Background. Given the high prevalence of hormone-sensitive breast cancer in Russia and around the world, it is extremely important to address the issue of indications for neoadjuvant (NACT) or adjuvant chemotherapy, as well as the scope and regimens of treatment. The article presents the results of our own study, considers the problems of toxicity and tolerability of dose-dense and standard NACT regimens.

Aim. To study the tolerability of dose-dense and standard NACT regimens.

Materials and methods. The prospective study included 109 patients. 53 patients received dose-dense NACT as preoperative treatment, 56 – the standard NACT regimen.

Results. In dose-dense NACT, the frequency and severity of anemia (p = 0.038), hepatotoxicity (p <0.001), peripheral polyneuropathy (p <0.001) increased, but the frequency of delayed start of the cycle in general (p = 0.012) and delay due to neutropenia (p <0.001) decreased.

Conclusion. When planning preventive chemotherapy in the treatment of breast cancer (NACT or adjuvant chemotherapy), it is necessary to take into account not only the oncological results in increasing recurrence-free and overall survival, but also the tolerability of therapy.

Background. Tumors of the gastrointestinal (GI) tract are characterized by high morbidity and poor prognosis. Over the past decade, sarcopenia (skeletal muscle depletion), myosteatosis, sarcopenic obesity were all shown to have negative prognostic effect in patients with various GI malignancies. However, the role of sarcopenic obesity (SO) in patients with GI tumors remains controversial. We have summarized clinical trial data on the effect of SO on treatment results in patients with malignant GI tumors who underwent surgical and/or drug antitumor treatment.

Materials and methods. Thisstudy was conducted in comliance with the Preferred Reporting Itemsfor Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched for relevant original studies published between January 2009 and December 2022 reporting postoperative complication rate and mortality, long-term survival and chemotherapy toxicity in SO patients with GI cancers.

Results. Twenty four studies with 9,601 patients were included. The percentage of SO patients ranged from 2.6 to 51 %. Due to significant heterogeneity of SO determination methods and varying threshold values, the association between SO and outcomes of interest was inconsistent. SO was significantly associated with development of major postoperative complications in six studies. In contrast, three studies did not show any effect of SO on postoperative complications. Only two studies demonstrated that the mortality rate was significantly higher among patients with SO compared to those without SO. Four studies using multivariate analysis showed statistically significant effect of SO on long-term survival, one study – on disease-free survival. However, three trials contradicted this finding and reported that SO was not a negative prognostic factor of long-term survival in GI cancer patients. Three studies investigating SO effect on the outcomes of drug antitumor treatment showed negative effect of SO on chemotherapy toxicity.

Conclusion. There is considerable heterogeneity in methods used to define SO in the literature, and current data is limited. Standardized terminology and deeper understanding of sarcopenic obesity pathophysiology is needed to further understand the effect of obesity and sarcopenia on clinical trajectory of patients with GI cancer.

Giant cell tumor of bone is a locally aggressive primary bone neoplasm affecting patients aged 20–50 years. Neoplastic stromal cells have a phenotype of immature osteoblasts synthesizing various cytokines and molecular factors leading to excessive activation of osteoclastogenesis and increased osteolysis in giant cell tumor of bone. Long-term treatment with denosumab is recommended for unresectable or disseminated disease.

A clinical case of long-term treatment with denosumab of initially generalized giant cell tumor of the right ischial bone with metastases to the lungs is presented. Stabilization of the process was first recorded 3 months after the start of therapy and has been maintained to date. The patient was transferred to a maintenance regimen 3 years after the start of treatment. The treatment was not accompanied by adverse events characteristic of bone-modifying agents.

Long-term use of denosumab allowed effective control of the tumor process and maintenance of satisfactory quality of life of the patient. Maintenance regimen of denosumab administration was not accompanied by a decrease in treatment effectiveness.

Hypopharyngeal injury in the pyriform sinus area during diagnostic gastroduodenoscopy is a rare and potentially severe complication.

In this paper, we describe successful treatment of a patient with such an injury complicated by the development of a soft tissue abscess of the neck. Treatment of the purulent complication was surgical and consisted of opening and draining of the soft paratracheal tissue abscess on the left side of the neck. The most important components of the treatment were antibiotic therapy and temporary prohibition of natural nutrition (nil per os) with complete parenteral and then enteral tube nutrition, which was continued until complete healing of the laryngeal injury. The patient suffering from pancreatic cancer was discharged from the clinic with restored natural (oral) food intake, in a satisfactory functional state and without weight loss.