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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.

Introduction. The multikinase inhibitors have demonstrated high clinical efficacy in treatment of the radioiodine refractory differentiated thyroid cancer. At the same time, the inclusion criteria in the studies has reflected a minimum set of characteristics important for beginning of use of these drugs and an approach that takes into account the tumor progression rate (the volume doubling time) in the absence of clinical manifestations of the disease that have made it possible to individualize the start of therapy. Aim. To describe and evaluate the barriers and drivers of use the “watch and wait” approach by Russian oncologists in treatment of the radioiodine refractory thyroid cancer. Materials and methods. We conducted 35 structured interviews with oncologists observing patients after radioiodine therapy in order to evaluate the “watch and wait” approach. unfortunately, data on use and prevalence of this approach in Russia are limited. The present study involved the use of deductive content analysis as well as analysis of implementation model of clinical guidelines and included investigation of issue of implementation of the “watch and wait” approach to current practice of therapy for radioiodine refractory differentiated thyroid cancer. One of the main tasks was to determine the influence of external factors on the treatment of this category of patients. Conclusion. Barriers and drivers of using “watch and wait” approach in the treatment of differentiated radioiodine refractory thyroid cancer are identified at several levels. for wide use of this approach, it is necessary to involve oncologists taking into account their attitude regarding changes in routine practices, patient expectations and to obtain additional data regarding its long-term effectiveness.

Skin cancer is the second most common tumor among non-melanoma malignant skin neoplasms, accounting for 20 % of cases. In the Russian federation in 2022, this pathology was identified in 79,124 people. The peak incidence occurs in the age range of 60–70 years. Considering the increasing life expectancy, the incidence of skin cancer is expected to rise. Despite the fact that regional metastases occur in 0.3–16 % of cases, the risk of metastasis can increase up to 48 % depending on high-risk factors. Since the presence of regional metastases is a key prognostic factor, special attention should be given to preventive interventions in the areas of regional metastasis.

Introduction. Thyroid cancer has a favorable prognosis but in long term patients are observed to be in psychological distress manifesting through elevated anxiety and depression which disrupt social adaptation. Studies have shown that 2–4 years after diagnosis and treatment of this malignant tumor, the majority of patients report dissatisfaction with family relationships and difficulties in performing everyday activities. These data demonstrate the necessity of rehabilitation aimed at patient adaptation to everyday life after therapy completion. Psychological help is an important aspect of rehabilitation.Aim. To evaluate the effectiveness of psychological help in patients with thyroid cancer.Materials and methods. The study included 42 women with thyroid cancer, stages I–III, Т1–3N0–1М0. Mean patient age was 44.5 ± 1.1 years. The patients were randomly divided into 2 groups matched by age, disease stage and type of surgical intervention: treatment and control groups. The treatment group (n = 24) included patients who underwent psychological training in the postoperative period, the control group (n = 18) included patients who did not receive psychological help. Mental state was evaluated using the Hospital Anxiety and Depression Scale (HADS). The patients’ mental state was evaluated dynamically: 1st testing was performed after surgery, 2nd testing 12 months after surgery. Psychological training was performed in the postoperative period and included 5 individual classes teaching self-regulation skills.Results. After the surgery, HADS scale showed insignificant increase in anxiety in both groups. Analysis of repeat testing showed decreased anxiety levels in patients in the treatment group from 7.7 ± 0.2 to 6.3 ± 0.2, i. e. to normal level. In the control group, anxiety significantly increased from 7.8 ± 0.2 to 9.2 ± 0.2 (Student’s t-test = 5.17; p = 0.000168). Additionally, 12 months after surgical treatment statistically significant differences in anxiety levels between groups were observed: 6.3 ± 0.2 and 9.0 ± 0.2, respectively (Student’s t-test = 9.55; р 0.05). Repeat examination showed decreased depression level (in treatment group from 7.9 ± 0.1 to 7.4 ± 0.2, in the control group from 8.1 ± 0.2 to 7.7 ± 0.1), however it remained in the range of mean values. No statistically significant differences between the groups were observed (Student’s t-test = 1.34; р >0.05).Conclusion. Psychological training using self-regulation techniques performed in the early postoperative period normalizes anxiety level and prevents its elevation in long term in patients with thyroid cancer.

Introduction. Oral squamous cell carcinoma is associated with a high risk of regional metastasis even in early stages (T1–2N0M0). Morphological examination reveals concealed metastases in 20 % of removed clinically unaffected lymph nodes.Objective – to evaluate the effectiveness of flow cytometry for detection of concealed metastases in sentinel lymph nodes as an indication for cervical lymph node dissection in patients with stage сT1–2N0M0 oral squamous cell carcinoma.Materials and methods. This study included 27 patients, including 13 patients (48.1 %) with stage T1N0M0 cancer and 14 patients with stage T2N0M0 cancer (51.9 %). At the first stage, all participants underwent primary tumor removal and cervical lymph node dissection with sentinel lymph node examination. After mobilization, half of these lymph nodes was used for routine morphological examination followed by immunohistochemical examination, while the second half of them was analyzed using flow cytometry. Then we compared the results obtained.Results. We examined 46 removed sentinel lymph nodes from 27 patients. Conventional histological examination revealed 4 concealed metastases (8.7 %). Polymerase chain reaction allowed us to detect another 16 metastases (37.8 %). Levels I, II, and III lymph nodes were most frequently affected. Flow cytometry demonstrated that 20 % of patients with a

Despite the advances in supportive care for cancer patients, they often develop such a serious complication of chemotherapy as febrile neutropenia. This disorder is the main cause of reduced treatment efficacy because of the lower doses of cytostatics or even withdrawal of myelosuppressive therapy in some cases. The mortality rate from infectious complications of febrile neutropenia currently reaches 10 %.Presence of risk factors in combination with aggressive chemotherapy necessitates prevention of febrile neutropenia to reduce potential risks of complications. Synthetic granulocyte colony-stimulating factors can be used to address this issue.Among patients with head and neck tumors, the most vulnerable population includes individuals receiving TPF or DCF regimen or chemoradiotherapy. Such patients require preventive administration of granulocyte colony-stimulating factors. Patients with grade III–IV neutropenia require prevention of febrile neutropenia with pegylated forms of granulocyte colony-stimulating factors (such as empegfilgrastim). This will ensure optimal treatment outcomes.

Four stages of medical rehabilitation of patients with differentiated thyroid cancer in Russia are described. Specific rehabilitation programs and methods are described for every stage. The pre-rehabilitation program includes psychological and nutritional support, exercise therapy, consultations by the surgeon and anesthesiologist, correction of concomitant disorders, prevention of thromboembolic complications and local hemodynamic abnormalities. At the rehabilitation stage in the ICU antibacterial therapy, patient positioning, percussion massage of the chest, passive mobilization, massage of the extremities are performed. The rehabilitation program at the specialized surgical department includes psychological rehabilitation, adequate pain management, exercise therapy, massage, nutritional support, prevention of thromboembolic complications, treatment of early postoperative complications. The in-hospital rehabilitation at medical facilities additionally includes treatment of delayed and late surgical complications, correction of radioiodine therapy consequences. The outpatient rehabilitation program also involves correction of hypothyroidism and minimization of adverse effects of suppressive hormone therapy, health resort treatment.

Background. Parathyroid cancer (PC) is extremely rare, usually diagnosed after surgery, there are no clinical recommendations for the treatment of metastatic PC.The study objective is to present the results of a clinical examination and treatment of patients with PC.Materials and methods. Retrospective analysis of 15 PC patients treated from 2001 to 2019. The results of laboratory tests, the surgical approach, the results of treatment, the rate of metastasis and relapse within 19 months (3 months – 11.6 years) after surgery are presented.Results. Tumor size is 35 mm (20–45 mm). Lymph node metastases – 1 (6.7 %), distant metastases – 2 (13 %). The median initial parathyroid hormone (PTH) is 735 pg/mL, calcium 3.22 mmol/L. Severe hyperparathyroidism with osteitis fibrosa cystica – in 6 (40 %). The surgical approach was parathyroidectomy in 10 (67 %), en bloc resection in 5 (33 %). Normalization of PTH and calcium after surgery – 13 (87 %). In two patients with distant metastases, the PTH and calcium remained high. A patient with Th6 vertebral metastasis was successfully operated on, with normalization of PTH and calcium, and 1.5 years was without relapse. A patient with lung and liver metastases received sorafenib after surgery, with decrease in calcium level. She died of progression 12 months after operation. Among patients with normalization of postoperative PTH, one had local relapse after 4 years. The patient was re-operated and 1 year after the second operation without relapse. The remaining patients are without relapse/progression.Conclusion. At the time of diagnosis, lymph node metastases are in 6.7 %, distant metastases – 13 %. Normalization of PTH and calcium after surgery suggests a good prognosis, but does not exclude the recurrence in the future, which requires long-term follow-up. Repeated surgery for local recurrence or solitary distant metastases can provide stable remission. Sorafenib in metastatic PC has managed to control hypercalcemia in the short term, however, antitumor efficacy requires further study.

Head and neck squamous cell carcinoma (HNSCC) is the most common cancer among head and neck malignancies and causes of cancer death. More than 50 % of patiens have relapses within first 3 years after treatment, with median survival less than 6 months. Cetuximab is the first targeted agent for HNSCC, is considered as alternative regiment in case of intolerance to platinum-based chemotherapy, and also can activate an antigenspecific T-cell immunity in head and neck cancer patients. Nivolumab is a check-point inhibitor, that improves overall survival of patients with advanced recurrent/metastatic HNSCC, due to the CheckMate-141 study results. The results of phase II study сoncurrent cetuximab and nivolumab in patients with recurrent and/or metastatic HNSCC showed a benefit for patients without prior check-point inhibitor exposure and overall well tolerated. Thus, we have 6 cases of HNSCC, treated with combination of nivolumab and cetuximab, resulted in durable (12 months) partial response or stabilization without severe adverse events. In our study, all 6 patients had prior check-point inhibitor exposure with nivolumab. Cetuximab was added to a treatment protocol after evidence-based progression during check-point inhibitor therapy. We demonstrate a case report of recurrent locally advanced HNSCC, treated with combination of nivolumab and cetuximab and resulted in stabilization. Only 1 patient had a progression after concurrent targeted and immune-therapy with nivolumab and cetuximab. New combination was well tolerated without severe adverse events. To our opinion, first results are challenging and we believe in great perspectives of comprehensive molecular profiling and combination of targeted and immune-therapy for better results.

Introduction. Basal cell cancer (BCC) accounts for up to 80 % of all types of non-melanoma skin cancers. In 97 % of cases, BCC develops on bare facial skin, especially at the nose-forehead border, nose wings, corners of eyes and lips. Surgery can lead to gross cosmetic defects, therefore more and more specialists prefer conservative methods, among which local drug therapy holds a special place.The study objective is to evaluate the effectiveness and safety of glyciphon ointment for BCC local treatment as well as the economic costs. Materials and methods. The study included 114 patients who underwent BCC local drug therapy with 30 % Glyciphon ointment, where 111 (97.4 %) patients had primary BCC, and 3 (2.6 %) ones – recurrent BCC. Results. The study recorded 115 cases of use of glyciphon ointment in 114 patients. Doctors were fully satisfied with the treatment results in 101 (88.6 %) cases. In 11 (9.6 %) cases, satisfaction was partial due to severe adverse events (edema and hyperemia of the facial skin, pain), and in 2 (1.7 %) cases the treatment was found unsatisfactory. Eighty-six (93.5 %) patients with adverse events continued Glyciphon ointment therapy. The relapse rate after local drug therapy was 4.4 %, indicating its high efficacy and good tolerance. According to the study, most patients required 1 treatment course with 1 package of Glyciphon. Total cost of the treatment is approximately 17,000 rubles. Total budget expenditures are estimated at 1 billion 190 million rubles. Local BCC therapy with Glyciphon comparing to surgery may save more than 1 billion rubles for the state budget.Conclusion. Local chemotherapy with 30 % Glyciphon ointment is an effective and safe method to treat BCC. Its use increases treatment availability for patients and can significantly reduce federal expenditures.

The study objective is to assess the effectiveness of psychological support to patients with laryngeal cancer after laryngectomy. Materials and methods.This study included 36 male patients aged between 45 and 62 years with morphologically verified stage II–IV (Т3–4N0–2М0) laryngeal cancer treated in the Department of Head and Neck Tumors, N. N. Blokhin National Medical Research Center of Oncology in 2011–2016. Patients were randomized into two groups. Group 1 included 14 patients who received antitumor therapy alone. Group 2 comprised 22 patients who additionally received psychological support. Patients’ mental state was assessed before treatment and 6 months after its completion using the Hospital Anxiety and Depression Scale and Symptom Check List-90 Revised. Two patients from Group 1 and 1 patient from Group 2 were excluded from the study at the first stage. Results. We found that patients in both groups had severe psychopathological symptoms (including depression, interpersonal sensitivity, and severe distress) six month after treatment completion (according to the Symptom Check List-90 Revised). Patients who received psychological support demonstrated higher level of depression than healthy controls, but it was still significantly lower than that in patients who received no psychological assistance. Similar results were obtained by the Hospital Anxiety and Depression Scale: patients who received psychological support had significantly lower level of depression than patients who had no psychological support (8.3 ± 0.9 vs 10.2 ± 0.6 points respectively). Conclusion. Patients with laryngeal cancer who received psychological assistance (including cognitive behavioral psychotherapy) demonstrated significantly lower level of depression 6 months after treatment completion compared to those who received no psychological support.

Introduction. Patients with head and neck tumors are often require tracheostomy. This procedure represents complex surgical manipulation and is associated with risk of certain complications, including life-threatening. The study objective is to essess the results of percutaneous tracheostomy with the new SafeTrach technique. Materials and methods. The study included 21 patients. All patients had a tracheostomy performed using the SafeTrach technique. Results. Mean duration of tracheostomy with SafeTrach technique was 11.8 ± 3.4 minutes independently of patients’ body mass index or previous treatment (correlation coefficients r = 0.08, p = 0.7 and r = 0.08, p = 0.73, respectively). Among all possible complications of tracheostomy only 1 (4.7 %) case of bleeding in postoperative period was noted in our study. Conclusion. The SafeTrach technique combines all the benefits of open and percutaneous tracheostomy. It is characterized by simplicity, it does not require endoscopic control, that indicates the feasibility of its widespread implementation.

Background. The implementation of tyrosine kinase inhibitors into clinical practice improved treatment outcomes in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC). Lenvatinib is recommended as a first-line drug for these patients. The study objective is to analyze clinical experience with lenvatinib in patients with RR-DTC in the Russian Federation. Materials and methods. The data from 18 clinical sites in Russia was analyzed for the period December 2015 and September 2019. Seventyseven patients with histologically verified DTC, proven resistance to radioactive iodine therapy, and tumor progression (according to the Response Evaluation Criteria In Solid Tumors 1.1 criteria) were included in the study. Results.Median progression-free survival in patients included into analysis (n = 72) was 26.1 months. In patients who responded to therapy (including those with partial and complete response), median progression-free survival reached 36.2 months, which is higher than that reported in the updated results of the SELECT study (33.1 months). Lenvatinib-associated adverse events (AEs) were observed in 87 % of patients. Severe AEs were registered in 18.2 % of participants. In 6.5 % of cases, AEs lead to lenvatinib cessation; in 74 % of cases, AEs required dose reduction.Conclusion. Our findings suggest high efficacy and good tolerability of lenvatinib in patients with RR-DTC in routine clinical practice in the Russian Federation.

The study objective is to analyze the results of combined antitumor therapy, which included glossectomy, to treat locally advanced and recurrent oropharyngeal squamous cell cancer.Materials and methods. We performed a retrospective analysis of multimodal antitumor therapy of 19 patients, who were treated in the Nizhny Novgorod Regional Clinical Oncologic Dispensary within 2009–2019. All patients underwent segmental resection of the mandible due to massive tumor invasion into the periosteum. After total glossectomy the defect was filled using pectoralis musculocutaneous flap. Due to the wide local tumor spread, a neck dissection (n = 7) or radical cervical lymphadenectomy (n = 12) were performed. During preventive surgery, metastases that were not detected before surgery were revealed in 2 patients in 1 neck lymph node. Results. Eleven patients had local purulent-necrotic postoperative complications. It was noted that after surgery but without radiation therapy complications developed in fewer patients (n = 4) and were less severe: of I degree – in 3 patients, of III degree – in 1 patient. Radiation therapy before surgery resulted in more severe purulent-necrotic complications in 7 patients: of I degree – in 2 patients, of II degree – in 1, of III degree – in 4. Mortality rates: 30-day, 60-day and 90-day – 10.5 %, 21 % and 37 %, respectively. The causes of death were complications of gastrostomy: profuse bleeding from the stomach wall (n = 1), acute psychosis complicated by cerebral edema (n = 1), increased heart failure (n = 1), necrosis of the anterior abdominal wall and cachexia, developed after gastrostomy (n = 1), continued tumor growth between chemotherapy courses (n = 3). Twelve patients survived more than 90 days after surgery, 3 patients – more than 2 years. As most of the patients could not swallow, they were administered a nasogastric tube, since a simultaneous gastrostomy increases the duration of a traumatic operation and aggravates the postoperative period.Conclusion. Multicomponent surgery after radiation therapy results in more often local purulent-necrotic postoperative complications than if the surgery is performed before radiation therapy. High mortality in the first 90 days after surgery (n = 7) due to local cancer spread is generally determined by the severe condition of patients with advanced cancer and the concomitant diseases. However, rejection of gastrostomy in favor of nasogastric tube seems reasonable, since several deaths in the early postoperative period may be occurred due to complications associated with gastrostomy.

The study objective is to analyze the experience of conformal radiotherapy in combination with cetuximab for cervical lymph node (LN) metastasis in patients with early-stage tongue cancer who had undergone multicomponent surgeries.Materials and methods. This retrospective study included 48 patients with primary squamous cell carcinoma of the tongue (Т1–2) that were treated in Nizhny Novgorod Regional Clinical Oncology Dispensary between 2012 and 2019. The experimental group comprised 25 patients who underwent hemiglossectomy with simultaneous preventive cervical lymph node dissection. The control group was composed of 23 patients who underwent hemiglossectomy alone due to the presence of concomitant somatic pathology. Before surgery, none of the patients had any signs of metastatic lesions in the cervical LNs according to the results of clinical and instrumental examinations. After surgery, 100 % of patients from the experimental group were found to have N1–2b cervical LN metastases at histological examination. Patients from the control group developed clinical signs of cervical LN metastasis within a year after operation. All patients underwent radiotherapy. The experimental group was divided into two subgroups: patients from subgroup 1 (n = 11) received cetuximab due to disease progression, whereas patients from subgroup 2 (n = 14) received cisplatin. Participants from the control group received no chemotherapy due to their concomitant somatic disorders and because regional metastasis was not confirmed.Results. In the control group, the time between surgery and patient’s death varied between 8 and 14 months. Patients from subgroups 1 and 2 survived for 12–60 months and 8–48 months respectively. So far, 9 patients from subgroup 1 and 6 patients from subgroup 2 are alive. Among them, 8 participants from subgroup 1 and 4 participants from subgroup 2 have no signs of disease progression. Three patients from subgroup 2 died of cardiovascular diseases (they had no cancer progression within 3 months after the completion of chemotherapy).Conclusion. Preventive lymph node dissection in patients with stage Т1–2 tongue cancer enables early detection of subclinical N1–2b metastases and ensures timely initiation of therapy. Our experience confirmed safety of cetuximab plus radiotherapy used to improve disease control and increase patient’s survival.

Lymphedema of the head and neck after combination treatment of tumors of this localization is an important problem as it leads to functional disorders, including life-threatening, and significantly decreases the quality of life. Early start of treatment prevents complications at the stage of edema. Currently, complete decongestive therapy in combination with low-level laser therapy allows to abate lymphedema manifestations.

The most severe consequences of surgical treatment of malignant neoplasms of the oropharyngeal zone are both violations of the breathing, swallowing, chewing functions, and complete or partial loss of speech. Logopedic rehabilitation of patients with tumors of the oropharyngeal zone plays an important role in the postoperative period, as it is aimed at restoring of all of the above functions.Restoration of the swallowing function is possible due to the restoration of the motor function of preserved anatomical structures, as well as the mobility of transplanted tissues with adequately performed plastic.To restore the respiratory function, it is recommended to use the following methods: coordination of inhalation and exhalation; inhalation commission which sufficient for expression; search for the optimal position of the body; the pause function and breathing exercises. Speech skills are restoring by the sound pronunciation correction. To overcome the lockjaw is the tonic spasm of the group of muscles of mastication, which leads to the mobility restriction of the temporomandibular joint, are performing the exercises, which regulate the degree of mouth opening. Also, patients are prescribed the use of the Jaw Motion Rehabilitation System TheraBite (Atos Mediсal, Sweden).

Basal cell carcinoma (BCC) is the most common type of malignant skin tumors, characterized by selective localization on the head and neck. Currently there is a variety of treatment methods for this disease, but some of them are not feasible due to patients’ age, cancer localization, morphological type, size, or number of tumor lesions. In that respect, local chemotherapy of BCC, especially for the problem face areas, can serve as a good alternative. Clinical and experimental trials have shown a high treatment effect for 30 % Glyciphon ointment in patients with BCC. In this article we present successful examples of treatment of patients with BCC on the problem face areas using Glyciphon.

Objective. Determination of mutation rates in KIT, NRAS and BRAF genes in 21 samples of mucosal melanoma of the upper aerodigеstive tract.Background. Head and neck mucosal melanomas (or upper aerodigestive tract mucosal melanomas) are rare and aggressive tumors of melanocytic origin. Head and neck mucosal melanoma (HNMM) comprises over 50 % of all mucosal melanomas. The aim was to determine the KIT, NRAS and BRAF mutation frequencies in 21 series of primary HNMM.Methods. Microdissected tumour cells were used from 21 formalin-fixed paraffin-embedded tumours. The tumour cells were screened for KIT, NRAS and BRAF mutations by direct sequencing.Results. Overall, 19 % (4 out of 21) of HNMMs harboured KIT, NRAS or BRAF mutations. Mutations in these oncogenes occurred in a mutuаlly exclusive manner. Both NRAS and BRAF mutations were identified at a similar frequency of 4,75 % each (1 and 1 out of 21), whereas KIT mutations were detected in 9,5 % (2 out of 21) of the HNMMs. KIT mutations were located in exon 11.Conclusion. Our findings shоw that NRAS and BRAF mutations, which are aсcessible for present targeted thеrapies, are only rarеly present in HNMMs, whereas KIT mutations seem to be relatively more frequent.

Metastatic neck lymph nodes in massive lesion of their tissue with tumor cells are accompanied by extracapsular extension to the adjacent structures in a number of cases. The greatest problem in clinical oncology is when even extended radical neck dissection fails to completely remove tumor tissue that is macroscopically detectable after surgical resection. In this situation, there is a continued growth of tissue mass that is left on the neck. Thus, the unresectable extracapsular spread of neck lymph node metastases to the adjacent tissues reduces the duration of life in the patients and worsens its quality.The basis for this investigation is clinical observations of patients who have been operated on at the Nizhny Novgorod Regional Clinical Oncology Dispensary (Hospital Two) in the period 2005 to 2016. Histologically, the tumors were squamous cell carcinomas. In this period, there have been 24 Crile operations (radical neck dissection) that are cytoreductive. A primary tumor has been (n = 15) or has not been (n = 9) previously excised. The extracapsular spread of metastatic lymph nodes corresponded to levels IIa, IIb, and III. Cytoreductive cervical lymphadenectomy with the pectoralis musculocutaneous flap covering an unresectable tumor for extracapsular unresectable squamous cell carcinoma metastasizing to the neck lymph nodes should be considered the operation of recovery. This type of surgery is warranted, as tumor mass reduction by eliminating the source of intoxication allows further antitumor treatment (radiotherapy or chemotherapy or their combination) that is contraindicated in patients with tumor lysis in the neck. When the cause of death is the exceedingly continued growth of an unresectable component of radio- and chemoresistant variants of tumor tissue on the neck, the covering of the component with a pectoralis major flap delays a fatal outcome in incurable patients to improve a number of quality-of-life indicators.

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).

Background. Incidence of oral cancer in Russia is 4.52 and mortality – 2.44. Head and neck cancer is characterized by the high risk of development of metastases in regional lymph nodes. Lymph nodes status exerts influence on the treatment plan and appears to be the major predictive factor. Regional metastases result into two-fold decrease of five-year survival. Therefore, evaluation and treatment of metastatic lymph nodes is of prime importance. Objective. The aim of this manuscript was to illustrate and summarize publications devoted to modern methods of ultrasound evaluation of cervical lymph node status in patients with squamous cell carcinoma of the oral cavity. Results. Numerous studies have demonstrated, that standard ultrasound investigation (in B-mode) is characterized by high sensitivity and specificity (specificity varies from 71.0 to 96.4 %, and specificity – from 46.6 to 91.0 %, according to different studies). In addition, ultrasound efficiency exceeds that of CT. Accuracy of ultrasound as the method of cervical lymph node investigation has increased after implementation of such methods, as elastography and elastometry (this techniques allow to achieve sensitivity of 98.1 % and specificity of 100 %).

To reveal the specific features of hematopoiesis in patients with head and neck squamous cell carcinoma (HNSCC), the authors analyzed the indicators of 41 bone marrow aspirates in relation to the clinical and morphological characteristics of the tumor and micrometastases detected in bone marrow. Puncture samples were morphologically and molecularly examined at the Laboratory of Hematopoiesis Immunology, N.N. Blokhin Russian Cancer Research Center. The found changes in the bone marrow cell composition in HNSCC patients showed themselves as an increase in the relative count of segmented neutrophils and a decrease in the level of immature granulocytes with no alternations in the neutrophil maturation index and in the percentage of granulocyte lineage cells. Bone marrow hypocellularity is a characteristic feature of high-grade HNSCC. The significantly enhanced leuko-erythroblastic ratio was due to a reduction in red blood cells: the erythroid cell maturation index rose, by increasing the percentage of bone marrow oxyphilic normoblasts in patients with locally advanced HNSCC. A highly sensitive method for detecting mRNA of the specific squamous cell carcinoma protein E48 was perfected using reverse-transcription polymerase chain reaction and Southern blotting, followed by an enzyme immunoassay that could recognize bone marrow micrometastases in 35 % of the patients with HNSCC. The patients with found bone marrow micrometastases showed a significant decrease in the proportion of polychromatophilic normoblasts and a significant increase in granulocytes in the presence of normal values of lymphocytes and other cellular elements of myelograms. It was established that in the presence of regional lymph node involvement, bone marrow micrometastases were significantly more frequently in the patients with HNSCC and tumor progression over a period of up to 9 months.

Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC), the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 %) cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale) 68 (89.5 %) patient was recognized as a excellent, and 8 (10.5 %) as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results.

Melanoma is an aggressive and rare neoplasm of melanocytic origin. Mucosal melanomas of the head and neck account for 1 % of neoplasms, 0,2–8,0 4 % of all melanomas and over 50 % of all mucosal melanomas. To date, in Russian and foreign literature only few retrospective series and case reports have been reported on mucosal melanoma. Despite melanoma’s common histological origin, head and neck mucosal melanoma presentation has some specific features due to its anatomical localization and poor clinical outcomes compared with those of cutaneous melanomas. Mucosal melanoma has a high metastatic potential. Five-year overall survival does not exceed 30 %. Advances in understanding of the clinical presentation can be used for prediction of behaviour and prognosis of this disease. We considered and analised articles devoted to clinical features of head and neck mucosal melanoma according to its localization.

Postsurgical survival is considered to be indicators of treatment efficiency in most cases. However, the sociomedical rehabilitation of patients in this group is no less important; not only life expectancy, but also functional rehabilitation and quality of life are in the lead in patients with Stage III–IVA due to their low 2-year and much lower 5-year survival. The main efficiency criterion is patients, quality of life as compared to antitumor treatment programs in the absence of differences in survival.As the only chance of cure or life prolongation in most cases, multicomponent surgery for locally advanced and recurrent oropharyngeal cancer may be refused by a patient for fear of being lost to society. Identification of surgical treatment-induced changes in quality of life in patients may be used as a criterion for assessing the performed operations.The body's changes in a patient with otopharyngeal cancer are associated with impairment of basic physiological functions (deglutition, mastication, and breathing), sensitivity (taste, olfaction, and hearing), and individual characteristics of a human being (for example, appearance and voice). The quality of life is integral characteristics of the physical, psychological, emotional, and social functioning of a patient, which is based on his subjective perception. The methods for studying the quality of life include first of all questionnaires that are classified as general and special ones.The general questionnaires are intended to assess the quality of life of both healthy individuals and patients regardless of their disease; the special questionnaires are used to study that in certain categories and groups of patients. The general questionnaires allow the comparison of patients with a population of healthy people. Account must be also taken of the fact that the quality of life varies with age and comorbidities. A great deal of procedures for measuring the quality of life in different groups of people determine whether it is expedient to use the most extensively studied method to adequately assess the findings and to compare with previously performed studies.Examination of changes in the quality of life after saving surgery is a promising line in the study of this disease and may be a success criterion for performed surgical treatment, including palliative care.

Speech quality was evaluated in 188 patients with acquired maxillary defects. Prosthetic treatment of 29 patients was preceded by pharmacopsychotherapy. 63 patients had lessons with a logopedist and 66 practiced self-tuition based on the specially developed test. 30 patients were examined for the quality of speech without preliminary preparation. Speech quality was assessed by auditory and spectral analysis. The main forms of impaired speech quality in the patients with maxillary defects were marked rhinophonia and impaired articulation. The proposed analytical tests were based on a combination of “difficult” vowels and consonants. The use of a removable prostheses with an obturator failed to correct the affected speech function but created prerequisites for the formation of the correct speech stereotype. Results of the study suggest the relationship between the quality of speech in subjects with maxillary defects and their intellectual faculties as well as the desire to overcome this drawback. The proposed tests are designed to activate the neuromuscular apparatus responsible for the generation of the speech. Lessons with a speech therapist give a powerful emotional incentive to the patients and promote their efforts toward restoration of speaking ability. Pharmacopsychotherapy and self-control are another efficacious tools for the improvement of speech quality in patients with maxillary defects.

Orthopedic treatment was performed in 53 patients with postoperative defects in the orbital area during 1969–2012. The developed practical guidelines could improve the cosmetic aspects of ectoprostheses, their fixation, and quality of life in the patients.

The mandibular periosteum is regarded as a metastatic site for oropharyngeal squamous cell carcinoma. This investigation is based on the clinical observations of 152 patients with locally advanced and recurrent oropharyngeal carcinoma, who have undergone surgery as part of combined and combination treatment at the Nizhny Novgorod Regional Oncology Dispensary (Branch One) in the period 2005 to2014. In9 (6 %) patients of them, mandibular periosteal metastases were the only manifestation of disease progression after termination of combined and combination treatment. The metastases were not verified before surgery and their manifestation was not accompanied by a local relapse or regional and distant metastases. In all the 9 patients, the mandibular periosteal metastasis was located in the projection of a previously removed tumor. When the surgery was attended by segmental resection of the lower jaw in the combined and combination treatment of locally advanced or recurrent oropharyngeal carcinoma, the mandibular periosteum to be removed is an effective measure to prevent the spread of periosteal micrometastases that could not be diagnosed preoperatively. Thus, the mandibular periosteum should be considered to be one of the metastatic sites for oropharyngeal squamous cell carcinoma, which must be taken into account when planning an operation in the combined and combination treatment of patients with locally advanced and those with a disease recurrence.

The paper details the surgical features of pectoralis flap repair of defect in in the treatment of locally advancedand recurrent oropharyngeal cancer.

The paper gives information on postoperative complications in 81 patients with locally advanced and recurrent oropharyngeal cancer who have been operated on at Oncology Department One of the Nizhny Novgorod Regional Oncology Dispensary (Branch One) in the period 2005 to 2011 (at the Oncology Dispensary of the city ofNizhny Novgorodprior to 2010).

Head and neck cancers, including thyroid carcinomas, are characterized by high risk of metastasizing in regional lymph nodes. Lymph nodes status determines treatment of thyroid cancer as well as disease prognosis. Excision of affected lymph nodes is associated with risk reduction of relapse and reduction of mortality. However surgical treatment can be associated with some difficulties. Due to technologic progress modern ultrasonographs offer the possibility to visualize minimal tumor nodes (5–10 mm), which are characterized with complexity of localization during surgical manipulation, particularly in patients with relapses, that previously passed treatment (surgery and/or radiation therapy). These lymph nodes can be missed during surgical treatment, which will lead to reduction of treatment efficacy. The paper details utility of intraoperative ultrasound investigation as a method of obtaining information about localization of nonpalpable tumor nodes, cancer extension, reduction the possibility of non-radical surgical treatment and unnecessary extension of surgical treatment in patients with thyroid cancers, characterized with regional lymph nodes involvement.

The paper gives the detailed surgical techniques of midline mandibulotomy, as applied to the surgical stage in the combined and complex treatment of the posterior third of the tongue. Based on the presented data on midline mandibulotomy that allows adequate access to the removed tumor and recovery of natural anatomical relationships, one may consider it to be a component of functional rehabilitation in patients.

Segmental mandibular resection is frequently a mandatory component of combination surgery in the treatment of locally advanced and recurrent oropharyngeal cancer.Objective: to detail the specific features of segmental mandibular resection, as applied to combination and complex treatment of locally advanced and recurrent oropharyngeal cancer. This study was based on the clinical observations of 31 patients with locally advanced and recurrent oropharyngeal cancer, who had been operated on in Cancer Surgery Unit One, Nizhny Regional Oncology Dispensary, Branch One (Nizhny Novgorod Oncology Dispensary before 2010), in the period 2005 to 2011.Results. Postoperative complications developed in 16 (50 %) patients: mild, moderate, and severe complications in 2, 8, and 6 patients, respectively. Thirteen patients were alive more than 2 years after surgery. Among in the deceased (n = 18), the cause of death was primary tumor progression in 10 patients; lung metastases developed in 1 patient; a second primary tumor (central lung cancer) did in 1 case. In the immediate postoperative period, two patients died (from gastric bleedingand pulmonary thromboembolism). In 4 dead patients, the causes of death were unassociated with a tumor process, but were associated with cardiovascular diseases.Conclusion. Segmental mandibular resection techniques during surgery are responsible for not only the frequency of postoperative complications, but also primarily for the efficiency of performed surgical treatment.

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).

The article represents a detailed technique of hiding mucosa defects in the retromolar area with temporal fascial and aponeurotic flap as applied to the surgical stage in the combined and complex treatment.

The fates of 450 patients with different defects of the upper jaw and midfacial tissues were traced after maxillofacial replacement were traced. The follow-up was 1 to 15 years. The immediate and late results of orthopedic treatment were studied using the follow-up and assessed from both the underlying disease and the degree of functional and cosmetic efficiency of orthopedic apparatuses.

A medicopsychological study of the time course of psychic changes was conducted in 88 cancer patients with defects of facial soft tissues (n = 38) and maxilla (n = 50). Since the patients’ visit to an oncologist, the diagnostic-stage depth of mental disorders was rather various: from mild asthenia to depression. Thus, 88 (100 %) patients were found to have an anxious feeling, 16 (18.2 %) had affective-shock reactions; 7 (7.9 %) had reactive depression. In the postoperative period, anxiety-depressive syndrome gave way to astheno-depressive one. After hospital discharge, the reactive state became less tense during psychosocial readaptation, the characteriological personality changes were increasingly more pronounced in the forefront in the patients. They became anxious, suspicious, unconfident about themselves, sensitive, tried to avoid difficult situations in life. The circle of interests was limited to thoughts on their own health. Combination therapy with psychotropic drugs was used to correct the mental status of patients with acquired maxillary defects in the study group. The dosage of the drugs was individually adjusted according to the degree of psychopathological manifestations.

The saliva is indispensable for preservation of healthy mouth and teeth, due to its composition and physical and chemical properties. Saliva preserves the teeth and favors their remineralization for account of afflux of irreplaceable minerals: calcium and phosphor. Due to contents of such epidermal growth factor it participates in tissue repair. The saliva contains the antibacterial, antiviral and antifungal drug resistance factors, suppressing the bacterial colonization of teeth and mucosa.Dry mouth (xerostomia) results in development of stomatitis, periodontitis effects, increases a risk of infectious lesions of oral mucosa. The severest forms of such pathology (Degrees II–III) are observed in the patients administered of X-ray therapy on head and neck area and in case of Sjogren’s syndrome, when the irreversible degenerative changes develop in эпителии salivary glands epithelium. Etiology and pathogenesis of xerostomia are not exhaustively studied yet, and treatment of such complex pathology is still symptomatic.

Speech recovery sessions were conducted in 63 patients with acquired maxillary defects. Assessment of speech quality in patients after auditory maxillary resection without a prosthestic has indicated 100 % significant rhinolalia, indistinct articulation. Prosthetic defect replacement completely corrects speech dysfunction and creates conditions for forming correct speech stereotypes. Speech therapy sessions and testing are aimed at increasing the performance of the speech apparatus and at improving the automatizaton of speaking skills. The techniques to remove nasal emission include: – articulation exercises (activation of the muscles of the lips, cheeks, tongue, pharynx, neck, and larynx); – speech respiratory gymnastics; – phonopedic (vocal) exercises. The elements of rational psychotherapy have extensive applications during each session and include suggestion, an emotional exposure to correct personality disorders, as well as pedagogical elements.

The paper presents information on a case of successful repair with a pectoral musculocutaneous flap for a paratracheostomic recurrence of laryngeal cancer.

The paper analyzes clinical observations of 40 patients with locally advanced and recurrent oropharyngeal cancer, who underwent multicomponent surgery with simultaneous removal of a primary tumor and cervical lymph outflow tracts, which was accompanied by discontinuity of the mandibular arch with concurrent tracheostomy.

Представленные клинические рекомен дации объединяют мнения членов рабочей группы по ключевым и наиболее спорным проблемам диагностики и лечения МРЩЖ, которые сложились в отечественной клини ческой практике. В рабочую группу вошли специалисты, работающие в различных ле чебных и научноисследовательских учреж дениях. Этот документ не является официально утвержденным различными структурами Ми нистерства здравоохранения РФ. Представ ленные в нем положения носят рекоменда тельный характер.

Представленные клинические рекомендации объединяют мнения членов рабочей группы по ключевым и наиболее спорным проблемам диагностики и лечения МРЩЖ, которые сложились в отечественной клинической практике. В рабочую группу вошли специалисты, работающие в различных лечебных и научно-исследовательских учреждениях.Этот документ не является официально утвержденным различными структурами Министерства здравоохранения и социального развития РФ. Представленные в нем положения носят рекомендательный характер.Основные предпосылки