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Results in Journal Head and Neck Tumors (HNT): 251

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M. A. Krylovetskaya, I. G. Komarov, A. Yu. Kontsevaya,
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-10-15

Abstract:
Background. The detection of primary tumor in patients with cervical lymph node metastases without the primary tumor found is very important, because its location often determines the treatment strategy. The study objective is to analyze the capabilities of upper respiratory tract fibroscopy for the detection of primary tumor in patients with cervical lymph node metastases from squamous-cell carcinoma without the primary tumor found.Materials in methods. A total of 70 patients with cervical lymph node metastases without the primary tumor found, in whom cytological examination of biopsy specimens collected from cervical lymph nodes revealed squamous-cell carcinoma, underwent upper respiratory tract fibroscopy in N.N. Blokhin National Medical Research Center of Oncology between January 2017 and May 2020.Results. In 24 out of 70 patients, fibroscopy helped to identify the primary tumor and collect biomaterial for morphological examination. Twelve patients were found to have oropharyngeal cancer; ten patients were diagnosed with nasopharyngeal cancer; and 2 patients had laryngopharyngeal cancer. Fifteen out of 24 patients had tumors less than 1.2 cm.Conclusion. Upper respiratory tract fibroscopy is a highly effective method for detecting small asymptomatic tumors. It can be recommended for the examination of patients with metastases from squamous-cell carcinoma without the primary tumor found, if the primary tumor is believed to be located in the upper respiratory tract
S. E. Titov, G. A Katanyan, T. L. Poloz, L. G. Izmaylova, О. А. Zentsova, L. G. Dryaeva, V. V. Anishchenko
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-50-59

Abstract:
Introduction. The main method of preoperative diagnosis of thyroid tumors and the identification of possible metastasis is a cytological examination of smears obtained by fine-needle aspiration biopsy. However, the cytological material of the lymph nodes may not be adequate, and the detection of metastases faces a number of difficulties. In our recent study, we described a variant of the molecular classifier that allows the detection and typing of malignant thyroid tumors by analyzing several molecular markers in cytological preparations.The study objective was to assess the applicability of the developed method for the preoperative detection of metastases of papillary and medullary thyroid cancer in the lymph nodes of the neck lateral cellular tissue.Materials and methods. A total of 86 cytological samples were used, obtained from individual lymph nodes of 62 patients who had a diagnosis – thyroid cancer. Samples were analyzed by real-time polymerase chain reaction regarding the preselected set of molecular markers: the BRAF V600E mutation, the normalized concentration of HMGA2, FN1 and SERPINA1 mRNA, 5 miRNAs and the mitochondrial/nuclear DNA ratio. The decision tree-based classifier was used to discriminate between benign and malignant samples.Results. The previously described classifier, based on the analysis of the BRAF V600E mutation, the content of HMGA2 mRNA, 3 miRNAs and the mitochondrial/nuclear DNA ratio, revealed metastases of thyroid cancer with good specificity (98 %) but less sensitivity (83 %). Therefore, a new classifier was built, including three markers – HMGA2 and FN1 mRNA, and miRNA-375, which, with regard to the detection of metastases, showed good sensitivity – 93 % with a slight decrease in specificity (up to 96 %).Conclusion. Thus, we demonstrated the possibility of preoperative detection of thyroid cancer metastases in the lymph nodes of the neck lateral cellular tissue by analyzing several molecular markers in cytological material.
М. V. Bolotin, A. M. Mudunov, V. Yu. Sobolevsky, А. А. Akhundov, И. М. Гельфанд, S. V. Sapromadze
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-25-31

Abstract:
Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps.Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face.Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.
F. S. Sevryukov, E. V. Borodavina, Р. А. Isaev, В. В. Полькин, , С. В. Васильков, Yu. А. Panaseykin, D. N. Derbugov, , S. О. Podvyaznikov, et al.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-44-49

Abstract:
Dermal toxicity of anti-cancer drugs apparent in patients with thyroid cancer. This side effect appears, in particular, in relation to increased administration of targeted anti-cancer treatment, especially tyrosinkinase inhibitors, towards various receptors of growth factors which are applied in the ethiopathogenesis of a tumor cell. Our article focuses on the dermatotoxity, designated also as skin reaction, which most frequently occurs in patients treated by tyrosinkinase inhibitors – sorafenib, vandetonib, cabozantinib and lenvantinib. High prevalence of dermatotoxity, reported by patients, treated with these drugs underscores the need for greater understanding of the pathogenesis and management of this syndrome.
A. R. Gevorkov, A. V. Boyko, L. V. Bolotina, S. V. Shashkov, G. R. Abuzarova, R. R. Sarmanaeva
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-60-73

Abstract:
The study objective is to improve quality of life in patients with oropharyngeal squamous-cell carcinoma during chemo/bioradiation therapy and at early stages after its completion which allows to perform the full extent of radiation within optimal treatment period.Materials and methods. A retrospective analysis of data on 196 patients who underwent chemoradiation therapy between 2005 and 2016 was performed. The results were used to develop and implement a program of support for chemo/bioradiotherapy. The program was characterized by: 1. use of Russian hydrogel materials for local delivery of antibiotics and wound-healing, anesthetizing, anti-inflammatory medications; 2. new regimens of pain relief with differentiated pathogenetic approach and use of modern transdermal long-acting forms; 3. nutritional support at every treatment stage; 4. assurance of compliancy. To evaluate the program, prospective randomized controlled study was performed between January of 2017 and March of 2019 including 60 patients.Results. Mucositis and dermatitis severity and changes in physical state associated with them, progression and duration of radiation did not significantly differ in the two groups. Use of the support program allowed to control adverse effects and to perform chemoradiotherapy to the full extent, at optimal time and with satisfactory quality of life.Conclusion. The program of support of chemo/bioradiotherapy in combination with psychological support is effective both form the point of view of optimization of treatment and rehabilitation times and from the point of view of maintenance of high quality of life in patients.
A. E. Kazimov, A. M. Mudunov, Z. V. Grigorievskaya, I. A. Zaderenko, S. B. Alieva, N. S. Bagirova, I. N. Petukhova, I. V. Tereshchenko, M. B. Pak
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-74-85

Abstract:
The study objective is to evaluate the effect of periodontal microorganisms on development of squamous-cell carcinoma of the oral mucosa and the risk of its recurrence.Materials and methods. Microbiological study of biomaterials from 150 patients was performed. The study group included 100 patients with T3–T4 squamous-cell carcinoma of the oral mucosa and was subdivided into two subgroups with 50 patients in each. The control group included 50 patients.Results. Analysis of the results obtained in the subgroup of primary patients showed the following trends: in 2 (50 %) of 4 patients with Fusobacterium spp., recurrence of the main disease was observed as well as a case of distant metastasis into the bones. Among 35 patients with Prevotella spp. in the biomaterials, in 16 (45.7 %) recurrence of the tumor was observed. Among 10 patients with Veillonella spp., recurrence was observed in 20 %. The most common aerobic microorganism was Streptococcus spр. Among patients who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology, recurrence was diagnosed in 28.5 %, distant metastases in 4.7 %. In the subgroup of repeat patients, the following trends were observed: among 27 patients with Fusobacterium spp., recurrence of the main disease was observed in 63 %. Among 26 patients with Prevotella spp. in the biomaterial, in 11 (42.3 %) local recurrence was observed. Among 24 patients with Veillonella spp., recurrence developed in 33.3 %. The most common aerobic microorganism was Streptococcus spр., recurrences developed in 21 % of cases.
A. M. Mudunov, E. G. Khazarova, Yu. V. Alymov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-86-90

Abstract:
Skin cancer of external ear is a very aggressive type of cancer with spread to the parotid gland, bone structures of the lateral skull base, meninges and brain tissue. At the same time, malignant tumors of the external ear are very rare disease, accounting for 0.2 % of all malignant head and neck tumors. This fact explains the small amount of investigation in this scientific field. Now, does not exist unanimous opinion about the treatment tactics for patient with locally advanced ear cancer. Surgical tactics for volumes of block resections of the temporal bone are different. Controversial issues relate to the appropriateness of surgical treatment in general in the case of advanced tumor process. In this article we performed publication analysis devoted to selection of optimal treatment tactics for patient with locally advanced ear cancer.
R. V. Lutovinin, V. N. Oshchepkov, Yu. A. Shubina, V. V. Kokareva
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-91-97

Abstract:
Introduction. Surgery is frequently preferable to therapy as it yields longer overall and recurrence-free survival. But surgery of locally advanced tumors of the oral cavity can not always guarantee preservation of oral functions. In the EORTC 24971 and RTOG 90-03 trials, effectiveness of conventional radiotherapy was demonstrated. Addition of brachytherapy allowed to double recurrence-free and overall survival. Implementation of proton therapy increased treatment safety. However, high cost of modern technology for radiotherapy limits its accessibility. Intra-arterial chemotherapy is characterized by lower toxicity. Additionally, it allows to create a pool for the 1st cycle of systemic circulation directly in the tumor and neighboring tissues, and a significant portion of the drug enters the draining lymph node replicating lymphogenic metastasis.The objective was to present a clinical case of successful treatment of inoperable squamous-cell carcinoma of the oropharynx using intra-arterial chemoradiotherapy.Clinical case. A patient sought medical help at the multidisciplinary clinical medical center “Medical City” where combination treatment was chosen: a course of chemoradiation therapy using an original approach combining external beam 3D-conformal radiotherapy and intraarterial chemotherapy. According to control computed tomography data, dynamics was described as partial response: 30 % reduction in marker lesions. The patient did not have any complaints and evaluated their quality of life as high which corresponded to the testing results.Conclusion. We have demonstrated benefits of intra-arterial chemoradiation therapy: low toxicity allows patients to receive a full course of radiotherapy without breaks and achieve high functional results. Considering palliative status of the patient, we did not aim to increase recurrence-free period but the objective of ensuring satisfactory quality of life was achieved. New, more physiological regimens of intra-arterial infusion will improve pharmacokinetic profile of chemotherapeutic drugs and will allow to achieve positive results.
T. M. Geliashvili, A. V. Vazhenin, T. P. Berezovskaya, E. B. Vasilieva, N. G. Afanasieva, V. V. Krylov, P. I. Garbuzov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-16-24

Abstract:
The study objective is to evaluate value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET-CT) and whole-body scintigraphy (131I-WBS) performed during the first course of radioiodine therapy for its ability to detect persistence metastatic foci and for its role in the management of differentiated thyroid cancer patients.Materials and methods. Forty patients with DTC underwent both post-therapeutic 131I-WBS and PET-CT. PET-CT performed on a positron emission tomograph combined with a 16-slice computer tomograph. Post-therapeutic 131I-WBS performed during radioiodine therapy on the single-detector gamma camera.Results. Sensitivity in detecting of the tumor persistence for PET-CT was 84 %, for post-therapeutic 131I-WBS 66 % (р >0.05). In 17 (42.5 %) patients additional PET-CT foci were found that negative on 131I-WBS, including 11 (27.5 %) cases of distant metastases. Fifteen percent of patients had metastatic foci visualized only on 131I-WBS, including 4 (10 %) cases of distant metastases. In 17 (44 %) patients tumor foci were identified by both methods. A high pre-ablative level of stimulated thyroglobulin was the only independent predictor of the presence of PET-CTpositive metastatic foci (p = 0.001).Conclusion. 18F-fluorodeoxyglucose PET-CT can be recommended during the first radioiodine therapy in differentiated thyroid cancer patients with a high risk progression group, as well as with suspected the tumor persistence in case of a high pre-ablation thyroglobulin level, to complete staging, improve the quality of management and ongoing risk stratification.
A. V. Karpenko, R. R. Sibgatullin, А. А. Boyko, М. G. Kostova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-32-43

Abstract:
The study objective is to assess functional and oncologic results of transhyoid approach used for surgical treatment of oropharyngeal carcinoma.Materials and methods. Operative records, hospital charts and data from out-patient department of 55 patients (T1 – 6, T2 – 16, T3 – 19, T4 – 14) with oropharyngeal carcinoma operated via a transhyoid approach were reviewed. Postoperative period was reviewed for complications. All oncologic adverse events were registered with special emphasis on the rate of local recurrence. A univariate analysis with chisquare and Fisher’s exact test was used to check the correlation between tumor factors and surgical variables (complications, mode of reconstruction). The influence of tumor- and treatment-related variables (T stage, differentiation, perineural invasion, p16 status, depth of invasion, extension to the oral cavity, adjuvant treatment) on the rate of local recurrence was studied in the same way. The log-rank test was used to assess differences in survival curves. The data was compared with other series of patients treated with the same technique.Results. Seventeen (30,9 %) patients developed 29 complications. There was 1 postoperative death. Five (9,1 %) patients required repeated operation. The mode of reconstruction (primary closure vs flaps) was a major factor influencing the rate of complications. Fifty (92,6 %) patients were able to resume oral diet with a duration of nasogastric tube feeding of 7–35 days. Three-year overall/disease-specific survival for the whole cohort were 47 and 51,1 %, for p16-positive (22 %) cohort – 65,6 and 87,5 %, for p16-negative (78 %) cohort – 40,6 and 46,8 %. Thirteen (24 %) patients developed a local recurrence. The rate of local recurrence was negatively affected by p16 negativity (p = 0,048), depth of invasion >10 mm (p = 0,044) and depth of invasion >15 mm (p = 0,003).Conclusion. Transhyoid approach may be considered as a surgical option for treatment of oropharyngeal carcinoma with acceptable rate of complications.
Yu. V. Kostalanova, K. A. Ganina, A. A. Makhonin, A. G. Gabrielyan
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-41-47

Abstract:
The immune system plays a key role in the development and progression of head and neck squamous cell carcinoma. Understanding the dysregulation and blockage of the immune system of malignant tumors in this location can improve treatment outcomes. A special group is made up of patients who have a widespread process and relapse after chemotherapy with platinum drugs, because they have a very poor prognosis and limitations in the possibilities of further treatment. To date, the most important data relate to drugs acting on the PD-1 (programmed cell death protein 1)/PD-L1 (programmed death ligand 1) immune checkpoints, which are used by the tumor to block the immune system, which have allowed to increase the effectiveness of treatment. The article presents a clinical case demonstrating the effectiveness of the use of checkpoint inhibitors after the use of platinum preparations.
C. R. Rahimov, A. A. Ahundov, G. I. Hajiyeva, R. Ch. Rahimli, D. A. Safarov, I. M. Farzaliyev
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-97-110

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E. R. Oganyan, , S. B. Alieva, N. A. Pirogova, A. A. Markovich, L. A. Kurbanova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-27-40

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Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-90-96

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A. O. Eremina, I. A. Zaderenko, , S. B. Alieva, A. B. Dymnikov, A. V. Khromushina, B. C. Pkheshkhova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-72-80

Abstract:
Oral mucositis is one of the most common effects of chemoradiotherapy in patients with oropharyngeal cancer. The development of oral mucositis is the main cause of interruption of antitumor therapy, which significantly affects the results of treatment of the main disease. Despite the fact that the disease is well studied in the literature, today there is no universal treatment and prevention protocol. The aim of this review is to analyze scientific publications devoted to the problems of etiology, pathogenesis, clinic, diagnosis, treatment and prevention of oral mucositis.
D. A. Miroshnichenko, A. P. Polyakov,
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-81-89

Abstract:
One of the main problems of nasopharyngeal carcinoma treatment is the high incidence regional and distant failures. The method of choice in the first line therapy for the primarily diagnosed nasopharyngeal carcinoma is chemoradiotherapy with poor success rate. The main etiological factor in the occurrence of nasopharyngeal carcinoma is the Epstein–Barr virus, which DNA’s copies could be detected in blood samples in patients with nasopharyngeal carcinoma, which may indicate tumor activity. The indicators of these titers reach different values depending on the stage of the tumor process, the presence of distant metastases, individual patient parameters, and the tumor response to the therapy. Given the high specificity of this biological marker, it is necessary to consider the possibility of its use as a prognostic indicator for assessing the success of the selected method of conservative treatment, as well as assessing the prognosis.
N. V. Severskaya, , I. V. Chebotareva, N. V. Zhelonkina, V. V. Polkin, , D. N. Derbugov, S. O. Podvyaznikov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-19-26

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S. I. Kutukova, , G. A. Raskin, Yu. V. Ivaskova, N. P. Belyak, , , P. M. Baykalova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-65-71

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, A. V. Ignatova, A. S. Morozova, S. O. Podvyaznikov, Yu. V. Alymov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-111-117

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, M. B. Pak, L. V. Demidov, K. A. Baryshnikov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-55-64

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E. V. Borodavina, P. A. Isaev, F. S. Sevrukov, A. V. Sidorin, V. V. Polkin, A. A. Ilyin, N. V. Severskaya, T. A. Agababyan, ,
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-48-54

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A. P. Polyakov, , , , E. A. Chistyakova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-3-12-18

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N. V. Sevian, A. Kh. Bekyashev, E. V. Prozorenko, N. A. Kozlov, , V. B. Karakhan, T. G. Gasparyan, D. E. Avtomonov, E. A. Bogush, V. Yu. Kirsanov, et al.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-97-100

Abstract:
Esophageal cancer spreads locally via the circulatory and lymphatic systems and can, extremely rarely, form brain metastases. The development of intracranial metastases is a long-term adverse event indicating poor prognosis. In this paper, we present a case of esophageal cancer with a brain metastasis in a patient who received combination therapy and demonstrated long-term progression-free survival.
А. О. Гузь, D. M. Fatkullin, A. V. Garev, A. S. Zakharov, M. I. Sokolova, A. P. Alekseeva
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-54-60

Abstract:
This review analyzes the research data concerning the problem of antibiotic prophylaxis (ABP) of wound infections after various surgeries for head and neck tumors. In patients with clean wounds, ABP should be used in exceptional cases only (for example, if the patient has any risk factors), otherwise it should be avoided. A short ABP course is recommended for patients with clean-contaminated wounds; however highrisk patients may require a prolonged course. There is some evidence of ABP efficacy in patients with non-contaminated wounds after cervical lymphadenectomy. When choosing a drug for ABP, a doctor should consider the site of surgery and the risk of wound contamination. The optimal drugs after head and neck surgeries include first- and second-generation cephalosporins, ampicillin in combination with sulbactam, metronidazole, and clindamycin. First- and second-generation cephalosporins in combination with metronidazole are preferable, but if the wound is infected with gram-positive bacteria, it is necessary to use clindamycin monotherapy. Reconstructive surgeries with a free flap require a short course of ABP with one of the following combinations: cefazolin + metronidazole, cefuroxime + metronidazole, or ampicillin + sulbactam; if the patient is allergic to beta-lactams, clindamycin can be used. Despite the availability of standard ABP regimens, a surgeon must apply a tailored approach when choosing an ABP regimen for each patient, taking into account risk factors and the volume of surgery.
, S. B. Potkin, , , A. S. Polonskaya
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-30-37

Abstract:
Background. Multikinase inhibitors of angiogenesis are currently the most effective group of drugs in target therapy for cancer. They are associated with a high prevalence of a specific cutaneous adverse reaction, which manifests as a hand-foot skin reaction (HFSR). This side effect is quite prominent in the majority of patients, usually graded as II–III degree, which leads to the dose reduction and even discontinuation of the drug. The study objective is to evaluate clinical, histological and ultrasound characteristics of a HFSR associated with MKI treatment, and to assess the influence of a HFSR on patient’s quality of life. Materials and methods. The study included 46 patients with HFSR, who were previously treated with sorafenib or lenvatinib. Clinical characteristics of HFSR, including severity grading, were evaluated. We also performed ultrasound and histological examinations and assess the Dermatology Life Quality Index. Results. Grade III HFSR was in 5 (10.86 %) patients, grade II – in 25 (54.35 %), and grade I – in 16 (34.79 %). Dermatology Life Quality Index depended on the HFSR severity, with the mean value 24.5 ± 2.4. Pathomorphological examination revealed irregular epidermal proliferation with hypertrophic psoriasiform acanthosis, minimal keratinocyte vacuolization, few apoptotic figures, dyskeratosis, hyperkeratosis and microvessel dilation in the papillary dermis. Ultrasound examination showed increased vascularization in papillary and reticular dermis in affected skin areas, which was more prominent in patients with severe degrees of HFSR. The pronounced enhancement of vascularization was detected in fragmented hypoechogenic sites along the border of papillary and reticular dermis and in similar sites along the border of dermis and hypodermis. Conclusion. The use of multikinase inhibitors leads to pronounced changes not only in the surface layers of the skin, but also in the dermis and subcutaneous fat, which significantly worsens the quality of life of patients. This indicates the need to search for pathogenetically based methods of treatment of HFSR and create practical guidelines for supportive treatment of patients with HFSR taking multikinase inhibitors.
A. S. Sharapo, V. Yu. Ivashkov, , M. V. Bolotin, M. Bektemirov, A. E. Raportinova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-22-29

Abstract:
The study objective is to analyze the results of the use of free osteomyofascial flaps in the reconstruction of combined post-resection facial defects with an intraoral component. Materials and methods. Fifty-three patients were operated by the proposed method. The muscle portions which were used with free flaps were: m. flexor hallucis longus with the free fibula flap (n = 27), m. vastus lateralis with anterolateral thigh flap (n = 11), m. subscapularis with the scapula free flap (n = 15). An analysis of postoperative complications was performed, as well as an analysis of the timing of dental implantation. Results. The average hospital stay was 15 days. The main complications from the recipient area were: local inflammation in the reconstruction area – 2 (3.8 %) cases, hematoma on the neck – 2 (3.8 %), fistula formation – 1 (1.9 %), full flap necrosis was noted in 1 (3.7 %) case, hypertrophic growths of granulation tissue on the muscle portions of the flaps in 3 (5.7 %). The main complications from the donor zone: hematomas – 0 cases. In 2 (13.3 %) patients after using a chimeric scapular flap, lymphorrea up to 50–70 ml was noted. Dental implantation was performed in 4 (9.5 %) cases. There were no complications or difficulties in performing dental implantation. The average time taken to form the soft tissue contour in the area of implants after installing the gingiva formers in our study was 2.5 weeks, which is 2 weeks faster than using flaps that include a skin paddle. Conclusion. This reconstruction method could be used as a main for the plastic elimination of combined facial defects with an intraoral component.
, T. I. Deshkina, , S. A. Kravtsov, T. V. Ustinova, A. A. Paychadze, , А. А. Fedenko
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-10-21

Abstract:
The results of the clinical studies have a direct impact on clinical practice. The main criteria for the effectiveness of treatment method are increasing the overall life expectancy and improving its quality. In the treatment of common forms of squamous cell carcinoma of the head and neck, induction chemotherapy can be used, including platinum drugs, preferably in combination with cetuximab. Next immuno-oncological drugs should be prescribed. In the future, in the 1st line of therapy, it is possible to replace cetuximab with pembrolizumab or monotherapy with pembrolizumab, which allows to increase the effectiveness of treatment and reduce its toxicity. The article presents 3 clinical observations that demonstrate the possibility of integration the results of clinical research in practice.
D. V. Sashin, , E. A. Kobyakova, A. Kh. Bekyashev, A. S. Subbotin, E. A. Nechipay, , N. A. Kozlov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-38-45

Abstract:
The study objective is to assess the possibilities of magnetic resonance imaging (MRI) in SWI (susceptibility weighted imaging) in the differential diagnosis of glial brain tumors and primary brain lymphomas. Materials and methods. Fifty-four patients with brain tumors were studied (men – 27 (50 %), women – 27 (50 %)). Average age 57.9 years. Histological examination of the surgical material revealed the glial nature of tumors in 41 patients (26 of them with glioblastoma, anaplastic astrocytomas – 15), primary brain lymphomas – in 13 patients. Brain MRI was performed using tomographs with a magnetic field of 3 and 1.5 T. A semi-quantitative assessment of the data obtained in the SWI mode based on the classification of ITSS (intratumoral susceptibility signals), reflecting the severity of interstitial vascular architectonics and microbleeding. Results. The degree of ITSS was 3 in glioblastomas (G4 ) in 26 (100 %) cases, in the structure of gliomas (G3 ) the ITSS values were 3 in 3 (20 %) cases, in the remaining 12 (80 %) cases – ITSS 2. In the group of primary brain lymphomas, the ITSS 1 was in 4 (30.7 %) cases, ITSS 0 was in 9 (69.3 %) cases. Conclusion. MRI in SWI mode is a promising technique that allows one to quantify the degree of pathological changes in tumor vascular architectonics and intratumoral hemorrhages and has shown high specificity in the differential diagnosis of malignant gliomas and lymphomas of the brain, accompanied by active accumulation of contrast medium.
E. O. Kudasova, , , P. A. Demenchuk, A. V. Zotov, T. M. Vasilyeva
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-90-96

Abstract:
Introduction. Timely maxillofacial orthopedic care is aimed at leveling the message of the oral cavity with the nasal cavity and its paranasal sinuses, orbit, helps to improve swallowing, speech, breathing and salivation. The objective of this work is to demonstrate the possibility of application of a polymethyl methacrylate prosthesis with a superhydrophobic modified surface directly on the operating table, as well as to demonstrate the possibility of using in the shortest postoperative period. Materials and methods. Patient Z., 28 years old, clinical diagnosis: chondrosarcoma of the upper jaw on the right, Т2N0M0, stage 2. A resection of the upper jaw was proposed with simultaneous reconstructive treatment and the application of a dental resection forming denture of the upper jaw. To form a hydrophobic surface, the prosthesis was modified with a high-frequency plasma of sulfur hexafluorides. The study of the quantitative and qualitative composition of microflora on the surface of the resection forming prosthesis was carried out after transportation of the prosthesis from the dental laboratory, after processing of high-frequency plasma of sulfur hexafluoride and before applying the resection forming prosthesis, 3, 7 days after the prosthesis was applied. Results. After modification of sulfur hexafluoride in the medium, the contact angle of contact with distilled water increased, the critical surface tension decreased compared to the initial one, and the hydrophobic properties were increased. Conditionally pathogenic microflora in a diagnostically significant amount was cultivated from the surface of the resection forming prosthesis obtained from the dental laboratory. Bacterial seeding after modification in the plasma of sulfur hexafluoride showed the absence of microflora strains; a slight increase in opportunistic microflora was obtained on days 3 and 7 after application of the prosthesis. In the immediate postoperative period (3 days), the patient complained of pain and discomfort associated with the surgical stage. Conclusions. The presented clinical case indicate that the superhydrophobic surface modified by sulfur hexafluoride contributes to a more stable healing of the postoperative defect.
А. М. Zaytsev, А. P. Polyakov, М. V. Ratushny, Т. М. Kobyletskaya, S. А. Kisariev, А. L. Sugaipov, О. N. Kirsanova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-79-84

Abstract:
The objective of the scientific report is to describe a rare clinical case of a combination of Forestier’s disease (diffuse idiopathic skeletal hyperostosis) and laryngeal cancer that have common symptoms. Case report. A 68-year-old male patient presented with hoarseness lasting for a year. Indirect laryngoscopy revealed a vocal fold tumor. Histological examination confirmed well-differentiated keratinizing squamous cell carcinoma of the larynx. A 6-cm tumor was located in the projection of the right vocal fold and had no signs of invasion into the supraglottis, subglottis, and anterior commissure. No other focal disorders were detected. The patient has undergone endolaryngeal laser resection of the larynx and tracheostomy. After probe removal, the patient had swallowing difficulties with esophageal content passing to the trachea mainly due to organic changes in the cervical spine at the СЗ–С4 level, where there was a massive local calcification of the anterior longitudinal ligament. We also noticed severe movement restriction in the cervical spine: the amplitude of movements did not exceed 10°. The formation of the C3–C4 segment was removed via ventrolateral approach. Conclusion. Dysphagia, dysphonia, and dyspnea may indicate both malignant tumor and large osteophyte causing compression of the trachea and esophagus. In this case, no symptom resolution after tumor removal led to the suspicion of a second disease, namely Forestier’s disease.
H. Chen, , R. I. Azizian, I. N. Pustynskiy, Д. К. Стельмах
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-61-68

Abstract:
This review covers the issues related to the application of radial free forearm flaps for the reconstruction of defects after surgeries for oral squamous cell carcinoma. The advantages of this method include optimal match of the flap to the tissues of the oral cavity, good adaptation to defect edges, and possibility to replace defects of almost any size and locations. Flap survival rate reaches 92.0–98.4 %. The method demonstrated good functional and aesthetic results when used for the repair of extensive defects of the tongue, oral floor, cheeks, as well as total defects of the lips, hard and soft palates. The main disadvantages of the method include aesthetic defects of the donor site and possible forearm dysfunction, but most patients are quite comfortable with these inconveniences. The death rate is 0.09 %; the incidence of complications is 15–24 %. The main cause of graft failure in this case is venous thrombosis. Advanced age is not currently considered as a contraindication for this method. Further studies evaluating free radial flaps are highly relevant, particularly those comparing this method with other ones and determining strict indications for it (such as size and location of the defect, tumor characteristics, and previous treatment).
L. G. Kozhanov, А. L. Kozhanov, Yu. Yu. Vyaltseva, А. V. Egorova,
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-85-89

Abstract:
The objective is to report a rare case of laryngeal cancer in spouses. Case report. A 59-year-old female patient was admitted to the Department of Head and Neck Tumors in December 2019 with complaints of hoarseness. In 1997, she had radiotherapy for T1N0M0 laryngeal cancer. After comprehensive examination, she was diagnosed with recurrent laryngeal cancer. The patient has undergone frontolateral laryngeal resection. A 67-year-old male patient was admitted to the Department of Head and Neck Tumors in November 2019 with T3N0M0 laryngeal cancer (diagnosed 2 months before). He has undergone extended frontolateral laryngeal resection followed by radiotherapy in the postoperative period. Discussion. Both patients had no risk factors, such as occupational hazards or smoking. However, both spouses had close relatives with cancer, what indicates their genetic predisposition to malignant tumors. The female patient was found to have human papilloma virus (HPV) in the tumor cells, whereas her spouse was HPV-negative, although rapid histology showed indirect signs of HPV, which does not exclude the elimination of HPV. Conclusion. In this rare case of laryngeal cancer diagnosed in two non-consanguineous spouses, the disease is likely to be caused by their hereditary predisposition, HPV infection, and the fact that they lived in the same socioeconomic conditions.
A. V. Ignatova, , S. О. Podvyaznikov, Yu. V. Alymov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-69-78

Abstract:
Mammary analogue secretory carcinoma (MASC) of the salivary gland is a rare salivary cancer, histologically resembling to secretory carcinoma of the breast. In 2017 World Health Organization reported MASC is a new salivary cancer subtype. The aim of this article is to collect and analyze data about MASC, particularly clinical, histological and molecular profile, to evaluate targeted therapy effects. We discuss a case report of dramatic and durable response with entrectinib and the development of acquired resistance in an NTRK3-fusion positive salivary cancer, detected by next-generation sequencing. Next-generation sequencing as a comprehensive molecular profiling, that helps to investigate molecular profile of rare tumors and gives an opportunity to use an effective therapeutic options. Identifying ETV6-NTRK3 positive MASC provides a better prognosis for metastatic disease by using a novel effective targeted therapy with tyrosine kinase inhibitors (entrectinib, larotrectinib). Despite a durable and dramatic response, we showed an interesting case of the development of acquired resistance to tyrosine kinase inhibitors mediated by the appearance of a novel NTRK3 G623R mutation. Finally, we believe in great perspectives of comprehensive molecular profiling and targeted therapy for rare malignancies with NTRK gene fusions, including second-generation tyrosine kinase inhibitors.
, , S. О. Podvyaznikov, А. V. Ignatova, Yu. V. Alymov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-46-53

Abstract:
The study objective is to perform retrospective analysis of the efficacy and safety of vandetanib for metastatic and non-resectable medullary thyroid cancer in routine clinical practice. Materials and methods. We analyzed treatment outcomes in 46 patients treated with vandetanib. We also evaluated progression-free survival, overall survival, time to progression, and frequency of adverse events. Results. At a median follow-up time of 27.4 months (range: 2.5–106.5 months) and median duration of vandetanib therapy of 21 months, disease progression was registered in 32.6 % of cases, whereas stable disease was observed in 28.3 % of cases and 8.7 % of study participants demonstrated partial response. One patient had complete response to treatment. Almost one-third of patients (28.2 %) died, including 2 individuals whose death was not associated with cancer. The one-year and three-year progression-free survival rates were 67.3 % and 33.3 %, respectively; the two-year and five-year overall survival rates were 82.4 % and 29.4 %, respectively. The efficacy of therapy was confirmed by a 79.4 % decrease in the serum level of calcitonin after treatment initiation. Side effects were observed in 33.9 % of patients (primarily skin and gastrointestinal toxic reactions) and were easily managed in most of the cases. Eight individuals (17.4 %) required cessation of vandetanib due to adverse events. Conclusion. Our findings suggest high efficacy and acceptable safety profile of vandetanib in the treatment of progressive locally advanced non-resectable and disseminated medullary thyroid cancer
Yu. V. Alymov, A. M. Mudunov, S. O. Podvyaznikov, G. Margolin
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-47-54

Abstract:
Introduction. Patients with head and neck tumors are often require tracheostomy. This procedure represents complex surgical manipulation and is associated with risk of certain complications, including life-threatening. The study objective is to essess the results of percutaneous tracheostomy with the new SafeTrach technique. Materials and methods. The study included 21 patients. All patients had a tracheostomy performed using the SafeTrach technique. Results. Mean duration of tracheostomy with SafeTrach technique was 11.8 ± 3.4 minutes independently of patients’ body mass index or previous treatment (correlation coefficients r = 0.08, p = 0.7 and r = 0.08, p = 0.73, respectively). Among all possible complications of tracheostomy only 1 (4.7 %) case of bleeding in postoperative period was noted in our study. Conclusion. The SafeTrach technique combines all the benefits of open and percutaneous tracheostomy. It is characterized by simplicity, it does not require endoscopic control, that indicates the feasibility of its widespread implementation.
D. V. Sikorsky, S. O. Podvyaznikov, N. V. Kanishcheva, M. V. Kuligin, D. V. Skamnitsky
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-38-46

Abstract:
The study objective is to analyze the results of combined antitumor therapy, which included glossectomy, to treat locally advanced and recurrent oropharyngeal squamous cell cancer.Materials and methods. We performed a retrospective analysis of multimodal antitumor therapy of 19 patients, who were treated in the Nizhny Novgorod Regional Clinical Oncologic Dispensary within 2009–2019. All patients underwent segmental resection of the mandible due to massive tumor invasion into the periosteum. After total glossectomy the defect was filled using pectoralis musculocutaneous flap. Due to the wide local tumor spread, a neck dissection (n = 7) or radical cervical lymphadenectomy (n = 12) were performed. During preventive surgery, metastases that were not detected before surgery were revealed in 2 patients in 1 neck lymph node. Results. Eleven patients had local purulent-necrotic postoperative complications. It was noted that after surgery but without radiation therapy complications developed in fewer patients (n = 4) and were less severe: of I degree – in 3 patients, of III degree – in 1 patient. Radiation therapy before surgery resulted in more severe purulent-necrotic complications in 7 patients: of I degree – in 2 patients, of II degree – in 1, of III degree – in 4. Mortality rates: 30-day, 60-day and 90-day – 10.5 %, 21 % and 37 %, respectively. The causes of death were complications of gastrostomy: profuse bleeding from the stomach wall (n = 1), acute psychosis complicated by cerebral edema (n = 1), increased heart failure (n = 1), necrosis of the anterior abdominal wall and cachexia, developed after gastrostomy (n = 1), continued tumor growth between chemotherapy courses (n = 3). Twelve patients survived more than 90 days after surgery, 3 patients – more than 2 years. As most of the patients could not swallow, they were administered a nasogastric tube, since a simultaneous gastrostomy increases the duration of a traumatic operation and aggravates the postoperative period.Conclusion. Multicomponent surgery after radiation therapy results in more often local purulent-necrotic postoperative complications than if the surgery is performed before radiation therapy. High mortality in the first 90 days after surgery (n = 7) due to local cancer spread is generally determined by the severe condition of patients with advanced cancer and the concomitant diseases. However, rejection of gastrostomy in favor of nasogastric tube seems reasonable, since several deaths in the early postoperative period may be occurred due to complications associated with gastrostomy.
S. A. Lukyanov, S. V. Sergiyko, , I. V. Reshetov, Yu. A. Veryaskina, A. V. Vazhenin, A. V. Gostimsky, L. I. Ippolitov, M. O. Rogova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-93-100

Abstract:
Introduction. Post-transcriptional mechanisms play a crucial role in the biological course and clinical manifestations of papillary thyroid cancer (PTC). Recent studies show that an increased content of oncogenic or reduced content of oncosuppressive microRNAs increases the aggressiveness of the tumor and correlates with an unfavorable prognosis of treatment, which allows them to be used in personalizing the treatment tactics of patients with PTC. The study objective is to compare the level of expression of 12 PTC-specific microRNAs and the frequency of V600E mutation of the BRAF gene in patients with different risk of relapse. Materials and methods. The study included 175 patients with PTC. For quantitative analysis of microRNA expression, a reverse transcription reaction followed by a real-time polymerase chain reaction in formalin-fixed paraffin blocks was used. Correlations between 12 microRNA expression and BRAF mutation with different clinical and anatomical features of PTC the risk of relapse according to the American Thyroid Association Risk Stratification System (2009) were analyzed. Results. We demonstrated that miR-146b, miR-221, miR-144, miR-451a, and miR-7 expression correlated with features such as extrathyroid tumor growth, larger size, multifocus, lymph node metastasis, and the presence of distant metastases of the PTC. Most importantly, miR-221, miR-144, miR-451a, and miR-7 expression correlated with risk levels, suggesting their potential significance in stratifying the risk of relapsing PTC. The dependence of the clinical behavior of PTC on the BRAF mutation has not been established.Conclusion. The result of the study will contribute to the individual choice of preoperative treatment tactics for patients with PTC.
G. A. Tkachenko, S. O. Podvyaznikov, , Е. V. Gusakova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-101-106

Abstract:
The study objective is to assess the effectiveness of psychological support to patients with laryngeal cancer after laryngectomy. Materials and methods.This study included 36 male patients aged between 45 and 62 years with morphologically verified stage II–IV (Т3–4N0–2М0) laryngeal cancer treated in the Department of Head and Neck Tumors, N. N. Blokhin National Medical Research Center of Oncology in 2011–2016. Patients were randomized into two groups. Group 1 included 14 patients who received antitumor therapy alone. Group 2 comprised 22 patients who additionally received psychological support. Patients’ mental state was assessed before treatment and 6 months after its completion using the Hospital Anxiety and Depression Scale and Symptom Check List-90 Revised. Two patients from Group 1 and 1 patient from Group 2 were excluded from the study at the first stage. Results. We found that patients in both groups had severe psychopathological symptoms (including depression, interpersonal sensitivity, and severe distress) six month after treatment completion (according to the Symptom Check List-90 Revised). Patients who received psychological support demonstrated higher level of depression than healthy controls, but it was still significantly lower than that in patients who received no psychological assistance. Similar results were obtained by the Hospital Anxiety and Depression Scale: patients who received psychological support had significantly lower level of depression than patients who had no psychological support (8.3 ± 0.9 vs 10.2 ± 0.6 points respectively). Conclusion. Patients with laryngeal cancer who received psychological assistance (including cognitive behavioral psychotherapy) demonstrated significantly lower level of depression 6 months after treatment completion compared to those who received no psychological support.
M. A. Kotov, Z. A.‑G. Radzhabova, , P. I. Krzhivitsky, O. I. Ponomareva, E. V. Kostromina, V. А. Kushnarev, M. A. Radzhabova
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-84-92

Abstract:
The study objective is to evaluate the informativeness of the biopsy technique of the signal lymph node (LN) in squamous cell carcinoma of the tongue cT1–2N0.Materials and methods. A prospective, single-center study included 26 patients with morphologically verified squamous cell carcinoma of the tongue cT1–2 and the lack of clinical and radiological data for metastatic damage to the LNs of the neck. All patients underwent a radioisotope study of the lymphatic flow from the primary tumor and the topography of the signal LNs. The informativeness of the biopsy of the signal LNs was evaluated in accordance with 2 diagnostic models. When using the first diagnostic model, all LNs accumulating colloids labeled with the 99mTc isotope were considered signal LNs. In the second model, only nodes accumulating radiocolloids and located in the immediate vicinity of the primary tumor of the tongue and / or connected with the primary tumor by the “pathway” of the lymphatic vessels were considered as signal LNs. Results. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy, according to the 1st diagnostic model, were 66.6 % (95 % confidence interval (CI) 9.43–99.16), 100 % (95 % CI 85.18–100 %), 100 %, 95.83 % (95 % CI 82.28–99.13 %), 96.15 % (95 % CI 80.36–99.90 %), and when all LNs located along with the signal LNs were removed at the same levels as regional LNs, the sensitivity increased to 100 %. In the second model, the diagnostic values were: 33.3 % (95 % CI 0.84–90.57), 100 % (95 % CI 85.18– 100.00), 100 %, 92 % (95 % CI 83.78–96.24), 92.31 % (95 % CI 74.87–99.05 %). Conclusion. Evaluation of lymphatic outflow from the primary tumor and assessment of sentinel lymph node location in patients with stage cT1–2N0M0 squamous cell carcinoma of the tongue allow a doctor to determine the volume of lymph node dissection for each patient individually. Unilateral lymph node dissection is acceptable in patients with unilateral lymphatic outflow, whereas in patients with bilateral lymphatic outflow, it is associated with a quite high (up to 10 %) risk of metastatic lesions in the lymph nodes on the opposite side of the neck. It is necessary to excise all lymph nodes accumulating radiocontrast agent and regional lymph nodes located at the same levels.
R. Yu. Karabut, A. V. Vazhenin, E. Y. Mozerova, T. M. Sharabura, , А. О. Гузь, A. S. Zakharov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-20-28

Abstract:
Introduction. There is no treatment for recurrence of head and neck squamous cell carcinoma, which significantly increases the overall survival (OS) of patients.The study objective is to analyze the results of treatment of patients with recurrences of squamous cell carcinoma of the head and neck and to assess the impact of risk factors for relapse, as well as different treatment options for relapse on OS. Materials and methods. In the period from 2012 to 2016, 182 patients with relapses of squamous cell carcinoma of the larynx, oral cavity and tongue received treatment in the Chelyabinsk regional clinical center of Oncology and nuclear medicine. The group 1 included 66 patients with resectable relapse who were operated. The group 2 consisted of 25 patients who received a course of radiation therapy. The group 3 consisted of 46 patients who underwent chemotherapeutic treatment of relapse. The group 4 was represented by combined treatment (surgery + radiation therapy), this group included 9 people. The group 5 consisted of those of patients who were not specifically treated for relapse because of the low Karnofsky index in patients ( Results. OS among patients who received special treatment was significantly higher compared with the group of symptomatic therapy. The median OS in the special treatment group was 40 months, and without it – 18 months. Comparing all types for treating relapse, the highest rates of OS were in the surgical treatment group. OS rates in combined therapy group and radiotherapy group were comparable rate in the radiotherapy. The lowest OS rate was after chemotherapy (only 21 months).Conclusion. Surgery is the optimal method for treating recurrent squamous cell carcinoma of head and neck, if it is resectable. If surgical treatment is not possible, no other method significantly increases the OS. If the overall status of the patient is normal, re-radiation or polychemotherapy may be performed. A limited category of patients can be subjected to combined treatment for relapse.
E. V. Borodavina, P. A. Isaev, A. Yu. Shurinov, , V. V. Krylov, K. M. Petrosyan, , , S. O. Podvyaznikov, , et al.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-65-72

Abstract:
Background. The implementation of tyrosine kinase inhibitors into clinical practice improved treatment outcomes in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC). Lenvatinib is recommended as a first-line drug for these patients. The study objective is to analyze clinical experience with lenvatinib in patients with RR-DTC in the Russian Federation. Materials and methods. The data from 18 clinical sites in Russia was analyzed for the period December 2015 and September 2019. Seventyseven patients with histologically verified DTC, proven resistance to radioactive iodine therapy, and tumor progression (according to the Response Evaluation Criteria In Solid Tumors 1.1 criteria) were included in the study. Results.Median progression-free survival in patients included into analysis (n = 72) was 26.1 months. In patients who responded to therapy (including those with partial and complete response), median progression-free survival reached 36.2 months, which is higher than that reported in the updated results of the SELECT study (33.1 months). Lenvatinib-associated adverse events (AEs) were observed in 87 % of patients. Severe AEs were registered in 18.2 % of participants. In 6.5 % of cases, AEs lead to lenvatinib cessation; in 74 % of cases, AEs required dose reduction.Conclusion. Our findings suggest high efficacy and good tolerability of lenvatinib in patients with RR-DTC in routine clinical practice in the Russian Federation.
S. O. Podvyaznikov, , A. V. Ignatova, Д. А. Василькин, A. N. Anisimov, P. I. Shchennikov
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-73-83

Abstract:
Introduction. Basal cell cancer (BCC) accounts for up to 80 % of all types of non-melanoma skin cancers. In 97 % of cases, BCC develops on bare facial skin, especially at the nose-forehead border, nose wings, corners of eyes and lips. Surgery can lead to gross cosmetic defects, therefore more and more specialists prefer conservative methods, among which local drug therapy holds a special place.The study objective is to evaluate the effectiveness and safety of glyciphon ointment for BCC local treatment as well as the economic costs. Materials and methods. The study included 114 patients who underwent BCC local drug therapy with 30 % Glyciphon ointment, where 111 (97.4 %) patients had primary BCC, and 3 (2.6 %) ones – recurrent BCC. Results. The study recorded 115 cases of use of glyciphon ointment in 114 patients. Doctors were fully satisfied with the treatment results in 101 (88.6 %) cases. In 11 (9.6 %) cases, satisfaction was partial due to severe adverse events (edema and hyperemia of the facial skin, pain), and in 2 (1.7 %) cases the treatment was found unsatisfactory. Eighty-six (93.5 %) patients with adverse events continued Glyciphon ointment therapy. The relapse rate after local drug therapy was 4.4 %, indicating its high efficacy and good tolerance. According to the study, most patients required 1 treatment course with 1 package of Glyciphon. Total cost of the treatment is approximately 17,000 rubles. Total budget expenditures are estimated at 1 billion 190 million rubles. Local BCC therapy with Glyciphon comparing to surgery may save more than 1 billion rubles for the state budget.Conclusion. Local chemotherapy with 30 % Glyciphon ointment is an effective and safe method to treat BCC. Its use increases treatment availability for patients and can significantly reduce federal expenditures.
H. Chen, , R. I. Azizian, I. N. Pustynskiy, O. A. Saprina, M. V. Bolotin
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-55-64

Abstract:
The study objective is to assess immediate and long-term results of replacing complex defects with a free radial forearm flap in the multimodal treatment of patients with locally advanced oral cavity squamous cell carcinoma. Materials and methods. Twenty eight patients (20 women and 8 men aged 23 to 71 years) with locally advanced oral cavity squamous cell carcinoma (including 10 buccal cancers, 8 carcinomas of tongue, 6 carcinomas of the floor of the mouth, 2 retromolar area carcinomas, 1 carcinoma of the hard palate and 1 carcinoma of alveolar region of the lower jaw) underwent tumor surgery with simultaneous plastic reconstruction of the defect using radial forearm free flap at the department of head and neck tumors of N. N. Blokhin National Medical Research Center of Oncology within 2010–2018. Primary tumors were detected in 2 patients and 11 patients had residual (n = 7) or recurrent (n = 4) tumors after radiotherapy or chemoradiotherapy. Results. An overall success rate was 96.4 %. Postoperative histology revealed that there were no tumor cells at the resection edges. Postoperative complications included: complete flap necrosis in 1 patient with severe concomitant diseases, marginal flap necrosis in 2 patients (in both cases after the necrotic tissue had rejected, wounds were healed by secondary intention), sural veins thrombosis in 1 patient, acute peptic ulcer bleeding on the 6th day after surgery in 1 patient treated with emergency endoscopic hemostasis. No lethal outcomes were reported. Postoperative period lasted in average 14 days. Upon subsequent observation tumor relapse in the oral cavity occurred in 4 (14.3 %) patients, relapses of regional metastases – in 2 (7.1 %). Good aesthetic and functional results were noted. Adequate restoration of breathing, chewing, swallowing and speaking resulted in a full patients’ rehabilitation. In all cases, the radial flap adapted well to the oral cavity organs and corresponded to the surrounding tissues in thickness and consistency. Conclusion. Use of a radial forearm free flap makes it possible to successfully reconstruct extensive and complex defects after surgery of locally advanced primary and recurrent forms of oral cavity squamous cell cancer of various locations. Due to flap’s high regenerative capabilities, preoperative radiation therapy does not affect the frequency of local complications. It allows restoring vital functions of the oral cavity and achieving good aesthetic and functional results.
A. L. Pylev, A. A. Zhandarova, K. S. Petrov, , V. A. Lisovoy, S. V. Golub
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-10-19

Abstract:
Anaplastic thyroid cancer is one of the most prognostically unfavorable tumors. This disadvantage traditionally consisted of a rapid increase in the size of the primary tumor with a tendency to the development of asphyxia and the rapid appearance of distant metastases, as well as a poor response to the recommended treatment methods. The result of many years of efforts by oncologists around the world were several treatment regimens, including an ideal amount of surgical intervention, chemotherapy and radiation therapy, but the effectiveness of this treatment, as well as the patient’s life expectancy after it, could not be called satisfactory. Improving the understanding of the molecular genetic characteristics of tumors, including anaplastic thyroid cancer, provided us with information on two possible features of the genetic apparatus of tumor cells that can have clinical significance: V600E mutations in the BRAF gene and fusion of NTRK genes. The clinical example described in this article is probably the first Russian illustration of the effectiveness of anti-BRAF therapy in a patient with anaplastic thyroid cancer. From our point of view, the benefit of this example is not only to demonstrate the effectiveness of modern targeted therapy, but also the need not to abandon other treatment methods, in this case, radiation therapy to the area of the primary tumor (and by analogy with this, surgical removal of the thyroid tumor glands in case of its resectability).
, , , , , , D. B. Ismailov, N. I. Mikhaylov, G. L. Kobyakov, Yu. Yu. Trunin, et al.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-1-29-37

Abstract:
Introduction. According to the recommendations of Russian and international professional associations, treatment of germinomas can be initiated without histological verification of the diagnosis, since it can be based on biochemical tumor markers. However, patients with brain germinomas usually have normal levels of these markers; therefore, histological verification is required. Stereotactic biopsy and transcranial biopsy are sometimes associated with a risk of damage to crucial anatomical structures. Currently, both biopsy and total removal of sellar and parasellar tumors can be performed via endoscopic endonasal approach. The study objective is to demonstrate the possibility of using endoscopic transsphenoidal approach for biopsy and total removal of chiasmosellar germinomas. Materials and methods. Thirteen patients with primary chiasmosellar germinomas underwent endoscopic endonasal interventions in N. N. Burdenko National Medical Research Center for Neurosurgery between 2010 and 2017. The “Germinoma-2008” protocol was used in the subsequent treatment of these patients. The male to female ratio was 2.25 : 1; mean age was 21.1 years (6–38 years).Results. The surgery volume varied between biopsy (n = 4) and partial (n = 5) or complete (n = 4) tumor removal. The diagnosis was histologically verified in all patients. None of the patients developed liquorrhea and / or meningitis in the postoperative period, which suggests that the surgery was effective and safe. Conclusion. The endoscopic endonasal approach for histological verification of the diagnosis and removal of chiasmosellar germinomas is safe and effective.
, A. V. Vazhenin, T. P. Berezovskaya, N. G. Afanasyeva, E. V. Vasilyeva, P. I. Garbuzov, V. V. Krylov
Head and Neck Tumors (HNT), Volume 9; doi:10.17650/2222-1468-2019-9-4-10-16

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A. I. Pronin, , D. V. Sashin, N. A. Meshcheryakova, , T. G. Gasparyan
Head and Neck Tumors (HNT), Volume 9; doi:10.17650/2222-1468-2019-9-4-24-31

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D. V. Sikorsky, N. V. Kanishcheva, S. O. Podvyaznikov, D. V. Skamnitsky, S. V. Smetanina, A. M. Ermolaeva, K. V. Bazanov, S. R. Pakhomov
Head and Neck Tumors (HNT), Volume 9; doi:10.17650/2222-1468-2019-9-4-32-37

Abstract:
The study objective is to analyze the experience of conformal radiotherapy in combination with cetuximab for cervical lymph node (LN) metastasis in patients with early-stage tongue cancer who had undergone multicomponent surgeries.Materials and methods. This retrospective study included 48 patients with primary squamous cell carcinoma of the tongue (Т1–2) that were treated in Nizhny Novgorod Regional Clinical Oncology Dispensary between 2012 and 2019. The experimental group comprised 25 patients who underwent hemiglossectomy with simultaneous preventive cervical lymph node dissection. The control group was composed of 23 patients who underwent hemiglossectomy alone due to the presence of concomitant somatic pathology. Before surgery, none of the patients had any signs of metastatic lesions in the cervical LNs according to the results of clinical and instrumental examinations. After surgery, 100 % of patients from the experimental group were found to have N1–2b cervical LN metastases at histological examination. Patients from the control group developed clinical signs of cervical LN metastasis within a year after operation. All patients underwent radiotherapy. The experimental group was divided into two subgroups: patients from subgroup 1 (n = 11) received cetuximab due to disease progression, whereas patients from subgroup 2 (n = 14) received cisplatin. Participants from the control group received no chemotherapy due to their concomitant somatic disorders and because regional metastasis was not confirmed.Results. In the control group, the time between surgery and patient’s death varied between 8 and 14 months. Patients from subgroups 1 and 2 survived for 12–60 months and 8–48 months respectively. So far, 9 patients from subgroup 1 and 6 patients from subgroup 2 are alive. Among them, 8 participants from subgroup 1 and 4 participants from subgroup 2 have no signs of disease progression. Three patients from subgroup 2 died of cardiovascular diseases (they had no cancer progression within 3 months after the completion of chemotherapy).Conclusion. Preventive lymph node dissection in patients with stage Т1–2 tongue cancer enables early detection of subclinical N1–2b metastases and ensures timely initiation of therapy. Our experience confirmed safety of cetuximab plus radiotherapy used to improve disease control and increase patient’s survival.
V. N. Pavlov, R. I. Safiullin, R. R. Bakiev, ,
Head and Neck Tumors (HNT), Volume 9; doi:10.17650/2222-1468-2019-9-4-80-84

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