Purpose: To carry out a quantitative assessment of the quality of planning the remote radiotherapy component of patients with uterine body cancer for three different radiotherapy technologies: 3D conformal radiation therapy 3D-CRT, radiation therapy with intensity modulation IMRT, and with intensity modulation in the rotational mode RapidArc. To determine radiation exposure to critical organs.

Material and methods: Radiotherapy plans for 102 patients were calculated using the Eclipse (Varian) planning system. Plans were evaluated using homogeneity and conformity indices from dose-volume histograms. When analyzing dose loads on the rectum, bladder and pelvic bones, a differential dose-volume characteristic was used, which reflects the modal dose D_dif. Radiotherapy was carried out on accelerators of the ClinaciX (Varian) model with a photon of 6 MV.

Results and conclusion: It turned out that 3D-CRT and IMRT are the most favorable methods for the remote component of radiotherapy. The smallest value of the modal dose D_dif for the rectum is achieved with the RapidArc method and is 41 ± 10 Gy. The smallest value of the modal dose D_dif for the bladder is also achieved with the RapidArc method and is 45 ± 9 Gy. The dose loads on the femoral heads are approximately the same for all three irradiation methods.

Modern nuclear medicine is a rapidly developing field that includes various non-invasive molecular imaging techniques with the ability to examine the whole body.

Inflammation is a frequent complication in surgical and traumatological practices, which is a complex, local and general pathological process that occurs in the body in response to injury. Having arisen under the influence of a damaging factor, inflammation is characterized by the development of a dynamic complex of changes. However, the search for inflammation foci of inflammation by traditional diagnostic methods in some cases is difficult even with a detailed clinical picture. In this case, nuclear medicine, which is able to visualize pathological processes, including those with a pathological increase in metabolism, may be the best option for finding the affected area.

A wide variety of radiopharmaceutical drugs makes it possible to determine the localization of the inflammatory focus in a short time and with high accuracy and makes nuclear imaging methods a priority for the early diagnosis of pathophysiological reactions.

This paper presents a review of domestic and foreign literature on the use of specific and nonspecific radiopharmaceuticals in the diagnosis of inflammation. Own cases is also presented.

Purpose: To improve the differential diagnosis of various adrenal tumors using a two-dimensional (2D) multivoxel ¹H-magnetic resonance spectroscopy (MRS) protocol.

Material and methods: The study included 32 patients who underwent examination and treatment from February 2021 to February 2022, who, according to various radiation methods of research, had tumor formations in the adrenal glands. In total, 36 neoplasms were found in the adrenal glands, of which: 10 adenomas in 10 patients (27.8 %), 5 adrenocortical carcinomas in 5 patients (13.9 %), 5 pheochromocytomas in 5 patients (13.9 %), 6 metastatic nodes in 5 patients (16.7 %, 1 patient had 2 metastatic nodes in both adrenal glands), 4 affected adrenal glands with lymphoproliferative diseases with bilateral adrenal involvement in 2 patients (11.1 %), 2 myelolipomas in 2 patients (5.6 %). We evaluated the age and sex of patients, the location of the tumor and its size, as well as the amplitude of metabolites obtained by multivoxel MRS: choline (Cho), creatine (Cr), glutamine/glutamate (Glx), N-acetylaspartate (NAA), lactate (Lac) and their Cho/Cr ratios, Lac/Cr, Cho/NAA, Glx/Cr.

Results: Malignant formations of the adrenal glands were larger in size compared to benign ones (p = 0.0265). The size of benign formations ranged from 1.4 cm to 8.5 cm (median 3.2 cm), malignant from 2 to 12 cm (median 5.8 cm).

Statistically significant differences in the groups of malignant and benign adrenal neoplasms were determined by the creatine content detected by MRS (p = 0.0323). Creatine content in benign formations was higher and ranged from 0.415 units to 52 units. (median 4.013 units), in malignant — from 0.221 units to 16.6 units (median 2 units).

With a threshold value of creatine content less than 3.42 units, the sensitivity of the trait in the differential diagnosis of malignant neoplasms was 73.3 %, specificity 66.7 %, accuracy 79.3 %. The area under the ROC curve (AUC) was 0.703, which corresponds to the good quality of the predictive model on the scale of expert assessments.

There was a moderate inverse correlation between the size of the adrenal gland formations and the creatine content in it according to MRS (correlation coefficient –0.432). If the size of adrenal neoplasm increase, the creatine content in it is proportionally decrease.

There were no statistically significant differences in the content of other metabolites and their ratios between malignant and benign adrenal neoplasms, also there were no statistically significant differences in the size of neoplasms, gender and age of patients.

Purpose: Determination of the effectiveness of using vacuum fine-needle aspiration biopsy under ultrasound control in patients with focal thyroid pathology.

Material and methods: The modified original experimental sample for vacuum fine-needle aspiration biopsy (patent RU No. 2757525) was developed with the help of which 48 vacuum fine-needle aspiration biopsy were performed under the control of ultrasound navigation in patients with focal thyroid pathology. The device is a full-fledged vacuum compressor that creates a negative pressure in the range from –0.1 to –0.8 bar, which is connected to a syringe using a metal container, foot switches, electromagnetic valves, high-strength hoses and an adapter, where a high discharge power is created and fragmentation and aspiration of cellular material occurs. The degree of discharge depended on the assumed morphological structure of thyroid nodes, which were determined using multiparametric ultrasound. The average vacuum level was selected in the range from –0.3 to –0.5 bar, which is significantly higher than the level of discharge created by a 10 ml syringe (–0.2 bar).

Results: During the vacuum fine-needle aspiration biopsy, no complications were detected during and after the manipulation. In the group of patients, 72.1 % (n = 32) women prevailed, the average age was 59.0±5.5 years. The collection of cytological material was carried out much easier, since when using v-TAB, the discharge in the syringe is formed using an apparatus that is kept at a constant level, which eliminated the need for translational movements of the syringe piston and needle in the focus for greater collection of cytological material, this indicates a low level of uninformative cytological conclusion (Bethesda I), n = 5 (11.2 %).

Conclusions: 1. The implementation of vacuum fine-needle aspiration biopsy allows to improve the quality of sampling of cellular material, which affects the informativeness of cytological examination of nodular formations of the thyroid gland.

2. The vacuum fine-needle aspiration biopsy allows you to individualize the procedure depending on the ultrasound semiotics of the nodular formation of the thyroid gland.

3. The vacuum fine-needle aspiration biopsy minimizes the number of uncontrolled needle movements during a biopsy, which reduces the risk of complications.

Purpose: To evaluate clinical effectiveness of arterial therapy in patients with gastrointestinal stromal tumors (GIST) metastases to the liver.

Material and methods: Between 2005 and 2021, intra-arterial chemotherapy was performed in 11 patients: 6 men and 5 women aged 40–78 (mean 59) years with immunohistochemically verified liver metastases of GIST. Resection of gastric (n = 4), jejunal (n = 3), sigmoid (n = 1), and pancreatic tumor (n = 1) was performed in 9 patients; tumor of unknown primary origin was in 2 patients. Before intra-arterial treatment, all patients received specific treatment of liver metastases in outside hospitals (liver resection, radiofrequency ablation, tyrosine kinase inhibitors or systemic chemotherapy), but progressed. We performed 56 treatment cycles: oily chemoembolization (n = 37) or its combination with chemoinfusion (n = 19).

Results: According to mRECIST, 1 patient showed complete and 3 partial responses. Stable disease in 4 and progression in 3 patients was seen. Liver resection was carried out in 3 responders. At present, 8 patients died in 28,4 mo (median 32 mo). Three patients are alive for 5–7 years.

Conclusion: Intra-arterial chemotherapy seems to be safe and promising treatment of GIST liver metastases, including patients showing refractory to tyrosine kinase inhibitors.

Introduction: Neoadjuvant treatment may not provide complete clinical response at the first stage in some patients with skin edema associated with breast cancer. This complicates selection of the subsequent local treatment method. We need to identify predictors that may help personalize the treatment and ensure the best possible long-term outcomes.

Purpose: To evaluate long-term outcomes (overall and relapse-free survival) in relation to the sequence of local treatment modalities and identify factors that have the greatest impact on the long-term outcomes of patients with skin edema associated with breast cancer.

Material and methods: The publication presents single-factor analysis and long-terms outcomes of 182 patients with persistent skin edema after systemic treatment. The patients were divided into three groups depending on the volume and sequence of local treatment modalities. Group I (n = 91 patient) included patients who received systemic treatment, surgery, and external beam radiotherapy (EBRT). Group II (n = 41) included patients who received only the systemic treatment and EBRT. Group III (n = 50) included patients who received systemic treatment and EBRT followed by resection of the primary tumor.

Results: The single-factor analysis showed that progression of breast skin edema after systemic treatment (р = 0.05), long break between the systemic treatment and start of the local treatment (more than 9 weeks, р = 0.028), large number of diseased nodes (р = 0.01), non-pCR (р = 0.013) and lymph nodes (р = 0.014) has a statistically significant effect on the relapse-free survival. The single-factor analysis of the overall survival showed that the most significant factors were age (р = 0.034), degree of therapeutic pathomorphosis in the lymph nodes (р = 0.05), and number of the diseased nodes (р = 0.021).

Purpose: Assessment of PET capabilities in the diagnosis of eosinophilic fasciitis.

Material and methods: A 37-year-old patient with complaints of subfebrile temperature, weight loss, swelling of the lower extremities, difficulty in movement in the knee joints underwent PET/CT with ¹⁸F-FDG to exclude paraneoplastic syndrome. According to the results of PET/CT, laboratory tests and anamnesis, eosinophilic fasciitis was suspected. A deep biopsy of the skin, muscles, fascia of the left shoulder was performed. Localization was chosen taking into account the convenience of anatomical access for biopsy, based on the highest values of accumulation of ¹⁸F-FDG. According to the results of morphological examination, the diagnosis of eosinophilic fasciitis was confirmed.

Conclusion: PET/CT made it possible, together with clinical and laboratory data, to assume the diagnosis of eosinophilic fasciitis, excluding paraneoplastic syndrome, and also to determine the optimal area for biopsy.

Synovial sarcoma (SS) is a rare malignant soft tissue tumor that is associated with a high risk of distant metastasis, which significantly reduces patients` life expectancy. The analysis of volume indicators of PET/ CT)with ¹⁸F-fluorodeoxyglucose (FDG) was performed in two patients with the same grade of SS malignancy. The presented clinical cases demonstrate that in different patients with similar values ¹⁸F- FDG of the standardized uptake value (SUV_max) PET/CT volume indicators such as Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) can vary significantly, and therefore they can be additional prognostic factors for overall survival.

Usage of therapeutic doses in radiotherapy for breast cancer to the breast or chest wall after surgery may be associated with an increased risk of complications from adjacent organs at risk, so careful monitoring of doses to organs at risk and the usage of different dose reducing methods are required. Within the clinical case described below we are trying to figure out if complex technologies of radiation therapy can be useful in treatment of breast cancer patients after radical mastectomy while it is needed to reduce the doses to organs at risk.