The surgical stage of radical treatment of advanced oropharyngeal cancer is often associated with combined resections,
which entail the formation of anatomically and functionally complex defects. The elimination of complex oropharyngeal defects requires a high level of reconstructive surgery in an institution that treats this group of patients. Most often, a radial flap is used to eliminate defects in the oral cavity and oropharynx, it has proven itself well in terms of high plasticity, but its use is associated with severe damage to the donor area, which is considered unacceptable in modern reconstructive surgery. Thus, the choice of the optimal plastic material for the replacement of complex oropharyngeal defects is an urgent oncological problem.
Goal: а retrospective analysis of the results of the elimination of combined oropharyngeal defects using a free revascularized medial surgical autograft in oncological practice.
Materials and methods. A retrospective study involved 15 patients (5 men and 11 women) with metamorphosed cancers of the oral cavity, tongue and oropharynx who received surgical treatment at the Saint Petersburg State Medical University City Clinical Oncology Dispensary (Saint Petersburg). The average age of the patients was 53 years. In all cases, a medial sural perforator flap was used for the purpose of simultaneous microsurgical removal of a combined oropharyngeal defect.
Research results. The medial sural flap was successfully used in all 15 cases. One case required revision of the postoperative wound and vascular anastomosis in the early postoperative period (hematoma). In one case, we encountered partial necrosis of the skin portion of the graft in the early postoperative period.
Conclusions. The experience of using the medial sural perforator flap in the reconstruction of oropharyngeal defects confirms its effectiveness. The main criteria for choosing an autologous tissue complex for oropharygeal reconstruction are comparable to those of a radial flap (elasticity, consistency of anatomy, length and diameter of vessels), however, minimal donor damage in the form of a linear scar on the back of the shin gives this transplant an undeniable advantage in terms of the patient’s quality of life.

Background. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors are a standard of care for ER-positive/HER2-negative metastatic breast cancer (MBC), yet real-world safety may differ from randomized controlled trials (RCTs).
Objective. To assess the safety of palbociclib and ribociclib combined with endocrine therapy in routine clinical practice.
Methods. Prospective, open-label, single-center, non-randomized study including 815 patients treated between April 2020 and October 2023. Palbociclib cohort: n=365 (125 mg QD, 21/7); ribociclib cohort: n=450 (600 mg QD, 21/7). Adverse events (AEs) were graded by CTCAE v5.0; standard statistics with p<0.05.
Results. Any-grade AEs occurred in 33.4% (palbociclib) and 24.0% (ribociclib). Toxicity spectra differed: palbociclib was associated mainly with hematologic AEs—neutropenia in 112/365 (30.7%), including grade 3–4 in 37/365 (10.1%); febrile neutropenia in 1/365 (0.3%). Ribociclib showed predominantly non-hematologic AEs — asthenia in 34/450 (7.6%) (mostly grade ≤2); ALT/AST elevations in 16/450 (3.6%); QT interval prolongation in 2/450 (0.4%). Diarrhea and rash were uncommon in both cohorts. Dose reductions implemented for toxicity did not compromise progression-free survival in within-group comparisons.
Conclusions. In real-world practice, CDK4/6 inhibitors demonstrate favorable tolerability with predictable, distinct toxicity patterns (hematologic with palbociclib; mainly non-hematologic with ribociclib), supporting individualized drug selection and safety monitoring strategies.

Lung cancer is the most common malignant neoplasm and ranks first in the structure of cancer mortality. Lung cancer has long been thought to be a smoker’s disease and largely preventable by limiting tobacco use, but recent studies have shown an alarming increase in the incidence of the disease among non-smokers of both sexes. Personalized medicine, including careful molecular genetic testing, optimizes treatment for each patient and improves their quality of life during therapy.
The subject of this article is a specific clinical case of the effective use of Osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), which has been widely used as first-line therapy in patients with metastatic EGFR-mutant non-small cell lung cancer (NSCLC), and currently shows excellent results in the adjuvant mode. The aim of the work is to analyze the effectiveness of the use of the third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in lung adenocarcinoma using an example from clinical practice. During the discussion of the specifics of treatment of a patient with NSCLC, the results of laboratory tests, data from various diagnostic and treatment methods are used.

Nowadays, small cell lung cancer and HIV infection can be under controlled diseases, and specialists have approved clinical guidelines for treating these conditions. However, given the life expectancy of patients with HIV infection on antiretroviral therapy and patients with small cell lung cancer on polychemotherapy, doctors often encounter cases of these conditions combined in practice. This article presents a clinical case of detection of metastatic nonsmall cell lung cancer and HIV infection at the same time. The main purpose of this article is to demonstrate the modern possibilities of treating lung cancer in persons with HIV using multidisciplinary approach.