№3 (2025)

Introduction. Gastrointestinal stromal tumors (GIST) are heterogeneous neoplasms that require immunohistochemical confirmation for accurate diagnosis. The main markers include CD117, DOG1, CD34, SMA, S-100, and Ki-67.
Objective. To evaluate the immunohistochemical profile of GIST in patients treated at the National Center of Oncology and Hematology and compare the results with international data.
Materials and Methods. A retrospective analysis was conducted on 75 patients with histologically confirmed GIST who were observed between 2019 and 2024. Expression of CD117, DOG1, CD34, SMA, S-100, and Ki-67 was assessed.
Results and Discussion. CD117 expression was positive in 94.7% of cases, DOG1 in 90.7%, and CD34 in 69.3%. SMA and S-100 were positive in 35.0% and 8.0% of cases, respectively. The Ki-67 proliferation index ranged from 1% to 30%, reflecting varying tumor aggressiveness. The findings are consistent with international publications, confirming the reliability of immunohistochemical diagnostics in settings with limited access to molecular testing in Kyrgyzstan.
Conclusion. Immunohistochemistry remains a key tool for diagnosing and predicting GIST. The use of standard markers and Ki-67 evaluation provides insights into tumor biology and helps optimize patient management strategies.

Introduction. Polypharmacy is a serious problem in oncology patients with cardiovascular comorbidity, which is associated with the need for simultaneous treatment of both conditions and increased risks of adverse events and reduced treatment adherence. Aim: To conduct a comprehensive assessment of the level of polypharmacy and its impact on clinical outcomes in this patient category.
Materials and methods. A retrospective observational study of 130 patients was conducted. Medical records were analyzed using statistical methods (Mann-Whitney U test, χ², OR calculation) in the StatTech v.4.8.7 program.
Results and discussion. Polypharmacy was identified in 48.5% of patients and was significantly associated with advanced cancer stages (54.0% vs 20.9%; p<0.001), palliative treatment (76.2% vs 46.3%; p<0.001), and frequent therapy interruptions (65.1% vs 20.9%; OR=7.0). These patients also had more severe comorbidities but underwent echocardiographic examination less frequently (65.1% vs 80.6%; p=0.046).
Conclusion. Polypharmacy is a marker of a complicated clinical status and requires the development of optimized patient management algorithms, enhanced cardiac monitoring, and the mandatory inclusion of echocardiography (EchoCG) in the examination protocol to improve treatment safety.

Introduction. Breast cancer (BC) is one of the most common oncological diseases among women worldwide. Its biological heterogeneity is due to the presence of various molecular subtypes that determine the clinical course of the disease, prognosis, and treatment choices. An important risk factor that significantly influences the incidence and outcomes of BC is obesity, and its impact varies depending on menopausal status. In the context of Kyrgyzstan, where the epidemiological situation and healthcare opportunities have their own characteristics, it is relevant to conduct a comprehensive analysis of the current state of the issue, identify key challenges, and outline directions for improving the prevention, diagnosis, and treatment of breast cancer.
Aim. To present a comprehensive overview of breast cancer (BC) epidemiology, substantiate the clinical significance of molecular subtypes, and analyze the cross-influence of obesity and age on the risk and outcomes of the disease, with an emphasis on data and practices in Kyrgyzstan.
Methods. An analysis of publications from peer-reviewed journals and reports from relevant organizations (PubMed, Cochrane, WHO, SEER, GLOBOCAN) from 2013 to 2024 was conducted. An analytical framework combining epidemiology, biology of subtypes, risk factors, and healthcare organization was used.
Results. Luminal subtypes dominate in the structure of BC; the triple-negative subtype is less common but accounts for the largest share of early recurrences. The relationship between BMI and risk depends on menopausal status: in premenopause, a higher BMI is associated with a lower risk, whereas in postmenopause, it is associated with an increased risk. According to GLOBOCAN estimates, globally, approximately 2.3 million new cases of BC were registered annually in 2020–2022; in Kyrgyzstan, the standardized incidence rate remains lower than the Central Asian average but shows a trend toward growth.
Conclusions. The biological heterogeneity of BC and modifiable risk factors require targeted prevention and coordinated clinical pathways. For Kyrgyzstan, the priorities are: increasing screening coverage, controlling lifestyle factors, ensuring access to immunohistochemistry/genetic testing, and routing patients with aggressive subtypes.

Introduction. In modern diagnostics of liver pathologies, imaging methods such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are actively used. However, they do not allow for accurate determination of the morphological nature of a lesion. The “gold standard” in cases of suspected tumor processes remains liver biopsy. In the Kyrgyz Republic, morphological verification is limited, which reduces the availability of timely treatment. Core biopsy under ultrasound guidance is an effective and safe method for morphological confirmation of diagnosis.
Objective of the study. To assess the significance of correlation between histological and cytological findings during morphological verification of liver tumors using core biopsy under ultrasound guidance.
Materials and Methods. From January 2019 to February 2024, 51 patients with suspected malignant liver tumors underwent core biopsy at the National Center of Oncology and Hematology of the Ministry of Health of the Kyrgyz Republic. The procedure was performed under ultrasound guidance using biopsy guns with 14G and 16G needles. Samples were sent for histological examination, and additional imprint smears were made for cytology. Statistical data analysis was performed using SPSS16.0, calculating the method's sensitivity and χ² values.
Results and Discussion. The most common diagnoses were “hepatocellular carcinoma” (23.5%) and “metastatic liver involvement” (20%). In 11.7% of cases, histology revealed benign or inflammatory changes. In 27.4% of cases, the result was non-informative. The overall diagnostic effectiveness of core biopsy was 72.7%.
Diagnostic confirmation based on both histology and cytology was achieved in 84.3% of cases. A statistically significant correlation between the two methods was established (p < 0.005), confirming the rationale for their combined use.
Conclusion. The obtained data confirm the high informativeness and safety of core biopsy in the diagnosis of liver tumors. The use of this method allowed clarification of the clinical diagnosis, avoidance of laparotomy, and diagnosis without complications. Core biopsy under ultrasound guidance is a necessary and effective element of comprehensive oncological liver diagnostics.

Introduction. Vulvar cancer is a rare malignant neoplasm of the external genital organs. It most commonly occurs in elderly women.
Objective of the study. To conduct a comparative analysis of certain epidemiological aspects of vulvar cancer in two neighboring Central Asian republics — Kazakhstan and Kyrgyzstan.
Materials and methods. The study covers the period from 2003 to 2012 and includes women with newly diagnosed cases of vulvar cancer in both countries. The material for the study comprised all registered cases of vulvar cancer from official sources.
Results and discussion. A total of 852 cases of vulvar cancer were registered in the Republic of Kazakhstan and 92 in the Kyrgyz Republic. The average annual crude incidence rate of vulvar cancer was 1.1 per 100,000 in Kazakhstan and 0.3 in Kyrgyzstan. The age-standardized incidence rate was 0.9 and 0.3, respectively. Incidence was statistically significantly higher among Russian women compared to the indigenous ethnic groups.
Conclusion. There is notable geographical and ethnic variability in vulvar cancer incidence between the two countries, with a slightly higher rate observed in the Republic of Kazakhstan compared to the Kyrgyz Republic. The descriptive epidemiological data obtained are of practical importance for understanding the etiology of the disease.

Introduction. Breast cancer is one of the most common cancers worldwide, affecting women of all ages and ranking first in terms of incidence and third in terms of mortality among all cancers. Approximately half of all breast cancer patients are in the elderly and senile age group.
Objective: To evaluate the five-year results in elderly and senile patients with breast cancer.
Materials and methods. The study included 180 elderly and senile breast cancer patients. The patients were divided into three groups according to the treatment method: surgical removal only, combined treatment (surgery + postoperative radiation therapy), and comprehensive treatment (surgical treatment + postoperative chemotherapy + postoperative radiation therapy).
Results. The number of elderly patients (from 60 to 74 years old inclusive) was 133 (73,8%), senile age (from 75 to 90 years old) — 47 (26,2%). According to the results of the study, which were established using the Kaplan-Meier method, the relapse-free and overall survival rates were significantly lower in patients who received surgical treatment in a single-mode approach, which was 88% and 77.3%, compared to the combined treatment (surgical treatment + postoperative radiation therapy), which was 100% and 82.5%, and the comprehensive treatment (surgical treatment + postoperative chemotherapy + postoperative radiation therapy), which was 90.8% and 80%, respectively. As for the volume of surgical intervention, overall survival and disease-free survival is higher with radical removal of the mammary gland with regional fiber.
Conclusions. The overall and relapse-free five-year survival rates were significantly higher with combined and comprehensive treatment compared to surgical removal alone.

Introduction. Hyperhomocysteinemia is a risk factor for the development of Henoch-Schönlein purpura (HSP), one of the most common hypersensitivity systemic vasculitides with small-vessel involvement.
Purpose of the study. To study plasma homocysteine levels and genetic abnormalities in homocysteine metabolism in patients with HSP.
Material and Methods. The study included 80 patients with HSP treated in the Department of Hematology, National Center of Oncology and Hematology, Ministry of Health of the Kyrgyz Republic. In addition to standard diagnostic methods, we measured plasma homocysteine levels and analyzed the genes MTHFR, MTR, and MTRR.
Results and Discussion. Examination of homocysteine metabolism revealed hyperhomocysteinemia in 67,5% of HSP patients. The MTHFR C677T mutation was found in 50% of patients, MTR A2756G abnormalities in 31,2%, and MTRR A66G polymorphism in 68,7%.
Conclusion. Diagnostics of HSP should include the determination of plasma homocysteine levels and genetic analysis of MTHFR, MTR, and MTRR. In cases of hyperhomocysteinemia with genetic abnormalities in MTHFR C677T, MTR A2756G, or MTRR A66G, folic acid supplementation should be included in therapy.

Introduction. Gastric cancer remains one of the most common and dangerous oncological diseases of the 21st century. The development of methods for diagnosis, treatment, and prevention of recurrences is a key direction for improving patients’ quality of life and longevity.
Objective. To evaluate the immediate results of surgical treatment of recurrent gastric cancer depending on the extent of the primary surgery.
Materials and Methods. Between 2002 and 2024, 97 patients with morphologically confirmed recurrence were examined in the thoracic department of the National Center of Oncology and Hematology. The patients were divided into three groups: those who underwent reoperation (n=37); those who received systemic chemotherapy (n=30); and those who received symptomatic treatment (n=30). Radical surgeries were performed in 32.4% of cases, while palliative interventions accounted for 67.6%.
Results and Discussion. The mean disease-free survival period was 26.1±3.2 months. Postoperative mortality was 5.4%. Chemotherapy was associated with adverse effects, which were managed by symptomatic treatment.
Conclusion. Repeat surgeries for recurrent gastric cancer can improve quality of life and, in certain cases, achieve radical outcomes, thereby justifying their application with careful patient selection.

Introduction. Esophageal cancer of the thoracic region remains one of the most challenging problems in modern oncological surgery. Among radical techniques, the Lewis and Garlock procedures are the most widely used.
Objective. To conduct a comparative evaluation of the immediate results of one-stage surgical interventions in thoracic esophageal cancer.
Materials and Methods. The study included 68 patients operated on at the National Center of Oncology and Hematology between 2008 and 2024. Lewis operations were performed in 53 cases, and Gerlock operations in 15 cases. The analysis was conducted considering the frequency of postoperative complications and the extent of lymph node dissection.
Results and Discussion. Postoperative complications were recorded in 25% of patients after the Lewis procedure and in 13.2% after the Gerlock procedure. The most common complications were anastomotic leakage, pneumonia, and pleuritis. However, the Lewis procedure allowed for extended lymph node dissection (2F), which provided a significant oncological advantage.
Conclusion. The Lewis procedure for cancer of the lower thoracic esophagus appears more favorable, as it enables extended lymph node dissection while maintaining an acceptable level of postoperative complications, comparable to that of the Gerlock procedure.

Introduction. Chronic myeloid leukemia (CML) is a myeloproliferative disorder occurring in 1-2 cases per 100,000 adults. CML is characterized by a balanced genetic translocation t(9;22)(q34;q11.2). This rearrangement is known as the Philadelphia chromosome (Ph chromosome).
Objective of the study. To evaluate the results of treatment with tyrosine kinase inhibitors in 546 patients with Ph+ CML in the Kyrgyz Republic for the period from 2003 to 2023.
Materials and methods. The results of molecular genetic studies of patients treated with drugs such as imatinib, nilotinib, dasatinib, ponatinib were used as materials.
Results and discussion. The overall survival rate for 20 years was 83%. The mortality rate is 5.1%. The rates of major molecular responses and complete molecular responses were 49% and 32%, respectively.
Conclusion. The use of different generations of tyrosine kinase inhibitors in CML can significantly increase the duration and quality of life of patients.

Introduction. Esophageal and gastric cancer are the main causes of tumor stenosis of the upper gastrointestinal tract, leading to dysphagia. Most patients are diagnosed at advanced stages. Palliative care includes stenting, which improves patients' quality of life by allowing them to continue eating.
Objective of the study. The aim of this study was to investigate the dynamics of dysphagia in patients after self-expanding metal stent placement in the esophagus and stomach.
Materials and methods. The study included 130 patients with dysphagia caused by malignant tumors. The degree of dysphagia was assessed before and after stenting, which was performed under gastroscopic control. Statistical data processing was used to analyze the results.
Results. The data show that after stenting, the number of patients with grade IV dysphagia significantly decreased. A positive trend was observed, with almost all patients with grade IV dysphagia showing improvement by days 12-14, and an increase in patients with grade I dysphagia.
Conclusion. The use of self-expanding metal stents is an optimal method for palliative treatment of patients with esophageal and gastric obstruction. This method provides rapid restoration of patency and improvement in quality of life without the need for general anesthesia.

Introduction. Stomach cancer is one of the most common and deadly types of cancer, with nearly one million new cases and over 720,000 deaths annually. Most cases are diagnosed at advanced stages. Infection with Helicobacter pylori and factors such as obesity play a significant role in the development of various types of stomach cancer.
Objective of the study. To investigate the frequency of genetic mutations and hereditary predisposition to stomach cancer in the Kyrgyz population.
Materials and Methods. The study included 113 patients with stomach cancer who were observed at the National Center for Oncology and Hematolo gy of Kyrgyzstan from 2017 to 2019. All patients provided informed consent, and the study was approved by the ethics committee. Genes TP53, POLD1, RET, PALB2, FANCA, FANCD2, and BRCA2 were studied using polymerase chain reaction.
Results and Discussion. Pathogenic or likely pathogenic mutations wereidentified in 6.2% of patients (7 out of 113). The majority of these patients (85.7%) were men. Mutations were found in high-penetrance genes, including TP53, POLD1, and BRCA2. Heterozygous mutations were also detected in genes associated with autosomal recessive disorders. The frequency of hereditary forms of stomach cancer in Kyrgyzstan is consistent with globaldata.
Conclusion. The high incidence of stomach cancer in Kyrgyzstan underscore the need for further investigation into genetic mutations. Mutations in TP53 and other genetic alterations may serve as potential prognostic and predictive markers for treatment.

Introduction. Chronic myeloid leukemia (CML) in children and adolescents is a rare malignant pathology of the hematopoietic system, accounting for only about 1-2% of oncohematological diseases, which determines the relevance of its study.
The aim of the study is to identify characteristics of the terminology of chronic myeloid leukemia based on literature analysis.
Materials and methods. The study materials were retrospective data obtained from searching the electronic databases PubMed, Medline, and Cochrane over the past 25 years. A total of 30 publications were analyzed, of which 10 met the inclusion criteria and were used for the review.
Results and discussion. The term "childhood" CML reflects not only the age of patients with a BCR-ABL1-positive variant of the disease, but also specific biological characteristics, the frequency of which decreases with age. In addition, differences in prognostic criteria and treatment features in children and adults have been identified, which require consideration when choosing treatment tactics.
Conclusion. The terminological and clinical specificity of CML in children emphasizes the need for further research and development of optimal approaches to the management of this group of patients.

Introduction. RANKL-RANK inhibition has shown tremendous clinical efficacy in giant cell tumours. Denosumab is a pathogenetically justified me thod of treating bone giant cell tumours. This type of therapy is the method of choice for treating unresectable or conditionally resectable tumours located in the pelvic bones, sacrum, and vertebrae. Blocking RANKL-RANK activity in relation to osteoclasts is also effective against bone loss associated with bone metastases and skeletal-related events (SREs) in solid tumours, prostate cancer, or breast cancer.
The purpose of the study. To study the possibility of using the legand active nuclear factor kappa B receptor (RANKL) for the conservative treatment of patients with bone tumors.
Materials and methods. We conducted a retrospective and prospective recruitment of patients with primary and secondary tumour bone lesions who were treated with active nuclear factor kappa B ligand (RANKL) drugs, either as monotherapy or as part of combination therapy. The study included 70 patients aged 16 to 70 years, with a mean age of 43 years ± 8.3 years – 33 women and 37 men.
Study results. Radiographic evaluation of treatment outcomes yielded the following data: tumour regression from 0 to 15%: n=5 (14.29%); tumour regression from 16% to 30%: n=12 (17.29%); tumour regression from 31% to 50%: n=23 (23.86%); tumour regression from 51 to 70%: n=24 (34.28%), tumour regression more than 70%: n=6 (8.57%). Assessment of functional effect according to the MSTS scale (%): 100-80 points n=28 (40%); 80-60 points n=35 (50%); <60 points n=7 (10%).
Conclusions. Against the background of therapy, rapid restoration of limb function and regression of pain syndrome are noted. It has obvious changes at the histological, radiological and clinical levels, which boil down to stabilisation of tumour size, calcification and better differentiation.

Objective. To study modern strategies of surgical treatment of colorectal cancer with synchronous liver metastases.
Materials and methods.The study materials included retrospective and prospective data obtained during the search in the electronic databases PubMed, Medline, elibrary, and Cochrane over the past 25 years. A total of 109 publications were analyzed for the review.
Results and discussion. At the initial diagnosis of colorectal cancer, liver metastases are detected in at least 30-50% of cases, of which 20-25% are resectable. In case of resectable liver metastases, the question of the timing

Background. Borderline ovarian tumors (BOTs) occupy an intermediate position between benign and malignant neoplasms, frequently affecting women of reproductive age. Bilateral gonadal involvement, observed in 15-25% of cases, significantly complicates the choice of treatment strategy, especially when fertility is being preserved. Making an organ-preserving decision requires a multidisciplinary approach and oncologic vigilance, particularly in the absence of stromal invasion.
Study Objective: To present a clinical case of bilateral borderline ovarian tumors in a young patient, with a focus on fertility preservation and oncologic safety.
Materials and Methods: An 18-year-old female patient presented with complaints of nagging lower abdominal pain. Ultrasound and MRI revealed a mass with intracapsular inclusions measuring approximately 17 x 15 cm in the right ovary; the left ovary was normal. A laparotomy with right cystectomy and left ovarian resection was performed. Urgent histological findings were obtained intraoperatively: bilateral serous borderline tumors (BSTs) of both ovaries. Healthy ovarian tissue was preserved. A greater omentum biopsy revealed no abnormalities. After confirming the diagnosis of BBTs (serous type), a complete histological examination, immunohistochemical verification, and an oncologic consultation were performed. The patient was included in a follow-up program.
Results and discussion. The diagnosis of bilateral serous borderline tumors was confirmed by pathology. Immunohistochemical profile: WT1+, p53 wild-type, Ki-67 <10%. After organ-preserving surgery, the patient recovered without complications. After 12 months, MRI and tumor markers showed no signs of recurrence. Reproductive function is preserved. The patient is recommended to undergo IVF if planning a pregnancy.
Conclusion. Organ-preserving treatment of bilateral BLO is possible with strict adherence to oncological principles, an experienced multidisciplinary team, and subsequent dynamic monitoring. This case highlights the need for an individualized approach and the importance of early diagnosis in gynecological oncology in young women.

Relevance. Pediatric oncology is increasingly important today and deserves the special attention of physicians of all specialties treating children. Situated at the intersection of various disciplines, pediatric oncology is rapidly developing, and all new advanced technologies in medicine and biology are finding their way into it.
Study Objective: To briefly describe the achievements achieved since the opening of the pediatric oncology department.
Materials and Methods: In 2012, the first pediatric oncology department was opened in Azerbaijan at the National Oncology Center (NOC). From 2013 to 2024, 1,533 children under 18 years of age with various oncological diseases received treatment and consultations. An analysis of tumor treatment outcomes in children for selected tumor sites was conducted. Patient survival rates were assessed using the Kaplan-Meier method. NHL treatment was administered according to the protocols of the BFM Group (Germany). In B-NHL (n = 85), the B NHL-BFM 04 programs were used, and rituximab was also included. Patients with L-NHL (n = 25) were treated according to the ALL IC-BFM 2002 protocol. In ALCL 6, the patient received treatment according to the B-NHL-BFM 04 protocol and the ALCL 99 program. The stages and prognostic risk groups of NHL were established in accordance with the recommendations of the BFM group. Nephroblastoma was treated according to the SIOP WT-2001, UMBRELLA 2018 protocol. The study included 59 children. For CNS tumors, depending on the histological form and degree of malignancy, the LGG-2004 (SIOP), HIT-HGG-2007, HIT-2000, HIT-MET 2018 (Germany) protocols were used. Survival rates were studied in 50 children with medulloblastoma. Treatment outcomes for 60 children with neuroblastoma were analyzed using the TPOG-NB 2009 and TPOG-NB 2020 (Turkey) protocols. Children with extracranial germ cell tumors received treatment using the MAKEY program. For nasopharyngeal carcinoma, the GPOH NPC-2003 program was used, etc.
Results and discussion. Overall and event-free 5-year survival (OS and EFS) for all NHLs (116 patients) were 80% ± 4% and 78% ± 4%, respectively. For nephroblastoma, 5-year survival (OS and EFS) were 87% ± 5% and 84% ± 5%, respectively. It should be noted that of the 59 treated patients, 33 children (55.9%) had stage III-IV disease, which undoubtedly influenced the outcome. For stages I-II, OS and OS rates were 96% ± 4%. Wilms tumor treatment can be considered a paradigm for the multimodal treatment of malignant solid tumors in childhood.
For medulloblastoma, OS and OS rates for all children (n=50) were 74% ± 7% and 63% ± 8%, respectively. These same rates for children in the standard-risk group (33 children) were 85% ± 9%.
For neuroblastoma, the initial results are encouraging given the clinical characteristics of the children (stage IV disease was diagnosed in 39 children, representing 63.9% of all patients). The five-year OS and DFS for all patients (n=60) were 50.6% ± 7% and 40% ± 7%, respectively. In children in the standard-risk group, these rates were 59% ± 13%.
Patients with extracranial germ cell tumors are successfully treated according to the 2005 MAKEI protocol; the five-year DFS was 95% ± 4%.
Conclusion. The results achieved since the opening of the Pediatric Oncology Department at the National Cancer Center demonstrate that the implementation of modern therapeutic approaches and international treatment protocols offers these children a good chance of achieving complete remission and guarantees good survival.

Relevance. Radiation therapy (photon, neutron, proton) alone/in combination or as a component of complex or combined treatment is indicated for more than 64% of patients with head and neck tumors (HNCT). Practice shows that the choice of an aggressive treatment method (radiation therapy course duration less than 40 days) directly affects the three-year survival rate, but is accompanied by undesirable toxicity in the form of grade III-IV mucositis, the incidence of which in patients is 51.2% versus 55.6% (p> 0.05). According to the results of a survey of radiation therapists in the USA and the Russian Federation (n=120), the management tactics for the occurrence of grade I-II skin manifestations of radiation toxicity in the first half of the EBRT course were: 1) 34% — a 10-14 day break in treatment, maintenance therapy; 2) 67% — a reduction in the number of planned fractions of the course, without reducing the effective dose; 3) 11% – reduction in the number of planned course fractions, lower effective dose. In turn, nutritional support, local antiseptics, painkillers, and low-intensity lasers can reduce the incidence of mucosal lesions by 6-fold (from 6.4% to 40.4%).
Study objective: To evaluate the potential of rehabilitation and supportive therapy methods in ensuring continuity of radiation therapy in patients with head and neck tumors.
Materials and methods: 297 patients with malignant neoplasms of the head and neck who underwent combined photon-neutron therapy (neutron contribution SOD = 2.4 Gy) from 1999 to 2005, as part of a radical independent radiation/chemoradiation course. Of these, 134 patients (45.11%) underwent laser therapy sessions through a quartz fiber for non-specific prevention and treatment of existing radiation reactions, with an exposure of 2-3 minutes for 5 days, along with accompanying symptomatic treatment; 112 patients (38.04%) were given a break in case of grade I-II radiation toxicity detected during the first stage of treatment, or worsening of their somatic status, with subsequent resumption of treatment after 10-14 days.
Results and discussion. Acute radiation reactions of grades I-III according to the RTOG scale were more common in the second group (153 patients, 94%) than in the first (79 patients, 59.1%). The immediate treatment outcomes were comparable in the first and second groups: complete response (81.6%) and 80.1%, partial response (18.4%) and 19.9%. However, the rate of continuous radiation therapy was higher in Group 1 – 98 patients (73%), despite maintenance therapy with modern drugs and laser therapy. In Group 2, this figure was only 27 patients (16.85%). When assessing the long-term three-year survival results, the rate in Group 1 was 89.42% and in Group 2 – 78.17%, respectively (p>0.05).
Conclusion. The most common complaints of patients requiring a forced treatment interruption were skin and mucosal reactions and dysphagia, which significantly reduce quality of life, impact their overall well-being, psychological state, emotional and social apathy, and even reduce the frequency of meals/nutrition. This observed trend requires further study and consideration of other rehabilitation methods, patients' comorbid status, continuity, and compliance.

Relevance. Globally, breast cancer (BC) and lung cancer (LC) have remained the leading cancers in incidence for many years, ranking first and second, respectively. In terms of mortality, LC consistently holds first place, while BC ranks fifth.
A similar situation is observed in the Republic of Kazakhstan: in 2021, BC ranked first in incidence, while LC ranked second. In terms of mortality, LC ranks first in the country, while BC ranks third.
In 1995, S. Hellman and R. Weichselbaum formulated the concept of the "oligometastatic state" – an intermediate stage between localized tumor progression and generalized metastatic disease. It has been shown that in some cases, removal of a limited number of metastases can increase patient survival and reduce tumor burden. Stereotactic radiosurgery (SRS) enables targeted treatment of lesion foci, minimizing damage to healthy tissue and delaying the need for systemic chemotherapy.
Study Objective: To evaluate the potential for improving the treatment efficacy of brain oligometastases in patients with lung cancer and breast cancer using modern stereotactic radiotherapy technologies.

Materials and Methods: This prospective study included 100 patients with verified brain oligometastases from lung and breast cancer. Patients were divided into two equal groups:
- Group 1 (n=50): total brain irradiation (WBRT) with a total focal dose of 30 Gy in 10 fractions;
- Group 2 (n=50): stereotactic radiotherapy (SRT) with a single dose of 21 Gy to the metastatic foci.
Efficacy was assessed using follow-up MRI scans at 3, 6, 9, and 12 months, as well as overall survival (OS) and disease-free survival (PFS) at 24 months of follow-up. Statistical data were processed using the χ² test; differences were considered significant at p<0.05.
Results and Discussion. The SRT group demonstrated a higher complete tumor response rate compared to the WBRT group: 80% versus 46% (p=0.002). Partial responses were observed in 18% of patients in the SRT group and 40% of patients in the WBRT group, with disease progression occurring in 2% versus 14% of patients, respectively.
The median disease-free survival was 18.4 months in the SRT group versus 10.7 months in the WBRT group (p<0.001). The overall two-year survival rate reached 72% in the SRT group and 48% in the WBRT group (p=0.01).
During the follow-up period, no clinically significant radiation-induced complications were observed in the SRT group. The treatment was well tolerated, and no additional medical support was required.
Conclusion: Stereotactic radiotherapy provides a higher local control rate and significantly increases relapse-free and overall survival in patients with oligometastases in the brain compared to total body irradiation, while demonstrating a low toxicity profile.

Background. Meningiomas of the brain, which develop from the meninges, account for approximately 30% of all CNS neoplasms. They are predominantly seen in women, especially those aged 30 to 60 years. Meningiomas are classified into three main grades based on histotype: G1 – benign, slow-growing, G2 – atypical, and G3 – anaplastic. The primary treatments for meningiomas are surgical removal and radiation therapy.
Stereotactic radiosurgery/radiotherapy (SRS/SRT), a new, high-tech radiation technique, is an important method for managing tumor growth, particularly in cases where surgery could lead to serious consequences for the patient. The effectiveness of radiation therapy may vary depending on the type of meningioma, highlighting the need to study these differences.
Purpose of the study. To determine the comparative efficacy of stereotactic radiotherapy for G1 meningiomas by analyzing clinical cases of fibrous and meningotheliomatous meningiomas.
Materials and Methods. The study included 12 patients with G1 meningiomas: 6 with fibrous meningiomas and 6 with meningotheliomatous meningiomas. In the fibrous meningiomas group, 3 patients received SRS with a single focal dose (SFD) of 16 Gy, and 3 others received SRT with a SFD of 5.5 Gy (SFD of 27.5 Gy). In the meningotheliomatous meningiomas group, 2 patients received SRS with a SFD of 16 Gy, and 4 patients received SRT (SFD of 5.5 Gy, SFD of 27.5 Gy). Outcomes were assessed at 3, 6, 9, and 12 months using contrast-enhanced MRI.
Results and Discussion All six patients with the meningotheliomatous form achieved complete regression, while among patients with the fibrous form, partial regression was observed in one patient and stabilization in five.
Conclusion: Meningotheliomatous meningiomas demonstrated greater sensitivity to stereotactic radiotherapy compared to fibrous forms, with a higher rate of complete regression.

Background. Prostate cancer (PCa) is a significant cause of morbidity and mortality. According to the World Health Organization, 1.4 million cases and 397,000 deaths were registered globally in 2022. Globally, PCa is the fourth-largest cancer incidence rate in men and the eighth-largest cause of cancer-related death in men, while in Asia, it ranks second and first, respectively. Early, personalized diagnosis and detection of PCa are becoming increasingly important. According to recent scientific data, a genetic predisposition to the risk of PCa is observed in 42% of cases.
Study Objective: To study the associations of single nucleotide polymorphisms with genetic predisposition to PCa in the Kazakh population.
Materials and Methods: The study was conducted in two stages. In the first stage, two groups were formed: 340 men from the Kazakh population diagnosed with PCa and 454 men from the Kazakh population in the control group (conditionally healthy individuals). Subjects aged 18 to 88 years underwent genotyping of single-nucleotide polymorphisms (SNPs) in DNA using molecular genetic sequencing. In the second stage, retrospective statistical analysis was performed using systematization and verification methods. The statistical significance criterion was set at p < 0.05 with a 95% confidence interval.
Results. An analysis of 135 genotypes of patients in two groups—the study and control groups—was conducted. The study revealed a statistically significant difference in age (under and over 60 years) of 38.5% at p < 0.0001 for the prostate cancer group. Significant differences were found in 16 SNPs. Intergroup comparison revealed differences in 39 genotypes.
Conclusion. Comparative analysis of binary and nominal indicators of the two groups allowed us to identify genotypes specific to men in the Kazakh population and confirm the relationship between age and an increased risk of prostate cancer. Based on the results of further research, a database of allele and genotype frequencies for prostate cancer in Kazakhs will be created, which will have prognostic value for screening.

Background. Squamous cell carcinoma (SCCC) is the second most common epithelial malignancy. Despite a high cure rate in the early stages, the 10-year survival rate does not exceed 20% for regional metastases, and less than 10% for distant metastases. The search for methods that ensure radical intervention, good functional and aesthetic results, and a reduced recurrence rate remains an important challenge.
Study Objective. To evaluate the results of two approaches to surgical treatment of SCCC followed by radiation therapy.
Materials and Methods. The study included 64 patients with morphologically verified SCCC (T1-T3, N0M0) treated between 2013 and 2019. Patients were divided into two groups:
Group 1 (n=32) – organ-preserving tumor resection with minimal excision, while maintaining radicality, followed by radiation therapy;
Group 2 (n=32) – standard radical surgical removal of the tumor followed by radiation therapy.
Surgical duration, blood loss, pain intensity, complication rate, relapse-free and overall survival were assessed.
Results and discussion. In Group 1, the average surgical duration was 39 ± 1.7 minutes, blood loss was 7.5 ± 2.1 ml, pain resolved in 0.89 ± 1.23 days, and no complications were detected. Three-year relapse-free survival was 78%, and overall survival was 67%. In Group 2, the average surgical duration was 89 ± 12.8 minutes, blood loss was 36.5 ± 12.7 ml, pain persisted for 3.68 ± 1.84 days, and complications occurred in 9.3% of patients (flap necrosis, seroma). The three-year relapse-free survival rate is 68%, and the overall survival rate is 76%.
Conclusion. Surgical treatment of CCRC followed by radiation therapy provides high oncological efficacy. The organ-preserving approach shortens the duration of the procedure, reduces blood loss and postoperative morbidity, while maintaining survival rates comparable to standard surgeries, making it a viable option for patients with complicated medical conditions.

Background. Recurrent cervical cancer (CC) is a serious clinical problem, especially in patients who have previously received combination therapy. Given the limited availability of repeat irradiation and the high toxicity of surgical intervention, the search for effective chemotherapy regimens is a priority in modern gynecologic oncology.
Study Objective: To evaluate the efficacy and tolerability of various chemotherapy regimens in patients with recurrent CC treated at the Kashkadarya branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology.
Materials and Methods: A retrospective analysis of 39 patients with recurrent CC observed from 2016 to 2021 was conducted. All patients underwent clinical and instrumental examination (ultrasound, MRI). Two polychemotherapy regimens were used: paclitaxel + cisplatin (n=20) and gemcitabine + cisplatin (n=19). Remission, toxicity, and survival rates were assessed.
Results and discussion. The highest efficacy was observed in the gemcitabine + cisplatin group: complete remission (CR) in 21.8%, partial remission in 5.16%, and stabilization in 76%. In the paclitaxel + cisplatin group, complete remission was achieved in 14% of patients, with an overall efficacy of 18%. Gemcitabine was associated with moderate grade II-III toxicity, primarily myelosuppression and gastrointestinal manifestations. Three-year survival rates were 81% and 62%, respectively (p=0.005).
Conclusion. Combination chemotherapy including gemcitabine and cisplatin demonstrated superior results in the treatment of recurrent cervical cancer compared to paclitaxel + cisplatin. Considering good tolerability and high therapeutic effect, this regimen can be recommended as preferred in the treatment of this category of patients.

Background. Lung cancer is a leading cause of cancer morbidity and mortality. The lungs are a frequent target for metastasis from malignant tumors in other locations, necessitating timely and accurate differential diagnosis. Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has proven highly informative, but its accuracy in certain clinical scenarios remains controversial.
Study Objective. To evaluate the informative value of 18F-FDG PET/CT in diagnosing solitary lung lesions and differentiating them into primary, metastatic, and benign.
Materials and Methods. Data from 32 patients with newly diagnosed focal lung lesions (58.3% men, 41.7% women, ages 22–82 years, median 59 years) were analyzed. All patients underwent whole-body PET/CT with 18F-FDG, followed by surgery with morphological verification. Histology results revealed lung cancer in 17 patients (53.1%), metastatic lesions in 11 (34.4%), and benign changes in 4 (12.5%). The intensity of radiopharmaceutical uptake was assessed by SUVmax; ROC analysis was performed.
Results and discussion. The median SUVmax in the overall group was 6.0 (IQR 3.9–8.4); for lung cancer, it was 7.0 (IQR 5.8–10.9), and for metastases, it was 4.3 (IQR 2.5–7.1). The optimal SUVmax cutoff value for detecting malignant neoplasms was 5.4, providing a balance between sensitivity and specificity. PET/CT tended to underestimate the size of lesions up to 40 mm and overestimate those larger. A linear model of 5.862 + 0.817×x (where x is the PET/CT size) predicted the true size with an accuracy of 84.5%, with an error margin of ±50%.
Conclusion. PET/CT with 18F-FDG is a highly informative method for the differential diagnosis of solitary lung lesions. A SUVmax threshold of ≥ 5.4 improves the accuracy of detecting malignant processes, and the use of a corrective linear model improves size estimation, which is important for staging and treatment planning.

Relevance. Recurrence of cervical cancer (CC) remains a serious clinical and oncological problem, especially in patients with advanced forms of the disease. Despite the advances in modern radiotherapy, the recurrence rate reaches 70% within the first two years after treatment, especially in the 31-50 age group. This necessitates the improvement of combined treatment methods, particularly combined radiation therapy (CRT).
Study Objective: To evaluate the effectiveness of CRT in the treatment of recurrent CC and to identify prognostic factors and clinical and morphological features influencing the recurrence rate.
Materials and Methods: A study involving 160 patients was conducted at the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology (Republic of Uzbekistan). The study group consisted of 80 patients with recurrent CC after combined treatment. The control group consisted of 80 patients who had not experienced recurrence for 5 years. The treatment used was external beam radiation therapy (EBRT) followed by intracavitary brachytherapy, with dose calculations.
Results and discussion. The average tumor regression rate was 1.9 in the study group and 10.8 in the comparison group. The highest treatment efficacy was observed in exophytic and mixed forms of cervical cancer (regression up to 9.1 times). Complete regression was achieved in 68.8% of patients in the study group. No acute toxic reactions or grade III-IV complications were recorded. Recurrences were more common with low regression rates, especially in endophytic tumors.
Conclusion. EBRT is an effective treatment for recurrent cervical cancer, especially in exophytic tumors. Regression rate can be considered a prognostic criterion for recurrence. Further individualized treatment decisions are needed.

Relevance. Currently, the treatment of cancer patients is based on personalized selection of drugs depending on the mutational status of the tumor, which is aimed at clarifying the prognosis of the disease and predicting the response to treatment.
Objective of the study. To search for mutations in paraffin-fixed tumor tissues in order to optimize the appointment of targeted therapy.
Materials and methods of the study. The study material was paraffin blocks with biopsy/surgical material of patients. DNA and RNA were extracted using the RecoverAll™ Multi-Sample RNA/DNA kit (Termofisher Scientific, USA) in accordance with the manufacturer's instructions. The molecular genetic method used was NGS technology using targeted semiconductor sequencing (Ion Gene Studio S5 Plus (Termofisher Scientific, USA). The DNA and RNA library was prepared with subsequent sequencing of the amplified fragments in the Ion PGM™ system. Bioinformatics analysis of the results was performed using the Ion Reporter™ Software, the Oncomine™ Focus Assay analysis module.
Study results. As a result of the study, genomic changes were detected in 95% of cases of solid tumors of various localizations. Missense mutations [BRAF; KRAS; IDH1; PIK3CA] were identified in 80% of cases. Combinations of two mutations [PIK3CA, FGFR3; PIK3CA, KRAS; EGFR, JAK3; BRAF, KRAS; ALK-PIK3R1; CDKN2-, IDH2; TP53, JAK2; ROS1, FGFR1]. In 10% of cases, an increase in the number of copies of the EGFR and KRAS genes was detected, and in 10% of cases, a fusion of the gene (RNA) MET- MET.M13M15; TMPRSS2-ERG. More than 5 mutations were detected in 5% of patients, this fact was noted in patients of the older age group and the rapid development of metastases.
The identified genome changes were processed by the server through the FDA, NCCN, EMA, ESMO registries to find the most suitable therapy options existing in world practice for a specific type and localization of the established mutation.
Conclusion. The mutational profile of the tumor is a necessary laboratory test in the practice of a chemotherapist for personalized prescription of targeted drugs, which has a beneficial effect on the duration and quality of life.

Relevance. Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, accounting for about 1% of all malignant neoplasms. They are characterized by hematogenous metastasis, with bone metastases occurring in approximately 9-10% of cases. Treatment of STS with bone lesions requires a multimodal approach to achieve radicality and preserve the limb.
Study objective. To evaluate the effectiveness of combined treatment of STS of the extremities with metastatic bone lesions.
Materials and methods. The study included 17 patients with STS and secondary bone lesions (hip - 9 cases, lower leg - 4, shoulder - 4). Morphological variants: liposarcoma - 6 (35.3%), leiomyosarcoma - 5 (29.4%), undifferentiated sarcoma - 4 (23.5%), synovial sarcoma - 2 (11.8%). The following regimens were used: polychemotherapy with surgery (n=7, 41.2%), radiation therapy with surgery (n=5, 29.4%), chemoradiotherapy with surgery (n=5, 29.4%). Radiation therapy was performed using accelerated fractionation (3.5 Gy × 1 time per day, 5 times per week, total focal dose 32 Gy). Organ-preserving surgeries were accompanied by endoprosthetics of joints or bone segments in 14 cases (82.3%), allotransplantation – in 3 cases (17.7%). Results and discussion. Therapeutic pathomorphosis of III-IV degree was noted in 12 patients (70.6%; 95% CI: 44.0–89.7%). According to RECIST criteria, tumor process stabilization was recorded in 10 patients (58.8%), partial response – in 4 (23.5%), progression – in 3 (17.7%). The average MSTS score was 80.5 ± 15.4%, while good functional results (≥70%) were recorded in 13 patients (76.5%), satisfactory – in 4 (23.5%). Distant metastases were detected in 3 patients (17.7%) within 10 to 18 months, 2 patients (11.8%) died from progression in the lungs with a median follow-up of 22 months. Conclusion. The use of multimodal regimens (chemotherapy, radiation therapy, and chemotherapy) in SMT with metastatic bone lesions allows achieving pronounced therapeutic pathomorphosis, ensuring a high percentage of organ-preserving interventions, and maintaining a satisfactory functional state of the limb.

Relevance. The chimeric BCR-ABL gene caused by the t(9;22)(q34;q11.2) translocation results in the formation of transcripts (b2a2, b3a2, e1a2, e19a2), which play a key role in diagnostics, determination of sensitivity to therapy, and prognosis of chronic myeloid leukemia (CML).
Purpose of the study. To determine the frequency of BCR-ABL transcripts in patients with CML in the population of the Republic of Kazakhstan.
Materials and methods. The study material was the peripheral blood of patients admitted from various regions of the Republic of Kazakhstan, who had t(9;22)(q34;q11.2 at debut. RNA was isolated using the GeneJET kit. BCR-ABL transcripts were detected using the High Capacity cDNA Reverse Transcription Kit (ThermoFisher). RT-PCR was performed on a QuantStudio 12 Flex analyzer (Applied Biosystems). The ABL gene served as a control. The average age of patients was 45±5 years.
Results and discussion. In total, 839 studies were conducted in 554 patients from 2018 to 2025, of which 57 patients underwent follow-up examinations every 6 months. Women predominated in the study cohort - 53%, men accounted for 47%. The frequency of transcripts was distributed as follows: b2a2 - 70%; b3a2 - 17%; e1a2 - 12%; e19a2 - 1.0%.
Co-expression of transcripts was detected during the study. The following combinations of transcripts were most common: b3a2/b2a2 - 53%; b2a2/e1a2 - 29%; b3a2/b2a2/e1a2 – 16%; b2a2/e19a2 – 1.0%; b3a2/ b2a2 /e19a2 – 1.0%.
Conclusion. The most common transcript type in patients with CML in the population of the Republic of Kazakhstan is b2a2, in 51% of patients co-expression of several transcripts was detected, and the most frequently diagnosed combination was b3a2/b2a2 (53%).

Relevance. In the city of Shymkent and the Turkestan region, cervical cancer is diagnosed annually in 150-170 women. Of these, 28-30% of patients are diagnosed with the process at stage III-IV. In the process of seeking and treating patients with cervical cancer, 8-12% of patients experience tumor bleeding. Due to the widespread introduction of intravascular interventions in the clinic, the technique of arterial embolization of the uterine arteries and pelvic vessels for hemostasis is more often used.
Purpose of the study. To assess the possibilities of emergency embolization of the uterine arteries and pelvic vessels for tumor bleeding in patients with cervical cancer.
Materials and methods. Thirty patients aged 33 to 48 years were treated. All patients had stage IIa-IIIb of the process (T2N0M0 - T2-3bN1M0). All patients at the time of admission noted bloody discharge from the genital tract with clots, periodically the discharge had a profuse one-time nature. In the complete blood count, all patients had anemia of grade 2-3, hemoglobin in the blood fluctuated from 45 to 78 g / l, in 2 patients hemoglobin was 30-33 g / l. The time of admission to the hospital from the onset of bleeding was 24-72 hours. All patients, by decision of the council of doctors (oncogynecologist, surgeon, chemotherapist, interventional surgeon), urgently underwent mechanical embolization of the uterine arteries (5 cases) and embolization of the internal iliac arteries from the trunk of the UPA, the start time of emergency EMA from the moment of admission to the OOD was 1-1.5 hours. Metal spirals Gian-Turco and a hemostatic sponge were used as an embolizing material.
Results and discussion. The analysis of immediate treatment results showed the effectiveness of the technique in all 30 patients (100%). The duration of the procedure is 25-40 minutes. The time it takes to stop bleeding from the start of the procedure when working with “four hands” (two vascular surgeons) is 7-15 minutes (depending on the anatomy of the UPA vessels). The effectiveness of mechanical hemostasis is 100%. The possibility of continuing special treatment is more than 80% of cases (mainly chemoradiation therapy). Pain relief was noted in 13 patients. During the follow-up examination after 1 month, stabilization of the process was noted in all patients. Chemoradiation therapy was performed, and 16 patients showed partial tumor regression with a decrease in the tumor node by 40-60% 2 months after special treatment. 24 patients successfully completed special treatment according to the selected chemoradiation therapy program. Of the complications, post-embolization syndrome was noted in 26 patients during the first 3-4 days, nausea and vomiting were observed in 15 patients, and grade 2 leukopenia was observed in 3 patients, which were stopped by conservative therapy. No serious complications associated with embolization were noted.
Conclusion. The use of minimally invasive X-ray surgical methods of hemostasis in patients with cervical cancer complicated by bleeding allows achieving effective hemostasis in a short period of time, makes it possible to continue special treatment (chemo- and radiation therapy), improves the quality of life and increases the survival rate of patients; 80% of patients can complete special treatment.

Objective of the study: To identify the features of colon cancer localization and instrumental visualization methods.
Material and methods. The analysis of data from 63 patients treated for colon cancer in 2017-2019 at the Republican Oncology Research Center of the Ministry of Health and Social Protection of the Republic of Tajikistan was carried out. The following instrumental diagnostic methods were used: ultrasound of the abdominal organs, rectoscopy, fibrocolonoscopy, irrigoscopy, bronchoscopy, CT of the abdominal and chest organs with contrast of the large intestine, MRI of the pelvic organs.
Results and discussion. The age of patients ranged from 21 to 78 years, the peak incidence occurs at the age of 50-65 years. In 77.8% of patients, the duration of the anamnesis ranged from 6 months to 1 year, anemia occurred in 39.6%. Fibrocolonoscopy was performed in 10 patients (16%), CT with contrast enhancement – ​​in 29 patients (46%), and rectoscopy – in 28 patients (44.4%). The prevalence of locally advanced process was revealed (T3-4 – 72.6%). Sigmoid colon lesions were noted in 22 patients (34.9%), cecum – in 12 patients (19%), hepatic and splenic angles, respectively – 9.5% and 11.1%. The diagnosis was verified in all patients, with adenocarcinoma in 80%. Sigmoid colon together with rectal cancer make up 65% of the total number of colorectal cancers. When establishing the staging of colon cancer, a significant prevalence of locally advanced process was revealed - stages III-IV (72.6%) among the total number of patients. At the same time, stages IIA and IVA were established in 10 people (16%) and 14 people (20.2%), respectively.
Traditionally, a digital examination is followed by a rectoscopy. Given the limited capabilities of a rectoscopy (the depth of examination is approximately 20 cm), there is a need for additional examination with a fibrocolonoscope. When performing a fibrocolonoscopy after a digital examination, a double instrumental examination is eliminated.
Conclusions:
1. The predominant lesion of the sigmoid colon (22-34.9%), as well as the cecum (12-19%), was determined.
2. Taking into account the identified trends, the optimal method for diagnosing colon cancer is fibrocolonoscopy. 3. Accurate preoperative diagnosis of the location of the tumor and the extent of its spread allows us to determine the adequate scope of the operation.

Relevance. Malignant glial tumors of the brain (MGBT) are characterized by an aggressive course, high recurrence rate and significant impact on the quality of life. Optimization of the resection volume and the use of modern methods of radiation and chemotherapy can improve oncological control and reduce treatment toxicity.
Objective of the study. To evaluate the results of complex treatment of MGBT using individualized planning of radiation therapy and chemotherapy depending on the morphological and functional characteristics of the tumor.
Materials and methods. The study included 174 patients with MGBT. The sizes of the primary and residual tumor according to MRI, the volume of resection, the timing of the start and technique of RT (3D-CRT, IMRT, VMAT), the use of radiomodifiers, the dynamics of the tumor volume during RT, early and late toxicity were assessed. Statistical processing was performed using the χ² test and the Cramér’s V coefficient.
Results and discussion. Complete tumor removal was achieved in 10.3% of patients, with a residual tumor remaining in 89.7%. The most frequently used methods were 3D-CRT (58%), IMRT – 35.6%, VMAT – 5.2%. Temozolomide was used in 33% of patients, mainly in anaplastic astrocytoma and glioblastoma (p=0.0011). During inter-course MRI control in 30 patients, the median decrease in GTV volume was 35.38%, with a simultaneous decrease in V10 for healthy tissues by 19.02%. Early complications included hair loss (92.53%), dry epitheliitis (79.89%), gastrointestinal reactions (83.33%); late complications included headaches (87.93%), memory loss (54.02%), epilepsy (52.30%). Conclusion. Personalized RT planning with perfusion MRI allows to reduce the volume of healthy tissues irradiated without losing oncological control. The use of modern RT techniques and temozolomide improves local control and survival in CT brain tumors, but the high frequency of complications requires the development of individual protocols for prevention and correction of toxicity.

Relevance. The standard treatment for patients with advanced urothelial carcinoma (AUC) is platinum-based chemotherapy, but progression-free survival and overall survival are limited by chemotherapy resistance.
Study objective. To demonstrate current drug therapy options in a patient with AUC.
Materials and methods. The abstract describes a clinical case of a 62-year-old male patient with a diagnosis of "C-r of the bladder St IIIA T1N1M0, MTS-lesion of the pelvic lymph nodes on the right, bilateral ureterohydronephrosis, condition after bilateral nephrostomy".
Morphological form: urothelial carcinoma G2 with invasion into the submucosa. The treatment outcome was assessed according to the RECIST 1:1 scale, before and during treatment.
Results and discussion. Before therapy, according to RECIST 1.1 criteria, the target lesion selected was a formation on the posterior wall of the bladder, growing through the muscular layer of the wall, infiltrating the paravesical tissue, the orifice of the left ureter, with a maximum diameter of 3.0 cm; layer thickness of 0.9 cm, non-target lesion: hyperplasia of the iliac lymph node on the right up to 1.3 cm (MTS), urethrohydronephrosis on the left is noted (the ureter is dilated to 1.6 cm), SLD-3.0 cm.
After 3 courses of chemotherapy, the size of the target formation decreased to 2.0 cm, layer thickness of 0.5 cm, non-target: regression of the MTS lesion, urethrohydronephrosis on the left persists (the ureter is dilated to 1.3 cm), nephrostomy, SLD-2.0 cm, a partial response to therapy is noted. Taking into account the partial effect of the chemotherapy treatment, the patient was given the monoclonal antibody Bavencio, where after 6 courses, a complete regression of the target formation and non-target lesions, elimination of nephrostomas was noted. Currently, the patient is on maintenance therapy with Bavencio, and the achieved complete regression of the process has been maintained for 21 months.
Conclusion. According to clinical trial data, the use of Bavencio before progression or intolerable toxicity in the treatment of patients with RUC increases the median progression-free survival (3.7 months) and the median overall survival (21.4 months), and is a new standard of therapy.

Relevance. Nephroblastoma is the most common malignant tumor of the kidneys in children and is characterized by pronounced morphological and biological polymorphism. Determination of the expression of immunohistochemical (IHC) markers p53, Ki-67 and CD34 has high diagnostic and prognostic significance, allowing to assess the proliferative activity, apoptotic resistance and angiogenetic potential of the tumor. In the conditions of Uzbekistan, systemic studies of these markers in children with nephroblastoma were limited, which determines the relevance of this work.
Purpose of the study. To evaluate the relationship between the expression of IHC markers p53, Ki-67 and CD34 with morphological features, stage of the disease, frequency of relapses and metastasis in children with nephroblastoma who received complex treatment followed by radiation therapy.
Materials and methods. A retrospective study of 230 children with morphologically verified nephroblastoma observed in 2012–2021 was conducted. IHC analysis was performed using monoclonal antibodies to p53, Ki-67, and CD34 (DAKO, Denmark). Expression levels (high, moderate, low) were determined and compared with the clinical stage (SIOP), degree of differentiation (G1–G4), frequency of relapses, and distant metastases. Statistical analysis was performed using the χ² test at a significance level of p<0.05.
Results and discussion. High expression of p53 was detected in 10.0% of patients, mainly at stages III–IV and low differentiation (G3–G4), associated with an increased risk of relapses (82.6%) and metastases (82.6%) (p<0.001). Ki-67>60% was found in 10.4% of cases, mainly in aggressive morphotypes, and also correlated with the frequency of relapses (83.3%) and metastases (79.2%) (p<0.001). High expression of CD34 (12.2%) reflected enhanced angiogenesis and was accompanied by a high level of metastatic lesions (67.9%) (p<0.001). In 40-50% of cases, data on markers were missing, which is associated with insufficient standardization of IHC diagnostics.
Conclusion. p53, Ki-67 and CD34 are independent unfavorable prognostic markers in children with nephroblastoma, reflecting a high potential for tumor aggression.

Relevance. Tumors of the parotid salivary gland (PSG) occupy a significant place in the structure of neoplasms of the head and neck, and pleomorphic adenoma is the most common benign form. Surgical removal with preservation of the branches of the facial nerve requires high technical training and is aimed at preventing relapses and reducing the risk of functional disorders.
Objective of the study. To evaluate the effectiveness of surgical treatment of PSG tumors with preservation of the branches of the facial nerve, to analyze the clinical features and results of operations.
Materials and methods. An analysis of 61 medical histories of patients with tumors and chronic inflammatory diseases of the PSG, who were treated in different periods (2012-2022), was carried out. Diagnostics included cytological examination, ultrasound, MRI, and, if necessary, express biopsy. Partial, subtotal and complete parotidectomy with dissection and preservation of the main branches of the facial nerve were used. During extirpation of the TSJ, the nerve was necessarily covered with a flap on a pedicle from the masseter muscle.
Results and discussion. The highest recurrence rate was observed in patients previously operated in non-specialized institutions. The use of complete extirpation of the TSJ with preservation of the branches of the facial nerve made it possible to reduce the recurrence of pleomorphic adenoma to 6.7%. Mild paresis of the facial muscles was detected in 75% of patients and regressed on its own, severe paresis - in 25% (with relapses and deep location of the tumor). The use of modified surgical approaches ensured good visual control and minimization of aesthetic defects.
Conclusion. Surgical removal of TSJ tumors with preservation of the branches of the facial nerve and their obligatory cover with muscle flaps is an effective method that allows to reduce the recurrence rate and provide satisfactory functional and aesthetic results.

Relevance. The production of radiopharmaceutical drugs (RPhD) in conditions of limited volume and work with short-lived isotopes is associated with special difficulties. Traditional GMP (Good Manufacturing Practice) standards, focused on large-scale production, are not always applicable in radiopharmaceutical laboratories. Therefore, the principles of GRPP (Good Radiopharmacy Practice), which adapt GMP requirements to the real conditions of RFLP production in small volumes, while maintaining high quality and safety standards, are of particular importance.
Purpose of the study. To evaluate the effectiveness of applying the GRPP principles in quality control of radiopharmaceutical drugs produced using radionuclide generators in conditions of limited production, using the example of the practice of the RSE "BMC UDP RK" on the PVC.
Materials and methods. An analysis of the GMP and GRPP regulatory framework was carried out, and technological processes for the production of RFLP using generator systems were considered. The experience of synthesizing ⁶⁸Ga-DOTA-TOC, ⁶⁸Ga-PSMA-11, ⁶⁸Ga-FAPI-46 and the planned ⁶⁸Ga-Pentixafor preparations was studied. Quality control methods and adaptation of production processes to limited production volumes were assessed.
Results and discussion. The application of GRPP principles allows for the effective adaptation of GMP requirements to the specific features of radiopharmaceutical preparations (RPhLP) production under limited production volume conditions. This approach provides a reliable quality control system optimized for small-scale production without compromising safety and compliance with international standards.
In our laboratory, GRPP principles were implemented in the processes of production and quality control of radiopharmaceutical preparations obtained using licensed radionuclide generators. This allowed us to adapt international GMP requirements to the specific features of small-scale production and ensure full compliance with modern standards in the field of radiopharmaceuticals.
Conclusion. The application of modern GRPP principles in quality control of radiopharmaceuticals obtained using licensed radionuclide generators is a key factor in ensuring the safety and efficacy of products in conditions of limited production volumes. This approach helps to optimize production processes, increase the reliability of manufactured drugs and ensures compliance with high quality standards. The implementation of these principles plays an important role in the development of radiopharmaceuticals, supporting innovative areas in molecular imaging and personalized medicine.

Relevance. Phyllodes tumors (PT), or cystosarcoma phylloides, are rare fibroepithelial tumors of the mammary gland, similar to fibroadenoma. Usually large, fast-growing, originate from the periductal stroma. They are classified as benign, borderline and malignant by histology, but all are potentially malignant. Accurate diagnostics are important for choosing surgical tactics.
Objective of the study. To evaluate the radiological and histopathological characteristics of PT in patients examined at the National Cancer Center.
Materials and methods. Retrospective analysis of PT cases for January 2024 - April 2025. All patients underwent mammography and ultrasound. Data were obtained from electronic medical records.
Results and discussion. 50 cases were identified: the average age was 28 years for benign, 35 years for borderline, 45 years for malignant. Borderline and malignant were larger (35-40 mm). In 38% of cases, the formations were mistakenly assessed as fibroadenomas, in 24%, the philoid tumor variant was indicated as a possible diagnosis.
On mammography, most benign (65%) and 35% of malignant tumors had a high density; calcifications were rare (2 benign cases). On ultrasound, clear contours were noted in 80% of benign and only in 40% of malignant; unclear - in 60% of malignant. Cystic cavities - in 40% of malignant and 10% of benign. Heterogeneity of the structure was found in 78% of malignant tumors. At the same time, some malignant tumors looked clearly defined, which complicates diagnosis.
Conclusion. OFTs are more common in women aged 28-45; malignant and borderline are large. Radiological differentiation from fibroadenoma is difficult. Mammography reveals high density in most benign and a third of malignant cases; calcifications are rare. On ultrasound, malignant variants are often heterogeneous, with cystic cavities and unclear contours, but may also have smooth outlines. Reliable diagnostics are possible only on the basis of biopsy results.

Relevance. Hormonal therapy (HT) in combination with CDK 4/6 inhibitors is a standard treatment for hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (mBC).
Study objective. Improving treatment outcomes for patients with HR+ Her2- mBC.
Materials and methods. The study included 400 patients with hormone-positive (HR+) Her2- mBC who received combination therapy (iCDK4/6+HT) from January 2019 to January 2024. A total of 182 tumor samples were analyzed, DNA was isolated using the GeneJET FFPE DNA Purification Kit. Amplification and detection of results were performed using the PIK3CA Mutation Analysis Kit for Real-Time PCR (Entrogen) consisting of the E542K, E545K, E545Q, H1047R, H1047L mutation spectra.
Results and discussion. Response duration to progression (months):
1 line - up to 43 months.
2 line - up to 35 months.
3 line and more - up to 12 months.
Of the 182 patients, 36 (19.8%) were found to have various mutations in the PIK3CA gene. The three most common missense substitutions in the PIK3CA gene were p.H1047R-18 (50%), mutation p.E542K-9 (25%), and mutation p.E545K-7 (19.5%). Another mutation p.H1047L was found in 2 cases (5.5%), and the mutation p.E545Q was not detected. 13 patients with PIK3CA mutation received CDK4/6 inhibitors in combination with HT in the 2nd and 3rd lines, the median time to progression was 4 months compared to the group of patients without mutation (the median time to progression of therapy in the 2nd and 3rd lines is 12 months). Conclusion. The use of combination therapy iCDK4/6 + HT in earlier lines for HR+ Her2-metastatic breast cancer demonstrates its efficacy, which is confirmed by a longer response before disease progression. The study showed that PIK3CA mutation led to a decrease in the median time to progression in patients receiving CDK4/6 inhibitors (5 months versus 12 months). This confirmed the theory of the negative impact of PIK3CA mutation on the outcomes of hormonal therapy.

Relevance. The main method of treatment for tumor lesions of the pelvic bones and lower extremities is resection of the affected bone with endoprosthetics. Functional results after oncological endoprosthetics remain unsatisfactory in 35-40% of cases. The need to improve functional results is a significant medical and social problem.
Purpose of the study. To assess the impact of perioperative rehabilitation on functional results in cancer patients who underwent surgical treatment with resection of the pelvic bones and lower extremities with endoprosthetics.
Materials and methods. A comprehensive analysis of the treatment results was carried out for 348 patients who underwent resection of the affected part of the pelvic bones and lower extremities with endoprosthetics. Of these, there were 150 men (43.1%) and 198 women (56.9%), the average age was 51.3 (19-82) years. The distribution of patients by the volume and type of surgical intervention was as follows: pelvic bone resection using a Lumic type endoprosthesis was performed in 23 patients; proximal femur resection with endoprosthetics – 124; distal femur resection with endoprosthetics – 108; proximal tibia resection with endoprosthetics – 75; distal tibia resection with endoprosthetics – 6; long bone diaphyseal resection – 12 patients. Results and discussion. The study included 348 patients who underwent surgical treatment with endoprosthetics of the resected bone section. In the group using the perioperative rehabilitation program (the first group), which included 167 patients, the functional results were better than in the control group and amounted to 81.2%. Mechanical complications were detected in 18 patients (10.7%). The average functional results in 181 patients of the second group who did not receive a full perioperative rehabilitation complex were 71.8%, mechanical complications were in 13.25% (24 patients).
Conclusion. Full perioperative rehabilitation is an important component, it significantly improves the functional result of the operated limb, promotes earlier activation, restoration of self-care in the shortest possible time after surgery. Improvement of functional results in patients also reduces the risk of mechanical complications.

Relevance. The study is devoted to the study of organizational and methodological, interdisciplinary and value-oriented problems of the use of X-ray therapeutic technology in the provision of oncological care.
Purpose of the study. To develop and scientifically substantiate organizational and methodological approaches and recommendations for improving RT care in oncology dispensaries.
Materials and methods. The sociological method (questionnaires, in-depth interviews), data extraction from medical records, mathematical and statistical methods were used.
Results and discussion. Three main models of organizing RT care are substantiated and differentiated. The potential for increasing the availability of RT care is realized through improving operational efficiency (duration of an RT session = 12.1 min.), the efficiency of equipment use (throughput - 36 patients per shift), optimization of the schedule and operating mode. Changes in clinical guidelines have led to an increase in the average bed-day from 12 to 24 days, which requires taking this factor into account when planning the work of the radiation therapy department and using prognostic mathematical models. Taking into account patient-associated factors improves the individual patient experience. Younger age (r=-0.398, p=0.009) and female gender (r=-0.475, p=0.001) are factors associated with higher emotional distress about appearance, which requires consideration when choosing therapy. Older patients were less involved in choosing a treatment method (r=-0.633, p=0.001). The use of a patient-oriented communication algorithm allows achieving satisfactory involvement (≥3 points, out of 4) in 67% of patients.
Conclusion. For the first time, organizational and methodological approaches and ways of improving RT care have been developed in accordance with modern goals, objectives, values ​​and trends in healthcare in general and oncological care in particular.

Relevance. Endometrial cancer is one of the most common malignant tumors of the female genital organs. Hormonal imbalance is considered one of the main etiological factors in the development of the disease. Long-term and uncontrolled exposure to estrogens, as well as progesterone deficiency, contribute to the proliferation of the endometrium and its subsequent malignant transformation. Menstrual dysfunction is also considered as a clinical indicator of these processes. It has been proven that such factors as early menarche and late menopause influence the development of endometrial cancer.
Objective of the study. To study the features of hormonal status and menstrual function in patients with endometrial cancer, as well as to assess the impact of these indicators on the risk of developing the disease.
Materials and methods of the study. From 2021 to 2024, a prospective study was conducted in the Oncogynecology Department of the National Cancer Center, including 120 women diagnosed with endometrial cancer. The stages of the study included: collecting the patients' anamnesis (menstrual history, reproductive history, age of menopause, cases of infertility and number of births). When assessing the menstrual function, the following were taken into account: age of menarche, type and duration of the menstrual cycle, intensity of bleeding during menstruation, age of menopause and cases of postmenopausal bleeding. For laboratory assessment of hormonal status, a study of estradiol (E2) and progesterone levels was performed.
Results and discussion. Menstrual history: in 62% of patients, menarche began early, in 54%, episodes of anovulatory cycles were noted during the reproductive period. The average age of menopause in postmenopausal patients was 47-55 years. Postmenopausal bleeding was observed in 38%. Hormonal status: in premenopausal women, progesterone levels were significantly lower than normal (p < 0.05), while estradiol levels were higher than normal (p < 0.01). In postmenopausal women with elevated E2 levels (27%), endometrioid adenocarcinoma was more often detected. A statistically significant correlation was found between high E2/progesterone ratio and poorly differentiated tumors.
Conclusion. Hormonal imbalance (high estrogen levels, low progesterone levels) and menstrual function characteristics (early menarche, late menopause) play an important role in the development of endometrial cancer. Regular monitoring of the hormonal profile and a thorough analysis of the menstrual history in women at risk are important for early diagnosis and prevention of the disease.

Relevance. Cervical dysplasia is a pathological change in the epithelium that precedes the development of invasive cancer. Early detection and monitoring of dysplastic changes is possible through screening programs. Cytology is an accessible method of primary diagnosis. This study is aimed at analyzing cytological data in women with established dysplasia.
Purpose of the study. The cytological characteristics of cervical dysplasia were analyzed in 120 patients. The work is based on a retrospective study of Pap smear data.
Materials and methods. A retrospective analysis of 120 cytological studies performed at the National Oncology Center for the period 2022-2024 was carried out. Age, inflammatory changes, and the presence of HPV infection were taken into account.
Results and discussion. The patients were divided into age groups and the presence of concomitant inflammatory diseases: 20-30 years old - 25 patients; 30-40 years old – 63 patients; 40-50 years old – 32 patients.
In the first group, 43% of patients had CIN I, 35% – CIN II, 22% – CIN III. In the second group, 39% of patients had CIN I, 45% – CIN II, 16% – CIN III. In the third group, 29% of patients had CIN I, 33% – CIN II, 38% – CIN III.
Conclusion. Cytological examination is effective in the early diagnosis of dysplasia. Its regular use in combination with HPV diagnostics allows for the timely detection of precancerous changes.

Background. Accuracy and reproducibility of quantitative data from hybrid imaging methods (PET/CT and SPECT/CT) are of key importance for diagnosis, monitoring and treatment planning of cancer patients. Calibration failures or insufficient quality control may result in significant deviations from standard SUV values, which may change clinical decisions. Development and implementation of standardized quality control (QC) and calibration procedures ensures data reliability, optimization of radiation dose and comparability of results between medical centers, especially in multicenter studies and international projects. It is known that the calculated SUV values ​​are affected by many technical factors, and without proper scanner calibration, biases and variability may occur that are not obvious during routine visual assessment. Therefore, international initiatives (QIBA, UPICT, EANM, etc.) and standards require ensuring the quantitative accuracy of PET measurements in multicenter studies. The accuracy and correctness of the information obtained from PET/CT (as well as SPECT/CT) images directly depend on the technical condition of the tomograph and require timely regular monitoring. According to the IAEA recommendations, modern PET scanners require periodic calibrations, and the main goal of quality control programs is to ensure that the images reliably reflect the distribution of the radiopharmaceutical in the patient's body. Without such a QA/QC system, the risk of measurement errors and a decrease in the reliability of studies increases, which in oncology can lead to errors in assessing the dynamics of the disease.
Purpose of the study. The report is aimed at substantiating the importance and describing the methods of calibration and quality control of PET/CT and SPECT/CT equipment in clinical practice. The goal is to demonstrate how maintaining calibration accuracy (especially the SUV parameter) and performing regular QC according to NEMA and IAEA standards improve the stability of equipment operation, reduce the likelihood of errors and ensure high clinical accuracy of study results.
Materials and methods. The Nuclear Medicine Center of the BMC UDP RK has implemented a comprehensive QA/QC program for hybrid PET/CT and SPECT/CT scanners. Equipment calibration includes inter-device calibration "scanner - dosimetric radionuclide calibrator". For this purpose, a homogeneous water cylindrical phantom with a known activity of a radiopharmaceutical (for example, ^18F) is scanned quarterly. The activity of the sample is preliminarily accurately measured by a dose calibrator traced to a national standard, which allows setting the calibration coefficient of the tomograph for the correct calculation of SUV. The criterion is obtaining a SUV value of ≈ 1.0 on the scan in the phantom with an acceptable deviation of no more than 10%; in practice, with strict adherence to the methodology, a deviation of ~5% is achieved. Additionally, time synchronization between the dose calibrator and the scanner is checked (to exclude decay errors when recalculating activity). SPECT/CT quality control is carried out in a similar mode. The uniformity of the gamma camera detectors is checked daily using a flat source (e.g. 57Co) or a flooded background phantom. System alignment tests (rotation center correction) and resolution checks are performed weekly and after service work. A Jaszczak phantom is used - a hollow cylinder with a set of radial rods and spherical inserts filled with a 99mTc solution. This phantom allows for a comprehensive assessment of the resolution, contrast and homogeneity of the SPECT image on different collimators, as well as to ensure the correct operation of the reconstruction algorithms and alignment with CT. The indicators obtained on the phantoms are compared with the manufacturer's passport values ​​​​and standard requirements (NEMA NU1 for gamma cameras, IEC / NEMA NU2 for PET, IAEA and European Association of Nuclear Medicine recommendations). If deviations outside the tolerance are detected, recalibration or maintenance of the equipment is immediately performed. All QC results are recorded, which allows tracking the dynamics of device characteristics over time.
Conclusion. Calibration and regular quality control of PET/CT and SPECT/CT equipment are mandatory conditions for accurate and reliable operation of the nuclear medicine department. For oncology, where even small changes in SUV or image errors can affect treatment tactics, maintaining strict QC protocols is the key to reproducibility of results and trust from clinicians. Conducting tests according to international standards (NEMA, IAEA, EANM) ensures the comparability of studies between different centers and devices. The implemented QC system allows early detection of deviations in the scanners and prevention of failures, without waiting for critical deterioration or equipment failure. As a result, the number of technical errors and repeated studies is reduced, the dose for patients is optimized, and most importantly, the reliability of diagnostic information and the effectiveness of therapy monitoring are increased. This approach improves the quality of oncological care, providing doctors with correct quantitative data and stable images for making clinical decisions.

Relevance. Screening for lung cancer and pulmonary nodules using low-dose computed tomography is associated with a decrease in lung cancer mortality. Comparative analysis of lung nodules and micronodules in cancer patients using this technique allows to reduce the total exposure dose per patient.
Objective of the study. To determine the level of radiation exposure during repeated examinations in cancer patients and automatically measure and compare pulmonary parenchymal nodules using the licensed Vidar-lung nodules program.
Materials and methods. The studies are conducted at the National Center of Oncology in Baku, in the CT and MRI department. The Siemens Definition Flash device is used with the Lung Low Dose and Ultra Low Dose protocols. Retrospectively, studies were taken from 30 patients who underwent low-dose CT.
Results and discussion. Of the 30 patients, 20 were men and 10 were women. The average age was 35 years. The maximum radiation dose for one examination is no more than 0.6 mSv. The same doses were used in subsequent control examinations.
Conclusion. Low-dose chest computed tomography allows to reduce the accumulated exposure dose in cancer patients with detected pulmonary nodules undergoing a repeated control examination according to the indications and recommendations of the oncologist.

Background. Until recently, kidney cancer was considered "radioresistant" in the context of traditional fractionated radiotherapy. However, the ability to accurately deliver high doses using stereotactic radiotherapy (SBRT) has changed this paradigm, and today its use has found its niche for patients who are denied surgery for one reason or another.
Objective. To evaluate the results of overall survival and local control after the use of stereotactic radiotherapy (SBRT) in the treatment of inoperable patients with stage I kidney tumor, to assess the level of renal toxicity.
Materials and methods. This study included 60 patients with verified kidney tumor who received SBRT courses at the State Autonomous Healthcare Institution "ChOKTsO i NM" in the period from 2011 to 2024. The average age of patients was 70±8.6 years (from 49 to 93). The ratio of men and women was 1:1. In 51 cases, STLT was performed on the primary tumor, in 8 cases - for recurrent kidney cancer after previous surgical treatment, including 1 patient - for recurrent cancer of both kidneys. The treatment was performed on the CyberKnife device with a total focal dose (TFD) of 30 to 45 Gy in 3 fractions.
Results and discussion. The median overall survival (OS) was not reached, since most patients remain censored. The one-year OS rates were 97%, 5-year 68%, one-year progression-free survival (PFS) - 95%. In the analysis of local control, 7 patients (11.6%) showed a complete response according to RECIST 1.1 criteria, half of the patients (31 patients - 51.7%) showed stabilization of the process, in 28.4% of cases (17 patients) - a partial response, in 8.3% (5 cases) - progression of the process.
As part of this study, a thorough analysis of patients with continued tumor growth after a course of STLT was carried out. The median occurrence of continued growth was 14 months (from 11 to 111 months). The initial size of the kidney tumor in these patients averaged 45 cm3 (from 21 to 80 cm3). In most cases (n = 3; 60%), a total focal dose of 45 Gy was administered. According to the RECIST1.1 criteria, the increase in the size of the tumor focus ranged from 28% to 80%. A decrease in the glomerular filtration rate and, as a consequence, renal excretory function was noted in 25% of patients 6 months after the treatment, but 2 years after the completion of STLT, renal function was completely restored in all cases.
Conclusion. Conducting STLT in inoperable patients with local stages of kidney tumor allows achieving a high level of local control and is accompanied by the development of moderate renal toxicity.

Relevance. Over the past decades, there has been significant progress in increasing the overall survival (OS) of patients with relapsed/refractory multiple myeloma (RRMM) [1, 2]. Despite this, the search for new therapeutic options to improve the effectiveness of RRMM therapy continues [3]. The recent inclusion of anti-CD38 monoclonal antibodies (mAbs) in clinical practice has provided significant progress in the therapy of patients with RRMM [3, 4].
Purpose of the study. To conduct a retrospective comparative analysis of our own experience with the use of anti-CD38 mAbs (daratumumab, isatuximab) as monotherapy for RRMM in the population of patients participating in clinical trials (CTs) and from real-world clinical practice (RCP).
Materials and methods. The present analysis includes data from 63 patients with RRMM who were treated from 06.2016 to 06.2020 at the MMNC named after S. P. Botkina was administered monotherapy with daratumumab (n=58) or isatuximab (n=5). The key inclusion criterion in the discussed CTs was a history of ≥3 lines of previous treatment, including a proteasome inhibitor and an immunomodulator, or refractoriness to both drugs. Patients had not previously received anti-CD38 therapy. In the RCP group, there were 6 patients with ECOG ≥3, which was not allowed in the CTs. Daratumumab and isatuximab were administered in standard doses, the cycle duration was 28 days. Therapy was administered until progression, death, or unacceptable toxicity.
Result. With a median follow-up of 20 months. (1-62 months) the overall response rate of patients in CT was higher than in RCTs (50% vs. 29.3%, respectively), as was OS - median 26.5 vs. 17.0 months, respectively. No differences were found between the groups in terms of progression-free survival (median 5 and 6 months, respectively). Infusion reactions (IR) associated with the use of anti-CD38 mAbs occurred mainly at the first administration (>90% of cases) and did not exceed grade 1-2.
Conclusion. The results of anti-CD38 mAb monotherapy in RCTs are inferior to those in patients included in international CTs. Based on experience/results, the primary use of anti-CD38 mAb in monotherapy is indicated in heavily pretreated patients with depleted bone marrow hematopoiesis reserves and accumulated organ toxicity, when the administration of intensive triplets may be accompanied by excessive adverse events. Switching from the intravenous form of daratumumab to the subcutaneous form allows to reduce the administration time of the drug from several hours to 3-5 minutes and thereby reduce the incidence of IR.

Background. For several decades, the ABVD regimen and several modifications of BEACOPP with or without subsequent radiation therapy have been the cornerstone of treatment for adult patients with classical Hodgkin lymphoma (cHL) [1]. Further progress in cHL treatment is associated with the development of immunotherapy and, in the future, the abandonment of "classical" cytotoxic agents [2]. New targeted agents are highly effective and can potentially help reduce toxicity [3].
Objective of the study. To analyze the efficacy and safety of the N-AVD regimen in the first-line therapy for cHL.
Materials and methods. A single-center retrospective study collected data on 26 patients with cHL who received N-AVD therapy in the Leningrad Regional Clinical Hospital from 03.2023 to 02.2025. Inclusion criteria: age ≥18 years, diagnosis of cHL established on the basis of histological and immunohistochemical examination of tumor tissue biopsy, absence of previous treatment and ECOG performance status 0-2. The recruitment of patients with widespread stages of cHL, in accordance with the GHSG criteria, stages III-IV according to Ann Arbor or IIB with massive mediastinum or with extranodal lesions was supposed. The treatment regimen included intravenous administration of nivolumab at a dose of 3 mg/kg + AVD. Patients with stage IIB were planned to receive 4 cycles of N-AVD followed by external beam radiation therapy (RT) to the areas of the initial lesion. In the case of stages III-IV, we focused on 6 cycles of N AVD, RT - optionally to residual masses. Treatment efficacy was monitored after every 2 cycles of N-AVD using PET-CT.
Results and discussion. As a result of the implementation of the entire therapy program, including the RT stage, the CR rate was 96%. With a median follow-up of 11.9 months, all 25 patients assessed for efficacy were alive and remained under observation. One-year PFS was 95.7 ± 4.3%. The most common AEs were stage 3-4 neutropenia. Of the immune-mediated AEs (iAEs), two cases of stage 2 and 3 autoimmune thyroiditis and stage 3 acute pericarditis should be noted. The iAEs were not the reason for discontinuation of specific therapy. Conclusion. The results demonstrated the efficacy of the N-AVD regimen in patients with widespread stages of cHL, which is not inferior to that of standard chemotherapy. The use of the N-AVD regimen is associated with the risk of developing iAEs that require special attention. This study leaves open the question of the advisability of consolidation RT in patients receiving N-AVD therapy; additional clinical data and longer follow-up periods are required.

Relevance. Photodynamic therapy (PDT) is an innovative and low-traumatic method for treating cervical pathologies associated with the human papillomavirus (HPV). However, the effectiveness of PDT can vary significantly among patients, which is due to individual molecular genetic characteristics. Polymorphisms of genes involved in the immune response and metabolism of photosensitizers, such as HLA-DQB1, HLA-DQA2, TAP2 and HLA-C, can affect the degree of accumulation of the photosensitizer, activation of cellular immunity and the response to oxidative stress caused by PDT. This determines the need for a detailed study of genetic factors that can predict tissue sensitivity to photodynamic effects.
Purpose of the study. To evaluate the effect of HLA-DQB1, HLA-DQA2, TAP2 and HLA-C gene polymorphisms on the efficacy of photodynamic therapy in patients with HPV-associated cervical diseases.
Materials and methods. The study included patients with HPV-associated cervical intraepithelial neoplasia who underwent photodynamic therapy. All patients underwent analysis of HLA-DQB1 (rs1063322), HLA-DQA2 (rs62619945), TAP2 (rs241448) and HLA-C (rs1050326) gene polymorphisms using molecular genetic methods. The frequencies of genetic variants in patients with different HPV types (16, 18, 51, etc.) and their relationship with the clinical efficacy of therapy were compared.
Results and discussion. Analysis of HLA-DQB1, HLA-DQA2, TAP2 and HLA-C gene polymorphisms in patients with different HPV types revealed significant differences in genetic predisposition to PDT effectiveness. In HPV 16 carriers, the rs1063322 polymorphism in HLA-DQB1 was found in 13.2% of cases, while with other HPV types its frequency was 5.12%. In patients with HPV 18, the rs62619945 polymorphism in HLA-DQA2 was observed in 55.6% of cases, which was significantly higher compared to other HPV types (20.5%, p=0.01). The rs241448 polymorphism in TAP2 was more often detected in HPV 51 carriers (8.33%), while with other HPV types it was less common. The rs1050326 polymorphism in HLA-C was more common in patients with HPV 18, but the differences did not reach statistical significance.
Conclusion. The data obtained confirm that genetic characteristics can affect the effectiveness of PDT. Taking into account the individual genetic profile of the patient allows increasing the effectiveness of therapy by 20-30% due to personalized selection of the photosensitizer and radiation parameters. This emphasizes the importance of introducing molecular genetic testing into clinical practice to optimize PDT in patients with HPV-associated cervical diseases.

Background. Currently, liver cancer caused by colorectal cancer metastases (CRLM) remains one of the most challenging and progressive issues in oncology. Despite significant advances in diagnosis and treatment, unresectable CRLM continues to pose a challenge to medical practice due to its aggressiveness and limited intervention methods. Specifically, accurate delineation of the gross tumor volume (GTV) in unresectable CRLM is crucial for radiotherapeutic treatment planning and determining critical organ doses.
Modern cancer management methods include the use of computed tomography (CT) and positron emission tomography with [(18)F]-fluorodeoxyglucose (FDG-PET/CT), which allow for a more precise characterization of the tumor process's nature and extent. However, despite improved visualization methods, challenges still exist in defining GTV boundaries, especially in cases with complex anatomical localizations and neighboring tissues.
In this context, this study aims to compare the results of GTV delineation in unresectable CRLM using two methods - CT and coregistered FDG-PET/CT. It is hypothesized that integrating FDG-PET/CT data can enhance the accuracy of tumor extent determination and thus contribute to more effective radiotherapeutic treatment planning. Furthermore, the potential to pre-assess GTV using FDG-PET/CT may help avoid radical interventions that could prove futile in cases of unresectable CRLM.
Purpose of the study: Our aim was to compare computed tomography (CT) and coregistered [(18)F]-fluorodeoxyglucose positron emission tomography CT-(FDG-PET/CT) based delineation of gross tumor volume (GTV) in unresectable colorectal liver metastasis (CRLM).
Materials and methods. Fifty-four patients with unresectable CRLM were enrolled but 16 were excluded due to detection of additional hepatic metastases in ten on PET/CT scans, precluding radiotherapy because of transcendent critical organ doses beyond tolerable limits; and of extrahepatic metastases in six. For 38 eligible patients, both CT and PET/CT images were acquired, and two 3D conformal plans were made using the CT and FDG-PET/CT fusion data sets. Radiotherapy plans (RTP) and doses to critical organs were analyzed.
Results. Comparisons between two RTPs revealed need for change in GTV in 31 of 38 analyzable patients (81.6 %). In 25 (65.8 %) patients, GTV was significantly increased, with a median of 33.2 % (p < 0.001), whereas median 12.8 % decrease in six (15.8 %) (p < 0.001). There were no clinically meaningful differences in critical organ doses.
Conclusion. Coregistered FDG-PET/CT may improve delineation of GTV and theoretically reduce the likelihood of geographic misses in unresectable CRLM. Additionally, integration of FDG-PET/CT in the initial assessments of CRLM may spare almost one third of patients from potentially futile radical interventions.

Relevance of the problem. Noncommunicable diseases are now responsible for most global deaths, and cancer is the leading cause of death and is expected to be the most important obstacle to increasing life expectancy in every country in the world. century. Cancer incidence and mortality are exploding worldwide. The reasons for this are complex, but they reflect the aging and growth of the population, as well as changes in the prevalence and distribution of major risk factors for cancer, some of which are related to socio-economic development. There are many risk factors that are not carcinogenic, but play a promoting role in the development of cervical cancer.
Objectives of the study: to identify a set of risk factors that are at least partially involved in the carcinogenesis of cervical cancer and to determine the likelihood of its development.
Materials and research methods: The material for this clinical study was data from a six-year follow-up of 240 patients with locally advanced forms of cervical cancer treated at the Osh Interregional Oncology Center and the National Center for Oncology and Hematology under the Ministry of Health of the Kyrgyz Republic. We studied epidemiological and clinical materials on cervical cancer, as well as reproductive factors affecting the occurrence and development of cervical cancer. In 17.91% of cases, patients with cervical cancer began sexual activity early, namely at the age of 18-20 years. Precancerous diseases - 19.58%, multiple births - 19.58%, primary infertility - 1.25%, medical abortion - 4 and more - 14.16%, chronic inflammatory diseases of the cervix - 10.0%, endocrinological disorders - 23.3% of observations. The number of women who regularly visited the gynecological consultation room - 33.74% of women. The number of visits, which is the absence of a gynecologist for a long time, almost 10 years or more, is 66.25%. A comparative study with the Vassarstat program showed that in the study group of patients with cervical cancer, patients who did not visit the gynecologist regularly were statistically more likely to have a higher risk of developing cervical cancer.
Conclusions. The study of relevant etiological mechanisms and risk factors for cervical cancer will allow the development of effective measures and technologies for the prevention of this type of cancer.
Conclusions. Among the risk factors for cervical cancer are frequent menstruation, chronic inflammatory processes, and endocrinological disorders.

At the National Center for Oncology and Hematology under the Ministry of Health of the Kyrgyz Republic, more than 35,163 thousand Kyrgyz people with oncopathology were registered as of the beginning of 2025. The lack of access to modern technologies for the diagnosis and treatment of oncological diseases, as well as medicines, still remains an unresolved problem, as evidenced by the low 5-year survival rate of patients in 2024 - 34.2%. In the period from 2020 to 2024, the absolute number of patients with malignant tumors in the republic increased: if in 2020 5377 were registered, then by the end of 2024 their number reached 6651. The absolute number of deaths from malignant tumors in 2020 was 3,539, in 2021 - 3,438, in 2022 - 3,352, in 2023 - 3,420 and in 2024 - 3,390 people. In 2024, the incidence of malignant tumors in the Kyrgyz Republic (number of new cases) is expected to increase by 91.3 per 100,000 population and the number of deaths will decrease by 46.5 per 100,000. In 2021, the number of new cases was 85.1 per 100,000 population, in 2022 - 88.5 per 100,000 population, and in 2023 - 86.0 per 100,000 population. In terms of causes of death from all diseases in the Kyrgyz Republic, malignant tumors are in second place after diseases of the circulatory system. The mortality rate in 2021 was 51.0 per 100 thousand population, in 2022 it was 48.1 per 100 thousand population, and in 2023 it was 48.2 per 100 thousand population. In 2023, the incidence was 446.35; annual mortality was 46.3. In 2024, the annual mortality was 30.7 per 100 thousand population. The largest number of patients with malignant tumors was recorded in Naryn region - 120.3 per 100 thousand population, followed by Chui region, Bishkek city, Issyk-Kul region - 120.0, 116.1 and 114.2 per 100 thousand population. The number of deaths from malignant neoplasms in the Kyrgyz Republic is in descending order of indicators: Naryn region - 72.7% 000, Issyk-Kul region - 58.4% 000, Chui region - 55.8% 000. Thus, 55.4% of cancer cases occur in people aged 35-64 years. In the structure of oncological diseases, the first place is occupied by: stomach cancer -12.8%, in the second place - breast cancer -12.6%, in the third place - lung cancer -8.4%, in the fourth place - cervical cancer -7.2%, in the fifth place - liver cancer -5.1%. In the structure of deaths in the Kyrgyz Republic, the first place is occupied by stomach cancer (8.2%), in the second place - lung cancer (6.0%), in the third place - breast cancer (4.2%). In the Kyrgyz Republic, stages 3-4 of the disease are diagnosed in 54.5% of patients across the country. The highest incidence of patients with stage 4. lung cancer – 48.4%, liver cancer, intrahepatic bile ducts – 50.4% and stomach cancer – 36.6%. Conclusion. These figures indicate a lack of information about cancer risk and prevention factors and low oncological awareness of primary care physicians and are a key indicator of the effectiveness of the entire healthcare system in preventing and early diagnosis.

Relevance of the issue. Palliative care for cervical cancer, including radiotherapy and chemotherapy, plays an important role in improving the quality of life of patients with advanced cancer by controlling symptoms and relieving pain. About 60% of patients said that they would like to discuss their diagnosis and treatment experience with a medical professional. Psychological support is aimed at improving the quality of life of sufferers.
The purpose of this work: to study the state of palliative care in the Osh region of the country, to reveal and how it affects the mental/psychological state of patients.
Materials and methods of the study. The study group included 83 patients with malignant neoplasms of the cervix, stages III-IV, who were registered in the Osh Interregional Oncology Center during the three-year observation period. The average age of the patients was 56 years (range 28 to 88 years).
Results. Special psychological tests were used for cancer patients. Only 16 (19.3%) of the women knew that cancer could be cured. Unfortunately, the remaining patients thought that cancer would not be cured or found it difficult to answer. They were not provided with psychological help. Of the 83 patients with advanced or disseminated forms of cervical cancer, subclinically observed anxiety (8-10 points) and clinically observed anxiety (11 points and above) were detected in 35 (42.3%) and 39 (46.9%) patients, respectively. On this scale, 9 (10.8%) patients were in the "norm" gradation. In a study of another scale assessing depression, subclinically observed depression (8-10 points) in cervical cancer patients was detected in 45 (54.2%) patients, and clinically observed depression - in 30 (36.1%) patients. Comparison of proportions according to the criterion of "anxiety" (norm and clinically expressed) according to the scale of anxiety and depression in the hospital showed that clinically expressed anxiety was also significantly more common than in the comparison group (p<0.001). In general, 75 (90.4%) of 83 patients with advanced stages of the tumor process had symptoms of subclinical and clinically noticeable depression.
Conclusion. Chronic pain prevailed, it was recorded in 80 (96.3%) patients. After palliative therapy, the number of patients with anxiety decreased from 39 to 19, i.e. almost twice, which was statistically significant with a high probability (p = 0.0006). After psychological correction, it was detected in 30 patients instead of 18. The difference was also statistically significant (p = 0.02). Subclinical symptoms of anxiety and depression were present in 35 (42.2%) and 45 (54.2%) patients before the start of palliative therapy, respectively. After palliative treatment, these symptoms significantly decreased - anxiety was detected in 16 patients and depression in 23 patients. All this indicated an improvement in quality of life.

Relevance of the problem. Malignant tumors in children are very rare in the overall structure of tumors. According to the International Agency for Research on Cancer, malignant tumors in children account for approximately 2-3% to 7-8% of all cancers.
Objective: to determine reliable data on the incidence of malignant tumors in children by gender and age.
Research material and methods. The study covered a nine-year period, only 204 children with newly diagnosed malignant tumors were identified.
Results. Morphological verification (histological and cytological) was 77.9%. In the structure of malignant tumors in children, leukemias took the first place - 95 (52 boys and 43 girls) - 46.6%. In second place were lymphomas - 29 (25 boys and 4 girls) -14.2%. Among lymphomas, non-Hodgkin lymphomas were most common - 18 patients (17 males and 1 female) - 8.8%. Among solid tumors, retinoblastoma was the most common after renal tumors - 16 children (8 males and 8 females) - 7.9%. Children with malignant bone tumors in the structure of the disease accounted for 5.9%. Central nervous system tumors accounted for 9 children (6 males and 3 females) - 4.4%. Genital neoplasms (testicular cancer in 2 males and ovarian cancer in 10 females) accounted for 0.9% and 4.9%, respectively. Other neoplasms (thyroid cancer, nasopharyngeal lymphoepithelioma, rectal cancer and other tumors) accounted for 1.9% of observations. Thus, hemoblastosis - 60.7%, solid tumors - 39.3%. Boys are more likely to suffer than girls (1.3:1). The average annual incidence rate in males was 5.72 and in females 4.42 per 100,000 children. All structural forms of the disease were more common in boys than in girls. Soft tissue tumors were more common in girls. The highest incidence rate was observed in the younger age group (5.2). In the other two age groups (5-9 and 10-14 years) the rates were 5.0 and 3.9 per 100,000, respectively. The highest incidence rates in the younger age group were observed in leukemia (3.2), nephroblastoma (1.0), and retinoblastoma (1.1). The highest incidence rates in the 5-9 age group were also observed in children with leukemia (3.1), lymphogranulomatosis (0.6), and renal tumors (0.5). At the age of 10-14, leukemia (1.3), lymphoma (0.6), bone tumors (0.6) and ovarian tumors (0.6) are leading in terms of morbidity.
Conclusion. The gender and age composition of the child population affects not only the overall level of morbidity, but also its structure, since each age group has its own structure of oncological diseases. These indicators allow the practitioner to predict and examine children at risk.

Relevance of the problem. In recent years, the incidence of salivary gland tumors has remained unchanged in the structure of oncological diseases and is 1-5%. More than 30 new cases of malignant salivary gland tumors are registered annually in the Kyrgyz Republic. The surgical stage of treatment remains the main one in the complex of therapeutic and diagnostic measures for salivary gland tumors.
Purpose of the study: to improve the results of treatment of patients with malignant epithelial tumors of the salivary gland.
Materials and methods of study. During the study period, 318 cases of salivary gland cancer were registered, which indicates the rarity of this pathology. The ratio of men to women with salivary gland cancer was as follows - 166 men and 152 women or 1.09, i.e. almost equal.
Results. Analysis of the conducted studies showed that only 7.8% of all observations regarding survival received radiation therapy. The two-year survival rate was 94.2±2.4%. The survival rate of patients who received only radiotherapy in the fourth year was 64.8±5.7%, and the five-year overall survival rate was 52.9±6.5%. It is worth noting that patients who received radiotherapy as a specific treatment and monotherapy mainly had late stages of the tumor - the third and fourth. Combined treatment in the form of surgery and radiotherapy was received by 61.6% of patients. They were mainly patients with the second and third stages of the disease. The overall survival rate for two years was - 91.9±2.7%. The overall five-year survival rate of salivary gland cancer patients who received combined therapy (surgery and radiotherapy) was - 71.9±4.2%. This indicator was the highest among the groups of patients who received different types of specific therapy. Patients with salivary gland cancer who received combined treatment with radiotherapy and chemotherapy was only 12.3% of the observations. The overall five-year survival rate of patients who received this type of specific treatment was 66.7±5.5%. Only symptomatic treatment of salivary gland cancer was performed in 16.4% of patients. The overall survival rate (5 years) of patients in this group was 58.3±5.9%. The total number of relapses after treatment of salivary gland cancer was 15.3%, after a combined approach - 11.1%, radiotherapy and chemotherapy - 22.2%, and radiotherapy alone - 29.4% of the observation period. The two-year survival rate in the absence of cervical lymph node involvement was statistically significantly higher - 96.7±1.7% - and 64.3±6.0% (P˂0.05). Analysis of data on five-year survival showed that the lowest rates obtained in the presence of metastases were 17.1±7.4%, and this difference was statistically significant compared to all other years of observation.
Conclusion. The most effective treatment for salivary gland cancer is a combination of surgery and radiation therapy.

Relevance of the problem. The five-year survival rate of patients with laryngeal cancer with combined treatment does not exceed 30%. Ways to improve long-term results of treatment, as well as ways to prevent disability, are being sought.
Purpose of the study: to evaluate the effectiveness of chemotherapy and radiation therapy.
Materials and methods of study. Chemoradiation treatment was performed on 67 patients with laryngeal cancer. As a result, the comprehensive examination revealed destructive T2 N0-3 M0 - 10, T3 N0-3 M0 - 38 and T4 N0-3 M0 - in 19 patients. Most patients (57-85.1%) had widespread tumors of the larynx, 46 patients (68.6%) had cancer metastases in the cervical lymph nodes before the start of treatment. Thus, the analyzed group of patients had a poor prognosis of the disease. All patients underwent 2-3 courses of combined chemotherapy according to three schemes PF, PFB and CPFB: drugs such as cisplatin, 5-fluorouracil, bleomycin). Comparative results of the effectiveness of the presented chemotherapy regimens showed the identity of therapeutic effects. Complete regression of the tumor or progression of the disease was not observed in any of the cases. Tumor reduction of at least 50% was observed in 64.2% of patients, none of the chemotherapy regimens was beneficial. Tumor reduction of more than 35.8% in 50% of patients indicates the high effectiveness of the combination of these drugs. A decrease in the inflammatory component of the tumor and surrounding tissues was observed. The primary tumor was reduced more effectively than regional metastases. After 7-10 days, after 2-3 courses of combined chemotherapy, patients underwent remote gammatherapy according to the allocated program to a total focal dose of 65-70 Gy. Evaluation of the results of chemoradiation treatment was carried out 2 months after the end of the treatment procedures.
Results. Of the total number of patients (67), 29 patients (43.3%) were alive after chemoradiation treatment. The three-year survival rate was determined by the extent of the metastatic process. In the group of patients (21) with clinically non-enlarged lymph nodes, 11 patients (52.4%) were cured. Residual tumors were detected in 28 patients (41.8%), which was a sufficiently high rate and required radical treatment of this group of patients.

Relevance of the problem. Malignant tumors of the maxilla and its sinuses account for 1-3% of all malignant tumors of other sites. Symptoms in the early stages are nonspecific and poorly expressed, so most patients turn to oncological institutions with already widespread diseases. Maxillary sarcoma, cylindroma of the maxillary sinus, is much less common than cancer of the maxillary sinus. Epithelial malignant tumors are thought to develop in the mucous membrane of the maxillary sinus, hard palate, alveolar process, while sarcomas have different histological associations and can arise from various tissues of the jaw. Despite the use of modern treatment methods, long-term cure is achieved in 18-30% of cases. When deciding on surgery for a malignant tumor of the maxillary sinus, one should consider the issue of radical removal. To perform a radical operation, the most gentle incisions and measures necessary to preserve function should be used.
The aim of the study: to find ways to improve the treatment of patients with widespread malignant tumors of the maxilla and its sinuses.
Material and methods. In our observation, there were 43 patients with malignant tumors of the maxillary sinus of stage III-IV of the disease.
Results. 13 patients underwent advanced surgical interventions, followed by radiation therapy. 27 patients received radiation therapy according to the radical program, 3 patients received palliative treatment. Lymphogenous and hematogenous metastasis is characteristic of maxillary sinus cancer. Regional metastases to the cervical lymph nodes were detected in 7 patients, which was 16.3%. The submandibular and superior lymph nodes of the deep cervical group were mainly affected.
Conclusion. The combined approach for the treatment of patients with stage III-IV of the maxillary sinus turned out to be the most effective, with its use the three-year survival rate was 56.5%, and the five-year survival rate was -51.3%. The determining factor in the prognosis of treatment is the morphological form and spread of the primary tumor.

Relevance of the problem. Relevance of the problem. Improving the quality of life of patients with advanced and advanced forms of tumors is one of the most important medical and social problems of modern healthcare, palliative care helps to solve it. Liver cancer is a serious disease that is steadily growing in many countries of the world, its incidence and mortality reach more than one million people per year. According to the International Agency for Research on Cancer, malignant liver tumors occupy the fifth place among all cancers that occur in the world. Late diagnosis is due to low sanitary knowledge, insufficient vigilance of general practitioners, and the absence of regular preventive examinations.
Purpose of the study: to assess the effectiveness of palliative care in patients with primary liver cancer.
Materials and methods. During the 14-year observation period, we identified 974 patients diagnosed with primary liver cancer, of whom 606 (62.2%) were men and 368 (37.8%) were women. Palliative care provided to 41 patients was evaluated.
Results. The predominant symptoms were identified and their severity was assessed. According to the questionnaires, among all the symptoms, chronic pain prevailed - 38 (92.7%), complaining of a gradual increase in pain under the ribs on the right and/or in the epigastric region, regardless of food intake. The pain was especially severe towards the end of the day, sometimes becoming severe at night. General weakness - 26 (63.4%), weight loss - 16 (39.0%), decreased appetite - 23 (56.1%), nausea - 13 (31.7%), vomiting - 8 (19.7%). Jaundice is less common - 7 (17.1%), 6 patients complained of itching of the skin. Ascites was detected in 12 (29.3%). Against the background of hepatomegaly and ascites, 9 (22%) patients had shortness of breath. 9 (22%) patients complained of insomnia. In a state of anxiety and panic, 9 (22%) patients were diagnosed.
Conclusion. After the start of comprehensive palliative treatment, the vast majority of patients (65.8%) achieved a significant reduction in the manifestation of the main symptoms of liver cancer: pain reduction – 78%, weakness – 53.6%, appetite improvement – ​​51.2%, dry mouth – 34.2%, weight loss – 29.2%. It is necessary to further develop palliative care for this difficult category of patients.

Relevance of the problem. Dissatisfaction with the results of the use of the main methods of NUR, surgical, drug and cryogenic treatment, as well as their various combinations, is the basis for the development of new optimal types of treatment.
The purpose of the study: to identify oral mucosa cancer and improve treatment outcomes.
Material and methods. An analysis of the history and treatment outcomes of 202 patients with oral mucosa cancer was conducted. Of the total number of patients, 121 (59.9%) were men and 81 (40.1%) were women. The first stage of cancer was detected in 3.0% of patients, the second - in 35.6%, the third - in 32.7% and the fourth - in 28.7% of patients. Despite the fact that it was possible to detect this pathology during the examination, 61.4% of patients fell into advanced stages (stages III - IV). The most common localization of tumors in the oral cavity was the tongue in 77 patients (38.1%), followed by the alveolar part of the lower and upper jaw in 44 patients (22.8%) and the floor of the mouth in 34 patients (16.8%). Treatment methods used in patients with oral mucosa cancer were: surgical treatment - 30 (14.9%), surgical treatment with postoperative radiotherapy - 95 (47.0%), radiation therapy - 32 (15.8%), radiotherapy + chemotherapy - 33 (16.3%), chemotherapy - 12 (6.0%).
Results. Three-year survival rate T1 - 83±2.7%, T2 - 72±3.3%, T3 - 62±3.5% and T4 - 28±3.3%.
Conclusion. In the early stages of oral cancer, in almost 10% of cases, local lesions of the mucous membrane are not detected at the first visit to the doctor. The disease is observed in 25% of patients. Radiation therapy was used in 79.1% of patients with oral tumors, in combination with surgical intervention in 47.0%, with chemotherapy in 16.3%, and as a stand-alone method in 15.8% of patients. Improving the results of treatment of oral cancer depends primarily on the accuracy of the initial diagnosis of cancer. According to observations of various authors, 80% of deaths from oral cancer could have been prevented by early detection of malignant tumors.

Relevance. Long-term statistics in Kyrgyzstan indicate a consistent pattern of lung cancer detection, with slight fluctuations. The literature contains data on the impact of COVID-19, a coronavirus infection that has claimed the lives of over 6 million people, on the course of lung cancer. This study aims to investigate the relationship between previous coronavirus infection and lung cancer.

Study Objective: To assess the impact of COVID-19 on changes in the clinical and morphological characteristics of lung cancer.

Materials and Methods: An analysis of clinical data from patients observed at the National Center for Oncology and Hematology of the Ministry of Health of the Kyrgyz Republic from 2018 to 2025 revealed that the statistical pattern has changed significantly from pre-pandemic (2018-2019) to 2020-2021.

Results and Discussion Changes in the clinical presentation and morphological characteristics of malignant neoplasms before and after the pandemic clearly correlate with literature data and are likely due to an increase in the prevalence of less differentiated tumors, which lead to a more aggressive course and more rapid generalization.

Conclusion. Difficulties in differential diagnosis, accelerated growth rates, earlier generalization, and an increased prevalence of less differentiated tumors significantly complicate the effectiveness of lung cancer treatment.

Background. Gastric cancer in Uzbekistan ranks first in incidence among men and fifth among women, with a stable mortality rate (3.8-4.0 per 100,000). Stages II-III account for 73-75% of cases, resulting in a high one-year mortality rate (27%) and low five-year survival rates (≈32%). Limited coverage of combination treatment (35.7%) and insufficient use of high-tech interventions require the development of screening, improved diagnostics, and the introduction of modern methods. Laparoscopic surgery after neoadjuvant polychemotherapy (NAPCT) reduces morbidity, complication rates, and accelerates recovery.
Study objective. To compare the short-term outcomes of laparoscopic surgery after NAPCT and traditional open surgery for locally advanced gastric cancer.
Materials and methods. Data from 165 patients were analyzed, divided into three groups: Group 1 – open surgery without NAPCT; Group 2 – NAPCT + open surgery; Group 3 – NAPCT + laparoscopic surgery. The following were assessed: blood loss, operative time, need for narcotic analgesics, hospital stay, complications (Clavien-Dindo), anastomotic complication rate, quality of life, rehabilitation time, and return to work.
Results and discussion. Blood loss was minimal in Group 3 (150 ml) versus 250–350 ml in Groups 1 and 2. Surgery duration was 120 min. (Group 1), 135 min. (Group 2), and 165 min. (Group 3). The postoperative period in patients in Group 3 was characterized by a lower need for analgesics (2 days versus 3.5 and 3), a shorter hospital stay (6.5 versus 8 and 7.5 days), and a lower number of complications ≤class II (6 versus 15 and 12). There were no anastomotic leaks. There was no one-year mortality, and three-year survival is being assessed. Group 3 demonstrated better quality of life indicators, with rehabilitation lasting 10 days (versus 3 weeks), and return to work lasting 2 weeks (versus 3-4 weeks).
Conclusion: Laparoscopic surgery after NAPCT for breast cancer is superior to open surgery in reducing morbidity, complications, and hospitalization time, while accelerating rehabilitation and improving quality of life. Despite the longer duration of the procedure, this method holds promise for implementation in oncosurgical practice.

Background. Pain in cancer patients is one of the most common complaints. The overall prevalence of pain syndrome among cancer patients is 44.5%. Inadequate pain control has a negative impact on the patient's psychoemotional state. The presence of depression can lead to decreased treatment adherence, worsening the clinical prognosis. The extent to which chronic pain syndrome (CPS) influences the development of depression in cancer patients has not yet been fully elucidated. Studying this issue will help determine whether chronic pain is a significant risk factor for depression in cancer patients.
Study Objective: To evaluate the presence of pain syndrome as a prognostic factor for the development of depression in cancer patients.
Materials and Methods: The study included 132 patients with confirmed malignant neoplasms at various stages, with a Karnofsky physical status of 60-100% and an ECOG performance status of no more than 2 points. Of these, 72 patients had chronic pain syndrome (CHS) (pain intensity according to the NOS was 4.9 ± 1.3) and 60 patients without pain syndrome. All patients were assessed for signs of depression using the Beck Depression Inventory, followed by analysis of the obtained data.
Results and discussion. Signs of depression are found in more than half of cancer patients in the general population (65.15%). Moreover, in patients with chronic pain syndrome, signs of depression were detected in the overwhelming majority – 79.17% (57 patients); in the group without pain syndrome – in 48.33% (29 patients). The severity of depression was significantly higher in the group of patients with chronic pain syndrome – the average score on the Beck Depression Inventory was 18 points, corresponding to moderate depression; in the second group – 10.2 points, which is typical of subdepression.

Conclusion. Chronic pain syndrome increases the frequency and severity of depression in cancer patients. Thus, pain in cancer patients can be considered as a prognostic factor for depression, and all of them require adequate pain therapy, as well as consultation with a psychologist and/or psychotherapist to correct any psychoemotional disorders that may arise.

Introduction. In recent years, the issue of quality in medical laboratories has gained increasing importance. According to the international standard ISO 15189:2023 “Medical laboratories — Requirements for quality and competence”, laboratories are required to develop quality indicators (QIs) and mo nitor them to ensure high service levels and patient safety. This article presents a review of the results of quality indicator monitoring, using the example of a private laboratory operating in the Kyrgyz Republic.
The purpose of the work сonducted within the framework of the Global Laboratory Leadership Programme (GLLP), developed by the WHO and implemented by the S. B. Daniyarov Kyrgyz State Medical Institute of Postg raduate and Continuing Education, the study aimed to examine quality indicators to improve the performance of clinical diagnostic laboratories. It also sought to propose a unified approach to establishing quality indicators (using private laboratories as an example) and criteria for their evaluation.
Materials and methods. During the planning stage, quality indicators for the pre-analytical, analytical, and post-analytical processes of a private laboratory were selected. Data from the Laboratory Information System (LIS) covering the years 2022 to 2024 were extracted and analyzed statistically using Excel 2020 with tables and charts. Three main laboratory quality indicators were used for the analysis: sample rejection rate; dough turnover time; customer satisfaction.
Results and discussion. Ensuring control over analytical processes requires selecting the most critical quality indicators. Integrating quality indicators into laboratory processes and collecting relevant data ensures the reliability of laboratory results and allows timely responses when deviations occur.
Conclusion. In the Kyrgyz Republic, there are no documents or guidelines that establish a unified approach to the selection of quality indicators and their assessment. Laboratories involved in tuberculosis services and HIV diagnostics have developed specific indicators tailored to their needs. However, clinical diagnostic laboratories applying for accreditation in accordance with the rules and requirements of the international standard ISO 15189 do not have specific quality indicators with accepted limits of acceptability of results.

Introduction. Cancer patients are at high risk of severe and extremely severe progression of COVID-19, and those with a single lung have an extremely high probability of fatal outcomes. The management of such patients must be based both on thorough examination data and on a stepwise yet immediate approach in accordance with existing clinical protocols.Objective: To present clinical cases of COVID-19 in patients with a single lung who had undergone radical surgical treatment for lung cancer and were in long-term remission.
Materials and methods. Two cases from the practice of the Thoracic Oncology Department of the National Center of Oncology and Hematology, Ministry of Health of the Kyrgyz Republic, were analyzed. Both patients had undergone extended pneumonectomies in 2014. In 2024, they were admitted to the thoracic department in severe condition, and both were confirmed to have COVID-19.
Results and discussion. A favorable treatment outcome was achieved despite the unusual situation and the severity of the condition in patients with a single lung who contracted COVID-19.
Conclusion. The presented cases convincingly demonstrate that, despite the official recognition of the end of the COVID-19 pandemic, the risk of infection with this dangerous virus still persists, especially in high-risk patients. Patients with a single lung naturally represent a group of extremely high risk with a high probability of death. We believe that only immediate, active treatment in accordance with the latest approved clinical protocol helped prevent a fatal outcome in these patients. These cases show that at the first signs of possible viral damage to lung tissue, patients must unequivocally be tested for COVID-19.