Objective: the comparison of the radiation load to the organs at risk for three modes of radiation treatment of the breast cancer patients.

Materials and methods. The research includes the dosimetric radiation treatment plans for the 20 breast cancer patients with the left-side localization. They all underwent a computed tomography (CT) scan in standard supine position in free-breathing (FB), supine position with active breathing control (ABC) device in deep inspiratory breath hold, and prone position in free-breathing (PP). Three-dimensional treatment plans were made for all 3 CTs. The dose valuations for 3D-planning were carried out for three CT-series. For each mode of radiation the doze-volume parameters of organs at risk were estimated: heart volume exposed to more than 25 Gy (V25 heart), mean dose (Dmean) to the heart and left anterior descending coronary artery (LAD).

Results. For all cases the contoured heart volume varied from 477–1056 cm3, with medium volume 769 cm3. The best marks such as V25 heart, Dmean heart and Dmean LAD, were achieved with on supine position with ABC method (4.25 %, 3.13 Gy, 1.3 Gy, respectively) in comparison with FB (9.49 %, 4.96 Gy, 1.95 Gy, respectively) and PP (12.8 %, 9.06 Gy, 24.18 Gy, respectively) (V25 heart: p = 0.00153; Dmean heart: p = 0,000; Dmean LAD: p = 0.00088), when both the breast and the axillary nodes were included in the volume. The advantage of the dosimetric indexes for FB and ABC did not change while axillary and supraclavicular nodes were added to the radiation volume ABC (V25 heart 3.49 %, Dmean heart 3.07 Gy, Dmean LAD 13.8 Gy) in comparison with FB methods (V25 heart 7.91 %, Dmean heart 4.99 Gy, Dmean LAD 19.89 Gy) (V25 heart: p = 0.00205; Dmean heart: p = 0.004; Dmean LAD: p = 0.03).

Conclusion. Radiation treatment of the breast cancer patients in the position with ABC contributed to the statistically significant reduction of the dosimetric parameters: V25 heart, Dmean heart and Dmean LAD.

Objective: to assess the results of accelerated hypofractionated radiotherapy and to comparatively analyze it with the standard radiotherapy in patients with stages I–IIA breast cancer (BC) after organ-sparing surgery.

Materials and methods. A total of 203 patients with stages I–IIA BC underwent radiotherapy after organ-sparing surgery. A control group of 91 patients received the standard radiotherapy (the single focal dose (SFD) was 2 Gy 5 times a week, 25 fractions; the total focal dose (TFD) was 50 Gy for 5 weeks). A study group of 112 patients had accelerated hypofractionated radiotherapy (SFD 3 Gy 5 times a week, 13 fractions; TFD 39 Gy for 2.3 weeks).

Results. Local recurrences were not detected in any patient after the hypofractionated radiotherapy regimen and were diagnosed in 3.3 % of the patients after the standard regimen. There were no statistically significant differences between the groups in 5-year overall and relapsefree survival rates. Further observation revealed a statistically significant difference in 6-year overall survival rates in the study and control groups: 99.1 and 70.4 %, respectively (p ≤ 0.046). The 6-year relapse-free survival rates in patients who had received the accelerated hypo-fractionated radiotherapy regimen were also significantly higher than in those who had the standard radiotherapy regimen: 97.9 and 71.3 %, respectively (p ≤ 0.043). The rate of post-radiation normal tissue damages after the hypofractionated radiotherapy regimen was significantly lower (15.2 %) than that after the standard regimen (27.5 %). Good and excellent cosmetic results of treatment were achieved in most (95.1 %) patients and did not differ in their frequency after different radiotherapy regimens.

Conclusion. The accelerated hypofractionated radiotherapy regimen showed a high efficiency and a favorable toxicity profile in patients with stages I–IIA BC.

Indications for the conservation of the skin flap over the tumor for potential offset of the operational access in aesthetically acceptable zone in patients with primary nodular breast cancer are discussed in the article. The survey results of 203 patients (T1–2N0–3M0) are analyzed. The study revealed that the risk factors affecting the skin flap involvement are the presence of the skin flattening as well as topographic and anatomical characteristics: tumor < 3 cm, located at a depth of < 0.46 ± 0.2 cm, tumor ≥ 3 cm located at a depth of < 1.66 cm. Based on the data the algorithm for immediate breast reconstruction from aesthetically acceptable zone for surgical oncologist is compiled.

The expression of androgen receptors is maximal in the luminal subtypes of breast cancer (BC) and increases with patient age, except triplenegative cancer cases. In reproductive age and perimenopause, the local hormonal environment of breast tumor is characterized by a 1.3– 2.0-fold predominance of androgens over estrogens (p < 0.05), but in postmenopause it depends on the biological subtype of BC. Only in the reproductive period, local hyperandrogenism is associated with the low expression of androgen receptors. As reproductive function fades away, androgen receptor expression increases and, even in perimenopause, relative hyperandrogenism in the tumor is associated with the high level of their expression. Thus, in addition to the standard immunohistochemical panel, it is also necessary to take into account other determinants of tumor biological behavior and menstrual function in women, in particular the local hormonal status of the tumor in combination with the expression of sex hormones, including androgen receptors, which allows consideration of anti-androgen therapy in treating a certain category of patients with BC.

Breast cancer (BC) is the second most common type of cancer worldwide and affects 1 in 8 women over the course of their lifetime. A personalized approach to treating BC can substantially increase efficiency and consequently maintain the active life of many people. This encourages investigators and physicians to better understand tumor biology in order to make a correct diagnosis, to determine recurrence risk, and to choose adequate therapy. This paper discusses the bases for the molecular classification of BC into its expression subtypes, as well as current prognostic kits that assist oncologists in classifying the subtypes of cancer and in predicting the development of the disease. The existing test systems are not universal, each of them is applicable only to a limited group of patients, but they totally cover a considerable number of cases. The tumor gene mutations in BC, which have been characterized by up-to-date methods, can serve as predictive markers for the efficiency of targeted therapy.

Clinical guidelines of the Russian Society of Oncomammologists for the prevention of breast cancer, differential diagnosis, treatment of precancerous and benign breast diseases

The article discussed the main treatment strategy for patients with platinum-sensitive relapsed the high-grade serous cancer of the ovaries, fallopian tube cancer and primary peritoneal cancer. The commonality of these tumors is caused by the same type of coelomic epithelium of mesodermal origin of the rudiments of Müllerian ducts, as well as similarities in the ways of carcinogenesis: the loss or inactivation of the tumor suppressor TP53, loss of function of proteins BRCA1 and BRCA2 – the controllers of DNA repair and genome integrity. Platinum drugs and PARP inhibitors have priority in treatment – “BRCA-associated” cancers. Maintenance monotherapy with the PARP inhibitor olaparib after platinum prolonged by 7 months progression-free survival. Olaparib will be to benefit patients with a BRCA mutation. Search mutations in the genes BRCA1 and BRCA2 of all high-grade ovarian cancer patients, allow to allocate patients with relapses requiring therapy resumed platinum drugs and continued the PARP inhibitor olaparib. In these cases, Lynparza (olaparib) 400 mg twice daily, as maintenance treatment in patients with platinum-sensitive relapse who had received two or more platinum-based regimens and who had a partial or complete response to their most recent platinum-based regimen and with BRCA-mutation have the greatest likelihood of benefiting from olaparib maintenance treatment.

In this article we analyzed the issues of optimizing the upfront debulking surgery for patients with advanced ovarian cancer. We reviewed the recent evidence highlighting the actual concerns of using neoadjuvant chemotherapy aiming to reduce the tumor burden and enhance the probability of optimal cytoreduction; the rates of complete and optimal cytoreduction. From the up-to-date point of view we designated the pros and cons of upfront and neoadjuvant chemotherapy, the major disadvantages of the only head-to-head comparison study of these approaches. Outlined the role lymphodissection and extended surgery for advanced ovarian cancer, including performance of small and large bowel, liver, spleen, peritoneum and diaphragm resections. We analyzed the existing risk factors of and prognostic models predicting the probability of optimal cytoreduction which allows the oncologists to select patients which will benefit from neoadjuvant chemotherapy and interval cytoreduction.

We analyzed the results of ultrasound and postoperative histological studies of 14 patients with primary diagnosis of gastric cancer who received treatment at the cancer research center in 2014. Metastases to the ovaries detected in all cases with disseminated gastric cancer as the primary diagnosis, and in monitoring the effectiveness of treatment. The most characteristic ultrasound signs of metastatic ovarian tumors. When elastography in all cases, metastatic the affected ovaries were determined in the solid sections of the component of high-density (stiffness), charterhouses type 5 (blue), the average rigidity coefficient was 10.2–32.2. Solid-cystic masses in cases of tumor were mapped to 4 of Krukenberg type (which met as the dense and elastic stretches, charterhouses blue and green colors).

The structure and trend of incidence, geographical prevalence, the comparative analysis and morphology of cancer of uterus, ovaries, vaginas and vulvas among inhabitants of Kabardino-Balkaria during 1990–2014 are presented. Rates of a gain of these new growths considerably exceed the all-Russian indicators especially concerning an endometrium carcinoma, but “rejuvenation” of diseases in Kabardino-Balkaria is not observed. Carcinomas of a body and a neck of a uterus meet among inhabitants of mountainous areas of the region than flat more often. Cancer tumors of endometrium and ovaries affect city dwellers, unlike a uterus neck more. The received results allow revealing actively patients at early stages of diseases, to hold medical examination and preventive events more effectively, to plan rational tactics of treatment of patients.

The clinical case of seldom found pathology – primary cancer of the uterine tube including at the same time both epithelial and sarcomatous component of a tumor is described. Data on a cancer of a uterine tube which, being a rare tumor are submitted, is morphologically similar to an ovary carcinoma. Predictively significant factors for this tumor are the disease stage, volume of residual tumoral masses, SA-125 indicators, and also as those the vascular invasion, degree of a differentiation of a tumor and age of patients are considered. On the basis of our supervision and clinical experience we came to a conclusion that this clinical case emphasizes not specificity of a current and complexity of timely diagnosis of a disease. Thus, an actual task is research of this problem for the purpose of improvement of quality of early diagnosis of primary cancer of uterine tube and use of new modern methods of treatment.