Purpose of the study. To evaluate the effectiveness and possibility of wide clinical use of denosumab in neoadjuvant mode in patients with giant-cell bone tumors to simplify the operation by reducing the size of the tumor, consolidating pathological fractures, improving the quality of life, restoring the function of adjacent joints, by conducting 2 courses of denosumab as neoadjuvant targeted therapy for patients with giant-cell bone tumors, as well as evaluating morphological changes in tumor.

Materials and methods. Considering the data on the efficacy of denosumab, all 10 patients underwent 2 courses of Denosumab 120 mg subcutaneously 1 time per month, as a neoadjuvant targeted therapy for a giant cell bone before performing a surgical treatment. The morphological picture was analyzed before and after the start of treatment, and the clinical and radiological results were evaluated.

Results. A similar clinical picture was observed in all 10 cases involving pain relief and restoration of support ability of the bone. X-ray changes demonstrated the development of sclerotic processes in the foci of lytic destruction. Consolidation of pathological fractures was observed. The main changes determining the clinical and radiological characteristics were associated with the morphological processes occurring in the tumor under the influence of denosumab. The morphological picture in the surgically removed bone samples was associated with the development of fibroscle-rotic processes leading to the consolidation of pathological fractures.

The histological changes were assessed at the light-optical level. Tumor cells (osteoblasts and osteoclasts) were replaced with fibrous tissue of varying maturity. That is, a response to the therapy (pathomorphosis in the tumor) was observed under the action of denosumab.

Conclusions. Denosumab in neoadjuvant targeted therapy for patients with giant cell bone tumors prior to surgical treatment allows reduction in tumor sizes and consolidation of pathological fractures. The functions of adjacent joints were restored during Denosumab treatment. Improvements in the quality of life of patients were registered. The clinical and radiological effect of the therapy corresponded to the morphological changes occurring in the tumor. All of the above made it easier to perform surgery.

Purpose of the study. To evaluate the diagnostic significance of accelerated and affordable verification of a bloodstream infection pathogen using biomarkers: procalcitonin and the Platelia ™ Candida Ag Plus mannan antigen.

Patients and methods. 349 cancer patients with febrile fever were examined from 6 medical and diagnostic oncological hospitals in the Southern Federal District of the Russian Federation during 2019. Patients aged from 1 to 85 years were hospitalized in intensive care, pediatric oncology and hematology oncology departments. Patient informed consent for the study wasobtained. The diagnostic algorithm included: a blood test using an automatic BacT /ALERT 3D analyzer and a parallel study of the level of biomarkers with enzyme immunoassay. Identification of strains and determination of sensitivity to antimicrobial agents was determined on a Vitek 2 automatic analyzer (BioMerieux, France). Procalcitonin levels greater than 10 ng/ml were registered to determine the development of bacterial inflammation. Procalcitonin was determined with Procalcitonin — ELISA-BEST kits (Russia). Mannan antigen was determined using Platelia Candida Ag kits (France). The result was considered positive at the antigen concentration of ≥125 pg/ml. Candida mannan antigen allowed us to decide on the involvement of Candida spp. in the infectious process.

Results. An integrated approach to the diagnosis of bloodstream infections increased the percentage of detection of pathogens up to 58.7%. Bacterial infection testing both with the blood culture method and the procalcitonin determination in blood serum revealed similar diagnostic values. Candida mannan antigen testing significantly improved the early diagnosis of Candidal infection, despite negative blood culture, which was probably associated with prolonged cultivation of Candida spp. in the blood (from 2 to 5 days). The inclusion of biomarker testing in the diagnostic algorithm in cases of suspected bloodstream infection allowed early pathogen identification and starting an adequate antibacterial or antifungal therapy.

Conclusion. An integrated approach to the diagnosis of bloodstream infections improved and, just as importantly, significantly accelerated the pathogen verification. Bacterial infection cases showed comparable results of hemoculturing and biomarker testing; however, in case of candidal infection, determination of Candida mannan antigen appears critical, as it was significantly more sensitive than the result of blood culture and allowed to identify the etiology of fever of unknown origin in many patients.

Purpose of the study. On the basis of the accumulated experience to optimize approaches to the preoperative preparation, technical aspects of X-ray surgical antegrade minimally invasive endobiliary interventions, rational postoperative management of patients in order to reduce postoperative complications, improving treatment outcomes and quality of life of patients.

Materials and methods. We analyzed 1610 percutaneous transhepatic endobiliary surgeries with separate examination of 1186 X-ray surgical procedures of percutaneous external biliary drainage (PEBD) and 424 cases of antegrade endobiliary stenting (AEBS)

Results. Complications after PEBD were developed in 9 (0.76%) patients: the procedure-related bleeding was noted in 3 (0.25%) cases, and bleeding caused by the progression of hepatic failure, hypocoagulation in 6 (0.5%) cases. 3 patients (0.25%) of this group died. Complications after AEBS were registered in 35 (8.3%) patients: acute postoperative pancreatitis in 24 (5.7%) cases, progression of liver failure, hypocoagulation in 9 (2.1%), tumor-induced duodenal stenosis in 2 (0.47%) cases. One patient (0.24%) of this group died. Reduction in complications after PEBD and AEBS is directly associated with surgery techniques, the use of special tools, and tactics of patient management.

Conclusion. The prevention of complications, treatment outcomes, and the quality of life of patients receiving interventional antegrade endobiliary surgery are inextricably associated with the technical aspects of interventions, the tools and tool materials, necessary correction of endogenous toxicosis, pancreatitis, hepatic failure, and hemostatic system disorders. Constant monitoring of the results of new technologies is necessary to analyze gathered experience for possible correction and optimization of tactical approaches and schemes for more effective treatment of patients with this severe pathology.

Purpose of the study. The primary study presents an analysis of the results of stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (SRBT) of extra — and intracranial tumors obtained during four years of observation at «National Medical Research Centre for Oncology».

Material and methods. The study enrolled 277 patients. 184 patients (66.4%) received SRS, 54 patients (19.5%) received intracranial SRT, 39 patients (14.1%) received extracranial SRBT. Radiation treatment plans were developed with iPlan and Elements planning software, BrainLab. Radiation therapy was performed with Novalis Tx, Varian linear accelerator. Outcome assessment was performed with iPlan and Elements software, BrainLab, by comparing tumor volumes based on brain MRI series for brain tumors (or CT imaging for extracranial pathology) before the treatment and during four-year follow-up. Stereotactic radiosurgical and hypofractive radiotherapy techniques were used. In radiosurgical surgery, radiation therapy was performed with a single high-precision approach of the therapeutic dose to the target for the purpose to reach biological effect in the irradiated volume with minimal impact on the surrounding tissues. Single focal doses (SFD) were selected due to histology, and the dose was prescribed according to the accepted criteria of The International Commission on Radiation Units and Measurements (ICRU) (2010) Report 83. Hypofractionated stereotactic radiotherapy was performed using 2-5 Fractions (FR) with an average range of 3-10 Gy.

Results. During the entire period of observation tumor volume and clinical symptoms in patients who received SRS were reported to reduce in 69,8%, to be stable in 19,6%, increased in 9,8%, respectively. For patients, who received intracranial SRT, tumor volume and clinical symptoms were reported to reduce in 59,3%, increased in 21,4%, to be stable in 9,3%. For patients with extracranial tumors, who went SRBT, tumor volume and clinical symptoms were reported to be stable in 58,9%, reduced in 38,5%, increased in 6,7%.

Conclusion. The analysis of the obtained data shows the high efficiency of SRS and SRBT methods, which allow to achieve local control over both malignant and benign tumours.

Purpose of the study. Amplifying the effects of low-intensity modulated electromagnetic radiation (EMR) of the extremely high frequency range (EHF) on the tumor and adaptational status of old tumor-bearing rats with the help of complexes of essential amino acids enriched withvitamins and microelements (AaVM).

Materials and methods. In experiments on 50 old white outbred male rats with transplantable sarcoma 45, the effects of EMR EHF and the combined effect of EMR EHF and AaVM were studied. For exposure to EHF EHF, the "Yav-1" medical device was used. The frequency modulation with 42.2 GHz as a center frequency was applayed. The duration of treatmaent was 4 weeks. We studied the dynamics of tumor size, adaptive status (according to hematological indicators of the character and tension of the general nonspecific adaptational reactions of the body), structural and functional changes in the tumor tissue, thymus and liver. In the statistical analysis of the results, student's t test and Wilcoxon-Mann-Whitney test were used.

Results. The anti-stress effect of EMR EHF on the organism of old tumor-bearing rats, accompanied by temporary inhibition of sarcoma 45 growth was shown. The combination of EMR EHF exsposure and AaVM (as an additional metabolic factor) leaded to a persistent pronounced antitumor effect in 60% of animals. Inhibition of tumor growth in 4 times or more, as well as individual cases of its partial regression were observed. At the same time, a higher adaptational status including more numerous signs of activation of the thymus and liver than in the cases of using only EHF EMR were noted.

Conclusion. The results indicate the promise of a combination of activation electromagnetic therapy and application of complexes of essential amino acids enriched with vitamins and microelements in the development of effective methods of accompanying and supportive treatment of cancer patients.

The article describes a clinical example of primary adenoid cystic carcinoma of the trachea, characteristics of its clinical course, diagnosis and the choice of treatment. We noted the non-specificity of complaints and clinical manifestations of tracheal cancer, the period between its beginning and diagnosis, the development of severe complications in the respiratory and cardiovascular systems due to the long asymptomatic course of the disease, the need for an integrated approach by various specialists in the treatment of such a complex category of patients. An approach to the surgical treatment of tracheal cancer is described taking into account its extension to the subglottic larynx, which required laryngeal extirpation. We showed the possibility of radical treatment of patients with tracheal cancer in large medical centers with such specialists as head and neck cancer surgeons, thoracic surgeons, endoscopists, anesthesiologists and resuscitators, therapists, radiologists, and chemotherapists.

Pancreatic cancer is a disease characterized by low visualization, high metastasis, and lethality. The average life expectancy for this nosology is less than 1 year. Early diagnosis of pancreatic cancer is difficult due to the lack of specific symptoms. As a rule, at the time of tumor visualization, every third patient has regional lymph nodes involved in the process, and every second patient already has distant metastases. We present a clinical case of a 73-year-old patient with a diagnosis of: cancer of the pancreatic head St IV, T4N1M1. The woman's primary positron emission tomography (PET-CT) revealed a metabolically active lesion with a size of 26х21х32 mm. After the combined multistage therapy under the control of PET-CT, it was possible to achieve complete leveling of the primary tumor focus and a relapse-free course of the disease for 11 months.

Our clinical observation showed the effectiveness of dynamic control (using PET-CT) treatment of metastatic pancreatic cancer, which influenced the patient's treatment strategy.

Conclusion. Patients with pancreatic adenocarcinoma ECOG ≥  3, despite the prevalence of the process, should be offered comprehensive treatment.