Consilium Medicum

Liver injury caused by antitumor therapy is a common disorder in patients with malignancies. It is due to the introduction of new innovative drugs into the treatment, which significantly increases the duration and quality of life, but also the frequency of side effects with liver damage of varying severity. The rate of hepatotoxicity during chemotherapy ranges from 5% to 100%. The spectrum of morphological changes in the liver is diverse and includes acute and chronic liver injury with damage to hepatocytes and outcome in fibrosis. The clinical features of the diagnosis of various types, variants, and phenotypes of drug-induced liver injury in the chemotherapy of solid tumors and hematological malignancies are addressed. The article reviews the literature on concomitant treatment with ademetionine to reduce metabolic disorders and hepatic toxicity caused by cytotoxic therapy. Clinical and biochemical effects persist for a long time after treatment. The results of using ademetionine to correct clinical symptoms such as fatigue are described in detail. The presented data supports a practical revision of the role of concomitant therapy with ademetionine to prevent and reduce the manifestations of hepatotoxicity induced by polychemotherapy. This approach contributes to a personalized approach to patients with malignancies, thereby significantly improving medical care and increasing the duration and quality of life.

Background. The clinical course of non-muscle-invasive bladder cancer is characterized by a tendency to develop local recurrences and the ability to tumor progression. The most effective method of preventing disease progression after transurethral resection of the bladder in patients of intermediate and high-risk groups is intravesical therapy with BCG antitumor vaccine containing attenuated Mycobacterium tuberculosis. Taking into account the increasing incidence non-muscle-invasive bladder cancer in Moscow, the organization of adequate use of BCG vaccine in clinical practice requires the involvement of significant organizational and human resources.

Aim. To develop and validate an organizational model for the delivery of BCG therapy for non-muscle-invasive bladder cancer at an outpatient cancer care center using hospital-substitution technologies.

Materials and methods. In the period from June 2023 to May 2024, BCG therapy has been performed in Oncology Center №1 of Yudin Moscow City Hospital in 180 patients with verified non-muscle-invasive bladder cancer of intermediate and high-risk groups.

Results. The study revealed a trend towards an increase in the absolute number of early bladder cancer in Moscow in the period 2018–2023. According to clinical guidelines, treatment of patients with non-muscle-invasive bladder cancer includes determination of the risk of recurrence and tumor progression with subsequent formation of indications for intravesical BCG therapy. The regimen of administration depending on the risk of recurrence includes 18–42 instillations for 12–36 months after transurethral resection of the bladder with follow-up examinations every three months. The procedure of intravesical BCG therapy takes 1–2 hours and does not require hospitalization. An organizational model of treatment an outpatient cancer care center based on various forms of hospital-substitution technologies is presented.

Conclusion. Intravesical BCG therapy is a highly demanded method for the treatment of non-muscle-invasive bladder cancer. This method can be widely used in outpatient settings through the use of hospital-substitution technologies.

Background. Iron deficiency anemia is a frequent consequence of colorectal cancer (CRC) which might lead to poor treatment outcomes.

Aim. To conduct a review analyzing the correlation between preoperative anemia and treatment outcomes (mortality, morbidity, survival) in CRC patients.

Materials and methods. The literature search was conducted in PubMed (NCBI) and Cochrane databases. Key query terms: colorectal cancer, anemia, mortality and survival rates, blood loss, hemotransfusion. The review included articles discussing the prevalence of anemia in CRC and its association with mortality, morbidity, survival.

Results. Anemia was found in 32–52% of CRC patients before surgery. It correlated well with higher incidence of postoperative morbidity and mortality as well as lower overall survival. The same findings were true regarding intraoperative blood loss and perioperative blood transfusion.

Conclusions. Preoperative anemia is a major modifiable prognostic factor in CRC patients along with intraoperative blood loss and perioperative transfusion. Thus, strong efforts should be invested in the development of patient blood management protocols. The most effective method of solving this complex problem is the introduction into clinical practice of the patient blood management concept, which includes the use of intravenous iron preparations at the preoperative stage, correction of coagulopathy, a comprehensive approach to intraoperative blood conservation, an extremely strict approach in determining the indications for hemotransfusion.

Squamous cell carcinoma of the head and neck is the sixth most common cancer worldwide. However, malignant tumors of the middle ear are extremely rare. Squamous cell carcinoma is the most common histologic type of tumor in this area, accounting for more than 50% of cases. Complex anatomical and topographic features of the inner ear and inapparent clinical symptoms result in delayed diagnosis of this disease. A case of a patient with highly differentiated middle ear squamous cell carcinoma is presented. The patient received complex treatment, including drug antitumor therapy according to the TPEx protocol: docetaxel + cisplatin + cetuximab. Being highly effective, this protocol requires a multidisciplinary approach in order to ensure maximum safety of therapy. The case illustrates the classic “portrait” of a patient with recurrent or metastatic squamous cell carcinoma of the head and neck and also provides a comprehensive description of the spectrum of adverse events faced by such patients and their oncologists. Based on this clinical case, the features of management of such adverse events are analyzed.