Objective. To improve the results of surgical treatment of patients with stage IA NSCLC requiring thoracoscopic anatomical resections.

Material and methods. One surgical team performed 132 thoracoscopic lobectomies and segmentectomies in one hospital between 2010 and 2020. This study was consecutive, non-randomized and retrospective.

Patients after thoracoscopic lobectomies and segmentectomies for stage IA NSCLC were compared. Additionally, an analysis was performed in 4 subgroups of patients: lobectomy (n=45) and segmentectomy (n=21) with a tumor size up to 2 cm; lobectomy (n=55) and segmentectomy (n=11) with a tumor size from 2 to 3 cm.

Results. The comparison groups are comparable in main clinical parameters. There was no mortality in both groups. There were no differences in the postoperative hospital day (6.0 and 6.2 days, p=0.58), the number of removed lymph nodes (9.2 and 9.9, p=0.52) and the percentage of complications (15.6% and 21.9%, p=0.75) when comparing segmentectomies and lobectomies.

Differences in the groups were revealed in the length of the machine stitch: in lobectomy — 218.5 mm, in segmentectomy — 309.8 mm (p=0.0001). This pattern was the same in the subgroup analysis. In patients with a tumor from 2 to 3 cm, when removing a segment, the size of the mini-access was smaller than during lobectomy (3.3 cm and 4.0 cm, p=0.0087), and the persistent air leak was longer (6.8 and 2.9 days, p=0.0332).

When analyzing long-term outcomes, no significant differences were found either in both group and subgroup analysis; however, there was a tendency towards an increase the overall five-year survival after segmentectomies compared with lobectomies in patients with tumor size ≤2 cm, while with tumor size from 2 to 3 cm, on the contrary, the best long-term results were found in patients operated on with thoracoscopic lobectomy.

Conclusion. Thoracoscopic lobectomy and segmentectomy are safe and effective for stage IA NSCLC; the short-term outcomes of surgical treatment of patients with stage IA NSCLC after thoracoscopic lob- and segmentectomies with tumor size ≤2 cm are not significantly different; in patients with the tumor size from 2 to 3 cm, the persistent air leak after segmentectomies was significantly higher than after lobectomies (p=0.033); when evaluating long-term outcomes, no significant differences were found between the study groups and subgroups.

Stereotactic radiation therapy in the hypofractionation mode is a method in which high doses of ionizing radiation (more than 3 Gy per fraction) are delivered in a small number of fractions (from 2 to 5). Treatment and the process of preparation for it are carried out using special fixing devices, dosimetric planning techniques of high conformity, with control of the treatment position using x-ray imaging. which makes it possible to ensure the required irradiation accuracy. The advantages are a shorter course of treatment compared to standard fractionation, a high biologically effective dose, a reduced effect of tumor repopulation, greater efficiency under hypoxic conditions, and satisfactory results when irradiating radioresistant tumors. The article presents clinical cases of the use of hypofractionation modes on the Halcyon elite linear accelerator.

Currently, patients with disseminated forms of skin melanoma have limited treatment options. The most effective treatments, according to research, are targeted drugs BRAF/MEK inhibitors when a mutation in exon 15 of the BRAF gene is detected in tumor biopsy tissue and immune synapse modulators, specifically anti-CTLA-4 and anti-PD-1 drugs. Both classes of drugs show a significant benefit in overall and progression-free survival, but convincing data on their effectiveness in second and subsequent lines of therapy are still lacking. Most often, with the progression of disseminated skin melanoma during tyrosine kinase inhibitor therapy, a dual immunotherapy combination is used. In the event of further progression, due to the limited treatment options, clinical oncologists face questions about the possibility of returning to targeted therapy, changing tyrosine kinase inhibitor drugs, or using the initial combination, and their impact on progression-free survival in choosing treatment strategies for such patients, as well as the potential use of BRAF/MEK inhibitors. Assessing the reuse of tyrosine kinase inhibitor drugs is a highly relevant issue in clinical oncology.

Stevens–Johnson syndrome (SSD) and toxic epidermal necrolysis (TEN) are life–threatening conditions accompanied by skin lesions, as well as in some cases mucous membranes, manifested by necrosis and detachment of the epidermis. These conditions are considered urgent and require emergency hospitalization. Most often, these conditions develop when taking drugs, but in some cases it is not possible to find out the cause of the disease. In described case, we discovered this condition in a patient, who received immunotherapy with pembrolizumab, a monoclonal antibody to the PD-1 receptor, which generally used in the treatment of cancer patients.

Brain metastases are the most common type of intracranial tumor formation. Modern treatment of brain metastases is a complex problem and traditionally patients with central nervous system lesions have a poor prognosis. However, advances in systemic drug therapy, advances in radiation treatments, and a multidisciplinary approach that individualizes the differential approach to each patient have significantly improved survival rates in this group of patients. Surgical resection plays an important role in the treatment of brain metastases. In this article, we discuss the evolving role of surgery in the treatment of this diverse group of patients with brain metastases.

Germ cell tumors are rare malignant neoplasms. Extragondal localization accounts for about 10% of all germ cell tumors, with up to 3% being mediastinal. The low incidence, along with a nonspecific clinical presentation, complicates initial diagnosis and leads to delays in diagnosis and the initiation of specific treatment. Primary care plays a crucial role in detecting such tumors and in patient routing. At the outpatient stage, the patient should be examined and referred to a specialized facility for specific treatment as quickly as possible. For differential diagnosis at the initial stages between mediastinal germ cell tumors and lymphoproliferative diseases, mediastinal sarcomas, thymomas, and others, monitoring tumor markers is necessary: alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG), and lactate dehydrogenase (LDH). When these markers are elevated and time is critical, it is permissible to start specialized antitumor treatment without histological confirmation.

Currently, it is also important to consider the role of the new coronavirus infection, which complicates differential diagnosis at the initial stages. This article presents a clinical case of late detection of a germ cell tumor and attempts to conduct systemic therapy in the context of the disease’s complicated progression.

Germ cell tumors (GCT) are a group of rare malignant neoplasms. At the same time, the group of patients with this pathology is mainly young people aged 25–35 years. Taking into account the rarity of the disease and the young age of patients, there may often be difficulties in diagnostics and treatment of this malignant tumor. On the example of the described clinical case of a patient with seminomatous GCT the most frequent problems that specialists may encounter in the treatment of this pathology are presented.