ISSN (print): 1815-1434, ISSN (online): 1815-1442 Founder: Meditsinskie izdaniya Editor-in-Chief: Poddubnaya Irina Vladimirovna, Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor Frequency / Access: 4 issues per year / Open Included in: White List (4th level), Higher Attestation Commission List, RISC, Scopus
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Intermediate results of the PERFECTION observational study in a population of patients with metastatic, persistent and recurrent cervical cancer
Background. Cervical cancer (CC) is among the four most common malignancies among the female population. For a long time, platinum-based chemotherapy was the standard of care and practically the only option available. However, treatment outcomes for patients with metastatic and recurrent CC remained poor. The use of immune checkpoint inhibitors significantly increased progression-free survival and overall survival in this group of patients. Currently, pembrolizumab is a priority option in treating patients with metastatic, persistent, recurrent CC with CPS ≥ 1 and is included in international and Russian clinical guidelines. Aim. To evaluate the efficacy and safety of a pembrolizumab biosimilar (Pembroria®) in patients with metastatic, persistent and recurrent CC in the interim analysis of the PERFECTION observational study. Materials and methods. The study included a group of 51 patients diagnosed with stage IV CC. The treatment efficacy was analyzed using the Fleming method with the objective response rate criterion according to RECIST 1.1. Safety was assessed by the incidence of adverse events (AEs) and serious AEs according to the CTCAE 5.0 toxicity scale. Results. At stage g2, an objective response was reported in 24 (47.1%) patients, which exceeded the target threshold (22 responses). 5 (9.8%) patients experienced immune-mediated AEs, a total of 6 cases, including 1 case of grade 3 AE. The overall objective response rate was consistent with KEYNOTE-826, but the AE rate was lower (34.5% in KEYNOTE-826). Conclusion. Pembroria® has demonstrated efficacy comparable to that of the original pembrolizumab product and an acceptable safety profile. Differences in the incidence of immune-mediated AEs associated with Pembroria® require further study, considering the duration of observation and sample size. The results support using Pembroria® in routine clinical practice.
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Interim results of an multicenter observational clinical study on treatment strategies for chronic lymphocytic leukemia/small lymphocytic lymphoma in Russia
Aim. To evaluate the survival rates in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in routine clinical practice in Russia and to analyze the impact of clinical and demographic factors on therapy selection and treatment outcomes. Materials and methods. An observational study of CLL/SLL treatment strategies has been conducted in 34 centers in Russia from 2021 to the present. Effectiveness was assessed based on survival rates, clinical characteristics, and therapeutic approaches. Statistical analysis included descriptive methods and Kaplan–Meier curves for survival outcomes. Cox proportional hazards models were used to assess the influence of various factors on progression-free survival (PFS). Results. As of the interim analysis (2021–2024), a total of 2,094 patients were included in the study. The majority of the cohort consisted of male patients (54.11%) aged ≥ 65 years (59.8%). Most patients (77.94%) had a favorable performance status of 0–1 according to the ECOG scale. Among molecular-genetic alterations, wild-type TP53 (86.43%) and IGHV (69.27%) were most commonly observed. According to the analysis of treatment data, the most frequently prescribed combinations were FCR (22.32%) and RB (18.67%). In later treatment lines, the proportion of targeted therapies increased. Overall survival among 1654 patients with known treatment start date remained high throughout 10 years of follow-up, and was 93.88% by year 10. Progression-free survival (PFS) was assessed for all patients receiving first-line therapy, including retrospective data. PFS was assessed separately for the second and subsequent lines by type of therapy. PFS among patients who received first-line therapy, regardless of the type of chemotherapy and the presence of TP53/IGHV mutation after 5 years was 76.93%. PFS in the targeted therapy group in patients who received the third, fourth and subsequent lines of therapy was significantly higher than in the immunochemotherapy group (p = 0.001 and 0.009 respectively). According to the Cox model, among patients who received first-line therapy, a significant association of a reduced risk of progression with male gender was shown (HR 0.52, 95% CI 0.33–0.82; p < 0.005). There was a trend towards an association of TP53 mutation with a high risk of progression (HR 2.02, 95% CI 0.91–4.51; p = 0.084), but statistical significance was not achieved. In patients who received the third, fourth and subsequent lines of therapy, targeted therapy was significantly associated with a lower risk of progression (HR 0.16, 95% CI 0.05–0.53; p = 0.002 and HR 0.27, 95% CI 0.10–0.75; p = 0.012, respectively). Conclusion. The interim analysis showed generally favorable PFS dynamics, but some subgroups of patients, e.g., those with TP53 mutation, demonstrated a less favorable prognosis. Targeted therapy was significantly associated with a lower risk of disease progression among patients receiving third, fourth, and subsequent lines of therapy. The obtained results confirm the data on the high efficiency of targeted therapy in the treatment of CLL/SLL, especially in patients with an aggressive course of the disease and unfavorable prognostic factors.
Multimodal prehabilitation in patients with gastrointenstinal cancer and cachexia: results of pilot study
Background. Patients undergoing surgical treatment for gastrointestinal tumors often suffer from symptoms of cachexia and sarcopenia. Preoperative preparation, or “prehabilitation”, is a potentially effective new approach to managing these patients. Aim. To evaluate whether multimodal prehabilitation decreases postoperative complications and improves functional recovery in cachexic patients undergoing gastrointestinal cancer surgery, in comparison to usual clinical care. Materials and methods. This prospective cohort study included data on 36 patients who underwent surgical treatment for gastrointestinal cancer from 2022 to 2023 at our cancer hospital. Sarcopenia and cachexia were assessed preoperatively using modern international consensus criteria. Patients participated in remote comprehensive prehabilitation program which encompassed nutritional and psychological support and supervised exercise. After prehabilitation functional results were assessed. Also, the 30-day postoperative complication rate measured according to the Clavien–Dindo criteria as well as 30-day and 90-day mortality. Results. After prehabilitation, 24 (66.6%) patients showed a statistically significant decrease in 400 m walking time (p = 0.028); 25 (69.4%) patients gained weight from 0.5 to 6 kg (p < 0.001). Conclusion. Multimodal remote prehabilitation can improve functional status in patients with gastrointestinal cancer and cachexia.
Prospects for the use of big data, artificial intelligence, machine learning, neural networks, and deep learning in the diagnosis and treatment of malignant tumors of the genitourinary system: a review
The review presents a comprehensive analysis of the latest advances in machine learning (ML), artificial neural networks (ANN), and deep learning (DL) in urologic oncology. As part of the study, the Russian and foreign scientific literature was ranked based on PubMed, MEDLINE, E-library, CYBERLENINKA, etc. The data related to the use of ML, ANN, and DL in the diagnosis and treatment of prostate cancer (PCa), bladder cancer (BC), testicular cancer, and kidney cancer was collected. Most often, ANN and ML in PCa were used for early diagnosis, prognosis, and personalized systemic treatment strategy development. ANN and DL models were trained with clinical parameters, NGS-sequencing results, Gleason scores, and digitized radiological, and histological images. Radiomics was also used to diagnose PCa, followed by analysis of special image texture features on a digital slide. In metastatic castration-resistant PCa, artificial intelligence (AI) algorithms were used to predict the response to docetaxel treatment. The prospects of using AI for tumor imaging during radical prostatectomy and when performing robot-assisted kidney resection were also addressed. A diagnostic approach for testicular malignancies based on computed tomography data is proposed using ML. Neuro-fuzzy modeling and ANN were used to diagnose BC. The algorithms were based on molecular biomarkers, including gene expression and methylation. The ML method based on images of cells obtained from urine samples of patients diagnosed with BC showed a diagnostic accuracy of 94%. DL in BC was used for accurate tumor typing based on their response to chemotherapy. Based on the results of deep machine learning, the molecular subtype of BC samples was predicted using histological examination. ML and DL algorithms for diagnosis, differential diagnosis, and prediction of recurrence and survival in kidney cancer were trained on CT texture analysis, genetic mutations, and Fuhrman nuclear grade. In addition to diagnosis, AI is used to optimize the treatment strategy for kidney cancer. In all cases, the ML, ANN, and DL algorithms improved the accuracy of diagnosis, survival assessment, and the effectiveness of pharmacological and surgical treatment of urologic malignancies.
Cancer-associated thrombosis: pathogenesis, risk factors, and treatment. A review
Cancer-associated thrombosis (CAT) is one of the most frequent and dangerous complications of malignancies, ranking 2nd among the causes of death in cancer patients. The article presents an overview of current data on the pathogenesis of thrombosis in cancer patients, including the key role of tumor cells, inflammatory cytokines, neutrophil extracellular traps, and dysregulation of hemostasis. CAT epidemiology, individual (age, comorbidities, mobility) and tumor-dependent (location, stage, histology) risk factors, as well as the effect of various types of anticancer therapy, including chemotherapy, surgery, and the use of central venous catheters, are considered. Particular attention is paid to modern approaches to the prevention and treatment of CAT, including direct oral anticoagulants, their advantages over low molecular weight heparins, and data from large randomized trials (CARAVAGGIO and API-CAT). The review includes an analysis of international and Russian clinical guidelines (ASCO, NCCN, RUSSCO), focusing on the need for an individual approach, considering the clinical situation, the risk of bleeding, and drug interactions. The presented data emphasize the importance of timely detection of CAT and rational choice of therapy to reduce the risk of complications and improve the prognosis in cancer patients. The presented data emphasize the importance of timely detection of CAT and rational choice of therapy to reduce the risk of complications and improve the prognosis in cancer patients. In addition, a reduced dose of apixaban (2.5 mg twice daily) after 6 months of therapy was found to be effective in preventing the recurrence of venous thromboembolism and reducing the incidence of clinically significant bleeding compared to the full dose.
Role of repeat biopsies of metastatic and recurrent lesions for the study of tumor heterogeneity in luminal breast cancer: Retrospective and prospective analyses
Introduction. Current guidelines (NCCN, ESMO, RUSSCO) for the treatment of breast cancer (BC) with the disease progression recommend performing a repeat biopsy with a reassessment of immunohistochemical (IHC) status. However, due to the weak evidence base, the indications and clinical significance of repeat biopsies are not clear, and repeated IHC examinations of histological specimens have not yet been introduced into routine practice. The dependence of the change in the tumor immunophenotype on its clinical and biological characteristics, and hence the potential markers for deciding to perform a repeat biopsy, remain poorly studied. Aim. To evaluate phenotypic variability of luminal BC based on comparison of repeat biopsies of recurrent/metastatic lesions with biopsies of primary tumors before treatment, and to study the effect of this variability on the treatment of the disease. Materials and methods. Between 2019 and 2024, 100 patients with early luminal A and B BC underwent a core biopsy of the primary tumor before treatment and a biopsy of a recurrent or metastatic lesion after the disease progression. In our study, the influence of the main clinical and morphological factors (patient's age, tumor differentiation degree, localization of metastases, presence of the driver mutations in the BRCA1/2 and PIK3CA genes, IHC subtype of the tumor, as well as administered chemotherapy, antihormonal, and radiation therapy) on the frequency of detection of discordance between paired biopsies was determined. The impact of discordance detection on further treatment approaches was also assessed. Results. Discordance of the IHC study results between the primary tumor before treatment and recurrent/metastatic lesions was found in 57% of cases, of which 37 cases were associated with a change in the tumor subtype, 20 cases with the loss/acquisition of IHC parameters that do not lead to conversion. Tumor subtype conversion was observed in 37% of cases. The luminal A subtype was the most unstable; in 54% (20/37) of cases, it converted into the luminal B subtype. The IHC discordance detection led to a treatment change in 48% of cases (27/57). There was no statistically significant effect of the studied clinical and morphological factors (see materials and methods) on the probability of discordance detection. However, the probability of conversion by multivariate analysis was significantly less in the luminal B subtype (70% less than in luminal A subtype) [odds ratio (OR) lumА/lumВ = 0.30, 95% confidence interval 0.10-0.80; p = 0.018], and adjuvant antihormonal therapy with tamoxifen was associated with a 79% reduction in the probability of conversion when compared with adjuvant treatment with aromatase inhibitors [OR IA/TAM = 0.29 (95% confidence interval 0.10-0.82); p = 0.024]. Conclusion. Performing a repeat biopsy in patients with luminal BC can reveal the discordance of IHC characteristics in 57% (57/100) of patients and the therapy-induced tumor subtype conversion in 37% (37/100) of patients, which led to a change in treatment approaches in more than 1/3 of cases (48%, 27/57). Risk factors for conversion of the IHC subtype include the luminal A subtype of the primary tumor and adjuvant antihormonal therapy with aromatase inhibitors. For this category of patients, a repeat biopsy is necessary since it helps to individualize further anti-tumor treatment.
Novel therapies for the metastatic HER2-positive breast cancer with metastases in the central nervous system: a clinical case
The molecular subtype of breast cancer (BC) associated with overexpression of HER2/neu is characterized by more frequent and early metastasis to the central nervous system, predetermining poor prognosis for patients in this category. Patients with secondary brain lesions due to tumors of any localization and histological structure are the most complex group of patients, with an extremely low level of quality of life and requiring special close monitoring and the development of a personal management algorithm. The introduction of a new drug, trastuzumab deruxtecan (T-DXd) [conjugate of a humanized immunoglobulin G1 antibody to the HER2 receptor and a topoisomerase I inhibitor, an exatecan derivative], as a new therapeutic option is a hope for patients with metastatic BC, including those with central nervous system involvement. The article presents the results of randomized clinical trials that supported these indications and the DESTINY-Breast12 phase IIIb/IV study, demonstrating the high intracranial activity of the drug. A case is presented to illustrate the efficacy of trastuzumab deruxtecan in a patient with HER2-positive (HER2+) metastatic BC with brain metastases.
Preclinical studies of cytotoxicity and cytostatic activity of five new imidazotriazine derivatives in MDA-MB231, BT474, and MCF-7 breast cancer cell cultures
Background. The results of the study of new imidazotriazine derivatives are presented to support their use as antitumor agents, including for breast cancer (BC) chemotherapy. The study is relevant due to the high prevalence and mortality of BC and other socially significant cancers. Antitumor drugs have limitations in their efficacy due to the primary or acquired drug resistance. As a result, 30% to 50% of patients do not receive adequate treatment, determining the need to develop new antitumor drugs. Aim. To evaluate the antitumor potential of 5 new imidazotriazine derivatives by testing their cytotoxic (CTA) and cytostatic (CSA) activity on BC cell cultures. Materials and methods. Culture of MCF-7, MDA-MB231, BT474, and MCF-10a cells and determination of CTA and CSA of imidazotriazine derivatives at concentrations ranging from 0.25 to 10.0 mmol/L. Results. For the MCF-7 culture, the maximum cell survival inhibition by the comparator (temozolomide) was 2.44, and the concentration causing 50% cell death (IC50) was 6.81 mmol/L; for other cell cultures, CTAs were slightly lower. Imidazotriazine 2 and imidazotriazine 3 showed values below or close to temozolomide; IC50 was not achieved in most cases. These two derivatives were considered to have low CTA and moderate CSA. Imidazotriazine 4 and imidazotriazine 5 showed higher activity than the comparator and were considered compounds with moderate CTA and CSA. Finally, imidazotriazine 1 showed the highest CTA and CSA values with a maximum cell survival inhibition of 4.35 and an IC50 of 1.94 mmol/L. Conclusion. Based on the results of the in vitro study, five new imidazotriazine derivatives have CTA and CSA in the following ascending order: imidazotriazine 2, imidazotriazine 3 < temozolomide < imidazotriazine 4 < imidazotriazine 5 < imidazotriazine 1. Therefore, 4-aminoimidazo[5,1-c][1,2,4]triazine-3,8-dicarboxylic acid diethyl ether (imidazotriazine 1) is the most promising new imidazotriazine derivative and is recommended for further preclinical studies.
Renal cell carcinoma associated with von Hippel–Lindau syndrome: an ambispective study
Background. Renal cell carcinoma (RCC) associated with von Hippel-Lindau syndrome (VHL) is characterized by multifocal bilateral involvement of the renal parenchyma and is the leading cause of death in this category of patients due to disease progression or the development of end-stage chronic kidney disease. Aim. To analyze the treatment outcomes of patients with RCC associated with VHL syndrome. Materials and methods. The ambispective study included data of 30 patients treated with VHL-associated RCC from 2016 to 2024. In 23 (76.7%) cases, VHL syndrome was classified as type 1, and in 7 (23.3%) as type 2B. Non-metastatic RCC at the initial diagnosis was detected in 28 (93.3%) patients and metastatic RCC in 2 (6.7%). Extrarenal manifestations of VHL syndrome occurred in all patients. Watchful waiting was used in 6 (20.0%) patients, surgical treatment of renal parenchyma tumors in 21 (70.0%), metastasectomy – in 2 (6.7%), and systemic antitumor therapy in 3 (10.0%). Treatment of extrarenal manifestations of VHL syndrome included surgical interventions in 20 (66.7%) patients, radiation therapy in 8 (26.7%), and laser therapy in 9 (30.0%). The median follow-up for all patients from the RCC detection was 46.6 [1-249.5] months. Results. The four-year overall (OS) and disease-specific (DSS) survival rates for all 30 patients were 93.3% and 93.3%, respectively. In 28 patients with primary non-metastatic RCC, the 4-year metastasis-free survival (MFS) was 74.2%. In 21 patients after radical surgery for the primary non-metastatic renal cell carcinoma, the 4-year OS was 88.9%, DSS was 88.9%, relapse-free survival (RFS) was 62.9%, local recurrence-free survival was 53.9%, and MFS was 63.6%. In patients with distant metastases, the 4-year OS was 66.7%. Two (6.7%) patients developed terminal chronic kidney disease requiring permanent hemodialysis. Conclusion. VHL-associated RCC is a chronic disease with a torpid course, allowing to recommend organ-sparing treatment of primary tumors and metastasis-directed therapy of oligometastases. Antiangiogenic therapy is effective in metastatic RCC.
Diagnosis of renal cell carcinoma in patients with prostate cancer: capabilities of PET/CT with 18F-PSMA-1007
Background. Prostate cancer (PCa) ranks 4th and 8th in the structure of morbidity and mortality worldwide. Combined positron emission and X-ray computed tomography (PET/CT) with a ligand of a prostate-specific membrane antigen is very encouraging in prostate cancer, renal cell carcinoma (RCC), lung cancer, and breast cancer in the staging work-up of the primary tumor, evaluation of the therapy effectiveness, and observation. Aim. To evaluate the capabilities of PET/CT with 18F-PSMA-1007 for the diagnosis of primary renal tumors in patients with PCa. Materials and methods. The study included 492 patients with histologically confirmed stage I–IV PCa. All patients were examined with PET/CT with 18F-PSMA-1007 during staging work-up, therapy, follow-up, and restaging in case of progression. The imaging was performed on a GE Discovery PET/CT 710 scanner. Results. Twenty-four (4.9%) patients had multiple primary malignancies of various localizations. In 8 (1.6%) of them, clear-cell RCC was diagnosed. The median age was 73.3 years. In most cases, the tumor was synchronous (6 [75%] patients) and metachronous (2 [25%] patients). The tumor was localized in the left kidney in 6 (62.5%) patients and the right kidney in 3 (37.5%) patients. The tumor was diagnosed in the upper segment in 5 cases, in the anterior segment, in 2 patients, and 1 patient had the tumor in the lower segment. The size of the primary tumor averaged 33.8 mm, corresponding to the T1a category. The median SUVmax in the tumor was 17.92. Histological examination of tumor biopsy specimens showed clear-cell RCC. In the first stage, surgical treatment was performed on 7 patients: 2 had laparoscopic nephrectomy, and 5 had organ-sparing interventions with an endoscopic approach. Systemic therapy was administered to 1 patient. Conclusion. PET/CT with 18F-PSMA-1007 is an alternative method for assessing the extension of the tumor process in patients with PCa during therapy and diagnosis. It detected primary multiple renal tumors in 1.6% of patients. The tumor size averaged 33.8 mm, corresponding to the T1a stage. In such cases, treatment should begin with surgery, allowing for the tailoring of treatment options.
Solid malignant neoplasms occurring against the background of HIV infection: diagnosis, treatment, outcomes – the experience of the Tsyb Medical Radiological Research Centre. Observational study
Background. More than 630,000 people die annually worldwide as a result of HIV, while malignant neoplasms (MN) are steadily coming to the fore among the causes of death. At the moment, there is not enough data on the treatment of HIV-infected cancer patients. Aim. To analyze the experience of treating HIV-infected patients with solid MN who underwent therapy at the Tsyb Medical Radiological Research Centre from 2018 to 2024. Materials and methods. The study included 154 patients, median follow-up – 35 months. The average age of the patients was 45.4 (30–78) years; 86 (55.8%) women prevailed. The following diagnoses were most often made: cervical cancer (n = 30, 19.5%), thyroid cancer (n = 22, 14.3%), breast cancer (n = 16, 10.4%), head and neck tumors (n = 24, 15.6%). In half of the patients, early stages (I–II) of MN were confirmed – 78 (50.6%), generalized tumor process in the onset of MN was observed only in 34 (22%) patients. The majority of patients – 136 (88.3%) had AIDS. HIV infection was confirmed at various times before the development of MN – from 6 to 279 months, on average after 114 months. The majority of patients have stage 4 HIV – 124 (80.6%). Suppressed viral load – less than 50 copies of viral RNA in 1 ml of blood, was detected in 96 (62.3%) patients. At the time of the start of specific antitumor treatment, the vast majority of patients – 132 (85.7%) have received antiretroviral therapy (ART), another 22 (14.3%) patients started taking ART after an oncological diagnosis. The level of CD4+ cells at the onset of MN was determined in all patients, ranged from 54 to 1036 cells/ml, with an average value of 454 and a median of 401 cells/ml. There were 12 (7.8%) patients with CD4+ cell count less than 200 per µl. Viral hepatitis (B or C) was previously detected in 24 (15.6%) patients, tuberculosis – in 6 (3.8%). Results. Surgical treatment was performed in 82 (53.3%) patients, of which 74 (90.3%) patients received surgery as a stage of program therapy, and for 8 (9.7%) patients surgical treatment was an independent type of therapy. Radiation/chemoradiotherapy was performed in 50 (32.5%) patients, of which 31 patients received it as a stage of program treatment (62%), and for the remaining 19 (38%) patients, radiation treatment was an independent type of therapy. Antitumor drug therapy was performed in 66 (42.8%) patients: neoadjuvant therapy in 12 (18.1%) patients, adjuvant therapy in 22 (33.3%) patients, palliative chemotherapy therapy in 32 (48.6%) patients. Complications of antitumor therapy were observed in 18 (27.3%) patients, complications of surgical treatment were observed in 1 (1.2%) patient, complications of radiation therapy were identified in 14 (36.8%) patients from the EBRT group, complications of chemoradiotherapy were observed in 6 (50%) patients. During the follow-up, 4 (2.6%) deaths of patients with combined pathology were registered: in two cases, death occurred due to the progression of a malignant tumor, in the other two – due to severe infectious complications during antitumor therapy. Conclusion. Thus, it is possible for oncological patients with HIV to undergo the entire volume of antitumor treatment, equal to that of patients without HIV, which allows achieving the same oncological results. Appropriate therapy becomes possible with adequate prevention of infectious complications, monitoring of ART, and monitoring drug interactions.
Results of lenvatinib as first-line targeted therapy for advanced hepatocellular cancer: a retrospective study
Background. Hepatocellular carcinoma (HCC) is one of the most aggressive tumor diseases, with an annual increase in morbidity and mortality. Therefore, the studies for effective treatment options is crucial. The evolution of HCC treatment and the priority of immunotherapy in the first line of advanced HCC leave questions about the place and effectiveness of tyrosine kinase inhibitors in the first line of antitumor therapy. Aim. This study evaluated the efficacy and tolerability of lenvatinib in patients in the first line treatment advanced HCC in real clinical practice. Materials and methods. The retrospective study included 41 patients who received targeted therapy with lenvatinib as the first line for unresectable HCC in medical institutions of the Russian Federation and were observed at Blokhin National Medical Research Center of Oncology. Results. The median progression-free survival in patients treated with lenvatinib was 13.9 months. The median overall survival (OS) was 27.3 months. One-year OS was 80%. Two-year OS was 56%. The best response to treatment in our study was stabilization in 67% of cases, and disease progression during therapy was observed in 23% of cases, assessed using mRECIST. Conclusion. In a selected cohort of patients with advanced HCC, tyrosine kinase inhibitors (in particular lenvatinib) was studied and the efficacy of lenvatinib treatment was demonstrated in key survival indicators in the first line of HCC therapy in real clinical practice. There was also a low incidence of adverse events leading to discontinuation of therapy and dose reduction.
Prognostic significance of primary and interval cytoreductive surgery in late-stage ovarian cancer. A retrospective study
Background. Modern methods of treatment of late-stage ovarian cancer (III–IV) are based on the immediate and maximum surgical removal of all manifestations of the tumor process. However, in some cases, surgical treatment has to be performed after neoadjuvant chemotherapy. Differences in the effectiveness of treatment with both approaches are the subject of discussion in oncogynecology. Aim. Analysis of overall survival and progression-free survival in patients with late-stage ovarian cancer (IIIC–IVB) depending on the timing and optimality of cytoreductive surgery. Materials and methods. A retrospective analysis of 467 patients with stage III–IV ovarian cancer who received comprehensive treatment at the Primorsky Regional Oncological Dispensary in the period 2004–2021. Results. Significant advantages in overall survival and progression-free survival were in patients with ovarian cancer of stages IIIC–IVB, who underwent primary cytoreduction (PCR), compared with patients who underwent interval cytoreduction. With suboptimal PCR volume, the overall survival rate is significantly lower than with full or optimal PCR. There is a tendency to better OS and IBD in patients with PCR in full and optimal volume, compared with patients who underwent PCR in full or optimal volume. Neoadjuvant chemotherapy in patients with serous ovarian carcinoma of low-grade IIIC–IVB stages significantly worsens immediate and long-term treatment results. Conclusion. In patients with advanced ovarian cancer, performing primary cytoreduction in full or optimal volume is the main treatment. Neoadjuvant chemotherapy is justified only as a therapy of despair in severe general condition or extreme prevalence of the disease.