№83. Практические проблемы современной онкологии в России

Morphological research is the only way to accurately verify the tumor pathology and the characteristics of its histological and genetic profile, necessary to personify the treatment strategy and predict the course of the disease. The review discusses organizational and technical aspects related to the preanalytical stage of working with biomaterial to achieve high-quality and reliable results. In particular, much attention is paid to the effect of cold ischemia on morphological, immunohistochemical and molecular parameters.

Keywords: morphology, cold ischemia, formalin fixation, delay, prognostic and predictive biomarkers, immunohistochemistry, FISH, ISH.

The final goal of creating standard approaches in medicine is to improve the quality of care. This article highlights controversial and unresolved medical and legal issues related to the development of clinical recommendations, as well as their application in real clinical practice.

Keywords: clinical guidelines, standards of care, chemotherapy, oncology.

The article discusses the history of development and the current status of medical care payment methods in various countries. The advantages and disadvantages of each method are discussed, as well as their potential impact on healthcare development. Diagnostic-related groups (DRG) and similar classifications of treatment cases (including Russian clinicalstatistical groups (CSG)) are used in most developed countries to pay for inpatient care, however, the proportion of funds directly received from them in the hospital budget structure is different, and the number modifications is great, which does not allow one to directly extrapolate other’s experience. Most studies show the possibility of optimizing the cost of providing medical care and stimulating the improvement of the quality and efficiency of hospitals after switching to DRG. A prospective assessment and quality control is needed with the widespread introduction of DRG, including an analysis of the effectiveness of the system in various fields of medicine.

Keywords: payment for medical care, diagnostic-related groups (DRG), clinical and statistical groups (CSG), prospective and retrospective payment methods, estimated financing, global budget.

Surgical oncology has undergone a number of tactical changes in the era of the development of drug therapy, but is still the only treatment that can cure most solid forms of cancer. Recently, surgical interventions are increasingly acquiring an individual approach to the patient. Surgical oncology is part of a multifaceted multidisciplinary team with a single philosophy in understanding the biology of tumor development, as well as the contribution of other disciplines to the treatment of cancer patients.

Keywords: surgical oncology, minimally invasive surgery, sentinel node biopsy, cytoreductive surgery, intraoperative chemotherapy, reconstructive surgery.

Innovative diagnostic approaches and modern methods of treatment of malignant tumors have undoubtedly influenced the increase in life expectancy of patients, but so far have not led to the possibility of a complete cure of patients with disseminated forms of tumors. This article highlights the reasons that prevent metastatic and advanced cancer from becoming a curable disease. This publication demonstrates a critical understanding of the possibilities and disadvantages of precision oncology, represents a transitional stage in the current understanding of the place of immunotherapy in the treatment of disseminated patients, updates the place of standard chemotherapy in the era of immunotherapy and targeted therapy, concretizes the possibility of improving the results of treatment of common and metastatic forms of malignancies.

Keywords: precision oncology, effectiveness of immunotherapy of malignant tumors, effectiveness of chemotherapy of malignant tumors, recovery of patients with advanced cancer.

Human papilloma virus (HPV) causes cervical cancer, other anogenital tumors, and oropharyngeal cancer. Carcinogenic to humans are 14 types of HPV. Of these, two types of HPV 16 and HPV 18 account for 70% of cases of cervical cancer, more than 80% for anal cancer, 65% for vaginal cancer and 36% for vulvar cancer. To prevent infection with HPV and, accordingly, tumors caused by HPV, three vaccines have been created and recommended: two-, four- and nine-valent. The efficacy of these vaccines has been proven in randomized clinical trials. Ten years of experience in their application in practice has confirmed their very effectiveness. HPV vaccination is included in 98 countries’ national immunization schedules.

Keywords: vaccination, human papilloma viruses, cervical cancer, anogenital tumors, oropharyngial cancer.

The article analyzes current data on the incidence, various treatment options and prognosis of cervical cancer in combination with HIV-infection. The relationship between the development of cervical cancer and the human immunodeficiency virus has been established. Antiretroviral therapy in patients receiving standard treatments for cervical cancer does not allow them to be carried out in full. This fact, combined with a compromised immune status of patients, leads to a high incidence of tumor progression and relapse.

Keywords: HIV-infection, cervical cancer, immunosuppression.

Objectives: to evaluate the effectiveness of the cytological method in the diagnosis of metastatic lesions of the pancreas.

Material and methods. We analyzed 249 biopsies performed on an outpatient basis over 4 years (2016–2019) at the Petrov National Medical Research Center of Oncology in 242 patients (11 cystic and 231 solid pancreatic tumors). In 139 cases, percutaneous trepan biopsy (TB) was performed by 18G needle under ultrasound control, with collecting material for cytological and histological examination, and in 110 cases – fine needle aspiration biopsy under endosonography (EUS-tab) by EndoFlex and Boston Sientific 22 G needles. Results. Our study presents the results of 249 pancreatic biopsies, from 116 men and 126 women, 15–89 years old (average age 60,5 years). The material for cytological research was found informative in 245 (98,39%) of 249 biopsies. Malignant process in cytological and (or) histological examination was established in 186 (76,86%) of 242 patients. Metastatic lesions of the pancreas were diagnosed in 17 of our patients – this is 7,02% of all pathology and 9,13% of malignant tumors of the pancreas: in 6 patients, the material was obtained using TB, in 11 – using EUS-tab. In 16 of 17 cases with pancreatic metastases, cytological examination correctly established the malignant process, and in 12 cases the nosological form of the tumor was determined. Immunocytochemical examination (ICC) was performed in 9 cases.

Conclusion. Among secondary pancreatic tumors, the most common are metastases of clear-cell renal cell carcinoma, colorectal cancer, and breast cancer. The cytological method, supplemented by the ICC study, is an accurate and safe diagnostic method for metastatic pancreatic lesions.

Keywords: pancreas, metastatic lesions, immunocytochemical examination.