Complete clinical response (determined by palpation, instrumental methods, and macroscopic examination) does not always imply the achievement of pathologic complete response. Correlation coefficient between complete clinical and complete pathologic responses is 0.6–0.7.

 Objective: to choose an optimal method for the assessment of residual tumor that will provide objective information on the efficacy of various neoadjuvant systemic therapy (NST) regimens.

Materials and methods. We investigated trepanobiopsy samples of breast tumors collected prior to NST initiation and tissue samples collected during surgery after NST completion. The following parameters were evaluated: tumor histological type, hormonal receptor status, Ki-67 and HER2 expression, tumor cell density and the dynamics of these parameters in response to NST. Therapeutic pathomorphosis was estimated using ypTNM, Miller–Payne and RCB grading systems.

Results. We observed various changes in the immunophenotypic profiles of the tumors in response to NST: luminal B subtype (HER2–) can become luminal A subtype due to decreased Ki-67 level and triple negative due to the loss of hormone receptors expression; triple negative breast cancer can acquire expression of hormone receptors and become luminal B subtype (HER2–).

Conclusion. Integral assessment of therapeutic pathomorphosis using various grading systems (Miller–Payne, ypTNM and RCB) provides objective information on the residual tumor status. Pathomorphological assessment of residual tumor is an important component in the initial evaluation of various NST regimens efficacy.

During the last years has been a worldwide trend towards rejuvenating breast cancer, and the evolution of reconstructive breast surgery is proceeding at a rapid pace. The surgical method is the primary method in the combined and complex treatment of breast cancer, and radical mastectomy is still the main option for surgical treatment in most Russian clinics. Most women who need a mastectomy prefer a one-stage breast reconstruction, because the woman is quickly rehabilitated psychologically and physically after this operation. Nevertheless, the use of silicone endoprostheses did not solve the problems of breast reconstruction in combined treatment in oncology. The issue remains unresolved of various complications, related not only to infections, but also to the development of capsular contracture after radiotherapy. Many patients with a one-stage breast reconstruction using a silicone endoprostheses lack the volume of their own tissues for reliable shelter of the endoprosthesis. In such cases, synthetic reticulated implants, biological implants or autologous flaps are used to cover and strengthen the lower slope of the reconstructed breast.

Interest in adjuvant endocrine therapy in the treatment of women with breast cancer does not fade for many years. In recent decades, more and more attention has been paid to the role of ovarian suppression. Recent publications and data from international congresses confirm the necessity of prescribing predominantly medicamentous ovarian suppression to women with breast cancer and preserved menstrual function not only as a therapy but also for fertility preservation.

Although metastatic breast cancer remains an incurable disease, significant achievements have been made in this area over the recent years, allowing to convert breast cancer into a chronically controlled disease characterized by a torpid course. Patients with hormone-sensitive HER2-negative cancer are more likely to achieve this relatively favorable clinical outcome. It became possible with the development and implementation of highly effective combination treatment regimens that include recently developed inhibitors of cyclin-dependent kinases (CDK) 4 and 6. This article presents an overview of randomized clinical trials assessing the efficacy and safety of CDK4/6 inhibitors. It is shown that neutropenia is class-specific undesirable effect and characterizes all 3 drugs (palbociclib, ribociclib, abemaciclib); ribociclib therapy, in addition, is associated with hepatoand cardiotoxicity (prolongation of QTc interval); abemaciclib, in addition to neutropenia, is characterized by diarrhea and thromboembolic events.

Endometrial cancer (EC) with an intermediate risk of locoregional recurrence and distant metastases includes stages IAG3 and IBG1–2 endometrial carcinomas. However, researchers often prefer to allocate stage IAG3 EC into a separate group of high-intermediate risk EC. The article analyzes treatment outcomes in 370 patients with stage IAG3 EC.

Objective: to evaluate the effectiveness of various methods and strategies for treatment of stage IAG3 EC.

 Materials and methods. Our retrospective study included patients with stage IAG3 EC registered for treatment in Belarus between 2006 and 2010. Of them, 55 women were diagnosed with stage IAG3 EC without myometrial invasion, whereas 315 women had stage IAG3 EC with myometrial invasion. A total of 151 patients received combined treatment that included surgery and radiotherapy (RT), 3 patients underwent surgical treatment (ST) only (standard hysterectomy with bilateral salpingoophorectomy), 25 patients received RT only and 191 patients had ST, RT, and chemotherapy (CT).

Results and discussion. Among patients without myometrial invasion, the five-year overall, cancer-specific and relapse-free survival rates were 79.7 ± 5.5; 86.6 ± 4.7 and 84.6 ± 5.0 % respectively, whereas in patients with myometrial invasion these rates were 75.6 ± 2.4; 81.3 ± 2.2 and 78.0 ± 2.4 % respectively. In both groups, CT did not improve survival over combined treatment, although in most of the patients relapses manifested as distant metastases. Low survival rates were observed in patients who received RT only. Among various combined treatment strategies, the best results were achieved in regimens that included adjuvant external RT on the pelvic area, but only in patients who did not undergo pelvic lymph node dissection in addition to standard hysterectomy with bilateral salpingoophorectomy.

Conclusions. CT gives no benefits for patients with stage IAG3 EC, although the majority of relapses manifested as distant metastases. Combination of CT and postoperative RT remains one of the best treatment options. In the case of standard hysterectomy with bilateral salpingoophorectomy and without pelvic lymphadenectomy, adjuvant external RT is recommended. Further studies are needed to assess the efficacy of extended surgeries with adjuvant contact RT.

Approximately 528 000 new cases and 266 000 deaths per year are attributed to cervical cancer (CC) worldwide. The implementation of laparoscopic techniques minimized intraand postoperative complications and allowed precise identification the disease stage, which can be used to individualize the treatment of locally advanced CC.

 Objective: to determine the role of laparoscopic staging in the treatment of locally advanced CC.

 Materials and methods. The study included 216 patients with stage IB2–IIIB CC according to the International Federation of Gynecology and Obstetrics staging system for cervical cancer (2011). The main group included 60 patients who underwent laparoscopic staging before treatment initiation; all participants in this group received individual treatment according to the results of laparoscopic staging. Comparison groups comprised patients receiving combined treatment (n = 99) and radical chemoradiotherapy (n = 57).

Results. Mean duration of surgery was 148.67 ± 66.57 min; mean number of lymph nodes removed was 12.83 ± 6.43. After laparoscopic evaluation, the stage of the tumor was corrected in 34 (56.67 %) patients: in 23 cases (38.33 %) the tumor was preoperatively underestimated, in 11 cases (18.33 %) it was overestimated. The diagnostic accuracy of assessing the status of regional lymph nodes using magnetic resonance imaging and ultrasound examination was 60.19 % and 63.16 % respectively.

Conclusion. Laparoscopic staging is an effective and safe method to determine the stage and the extent of the tumor, which allows individualizing the treatment of locally advanced CC.

Pelvic inflammatory diseases as complications of invasive diagnostics and surgical treatment occur often enough in patients with gynecological disorders. The risk of infectious complications is always individual and depends on many factors. The implementation of a personified approach and optimization of antibacterial prophylaxis can decrease the incidence of inflammatory reactions and reduce the risk of infectious complications.

Objective: to estimate the efficacy and tolerability of combiflox (ornidazole 500 mg + ofloxacin 200 mg) in long-term antibiotic prophylaxis after gynecological and oncological surgeries.

 Materials and methods. We assessed the results of a 7-day oral course of combiflox after intravenous intraoperative antibiotic prophylaxis (ciprofloxacin 500 mg + metronidazole 500 mg) in 73 women that underwent gynecological or oncological surgeries. All patients were monitored for postoperative complications, including any wound inflammation, low-grade hyperthermia, symptoms of postoperative vaginitis, endometritis, limited peritonitis, adnexitis.

Results. We found that 43.8 % of patients were at high risk of developing postoperative inflammatory complications; in most of the cases, it was associated with obesity (body mass index >30 kg/m2). Three out of 32 overweight patients (9.3 %) developed postoperative complications, whereas none of the 41 patients with minimal risk factors had such events. No combiflox-related adverse effects were observed during the study. All patients reported good tolerability and high convenience of the drug.

 Conclusion. The need for long-term antibiotic prophylaxis depends on the type of surgery and individual risks for infectious complications. Low-cost oral therapy with combiflox (ornidazole + ofloxacin) during the postoperative period reduces the risk of infectious complications, especially among patients with a body mass index >30 kg/m2, since they are particularly prone to wound complications.

Annually in Russia about 30 000 cases of oncological diseases in young women are diagnosed. The diagnosis of reproductive problems associated with treatment is still little discussed, although the practical recommendations of many professional organizations, including the American Society of Clinical Oncology, underscore the need for mandatory oncologist review of options for maintaining the patient’s fertility. The article analyzes the medical organization when detected in a female patient of childbearing age cancer is to use therapies aimed at subsequent implementation by the patient of her reproductive rights. It is noted that such opportunities are limited to current law, giving the right to persons with cancer at the expense of budget funds to use the methods of assisted reproduction and cryoconservation technologies for maintaining reproductive potential in cancer patients. The article presents evidence of the urgency of introducing changes to the orders of the Ministry of Health of Russia that limit the use of methods of assisted reproductive technologies for cancer patients at the expense of the budget.