MD-Onco

Background. Sex hormones play a crucial role in normal sexual and reproductive development during puberty. Hodgkin’s lymphoma (HL) and its chemotherapy may significantly disrupt hormonal balance, adversely affecting the reproductive system.

Aim. To investigate the levels of sex hormones – estrone (E1), estradiol (E2), estriol (E3), progesterone (P4), total testosterone (T), free testosterone (FT), sex hormone-binding globulin (SHBG), as well as estrogen receptors α (ERα), β (ERβ), and androgen receptor (AR) – in the blood of pubertal children with HL before chemotherapy (CT) and after its completion.

Materials and methods. The study included 40 pubertal children of both sexes with HL (median age 13.65 years, range 11–17). The control group consisted of 40 age- and sex-matched healthy children (median age 15.25 years). Hormone levels were measured in blood samples from the patient group before treatment and 14 days after completing all CT courses. Reference values were derived from the control group. Statistical analysis was performed using Statistica 10 software.

Results. Prior to HL treatment, girls showed a 27.8-fold increase in E3 compared to controls. Levels of E1, P4, T, FT, and AR were decreased by 2.4-, 3.7-, 2.0-, 2.3-, and 3.0-fold, respectively. Post-CT, E1 decreased 3.4- and 8.0-fold relative to pre-treatment and controls, respectively; E3 decreased 3.8-fold but remained elevated 7.3-fold above controls. P4 was reduced 2.0- and 7.5-fold versus pre-treatment and controls. ERα declined 8.3- and 7.5-fold relative to pre-treatment and controls. T and FT remained decreased by 2.0- and 1.9-fold, respectively. AR increased 2.2-fold amid a 1.6-fold decrease in SHBG compared topre-treatment. Boys before treatment exhibited reductions in E1, E2, P4, FT, and AR by 1.9-, 2.7-, 1.7-, 1.4-, and 4.7-fold, respectively, relative to controls. Total testosterone was elevated 1.8-fold in 50 % of patients but decreased 42.0-fold in the remainder. SHBG was increased 2.4-fold. After CT, E2 rose 1.6-fold but remained 1.7-fold below controls. P4 decreased 2.6-fold compared to pre-treatment and was 4.5-fold below controls. T remained 1.7-fold above controls in half of patients and increased 10.2-fold in others but stayed 4.1-fold below controls. FT decreased 1.6-fold and was 2.2-fold below controls. AR increased 3.0-fold but stayed 1.6-fold below controls. SHBG decreased 1.7-fold but exceeded control levels by 1.4-fold.

Conclusion. Despite limitations in gonadal tissue sampling and preservation in pubertal patients with HL before treatment, developing new fertility preservation strategies through a multidisciplinary approach involving pediatric oncologists, reproductive specialists, endocrinologists, and psychologists is critical. Assessing hormonal status before and after antitumor therapy enables identification of at-risk patients and timely correction of hormonal imbalances, improving reproductive outcomes in HL survivors.

Aim. To evaluate efficacy and safety of neoadjuvant chemotherapy (nCT) using the mFOLFIRINOX regimen in treatment of patients with resectable pancreatic cancer.

Material and methods. From 2020 to the present, a phase II study has been ongoing at the Pavlov First Saint Petersburg State Medical University investigating the efficacy of nCT using the mFOLFIRINOX regimen followed by radical surgery in patients with resectable pancreatic cancer in comparison to radical surgery at the first stage. As of May 2025, 152 patients were included in the study (standard treatment group (n = 76), nCT group (n = 76)). Patients in the standard treatment group underwent radical surgery followed by mFOLFIRINOX adjuvant chemotherapy for 12 cycles; patients in the experimental treatment group underwent tumor verification at the first stage, after which 6 cycles of mFOLFIRINOX nCT and radical surgery followed by mFOLFIRINOX adjuvant chemotherapy were performed for 6 cycles. This article discusses immediate surgical outcomes, complications and mortality.

Results. A statistically significant superiority of the nCT group over the standard treatment group was observed per various parameters. The frequency of R0 resections in the per protocol population was lower in the standard treatment group: 70.2 % versus 86.2 % in the nCT group (odds ratio (OR) 0.81; 95 % confidence interval (CI) 0.67–0.97; p = 0.03). The frequency of portal/superior mesenteric vein resection was higher in the standard treatment group: 21 % versus 7.9 % in the nCT group (OR 2.66; 95 % CI 1.46–6.34; p = 0.02). The frequency of N+ lymph node status was higher in the standard treatment group and amounted to 58.1 % versus 32.8 % in the nCT group (OR 1.77; 95 % CI 1.19–2.73; p = 0.004). The frequency of clinically significant postoperative pancreatic fistula B + C was higher in the standard treatment group: 47.4 % versus 18.4 % in the nCT group (OR 0.64; 95 % CI 0.5–0.8; p = 0.001). Survival analysis revealed statistically significant superiority of the nCT group. Thus, 1-year recurrence-free survival and overall survival rates were higher in the nCT group compared to the control group: 76.3 and 82.9 % versus 35.5 and 63.2 %, respectively (p = 0.0001). Median overall survival and recurrence-free survival were also higher in the nCT group: 31.3 months in the nCT group versus 18.2 months in the standard treatment group (OR 2.1; 95 % CI 1.41–3.16; p = 0.001), and 18.3 months versus 9.4 months (OR 2.5; 95 %; CI 1.73–3.64; p = 0.001), respectively.

Conclusion. nCT is a promising and safe method that can improve immediate treatment outcomes in patients with resectable pancreatic cancer.

Despite successes in therapy, multiple myeloma is a disease characterized by recurrent or refractory progression. The problem of drug resistance developing through complex mechanisms with complicated molecular interactions remains important. Special consideration is given to epigenetic processes. Detailed studies aimed at combinations of different antitumor agents and identification of optimal risk-adapted therapy using epigenetic markers are necessary.

The article presents a literature review on the problem of multiple myeloma drug resistance and a clinical observation demonstrating efficacy of elotuzumab in combination with lenalidomide and dexamethasone (Elo-Rd regimen) in a patient after 1^st-line therapy with bortezomib (VCD). Partial remission persisting for 3 years in combination with satisfactory tolerability, good quality of life, and absence of significant adverse events allows to hope for a favorable prognosis in the patients with bortezomib resistance.

The problem of anemia and iron deficiency in patients with malignant neoplasms is important due to pathogenetic features, necessity of differential diagnosis and consideration of concomitant disorders. Integral evaluation using personalized approach can promote timely correction of iron deficiency. Adverse effects of anemia in the preoperative period of some malignant neoplasms on the prognosis of oncological disease and development of chemotherapy-induced anemia predetermine the use of highly stable ferric carboxymaltose complex aimed at fast replenishment of iron with minimal toxicity which significantly improves patients’ quality of life and treatment adherence. Results of randomized trials, as well as real practice data, showed high efficacy and manageable toxicity profile of ferric carboxymaltose in various clinical situations involving iron deficiency.

The article presents a literature review on the problem of anemia and iron deficiency, its correction in patients with malignant neoplasms. Data from clinical trials demonstrating successful use of ferric carboxymaltose in comorbid patients are presented. The choice of this iron formulation for intravenous administration is made on the basis of personalized approach which allows to significantly improve the quality of life.

Infantile hemangioma or infantile vascular malformation is a benign vascular neoplasm that occurs as a result of abnormal proliferation of endothelial cells with disturbed blood vessel architecture.

This article provides a current review of the literature, information on the classification of infantile hemangioma, etiology, diagnosis, and treatment.

Background. The article advances a hypothesis that sentinel lymph node lesions can be detected using intraoperative three-vector fine-needle aspiration biopsy which does not require lymph node dissection. After identification of the sentinel lymph node using standard techniques, material was extracted through three-vector aspiration with immediate cytology, subsequent resection of the lymph node with immediate cytology of touch smears, scrapings and further planned morphological examination.

Aim. To evaluate the efficacy of the proposed approach in patients with primary operable forms of breast cancer (stages T1–2N0–1).

Materials and methods. The prospective study included 70 women diagnosed with stage I–IIB ductal or lobular breast cancer. Mean age of the patients was 54.2 (34–78) years. In most cases the disease was detected at early stage: stage IА was diagnosed in 74.3 % of patients, IIА – in 25.7 %. Morphological examination confirmed invasive ductal carcinoma in 85.8 % of cases with it being the most common histological type.

In terms of molecular subtype, the most common was luminal B HER2neu-negative breast cancer: 58.6 % of patients, and luminal А cancer: in 41.4 %. In 74.3 % of patients, breast cancer was moderately differentiated.

Results. The use of intraoperative three-vector fine-needle aspiration biopsy with subsequent evaluation of cytology and planned histological analysis of the sentinel lymph node in patients with breast cancer allowed to determine diagnostic parameters of the developed technique. Sensitivity of the method was 81.2 % with 2 false negative cases, while specificity reached 100 %, and overall diagnostic accuracy 94.6 %. Prognostic significances of positive and negative results were 69.2 and 93.8 %, respectively. Sensitivity, specificity, prognostic significance of positive result of three-vector fine-needle aspiration biopsy were respectively 19.7; 0.7 and 12.1 % higher than the standard method of immediate cytology of touch smears.

Conclusion. The developed method can be recommended for wide use in T1–2N0–1 breast cancer.