Russian Journal of Oncology

BACKGROUND: The proportion of pancreatic cancer remains high in the overall cancer incidence. Pancreatic ductal adenocarcinoma is a highly aggressive and lethal tumor.

AIM: To evaluate the microvascular endothelial function in patients undergoing pancreatic head cancer surgery and to establish a correlation with surgical outcomes.

MATERIALS AND METHODS: A prospective observational randomized study was conducted from 2009 to 2022. The study included two cohorts: healthy subjects (control group, n=٤٠) and patients diagnosed with pancreatic head cancer (patient group, n=95) who underwent a Whipple procedure. The assessment of the functional parameters of the microvascular endothelium included measurements of circulating endothelial cell count, von Willebrand factor (vWF), and endothelium-dependent vasodilation.

The patient group was divided into two subgroups: the main subgroup included patients who underwent a laparoscopic Whipple procedure (n=44) and the comparison subgroup consisted of those who underwent laparotomy (n=51).

In the main subgroup, patients were administered a combination of arginine glutamate (1.0 g daily) and enalapril (2.5–5.0 mg daily) for the treatment of endothelial dysfunction.

RESULTS: In the main group, sums of circulating endothelial cell and vWF were significantly lower (7.0±1.4 and 93.6±23.3, respectively), whereas endothelium-dependent vasodilation was higher (9.8±3.2) as compared to the control group (p <0.0001).

In the population of the main subgroup who received endothelial dysfunction treatment, a 4.2- and 4.6-fold reduction in circulating endothelial cell and vWF levels, respectively, was observed (p <0.0001 for both). Additionally, a 4.0-fold increase in endothelium-dependent vasodilation was documented (p <0.0001). The circulating endothelial cell count of more than 7.0×10⁴ cells/L, vWF of more than 120%, and less than 10% increase in endothelium-dependent vasodilation during the study period increase the risk of early postoperative complications by 2.7, 1.9, and 1.7 times, respectively (p <0.0001). The incidence of surgical and non-surgical complications was 28.4 and 24.2%, respectively. The in-hospital mortality rate was 5.3%. In the main subgroup, the incidence of septic and non-surgical complications was 2.5 and 3.1 times lower, respectively, than in the comparison subgroup (p <0.05).

CONCLUSIONS: The combination of endothelial dysfunction treatment and laparoscopic surgical technique has been shown to have a protective effect on the microvascular endothelium in patients with pancreatic head cancer, reducing the risk of early postoperative complications. The baseline vascular endothelial function has been demonstrated to correlate with the risk of early postoperative complications and long-term adverse events, including relapses and/or metastases.

BACKGROUND: The sensitivity of computer tomography (CT) guided transthoracic needle biopsy for the verification of lung tumors is reported to range from 74 to 90%. An augmented reality robotic navigation system for CT-guided percutaneous lung biopsy has been developed to facilitate more precise biopsy of lung lesions. The present study describes the authors’ experience with the navigation system for transthoracic lung biopsy.

AIM: To analyze the safety and diagnostic value of performing a transthoracic biopsy of lung tumors using a robotic CT navigation system.

MATERIALS AND METHODS: The study included a retrospective analysis of CT-guided robot-assisted transthoracic lung biopsy procedures performed in the Thoracic and Abdominal Surgical Oncology Department No. 72 of the Botkin Moscow General Scientific and Clinical Center between November 30, 2023 to April 04, 2024. A total of 104 patients were included in the study. The biopsy was performed following the developed algorithm.

RESULTS: The specimens obtained were morphologically valuable in 91.8% of cases (n=101/110). A total of 1–4 specimens (tissue columns) were obtained from each patient during the biopsy procedure. Specifically, 1 specimen was obtained from 7 patients (6.4٪), 2 specimens from 57 patients (51.8٪), 3 specimens from 43 patients, and 4 specimens from 3 patients (2.7٪). Among the patients for whom morphologically valuable specimens were obtained (n=101), the diagnosis of malignant tumor was confirmed in 76 cases (75.2%). In all remaining cases (n=25, 24.8%), benign lesions or inflammatory/post-inflammatory changes were diagnosed. Complications of various severity degrees occurred in 17 cases (15.5%). No deaths were reported (0%). The findings revealed no statistically significant differences in the frequency of cases with a verified diagnosis based on the diameter of the biopsy needle (p=0.124). Furthermore, the analysis revealed no statistically significant effect of the diameter of the biopsy needle (16G or 18G) on the overall complication rate (18.2 and 9%, respectively; p=0.266) and the frequency of pleural drainage for postoperative pneumothorax (10.4 and 6%, respectively; p=0.72).

CONCLUSIONS: The CT-guided robot-assisted transthoracic lung biopsy is a safe and effective technique for the morphological verification of malignant tumors.

Cancer remains a major cause of mortality worldwide, and its heterogeneity poses significant challenges in the development of effective therapeutic strategies. Recent innovations in molecular biology and immunology have created new opportunities for the development of highly selective therapies that target specific molecular mechanisms of tumor cells. This review discusses recent advances in targeted cancer therapy, including proteolysis-targeting chimeras (PROTACs) for targeted protein degradation, PI3K/AKT/mTOR inhibitors, and antibody-drug conjugates. The review focuses particularly on satituzumab govitecan and datopotamab deruxtecan. It also covers the potential of chimeric antigen receptor (CAR) T-cell therapy targeting antigens such as BCMA. A particular emphasis is given to the role of exportins, specifically XPO1, as potential targets for addressing drug resistance. Recent clinical studies, achievements, and emerging challenges in adopting these novel therapeutic approaches are reviewed. The distinctive contribution of this review is its exhaustive analysis of advanced targeted strategies and immunotherapies that have the potential to considerably improve treatment outcomes and quality of life for patients with various types of cancer. Overcoming resistance and optimizing therapeutic strategies promise to further increase the effectiveness of cancer therapy and improve the quality of patients life.

The term “microbiome” is defined as the community of all microorganisms and their metabolic byproducts within their environment. It also refers to the complete set of genetic material and the relationships between these microorganisms within a specific ecological setting throughout a certain period of time.

The human microbiome profile develops from birth and remains relatively stable throughout adult life. The microbiota’s primary functions include involvement in the most essential processes of the body’s vital activity, such as the development of adaptive mechanisms, immune defense, physiological homeostasis, cognitive function, and regulation of energy resources within the body. Consequently, the microbiota plays a pivotal role in preserving equilibrium within the macroorganism itself and between the macroorganism and its environment.

This article presents the findings of numerous scientific investigations that examine the impact of microbiota on the vital activity of tumors. These studies demonstrate that the microbiota can either accelerate or decelerate tumor growth, and in certain instances, the bacterial community does not contribute to the development of tumors.

Tumors, characterized by the profound cellular changes resulting from the impairment of essential DNA mechanisms, create a specific environment that fosters bacterial colonization. In general, tumor tissue is known to have a higher bacterial load compared to normal tissue. Bacteria have been observed to produce certain metabolites that are subsequently used by tumor cells. Consequently, these bacteria and tumor cells compete directly for nutrients essential to their vital functions. The study examines the conditions underlying a particular scenario in which tumors and microbiota may interact.

The review presents findings from studies that have sought to regulate intratumor microbes as a potential new target for anti-cancer therapy. This includes the use of bacterial platforms and fecal microbiota transplantation.

Additionally, this study presents investigational findings concerning the use of microbiota in the treatment of acute respiratory viral infection, with a focus on chemotherapeutic and immunotherapeutic protocols. These findings corroborate the efficacy of microbiota-based interventions and concurrently highlight the potential for adverse complications.

BACKGROUND: The treatment of chondrosarcoma can be challenging due to the rarity of the tumor, the characteristics of the disease progression, and the variability of its anatomical location. Surgical resection of the tumor is not always feasible, particularly complete resection, due to its proximity to vital organs such as the spinal cord. The low cell sensitivity to chemotherapy and radiotherapy further limits treatment options and poses a poor prognosis. These factors contribute to a high incidence of local relapses, with their frequency reaching 58%. Particular emphasis is hereby placed on the recent advancements in high-dose chondrosarcoma irradiation using stereotactic radiotherapy, a technique that has been demonstrated to effectively overcome the radioresistance exhibited by malignant cells and thereby ensure the comprehensive eradication of the tumor.

DESCRIPTION OF CLINICAL CASE: A female patient diagnosed with chondrosarcoma Th12 underwent Th11-12 laminectomy with the removal of an extratradural extramedullary tumor located on the anterior surface of the dural sac. Contrast-enhanced magnetic resonance imaging revealed a residual tumor two months post-surgery, accompanied by a clinical progression. The relapsed tumor bed was irradiated in a single dose of 9 Gy daily to a total dose of 45 Gy (116 Gy). Five months after the initiation of radiotherapy, a clinical improvement was observed, as evidenced by a decrease in pain on a visual analog scale. Furthermore, the dose of opioid analgesics was reduced. Objectively, based on magnetic resonance imaging findings, the disease stabilized. At the 13-month follow-up, a decrease in the lesion size was documented.

CONCLUSIONS: Stereotactic radiotherapy for residual tumor following chondrosarcoma surgery has been demonstrated to stabilize the patient’s overall condition, reduce the necessity for opioid analgesics, enhance the patient’s quality of life, achieve partial regression of the tumor, and attain long-term disease remission.