In the absence of a unified approach in numerous recommendations and consensuses for chemoradiotherapy of patients with squamous cell non-metastatic anal canal cancer, medical practitioners need a practical consolidating “tool” combining all information sources, which is the purpose of this article.

Based on international recommendations and consensuses on radiation therapy, the expert group analyzed the data and compiled the most optimal approaches to target volume delineation. This was done based on a balanced analysis of the advantages and disadvantages of the fractionation modes used and the criteria for dose distribution in irradiated apparatus proposed by both other authors and the team of the radiotherapy department of the N. N. Blokhin National Medical Research Center of Oncology. Examples of delineating anatomical structures and target volumes are provided.

Introduction. Pelvic side wall could be involved by tumor or desmoplastic reaction in patients with gynaecological pelvic malignancies and rectal cancer. Up until recently surgery was considered to have no prospects due to high frequency of palliative procedures and low survival rate.

Aim. To conduct a retrospective analysis of short- and long-term results in patients after laterally extended endopelvic resection.

Materials and methods. This study included consecutive patients between 2013 and 2023, who undergone laterally extended endopelvic resection at the Leningrad Regional Oncology Center named by L.D. Roman. Principal data were collected and classified. G. Vizzielli and R. Naik classification formed the grounds for surgery type selection. Procedure was considered to be radical with no signs of macro- and microscopic tumor presence in surgical margins.

Results. Over the 2013 to 2023 period 54 laterally extended endopelvic resections were performed. Of these, 50 (92.6 %) were woman and 4 (7.4 %) men. An R0 resection was performed in 44 (81 %) of 54 cases, postoperative morbidity was 67 % with 5,6 % mortality, and 5-year overall survival of 23 %. 5-year overall survival was reached only in patients with colorectal cancer (44 %) and uterus tumors (40 %). In case of palliative procedures (R1/R2 resection) overall survival was less than 3 years.

Conclusion. Clear resection margin was considered to be the crucial prognostic factor. An improvement of surgical techniques, an exploration of pelvic side wall structures, and sensible patient selection could improve short- and long-term outcomes in this complex group of patients.

Introduction. Stereotactic radiation therapy (SRT) for metastatic brain damage is one of the main methods that contribute to achieving local control (LC) over the metastatic focus. However, despite an extensive number of scientific publications, the most effective and safe treatment regimen, as well as the factors influencing the development of radionecrosis (RN), are still not fully determined.

Aim. To evaluate the toxicity and effectiveness of the SRT course in patients with metastatic brain damage.

Materials and methods. This retrospective single-center study included all patients who underwent SRT for brain metastases from 2020 to 2024. Inclusion criteria: the ability to analyze data from 6-month and 1-year LC. The primary endpoint of the study is the effect of clinical, radiological, radiobiological, and dosimetric parameters on the incidence of RN. Secondary endpoints: RN frequency index, indicators of 6-month and 1-year LC.

Results. 62 patients with a total of 97 metastatic foci were included in the study. According to the results of the study, the development of RN was detected in 12.9 % (n = 8) of patients. When recalculating the RN frequency (n = 8), based on the total number of irradiated foci (n = 97), the RN frequency was 8.2 %. No factors influencing the development of RN have been identified. 6-month and 1-year control over irradiated foci was achieved in 54.8 % (n = 34) and 38.7 % (n = 24) of patients. Similar LC indices, based on the total number of irradiated foci, were 53.6 % (n = 52) and 34 % (n = 33), respectively. According to the results of a single- and multifactorial analysis, systemic therapy after a course of SRT affected the 6-month LC index for irradiated foci (odds ratio 7.53; 95 % confidence interval 2.49–22.7; p < 0.01). This factor also significantly affected the 6-month LC in patients (p = 0.01). The conformity index had a significant effect (p = 0.02) on the same indicator for irradiated foci according to the results of a single-factor analysis, but had no effect when conducting a multifactorial analysis. At the same time, no factors affecting the 1-year LC index were identified for both patients and irradiated foci.

Conclusions. The results obtained reflect the low toxicity of the SRT course with insufficient LC values. In turn, systemic drug therapy can play an important role in achieving control over the irradiated focus. Such data can become the basis for further optimization of the SRT course in patients with brain metastases, as well as for conducting new scientific research in this field of radiation therapy.

Introduction. Cancer of the stomach and cardio-esophageal transition is one of the key causes of mortality from malignant neoplasms in the world. Despite advances in targeted therapy in the treatment of HER2-positive gastric adenocarcinoma, the prognosis for most patients remains poor. The high degree of heterogeneity of the disease, relapse rates and limited treatment efficacy highlight the need to examine factors influencing therapy outcomes and possibility of their accounting in order to perform a personalized treatment.

Aim. To evaluate the factors influencing progression-free survival and overall survival in patients with metastatic HER2-positive gastric cancer and/or cardio-esophageal transition.

Materials and methods. The study included data from patients with metastatic HER2- positive gastric cancer from 5 oncology hospitals who received 1st-line trastuzumab between 2019 and 2024. Statistical analysis was performed using univariate and multivariate analyses to assess the impact of different clinical characteristics on progression-free survival and overall survival.

Results. The study included 117 patients with metastatic gastric cancer who received trastuzumab in the 1st line of therapy. In univariate analysis of patient characteristics, the presence of bone metastases, age over 65 years, presence of ascites, ECOG status 1–2, degree of G3 differentiation, female sex were prognostically significant for progression-free survival and overall survival. As a result of multivariate analysis, age 65 years and older (p = 0.016), female sex (p = 0.003), presence of poorly differentiated tumors (p = 0.021), the presence of metastases in supraclavicular lymph nodes (p = 0.043) were prognosis factors associated with decreased overall survival. And the presence of secondary foci in bones was an independent prognosis factor associated with decrease in PFS according to results of multifactorial analysis (p = 0.043).

Conclusion. Despite the effectiveness of targeted therapies, factors such as age, sex, functional status and metastasis localization have a decisive impact on the disease prognosis. Analysis of larger sample of patients is needed to definitively confirm the findings.

Introduction. The intermediate stage (Barcelona Clinic Liver Cancer, stage B, BCLC B) of hepatocellular carcinoma (HCC) is relevant for study in terms of existing problems associated with the treatment of patients with this type of pathology. The BCLC B subgroup comprises approximately 30 % of patients at the time of diagnosis of HCC. However, liver resection may be a more effective treatment option in a selected group of patients with intermediate stage disease that is not included in current BCLC guidelines.

Aim. Aim of the study is a comparative assessment of the frequency of postoperative complications and mortality in surgical treatment of patients with HCC BCLC A and BCLC B, analysis of risk factors for the development of severe postoperative complications.

Materials and methods. The retrospective analysis included patients who underwent surgery for BCLC A and BCLC B stages of HCC at the N. N. Blokhin National Medical Research Center of Oncology in the period from 2000 to 2022. The main clinical and laboratory data, intraoperative parameters, severity of postoperative complications according to Clavien– Dindo that arose within 30 days after surgery, postoperative mortality, and factors influencing the risk of developing severe postoperative complications were analyzed.

Results. The BCLC A group included 120 patients, the BCLC B group included 110 patients. Six (5.5 %) patients in the BCLC B group had Сhild – Pugh В cirrhosis, and none in BCLC A group. Model for end-stage liver disease index 10–19 was more often observed in the BCLC B group than in BCLC A group (20 (18.2 %) vs 8 (6.7 %), р = 0.009), more patients had bilobar involvement (38 (34.5 %) vs 11 (9.2 %), р < 0.0001). There were no other significant differences between groups. The median duration of surgery was 160 (60–360) min and 200 (70–360) min in BCLC A and BCLC B groups (p = 0.001), the median blood loss was 700 (10–8000) ml and 1000 (5–7500) ml (p = 0.152), postoperative mortality was 3 (2.5 %) and 3 (2.7 %), respectively (p > 0.99). There were also no statistically significant differences in the total number of early postoperative complications: 46 (38.3 %) in the BCLC B group and 22 (29.1 %) in the BCLC A group, p = 0.164. When conducting a multivariate analysis, only the presence of portal hypertension (hazard ratio 10.596, 95 % confidence interval 3.351–33.500, p < 0.0001) was associated with an increased risk of postoperative complications, while when performing sparing liver resection, a decrease was noted (hazard ratio 0.157, 95 % confidence interval 0.040–0.617, p = 0.008).

Conclusion. During the comparative group analysis, the incidence of postoperative complications and mortality did not differ statistically significantly, which may indicate the safety of surgical treatment in the BCLC B group of patients and indicate the possibility of liver resection in the selected group of patients.

Introduction. The appropriateness of liver resection in patients with intermediate stage hepatocellular carcinoma (HCC) according to Barcelona Clinic Liver Cancer (BCLC stage B, BCLC B) is a subject of debate.

Aim. Aim of the study is an analysis of long-term treatment results in patients with HCC BCLC B who underwent liver resection.

Materials and methods. The retrospective analysis included patients with HCC BCLC B who underwent liver resection at the N. N. Blokhin National Medical Research Center of Oncology in the period from 2000 to 2022. The incidence of postoperative complications and mortality, overall survival (OS) and progression-free survival (PFS), as well as factors influencing these indicators, were assessed.

Results. Clinical data from 110 patients were analyzed. The overall incidence of postoperative complications was 29.1 % (n = 32), the incidence of clinically significant complications was 9 % (n = 10), and postoperative mortality was 2.7 % (n = 3). The median follow-up was 36 months. Three-year OS was 57.1 %, median OS was 76.4 months. Three-year PFS was 31.3 %, median PFS was 13.3 months. In a multivariate analysis, a low degree of tumor differentiation was a factor that negatively affected OS (odds ratio 2.323, 95 % confidence interval 1.162–4.644, p = 0.017) and PFS (odds ratio 2.257, 95 % confidence interval 1.304–3.906, p = 0.004).

Conclusion. Liver resection may improve long-term treatment outcomes in a selected group of patients with HCC BCLC B.

Aim. To evaluate the 3-year disease-free survival (DFS) of elderly and senile patients who underwent emergency and planned operations for cancer of the colon left half.

Materials and methods. A retrospective cohort study with pseudorandomization included 514 patients divided into 2 groups. The 1^st group (n = 257) included patients who underwent emergency operations in surgical departments of clinical hospitals in Smolensk during the period from 10.10.2014 to 03.04.2023. Using the pseudorandomization procedure by comparison 1:1 the closest neighbor matching method, the 2nd group (n = 257) was formed from the database maintained prospectively which included patients having been operated routinely during the same period at the Smolensk Regional Oncological Clinical Dispensary. Inclusion criteria: 1) age 70–89 years; 2) patients with stage II–III cancer of the left colon, who underwent emergency surgery for acute obstructive obstruction, and patients with uncomplicated colon cancer having been operated in a planned manner; 3) histological type of tumor – adenocarcinoma. Non-inclusion criteria: 1) uncomplicated stage I colon cancer; 2) stage IV and/or locally advanced process; 3) emergency resection intervention in connection with other urgent complications; 4) non-epithelial malignancy, carcinoid. 3-year DFS was prospectively studied and factors of poor prognosis were identified.

Results. The groups were matched for sex, age, Charlson comorbidity index, cancer location, and stage. The Charlson comorbidity index in both groups was ≥7 in most observations.

Statistically significant differences in 3-year DFS were observed between the 2 study groups (p = 0.0014). The median follow-up in both groups was 30 months. In the subgroup analysis, statistically significant differences in 3-year DFS were found between patients who underwent emergency colonic resection at stage 1 according to the type of Hartmann operation (n = 145) and patients who developed decompression colostomy at the emergency stage, and stage 2, radical, was carried out after their condition was stabilized (n = 112) (p = 0.042). The median DFS for patients with Hartmann surgery was 24 months, patients with decompression colostomy was 28 months. Using a univariate analysis followed by confirmation in a multivariate analysis, factors of negative influence on the 3-year DFS indicators were determined: emergency resection intervention (hazard ratio (HR) 1.58; 95 % confidence interval (CI) 1.18–1.85; p < 0.001); local tumor status T4 (HR 1.22; 95 % CI 1.05–1.41; p < 0.001); step N+ (HR 1.36; 95 % CI 1.07–1.68; p < 0.001); resection R1 (HR 1.42; 95 % CI 1.04–1.51; p = 0.033); lymphovascular and perineural invasion (HR 1.55; 95 % CI 1.39–1.81; p < 0.001).

Conclusion. The 3-year DFS of elderly and senile patients with left-sided localization of colon cancer is affected by surgical tactics, especially in an emergency. In the case of acute obturation obstruction, the formation of decompression colostomy is associated with higher DFS rates comparable to those of elective surgery.

Introduction. Differential diagnosis of indeterminate biliary strictures is necessary for adequate planning of the treatment, which affects prognosis and helps to avoid unnecessary surgical interventions in patients with benign biliary strictures. Despite technological advances, the diagnostic accuracy of methods for the diagnosis of malignant lesions remains insufficient.

Direct visualization of the biliary tree using peroral cholangioscopy may improve the ability to diagnose indeterminate biliary strictures.

Aim. To investigate sensitivity and specificity of peroral cholangioscopy in the diagnosis of indeterminate biliary strictures.

Materials and methods. A retrospective review of the patient database of the N. N. Blokhin National Medical Research Center of Oncology was conducted for the period from January 2022 to May 2024. Twenty-seven patients with indeterminate bile duct strictures were included in the study. After direct visualisation of the bile duct system, macroscopic tissue changes were determined and samples were taken for biopsy with SpyBite (Boston Scientific, USA) forceps.

Results. SpyGlass (Boston Scientific, USA) visual impression accuracy was 87.6 %, sensitivity – 80.0 %, negative predictive value – 88.9 %, specificity and positive predictive value – 94.11 and 88.9 % respectively. SpyBite forceps biopsy results had a specificity and positive predictive value of 100 % but sensitivity and negative predictive value of 54.5 and 76.2 % respectively.

Conclusion. Peroral cholangioscopy is an effective option in the differential diagnosis of indeterminate biliary strictures.