Introduction. Breast cancer, which occurs in young women, is more often classified as a biologically aggressive subtype (HER2+ and triple negative) compared with postmenopausal patients. At the same time, it is important to know whether age, in itself, determines a less favorable outcome of the disease in young patients.

Aim. To evaluate overall and recurrence-free survival rates in premenopausal and postmenopausal patients who underwent various levels of surgery and received neoadjuvant and adjuvant systemic therapy.

Materials and methods. Of the 3,450 analyzed patients, the final analysis included 265 patients with breast cancer (clinical stage T1–3N0–1M0) who received treatment between 2011 and 2019, who were divided into 2 groups depending on age category, biological tumor subtype, types of neoadjuvant and adjuvant treatment.

Results. Of 265 included patients, 162 (61.1 %) were premenopausal women, 103 (38.9 %) were postmenopausal women. The median follow-up was 5 years. The 5-year overall survival was 96.8 % (95 % confidence interval (CI) 92.6–98.7) in premenopausal patients and 95.1 % (95 % CI 88.5–97.9) in postmenopausal patients. The differences in overall survival estimated using the likelihood ratio test were not statistically significant (p = 0.927). The 5-year recurrencefree survival rate was 77.6 % (95 % CI 70.3–83.3) in premenopausal patients and 84.2 % (95 % CI 75.6–90.0) in postmenopausal patients. The differences in disease-free survival estimated using the likelihood ratio test were not statistically significant (p = 0.253).

Conclusion. When comparing patients with early breast cancer, overall and relapse-free survival did not depend on menopausal status. It is necessary to conduct randomized trials to determine the effectiveness of drug therapy.

Background. The possibilities of the prepectoral two-stage reconstruction after mastectomy with tissue expanders without using other devices for covering are not clear and sometimes doubtful.

Aim. To analyze the results of the first stage of breast prepectoral reconstruction with tissue expander without using other devices for covering. Namely, the frequency of early complications (seromas, protrusion/extrusion, infection), time for complete implant’s filling.

Materials and methods. Retrospective review of 70 breast cancer patients, who underwent mastectomy with immediate breast reconstruction with textured expanders: 35 in prepectoral position (main group) and 35 in subpectoral position (control group). Inclusion criteria: no possibilities for breast-conserving surgery, indications for two-stage reconstruction and patient’s agreement. Extra criteria for the main group: rather good thickness of subcutaneous fat (PINCH-test ≥1.5 cm), no scars in operation region, good perfusion of flaps after mastectomy. Expansion with saline were in operation room firstly following it each 7–14 days. All expanders have been filled to the moment of direct results were estimated.

Results and conclusion. Prepectoral position of tissue expander without using other devices for covering don’t rise the long-term seroma frequency, necessary time of postoperative drainage and expander loss risk (p ˃0.05). More comfortable and fast expander expansion to required volume in main group was the clear profit (p ≤0.05). Thus, according to our preliminary results prepectoral implantation of tissue expander without using other devices for covering in two-stage breast reconstruction after mastectomy can be the adequate choice in some patients.

Aim. To evaluate the effectiveness of a new method for removing multiple benign breast tumors through a single access with subsequent correction of ptosis using a hemispherical glandular flap in comparison with bilateral sectoral resection of the mammary glands.

Materials and methods. A prospective observational study was conducted involving 154 patients with benign breast tumors who were treated from 2022 to 2024. The patients were divided into two groups depending on the type of surgery performed: group I included 78 women with removal of multiple breast tumors through a single surgical access with subsequent correction of ptosis using a hemispherical glandular flap, group II included 76 patients with bilateral sectoral resection of the mammary glands. A comparative analysis of these types of surgical treatment of benign breast tumors was performed, and the quality of life of the patients before surgery and one year after surgical treatment were assessed.

Results. When comparing the early postoperative period, no significant differences were found between the new method of removing multiple breast tumors through a single surgical access with subsequent correction of ptosis with a hemispherical glandular flap and bilateral resection of the mammary glands in terms of the number of hospital days, pain syndrome and sensitivity of the nipple-areolar complex. Carrying out surgical treatment with one-stage correction of ptosis allowed all patients to achieve a good long-term aesthetic result, avoid asymmetry, gross deformation of the mammary glands, while in group 2, 71 % of patients had aesthetic defects after surgery,  p<0.001. Evaluation of the mental component of quality of life one year after surgery showed a significant advantage of performing surgical treatment in group 1 compared to that in group 2, p < 0.001, which is most likely due to the removal of multiple breast tumors with simultaneous elimination of mammary ptosis, which had a positive effect on the psychoemotional state and quality of life of women.

Conclusion. Our results prove the high efficiency and advantage of a new surgical method for removing multiple benign breast tumors through a single approach with subsequent correction of ptosis with a hemispherical glandular flap in terms of immediate surgical and long-term aesthetic results and improving the quality of life of patients.

Background. Goldilocks mastectomy is an innovative surgical technique developed for patients with breast cancer who are looking for a balance between oncologically safe tumor removal and an optimal final aesthetic result.

Aim. To perform an optimal type of reconstruction in overweight patients with serious comorbidities who have abandoned the standard options for restoring the shape of the breast by preserving a de-epidermized lower flap during mastectomy.

Materials and methods. This study included 22 patients (31 Goldilocks mastectomy) aged 31 to 75 years diagnosed with breast cancer who received treatment from June 2023 to November 2024 at the N.N. Petrov Research Institute of Oncology. The average body mass index was 29.69 ± 3.92 kg/m². Obesity was diagnosed in 86.4 % (19/22) of cases. All patients had 2 or 3 degrees of mammary gland ptosis.

Results. In 59.1 % (13/22) of cases patients underwent unilateral Goldilocks mastectomies, in 40.9 % (9/22) – bilateral operations using this technique. In 16 patients (72.7 %) the nipple-areolar complex was preserved. The overall complication rate was 12.9 % (4/31). The patients noted that the final subjective perception of the treatment results exceeded the expectations of the performed surgical intervention.

Conclusion. Breast reconstruction in overweight patients can be performed in various ways. Based on the experience of the N.N. Petrov Research Institute of Oncology and the results of this study, Goldilocks mastectomy is the best reconstruction option for patients with high body mass index or ptosis of the mammary glands, as well as concomitant diseases. This technique allows the surgeon to remove breast tissue within the anterior and posterior leaves of the superficial fascia, create additional volume using a de-epidermized flap, which preserves oncological safety and improves the aesthetic result.

Background. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors (abemaciclib, palbociclib, ribociclib) plus aromatase inhibitors (AI) are the modern standard-of-care of the first-line treatment of hormone-dependent (HR+) HER2-negative (HER2–) advanced breast cancer (ABC).

Aim. To evaluate the effects of using CDK4/6 inhibitors for treating patients with HR+/HER2– ABC on reducing overall cancer mortality in Russia.

Materials and methods. Proposed mathematical model describes duration of therapy and treatment outcomes for AI alone or in combination with CDK4/6 inhibitors in patients with HR+/HER2– ABC. The model was based on overall survival and progression-free survival data from clinical trials and matching-adjusted indirect comparison. Frequency of drug prescriptions in both current and forecast practices was derived from regional surveys. The model was used to estimate the number of lives saved and healthcare system costs when transitioning from current practice to the forecast one by 2030, considering the number of adult patients with HR+/HER2– ABC, who may start considered therapy annually in Russia.

Results. Annually, up to 10,794 patients with HR+/HER2– ABC in Russia are diagnosed and indicated for first-line therapy using CDK 4/6 inhibitors in combination with AI. However, 30 % of them are prescribed suboptimal AI monotherapy. Expanding CDK4/6 inhibitor usage in combination with AI to 83 % with the increase of using ribociclib and reallocating the prescription of drugs according to the forecast practice may lead to reduction in mortality from malignant neoplasms by 934 cases by 2030. Transitioning to the forecast therapy practice will require a 20 % increase in funding.

Conclusion. The use of CDK4/6 inhibitors in patients with HR+/HER2– ABC has a significant and quantifiable impact on reducing cancer-related mortality in Russia.

Background. Neoadjuvant chemotherapy is an option for the treatment of advanced ovarian cancer. The data about optimal chemotherapy cycles before surgery is contradictory. We conducted a retrospective study to evaluate long-term outcomes following interval and delayed cytoreductive surgeries.

Aim. To compare long-term outcomes following interval and delayed cytoreductive surgeries.

Materials and methods. The study included 115 patients who suffered from advanced ovarian cancer (IIIC–IVB stages) and were operated in Moscow City Oncology Hospital No. 62 after 3–4 (interval cytoreductive surgery; n = 58) or 5–6 cycles (delayed cytoreductive surgery; n = 57) of neoadjuvant chemotherapy between January 2018 and December 2021. The primary endpoint is overall survival; secondary endpoint is disease-free survival.

Results. Median disease-free survival was 18 months in the interval cytoreductive surgery group and 16 months in the delayed cytoreductive surgery group (p >0.05). Median overall survival was 47 months in both groups (p >0.05).

Conclusion. The number of cycles of neoadjuvant chemotherapy did not affect overall and disease-free survival in patients with advanced ovarian cancer.

Background. Malignant neoplasms of the ovaries are the fifth leading cause of death in women in the United States and the eighth in the world. Over the past ten years, both in Russia and in the Tyumen Region, there has been a gradual increase in the incidence of ovarian cancer: the average annual growth rate of standardized incidence rates from 2012 to 2022 in the Russian Federation was 0.03 %, and the overall increase was –2.52 %. Hereditary predisposition associated with the presence of a mutation in the BRCA1/2 genes plays a major role in the occurrence of this malignant disease.

Aim. To evaluate the efficacy and tolerability of maintenance therapy with a PARP inhibitor in patients with high-grade serous and endometrioid ovarian cancer in the Tyumen Region from 2019 to 2023.

Materials and methods. A retrospective statistical analysis of the overall incidence of ovarian malignancies, assessment of 5-year overall survival and progression-free survival in patients receiving a PARP inhibitor and previous platinumbased polychemotherapy was performed.

Results. The total group of examined patients included 79 women, of whom PARP inhibitor as maintenance therapy for primary ovarian cancer was prescribed to 36 observed patients, a separate placebo group was allocated – 27 patients who did not receive targeted therapy after platinum-containing polychemotherapy regimens. In the course of the work, it was found that the use of PARP inhibitor demonstrates better results both in terms of 5-year overall survival (absolute gain was 11.6 %) and progression-free survival (absolute gain – 35.6 %).

Conclusion. Regardless of the volume of cytoreduction and previous treatment regimens, disease progression against the background of taking a PARP inhibitor was observed significantly less frequently than in patients who did not receive targeted therapy: 33.3 % versus 58.6 %.

Aim. To determine the most appropriate strategy for screening and early diagnosis of cervical cancer in the Russian Federation in terms of clinical (diagnostic) and cost-effectiveness.

Materials and methods. To assess the clinical (diagnostic) effectiveness of various screening strategies, a systematic review of publications on studies evaluating the effectiveness of cytological examination and human papillomavirus (HPV) testing for the diagnosis of cervical cancer and its precancerous conditions was conducted. This analysis included publications on the results of studies that assessed the sensitivity and specificity of diagnostic tests used in screening programs. Economic evaluation of the use of various screening strategies was carried out using a mathematical model. The analysis is based on the Markov model of the natural development of oncogenic HPV infection in the absence of screening. Mathematical modeling was performed for a cohort of patients aged 30–64 years inclusive, who have not undergone hysterectomy and who initially have no symptoms of cervical cancer. Clinical and economic analysis was performed from the perspective of the Moscow healthcare system and taking into account the time horizon of 40 years. In a cost-effectiveness analysis, the costs and effectiveness of three screening strategies: conventional cytology followed by triage (p16 and Ki-67 expression detection, CINtec® technology); HPV testing (Cobas HPV®) followed by CINtec® triage and conventional cytology; co-testing – conventional cytology + HPV testing (Cobas HPV®) followed by CINtec® triage, were compared with a strategy of using conventional cytology alone.

Results. The article presents the results of the evaluation of the clinical (diagnostic) efficiency of HPV testing compared with cytological studies, traditional cytological study compared with other diagnostic methods, HPV testing compared with other diagnostic methods, co-testing compared with cytological study only and the use of new biomarkers for the diagnosis of cervical neoplasia, including biomarkers for the detection of p16 and Ki-67 expression. Also, the analysis of cervical cancer screening programs in foreign countries, the efficiency of organized screening programs and the analysis of the cost-effectiveness of various screening strategies in Moscow are conducted. It has been established that there is no single model of cervical cancer screening in the world that would be suitable for every country. In most countries, there is a clear trend towards the transition from cytological testing to testing based on the detection of HPV DNA in certain age cohorts of women. It is also worth noting that not all developed countries have switched from opportunistic to organized cervical cancer screening. Based on the results of the clinical and economic study, it was determined that all the screening strategies studied are cost-effective, and the “Co-testing” screening strategy is the most effective in terms of reducing the number of cases of cervical cancer and deaths from cervical cancer.

Conclusion. The co-testing strategy, including the use of a biomarker to detect the expression of p16 and Ki-67, should be considered as the main one for conducting screening and early diagnosis programs for cervical cancer in the Russian Federation.

Background. The incidence of recurrent cervical dysplasia and early-stage cervical cancer varies between 2 % and 34 % depending on risk factors; thus, treatment and prevention strategies should be chosen individually. Constantly high incidence of cervical cancer and its recurrence necessitates improved preventive measures.

Aim. To identify predictors of intracervical recurrence of high-grade squamous intraepithelial lesion (HSIL) and earlystage cervical cancer using multivariate analysis in order to improve treatment strategies for newly diagnosed HSIL patients and patients with recurrent HSIL.

Materials and methods. This retrospective multicenter study included 322 patients newly diagnosed with HSIL (n = 300) and early-stage cervical cancer (n = 22), as well as patients with recurrent HSIL. The study was conducted at E.N. Meshalkin National Medical Research Center, Novosibirsk Regional Clinical Oncology Dispensary, Federal Research and Clinical Center for Specialized Medical Care and Medical Technologies of Federal Biomedical Agency of the Russian Federation, Siberian Center of Oncology and Gynecology “AvisMed” LLC, and “Zdorovye” LLC between 2011 and 2924.

All new patients with HSIL or cervical cancer in situ underwent loop radio-wave excision (conization) of the cervix and endocervical curettage. All patients were followed up after this procedure.

After histological examination patients tested positive for human papillomavirus (HPV) with a high recurrence risk were recommended antiviral therapy. Patients were divided into four groups according to the type of their treatment: 1) radio-wave conization of the cervix alone (control group); 2) radio-wave conization of the cervix in combination with laser photodynamic therapy of the cervix; 3) radio-wave conization of the cervix in combination with HPV quadrivalent vaccine; 4) radio-wave conization of the cervix in combination with Cervicon-DIM therapy. Patients with recurrent HSIL also had immunohistochemical or immunocytochemical assessment of p16 and Ki-67 coexpression.

Conclusion. Our study demonstrated the importance of identifying risk factors for recurrence and assessment of p16 and Ki-67 expression. The most significant risk factors included age over 36 years, positive resection margin, and involvement of endocervical crypts. Combination therapy with cervical conization plus local antiviral therapy with Cervicon-DIM was found to be most effective. Endocervical curettage using an endocervical resector can be used for the early diagnosis of HSIL and early-stage cervical cancer.

Background. Currently, women over 65 years of age comprise a quarter of endometrial cancer (EC) patients, but this population remains underrepresented in clinical trials. The combination therapy with lenvatinib plus pembrolizumab has demonstrated a significant improvement in progression-free survival and overall survival in patients with mismatch repair system proficiency (pMMR/MSS) after a single prior treatment line. However, data on the efficacy and safety of this regimen in real-world clinical practice, especially in elderly patients, are limited.

Aim. To describe the efficacy and safety of EC therapy with lenvatinib and pembrolizumab in elderly patients.

Materials and methods. In this retrospective single-center study conducted at a Moscow hospital (December 2020 – March 2024), we collected data on the efficacy and safety of lenvatinib and pembrolizumab therapy in 26 patients over 65 years of age. Patients with pathologically confirmed EC without evidence of microsatellite instability were included. The primary endpoint of the study was progression-free survival; additionally, we evaluated the clinical characteristics of the patients, analyzed the objective response rate and the incidence of adverse events.

Results. The median age was 69 (65–81) years, 23 % of patients were older than 75 years. The performance status of 92.3 % of patients was classified as ECOG 0–1, endometrial adenocarcinoma was the most frequently detected type (61.5 % of cases), serous carcinoma was reported in 10 (38.5 %) patients. The median number of prior treatment lines was 3 (2–6). The objective response rate reached 25 %, and the disease control rate was 75 %. The median progression-free survival was 5.67 (1.4–35.3) months. Adverse events of any grade were noted in 24 (92.3 %) patients. Lenvatinib dose reduction was performed in 76.9 % of cases. The most frequent adverse events were arterial hypertension (in 16 (61.5 %) patients), fatigue (in 5 (19.2 %) patients), and diarrhea (in 3 (11.5 %) patients).

Conclusion. In this real-world clinical practice study in Russia involving patients with recurrent and metastatic EC without mismatch repair system deficiency (pMMR/MSS) over 65 years of age who received lenvatinib plus pembrolizumab, the efficacy and safety of the treatment were comparable to those reported in earlier studies, suggesting the feasibility of combination therapy in this population with appropriate attention to performance status and management of adverse events. Additional studies are required to evaluate the efficacy and safety of the combination therapy of lenvatinib and pembrolizumab in patients with a more severe functional status.

The article presents a rare observation of the treatment of intravascular tumor thrombosis of low-grade endometrial stromal uterine sarcoma, which was carried out at the A.S. Loginov Moscow Clinical Scientific Center. A review of the literature on uterine sarcomas is presented. The patient’s computed tomography scans are demonstrated, the stages of a complex operation are documented, which involved the removal of not only the main tumor focus, but also a tumor thrombus from the inferior vena cava, resection of the inferior vena cava, and iliac veins. Photographs with a description of morphological tumor specimens and data on the clinical course and treatment results of a patient with intravascular tumor thrombosis of low-grade endometrial stromal uterine sarcoma are presented.

The combination of lenvatinib and pembrolizumab has emerged as the first non-chemo treatment for advanced endometrial cancer, particularly in cases refractory to standard therapies. This case describes the efficacy and safety of the combination of lenvatinib and pembrolizumab in the treatment of a 62-year-old patient with endometrioid adenocarcinoma who received first-line therapy with the combination of lenvatinib and pembrolizumab in the absence of repair system deficiency after adjuvant therapy. This combination offers the potential to extend survival in patients with mismatch repair proficient endometrial cancer who have received systemic neoadjuvant or adjuvant therapy.