Surgical treatment remains one of the leading methods in the treatment of breast cancer. Every year, the number of breast reconstruction operations is steadily increasing. But the number of possible complications associated with performing such operations also increases. Breast reconstruction using an expander may be one of the acceptable options for patients who are planning radiation therapy. The article analyzes the results of two-stage reconstructive plastic surgery on the breast in the complex treatment of patients diagnosed with breast cancer. In 90.5 % of cases, a good cosmetic result was obtained. The risk of losing the implant after chemotherapy was 4.8 % and 13.9 % for chemotherapy combined with radiation therapy, respectively. Two-stage breast reconstruction can be used with careful selection of patients.

Background. Neoadjuvant chemotherapy (NACT) is an important stage in the treatment of patients with breast cancer. Positron emission tomography/computed tomography (PET/СT) with fluorodeoxyglucose labeled with ¹⁸F (¹⁸F-FDG) is widely used as an effective method of metabolic tumor imaging at the stages of treatment. The aim of this study was to evaluate the possibility of using PET/CT with ¹⁸F-FDG to determine the early tumor response to NACT.

Materials and methods. The results of PET/CT with ¹⁸F-FDG in 27 patients with breast cancer were retrospectively analyzed. The study was performed before the start of NACT, after the 2^nd cycle of chemotherapy and after completion of all courses, the maximum accumulation of ¹⁸F-FDG in the tumor tissue (SUV_max), as well as the dynamics of changes in SUV_max after NACT (SUV(%)) were assessed. According to the results of postoperative morphological examination, the patients were divided into two groups: with complete tumor regression (pCR) and with no complete tumor regression (non-pCR).

Results. The results of the study showed that the SUV(%) between the primary and interim examination, as well as between the intermediate and preoperative PET/CT scans, was 66.6 ± 13.3 % and 31.6 ± 17.5 %, respectively. The dynamics of SUV(%) between the primary and intermediate scans in the pCR and non-pCR groups was 79.04 ± 4.1 % and 63.8 ± 13.1 %, respectively (p = 0.02). The SUV_max value in the pCR and non-pCR groups during the primary PET/CT scan was 8.5 ± 0.78 and 8.2 ± 0.78, respectively (p = 0.5), while the intermediate scan was 1.8 ± 0.35 and 3.0 ± 0.14 (p = 0.03). Based on the research results, an ROC analysis was carried out, which showed that the optimal value of SUV(%) is 73.55 %, which showed the highest sensitivity and specificity.

Discussion. Given that the change in SUV_max between primary and intermediate PET/CT was more pronounced than between intermediate and preoperative scans, it can be assumed that metabolic changes in the background of NACT are observed already in the early stages of treatment and persist until the end of therapy, thus, the ineffectiveness of the chemotherapy regimen can be determined using an intermediate PET/CT scan and a timely change in the treatment plan.

Conclusions. We consider 73.55 % to be the optimal value of SUV(%) for intermediate PET/CT scanning; for this indicator and above, it is expected to expect a complete morphological response of the tumor to NACT. We believe that PET/CT with ¹⁸F-FDG at an intermediate stage of observation during NACT is a valuable method for predicting early tumor response to therapy.

Background. Breast cancer (BC) refers to multifactorial polygenic diseases that occur as a result of the combined interaction of genetic and environmental factors. Glutathione-mediated detoxification is of key importance in ensuring the resistance of body cells to the damaging effect of xenobiotics.

Objective: to study the prevalence of deletion polymorphisms of the GSTM1 and GSTT1 genes and to establish their influence on the formation of cancer risk in patients with BC in the Primorye region (Russia).

Materials and methods. The study involved 176 women with BC, aged 23 to 79 years (mean age 48 ± 13 years) and 66 conditionally healthy individuals without cancer. The detection of deletion (null) genotypes of the GSTM1 and GSTT1 was carried out using multiplex PCR followed by analysis of the melting curves of the reaction products.

Results. The frequency of GSTT1-0 genotype among BC patients was higher than in the control group (14.77 % versus 6.06 %), significantly exceeding the indicators in the control group by more than 2.5 times (p <0.1), indicating an association between the carriage of the GSTT1-0 genotype and the risk of developing BC. At the same time, the frequencies of the GSTM1-0 genotype in the study groups were comparable; no statistically significant association with the risk of developing BC was found.

Conclusions. Homozygous deletion of GSTT1 (GSTT1-0) can potentially be considered as a low-penetrant risk factor for developing BC in the population of Primorye region.

Objective: to perform a retrospective analysis of the quality of mammography screening in Khanty-Mansiysk State Region – Yugra from its beginning to 2018 inclusive.

Materials and methods. During this investigation a throughout analysis of epidemiological indicators (breast cancer mortality and morbidity), quality indicators (coverage of the target population, cancer detection in general and early detection, sensitivity and morbidity) and mammographic screening performance indicators (projected and observed morbidity and mortality) was carried out.

Results and conclusions. During this period, 572,348 women were screened, 9.7 % of whom were recommended for further screening. The coverage of the target population for one round was 33 %. Screening test sensitivity for the specified period was 80 %. The observed number of women with newly detected breast cancer cases of stage I in 2018 made 42 % (53 cases) higher in comparison with expected numbers, and in stage T2+ it made 21 % (62 cases) less. The observed number of deaths in 2018 was 23.7 % lower than expected. The above-mentioned demonstrates once again that mammography screening in Khanty-Mansiysk State Region – Yugra has led to the improvement of early diagnosis of breast cancer. This, in turn, leads to a steady decline in breast cancer mortality among women over 40 years of age.

The emergence of a new class of drugs – inhibitors of cyclin-dependent kinases 4/6 (CDK4/6) – has changed the paradigm of treatment of patients with luminal HER2 negative metastatic breast cancer. Their effectiveness is confirmed not only by randomized, but also observational studies on a wide heterogeneous population of patients from daily clinical practice; the use of these drugs in the 1^st line is significantly expanding in the world. On the territory of the Russian Federation, an observational study of Prometheus was carried out, the purpose of which was to assess the frequency of prescribing CDK4/6 inhibitors, as well as other types of treatment in 1–2^nd lines in real clinical practice in Russia, as well as factors and preferences of doctors influencing the choice of therapy. A survey of the target audience, whose answers can be considered reliable and reflecting today’s Russian clinical practice in the treatment of breast cancer, showed that, despite the fact that the overwhelming majority of doctors (78 %) believe that the maximum benefit from the appointment of CDK4/6 inhibitors is expected for the 1^st line therapy, in real clinical practice, only 35 % of doctors practice 1 st line prescription. In the 2nd line of therapy, CDK4/6 inhibitors are prescribed by 45 % of experts, in the 3^rd (or more) line – 20 %. According to the respondents, the main obstacle to the appointment of CDK4/6 inhibitors is the unresolved issues of the availability of therapy (44 %) and its cost (34 %). Among all the proposed clinical criteria, only the criterion “visceral metastases with impaired function of internal organs” influences the decision not to prescribe a combination of hormonal therapy and a CDK4/6 inhibitor in 1–2^nd lines of therapy. Criteria such as ECOG status, menopause status, tumor subtype preceding chemotherapy, timing of progression do not determine the choice when deciding not to prescribe combination therapy.

HER2-positive breast cancer is a unique subtype of the disease, not only in terms of aggressive biology, but also in terms of treatment options. Over the past 15 years, the strategy for treating early HER2-positive breast cancer has undergone a real evolution – from the absence of anti-HER2 therapy to the sequential introduction of adjuvant, neoadjuvant and post neoadjuvant approaches. This review describes key studies of systemic therapy for HER2-positive breast cancer stage I–III, which made it possible to establish clear priorities in the sequence of surgical and systemic steps, identify high risk groups which need of escalation of treatment, and determine the optimal anti-HER2 therapy for each steps, as well as de-escalation of stage I treatment without losing its effectiveness. The news from the latest cancer conferences (SABCS, ESMO, ASCO) on the impact of various biological markers on the effectiveness of anti-HER2 agents is presented. A clear concept of modern treatment of early HER2-positive breast cancer has been formed, allowing individualized approaches, and achieving better results of the therapy this aggressive biological subtype.

Objective: to compare cosmetic result of two techniques of boost delivery to the tumor bed after breast concerving treatment.

Materials and methods. A retrospective analysis of the results of treatment of patients with stage IA–IIIA breast cancer from three groups was carried out: 1) 45 women received tumor bed boost with interstitial brachytherapy; 2) 48 women with electrons (energies from 6 to 18 MeV); 3) 59 women did not receive additional irradiation of the removed tumor bed. The analysis of the cosmetic results of treatment was carried out using subjective and objective methods using mammographic data, including information about the most common complications from the skin, subcutaneous fat and remaining breast tissue, such as telangiectasias, fibrosis, and fatty necrosis.

Results. According to the results of self-assessment by patients and assessment by independent expert (oncologist), carried out on a 4-point Harvard scale, the cosmetic result in most cases was characterized as “excellent” or “good”. Frequency and grade of telangiectasia were used for objective evaluation of skin complications and were similar in all 3 groups. The incidence of localized fibrosis also did not differ and was most often observed as absent or moderate (grade 1–2). There were no significant differences between the severity and incidence of fatty necrosis on both physical examinations and when it was evaluated on mammography.

Conclusions. additional irradiation of the tumor bed does not compromise cosmetic result of the treatment. In most cases (57–78 %) estimated as “good” and “excellent”. The cosmetic result of the treatment does not depend on the technology of boost delivery.

Gestational trophoblastic disease is a rare tumor highly sensitive to systemic drug therapy. The standard regimens of chemotherapy of I and II lines for patients in the high-risk group for gestational trophoblastic disease are the EMA-CO, EMA-EP and TP/TE regimens, which have been demonstrated to be effective and require adherence to drug doses and intervals of administration. If these criteria are not met, the risk of developing resistance with an unfavorable outcome for patients is extremely high. The situation is extremely difficult when a patient has an absolute allergic intolerance to one of the components of standard regimens, which is presented in a clinical case.

Uterine cancer is one of the few cancers with an increasing incidence and mortality rate in developed countries, which partly reflects the increasing prevalence of obesity and aging of the female population. Despite the fact that uterine cancer is usually diagnosed when lesions have affected only the uterine body, searching for new treatment regimens for advanced disease remains highly relevant due to unsatisfactory results of chemotherapy and high mortality among women with stage III–IV uterine cancer.
In this article, we discuss the main aspects of using lenvatinib and pembrolizumab that have been approved by the US Food and Drug Administration (FDA), Australian Therapeutic Goods Administration (TGA), and Ministry of Health of Canada (HC). The lenvatinib + pembrolizumab scheme showed its efficacy (38.3 % objective responses) and safety (grade III and IV adverse events were reported in 83 (66.9%) of 124 patients) in 94 patients with advanced endometrial cancer whose tumors did not show signs of microsatellite instability (MSI) and defective DNA mismatch repair system. In 25 (69 %) patients who responded to treatment, the time to response was more than 6 months. In this article, we also report a case of progressive uterine cancer in a patient, who benefited from therapy with the combination of lenvatinib and pembrolizumab. We also describe adverse events of such therapy and ways of their management.