The leading position among cancer in women is breast cancer. The work analyzed the results of surgical treatment of 274 women aged 18 to 40 years with various stages of breast malignancy who underwent only a radical mastectomy (n = 141, group I), or a radical mastectomy with a single two-stage mammoplasty (n = 133, group II). The comparison group (n = 40, group III) was composed of healthy women after breast reconstruction based on aesthetic indications. When performing a mastectomy with subsequent one-time reconstruction, 68.4 % of cases achieved an excellent result, in 26.6 % of cases – good, in 4.5 % of cases – satisfactory, in 1.5 % – unsatisfactory. In women of group I, relapses of the disease developed 57.8 % more often, and metastasis – 1.9 times often, than in patients of group II. It was established that one-time reconstruction of the breast has a beneficial effect on the psycho-emotional state of women suffering from breast cancer, without increasing the risk of developing a relapse of the disease. The application of a two-stage technique of breast repair using tissue expanders in most cases allows achieving excellent cosmetic results.

Background. Oncoplastic breast resections with perforator flaps are relatively common now; however, many studies demonstrate contradictory results, especially in terms of long-term outcomes.

Objective: to assess short-term and long-term outcomes of oncoplastic breast resection with defect repair using perforator flaps.

Materials and methods. This study included 62 breast cancer patients who underwent oncoplastic breast resection with defect repair using local perforator flaps, including lateral intercostal artery perforator (LICAP) flaps (40.3 %), lateral thoracic artery perforator (LTAP) (19.4 %), anterior intercostal artery perforator (AICAP) (27.4 %), and medial intercostal artery perforator (MICAP) (12.9 %) flaps. The assessment of oncological, functional, and aesthetic outcomes was performed in patients who were followed-up for at least a year (n = 57). Mean follow-up time was 26.5 months (range: 14–38 months).

Results. The following complications were registered among the patients studied: seroma in the area of excised primary tumor (8.1 %), insufficient blood supply of the flap that caused focal lipofibrosis/liponecrosis (3.2 %), positive resection margin (3.2 %), low position of the submammary fold (11.3 %), locoregional recurrence (0 %), generalized process (3.5 %). All women evaluated their functional and aesthetic result as good or excellent. According to BCCT.core 3.0, 91.3 % of patients achieved good and excellent results.

The purpose of the study was to mine, compile and analyze the published data on breast cancer (BC) systematization, diagnosis and treatment. In the current review, modern approaches in BC subtypes diagnosis based on genomic profiling, miRNA expression pattern analysis, SNP analysis in BRCA1 and BRCA2 genes, as well as proteomic mapping as essential components of the disease peculiarities improving the prognostic outcome were compiled and analyzed. Further, tumor-initiating stem-like cells as a factor affecting both prognosis and treatment choice for BC are considered and evaluated. And finally, modern principles of enhancing tumor sensitivity to therapeutic effects of anticancer drugs, which comprise the use of cytostatics in condensed modes, combining drugs, which exert different mechanisms of cytotoxicity, as well as the introduction of new chemotherapy drugs into therapeutic practice, including those targeted against the common metabolic pathways both in stem-like and committed breast cancer cells, are compiled and discussed. The analysis indicates that the current paradigm in BC treatment is development and implementation of the newest methods for diagnosis of BC sybtypes, which, being combined with those already implemented, would allow the administration of treatment according to the individual peculiarities of a tumor.

The present review shows a modern view on ultrasound differential diagnosis of hyperechoic benign breast lesions. The main ultrasound semiotic signs of the most common focal benign structures are noted, in comparison with the data of histopathological analysis.

Malignant breast tumors in men are quite rare and require deeper investigation. Men are 100 times less likely to develop breast cancer than women. However, its incidence among men has grown over the last few years. In this article, we describe own observations of breast cancer in males and report a case of ст1сN0M0 stage 1A cancer of the left breast in a man and provide the details of clinical and morphological disease characteristics, tumor immunohistochemistry, and treatment outcome.

PARP inhibitors. However, in clinical practice, despite the proven antitumor efficacy of drugs, acquired resistance to PARP inhibitors leads to difficulties in selecting further therapy due unknown resistance mechanisms and absence of algorithm of action. Despite the various mechanisms of resistance to PARP inhibitors, the choice of subsequent combination therapy after the detection of resistance to PARP inhibitors should be based on an understanding of these mechanisms and the existence of heterogeneous metastatic process. At the same time, it is very important to study the molecular and genetic characteristics of the disease at each stage of progression, which will help to identify the cause of resistance and select the optimal treatment strategy. It seems that liquid biopsy of circulating tumor DNA, detection of circulating tumor cells, circulating microRNA or exosomes may be more suitable methods of molecular diagnostics than repeated biopsies. Currently, there are data on the identification of two types of resistance to PARP inhibitors: mechanisms independent and dependent on the BRCA1/2 gene and homologous DNA recombination repair (HRR) mechanisms. Strategies for using combinations of different therapeutic regimens in conjunction with PARP inhibitors are very promising options for preventing treatment resistance in view of the increasing number of patients with similar clinical course of the disease.

In the presented clinical case, BRCA1-associated triple-negative breast cancer demonstrates an aggressive clinical course in case of adjuvant chemotherapy absence. Using the example of a clinical case, the effectiveness of therapy with the PARP inhibitor olaparib in disseminated BRCA1-mutated breast cancer, including those with brain metastases, was confirmed. At the same time, against the background of good tolerance and сlinical efficacy especially in the case of brain metastases, the use of the PARP inhibitor olaparib is a worthy alternative to chemotherapeutic regimens. The selection of subsequent therapy after a PARP inhibitor requires a balanced approach, taking into account the possible causes of crossresistance with chemotherapy regimens.

Background. The increasing incidence of cervical cancer in Irkutsk region causes a growing workload for healthcare institutions of all levels. Therefore, we considered it necessary to analyze the quality of cancer care in Irkutsk region and its administrative center (Irkutsk city).

Objective: to analyze the epidemiological situation of cervical cancer in Irkutsk region and Irkutsk city with the consideration of COVID-19 impact.

Materials and methods. We used annual forms of federal statistical surveillance No. 7 “Information on malignant tumors” and No. 35 “Information on patients with malignant tumors” for Irkutsk region and Irkutsk city, as well as the information from the Federal State Statistics Service of the Russian Federation on the age-sex structure of population for 2010–2020. All calculations were performed in accordance with the methodological recommendations of P.A. Herzen Moscow Oncology Research Institute. Results. A total of 4,190 women were diagnosed with cervical cancer in Irkutsk region in 2010–2020; of them, 780 were from Irkutsk. We observed a 3.5 % and a 25 % decrease in the absolute number of new cases in Irkutsk region and Irkutsk city, respectively. Such a difference between the region and the city can be explained by a stricter adherence to the measures aimed at prevention of new coronavirus infection with suspended screening of certain groups of the adult population, as well as infection of healthcare professionals and their mobilization to COVID-19 hospitals, which had a negative impact on cancer care and, first of all, primary diagnostics of cervical cancer. There was an increase in the incidence of cervical cancer before the pandemic in both Irkutsk region and Irkutsk city up to 2019. The effectiveness of early diagnosis (active and early detection) increased significantly from 2010 to 2019; however, it became lower in 2020, due to transformation of many inpatient settings into COVID-19 hospitals and restrictive measures for preventive medical examination. Our findings suggest underdiagnosis of diseases during screening: we observed an increasing proportion of patients with late diagnosis (from 47.1 % in 2019 to 53.8 % in 2020), and, as a result, an increase in one-year mortality (from 16.9 to 17.9 %).

Conclusion. Preventive measures for COVID-19 had a negative impact on the epidemiological situation of cancer in Irkutsk region in 2020 and worsened the quality of cancer care.

Objective: to elaborate a new algorithm, based on serum CA125, HE4 and age, to assess the risk of malignancy in premenopausal patients with pelvic mass, which performs better than Risk of Ovarian Malignancy Algorithm (ROMA).

Materials and methods. The training dataset included 284 premenopausal patients operated because of the presence of pelvic mass, out of which there were 249 patients with benign diseases and 35 patients with malignant or borderline tumors. A novel algorithm, based on serum HE4, CA125 and patient’s age as variables, has been developed. This algorithm was named Risk of Ovarian Cancer Kazan Index (ROCK-I). The validating dataset consisted of 227 consecutively operated premenopausal patients with pelvic mass out of which there were 193 cases of benign diseases, 27 cancers and 7 borderline ovarian tumors (BOT).

Results. In the validating dataset ROCK-I and ROMA demonstrated 15 and 30 false positive results respectively. Thus the specificities of ROCK-I and ROMA were 92.2 % and 84.5 %, respectively (р = 0.017). The sensitivities of ROCK-I and ROMA for the joint group of Epithelial ovarian cancers (EOC) (all stages) together with BOT stage IC2–III were 96.3 % and 92.6 %, respectively (p = 0.55). For all malignant disease (all stages) together with BOT stage IC2–III the sensitivities were 90 % and 86.7 %, respectively (p = 0.69). The positive predictive values of ROCK-I and ROMA were 65.1 % and 47.4 %, respectively (p = 0.07). When the scenario of discrimination “benign disease vs the joint group of EOC (all stages) together with BOT stage IC2–III” was used, ROC-AUC of ROCK-I, ROMA and CA125 were 0.988, 0.946 and 0.937. The difference in ROC-AUC between ROCK-I and CA125 was statistically significant (p = 0.01) while the difference between ROMA and CA125 was not (p = 0.79).

Conclusion. The proposed ROCK-I has demonstrated greater diagnostic performance than both ROMA and CA125 in the analyzed dataset. If an independent validation shows similar or even slightly lower superiority of ROCK-I over ROMA, it may provide a new basis of routine-use of HE4 in premenopausal patients with pelvic mass.

Endometrial cancer is the most common gynecologic malignancy in Russia. Surgery and/or chemoand radiotherapy remain standard clinical approach. This review describes multidisciplinary approach as the state of the art in the disease management. We notice the importance of molecular assessment for driving the clinic decision and newly emerging medical treatments, such as immunotherapy and antiangiogenic tyrosine kinase inhibitors and immunotherapy combinations.

Cervical cancer (CC) occupies the fifth place in the structure of female oncopathology (n Russia. The share of CC is 5.2 % among all oncological diseases. iin Russia, 6.392 women died of CC in 2018. And the mortality rate from this disease is growing every year. In recent years, there has been an increase in the mortality rate among women aged 35 to 59 years at the age of the greatest social activity. The problem of etiology, pathogenesis and diagnosis of the disease remains relevant, despite the active development of medical science. The main cause of CC is considered to be the human papillomavirus of oncogenic genotypes. At the same time, even the active introduction of vaccination does not lead to a decrease in the rate of increase in morbidity and mortality from CC. At the same time, it is known that risk factors for the occurrence of the disease are early onset of sexual activity, frequent change of sexual partners, rejection of barrier methods of contraception, smoking, immunosuppression. Currently, the issue of the influence of sexually transmitted infections on the occurrence of CC has not been fully studied. We wondered what etiological factors have been most studied and reliably influence the occurrence of the disease, what preventive measures can help in this. We assume that only an integrated approach (lifestyle changes, vaccination, preventive medical examinations) can help defeat CC. The article discusses the key causes of the disease, the history of the study of the etiology of CC, the current state of the problem.

The incidence of uterine cancer in Russia increased by 28.8 % over the last 10 years. This trend is partly associated with an increasing prevalence of overweight and aging of the female population. Despite the fact that uterine cancer is limited to the uterine body in 84 % of cases, searching for new treatment regimens for patients with progressive disease is still relevant because of their poor outcomes of chemotherapy and high mortality among patients with stage III– IV cancer.

The aim of this study was to present our own view on the effectiveness of lenvatinib + pembrolizumab in patients with advanced or recurrent endometrial cancer on the basis of international and own experience.

The international experience with lenvatinib + pembrolizumab for advanced endometrial cancer without high microsatellite instability or impairments of DNA repair mechanisms after disease progression following previous systemic therapy showed their efficacy (38.3 %), while the effect lasting more than 6 months was observed in 69 % of cases. We report two cases of progressive uterine cancer in patients who developed complete clinical remission and demonstrated good tolerability of the therapy.