The presence of circulating tumor cells in the blood of patients with triple negative breast cancer (early and locally advanced cancer) before and after preoperative chemotherapy was assessed using expression markers. Before therapy, circulating tumor cells were detected in 5 of 13 (38%) patients with early cancer and in 7 of 17 (41.2%) patients with locally advanced cancer. After therapy, the circulating immune cells were detected in one patient with locally advanced cancer, who had no circulating cells before therapy. The tumor was resistant to chemotherapy and the disease progressed. The detected circulating tumor cells were HER-2-positive, while the primary tumor was HER-2-negative. It was concluded that the circulating immune cells can be a potential marker of the efficiency of therapy and predictors of the disease course, while their phenotype can differ from the phenotype of the primary tumor.

Breast cancer (BC) is a malignant tumor originating from the epithelium of the breast tissue. There is no single etiological factor in the development of breast cancer. In 310% of patients with breast cancer, the development of the disease is associated with the presence of mutations in the breast cancer gene (BRCA) 1, BRCA2, CHEK, NBS1, TP53. In other patients, breast cancer is sporadic.

The article presents a methodology and results of developing diagnosis related groups (DRGs) for the cases of healthcare provided with the use of radiotherapy and chemoradiotherapy for malignant neoplasms in Russian Federation. A key element of the methodology is the standardized module of healthcare (SM) which allows calculating the tariffs for medical care in accordance with clinical guidelines. As a result of the application of the new methodology, in 2019, changes were made to the DRG model in terms of payment for radiotherapy and chemoradiotherapy. The changes included developing 10 DRGs for in-patient radiotherapy and 10 DRGs in day hospital; 7 DRGs for in-patient chemoradiotherapy and 5 DRGs in day hospital. New classification criteria have been introduced into the DRG model for attributing the case to a certain DRG, in addition to the medical service used before. The number of fractions became a new criterion for radiotherapy, the number of fractions and the international non-proprietary name of the drug were proposed for chemoradiotherapy. A wider range of DRG’s weight coefficients was calculated, which allows more differentiated reimbursement of the costs of medical care provided by medical organizations depending on the method and the regimen used.

One of the main issues in the treatment of multicentric breast cancer (BC) is to choose the type of surgery (paying attention to the tendency to reduce the volume of surgical interventions). Many studies have demonstrated an adverse effect of this form of BC on long‑term survival outcomes (increased risk of recurrence, decreased overall survival rates, etc.). However, none of the studies examined the effect of surgery extent on the quality of life of these patients.Objective. To assess the effect of the surgery type on the quality of life of patients with multicentric BC.Materials and methods. 190 patients were included in the study. The median follow‑up was 72 (7–116) months. Age ranged from 27 to 76 years. The majority of patients (150 women, 78.9 %) had luminal HER2‑negative tumors, while «aggressive» (HER2‑overexpressing, triple negative) subtypes were detected in 40 (21.1 %) of them. 134 patients underwent radical mastectomy (40 of which also had immediate breast reconstruction), 56 received breast‑conserving surgery. Statistically significant differences were not observed among stages III and I–II BC (p = 0.125). The quality of life was assessed with the use of EORTC QLQ-C30 and EORTC QLQ-BR23 scales at ≥ 12 months after performing surgical treatment.Results. The quality of life was assessed depending on the type of surgical intervention. The patients after breastconserving surgery and immediate breast reconstruction demonstrated a significant advantage, primarily in the general perception of one's own health (p < 0.05) and emotional status (p < 0.05). Also, there were no significant differences in quality of life between the groups of patients after breast‑ conserving surgery and immediate breast reconstruction.Conclusion. Due to the increase in the life expectancy of breast cancer patients, the issues of maintaining a high quality of life are becoming increasingly important. From this point of view, performing breast‑ conserving and reconstructive surgeries is preferable for patients with multicentric BC.

ОПУХОЛИ ЖЕНСКОЙ РЕПРОДУКТИВНОЙ СИСТЕМЫ TUMORS OF FEMALE REPRODUCTIVE SYSTEM