Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer (BC), comprising approximately 20% of newly diagnosed BC cases. The poor prognosis, high recurrence rates, and inefficacy of hormone-based therapies make TNBC one of the greatest challenges in contemporary oncology. The unique immunological features of TNBC, including relatively high tumor mutational burden, abundance of tumor-infiltrating lymphocytes, and elevated PD-L1 expression, offer a wide range of opportunities for immunotherapeutic approaches, of which the most progressive and promising are neoantigen-driven ones. This review examines the current landscape of neoantigen-based therapeutic approaches in TNBC treatment, spanning from discovery methodologies to clinical applications. We provide a critical analysis of the tumor microenvironment (TME) in TNBC, highlighting the balance between its immunoactivating (CD8+ T-cells, dendritic cells) and immunosuppressive (regulatory T-cells, M2 macrophages) components as the key determinant of therapeutic success, as well as reviewing the emerging approaches to TME reprogramming and recruiting in favor of better outcomes. We also present state-of the-art methods in neoantigen identification and prioritization, covering the landscape of technological platforms and prediction algorithms, addressing the existing accuracy limitations along with emerging computational solutions, and comprehensively discussing the TNBC neoantigen spectrum. Our analysis shows the strong domination of patient-specific (“private”) neoantigens over shared variants in the TNBC, with TP53 as the only gene with recurrent variants. Finally, we extensively cover neoantigen-recruiting therapeutic modalities including adoptive cell therapies, personalized vaccine platforms (peptide-based, mRNA/DNA vaccines, dendritic cell vaccines), and oncolytic viruses-based approaches. Our study of current clinical trials demonstrates the substantial gap between early proof-of-concept experiments and further applicability of neoantigen-driven therapies. The major challenges hampering the success of such methods include neoantigen prediction inaccuracy rates, high manufacturing costs, and time consumption. Promising ways to overcome these difficulties include the development of combinational strategies, TME modeling and modifying, and improvement of the therapy delivery properties, along with the optimization of production workflows and cost-effectiveness of vaccine development.

The article is devoted to the actual topic of breast reconstruction with autologous tissues. The article discusses the key stages in the development of breast reconstructive surgery using free flaps using microsurgical techniques. A flap of the anterior abdominal wall, among other techniques, is the method of choice for breast reconstruction today, also because it allows you to achieve the most "natural" result. The authors compares different variants of autologous flaps, describes the advantages of the DIEP flap in comparison with the TRAM flap. Also, special attention is paid to the choice of breast reconstruction method depending on age, constitutional characteristics and the presence of risk factors such as smoking, diabetes mellitus and excess BMI. Analyzing the advantages of breast reconstruction with autograft flaps, the author concludes that there is a higher quality of life and improved outcomes in these patients than in patients who underwent implant-based reconstruction. Based on the literature review, it was found that breast reconstruction with the help of perforating flaps is still an area of innovation and constant progress: research in this area to date is mainly aimed at reducing the morbidity of the donor area and methods for isolating recipient vessels, shortening the rehabilitation period and developing reproducible reconstruction method.

Биопсия сторожевого лимфатического узла при раке молочной железы с применением метода флуоресцентной визуализации красителя индоцианин зеленый

Breast reconstruction after complex oncological treatment is an urgent issue due to the high incidence of breast cancer. Aim. To analyze the effect of postoperative radiotherapy on the incidence of fat necrosis in single-stage autologous breast reconstruction with a DIEP flap and to evaluate the number of complications in groups with and without postoperative radiotherapy, as well as to determine the risk factors for complications. Materials and methods. The medical records of 34 breast cancer patients who underwent one-stage breast reconstruction using a DIEP flap after skin-sparing/subcutaneous mastectomy with and without subsequent radiation therapy were retrospectively studied. The frequency of complications in groups with and without postoperative radiation therapy was assessed. Results. Complications developed in 22 (64.7%) patients out of 34. Mild complications developed in 6 (17.6%) patients (divergence of the edges of the postoperative wound of the anterior abdominal wall). Complications of moderate severity developed in 12 (35.3%) patients. Severe complications developed in 4 (11.8%) patients. Out of 22 patients, 6 (17.4%) patients developed areas of fat necrosis after remote radiation therapy in the delayed period, 4 (11.8%) patients, without ESWL, also developed fat necrosis of a part of the flap (areas up to 5 cm). Excision of the area of fat necrosis of the flap was performed in 2 (5.9%) cases under local anesthesia, the rest of the areas of fat necrosis were not excised. The percentage of complications was higher in the group of patients with obesity (20.6%), which indicates that obesity is a risk factor for the development of intraoperative and postoperative complications in patients with simultaneous breast reconstruction with a DIEP flap. Conclusion. During radiotherapy after breast reconstruction with a DIEP flap, the incidence of fat necrosis of the flap was higher. Obesity is a risk of intraoperative and postoperative complications in patients with simultaneous increased breast reconstruction with a DIEP flap, since the incidence of complications was in the group of patients with obesity.

Objective: to provide various methods for sentinel lymph node detection considering their advantages and disadvantages.Material and Methods. The search of the relevant articles published in Pubmed, MedLine, RINTs, etc. database was conducted. 49 publications from 1970 to 2018 were analyzed.Results. Currently, sentinel lymph node biopsy (SLN biopsy) has become a worthy alternative to traditional lymphatic surgery for early breast cancer. SLN biopsy significantly decreases the number of postoperative complications caused by lymphadenectomy and improves the quality of life of cancer patients. So far, a large number of SLN detection techniques have accumulated. Each of these techniques has its own advantages and disadvantages.Conclusion. Despite a large number of SLN detection methods, the question of the optimal technique is currently debatable.

Reconstructive surgeries have long been considered as an essential part of rehabilitation of breast cancer patients. The majority of patients tend to choose one-stage reconstruction, because this type of surgery ensures rapid emotional and physical recovery. Due to the lack of subcutaneous fat in a substantial proportion of cases, which leads to postoperative complications, the most common surgical tactics now is simultaneous reconstruction after subcutaneous mastectomy with subpectoral implant location and strengthening of the lower breast slope using different materials. So far, there has been no gold standard material for secure covering of the lower pole of the implant. Autologous acellular dura mater grafts are a promising material for breast reconstruction. Studies evaluating biointegration, compatibility, inertness, reactivity, and cost effectiveness of autologous acellular dura mater grafts have determined feasibility of using these grafts in reconstructive surgeries.