Background. At the moment, in order to increase both local control and relapse-free and overall survival in patients with de novo metastatic breast cancer, in addition to systemic therapy, local methods of therapy are also used, such as radiation therapy to the primary tumor. Radiation therapy can be performed both in the adjuvant and radical regimen. The data about the comparability of effectiveness of radiation and surgical methods of treatment in terms of overall survival are currently contradictory.

Aim. To compare rates of progression-free survival and the frequency of achieving local control of the primary tumor among patients with de novo metastatic breast cancer after a radical course of radiotherapy or surgery followed by adjuvant radiation therapy as part of combined treatment.

Materials and methods. The study cohort comprised 89 patients, from which in 50 (56 %) patients radiation therapy was performed as an adjuvant treatment after surgery on the primary site, and in 39 (44 %) patients, it was performed as a radical treatment. The irradiated volume included the ipsilateral half of the anterior chest wall or the breast, depending on the extent of surgery, and the regional lymphatic drainage zones, if it was clinically indicated, in the first group, and the breast and regional lymph nodes in the second group.

Results. Two-year progression-free survival was 74 % in the adjuvant radiotherapy group and 67 % in the radical radiotherapy group, two-year local control was 100 % and 82 %, respectively. In both subgroups, progression was most frequently detected in patients with luminal B HER2-negative subtype.

Conclusion. Both presented options of radiotherapy showed their effectiveness in terms of achieving local control and progression-free survival. Further research is needed on the role of radiation therapy in the combined treatment of patients with de novo metastatic breast cancer, including search of subgroups of patients for whom radiotherapy in one regimen or another will lead to further improvement in both progression-free survival and overall survival.

Aim. The analysis of the dynamics of breast cancer (BC) incidence and mortality among the female population of the Republic of Dagestan for 2014–2022.

Materials and methods. The study is based on the analysis of statistical data on the incidence of BC among the female population of the Republic of Dagestan for the period from 2014 to 2022. The analysis uses methods of epidemiological, statistical, comparative analysis and graphical interpretation of data.

Results. The average incidence rate of BC over the period from 2014 to 2021 was 17.7 ± 0.3 cases per 100,000 population. The dynamics of incidence over the eight-year period revealed an increase in the discussed indicator by 6.7 %.

The standardized incidence rate of breast cancer in 2014 was 41.5 % lower than the all-Russian average (28.4 cases per 100,000 population), and in 2021 it was 38.2 % lower (28.8 cases per 100,000 population). The largest share in the structure of incidence was among patients with stage II of BC. Noteworthy is the tendency to increase from 2019 to 2022 the proportion of patients with stage I from 11.8 to 20.8 % due to a decrease in the proportion of patients with stage III – from 26.1 to 19.6 %. The peak incidence of the discussed pathology in all years of the study was observed in the age group of 55–64 years, with its gradual increase from 30–40 years and decrease after 75 years. The number of deaths due to BC over the analyzed period decreased from 224 cases in 2019 to 163 cases in 2022. At the same time, one-year mortality in 2019 was 15.6 % (n = 35) of the total number of deaths, in 2020 it was 23.4 % (n = 43), in 2021 it was 15.6 % (n = 28), and in 2022 it was 16.6 % (n = 27). The standardized BC mortality rate of BC in 2021 was 12.8 cases per 100,000 population. The largest number of fatal cases was observed in the age group of 55–69 years, with its gradual increase from 40–45 years and decrease after 70 years, followed by an increase towards 80 years.

Conclusion. The conducted population study allowed us to consider in detail the features of the dynamics of BC incidence and mortality rates, population coverage of screening programs and diagnostic methods. All the data obtained and analyzed indicate the need to pay more attention to regional peculiarities, as well as to improve the medical infrastructure of the region.

In this article, we report the interim results of a prospective non-interventional ValerEE study analyzing the efficacy and safety of ribociclib therapy in combination with endocrine therapy compared to other combination chemotherapy regimens in the first-line treatment of patients with hormone-sensitive HER2-negative advanced breast cancer in routine clinical practice in Russia. We analyzed the data of 188 patients, of whom 146 patients received ribociclib in combination with endocrine therapy, while 27 patients received other combination chemotherapy. Fifteen patients were excluded from the analysis as they did not meet the inclusion criteria (received monochemotherapy). The majority of participants were women (99.4 %) with a mean age of 59.1 years; most of them (76.9 %) reached menopause. Mastectomy with lymphadenectomy were the most common surgeries (47.4 % of cases). Ductal cancer was diagnosed in 83.2 % of patients. Expression of estrogen and progesterone receptors was detected in 100 % and 89.6 % of participants, respectively. Metastases were primarily located in the bones (60.7 %), lungs (53.8 %) and liver (50.3 %). Anastrozole was the most common endocrine agent used in combination with ribociclib (65.8 %); paclitaxel plus carboplatin were the most common (33.3 %) combination chemotherapy. The ratio of therapeutic options observed in this study reflects current clinical recommendations and routine clinical practice in the Russian Federation. Patient groups were well balanced with no significant differences between them, which will ensure accurate assessment of the effectiveness of different therapeutic regimens later.

Understanding the state of regional axillary lymph nodes is a significant factor in determining the stage and prognosis of the disease in the treatment of breast cancer. It’s also plays a leading role in determining the therapeutic strategy for treating patients. However, today, de-escalation of the volume of surgical intervention on the axillary lymph collector continues with the prospect of refusing any treatment of the axillary region for certain groups of patients in the future. The article discusses current studies aimed at determining the volume of surgical treatment on the axillary lymph nodes in different clinical situations.

Breast cancer is a heterogeneous disease. Luminal breast cancers account for up to 75 % of all breast cancer cases. However, even within this large group, there are significant differences in the course of the disease and therapeutic response to endocrine therapy, which dictates the need to explore and consider all available biological characteristics of the malignant tumor in optimal treatment decision making. Currently, adjuvant therapy for patients with breast cancer is mainly based on clinical and pathological factors. Multigene signatures that would help in personalizing systemic therapy are currently not available in our country. Therefore, there is a constant search for tools that could effectively predict the effectiveness of endocrine therapy at the early stages of treatment. One of such tools is a preoperative hormone sensitivity test.

A clinical case of pregnancy in a patient with breast cancer during adjuvant hormonal therapy with tamoxifen is presented. The patient underwent combined treatment: neoadjuvant chemotherapy with ovarian suppression, organpreserving surgery, radiation therapy and further hormonal therapy after the cancellation of ovarian suppression. The clinical case emphasizes the need to inform patients about the risk of pregnancy without restoration of menstrual function during tamoxifen intake and the importance of reliable contraception.

Efficient multimodal diagnostics of tumor type and intraoperative assessment of resection margins purity are the main indicators for reducing the risk of local recurrence after organ-preserving surgery (OPS) in patients with early breast cancer. The use of new high-resolution imaging techniques, an integrated approach to data analysis and numerical image processing will improve the overall efficiency of diagnostics and surgical treatment of tumors at early stages. The objective of the presented clinical observations was to demonstrate the advantages of an integrated approach to breast cancer diagnostics, which includes, in addition to standard ultrasound elastography, tissue examination by multimodal optical coherence tomography (OCT) in the modes of visualizing the structure and calculating tissue stiffness.

We demonstrate clinical examples of two malignant breast tumors with a similar diagnosis of “invasive cancer of a nonspecific type, moderate malignancy, T1–2N0M0”. The patients underwent preoperative standard ultrasound examination and subsequent OPS with additional intraoperative multimodal OCT in the modes of structural OCT with visualization of the attenuation coefficient and OCT-elastography with calculation of Young modulus in kilopascals. The examples of a tumor that was erroneously classified as benign according to the results of preoperative compression ultrasound elastography and another tumor that was correctly classified as malignant are considering. Post-operative tissue examination using multimodal OCT allowed us to establish that both cases demonstrate features of malignancy: quantitative processing of structural OCT images of the mammary gland tissues revealed a decrease in the attenuation coefficient of the OCT signal (<4 mm^–1) in both cases, which is typical for tumor tissue; stiffness maps constructed from the OCT data demonstrated high stiffness values (>400  kPa), which indicated the presence of tumor cells / tissue in both cases, which was confirmed by histological examination. It has been established that, compared with ultrasound elastography and structural OCT, OCT-elastography method allows more accurate determination of malignant tumors and clear visualization of the boundary between non-tumor and tumor tissues of the mammary gland.

Multimodal OCT with complex calculation of the OCT signal attenuation coefficient and stiffness values  has a certain potential for improving the intraoperative assessment of tumor structure features and determining the resection margins of breast cancer in OPS.

Aim. To investigate pelvic and urodynamic disorders in women after spontaneous vaginal delivery complicated by perineal trauma.

Materials and methods. The study included 200 women of reproductive age (18–35 years): the main group comprised 100 patients with perineal trauma (first- and second-degree tears, episiotomy), and the control group consisted of 100 patients after vaginal delivery without trauma. Six months postpartum, all participants underwent a comprehensive examination, including medical history collection, gynecological and physical examinations, perineometry, pelvic floor ultrasound, uroflowmetry, and questionnaires (International Conférence on Incontinence Questionnaire – Short Form, King’s Health Questionnaire). Pelvic floor muscle tone was assessed by palpation using the Oxford 5-point scale, while contractile strength was measured with perineometry (iEASE XFT-0010, China) using biofeedback (three 10-second trials). Pelvic ultrasound was performed on a Voluson E8 system with convex and transvaginal probes, both at rest and during the Valsalva maneuver, with evaluation of pelvic diaphragm morphometry, urethra, bladder, and α, β angles. Uroflowmetry was used to analyze urinary flow rate and voided volume.

Results. The study groups were comparable in age, height, fetal head circumference, and labor duration (p >0.05). Neonatal weight was slightly higher in the main group (3479.3 ± 442.0 g vs. 3340.2 ± 381.4 g, p >0.05). Birth trauma distribution included first-degree tears (36.9 %), second-degree tears (31.0 %), and mediolateral episiotomy (32.1 %). Lower urinary tract symptoms were more frequent in the main group: increased voiding frequency (71 % vs. 42 %), stress urinary incontinence (38 % vs. 21 % with exertion; 45 % vs. 32 % with cough / sneeze), and urgency (17 % vs. 12 %). King’s Health Questionnaire responses indicated more pronounced impact on quality of life (anxiety, self-esteem, daily activity, work performance). Perineometry demonstrated reduced pelvic floor muscle strength (all three measurements p <0.05), with no significant difference in maximal contraction duration. Ultrasound revealed greater urethral length during Valsalva (31.71 ± 4.8 mm vs. 28.02 ± 2.5 mm, p <0.05) and wider urethra at rest and during straining (p <0.05). Although mean α and β angles did not differ (p >0.05), their displacement was significantly higher in the main group (α: 4.51 ± 2.5° vs. 2.49 ± 1.0°; β: 11.77 ± 7.0° vs. 6.94 ± 4.6°, p <0.05), suggesting increased urethral mobility. Uroflowmetry showed reduced mean and peak flow rates (11.65 ± 3.7 and 20.57 ± 6.9 ml / s vs. 17.86 ± 2.0 and 25.18 ± 3.0 ml / s, p <0.05) and a non-significant trend toward longer voiding time (p >0.05).

Conclusion. The results of the study demonstrate that perineal birth trauma is a significant risk factor for the development of pelvic and urodynamic disorders in the early postpartum period. Women with perineal tears and episiotomy were found to have a statistically higher prevalence of urinary frequency, stress urinary incontinence, and urgency six months after delivery, accompanied by decreased pelvic floor muscle strength on perineometry and greater urethral hypermobility during functional tests. These changes were associated with a deterioration in quality-of-life indicators according to questionnaires, including increased anxiety, reduced self-esteem, and social maladaptation. Instrumental assessment (ultrasound and uroflowmetry) confirmed the presence of functional and morphometric changes, such as urethral elongation and widening, increased displacement of angles α and β, and reduced mean and peak urinary flow rates. The findings highlight the need for active screening and early correction of pelvic floor disorders in the postpartum period to prevent chronicity, reduce the risk of progression of urodynamic dysfunction, and improve patients’ quality of life.

Background. Fertility preservation is a critical component of comprehensive cancer treatment. One promising method for obtaining genetic material is superovulation stimulation using letrozole.

Aim. Comparative assessment of the efficacy and safety of protocols using letrozole alone and in combination with recombinant follicle-stimulating hormone.

Materials and methods. The study included 130 patients with reproductive system malignancies. Participants were divided into two groups based on the superovulation induction protocol used, with further stratification by anti-Müllerian hormone (AMH) level (<1.2 ng / mL and ≥1.2 ng / mL). All patients underwent superovulation stimulation, oocyte retrieval with quantitative assessment, and dynamic monitoring of estradiol levels before / after stimulation.

Results. In the subgroup of patients with AMH levels ≥1.2 ng / mL (n = 90), the combination of letrozole with recombinant follicle-stimulating hormone demonstrated superior outcomes, more oocytes compared to letrozole monotherapy (8.6 ± 3.1 vs 5.3 ± 5.1; p = 0,02). While the proportion of patients achieving estradiol levels <50 pg / mL showed no significant difference between groups (22 % vs 18 %; p = 0.62).

For patients with AMH levels <1.2 ng / mL (n = 40), both protocols showed comparable efficacy in terms of oocyte retrieval (2.8 ± 2.5 vs 2.1 ± 2.3; p = 0.42). However, the combination therapy provided significantly better estradiol suppression (77 % level reduction vs 65 %; p = 0.03), suggesting improved hormonal control in this patient population.

Conclusion. For patients with AMH ≥1.2 ng / mL, letrozole + recombinant follicle-stimulating hormone significantly increases oocyte yield without substantially elevating estradiol risk, supporting its use in fertility preservation programs. Patients with diminished ovarian reserve require further clinical investigation

Background. The incidence and mortality rates of gynecological cancer in the Siberian Federal District (SFD) are higher than in Russia. In the context of the current demographic crisis against the backdrop of declining birth rates in Russia, issues of preserving and studying women’s health, including oncological health, are relevant.

Aim. Analysis of gynecological cancer epidemiological indicators in the SFD and its territories for 2013–2023.

Materials and methods. The indicators were calculated based on reporting forms No. 7 “Information on malignant neoplasms” of the subjects of the SFD, as well as information on the number and age and sex composition of the population of these territories of the Russian Federal State Statistics Service for 2014–2023. The analysis of the indicators was carried out using the Z-criterion and regression analysis.

Results. In the SFD, over the study period, an increase in the incidence of uterine cancer (UC) by 30.0 % and ovarian cancer (OC) by 11.0 % and a decrease in cervical cancer (CC) by 13.1 % were detected. An increase in the average age of UC patients from 61.2 to 63.3 years, from 57.3 to 58.1 years for OC, and from 50.8 to 52.5 years for CC was observed. An increase in the cumulative risk of developing cancer in the SFD in 2023 was noted: 2.5 % for UC, 1.4 % for OC, and a decrease in the risk for CC to 1.6 %. A higher rate of increase in the intensive incidence rate for UC and OC was noted in women of reproductive age (51.6 and 35.5 %, respectively) than in women over 50 age group (39.3 and 5.5 %), for CC – a small increase in the indicator in the young (+0.3 %) and a decrease in the older age group (–17.3 %). Mortality decreased by 12.6 % for UC, 14.1 % for OC, and 20.8 % for CC. No significant changes in the recording reliability index were observed.

Conclusion. The results of the study on changes in dynamic epidemiological indicators can serve as a basis for adjusting territorial programs of anti-cancer measures and population screening for the purpose of early diagnosis and prevention of gynecological cancer.

Aim. To identify risk factors for the development of pelvic organ prolapse (POP) in women after hysterectomy.

Materials and methods. The study included 200 patients who presented for a scheduled follow-up examination 6 months after hysterectomy. The main group consisted of 100 patients who developed POP within 6 months after surgery, while the control group included patients without POP following the procedure. The diagnosis of POP was established based gynecological examination, and its severity was assessed using the international Pelvic Organ Prolapse Quantification (POP-Q) system. Inclusion criterion: hysterectomy performed six months prior to the study. Exclusion criteria: presence of oncopathology and refusal to participate (refusal to sign informed consent to participate in the study).

Results. According to POP-Q system, stage I POP was detected in 47 % of women, stage II in 34 %, and stage III in 19 %. Patients with POP were significantly more likely to be aged ≥54 years (55 % vs. 11 %, p <0.05), have a history of obstetric trauma (47 % vs. 12 %, p <0.05), and report regular heavy lifting (35 % vs. 9 %, p <0.05). Anthropometric parameters (height, weight, body mass index) and the prevalence of somatic pathology (diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, connective tissue dysplasia, chronic constipation) did not significantly differ between groups (p >0.05).

Conclusion. Age over 54 years, obstetric trauma, and a lifestyle associated with regular heavy lifting are key predictors of POP after hysterectomy. These factors exert a cumulative negative effect on the pelvic support structures, predisposing to functional insufficiency and organ descent. Identification of these risk factors during the preoperative evaluation enables the formation of high-risk groups, development of individualized preventive strategies, and optimization of surgical approaches to reduce the likelihood of recurrence.

Background. Endometrial cancer (EC) is a significant global health problem. Treatment outcomes for recurrent EC have long been unsatisfactory: with standard platinum-based combination chemotherapy, the 5-year survival rate for these patients does not exceed 18 %. EC treatment is currently undergoing significant transformation, primarily due to the advent of molecular classification. Immunotherapy research has led to the development of a highly effective therapeutic option (pembrolizumab with lenvatinib) for advanced microsatellite-stable / MMR-proficient (MMS / pMMR) EC, necessitating the evaluation of long-term outcomes and parameters affecting its efficacy.

Aim. To evaluate the long-term outcomes of immunotargeted therapy (ITT) for advanced MMS / pMMR EC and to identify clinical and morphological parameters affecting its efficacy.

Materials and methods. The study analyzed data from 60 patients with advanced MMS / pMMR EC received ITT in oncological dispensaries in Siberia and the Russian Far East. Progression-free survival (PFS) was analyzed using the Kaplan–Meier method, with PFS defined as the time from the ITT initiation until disease progression or death against the background of treatment. The influence of the selected clinical and morphological parameters on PFS was assessed using the log-rank test. Differences in patient subgroups divided by median PFS were assessed using the Mann–Whitney test for independent samples (quantitative variables) and Fisher’s exact test (qualitative variables). Differences were considered statistically significant when the significance level was reached (p <0.05)

Results. The median PFS in patients with advanced EC who received ITT was 12.6 months, with the lower quartile was

5 months and the upper quartile was 28.1 months. Among patients who had disease progression before 12.6 months, 25 % had progression within 2.57 months, and 75 % had progression within 6 months. The median time to progression was 4.05 months. Among patients who survived 12.6 months without disease progression, only the 75 % quartile, which was 16 months, was identified. The median PFS was not reached. Clinical and morphological parameters influencing the efficacy of ITT were identified.

Conclusion. ITT is currently a promising option for long-term control of advanced EC after platinum-based chemotherapy.

Endometrial cancer (EC) is one of the most common malignant tumors of the female reproductive system. Traditional clinicopathological factors do not always adequately reflect tumor biology, making molecular stratification increasingly important. A key element of this approach is the assessment of mismatch repair deficiency (dMMR) and microsatellite instability (MSI).

Aim of this work is to summarize current evidence on the clinical value of dMMR testing in EC and to define when and in whom it should be performed.

dMMR / MSI tumors account for approximately 20–30 % of EC cases. Testing provides several critical benefits: 1) identification of a distinct molecular subtype with characteristic biological behavior and intermediate prognosis; 2) early diagnosis of Lynch syndrome, enabling timely preventive strategies for patients and their relatives; 3) guidance in therapeutic decision-making, since dMMR / MSI tumors are highly sensitive to PD-1 inhibitors. Current international guidelines recommend that all patients with newly diagnosed EC undergo dMMR testing, regardless of age, family history, or histological subtype. This universal approach improves risk stratification, allows identification of hereditary cancer syndromes, and ensures access to effective immunotherapy in recurrent or metastatic settings

Aim. To evaluate the efficacy of the dietary supplement NefroBest-N® for the prevention of urinary tract infections and inflammation after gynecological and oncogynecological surgeries.

Materials and methods. The observational study included two groups of patients. The study group included 72 patients who received therapy containing the herbal preparation NefroBest-N®, 1 capsule twice daily for 30 days following surgery.

The control group included 60 patients who did not receive phytoprophylaxis postoperatively. Antibiotic prophylaxis for all patients was administered with cefazolin 1 g intravenously 1 hour before surgery. Patients also underwent a standard preoperative examination, including a blood biochemistry panel (urea, creatinine, potassium, sodium, C-reactive protein), a urinalysis (presence of mucus, white blood cell count), and a urine culture.

Results. Postoperative leukocyturia was more often observed in the control group – 23.3 % of cases versus 8.3 % of cases in the main group. Extended antibiotic therapy was also more common in the control group. According to the questionnaire, patients receiving NefroBest-N® scored better on their general condition than the control group (16 points versus 12 points), as well as they had less pronounced dysuric symptoms (21 points versus 29 points, respectively) and pain (12 points versus 18 points, respectively).

Conclusion. The use of the herbal preparation NefroBest-N® in the postoperative period reduces the risk of developing leukocyturia and dysuric symptoms, improving the overall well-being of patients.