0 was observed in 6.1 % cases, decreased vocal function in 100 % of cases, granuloma formation in the postoperative period in 19.4 % of cases, formation of a scar narrowing the laryngeal lumen in 4.3 % of cases.Conclusion. High 3-year recurrence-free survival as well as small percentage of postoperative complications and severe functional abnormalities show high effectiveness of endolaryngeal laser resections in treatment of cancer of the voice box and recommend this technique for active use in daily practice of head and neck tumor specialists. more...

Introduction. Lymphomas are a heterogenic group of tumors of the lymphatic and hematopoietic systems, and in many cases tumor process develops in the area of the head and neck including skin and mucosa, orbit, nasal cavity and paranasal sinuses, oral cavity, oropharynx, salivary glands, thyroid, and cervical lymph nodes. Differential diagnosis of lymphomas of the head and neck is complicated because it can be accompanied by another non-tumor pathology. High heterogeneity of lymphomas of the head and neck requires structurization of knowledge on their epidemiological and clinical manifestations.The study objective is to optimize early diagnosis as it allows to significantly increase cancer alertness in local practitioners, oncologists, diagnosis specialists and, in turn, to decrease verification frequency in generalized disease processes. Study of clinical characteristics of lymphoproliferative disorders of the head and neck leads to increased quality of differential diagnosis.Materials and methods. A study of lymphoproliferative disorders affecting head and neck was performed. Study material consisted of data on 174 patients hospitalized at the N.N. Blokhin National medical Research Center of Oncology between 1999 and 2020.Results. Based on the current clinical and morphological classification of lymphoproliferative disorders, data on location of lesions, characteristic signs of extranodal lesions and cervical lymph nodes involvement, as well as methods of diagnosis of lymphomas of the head and neck, are presented.Conclusion. The obtained data helps solve problems of diagnosis of lymphoproliferative disorders affecting the head and neck and serve as a basis for successful, predictable treatment of lymphomas. more...

Introduction. The increasing incidence of oropharyngeal squamous cell carcinoma observed globally in recent decades gave rise to research in this area. In 2005, human papillomavirus was proved to be an etiological factor of oropharyngeal squamous cell carcinoma. Currently, oropharyngeal squamous cell carcinoma associated with human papillomavirus is believed to have some unique characteristics. The analysis of oropharyngeal squamous cell carcinoma epidemiology appears to be highly relevant.Objective – to assess the incidence and prevalence of oropharyngeal squamous cell carcinoma associated with human papillomavirus in Russia on the example of a certain sample of patients.Materials and methods. We analyzed medical records of 199 oropharyngeal squamous cell carcinoma patients treated in N. N. Blokhin Russian Cancer Research Center between 2016 and 2021. We analyzed the frequency of tumors associated with human papillomavirus, age, sex, tumor spread and stage depending on р16 status.Results. More than half of the patients from our cohort (58.3 %) were р16‑positive. The peak incidence was observed in individuals aged 45 to 64 years (more than 60 % of cases). Males were twice as likely to have р16‑positive tumors than females. A total of 60.9 % of patients with р16‑positive tumors had stage I disease, whereas 51.2 % of patients with p16‑negative tumors had stage IV disease.Conclusion. The results obtained for a sample of Russian patients are comparable with the findings of foreign authors. more...

Background. Lymphomas are a heterogeneous group of the lymphoid and hematopoietic system tumors. Neoplastic process often develops in head and neck area, including the integumentary tissues, orbit, nasal cavity, paranasal sinuses, oral cavity, pharynx, salivary glands, thyroid gland, as well as neck lymph nodes. The difficulties of head and neck lymphomas diagnosis are significant, since very often there is a combined non-tumor pathology. The high heterogeneity of lymphomas in the head and neck area requires structuring knowledge about their epidemiology and clinical manifestations.Objective: to study the epidemiological and clinical features of the head and neck lymphoproliferative diseases, which will lead to an improvement in diagnostic quality of this nosology’s.Materials and methods. The frequency of head and neck lymphoproliferative diseases detection was estimated based on the study of epicrisis and clinical data of 174 patients hospitalized at the N.N. Blokhin National Medical Research Center of Oncology in the period from 2000 to 2020.Results. Taking into account the modern clinical and morphological classification of lymphomas of the World Health Organization (2017), information about the features of localization, characteristic signs of extranodal foci and lymph nodes is presented. Detection frequency of various subtypes non-Hodgkin’s and Hodgkin’s lymphomas were determined on a sufficient cohort of patients.Conclusion. Based on the analysis of clinical and morphological features of head and neck lymphomas, epidemiological and clinical features are described in detail, and differences in the symptoms and clinical manifestations of non-Hodgkin’s and Hodgkin’s lymphomas with a predominant head and neck involvement are revealed. more...

Radiation therapy as one of the main specific method of treatment is widely used to treat patients with laryngeal cancer. Currently, the main radiotherapy technique for the treatment of patients with head and neck cancer is linear electron accelerators that can provide individual, complex configurations of radiation volumes. The article presents new modern technologies of radiation therapy in the early and locally-advanced stages of the disease, principles of organ-preservation treatment in laryngeal tumors, indications for pre-and postoperative radiation, methods of prevention of post-therapeutic complications. more...

The article is devoted to the diagnosis and treatment of an extremely rare tumor – a sarcoma from follicular dendritic cells with extranodal lesion in the region of the head and neck. These tumors are characterized by a high potential for metastasis and recurrence. Difficulties in choosing the optimal treatment tactics are associated with a small number of observations. Surgical, radiotherapeutics and chemotherapy methods are used. The literature data and the description of 2 own clinical observations of the sarcoma from follicular dendritic cells (with the involvement of the maxillary sinus and the nasal cavity) are presented. Treatment (surgery followed by radiotherapy) was successful. The appointment of adjuvant therapy improves the results of treatment in comparison with the surgical method alone. more...

Reconstruction of head and neck defects after surgery for cancer remains challenging. The choice of the reconstruction technique depends on the tumor size and localization, type of the defect, patient’s age, concomitant diseases, and disease prognosis. Surgeons have currently a broad range of material for reconstructive surgery, from free flaps to revascularized flaps. Microsurgical reconstruction has made a revolution in treatment of patients with complex head and neck defects. However, the use of this technique may not be advisable for some patients. The search for new techniques is needed to improve functional and aesthetic results and reduce traumatism without compromising oncologic outcomes. Thirty-six patients underwent surgery with reconstruction using the submental island flap, a new alternative in the reconstruction of various head and neck defects. The graft was taken after making a neck incision for neck lymph node dissection. A few patients develop total and marginal necrosis of the graft. Short- and long-term results showed no worsening of oncologic outcomes in the selected group of patients. more...

Oropharyngeal metastases are very rare and occur in approximately 1.0–1.5 % of all malignant tumors of the oral cavity and oropharynx. Information on oropharyngeal localization of metastases of kidney cancer is almost absent in the literature. A description of a rare clinical observation of metastasis of clear cell renal cell carcinoma into the oropharynx is presented. more...

Introduction. Patients are characterized by locally advanced tumors in 70–80 % of cases at presentation, so possibility of cure and surgical treatment is limited. Total glossectomy, tongue base resection is associated with severe and permanent disability. Such surgical procedures lead to severe dysphagia, alalia and social maladjustment. Enumerated issues motivated us to develop new method of surgical treatment of locally advanced base of tongue cancer.Objective is to introduce new opportunities of surgical treatment of locally advanced cancer of the tongue base.Materials and methods. Glossectomy is accomplished in 5 patients suffering from tongue cancer and admitted to N.N. Blokhin National Medical Research Center of Oncology. Swallowing and speech is preserved in all 5 cases.Results. The main advantage of the proposed method is that the cut out muscle flap has a different innervation from different cranial nerves involved in the rate of swallowing, so there is not just a mechanical movement of the epiglottis, but also the control of swallowing by the central nervous system. The reduction of injury and operation time in the proposed method is due to the fact that tissues directly contacting with the defect are used to preserve swallowing and speech. The proposed muscle flap has various sources of blood supply, which improves its nutrition and reduces the risk of complications, and healing occurs in a shorter time in comparison with the prototype. All of the above reduces the duration of hospitalization for an average of 7–9 days.Conclusion. The developed surgical technique allows to achieve early rehabilitation; patients are able to breathe effortlessly, swallow and speak. There is no need in permanent tracheostoma and percutaneous endoscopic gastrostomy tube. All patients remains socially active. more...

We present a clinical case of osteosarcoma of the larynx. It is a rare and aggressive tumor characterized by frequent local recurrence and the appearance of distant metastases. This is the only one case of osteosarcoma of the larynx in N.N. Blokhin National Medical Research Center of Oncology for the period from 1988 to 2017. more...

The article presents a literature review on the use of the displaced skin and fascial supraclavicular flap in the reconstruction of defects of the head and neck. Given that the flap was relatively recently introduced into clinical practice, we have found it necessary to consider the anatomical features, scope, intake flap technique, complications and long-term results. more...

Cutaneous melanoma (CM) is a highly aggressive malignant tumor. The incidence of CM is 1–4 % of all cancers and 3–5 % of all malignant neoplasms of the skin. According to different authors, CM is localized in the area of head and neck (H&N) in 22–46 %. Despite revolutionary discoveries in recent years in the treatment of metastatic melanoma, the main treatment option of primary СМ is still surgery. However, the question about the size of surgical margins and tissue sparing excision is still pending, particularly in the area of the head and neck. Despite the possibilities of modern methods of revealing of metastases in lymph nodes (LN), diagnosis of “latent” metastases in LN and further tactics of treatment remains the matter of argument. The purpose of this publication is to review the literature on the current problem in the surgical treatment of СМ of the H&N.This article is the result of analysis of publication devoted to surgical treatment and diagnosis of СМ metastases in the LN of the H&N. more...

Data on 573 patients with nasopharyngeal carcinoma registered for treatment in N.N. Blokhin Russian Cancer Research Center in 1980–2010 was used for the analysis. The study revealed high rate of late-stage diagnosis of nasopharyngeal carcinoma (82.9 %), low cancer suspicion, poor diagnostics in general practice (73.2 %). Active screening for nasopharyngeal carcinoma is virtually absent in Russia. According to the study results, combined radiotherapy is an optimal method for nasopharyngeal cancer treatment; chemoradiotherapy with platinum drugs, doxorubicin, bleomycin combined with hyperfractionated radiotherapy is preferable for treatment of locally advanced and reginal tumors. more...

Introduction. Prognosis of patients with localized primary cutaneous melanoma depends on various clinical and pathomorphological aspects. The latest ones are the Breslow depth, Clark invasion, ulceration and mitoses in primary tumor. All of this prognostic features have been studied and discussed during last 30 years. The analyses of the prognostic value of this factors is being continued till nowadays, and that is the main idea of our current study.The aim of our study is to determine the influence of pathomorphological factors on long-term treatment results in patients with primary head and neck cutaneous melanoma.Materials and methods. 174 patients with localized primary head and neck cutaneous melanoma were included (were considered for the analysis) (1995–2014). All the patients were considered for Breslow depth (T), Clark invasion, and ulceration using archived pathomorphological tissue samples. The proliferative tumor activity (mitotic rate) was determined in 24 cases with tumor with tumor thickness less than 1.0 mm.Results. Recurrence-free survival according to ulceration and N0 correlated with long-term treatment results. So, 5-year survival was worse in group with ulceration – 51,8 ± 5,9 % rather than group without ulceration – 69,5 ± 6,4% (р = 0,046). Recurrence-free survival according to Clark invasion and N0 correlated with long-term treatment results and worsened with growth of invasion level. So, 5-year survival in I level group was 100 % versus 27,8 ± 9,4 % in V level group (р = 0,00014). Recurrence-free survival according to mitotic rate did not correlate with long-term treatment results. So, 5-year survival was 79,5 ± 13,0 % and 81,8 ± 11,6 % respectively.Conclusions. Ulceration of the primary tumor is a factor affecting the rate of regional metastases, which subsequently leads to decrease in relapse-free survival. Also, a direct relation exists between increased rate of regional and distant metastases and increased Clark level of invasion. Mitotic index has a certain effect on the rate of regional metastases, but it doesn’t manifest in analysis of long-term results. Supposedly, this factor is not “strong” enough. more...

Objective: improve results of the treatment of patients with malignant salivary gland neoplasm (MSGN).Materials and methods. Analysis of 417 patients suffering from MSGN treated in the Federal State Budgetary Institution “N.N. Blokhin Russian Cancer Research Center” from 1988 to 2014. All the subjects were divided into 4 main groups according to the treatment assigned: group of the surgical treatment – 27.3 % (n = 114), group of the combined treatment (surgery and radiotherapy (RT)) – 54.0 % (n = 225), group of the complex treatment (surgery, radiotherapy and chemotherapy) – 10.5 % (n = 44), group of conservative treatment (radiotherapy and/or chemotherapy) – 8.2 % (n = 34).Results. Best 5-year disease-free survival (DFS) was observed in patients with localization of the tumor process in the minor salivary glands (MSG), mucosal tunic (MT) of mouth (73.2 ± 5.5%) and parotid gland (62.3 ± 3.3 %), while the lowest survival rate was observed in tumors of sublingual salivary gland (0%) (median was not achieved, p = 0.07). Depending on the morphological variants the best 5-year DFS was observed in groups of myoepithelial carcinoma, and acinar cell carcinoma: 81.3 ± 9.8 and 79.1 ± 8.4 %, respectively (median was not reached, p > 0.05); the worst survival rate was observed in patients with squamous cell carcinoma, carcinoma of the salivary ducts and adenocarcinoma: 45.7 ± 15.5; 50.3 ± 12.7 and 53.0 ± 5.5 %, respectively (median was not reached). In poorly differentiated tumors (G3 ) 5-year DFS was lowest and was equal to 32.7 ± 4.1 %, while in G1 tumors – 83.6 ± 3.1% (p = 0.000001). In G3 tumors addition of radiotherapy to the surgery significantly reduces the incidence of local recurrence - from 51.4 % (surgical treatment alone) down to 33.8 % (combined treatment) (p = 0.08). There was a significant decrease in 5-year disease-free survival rate from 74.2 ± 2.6 % without any adverse pathological signs down to 37.9 ± 5.4% in the presence of these signs (p = 0.000001). Cervical lymph node dissection is absolutely indicated for tumor localization in submandibular salivary gland, as it reduces an incidence of local recurrence: 15.8 % versus 25.9 % in the group without lymph node dissection, p> 0.05. In case of other MSGN localizations, prophylactic lymphadenectomy does not improve long-term outcomes. Radiotherapy in the post-op period significantly improves long-term results of treatment in comparison with a group of preoperative radiotherapy (local recurrence rates are 29.5 and 9.7 %, respectively, p = 0.0002). The use of chemotherapy can be justified in case of neoplasms with poor differentiation (G3 ) since this significantly reduces an incidence of distant metastases (17.6 and 9.1 % in groups of the combined treatment and in the group of conservative chemoradiotherapy respectively, p > 0.05). more...

We present rare clinical case of laryngeal paraganglioma. Modern possibilities of the disease diagnostics, determination of the prevalence of tumor process, methods, and assessment of the effectiveness of treatment are shown in this paper. more...

Клинические рекомендации подготовлены на основании материалов научно-практической конференции Проблемной комиссии «Опухоли головы и шеи» Научного совета по злокачественным новообразованиям Отделения медицинских наук Российской академии наук и Министерства здравоохранения РФ, посвященной памяти профессора Александра Ильича Пачеса, «Актуальные вопросы диагностики и лечения рака ротоглотки» (25 июня 2015 г., г. Архангельск). more...

The incidence of squamous cell carcinoma of the head and neck remains high and ranks tenth in the structure of overall cancer morbidity. Surgical radicality has remained one of the major determinants of the long-term results of treatment so far. In the period December 2014 to January 2016, our clinic performed surgical interventions as transoral laser oral cavity and oropharyngeal resections using carbon dioxide (CO2) laser in 34 patients. Tumors are most commonly located in the area of the tongue root and oropharynx in 16 (47.1 %) patients, tongue (its anterior two thirds) in 14 (41.2 %), and mouth floor in 4 (11.7 %). The average length of hospital stay after transoral laser resections was 10.14 days. A nasogastric tube was postoperatively placed in 6 (17.6 %) patients for 8 to 17 days. According to the results of planned histological examination, surgical interventions were microscopically radical in all cases. Transoral CO2 laser resections make possible to perform rather large radical surgical interventions with a satisfactory functional and cosmetic results, without deteriorating the long-term results of treatment. more...

Objective: to investigate the efficiency of radiotherapy for malignant salivary gland tumors and to reveal prognostic factors influencing overall and relapse-free survival rates in this patient group.Materials and methods. The retrospective and prospective data of 111 patients with malignant salivary gland tumors were analyzed. All the examinees received preoperative radiotherapy to the primary focus and, if need be, regional metastatic areas; the cumulative focal dose was 40–65 (56.0 ± 8.9) Gy. In the following step, the patients were surgically treated. They were divided into 2 groups according to the degree of therapeutic pathomorphism: 1) Degree 0–III (91.9 %) and 2) Degree IV (8.1 %).Results. Five- and ten-year overall survival rates were 60.1 ± 5.1 and 50.4 ± 5.7 % and 7.5 ± 11,69 and 87.5 ± 11.69 % (unachieved median) in Groups 1 and 2, respectively (p = 0.04); relapse-free survival rates were 53.6 ± 5.1 and 41.33 ± 5.5 % in Group 1 and 88.8 ± 10.4 and 88.8 ± 10.4 % in Group 2 (unachieved median) (р = 0.015). Cox multivariate regression analysis showed that the significant independent signs for overall survival were the pathomorphological characteristics of a tumor (risk ratio (RR) = 1.933; p = 0.010), process location (RR = 0.705; р = 0.010), and tumor grade (RR = 1.825; р = 0.010); those for relapse-free survival were the pathomorphological characteristics of a tumor (RR = 2.177; р = 0.001), regional lymph node metastases (RR = 1.543; р = 0.013), tumor localization (RR = 0.700; р = 0.014), effect of radiotherapy (RR = 1.767; р = 0.042), and tumor grade (RR = 1.754; р = 0.005). more...

The paper gives the results of treatment in a female patient with locally advanced thyroid cancer with a tumor thrombus in the internal jugular vein with laryngeal or tracheal involvement, and a giant metastasis into the bone of the vault of the skull. more...

The study included 314 patients with recurrent squamous cell carcinoma of the oral cavity and oropharynx after radical treatment. Patients were divided into groups depending on the timing – patients with early recurrence (n = 162), and late recurrence (n = 152 ), and depending on the type of treatment of recurrent tumors: conservative treatment group (n = 56 ), surgical (n = 235) and combined treatment (n = 23) group. A comparative evaluation of the effectiveness of the treatment of these patients based on the results of treatment, survival rates, the frequency and severity of complications. The conservative therapy of recurrent tumors of the oral cavity if surgical treatment is impossible is effective, especially in cases of late recurrent tumors but only surgical or combined treatment may reach the five-year survival rate in patients with recurrent tumor, cancer of the oral cavity and oropharynx. more...

The paper describes an original method for one-stage repair of combined through-and-through defect of soft tissues of the cheek, mouth angles, upper and lower lip. Russian Federation’s patent for invention No. 2489096 was granted for this method. We propose to use 3 different flaps cut from different anatomic areas, which have varying histological structures and independent blood supply. The important characteristic of our procedure is that the replacement flaps perform various functions. The ultimate result is to ensure the functional and anatomic adequacy of resected tissues (resultant through-and-through defect of the cheek, mouth angles, and upper and lower lip fragments), to improve the blood supply of used flaps, to reduce the time of patient rehabilitation, to decrease surgical traumaticity. The method is easy-to-use. more...

In 1969–2012, prosthetic replacement was performed in 102 patients with postoperative maxillary defects, including 90 patients with complete secondary adentia and 12 with total maxillary defect. Procedures for fixation of immediate prostheses (protective plates) were improved; practical guidelines were elaborated to transform the protective plate into a primary permanent prosthesis with an obturator. The primary permanent (forming) prosthesis is recommended in the postoperative period (on days 10–15). more...

Malignant oral tumors account for 6 % in the total cancer incidence. The rate of recurrent tumors ranges from 25 to 50 %. About 80 % of patients with failed treatment are to undergo radiation, chemoradiation, or drug therapy. After retreatment, severe complications occur in more than half of the patients even to death (2 %). Some progress has been made in the treatment of recurrent tumors due to the current possibilities of surgical treatment. Surgical reintervention can be made and satisfactory treatment results obtained in a number of patients even if they develop recurrent tumor after a previous saving operation. more...