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This article presents the results of a clinical study that examined the diagnostic efficacy of fluorescent diagnostics (FD) of non-muscularinvasive bladder cancer using a photosensitizer of FD of malignant neoplasms – 5-aminolevulinic acid hexyl ester (5-ALA HE) compared with standard cystoscopy. The study involved 110 patients. The study began with intravesical administration of 50 ml of 0.2% solution of 5-ALA HE, the exposure time was 1 hour, after which the drug was removed from the organ. During the next hour, the mucous membranes were examined in two cystoscopy modes, followed by a standard transurethral resection of all urothelium sites with suspicion for tumor lesion based on white light and visible red fluorescence, and a control blind biopsy from the visually unchanged and non-fluorescent mucous tissue in each patient. The results of the study indicate the high effectiveness of the developed FD methodology with 5-ALA HE in detecting non-muscularinvasive bladder cancer during intravesical administration of the drug, due to selective accumulation of hexasens-induced PPIX in the tumor tissue compared with healthy mucosa. Compared with the results of standard cystoscopy, fluorescence diagnostics significantly increased diagnostic sensitivity by 24.4% (from 75.1% to 99.5%), diagnostic accuracy – by 15.8% (from 82.4% to 98.2%) and a negative predictive value – by 33.2% (from 65.8% to 99%) (p≤0.05). Additionally, a total of 37 (33.6%) patients was found to have 63 foci of fluorescence with a diameter of 2.5 to 3.0 mm. 59 of these were morphologically confirmed to contain cancer cells.

Currently, reconstructive-plastic surgery is becoming the standard for surgical and combined treatment of breast cancer (BC) patients.With a one-stage reconstruction of the breast, the use of biological implants that can replace muscle autografts and, consequently, reduce trauma, blood loss and operation time, and also to avoid defects in the donor zones is becoming topical. From 2014 to 2017, 151 reconstructive operations on 121 patients with BC (average age 41.5 years) using synthetic and biological materials were carried out in P.Herzen Moscow Oncology Research Institute. 0 stage of BC TisN0M0 was diagnosed in 11 (9.1%) patients, I stage – in 52 (42.9%), IIA – in 41 (33.9%), IIB – in 9 (7.4%), IIIA – in 4 (3.3%), IIIB – in 2 (1.7%), IIIC – in 2 (1.7%). To strengthen the lower slope, a biological implant – Permacol acellular dermal matrix, was used in 34 cases. Cosmetic result was rated as excellent in 20 (58.9%) cases, good in 11 (32.3%), unsatisfactory in 3 (8,8%). Biological materials are an important addition to various options for breast reconstruction. The criterion for selecting the material for strengthening the lower slope of the breast with subcutaneous or cutaneous mastectomy for cancer with a one-stage reconstruction using a silicone endoprosthesis is the pinch-test value.

Introduction. In recent years, considerable success has been achieved in complex and combined treatment of breast cancer (BC). Reconstructive plastic surgery plays an important role in the rehabilitation of patients with breast cancer and it is currently considered as the causal treatment of mental disorders caused by loss of femininity and integrity of one’s own body. One-step breast reconstruction for cancer treatment makes it possible to use supplementary materials — synthetic and biological implants that can replace muscle autografts and thereby reduce trauma, blood loss, operation time, and thereby help to avoid the defect of donor areas. The authors describe the state of the art at present and demonstrate the results of their own research. Materials and methods. The object of study was 38 of breast cancer cases and 1 case of multiple gelioma caused by silicone implant rupture. 44 operations have been completed: 21 — radical subcutaneous mastectomy, 1 — subcutaneous mastectomy, 17 — skin-sparing radical mastectomy with one-step reconstruction with mesh implant (12 — titanium, 16 — polyester), 11 — acellular dermal matrix Permacol, 5 — prophylactic contralateral subcutaneous mastectomy with one-step reconstruction with silicone implant and a mesh implant due to a mutation of the BRCA1 gene. The technique of operations and the results of studies have been described in detail. Results. In the late post-operational period, the implants were removed in 5 cases: in 2 patients due to the development of inflammation of ADM, 3 — in connection with the development of bedsores and diastasis of the skin in the wound area when synthetic implants were used. From the total number of patients in the group (n = 39) excellent cosmetic results were reported in 21 cases (54%), good — in 13 (33%) and unsatisfactory — in 5 (13%) cases due to the removal of the implants. Conclusions. Biological and synthetic materials are significantly important options for breast reconstruction. They are adequate substitutes for autologous muscle flaps if the patients for the operation are properly select.

The article presents a clinical observation of the patient of 38 y.o. with cancer of the left breast stage IIIC урТ4bN3М0L1V1. On the 1st step of the treatment the patient had 2 courses of CAF neoadjuvant chemotherapy, on the 2nd step – extended radical mastectomy on the left with intraoperative photodynamic therapy and closure of the defect with ТRАМ-flap, on the 3rd step – continuation of the chemotherapy (8 courses), on the 4th step – radiation therapy to the chest wall on the left and zones of regional lymph drainage, targeted therapy with herceptin a (1 year). Four years later a silicone implant was inserted into the left breast. Corrective surgery (reduction mammoplasty on the right side) was performed in april, 2017. Currently, the patient has remission of the disease of the left breast, the period of remission accounts for 8 years.

Clinical observation of a patient with an orphan disease (mucinous peritoneal carcinomatosis) after 2 courses of intraoperative photodynamic therapy with photogem photosensitizer is presented. During the first course of photodynamic therapy, photogem was administered at a dose of 2.5 mg/kg, the energy density of the laser radiation was 10 J/cm2. The duration of stabilization after the first course of treatment was 2 years, after which the progression of the disease was registered. The second course of photodynamic therapy was carried out in the same way. The duration of stabilization after the first course of treatment was 2.5 years. The patient died as a result of an accident unrelated to the disease.

The article is devoted the problem of prevention of perioperative venous thromboembolic complications (VTEC) in cancer patients. The study identifies the causes of thrombosis in this category of patients and describes in details the major and minor risk factors for the development of VTEC. The results of studies on the influence of the morphological characteristics of the tumor, the stage and location of tumor on the risk of development of VTEC are performed. It is noted that along with the likelihood of thrombosis, cancer patients at the stages of surgical treatment there is an alternative risk factor – bleeding. The frequency of hemorrhagic complications and their risk increases in the presence of disintegration of the tumor, its proximity to the main vessels, extent of surgical aggression, as well as due to the introduction of anticoagulants. The approaches to the selection of the optimal method is specific or nonspecific prevention of VTEC depending on the nature and volume of the intervention, estimated blood loss and patients’ rehabilitation time are described. We show the advantages of low molecular weight heparins compared with unfractionated heparin for the prevention of VTEC in Oncology. The article presents long-term experience of employees of one of the leading cancer institutions in Russia – P. Hertsen MORI, whose team took an active part in the development of Russian clinical guidelines for the prevention and treatment of VTEC in Oncology.

The investigators analyzed the world literature on and the immediate and late results of 14 total small pelvic exenterations with different urinary tract reconstruction modalities. Postoperative complications occurred in 57.1 % of patients; postoperative mortality was 7.1 %. Late results were followed up in 12 patients. Overall survival at 10 to 48 months after surgery (median 26 months) was 83.3 %; relapse-free survival was 75 %. Urine derivation was made via orthotopic bladder plasty in 5 patients, Bricker operation in 6, and bilateral ureterocutaneostomy in 3. Functional results were regarded as good in all the patients after orthotopic bladder plasty. Thus, adequate urinary tract reconstruction allows one to expect the quality of life to be better without a negative impact on oncological results.

Renal cell carcinoma (RCC) is one of the most urgent topics in modern oncourology. This is attributable to the high morbidity and mortality rates associated with this pathology. Renal dystopia is a rather rare developmental anomaly. The literature data describing cases of the diagnosis and treatment in patients with dystopic kidney malignancies are scarce. Moreover, if a tumor is present in the solitary dystopic kidney, it is often extremely difficult to perform an organ-saving operation for a number of features of the anatomic structure of the dystopic kidney and its vascular architectonics. The paper describes a clinical case of S-shaped crossed dystopic kidney resection in a patient with RCC.

The paper presents data on planned measures to modernize our cancer service, one of the key areas of public health modernization, the main goal of which is to maximally ensure the citizens' right to have accessible and qualitative medical care. To adequately finance the field and to set up a current legislative base will give rise to the reorientation of the cancer service to priorities for primary prevention and active detection of malignancies, to an improvement of quality of life in cancer patients; to the formation of the populations' positive and integral awareness of health and healthy society, to the rational use of available manpower resources and inventory of all health facilities, which is extremely important under current conditions.

A recombinant pseudoadenovirus nanostructure (RPAN) based on human adenovirus of the 5th serotype that carries the human Lf gene was constructed to develop an effective system of human lactoferrin (Lf) production. It was shown using the model of toxicosis induced by cisplatin (DDP) that RPAN that carries the expressing cassette with a human Lf gene in its genome provides a high rate of Lf gene expression in animal organisms and ensures a high level of expression. The recombinant human Lf expressed in vivo, as does natural one, decreases the intensity of acute toxic reactions caused by DDP. It was shown that RPAN does not stimulate the growth or metastasis of experimental tumors. Moreover, at the early stages, it inhibits the growth of Lewis lung carcinoma (LLC), Ehrlich carcinoma (ELD), and sarcoma S-37. The obtained experimental data are indicative of the good prospects of the further medical-biological and medical study of RPAN and the production of a new, genetically engineered medicine of the new generation on its basis.

Thirty years experience of treatment of soft tissue desmoid fibroma (Moscow Oncologic Institute) is presented. Efficacy of surgical treatment versus combined and radiation therapy was studied. The rate of relapse of extraabdominal desmoids after surgical treatment was 94%, after combined treatment with preoperative radiation therapy the relapse rate decreased up to 27.5% but after postoperative radiation therapy up to 53%. After radiation therapy the relapse rate was 15.7%. However radiation therapy has limitations related the necessity of massive tumor irradiation and application of high doses of irradiation that may cause postradiation affect of tissues. During subsequent search the original method of chemiotherapy (tamoxiphen, vinblastin, methotrecoat) was tested. This method allows to achieve the persistent remission in 81.3% of patients. Principles of therapeutic tactics in desmoid fibromas are formulated.

170 patients, operated on the reason of breast cancer, received reconstructive surgery. Of them 63 had simultaneous organ preserving surgery with extramammary tissues translocation; 52 had organ preserving operation with the use of reductional mammoplasty and 55 patients had subcutaneous mastectomy with nipple preservation. Results of the study demonstrate that the method of organ preserving surgery with extramammary tissues translocation has more possibilities. The second place is occupied by the method of subcutaneous mastectomy with nipple preservation or in combination with muscular thoracodorsal flap replantation. The most complicated and giving the worst cosmetic result is the use of TRAM plasty. The algorithm of choice of the reconstructive operation for patients with breast cancer was worked out. Long term follow up showed the tumor progression in 29 (17.1%), remote metastases in 15 (8.8%) and local recurrence in 6 (3.5%) patients after organpreserving surgery and in 2 (1.2%) patients after subcutaneous mastectomy.

The paper presents data on planned measures to modernize our cancer service, one of the key areas of public health modernization, the main goal of which is to maximally ensure the citizens' right to have accessible and qualitative medical care. To adequately finance the field and to set up a current legislative base will give rise to the reorientation of the cancer service to priorities for primary prevention and active detection of malignancies, to an improvement of quality of life in cancer patients; to the formation of the populations' positive and integral awareness of health and healthy society, to the rational use of available manpower resources and inventory of all health facilities, which is extremely important under current conditions.

561 patients with rectal cancer were included in the study. The main group consisted of 119 patients, operated on during 2006-2009 years. They received total mesorectumectomy with the following pathomorphological control of the radicality. The group of control consisted of 442 patients, who had the rectum mobilized in a "standard" blunt fashion, without using principles of interfascial separation. The operation of total mesorectumectomy proved to take more time, though, it allowed to decrease the intraoperative blood loss, frequency of postoperative urogenital complications and did not increase rates of colorectal anastomosis insufficiency.

The Ad5-Lf recombinant pseudoadenovirus nanostructure (RPAN) based on adenovirus of the 5th serotype and containing lactoferrin (Lf) gene was constructed. The goal of this work was to develop a system for efficient production of human lactoferrin (Lf) in human body. It was shown using the model of cisplatin (DDP)-induced toxicosis that human Ad5-based RPAN with human Lf gene expressing cassette in its genome provides high rate of expression of Lf gene in animal body. In vivo recombinant human Lf demonstrates detoxification effect against acute DDP-induced toxic reactions similar to that of the native Lf. RPAN does not stimulate growth of primary and metastatic nodes of experimental tumors. Moreover, it inhibits the growth of Lewis lung carcinoma (LLC), Ehrlich carcinoma (ELD), and S37 sarcoma in early periods after tumor transplantation. The obtained experimental data are indicative of the good prospects of further biologic and medical study of RPAN and development of RPAN-based genetic engineering medicine of the new generation.

454 patients, aged 17-79 years, were operated on metastatic lung lesions during the period from 1970 to 2007 years. Overall 538 operations were performed, of them 40 bilateral lung resections, 33 patients were reoperated on the subject of recurrent lung metastases. Postoperative complications were registered in 44 (9,6%) patients. Lethality rate was 1,1%. Overall 5-year survival after solitary metastasis removal was 34,9+/-3,1%, after removal of several lesions the survival rate was 21,7+/-4,8%, and after operation on the subject of multiple lung metastasis the survival rate was 14,7+/-4,5%. The level of intrathoracic lymph nodes involvement and type of the performed surgery showed to be independent prognostic factors.

The introduction of laser information technologies to medical practice has improved the results of reconstructive and plastic operations in oncology thanks to a possibility to plan the surgery beforehand. Sixty-eight patients were operated on at Gertsen Moscow Research Oncology Institute between 2001 and 2006; 99 stereolithographic models were used to plan different stages of the surgical intervention. The tasks fulfilled with an individual stereolithographic model, may be relatively divided into three groups: 1) planning the resection stage; 2) planning the reconstructive surgery; 3) assessing the necessity to correct the complex autograft after the reconstructive surgery. The use of laser stereolithographic modelling in surgical treatment of patients with locally advanced malignancies made it possible to complete the reconstructive operation successfully in 98.4% of the patients, and rehabilitate functionally 88.6% of the patients.

Severe postoperative complications and critical conditions caused by profuse hemorrhage, pulmonary thromboembolism, anaphylactic shock in response to drugs, as well as circulatory arrest, pyoseptic processes are accompanied by significant activation of free radical lipid oxidation along with progressive depletion of the antioxidative defense system, i. e. the development of oxidative stress underlying the development of acute multiple organ dysfunctions (MOD) of posthypoxic or toxemic genesis, and they require special treatment policy. The active antioxidants Ceruloplasmin and Laprot based on natural human protein antioxidants are the drugs of choice in correcting oxidative stress. Their use as part of traditional intensive care restores imbalance of oxidative-antioxidative processes in the body and significantly enhances the efficiency of therapy for critical conditions and it should be regarded as an essential pathogenetic component of complex intensive care. The developed tactics of effective antioxidant therapy promotes optimization of the course of a rehabilitative period in patients after prior critical conditions and reduces the need for invasive hardware methods of correcting endotoxemia and MOD, which determines its economic expediency in addition to therapeutic one. Key words: critical conditions, oxidative stress, the antioxidants Ceruloplasmin and Laprot.

In vivo and in vitro experiments on the application of cell technologies to tissue defect closure were conducted; autologic mesenchymal stem cells on 3-demensional matrices were used. The authors analyze the results of the application of bioengineering tissue equivalents for the closure of soft tissue and upper airway defects after extensive resections performed in 52 oncological patients. Tissue equivalents with stem cells provide engraftment and long-term graft functioning; they also modify wound surface, thus stimulating wound epithelization. In this study the application of tissue equivalents led to wound healing and functional recovery in 87% of patients.

The calcium antagonist verapamil, a P-glycoprotein inhibitor, affects the growth of human tumor transplants under the capsule of the animal kidney with an oscillating-type dose-effect dependence. The maximal positive effect of verapamil is tumor regression and the maximal negative effect stimulation of transplant growth. In 3 out of 6 cases (gastric adenocarcinoma) verapamil at 9 mg/kg injected 0.5 h prior to vincristine inhibited tumor resistance to the latter. These data offer promise for increasing the effectiveness of chemotherapy in patients with cancer of the stomach by means of chemotherapy combined with P-glycoprotein blockers in doses determined for each individual.

Effects of γ-irradiation in a dose of 6 Gy and platidiam in a total dose of 16 mg/kg on the growth rate of transplants of 20 human pulmonary carcinomas under the renal capsules of immunodepressed mice were studied. Ten out of 11 tumors resistant to radiation were found to be resistant to platidiam as well. On the other hand, only 10 out of 15 carcinomas resistant to platidiam were resistant to radiation.

402 patients with tumors of the head, neck and gastrointestinal tract as well as of the locomotor system underwent microsurgical autotransplantation of tissues during the treatment and rehabilitation. 483 microsurgical autografts from fascio-cutaneous, muscular and osseous tissues were used as well as from visceral organs (the stomach, omenthum, the bowels). Successful outcomes of plastic and reconstructive operations were obtained in 95% of all the cases. Successful microsurgical plastics favoured timely application of combined antitumor treatment. In 50-60% of oncological patients a complete social and labour rehabilitation was achieved. The method proved to be perspective for further development and implementation in oncology.

The study was made of 568 cases of "initial" cancer cases, 825 morphological substrates of the polyps and 90 ones of chronic gastric ulcer. Chronic gastritis was the most frequent precancer disease (88.7% of cases). Malignant polyps accounted for 10.7% and chronic ulcer for 0.6% of cases. Relevant criteria for risk groups are proposed. Severe epithelial dysplasia as a morphological manifestation of gastric precancer can serve a marker of the risk of malignant transformation.

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.

The authors present information on 44 patients with local breast carcinoma (Stages II and III) who were treated by a new type of operation in the form of radical subtotal resection of the breast and one-stage reconstruction without the use of endoprostheses. The authors describe some scientific and technical problems of the performance of these complicated surgical interventions. In future these operations may become operations of choice for a certain category of patients because they solve both therapeutic and rehabilitation problems.

This article describes a biosteodermomuscular flap formation. The flap contains parts of VIII-IXribs, the broadest muscle of the back and a musculus serratus anterior. This method has been successfully used for a one-step segmental resection and microsurgical plastic operations on distal parts of extremities in five patients with malignant tumors of soft tissues.

Reproductive function was investigated in 155 females who had undergone organ-saving surgery for early forms of cervical carcinoma. Ninety-nine patients had their appendages unilaterally removed as part of therapy for ovarian malignancies, stage 1a. and 19 more who had received gestagen therapy for pre- and cancer of the endometrium. Menstrual function remained unimpaired in 99.3%. Changes in this function were observed postoperatively in 31 (20%) cases of cervical carcinoma. Paliative treatment for ovarian malignancies was followed by amenorrhea in 2 cases while changes in menstrual function-in 28 (28.3%). After hormone therapy those changes were registered in 11 (57.9%). One hundred and seven pregnancies in 75 (48.4%) patients were reported in group 1, 131 pregnancies in 72 (72.7%) -in group 2 and 16 pregnancies in 10 (52.6%) patients-in group 3. One hundred and thirteen babies were born after organ-saving surgery for early forms of cancer of the internal genitals perinatal mortality reaching 4.4%. Organ-saving therapy for early malignancies of the ovary, endometrium and cervix uteri has been found to be an effective means of treating the disease and maintaining certain specific functions of the female organism.

During clinical trials of photodynamic therapy (PDT) the tissue fluorescence spectra under 510 nm laser excitation were recorded in 22 patients with tumors of the lungs, larynx, skin, gastric and esophageal carcinoma, and cancer of the gynecological organs before (autofluorescence) and after drug administration. A spectroscopic fluorescence detection system, developed at the General Physics Institute, Russian Academy of Sciences, was applied for tumor diagnostics. The system has been used for clinical fluorescence diagnostics with the aid of HPD-type photosensitizer Photogem (Moscow Institute of High Chemical Technologies) marked by selective retention in malignant tumors. Methods and equipment for spectra analysis aimed at estimating drug distribution in the near-surface layers of tissues, determining the tumor boundaries before photodynamic treatment, as well as studying drug pharmaco kinetics have been developed and tested. The results demonstrate the possibility of tumor detection by fluorescence even in low selectivity of drug accumulation which appears to be dependent on the stage and type of the disease and the organ involved.

On the basis of analysis of the histological structure of 1,095 polypoid and nonpolypoid tumors, the frequency of detection of "primary" carcinoma and its clinical and histological features were studied. It is shown that one third of pTI category carcinomas are devoid of signs of a preceding adenoma. Polypoid primary carcinomas account for only 15.8% of cases. The prevailing plaque-like, flat, and ulcerated tumors invade the submucous layer more frequently than malignancy adenomas of the corresponding size and produce metastases to the lymph nodes more frequently. The tumor develops against the background of precancerous and dysplastic changes in the epithelium in the nonpolypoid mucosa and in the adenomas. The indications for economical operations in primary carcinoma, in distinct from those in malignancy adenomas, should be determined with caution.

Individual laboratory prediction of the sensitivity of human neoplasms to chemicals is justified on the basis of the authors' own data and those available in the literature. The potentialities and limitations of methods for individual prediction, as well as clinical results are discussed. Data are given on some biological mechanisms responsible for tumor growth which have been obtained in in vitro and in vivo tests with human tumor tissue and carcinoma cells. Further perspectives of this line of studies are discussed.