Background: The incidence of esophageal cancer is increasing. In this connection, the search for the most effective methods of treating this disease continues. In most patients, esophageal cancer is diagnosed at III– IV stages of the disease. Currently, the standard of treatment for inoperable patients is chemo radiotherapy. Brachytherapy is one of the perspective methods of radiation therapy. Using of brachytherapy in the complex treatment of patients with esophageal cancer makes possible to increase the radiation dose without increasing the risk of complications after treatment.

Methods: The study included 20 patients with inoperable esophageal cancer (most of them with III stages, 60 %). The age of the patients is from 51 to 89 years, ECOG performance status ½ (25 %/75 %), dysphagia score 1/2/3–4 (25 %,50 %, 25 %). All patients were diagnosed with esophageal squamous cell carcinoma. Most patients were with tumor in the middle third of the esophagus (70 %). The greatest length of the tumor was 10 cm. On the first stage of treatment patients underwent external-beam radiation therapy 46 Gy in 2 Gy fractions with simultaneous chemotherapy. After that, brachytherapy was performed (single dose of 5 Gy, 2 fractions with an interval of 6–7 days, 62,8 Gy (EQD2, α/β = 10 Gy).

Results: Patients received therapy support for cardiovascular and lung diseases and nutritional support before, during and following chemoradiotherapy. There were no patients with hematological toxicity grade 3–4. Esophagitis grade 2 was noted in 40 % of patients, grade 1 in 60 % of patients. Esophagitis resolved on its own 2 weeks after completion of therapy. Complete tumor regression was observed in 10 % of patients, partial regression in 80 % of patients, stabilization of tumor process was observed in 10 % of patients. All patients have a poor QOL due to physical and psychological disorders. The general health situation and physical function after 3 months of treatment was improved compared to the prior to treatment period.

A review of the literature on the current capabilities of radioisotope imaging of prostate cancer is presented. Various views and experience of using PET/CT for visualization of prostate cancer are considered. Particular attention is paid to the use of various radiopharmaceuticals used in staging, restaging prostate cancer, as well as monitoring the response to treatment. The advantages and disadvantages of most radiotracers used to search for disease recurrence are highlighted, as well as the peculiarities of their use in various clinical situations. The features of the effect of hormonal therapy for prostate cancer on imaging are discussed.

Purpose: To evaluate and compare the diagnostic efficacy of the planar lymphoscintigraphy, SPECT (SPECT/CT) and intraoperative detection with handheld gamma-probe in the identification of the sentinel lymph node (SLN) among patients with melanoma.

Material and methods: 324 patients with cutaneous melanoma who underwent treatment at N.N. Blokhin National Medical Research Center of Oncology between 2018 and 2020, were included in this study. For SLN identification lymphoscintigraphy (n = 324) and SPECT (SPECT/CT) (n = 259) images were obtained preoperatively after injection of 99mTc-labeled colloid particles. Lymphatic mapping was implemented with permanent skin marker designating the anatomical landmarks of sentinel node’s location. Additionally, SLN localization was identified by handheld gamma-probe (n = 294). The status of the remote sentinel lymph node was determined by a histological assessment considered as the gold standard.

Results: SPECT (SPECT/CT) provided additional information in 67 patients (25.8 %) with planar lymphoscintigraphy: in 45 cases it revealed more SLN within the same regional lymphatic drainage basin, and in 22 (8.5 %) showed additional (lymphatic drainage) basin or unusual drainage pattern. In 10 patients (3.9 %) SPECT/CT revealed SLN not visible in the planar lymphoscintigraphy (false-negative). False SLN identification results were detected mostly in patients with head and neck melanoma. The overall rate of surgical approach modification in the total group is 10.4 % (10 patients among 259), the additional information provided by SPECT (SPECT/CT) impacted management and surgical planning in 11 (37.9 %) of 29 patients of head and neck melanoma group.

Analysis of planar lymphoscintigraphic imaging, tomographic imaging (SPECT and SPECT/CT), and intraoperative detection revealed a sensitivity and PPV of 95.6, 100, 100 % and 98.7, 97.7, 96.9 %, respectively.

Conclusion: Radionuclide imaging techniques are reliable and account for the current need for navigating the surgical access when performing a sentinel lymph node biopsy. SPECT and SPECT/CT visualizes more sentinel nodes than conventional images, reduces false-negative rate and improved anatomical location of sentinel nodes. The diagnostic effi of SPECT and SPECT/CT is superior to the static lymphoscintigraphy in sentinel lymph node detection due to the better sensitivity (100 and 95.6 %, respectively) with a similar positive predictive value PPV (97.7 and 98.7 %, respectively). These advantages may lead to a surgical adjustment in a considerable number of patients, especially in the head and neck melanoma.

Purpose: Analysis of infectious complications incidence in different types of percutaneous externalinternal biliary drainage in patients with obstructive jaundice of tumor genesis.

Material and methods: The results of using antegrade external-internal drainage of the biliary tree in transpapillary and suprapapillary variants in 110 patients were analyzed. External-internal biliary drainage was performed in stages, after percutaneous transhepatic cholangiostomy or involuntarily primary with proximal obstruction of the biliary tree with bile duct segregation if it is impossible to form a fixing element of drainage proximal to the obstruction zone.

Results: In the first group, transpapillary external-internal drainage was performed in 30 patients with peripapillary tumor obstruction. Of the 26 patients with proximal obstruction, suprapapillary external-internal drainage was performed in 8 patients, transpapillary — in 18 patients. Postmanipulation cholangitis in the first group occurred in 16 cases (28.6 %), liver abscesses developed 4 cases (7.1 %). In the second group, among 30 patients with transpapillary drainage on the background of peripapillary tumor obstruction, signs of acute cholangitis developed in 4 cases. Cholangitis was stopped by timely transfer of external-internal drainage to external. Among 24 patients with proximal obstruction of the biliary tree, suprapapillary external-internal drainage without complications was performed in 18 cases, transpapillary in 6 patients with the proximal block without disconnecting of the biliary tree. Acute cholangitis developed in 2 cases. Patients of the second group had no liver cholangigenic abscesses. There were no cases of hospital mortality in both groups.

Conclusion: Factors in the development of postmanipulation cholangitis and liver abscesses during external-internal drainage of the biliary tree against the background of its tumor obstruction are the transpapillary position of endobiliary drainage with duodeno-biliary reflux in persistent biliary hypertension. In the case of suprapapillary location of the working end of external-internal drainage during antegrade drainage of the proximal tumor obstruction of the biliary tree with dissociation, the risk of postmanipulation cholangitis in non-drained liver segments is minimal. In the event of post-manipulation cholangitis in the case of transpapillary drainage of the biliary tree, a temporary transformation of external-internal drainage into external cholangiostomy is necessary.

The review presents an analysis of the literature and our own data on the use of intra-arterial chemotherapy in pancreatic cancer. It is concluded that transcatheter arterial administration of cytostatics is a relatively safe and effective method of treatment. Combination of celiac axis infusion with arterial chemoembolization, as well as infusion with radiotherapy increase the survival. Neoand adjuvant arterial chemotherapy improves the results of pancreatic surgery. The use of new locoregional chemotherapy regimens is promising and requires further study.

Introduction: Selective ophthalmic arterial injection (SOAI) therapy for intraocular retinoblastoma is currently recognized by the world ophthalmic-oncological communities and this method is used in leading specialized institutions. However, the using of this type of treatment can lead to complications. Side effects can be both systemic, affecting the course of the procedure itself, and local in nature, associated with intraocular changes.

Purpose: Conduct an analysis of complications during SOAI in children with intraocular retinoblastoma.

Material and methods: The study includes the results of treatment of 110 children (129 eyes) with unilateral and bilateral retinoblastoma who received SOAI both with insufficient efficacy of previous treatment for resistant and recurrent forms of RB (99 children / 116 eyes), and as primary local chemotherapy without previous treatment (11 patients / 13 eyes). 313 procedures were performed, of which the treatment stage was completed in 303 cases. Depending on the hemodynamic characteristics of the blood supply to the eye and the orbital region, 2 methods of delivering of the chemotherapy were used: 1) microcatheter technique (245 procedures performed; 81.0 %) 2) microballoon technique (58 procedures performed; 19.0 %).

Results: The structure of the complications was as follows. 1. The group of intraoperative complications included: spasm of the ICA, cerebral arteries — 4 cases (1.3 %), acute cardio-respiratory manifestations and hemodynamic instability — 93 (29.7 %). 2. Group of general complications: cerebrovascular accident — 3 cases (0.9 %), hematological toxicity — 14 (4.5 %). 3. Group of local complications. A) External extraocular manifestations: transient eyelid edema — 49 (15.7 %), frontal arteritis — 2 (0.6 %), ptosis of the upper eyelid — 11 (3.5 %), ptosis and deviation of the eyeball — 2 ( 0.6 %), soft tissue necrosis — 1 (0.3 %). B) Intraocular manifestations: retinal detachment — 13 (4.2 %), chorioretinal atrophy — 4 (1.2 %), edema of the optic nerve head — 2 (0.6 %), atrophy of the optic nerve head — 1 (0.3 %), hemophthalmia — 3 (0.9 %).

Conclusion: Modern interventional endovascular methods allow to carry out the SOAI safety and reduce the number of possible complications.

Purpose: To assess the quality of planning for the combined radiotherapy of patients with advanced cervical cancer (cervical cancer). To assess the impact of taking into account not only the external, but also the internal wall of the organ of risk during contouring on the magnitude of the radiation load on the organ of risk (OR). Estimate the total dose to the OR from the remote and intracavitary components.

Material and methods: The planning quality assessment was carried out for three technologies of remote exposure, namely: 3DCRT, IMRT and IMRT in the rotational RapidArc mode. Radiotherapy was performed on linac Clinac iX models (Varian, USA) with photon energy of 6 MeV, intracavitary RT (IRT) — on a MicroSelectron apparatus with a 192Ir source. The calculation was carried out on the treatment planning system Eclipse (Varian, USA) and Oncentra Brachy.

Results: The evaluation of the quality of conformal radiotherapy planning was carried out in 69 patients with locally advanced cervical cancer 2b–3b stages according to homogeneity and dose conformance indexes in target volumes and OR in combined radiation therapy programs. The best values of the indices of homogeneity and conformity were obtained with the IMRT technology and 3DCRT. The values of the conformity index CI for PTV for the IMRT technology has advantages in terms of doses to OR. For a group of 94 patients, an analysis of dose loads on the rectum, bladder was carried out with only the external contour of the OR and taking into account the inner wall. For 37 patients, the total values of doses to OR for combined RT were evaluated.

Conclusion: The quantitative advantages of homogeneity and conformance indices for the tumor and dose loads in OR of 3D CRT and IMRT technologies for patients with cervical cancer 2b–3b are revealed. We removed from the use of technology RapidArc for this group of patients. The advantages of contouring with or without thickness are not revealed. The contouring for all the mentioned cases of technology can be carried out along the outer contours of the OR.

A combined approach to cytoreduction in a patient with a neuroendocrine tumor G1 the ileum with multiple bilobar metastases G2 in the liver, originally considered as a candidate only for drug therapy, has been demonstrated. The first stage was laparoscopic resection of the ileocecal segment of the intestine, followed by interventional radiological intervention — a two-stage selective transarterial oil chemoembolization of the liver with bleomycin. As a result, 90 % cytoreduction, suppression of clinical manifestations, normalization of chromogranin A and serotonin were achieved. The patient continues to be observed without signs of progression for more than 4 years from the moment of diagnosis. It is shown that multidisciplinary treatment of patient with timely inclusion of interventional-radiological interventions allows achieving long-term favorable results in patients with advanced stage of disease.

Purpose: To conduct a retrospective analysis of the clinical case of metastatic vertebral lesion in prostate cancer and the algorithm for the use of instrumental diagnostic methods.

Material and methods: Patient 67 years old. History of prostatectomy for prostate cancer. Suspected metastatic lesion of the left transverse process of the 7th thoracic vertebra based on PET/CT. For clarification, MRI, Skeletal scintigraphy, SPECT/CT were performed.

Conclusion: Access to a wide range of instrumental methods does not guarantee correct diagnosis. Modality, research methodology, time between the first and clarifying methods — all these factors affect the correct diagnosis, the choice of the treatment method, the timeliness of the start of treatment and, as a result, the fate of the patient.