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This review discusses surgical management options, both radical and palliative surgical management for malignant pleural disease in lung cancer. No current clinical guideline recommends their routine implementation. Nevertheless, radical surgical management is used to improve the long-term results for patients with malignant pleural disease. The observational data suggest the effectiveness is not apparent, which is also associated with the patients’ heterogeneity and surgical methods. Most experts agree that it is impossible to draw well-grounded conclusions about the feasibility, efficacy, safety and optimal scope for surgical interventions in lung cancer patients with malignant pleural diseases. They advocate further research and randomised trials, considering the expected potential of using modern multidisciplinary approaches. When determining the tactics of malignant pleural disease management, an individual approach is required. It is crucial to consider the most significant prognostic and predictive factors: laterality, tumour spread (distant and regional metastases), sex, age, comorbidities, morphology, the presence of driver mutations, and the risk of postoperative complications. Personalisation of methods for managing malignant pleural disease in lung cancer is a promising area of modern oncology. However, many aspects of approaches to solving this problem remain unclear and require further research.

Purpose: To determine impact of various planning tumour volume (PTV) margins on final dose distribution in patients with maximal intrafraction prostate displacement. Materials: We analyzed data of 15 prostate cancer patients with maximal (значения) prostate intrafraction displacement registered during stereotactic body radiotherapy (SBRT) — 5 fractions of 7.25 Gy. Prostate displacement was determined by cone beam CT that was performed before and after each fraction. Modeling of dose distribution considering prostate displacement was performed for every fraction by isocenter shift. Final dose distribution was calculated as the sum of all fractions and was evaluated for PTV with various margins: 5-5-5-3, 3-3-3-1, 5-5-5 and cropped rectum. Results: The dosimetric impact of maximal intrafraction prostate motion was minimal for target coverage even for PTV with minimal margins (3 in all directions and 1 mm — posterior): CTV V100% varied from 97.5 to 100%. Prostate displacement reduced the dose to the rectum in all but minimal doses were detected for PTV 3-3-3-1: average D2cc — 31.87 Gy (28.41–34.05). For PTV 3-3-3-1 average bladder V100% volume slightly increased from 3.67 (SBRT plan) to 4.87 cc (simulation of intrafraction prostate displacement). Conclusions: The dosimetric impact of maximal intrafraction prostate motion was minimal for target coverage and doses in rectum and bladder even for PTV with minimal (3-3-3-1) margins.

Purpose: optimization of the technique of additional irradiation of the removed tumor bed using high-dose brachytherapy for breast cancer. Material and Methods: the results of treatment of 28 patients diagnosed with breast cancer were analyzed. After surgical treatment and a course of external radiation therapy, all patients underwent additional irradiation of the removed tumor bed using high-dose brachytherapy. The assessment of the operation protocols, the data of the pathomorphological conclusion was carried out, and on the basis of pre- and postoperative CT images, the formation of irradiation fields for high-dose brachytherapy was carried out. Results: After deformable (nonrigid) registration of pre- and postoperative CT images of 28 patients, it was revealed that in 18 women (64.3% of cases) the location of interstitial markers and the primary tumor focus does not match topographically, which can cause incorrect formation of borders irradiation. In 35.7% of cases, radiopaque markers were located on the chest wall (on the pectoralis major muscle) when the primary tumor was located in the breast tissue. In 25% of cases, the markers were located cranial or caudal to the topography of the primary tumor focus. Label migration occurred in 3.6% of cases. In 35.7% of cases, the topography of the primary tumor node and marks completely coincided. Conclusions: The use of deformable (non-rigid) registration of pre- and postoperative CT images is a simpler method to determine the topography of the removed tumor bed, which subsequently leads to a more accurate formation of the clinical volume of irradiation.

Purpose. To study the influence of PD-L1 expression on the dynamics of immunological changes before and at different intervals after stereotactic body radiation therapy (SBRT) of metastatic lesions in patients with metastatic forms of solid tumors. Materials and methods. A quantitative assessment and analysis of blood immunological parameters was conducted before irradiation, via 3-4 weeks and via 6-8 weeks after SBRT in patients with malignant tumors with oligometastases in the liver or lungs, in groups with negative and positive expression of PD-L1. All peripheral blood samples were analyzed by flow cytometry. Statistical analysis was performed using Friedman and Nemenyi criteria. Results. 3-4 weeks after the end of SBRT in group CPS 1, we revealed statistically significant increase of activated T-helpers 6-8 weeks after and decrease of T-regulatory lymphocytes (CD4+CD25brightCD127low) 3-4 weeks after completion of SBRT compared with the study before radiotherapy. When we analyzed the indicators by the TPS index, most of the statistically significant changes were recorded in the group with negative expression (TPS

Soft tissue sarcomas (STS) are rare and heterogeneous group of mesenchymal cell tumors, accounting for only 1% of all malignances. Every year about 3700 new cases of STS are registered in Russia, while the annual increase rate was 6.45% in 2019. Randomized studies confirm the feasibility of combination therapy for STS. The review contains a comprehensive description of the proposed methods of combined treatment of STS. Advantages, disadvantages, directions and features of various methods of radiation therapy for STS are shown on the examples of scientific research of recent years.

Lung cancer (LC) is a common malignant neoplasm (MN) with high lethality, often detected at late stages. The implementation of lung cancer screening can change the ratio in favor of the early stages. Screening could help diagnose early-stage LC in 60% of patients. Multiple primary LCs occur in 4–10% of patients within five years after treatment. The presence of oligo-metastatic disease only in the lungs (up to 5 nodules) occurs in 6-40% of patients with malignant tumors, and complete resection could increase 5-year survival to 20-40%. Due to functional limitations, surgical treatment can be performed only in 65-70% of patients. Stereotactic radiation therapy gives an opportunity to accurately deliver a high dose of radiation to the tumor with minimal damage to the surrounding healthy tissues. Local control is possible in 85–95% of cases, and 3-year overall survival is about 60–80%. New algorithms for fractionation and dose determination (BED10 ≥ 100 Gy) could improve the treatment results for early-stage lung cancer and oligometastatic lesions. In this non-systematic review, we analyze a recent publication and our own experience. We consider the effectiveness and safety of stereotactic radiotherapy and planning, modeling, fractionation, dose restrictions on critical organs, radiation reactions, and adverse events. We conclude that randomized controlled trials can reveal the stereotactic radiation therapy's potential in patients with primary and oligo-metastatic pulmonary tumors.

Purpose. To evaluate immunological status in patients with metastatic forms of solid tumors before and at different intervals after stereotactic body radiation therapy (SBRT) of metastatic lesions depending on the dose and the number of irradiated metastasis. Materials and methods. A quantitative assessment and analysis of blood immunological parameters was conducted before irradiation, via 3-4 weeks and via 6-8 weeks after SBRT in patients with malignant tumors with oligometastases in the liver and lungs, in groups with a total focal dose (TFD ≤ 45 Gy ) and TFD> 45 Gy, and also in groups with irradiation of one metastases and two or more. All peripheral blood samples were analyzed by flow cytometry. Statistical analysis was performed using Friedman and Nemenyi criteria. Results. 3-4 weeks after the end of SBRT, when using higher doses (TFD> 45 Gy), we observed statistically significant increase of T-lymphocytes (CD3+CD19-); T-helpers (CD3+CD4+); activated T-helpers (CD3+CD4+HLA-DR+); activated cytotoxic T-lymphocytes (CD3+СD8+HLA-DR+). Decreasing of B-lymphocytes (CD3+CD19-) was observed in both dose groups (TFD ≤ 45 Gy and TFD > 45 Gy). We also noted the activation of the T-cell link of immunity both in the group with irradiation of one metastatic lesion, and in the group where 2 or more metastases were exposed to irradiation. Conclusion. Using of higher doses of SBRT is associated with a more activated antitumor T-cell immune response, while the analysis of groups of patients with different ammount of irradiated metastasis currently requires further research.

The purpose of the study is to assess the effectiveness and toxicity of the treatment of prostate cancer (PCa) with combined radiation therapy (CRT), where high dose rate brachytherapy (HDR-BT) "boost". Materials and methods: CRT was carried out in 98 patients of high-risk and extremely high-risk PCa. External part of treatment (conformal external radiation therapy) provided total dose 46-50 Gy with a single focal dose (SFD) 2 Gy to the prostate gland (PG), seminal vesicles and regional lymphatic zones. Two regimes of "boost" to the PG and seminal vesicles were used: in the first group – two fractions of 10 Gy (81 patients), in the second - 15 Gy (17 patients). Results: median follow-up equals: I group - 57.5 months, II group - 55.2. Three- and five-year survival without biochemical progression in group I - 75.4% and 69.0%, II group - 76.4% and 52.9%, respectively. Similar indicators regardless of the CRT regime in groups of different risk of relapse were equal: high risk - 84.6% and 75.9%, extremely high risk - 69.4% and 60.7%, respectively (p=0.05). There were no late radiation genitourinary and gastrointestinal complications of 4-5 degrees. The most significant variants of late disorders were the formation of urethra stricture (one patient of the I group) and stenosis of the rectum (one patient of the II group). Late genitourinary radiation toxicity (L-GURT) was mainly represented by changes that can be characterized as 1 degree (RTOG/CTCAE): I group - from 40.6% to 53.2%, II - 18.8% to 35.3%. Conclusions: the studied CRT regimes showed perfectly acceptable survival rates with no signs of biochemical progression and radiation toxicity during the five-year period of follow-up.

In 5 year 180 patients (89 men and 91 women) underwent radiosurgery of brain metastases. Most patients had breast cancer and less than 5 lesions. Median overall survival (MOS) was 12,5 months, median progression free survival (MPFS) - 6,1 months. Both values were higher in patients with solitary lesions: 22.5 vs 10 months (р=0.00703) and 9 vs 6 months (р=0.02787), respectively.MOS was 18 in women with breast cancer, 12 months in patients with non small cell lung cancer. 8 - with melanoma and only 4 months - for small cell lung cancer. MPFS was significantly shorter for lesions volumes above 15 cm3. In field progression was detected in 37 (2-24 months after treatment) of 180 cases (20,5%). Second radiosurgery was performed in 24 cases.

Preoperative radiotherapy in patients with soft tissue sarcomas characterized by important advantages: high precision of dose delivery, reduction of tumour volume and implantation potential, induction of immunologic response. Postoperative radiotherapy associated with decreased complication rate, delivery of treatment to microscopic disease according to pathologic report. Combination of pre- and postoperative irradiation gives the opportunity to use best of both methods. The aim: analyses of feasibility and safety of radiotherapy protocol that combined pre- and postoperative radiotherapy in patients with soft tissues sarcomas of extremities. Materials and methods: from 06.2018 to 01.2020 ten patients with soft tissue sarcomas of extremities were included in the protocol. Preoperative stereotactic ablative body radiotherapy (SABR) was performed as 5 fraction of 7 Gy on the main tumor volume with dose reduction to 5Gy in 5 fraction on the margins of the field. Postoperative radiotherapy started 5-8 weeks after surgery and was performed as standard compartmental irradiation in 25 fractions of 2Gy. Complications were determined according to CTCAE and wound complication scales. Results: from 06.2018 to 01.2020 10 patients with soft tissue sarcomas of extremities were included in the study. Pre-opeartive SABR and subsequent radical resection with tumor free surgical margins were performed in all 10 cases. Primary wound closure was mentioned in all patients. With relatively short follow-up of 9.1 (3-20) months we didn’t mentioned any case of grade II or more toxicity and no local recurrences. Conclusion: Our preliminary results demonstrate that combination of preoperative SABR and postoperative conventional radiotherapy is feasible and associated with low probability of grade II (and higher) toxicity.

Objective: to evaluate the diagnostic accuracy of sentinel lymph node biopsy after neoadjuvant chemotherapy. Materials and methods: the study included 264 patients with early (operable) and locally advanced breast cancer (cT1N1-3, cT2N0-3, cT3N0-3, cT4N0-3). All patient underwent corebiopsy with histological examination and ICH (to determine the tumor grade (G), expression of ER, PR, Ki67, Her2), fine needle aspiration of suspicious axillary lymph nodes. Before, during and after the neoadjuvant therapy, all patients undergo: physical examination (palpation), mammography, ultrasound, SPECT-CT. The effect of neoadjuvant chemotherapy was evaluated after the 2nd, 4th, and 6th cycles of therapy. 197 patients (74.6%) had tumors more than 2 cm (cT2), 210 (79.8%) were N + (cN1-N3), 174 patients (65.9%) had luminal tumors (ER+), 84 patients (31.8%) had triple-negative breast cancer (ER-, PR-, HER2-) and 53 patients (20%) had HER2-positive breast cancer. Most patients (56.4%) had a high level (> 30%) of Ki67 expression. Results: 210 of 263 patients (79.8%) had metastases in regional lymph nodes before treatment. Almost half of them had a decrease in the stage from N + to ycN0 after NACT. According to the ultrasound data 48 patients had decreasing of the stage to ycN0. Sentinel lymph node biopsy showed ypN0 category in 35 patients and ypN+ in 13 patients. The false-negative rate was 5.7%. The sensitivity of the method was 94.3%, the accuracy of ultrasound was 95.8%. According to the SPET-CT data 51 patients had decreasing of the stage to ycN0. Sentinel lymph node biopsy showed ypN0 category in 35 patients and ypN+ in 16 patients. The false-negative rate was 2.85%. The sensitivity of SLNB after NACT in patients cN0/cN+ → ycN0 was 91.2%, accuracy - 96.3%, predictive value of the negative result - 92.4%. Conclusion: SLNB can be performed in cN0/cN+ → ycN0 patients after NACT, provided that 3 or more sentinel lymph nodes are removed and there are no tumor cells in them.

Purpose: the aim of the study is to assess the effectiveness and safety of prostate cancer treatment (PCa) with high dose rate brachytherapy (BT-HDR) in monotherapy on 5 years of follow-up. Materials and methods: BT-HDR is performed in 198 patients of PCa. The fractionation schedule was presented by two options: two fractionations of 13 Gy in the first group (67 people) and three fractionations of 11.5 Gy in the second (131 patients). The treatment was carried out with 192Ir (Microselectron). Results: the median for patient care was: I group - 59.2 (41.4-90.3), II - 56.1 (39.4-86.4) months. During the follow-up, no patients died from the progression of the PCa. The three-year survival rate without biochemical progression was 98.5%, while the second group had 92.8%; 88.8% and 88.1%, respectively. There were no significant differences in survival rates between the BT-HDR fractionation regimes compared. In most cases, late genito-urinary radiation toxicity was represented by changes that could be characterized as 1st degree. A total of 161 patients with a three-year follow-up period had three cases (1.8%) radiation-induced stenosis urethra (complications of 3 degrees): two of them in the first group, one in the second group. Only one patient (I group) (1.5%) recorded late recto-intestinal toxicity of the 2nd degree. There were no third or higher violations in the observed groups. Conclusions: the studied mono-modes of fractionation of BT- HDR PCa (two factions of 13 Gy and three factions of 11.5 Gy) demonstrated quite acceptable indicators of effectiveness and safety with a five-year period of observation. It has been established that there are no significant differences in the frequency of biochemical relapses, as well as the severity of early and late radiation toxicity in the groups compared.

In this article we summarize our own experience of lung cancer diagnostics using exhaled breath analysis with a non-selective method using metal oxide chemoresistor gas sensors with cross-sensitivity combined with the sputum cytology. Volatile organic compounds of exhaled breath change the conductivity of the sensor, the resulting pulse is displayed as a peak on the graph, the area of which is used as test results. The combination of two diagnostic techniques in 204 participants demonstrated the possibility of non-invasively detecting the disease at an early stage. The sensitivity, specificity and accuracy of the breath analysis was 91.2%, 100% and 93.4%, respectively. The combination of the breath test and the sputum cytology compared to the breath test alone showed statistically significant (p = 0.03) increase in sensitivity to 96.8% (95% CI: 80.9% -99%) with acceptable decrease in specificity to 93.4% (95% CI: 88% -96%). The convenience of analysis and realtime measurements show some promise for the early detection.

Purpose. To evaluate immunological status in patients with metastatic forms of solid tumors before and at different intervals after stereotactic body radiation therapy (SBRT) of metastatic lesions. Materials and methods. A quantitative assessment and analysis of blood immunological parameters was conducted before irradiation, after 3-4 weeks and 6-8 weeks after SBRT in patients with malignant tumors with oligometastases in the liver and lungs. All peripheral blood samples were analyzed by flow cytometry. Statistical analysis was performed using Friedman and Nemenyi criteria. Results. 3-4 weeks after the end of SBRT, we observed statistically significant increase of T-lymphocytes (CD3+CD19-); T-helpers (CD3+CD4+); activated T-helpers (CD3+CD4+HLA-DR+); activated cytotoxic T-lymphocytes (CD3+CD8+HLA-DR+) and decrease of B-lymphocytes (CD3-CD19+). Subsequently, after 6-8 weeks after the end of irradiation we detected decrease of T-lymphocytes (CD3+CD19-) and continuing increase in activated T-helpers (CD3+CD4+HLA-DR+) and activated cytotoxic T-lymphocytes (CD3+CD8+HLA-DR+). Conclusion. Thus, revealed dynamics of immunological parameters indicates the induction of the T-cell link of antitumor immunity against decreasing of indicators of humoral immunity.

Purpose: to determine accuracy of sentinel lymph node biopsy in patients with IAB-IIAB cervical cancer. Materials and methods: diagnostic performance of sentinel lymph node (SLN) biopsy was evaluated in 46 women with cervical cancer. SLN mapping was performed after peritumoural injection of 99mTc-labelled radiocolloids. All regional lymph nodes with uptake of radiocolloids were regarded as sentinel. SSLN biopsy was completed by standard lymph node dissection in all cases Results: SLN were visualized and detected in 42 of 46 (91.3%) cases. The monolateral pattern of lymph flow was determined in 19 women, bilateral localization of SLN revealed in remained 23 cases. Monolateral lymph flow characterized by high probability of metatstic involvement of regional lymph nodes (21.1%) and low sensitivity of SLN biopsy (0%). On the contrary, in women with bilateral lymph flow metastases in regional lymph nodes were mentioned in 2 of 23 cases (8.7%) and sensitivity of SLN biopsy was 100%. Conclusion: In patients with SLN localization on both sides of the pelvis SLN biopsy correctly predicted status of regional lymph nodes. In cases with monolateral localization of SLN biopsy characterized by high false negative rates.

This article reviews the literature and summarizes single institution experience of applying different diagnostic algorithms for lung cancer. All diagnostic methods can be divided into three groups: non-invasive; minimally invasive and invasive. The non-invasive methods include clinical examination; imaging methods for anatomical, functional and multimodal visualization; sputum cytological, analysis of the exhaled breath, detection of various blood and sputum markers. Minimally invasive methods include endoscopy, percutaneous fine-needle and core-needle biopsy. Invasive methods include diagnostic thoracoscopy and laparoscopy, mediastinoscopy, parasternal mediastinotomy and diagnostic thoracotomy. While creating an individual diagnostic plan for each patient it is necessary to carefully analyze the effectiveness, safety, sensitivity, specificity and of different methods available among wide range of modern diagnostic techniques. Optimization of lung cancer diagnosis methods, which includes early cancer detection, is one of priority areas of modern oncology. Many aspects of this problem remain unresolved and require further research

In this literature review we analyze the effectiveness of radiotherapy (as an independent method and in combination with surgery and chemotherapy) in the treatment of locally advanced non-small cell lung cancer. The postoperative adjuvant radiotherapy can increase overall survival and reduce the frequency of local recurrences in IIIA / N2 stage of NSCLC, however, its positive effect can be offset by the damage to surrounding structures. Modern high-tech equipment, improved planning systems, methods radiation doses delivery, and the fractionation regimen can improve the outcomes of radiation therapy. No bimodal treatment has shown advantages over other combinations. Some improvement in survival was noted in a number of studies using three-modal treatment, but it was also associated with an increase in the proportion of postoperative complications, especially after pneumonectomies. The heterogeneity of the IIIA / N2 NSCLC group and criteria for their operability present certain difficulties for a correct comparison of the treatment results, which requires further discussion. In most studies, insufficient attention has been paid to the influence of multimodal treatment on the quality of life of patients, which, taking into account comparable results of treatment, can be crucial in determining indications and contraindications.

Purpose: to determine preoperative SPECT-CT localization of sentinel lymph nodes (SLN) in women with cervical cancer. Materials and methods: SPECT-CT visualization of SLN was performed in 44 women with clinical stage IB-IIB cervical cancer. SPECT-CT examinations started 120-240 min after peritumoural injections of 99mTc-radiocolloids (200-300MBq in 0.4-1ml). All visualized LNs with uptake of radiocolloids were regarded as SLN. In all women we determined topography of SLN and lymph-flow patterns. Results: SLN were successfully visualized in 93.1% cases (41/44 women). The bilateral pattern of lymph flow was mentioned in 26 (63.4%), monolateral - in 15 (36.5%) cases. SLN localized in external iliac region in 25 (60.9%), internal iliac - in 14 (34.1%), obturator - in 22 (53.6%), presacral - in 1 (2.4%), common iliac region - in 21 (53,8%) cases. Uptake of radiocolloids in paraaortal lymph nodes was mentioned in 14 (34.1%) women Conclusion: SPECT-CT visualization of SLN can give important information for surgery and radiotherapy planning.

The main purpose of the study was to determine distribution of sentinel lymph nodes in patients with tongue cancer. SPECT-CT visualization of sentinel lymph nodes was performed in 19 primary patients with clinically T1-2N0M0 tongue cancer. SPECT-CT acquisition started 60-120 min after peritumoral injections of 99mTc-nannocolloids (100-150MBq in 0.3-0.4ml). Finally we analyzed lymph flow patterns and localization of lymph nodes with radiocolloids uptake. Bilateral lymph flow from the tongue cancer was detected in 9 (47%) of 19 patients. In 6 cases bilateral pattern was associated with tumors less than 5mm from medial sulcus of the tongue. On the contrary, in 9 of 10 patients with lesions more than 4mm from medial sulcus we detected monolateral lymph-flow. In 4 (21%) of 19 patients SPECT-CT visualized sentinel lymph nodes only in groups Ib-IIa. Modeling of radiotherapy with with standard and lymph-flow guided radiation fields was performed on Eclips treatment planning station. It demonstrated that with lymph-flow guided strategy irradiated volumes can be reduced from 1224 cm3 to 367 cm3, dose to spinal cord can be reduced from 24,7Gy to 14.3Gy, medial dose to contralateral parotid gland - from 24,6Gy to 12,4 Gy. SPECT-CT with radiocolloids can be successfully used for visualization of lymph flow from the primary tumour and subsequent radiotherapy planning.

An active introduction of screening programs potentially leads to a significant increase in the proportion of patients with early forms of non-small cell lung cancer. Surgical treatment, which is the standard of care for localized forms, due to functional limitations can be performed only in 65-70% of patients. The solution to this problem can be found in the improvement of the results of radiotherapy by using modern equipment, the planning systems, improved fractionation schemes and introduction of methods for summing radiation doses. Stereotactic radiotherapy allows high-precision delivery of high radiation dose to tumor with a minimal damage to surrounding healthy tissues. In this literature review based on the analysis of a large number of publications we show that it is not yet possible to make valid conclusions about the effectiveness and safety of stereotactic radiation therapy as an alternative to the surgical methods. It is necessary to plan and conduct randomized trials without further delay taking into account the expected high relevance of the method.

Purpose: dosimetric comparison of high dose rate interstitial brachytherapy (HDR) and irradiation with electrons for radiation boost after whole-breast irradiation. Material and methods: in 62 patients with рТ1N0М0-рТ2№М0 breast cancer we used HDR brachytherapy for delivering boost to tumor bed. In all cases insertion of plastic needles was performed under CT control with subsequent 3D planning. Pre-insertion CT were used for 3D planning of boost delivery with electrons. Results: Boost delivery with HDR brachytherapy had several important advantages when compared with boost with electrons. HDR brachytherapy demonstrated more accurate irradiation of tumor bed: D90 HDR - 93,1 % (69,1 % - 118 %), D90 electrons - 86,2 % (47,6 % - 104,1 %). Boost delivery with HDR brachytherapy help to minimize radiation burden to left main coronary artery - Dmax electrons - 14.8 % (0.2 %-71.8%), Dmax HDR - 5.2 % (0.7 %-14.2 %). Radiation burden to left anterior descending artery is also decreasing: Dmax electrons - 21.9 % (0.8 %-94.1 %), Dmax HDR - 10.5 % (1.9 %-31.5 %). Radiation dose absorbed in ip-silateral lung also significantly lower with HDR brachytherapy: Dmed electrons - 6,5 % (0,5 % - 19,3 %), Dmed HDR - 2,3 % (0,8 % - 10,8 %). Conclusions: the present dosimetric analysis indicated that boost delivery with HDR brachytherapy is more accurate than irradiation with electrons.

The aim of the study: to evaluate efficacy and toxicity of interstitial high-dose-rate prostate brachytherapy when it was used as monotherapy for low-, intermediate risk prostate cancer. Material and methods: 198 primary patients with low-, intermediate risk prostate cancer that were treated from 1.07.2012 to 01.07.2017 were included in the study. Two fractions of 13Gy were used in 67 men, 3 fractions of 11.5Gy -in the remaining 131 patients. The reported end points were overall/cancer-specific survival, biochemical control rates according to Phoenix definition. Toxicity was scored according to the RTOG scale. Results: The median follow-up time was 28.7 [19.3; 36.6] (10.9-58.9) months. The 3-year biochemical control (nadir+2) was reached in 94.1% cases. Late grade III genito-urinary toxicity was represented by urethral strictures in 1.6% of evaluated patients. Grade III rectal toxicity was not mentioned. IIEF score before treatment was below 16 in 28.8% patients and after brachytherapy - in 52.9% cases. Conclusion: high dose rate brachytherapy can be effectively and safely used for monotherapy of patients with low-, intermediate risk prostate cancer.

Objective: To compare diagnostic capability of mammography and mammoscintigraphy with 99mTc-methoxyisobutylisonitrile (MIBI) in diagnostic of multicentric breast cancer. Material and Methods: We respectively analyzed 437 consecutive women with suspected breast cancer between 2014 to 2016. All of them underwent mammography and mammoscintigraphy. Craniocaudal and mediolateral oblique images were obtained. Mammoscintigraphy was performed 15-20 min. after intravenous injection 740 MBq of 99mTc-methoxyisobutylisonitrile (MIBI). Final interpretation of the data was done according to histological examination. Results: Breast cancer was detect in 367(84%) of patients. Most of them 320(87%) had single node breast cancer and 47(13%) - multicentric breast cancer. Sensitivity, specificity and accuracy in diagnostic of multicentric breast cancer were 40,4%, 95,3%, 88% for mammography and 83%, 98%, 96% for mammoscintigraphy respectively. The combination of these methods allowed significantly increase sensitivity of breast cancer detection up to 93,6%. Specificity was 93,4%.

Cancer screening literature was discussed in this review publication. Broad spectrum of studies was used to make conclusion about effectiveness of screening methods in reaching its major objectives, perspective of screening methods for several cancer types were also discussed. Qualitative assessment of studies was done. Cervical cancer, breast cancer and colorectal cancer screening was proved to be effective. Effectiveness of prostate and lung cancer screening as well as population-based stomach cancer prevention is also discussed. Negative and inconclusive results of screening studies of the other cancer types were also mentioned and perspectives for future diagnostics option for cancer screening were given.

This paper summarizes recent Russian and international literature describing endoscopic surgical methods in lung cancer management, particularly, video-assisted lung anatomic resection with different approaches. Own experience of 72 video-assisted single-port lobectomies of stage I-II lung cancer patients is presented. The mean operating time in the second part of the learning curve (40 last procedures) was 90.3, statistically not different from the time of open procedure. Mean blood loss was 98,3 ml. Mean number of lymph nodes was similar in video-assisted single port and open group (14,2 vs 14,8). The conversion rate was 2,8% (2 cases). Only 5 (6,9%) non-lethal complication were associated with thoracoscopic procedure -pneumonia and 4 cases of arrhythmias. The duration of air leak was 2,3 days. The duration of chest drain use was 4,6 days. Postoperative pain was minimal, pain-killers were used not more than 2-3 days after surgery. Patients were ready to be discharges in 5, 8 days.

Oncologists nowadays are faced with big amount of heterogeneous medical data of diagnostic studies. Possible errors in determining the nature and extent of spread the tumor process will inevitably reduce the effectiveness of treatment and increase the unnecessary costs to it. To reduce the burden on clinicians, various computer-aided solutions based on machine learning algorithms are being developed. We made an attempt to evaluate effectiveness of thirteen machine learning algorithms in the tasks of classification of pathologic tissue samples in cancerous thorax based on gene expression levels. For a preliminary study we used open data set of molecular genetics composition of lung adenocarcinoma and pleural mesothelioma. Effectiveness of machine learning algorithms was evaluated by Matthews correlation coefficient and Area Under ROC Curve. Best results were showed by two methods: Bayesian logistic regression and Discriminative Multinomial Naive Bayes classifier. Nevertheless, all of the methods were effective at automatic discrimination of two types of cancer. That proves machine learning algorithms are applicable in lung cancer classification. In the future studies it will be carried out a similar analysis of the diagnostic value of methods for other malignancies with more complex differential morphological diagnosis. Similar methods can be applied to other diagnostic studies including computerized tomography image analysis in the differential diagnosis of lung nodules.

The efficacy of SPECT-CT with 99mTc-MIBI for detecting axillary lymph node (LN) involvement was evaluated in 184 patients with primary breast cancer. All patients were operated with histological examination of axillary LNs. During statistical analysis we determined correlation between LN metastases and various diagnostic and clinical characteristics. SPECT-CT signs of LN involvement were as follows: short axis more than 10 mm, cortical thickness more than 4mm, solid structure, round shape, intensive tracer uptake. More than 2 metastatic LNs were considered as plural metastatic damage. The complex model for evaluation axillary LN involvement was elaborated. The use this data in our study showed that SPECT-CT 99mTc-MIBI could correctly exclude 2 or more metastatic LNs in 96% breast cancer patients.

On the basis of the Departments of Oncogynecology and Radiology of the N.N. Petrov Research Institute of Oncology there was performed a comparative analysis of the results of detection of the sentinel lymph node using a fluorescent method with Indocyanine Green (ICG) and a radioisotope method with 99m-labeled colloidal radiopharmaceutical in endometrial cancer patients undergoing laparoscopic hysterectomy with lymphadenectomy from June 2016 to December 2016. The study included 19 patients with early endometrial cancer. Specificity and sensitivity of methods of radiation diagnostics (ultrasound and MRI) in the detection of metastatic involvement of pelvic lymph nodes are also presented.

In this study we analyzed prostate intrafraction motion during the course of stereotactic radiotherapy (STRT). STRT (5 fraction of 7.25Gy) was performed in 31 primary patients with prostate cancer. At least 3 gold fiducial markers were implanted in prostate of every patient 3-5 days before simulation. Prostate position on treatment table was verified with cone beam CT just before and immediately after the end of each radiotherapy session. This data help to determine prostate displacement in cranio-caudal, anterior-posterior and lateral axes. Average values of intra-fractional prostate displacement were as follows: 0,8+/-1,2mm - in cranio-caudal, 0.9+/-1,0mm - in lateral and 1.3+/-1,3mm - in anterior-posterior directions. In 5%-8,3% cases prostate displacement in cranio-caudal and lateral directions exceeded 2mm with maximal value of 5mm. In accordance with obtained average shifts we recommend following PTV margins: 1mm - in anterior-posterior and 3mm - in all other directions. In this case average intrafractional prostate shifts would not compromise dose delivery to prostate (V100 - 98%, D90 - 101%) and in comparison with standard (3mm, 5mm, 5mm, 5mm) margins would permit 16% reduction of rectum volume incorporated in 80% isodose. We propose that small average intrafractional displacement of prostate permits the use of narrower PTV margins without compromising coverage of the target and significant reduction of rectum volume covered by 80% isodose.

In 437 primary patients with breast cancer (BC) we compared diagnostic accuracy of mammography (MG) and mammoscintigraphy (MCG) with 99mTc-MIBI. All women, included in the study, had lesions suspicious for BC. In 108 suspicious lesions were less than 10 mm in diameter. On histology 33 (30,5%) patients had invasive BC, 20 (18,5%) - noninvasive BC, 6 (5,6%) - lobular carcinoma, 2 (1,9%) - mucinous BC, 8 (7,4%) - fibroadenoma and in remained 39 cases (36,1%) - localised fibrosis. In the group of women with lesions below 10 mm sensitivity, specificity and accuracy of MG in diagnosis of BC were 72%, 74%, 73%, for MCG - 62%, 51%, 57%. Combination of MG and MCG helped to increase sensitivity to 93,4%. In 53 women with dense breasts sensitivity, specificity and accuracy of MG were 40%, 71,4%, 64%; for mCg two times higher (82%) with specificity of 55% and 60% accuracy. Combination of MG and MCG allowed increasing the sensitivity of diagnosis of minimal BC 2 times more (up to 91%).

One of the most important problems of modern medicine, which, in particular, precludes the effective implementation of new diagnostic methods such as population screening, is the steady increase of volumes of important medical data, as well as insufficient attention to the analysis of the dynamics of the patients’ condition. These problems can be solved by the information support of medical specialist in the process of research and in the formation of recommendations for further management of patients. In the study, we examined the possible ways of solving these problems through the development of software tools for creation of knowledge bases of recommendations for monitoring and treatment of various diseases, as well as intelligent decision support by the example of cancer. The results of tests of these solutions allow speaking about their effectiveness and applicability in clinical practice.