Overall survival of children with brain tumors after radiation therapy in Kazakhstan.

e22011 Background: Tumors of the central nervous system in children occupy the 2nd place in frequency in the structure of malignant neoplasms of childhood and the 1st place among solid tumors. They make up about 20% of all malignant neoplasms of childhood and are mainly represented by brain tumors. The purpose of the study was to analyze the survival rate depending on various factors during radiation therapy (RT) of brain tumors in children. Methods: Retrospective study included 277 patients who received RT from 2016 to 2020 at the Pediatric Oncology Center of the Kazakh Research Institute of Oncology and Radiology. The average follow-up time was 34.3 months. The median age was 9.5 years. RT was performed on a linear accelerator “TrueBeam”, in a single dose of 1.8 Gy, total 50.4-54.0 Gy, 5 fractions per week. Survival distributions was estimated by Kaplan and Meier curves and survival differences were evaluated using the log-rank test. IBM SPSS Statistics V23 was used for statistical analyses. Results: The overall survival (OS) rate of 277 patients was 70.8%, with an average life time of 55.6 months, 95% confidence interval (CI) (51.9 - 59.2). Children under 10 years of age showed a 12.5 % worse OS compare to children after 10 years of age. In patients with unconfirmed morphological verification, OS is 31.5% worse than in children with confirmed morphological verification. In children with grade I-II tumor differentiation, OS was 30.6% higher than in children with grade III-IV tumors. The method of RT (conformal RT, IMLT), gender of patients did not have a statistically significant effect on OS. Conclusions: Our study showed that OS rate depends on various factors, such as age, presence of morphology verification, and the degree of tumor differentiation. RT allows to achieve better survival in patients older than 10 years who received RT with a morphologically confirmed diagnosis of GI-II. RT is one of the main treatments for brain tumors in children.[Table: see text] </jats:p

Resolution of the Expert Council on the new approach to drug therapy for non-metastatic castration-resistant prostate cancer

Prostate cancer (PC) is one of the most common malignant neoplasms in the male population. The widespread introduction of modern diagnostic methods and the determination of prostate-specific antigen (PSA) levels have increased the number of detected cases of localized and locally advanced PC forms. However, in some patients treated with radical methods and long-term androgen deprivation therapy (ADT), the disease continues to progress in the form of an increase in PSA levels with castration testosterone values and with no distant metastases. Such a course of the disease is referred to as non-metastatic castration-resistant prostate cancer (nmCRPC).&#x0D; Purpose: The article reports the results of a meeting of the Expert Council arranged by the Kazakh Research Institute of Oncology and Radiology on December 25, 2020, on non-metastatic castration-resistant prostate cancer diagnostics and treatment.&#x0D; Results: Large clinical studies highlight the critical importance of controlling the PSA doubling time as the main prognostic factor for an unfavorable outcome to increase patient survival and prevent the development of distant metastases.&#x0D; Based on the results of large randomized studies, experts recommended using new-generation androgen receptor antagonists in combination with ongoing ADT to improve the clinical outcomes in nmCRPC patients at high risk of metastatic progression. The Expert Council was presented with the data of a registration clinical study on darolutamide efficacy and safety.&#x0D; The advantages of introducing this drug into clinical practice to expand the choice of therapeutic options were identified.&#x0D; Personalized adjustment of a treatment regimen will increase the treatment efficacy and ensure higher survival in this category of patients.&#x0D; Conclusion: Increasing survival as the main objective in treating nmCRPC patients requires improved diagnostics through regular controlling of testosterone and PSA levels, calculation of PSA doubling time, and the use of radiological diagnostic methods to rule out distant metastases. The choice of therapy in patients at high risk of metastasis shall consider the patient’s status and the treatment efficacy and safety balance.</jats:p

Resolution of the Expert Council on the New Approach to Drug Therapy for Non-Metastatic Castration-Resistant Prostate Cancer

Relevance: Prostate cancer (PC) is one of the most common&#x0D; malignant neoplasms in the male population. The widespread&#x0D; introduction of modern diagnostic methods and the determination of prostate-specific antigen (PSA) levels have increased&#x0D; the number of detected cases of localized and locally advanced&#x0D; PC forms. However, in some patients treated with radical&#x0D; methods and long-term androgen deprivation therapy (ADT),&#x0D; the disease continues to progress in the form of an increase in&#x0D; PSA levels with castration testosterone values and with no distant metastases. Such a course of the disease is referred to as&#x0D; non-metastatic castration-resistant prostate cancer (nmCRPC).&#x0D; Purpose: The article reports the results of a meeting of the&#x0D; Expert Council arranged by the Kazakh Research Institute of&#x0D; Oncology and Radiology on December 25, 2020, on non-metastatic castration-resistant prostate cancer diagnostics and&#x0D; treatment.&#x0D; Results: Large clinical studies highlight the critical importance of controlling the PSA doubling time as the main prognostic factor for an unfavorable outcome to increase patient&#x0D; survival and prevent the development of distant metastases.&#x0D; Based on the results of large randomized studies, experts&#x0D; recommended using new-generation androgen receptor antagonists in combination with ongoing ADT to improve the&#x0D; clinical outcomes in nmCRPC patients at high risk of metastatic&#x0D; progression. The Expert Council was presented with the data of&#x0D; a registration clinical study on darolutamide efficacy and safety. The advantages of introducing this drug into clinical practice to expand the choice of therapeutic options were identified.&#x0D; Personalized adjustment of a treatment regimen will increase&#x0D; the treatment efficacy and ensure higher survival in this category of patients.&#x0D; Conclusion: Increasing survival as the main objective&#x0D; in treating nmCRPC patients requires improved diagnostics&#x0D; through regular controlling of testosterone and PSA levels, calculation of PSA doubling time, and the use of radiological diagnostic methods to rule out distant metastases. The choice of&#x0D; therapy in patients at high risk of metastasis shall consider the&#x0D; patient’s status and the treatment efficacy and safety balance.</jats:p

Molecular genetic testing for BRAF V600 gene mutations&#x0D; in melanoma in the Republic of Kazakhstan

Relevance: Along with other diagnostic methods, all current recommendations and protocols for malignant tumors’&#x0D; diagnostics and treatment require mandatory molecular&#x0D; genetic testing at the initial diagnosis and in case of disease&#x0D; progression. The discovery of the BRAF gene mutation in skin&#x0D; melanoma allows the treatment with tyrosine kinase inhibitors, so-called BRAF inhibitors. This increases the probability of&#x0D; tumor response by half and opens up new therapeutic options.&#x0D; The study aimed to identify the BRAF V600E gene mutation frequency in patients with stage III-IV melanoma in the&#x0D; Republic of Kazakhstan to determine the need for targeted&#x0D; therapy.&#x0D; Results: 2251 persons are currently registered with melanoma in the Republic of Kazakhstan, with 355 new primary&#x0D; melanoma cases in 2019. Of them, 54% were diagnosed at&#x0D; stages III-IV and were subject to molecular genetic testing.&#x0D; 278 of 2251 patients were sent for BRAF mutations testing.&#x0D; The mutations were detected in 105 (37.7%) patients.&#x0D; Conclusion: The introduction of molecular genetic&#x0D; testing for malignant neoplasms under the Comprehensive&#x0D; Cancer Control Plan framework for 2018-2022 will increase&#x0D; the use of molecular genetic methods in the Republic of Kazakhstan. Molecular genetic testing is an important step in&#x0D; diagnosing melanoma and choosing the appropriate therapy to personalize cancer treatment.</jats:p

Molecular genetic testing for BRAF V600 gene mutations in melanoma in the Republic of Kazakhstan

Along with other diagnostic methods, all current recommendations and protocols for malignant tumors’ diagnostics and treatment require mandatory molecular genetic testing at the initial diagnosis and in case of disease progression.&#x0D; The discovery of the BRAF gene mutation in skin melanoma allows the treatment with tyrosine kinase inhibitors, so-called BRAF inhibitors. This increases the probability of tumor response by half and opens up new therapeutic options.&#x0D; The study aimed to identify the BRAF V600E gene mutation frequency in patients with stage III-IV melanoma in the Republic of Kazakhstan to determine the need for targeted therapy.&#x0D; Results: 2251 persons are currently registered with melanoma in the Republic of Kazakhstan, with 355 new primary melanoma cases in 2019. Of them, 54% were diagnosed at stages III-IV and were subject to molecular genetic testing. 278 of 2251 patients were sent for BRAF mutations testing. The mutations were detected in 105 (37.7%) patients.&#x0D; Conclusion: The introduction of molecular genetic testing for malignant neoplasms under the Comprehensive Cancer Control Plan framework for 2018-2022 will increase the use of molecular genetic methods in the Republic of Kazakhstan. Molecular genetic testing is an important step in diagnosing melanoma and choosing the appropriate therapy to personalize cancer treatment.</jats:p

Implementation of HPV vaccination pilot project in Kazakhstan: Successes and challenges.

e13056 Background: Cervical cancer (CC) is the second most frequent cancer of women after breast cancer. Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries more than 10 years ago. The standardized incidence of СС in Kazakhstan (KZ) in 2017 was 17.1 per 100,000 women. From 2013 to 2016, there was a pilot project of school-based HPV vaccination of adolescent girls in four districts of KZ. Vaccination was carried out with two vaccines (Gardasil and Cervarix) on the choice of parents in a three-dose regimen. Due to the high rejection of vaccination, this program was completed in 2016. Aim of study was to analyze the results of HPV vaccination in KZ. Methods: The results of vaccination of adolescent girls from 9 to 15 years old were evaluated. We analyzed database registry of Kazakhstani vaccinated girls to evaluate vaccine coverage in four district of KZ. Results: A total 11,648 adolescent girls were fully vaccinated during the pilot program for 2013-2016. The average age of the vaccinated is 12.67 ± 1.04. In 2013, immunization was performed for 1,816 girls aged 11–13 years. In 2014, the age range of the target group was expanded to 15 years. The number of vaccinated girls increased to 5,699 adolescent girls. 7,136 girls were fully vaccinated in 2015. 10,004 girls have not received full doses of vaccine. Overall coverage rates of fully vaccinated were 14.8%. The majority of coverage results was stastically similar except for Almaty, where coverage was higher than the average coverage (17.9% vs. 14.8%, p &lt; 0.05). Conclusions: Pilot project of vaccination in Kazakhstan was declared unsuccessful. This situation is associated with a lack of information campaigns on vaccination. This findings highlights the need for phased implementation of vaccination through an educational campaign of parents. </jats:p

Overdiagnosis and Overtreatment in Prostate Cancer

Prostate cancer (PCa) is one of the most common malignancies among men worldwide. While prostate-specific antigen (PSA) screening has improved early detection, it has also led to significant challenges regarding overdiagnosis and overtreatment. Overdiagnosis involves identifying indolent tumors unlikely to affect a patient&rsquo;s lifespan, while overtreatment refers to unnecessary interventions that can cause adverse effects such as urinary incontinence, erectile dysfunction, and a reduced quality of life. This review highlights contributing factors, including the limitations of PSA testing, advanced imaging techniques like multi-parametric MRI (mpMRI), medical culture, and patient expectations. The analysis emphasizes the need for refining screening protocols, integrating novel biomarkers (e.g., PCA3, TMPRSS2-ERG), and adopting conservative management strategies such as active surveillance to minimize harm. Risk-based screening and shared decision-making are critical to balancing the benefits of early detection with the risks of unnecessary treatment. Additionally, systemic healthcare factors like financial incentives and malpractice concerns exacerbate overuse. This review advocates for updated clinical guidelines and personalized approaches to optimizing patient outcomes while reducing the strain on healthcare resources. Addressing overdiagnosis and overtreatment through targeted interventions will improve the quality of life for PCa patients and enhance the efficiency of healthcare systems