Objective: to analyze short-term and long-term outcomes of expanded surgeries in patients with recurrent ovarian cancer and to identify factors affecting their overall survival (OS) and progression-free survival (PFS).

Materials and methods. This retrospective study included patients with recurrent ovarian cancer stage I–IV less than 80 years of age who was treated in the Department of Gynecologic Oncology, N. N. Blokhin National Medical Research Center of Oncology, between 2015 and 2017. Other inclusion criteria were as follows: time to relapse more than 12 months and no chemotherapy during the last 6 months or more. We analyzed the main perioperative parameters, OS, PFS, and prognostic factors affecting OS and PFS.

Results. This study included 55 patients. Of them, 44 (80 %) women have undergone complete cytoreductive surgery, whereas 11 (20 %) women have undergone optimal cytoreductive surgery. The median duration of surgery was 210 minutes (range: 60–390 minutes), median blood loss was 400 mL (range: 30–4500 mL). Postoperative complications were observed in 23 (41.2 %) patients; 5 (9.1 %) patients developed grade IIIB complications. Median follow-up time was 30.3 months (range: 7.5–67.1 months). Three-year OS was 73.7 % and three-year PFS was 30.7 %. More than one line of chemotherapy before repeated cytoreductive surgery was found to be a negative factor affecting OS (hazard ratio 2.749; 95 % confidence interval 1.059–7.138; p = 0.038). The primary ECOG performance status had a significant impact on PFS (hazard ratio 0.543; 95 % confidence interval 0.347–0.851; p = 0.008).

Conclusions. Poor ECOG status and more than one line of chemotherapy before repeated cytoreductive surgery for ovarian cancer relapse were demonstrated to have a negative impact on survival in this group of patients. However, in some patients, repeated cytoreductive surgeries ensured long-term remission. 

Objective: comparison of the effectiveness of the results of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer using classical and hypofractionated schedule of radiation therapy.

Materials and methods. This study is based on a retrospective analysis of a database of patients with locally advanced rectal cancer (T3C–D, positive circumferential resection margin or T4) who underwent a prolonged course of neoadjuvant chemoradiotherapy followed by surgery. The patients were divided into two groups: the first (main) group, 71 patients who received a course of chemoradiotherapy in hypofractionation schedule as part of neoadjuvant treatment (4 Gy × 40 Gy, 3 fractions per week) in combination with chemotherapy with capecitabine 1650 mg / m2 in two doses on weekdays. The second group (control group) included 79 patients who treated with long-course chemoradiotherapy in the classic fractionation mode (2 Gy × 50–58 Gy, 5 fractions per week) in combination with chemotherapy with capecitabine 1650 mg / m2 in two doses on weekdays. In the preoperative period, along with chemoradiotherapy, 4–8 courses of the systemic chemotherapy in the CapOx mode was used. The primary endpoint of this study was pathological complete response. Secondary endpoints included the seve rity of early radiation and hematological toxicity, the incidence of local recurrence, distant metastases, overall and disease-free survival.

Results. The study included 150 patients. The overall frequency of acute radiation toxicity of grade III–IV was 5.6 % in the main group and 8.9 % in the control group (p = 0.658), from them hematological toxicity – 2.82 % and 7.6 %, respectively (p = 0.350), skin and pelvic organ toxicity – 2.82 % and 1.3 %, respectively (p = 0.926). Complete pathological response of III degree in the groups achieved 22.5 % and 19 %, respectively (p = 0.593), grade IV – 18.3 % and 15.2 %, respectively (p = 0.829). In the main and control groups, 4.2 % and 3.8 % of local recurrence were registered, respectively (p = 0.954; hazard ratio (HR) 1.05; 95 % confidence interval (CI) 0.21–5.22). The median time of disease-free survival was 39.4 months. The three-year disease-free survival in the main group was 73.2 % and in the control group 64.6 %, respectively (p = 0.353; HR 0.79; 95 % CI 0.42–1.35). The three-year overall survival in the main and control groups were 84.5 % and 82.3 %, respectively (p = 0.743; HR 0.87; 95 % CI 0.39–1.92).

Conclusions. The hypofractionation schedule can be considered as an alternative and not inferior to the standard dose fractionation regimen in a prolonged course of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. 

Objective: to assess the potential need for telehealth consultations in regions for the treatment of patients diagnosed with anal cancer and to analyze the most common treatment errors.

Materials and methods. We analyzed telehealth consultations provided for 3 Federal districts between April 2019 and April 2020. The following parameters were evaluated: the ratio between the predicted need for telehealth consultations and the real number of requests, the number of medical errors in patients who had already undergone first and / or subsequent treatment stages (according to relevant clinical guidelines).

Results. Fifteen telehealth consultations were provided during this year: 13 of them (86.7 %) for disease progression or complications and 2  of them (13.3 %) to determine the initial treatment strategy. Treatment errors were registered in 11 out of 13 cases (84.6 %). The predicted need based on the population size was 565 consultations per year; the predicted need based on the real number of patients visited cancer clinics was 81 consultations.

Conclusions. We found many significant errors in treatment regimens of patients with squamous cell anal carcinoma. Wider use of telehealth consultations with Federal centers will ensure the correct choice of the initial treatment strategy. 

Objective: to evaluate short-term and long-term outcomes of surgical treatment for colorectal cancer metastases to the lungs and to analyze factors affecting the efficacy of surgery.

Materials and methods. This study included 211 patients with colorectal cancer metastases to the lungs treated between 1994 and 2014. We enrolled patients with resectable or conventionally resectable metastases (according to chest computed tomography evaluated by a thoracic surgeon); the exclusion criteria were as follows: multiple primary tumors and age more than 85 years. We assessed the type of surgeries, frequency of R0 resections, incidence of postoperative complications, overall survival, and progression-free survival.

Results. One hundred and sixty-two patients out of 211 (76.8 %) have undergone atypical lung resection. Forty-nine patients (23.2 %) have undergone pneumonectomy, bilobectomy, or lobectomy. The majority of patients (96.2 %) have had R0 resection, whereas 2.9 % of study participants have had R1 or R2 resections. One patient has undergone a trial surgery. Clinically significant postoperative complications were observed in 4 (2 %) patients; postoperative mortality was 0.5 % (1 case). The five-year overall survival rate was 52.7 %; the 5-year progression-free survival rate was 45.8 %. Development of metastases within 24 months after primary surgery was found to be a significant factor negatively affecting overall survival (hazard ratio 0.347; 95 % confidence interval 0.227–0.53; р <0.0001).

Conclusions. Surgical treatment is currently the only truly effective treatment, which can improve long-term survival of patients with colorectal cancer metastases to the lungs; the best treatment results are achieved in patients with a relapse-free interval of more than 24 months. 

This article discusses the possibility of neoadjuvant chemotherapy without radiotherapy in patients suffering from rectal cancer without mesorectal fascia involvement but with negative prognostic factors. It analyzes possible risks and benefits of such an approach and provides the data of clinical trials available so far.

Gardner’s syndrome is a genetically determined disease characterized by a combination of colon polyposis, osteomas, and various soft tissue tumors. In this article, we discuss disease epidemiology, etiology, manifestations, and treatment methods. We also report a case of Gardner’s syndrome.

Primary rectal melanoma is a rare malignant tumor with an aggressive course and poor prognosis. The article describes a clinical observation demonstrating the successful comprehensive treatment of primary rectal melanoma. A patient with a complicated course of rectal melanoma, stage IV of the first stage was performed by surgical treatment with removal of the external intestine according to the Hartmann type with removal of the uterine appendages from both sides of the en-block, and resection of the left pelvic plexus. In the postoperative period, the patient underwent chemoembolization of the liver with combined immunotherapy. The patient is alive two years after the operation; there is no evidence for local recurrence and progression of the disease.