№84. Роль мультидисциплинарного врачебного консилиума в онкологии

Tumour board for the decision making is an integral part of the treatment strategy
of the patient. The main issues that are discussed at the MTD are morphological diagnosis,
stage of the disease, the choice of optimal treatment options and their sequence.
Of course, the direct participants of the tumour board should be key specialists from
each area of the oncology. The main goal is to improve the quality of the treatment of
the particular patient. At the same time, the earlier an individual patient is discussed,
the need for unnecessary diagnostic tests is reduced and treatment time is saved.
Definitely, there is a need for research to explore more effective methods to support
these overloaded, but the key MTD for the most effective treatment of the particular
patient in terms of the impact on his overall survival.

Keywords: tumour board, multidisciplinary group (MTD), quality of the treatment, overall survival.

Tumors lesion of the pancreas is a rare, but lethal condition. Early diagnostics and
screening are not effective. It often presents at an advanced stage, and radical surgery is an option only for small group of patients. All risk factors could be divided in two groups: genetically-determined and environmental factors. Most patients with pancreatic cancer remain asymptomatic, and clinical manifestations appear when the disease reaches an advanced stage. Computed tomography is the most effective instrument for diagnostics and
staging in patients with pancreatic tumors. In all cases it is used in combination with laboratory and instrumental research
methods. Treatment of these patients should be complex or in combination of different methods. Treatment should be
in all cases based on pathomorphological verification and performed only in specialized oncological centers. Despite the
advances in science and oncology, patients with pancreatic tumors are still have very poor prognosis.

Keywords: pancreas, cancer, resectability criteria, neuroendocrine tumors, oncological outcomes.

Head and neck oncology is a complex multidisciplinary problem. The core of the professional team consists of a surgeon, radiotherapy specialist and medical oncologists, who determine therapeutic approach for every patient with malignant tumors of upper aerodigestive tract. This review deals with the principles of collaboration of those specialists in the frames of the standard multi-speciality meeting with all its advantages and drawbacks.

Keywords: head and neck oncology, squamous cell carcinoma, multidisciplinary approach, multidisciplinary team.

Despite the big success of drug therapy in advanced forms of renal cell carcinoma, the importance of surgical treatment
is still relevant. Risk and predicting factors affecting the choice of treatment strategies, the expediency of using a surgical
method, including cytoreductive operations, metastasectomy, lymphadenectomy, and removal of tumor thrombi of inferior
vena cava are actively discovered. The authors investigate the influence of these components of surgical treatment on
oncological results. In our work, we have summarized the results of the latest, most relevant studies on the problem of
surgical treatment of advanced forms of kidney cancer.

Keywords: kidney cancer, renal cell carcinoma, cytoreductive surgery, lymphadenectomy, metastasectomy, thrombectomy.

Urgent situations in oncology combine several clinical conditions that might
be a result of comorbidity decompensation, diagnostic or treatment complications,
consequence of underlying cancer. The appearance of this situation usually requires an
application of an urgent algorithm that might not be related to anticancer treatment.
In this article we discuss the algorithms for febrile neutropenia, malignant spinal cord
compression and malignancy related superior vena cava syndrome.

Keywords: febrile neutropenia, malignant spinal cord compression, malignancyrelated superior vena cava syndrome, urgent oncology.

Smoking is the main cause of chronic noncommunicable diseases, mortality from which is 75–80% of total mortality in Russia. At the same time, smoking is number one among the preventable causes of death. Smoking not only increases the risk of cancer, but also affects the survival of cancer patients. Despite the fact that smoking prevalence is decreasing in Russia, 49% of men and 14% of women still smoke. The most effective way to prevent smoking related illness is, to completely, abandon this habit. In the, long run, smoking should be, completely, eliminated. However, in the short term, for smokers with a strong nicotine addiction who cannot give up smoking, it is advisable to switch to electronic nicotine delivery systems (ENDS). ENDS aerosol contains significantly less toxic and carcinogenic substances than cigarette smoke and most likely does less harm to consumers than cigarettes. Given the effectiveness of ENDS for smoking cessation, the transition to them for many smokers will be only a stage for a complete cessation of smoking. For cancer patients, the transition to ENDS eliminates the negative effect of smoking on the outlook. The Russian experience presented in the review of reducing tar levels in cigarettes, which was accompanied by a drop in mortality from lung cancer and other cancers associated with smoking; a decrease in lung cancer mortality among young British men who switched to filter cigarettes; epidemiological studies that proved that lung cancer risk depends on the level of tar confirm that tobacco harm reduction leads to a decrease in the incidence and mortality from cancers caused by smoking. Evidence-based prevention is the most effective method for reducing mortality from all causes.

Keywords: trends, smoking prevalence, mortality, lung cancer, nicotine replacement therapy, electronic nicotine delivery systems, harm reduction.

As a result of the study involving the analysis of the literature data and our own experimental results, it has been shown that modern nicotine delivery systems, alternative to conventional cigarettes (ANDS), indeed exhibit a strong potential in the preventing cancer and other diseases characteristic of smokers. Diverse ANDS are the tools that allow a smoker without psychological stress to reduce risks to a health caused by negative influence of cigarette smoke. However, the methodology of using ANDS is still not sufficiently developed and, in fact, does not take into account the individual needs and physiological risks for each smoker, so the effectiveness of ANDS still raises questions. All contemporary ANDS areconventionally divided into three groups:

1) tobacco-free smoking simulators (tobacco-free and nicotine-free electronic cigarettes),

2) non-inhalation nicotine delivery systems (plasters, chewing gums, nicpacks, snus) and

3) systems combining smoking simulation and nicotine delivery (electronic cigarettes and tobacco heating systems, THS).

Our studies have demonstrated that the preferred strategy for quitting smoking and minimizing biological risks pertains to a combination of using systems from the first and second groups, and particularly, a combination of nicotine-free electronic cigarettes and nicotine packs of oral fixation. According to preliminary estimates based on ongoing preclinical trials, nicpacks with reasonable nicotine content are one of the safest and most effective forms of nicotine delivery.

Keywords: alternative nicotine delivery systems, smoking, cancer prevention.

Myeloid-derived suppressor cells (MDSC) are a heterogeneous population of immature myeloid cells. Their function is to inhibit both adaptive and innate immunity. In chronic inflammation, injuries, malignancies, and other pathological conditions, differentiation of myeloid cells follows the path of formation and accumulation of MDSC. Increased interest in the study of MDCS in oncological diseases is associated with their suppressive effect on the antitumor immune response, which contributes to the progressive growth of the tumor. The review provides a detailed description of the origin of MDSC, their phenotypic heterogeneity, analyzes the main mechanisms of the suppressor function of MDSC and their participation in the suppression of antitumor immunity, provides data on the main therapeutic approaches aimed at overcoming the suppressor function of MDSC.

Keywords: myeloid suppressor cells, immunosuppression, oncology, immunotherapy, antitumor immunity.

Laryngeal cancer is the most common malignant tumor among ENT organs. Treatment of patients with cancer of the
larynx IV is usually combined or complex. Patients with metastatic laryngeal cancer already have nutritional insufficiency
of varying severity before starting treatment. In the treatment of patients with locally advanced laryngeal cancer, special
attention should be paid to nutritional support. The article presents the data of the study on the use of detoxifying dietary
therapeutic nutrition in patients diagnosed with laryngeal cancer stage IVA T4aN0M0 during complex treatment.

Keywords: squamous cell carcinoma, detoxication, nutritional support, laryngectomy, larynx.