Pleural malignancies represent a clinically devastating group of oncological disorders, most commonly arising from metastatic disease, with lung and breast cancers being the most frequent primary sites. Malignant pleural mesothelioma is a primary malignancy of the pleura and occurs less often than metastatic pleural disease. Pleural malignancies often present with malignant pleural effusion, which typically indicates advanced-stage disease and is associated with poor overall prognosis. Treatment of pleural malignancies includes both palliative and definitive approaches. Palliative interventions primarily aim to relieve symptoms and improve quality of life. Definitive treatments include systemic chemotherapy, targeted therapy, and immunotherapy, depending on the type and molecular profile of the underlying tumor. In mesothelioma, platinum-based chemotherapy in combination with pemetrexed remains the cornerstone of treatment, while the combination of nivolumab and ipilimumab is recommended as first-line therapy for unresectable disease. For metastatic disease, systemic therapy is typically tailored to the primary tumor’s characteristics. Intrapleural administration of chemotherapeutic agents is one of the therapeutic strategies and hyperthermic intrathoracic chemotherapy and pressurized intrathoracic aerosol chemotherapy are the most recent innovations that are under active investigation. This review provides an up-to-date synthesis of systemic chemotherapy strategies for pleural malignancies, their integration with targeted and immune-based therapies, and recent advances in intrapleural chemotherapy modalities. It also explores existing knowledge gaps and outlines directions for future research and potential changes in clinical practice.

Background: Gastric cancer is a serious health issue both globally and in Kazakhstan. Worldwide, gastric cancer ranks fifth in incidence, with the highest rates reported in East Asia, the Andes of South America, and Eastern Europe, while the lowest rates are reported in North America, Northern Europe, Africa, and Southeast Asia. Over 70% of the cases occur in resource-limited countries. In Kazakhstan, gastric cancer ranks third in morbidity and second in mortality, representing a serious clinical and social problem. Annually, 1600 deaths from malignant gastric neoplasms are registered. Peritoneal metastasis is considered one of the most severe complications of gastric cancer and has long been regarded as its terminal stage. The average life expectancy of patients with peritoneal metastasis is only 3-6 months, reflecting a high mortality rate and the limited efficacy of current treatments. Objective: We hypothesize that the prophylactic use of pressurized intraperitoneal aerosol chemotherapy (PIPAC) may reduce the incidence of peritoneal metastasis. The aim of this study is to evaluate the incidence of peritoneal metastasis following prophylactic PIPAC in patients with gastric cancer. The primary goal of this research is to evaluate whether adding prophylactic PIPAC to standard treatment before neoadjuvant chemotherapy can reduce the incidence of peritoneal metastasis in patients with locally advanced gastric cancer. Methods: This study is a single-center nonrandomized controlled trial with a planned enrollment of 160 patients. All participants will be included in one of the 2 groups: intervention group (PIPAC + perioperative chemotherapy + gastrectomy with D2 lymphadenectomy) or control group (perioperative chemotherapy + gastrectomy with D2 lymphadenectomy). The primary end point is the incidence of peritoneal metastasis, and the secondary end points are overall survival, recurrence-free survival, treatment-related adverse events, and personal satisfaction. Results: As of September 2025, this study is funded and recruiting; 102 participants have already been enrolled. Recruitment is planned to be performed between January 2025 and December 2026. No interim analyses have been performed; primary results are planned for Q1 2027. The manuscript is expected to be published by Q4 2027. Conclusions: Compared to standard chemotherapy, PIPAC has been reported to significantly improve survival rates in patients with peritoneal metastasis of gastric origin. We suggest that the neoadjuvant use of PIPAC may reduce the incidence of peritoneal metastasis and improve long-term survival outcomes. The results of our study will provide key information on the practicality and viability of PIPAC as a prophylactic technique for preventing the progression of gastric cancer. Trial Registration: ClinicalTrials.gov NCT06784765; https://clinicaltrials.gov/study/NCT06784765 International Registered Report Identifier (IRRID): PRR1-10.2196/78053

Breast cancer (BC) is the most common cancer in Kazakhstan, and a population-based breast cancer screening program was introduced in 2008, initially targeting women aged 50–60 years. It was subsequently expanded in 2018 to include women aged 40–70 years. This study evaluates the national BC screening program from its introduction in 2008 onward, focusing on program outputs, outcomes, and associated expenditures. Several administrative datasets and official sources were analyzed, including the legislative acts database, analytical reports on cancer screening programs, and cancer reporting forms. Trends in key indicators were summarized using the average annual percent change (AAPC). From the program’s inception, the absolute number of women screened increased steadily, with an AAPC of 6.23%. In contrast, the proportion of eligible women covered by screening declined over time, particularly following the expansion of the target age groups in 2018. Stage I BC detected through screening accounted for only about 50% of all stage I BC cases diagnosed nationwide, while the contribution of screening to stage II cancers was below 30%. Neither the introduction nor the subsequent expansion of the BC screening program was associated with statistically significant immediate or trend changes in national BC incidence or mortality rates. These findings may inform evidence-based discussions on potential refinements to BC screening policy and practice in Kazakhstan.

Whipple procedure is a most common performed surgery in patients with benign and malignant tumors of pancreas and periampullary region. There is a scarce of data regarding Whipple procedure outcomes in Kazakhstan. The aim of this study was to analyze Whipple procedure outcomes.All Whipple procedures,performed between 2019 and 2023 in National Research Oncology Center, Astana.Data regarding patients were retrieved from electronic records. 97 patients underwent Whipple procedure for malignant tumor. POPF was the most frequent complication after PD. The 1,2,3-year survivals were 83 %,65 % and 48 % respectively. Median survival after Whipple procedure in our study was 20.5 month (95 % CI 18.2-24.0). Surgery remains the only curative treatment method for patients with pancreatic cancer. POPF occurrence was the most common complication and was higher in comparison to other studies. Our findings demonstrate that the modified Blumgart and Dunk anastomosis with duct-to-mucosa suturing significantly reduce the occurrence of postoperative pancreatic fistula. It can be concluded that first 4 year of experience showed comparable learning curve and further improvement in surgical technique and patient selection can decrease morbidity and mortality rate after pancreatoduodenectomy.

Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of relapsed and refractory hematologic malignancies but can cause rapidly progressive inflammatory, neurologic, infectious, hematologic, cardiovascular, respiratory, and renal complications with overlapping clinical manifestations. This review aimed to synthesize current evidence on their early diagnosis, monitoring, critical care, and interdisciplinary management. A targeted narrative search was conducted in PubMed, including MEDLINE-indexed records, Google Scholar, and websites of international professional societies; the last search was performed on 30 September 2026. The structured PubMed strategy retrieved 4,178 records. Publications from January 2016 through September 2026 were considered, together with two earlier foundational guidelines on febrile neutropenia and acute kidney injury. Thirty-five sources were included after title/abstract screening and targeted full-text assessment. The review addresses cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome, infection and sepsis, acute organ dysfunction, prolonged cytopenias, and secondary immunodeficiency. Standardized toxicity grading, serial neurologic assessment, and continuous evaluation of hemodynamics, oxygenation, fluid balance, renal function, coagulation, ferritin, fibrinogen, blood cell counts, and microbiological findings are central to early recognition of deterioration. Fever and organ dysfunction require simultaneous evaluation for immune-mediated toxicity and infection because these conditions may coexist and no single biomarker reliably excludes sepsis. Management should combine syndrome-directed anti-inflammatory treatment, prompt empirical antimicrobial therapy when indicated, and timely organ support. Advanced support outside the intensive care unit is an organizational exception rather than an evidence-proven equivalent model and must not delay transfer. Predefined escalation pathways and coordinated multidisciplinary care are essential for safe implementation of CAR T-cell therapy. Keywords: receptors, chimeric antigen, immunotherapy, adoptive, cytokine release syndrome, neurotoxicity syndromes, critical care, sepsis, patient care team.

Introduction: According to the Global Cancer Observatory, breast cancer occupies a leading position in the world. According to the Bureau of National Statistics, in the structure of oncological morbidity, breast cancer ranks first (13.2%); lung cancer (10.0%) ranks second, colorectal cancer (9.3%) ranks third, and stomach cancer (7.4%) ranks fourth. Numerous studies and meta-analyses provide valuable data on the frequency, nature and risk factors of pain syndrome after mastectomy. According to studies, the frequency of occurrence of POPS after mastectomy varies from 20% to 68%, depending on the criteria for assessing the study and the nature of pain. In this regard, we, within the framework of the project "Creation and implementation of innovative methods for treating oncological diseases" conduct a comparative prospective study in patients with radical mastectomy. We present the intermediate results of the data obtained. Aim: to conduct a comparative analysis of the effectiveness of traditional postoperative analgesia and erector spinae plane (ESP) block in radical mastectomy. Materials and methods: the study was conducted at NROC in Astana. The study involved 40 patients after radical bilateral mastectomy Results: Both groups included patients who underwent bilateral radical mastectomy. In both groups, general endotracheal anesthesia was performed using inhalation anesthesia. Thus, the first registration of pain in the control group occurred after 57.7±16.3 minutes, while in the main group the first intense pain according to VAS more than 5 points was registered after 713.8±129.8 minutes ((p<0.05). Conclusion. Thus, the results obtained in our study show the high and reliable effectiveness of the ESP block in the early postoperative period in patients with radical mastectomy. Publications of peerreviewed journals also emphasize the high importance of regional anesthesia in the prevention of postoperative complications during mastectomy. Moreover, these are not single effects, but a complex improving patient outcomes after radical bilateral mastectomy. Введение. Рак молочной железы по данным глобальной обсерватории рака занимает лидирующую позицию в мире. По данным бюро национальной статистики в структуре онкологической заболеваемости на первом месте находится рак молочной железы (13,2%); на втором – рак легкого (10,0 %), на третьем – колоректальный рак (9,3 %), на четвертом – рак желудка (7,4 %). Многочисленные исследования и мета-анализы, проведенные в различных странах, предоставляют ценные данные о частоте, характере и факторах риска болевого синдрома после мастэктомии. Согласно исследованиям, частота появления ПОБС после мастэктомии варьирует от 20% до 68%, в зависимости от критериев оценки исследования и характера болевых ощущений. В этой связи, нами, в рамках проекта «Создание и внедрение инновационных методик лечения онкологических заболеваний» проводится сравнительное проспективное исследование у пациенток при радикальной мастэктомии. Мы представляем промежуточные результаты полученных данных. Цель: провести сравнительный анализ эффективности традиционного послеоперационного обезболивания и erector spinae plane (ESP) блока при радикальной мастэктомии. Материалы и методы: исследование проведено в Национальном научном онкологическом центре г. Астана. В исследовании приняли участие 40 пациенток после радикальной двусторонней мастэктомии. Результаты: В обеих группах участвовали пациентки, которым выполнялась двусторонняя радикальная мастэктомия. В обеих группах проводилась общая эндотрахеальная анестезия с применением ингаляционной анестезии. В после операционном периоде в контрольной группе отмечалось скорое развитие болевого синдрома, в отличии от основной группы. Так первая регистрация боли в контрольной группе наступала через 57,7±16,3 минут, в тоже время в основной группе первая интенсивная боль по ВАШ более 5 баллов регистрировалась через 713,8±129,8 минут ((p<0,05). Интенсивности болевого синдрома, в группах также имело выраженное отличие. Заключение. Таким образом полученные в нашем исследовании результаты показывают высокую и достоверную эффективность ESP блока в раннем послеоперационном периоде у пациенток при радикальной мастэктомии. В...