Purpose: To determine the most effective option for repeated radiation therapy in patients with continued growth of primary high-grade brain glioma, taking into account the isodose distribution during the initial course of radiation therapy.

   Material and methods: As a result of a retrospective analysis, the results of treatment of 100 patients with confirmed progression of high-grade glioma treated at the Chelyabinsk Regional Center for Oncology and Nuclear Medicine in the period from 2010 to 2020 were evaluated. The ratio of men and women was approximately equal (56 men and 44 women). The mean age of patients of both sexes was 47.2±11.9 years. According to the histological conclusion, patients with glioblastomas (GB) prevailed (n = 58), 42 patients were diagnosed with anaplastic astrocytoma (AA). Reoperation was performed in 26 patients. Repeated radiation therapy in an independent variant was performed in 76 patients of them: 17 patients received a course of neuronal therapy in mono mode and in 17 patients in combination with external beam radiation therapy; 23 patients underwent stereotactic radiotherapy (SRS) using the CyberKnife device; in 19 cases, remote radiation therapy. In 24 cases, a chemotherapeutic component was added in addition to radiation treatment.

   Results: Mean time to relapse was 23 months. The median overall survival (OS) for all patients was 35 months. (DI 26.2–43.7). Indicators of 1-year OS — 85.6 %; 3-year-old — 44.1 %, 5-year-old — 26.5 %. Depending on the type of radiation therapy: the highest progression-free survival (PFS) was found with SPLT and combined photon-neutron therapy (SPNT) as in the group of patients with recurrent EH for 15, 17, and AA 24 and 40 months, respectively. Among the patients included in our study, the majority of patients (42 people) had central recurrences (in which 95 % or more of the volume of the recurrent tumor was within 100-95 % of the initial isodose), 6 had marginal relapses (20 to 80 % of the recurrent volume is within the surface of 95 % isodose), and in 2 cases a distant recurrence was recorded (less than 20 % of the recurrent volume was within 95 % of the isodose). Distant recurrences (marginal and distant) occurred within an average of 12 months, while central recurrences were diagnosed on average 26 months after the end of the course of radiation (chemoradiation) treatment.

   Conclusion: Thus, when analyzing our data, in all patients with continued growth of primary high-grade brain gliomas, the method of choice for a repeated course of radiation therapy is stereotactic radiation therapy or a combined course of photon-neutron therapy, which allows to overcome the existing radioresistance.

   Purpose: To evaluate the informativity of PET/CT with ¹⁸F-FES in determining estrogen receptor (ER) positivity in breast tumor tissue, as well as in regional lymph nodes or distant metastatic foci.

   Material and methods: The data of 30 patients who underwent PET/CT with ¹⁸F-FES performed at the stage of primary diagnosis were retrospectively analyzed. The study included patients before the start of specific treatment or on the background of neoadjuvant hormone therapy, with previously determined expression of ER according to the results of IGC. 14 patients underwent ¹⁸F-FDG PET/CT with 2–7 days difference between both PET/CT.

   Results: In our study, the mean SUVmax value in the primary tumor focus was 4.8, the lowest SUVmax = 1.61, and the highest SUVmax = 18.86. ¹⁸F-FES accumulation considered suspicious for metastatic lesion in axillary lymph nodes on the affected side was detected in 16 patients (56 %), mean SUVmax = 5.2, lowest SUVmax = 0.99, highest SUVmax = 11.54. On subsequent histological examination, tumor changes in axillary lymph nodes were confirmed in 16/16 patients.

   Conclusion: PET/CT with 18F-FES is a diagnostic method for noninvasive evaluation of ER expression in tumor foci, which can complement the data of traditional diagnostic methods and has a significant clinical potential. In our study, the results of PET/CT with ¹⁸F-FES coincided with the data of immunohistochemical study in 100 % of cases.

   Purpose: Evaluation of nephrotoxicity by renal scintigraphy in patients with metastatic castration-resistant prostate cancer receiving radionuclide therapy ¹⁷⁷Lu-PSMA-617.

   Material and methods: In this work the data obtained by renal scintigraphy using two radiopharmaceutical drugs 99mTc-MAG3 and 99mTc-DTPA were analyzed in 32 patients with metastatic castration-resistant prostate cancer receiving radionuclide therapy ¹⁷⁷Lu-PSMA-617.

   Results: In all patients included in this study, both before the start of radionuclide therapy and after receiving several fractions of therapy, there were no critically significant violations of renal function. By the last fraction of radionuclide therapy on the KDIGO scale, category C1, corresponding to normal renal function, was observed in 34 % of patients, which is 6 % more than before the start of therapy. At the same time, 6 % of patients began to have significantly reduced renal function (category C3b), which was not determined in any of the patients before the start of therapy with ¹⁷⁷Lu-PSMA-617. In 13 % of patients there was a moderate decrease (category C3a) and in 47 % of patients there was a slight decrease (category C2) in renal function.

   Conclusions: Despite the prevailing concerns about nephrotoxicity caused by ¹⁷⁷Lu-PSMA-617 therapy, the glomerular filtration rate, calculated both by a formula based on creatinine levels in the blood and when using renal scintigraphy with ^99mTc-DTPA, remained within the age norm in this study. At the same time, there was a tendency to increase the level of creatinine in the blood after the second fraction of radionuclide therapy, which may indicate initial functional changes in the kidneys. It was also noted that from fraction to fraction there is a gradual slowdown in the main time indicators of filtration and excretory kidney function (according to dynamic renal scintigraphy), such as T_max and T1/2, which may also indicate functional changes in the kidneys against the background of therapy.

   Background: Breast cancer (BC) occupies a leading position among my oncological diseases detected in women. Identification and search for predictors of malignant neoplasms using radiation and molecular genetic methods of research allows timely diagnosis and treatment, which improves the prognosis for breast cancer.

   Purpose: To identify a correlation between the molecular subtype of a breast cancer tumor at an early clinical stage and the patterns of the mammographic method.

   Methods: A prospective, single-center study of 363 patients diagnosed with breast cancer followed up during 2021. X-ray mammography in two projections, ultrasound-guided trephine biopsy for histological verification, and immunohistochemical (IHC) analysis to determine molecular subtypes were performed.

   Results: There were statistically significant differences in age between subtypes luminal A, luminal BHER2+ (p < 0.001) and triple negative (p = 0.037), luminal B, luminal BHER2+ (p = 0.001) and triple negative (p = 0.046), luminal BHER2+ and nonluminal HER2+ (p = 0.002), between nonluminal HER2+ and triple negative subtype (p = 0.034). When comparing the structure of radiological density, statistically significant differences were revealed between the subgroups luminal B, luminal BHER2+ (p = 0.010) and triple negative (p = 0.010), between luminal A and triple negative subtypes (p = 0.010). When comparing the leading mammographic symptom (p < 0.001), radiological contours of the formation (p < 0.001), the density of pathological changes (p < 0.001), the size, the newly detected pathological process (p < 0.001) statistically significant differences were also found in the subgroups. A division into groups according to the size of pathological changes within the biotypes was noted, where the aggressive phenotypes of the triple negative subtype (p = 0.001), non-luminal HER2+ (p = 0.02) and luminal B (p = 0.02), in contrast to luminal A, were manifested by a greater extent. the maximum linear size of the tumor. A symptom of nipple retraction (p = 0.048) was described, which was not characteristic of triple negative and non-luminal HER2 cancer.

   Conclusions: Visualization features of differences in the radiological manifestation of breast cancer of different biological subtypes up to 20 mm can be predictors of molecular subtypes. Pathological verification and IHC study remain a mandatory study, but it may be necessary to conduct an X-ray histological correlation before starting treatment and, if obvious discrepancies are detected, repeat the IHC analysis from the surgical material.

   The article is the consensus opinion of specialists involved in ultrasound examination, computed and magnetic resonance imaging of peripheral, abdominal and retroperitoneal lymph nodes, oncologists, authors of clinical recommendations of the Russian Society of Head and Neck Tumor Specialists based on an analysis of modern literary sources devoted to the problem of assessing the condition lymph nodes.

   The purpose of the publication is to bring ultrasound terms to uniform standards when describing lymph nodes, to introduce the Node-RADS system into the practice of ultrasound examination, to improve mutual understanding between diagnosticians and clinicians in the interpretation of ultrasound results in assessing the condition of lymph nodes, optimize the work of primary care ultrasound diagnostic doctors.

   Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure to diagnose and treat the biliary tract and pancreas’ diseases. We would like to present a clinical case of a 66­year­old patient, who underwent ERCP due to obstructive jaundice complicated by the subcapsular hematoma, 11.6×4.7×13.4 cm in size according to the computed tomography (CT), and by the left­sided hydrothorax after the hematoma was removed. The patient was successfully treated and discharged on the 15^th day after drainage of the pleural cavity. Subcapsular hematoma is a potentially lethal and rare complication that can be treated with a conservative therapy, if diagnosed at an early stage.

   This review summarizes the literature data about hepatic artery infusion chemotherapy in the treatment of advanced hepatocellular carcinoma. This method is safe and effective in tumors of very large volume and also in cases of portal vein tumor thrombosis when other interventional technologies (chemoembolization, radioembolization) are contraindicated or ineffective. Good results are the reasons for inclusion hepatic artery infusion chemotherapy in South-Asia clinical recommendations for the treatment of advanced hepatocellular carcinoma, but this method fails to attend in USA and European guidelines. Arterial infusion chemotherapy looks like non-expensive and technically simple procedure. It’s use in American and European patients including Russia
is topical.

   Introduction: In oncourology it is important not only to detect prostate cancer, it is necessary to detect a tumor with a potential for death. Multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy is necessary to improve the detection of clinically significant prostate cancer.

   Purpose: To assess the feasibility of using targeted prostate biopsy based on the developed original approach of cognitive biopsy, involving the use of three-dimensional models based on MRI data.

   Material and methods: From 2017 to 2021, a systemic transrectal biopsy of the prostate gland was performed in 126 patients at the NMRC of Oncology, supplemented by a cognitive MRI targeted biopsy. As a control group, the study included 115 patients with traditional transrectal biopsy performed at the NMRC Oncology in 2017-2020. Before the biopsy, all patients underwent MRI. The obtained MRI data of the main group processed at the workstation, after which models of the prostate gland, the alleged tumor process, were built according to the methodology developed by us.

   Results: After performing a transrectal prostate biopsy on the basis of 3D models, histological results were compared with the MRI data performed on all patients before the biopsy. Among 126 patients of the main group, the changes in MRI using the PI-RADS v2.1 system distributed as follows: in 48 patients, the PI-RADS score was 3 points, in 32 — 4 points, in 46 — 5 points. Among 115 patients of the control group, the changes in MRI using the PI-RADS 2.1 system distributed as follows: in 44 patients, the PI-RADS score was 3 points, in 26 — 4 points, in 45 — 5 points. Among patients with 3 points on the PI-RADS scale who underwent biopsy using the cognitive FUSION method, prostate cancer was diagnosed in 7 patients (14.5 %), in 19 patients (59.4 %) with 4 points on PI-RADS and in 38 patients (82.6 %) with a value of PI-RADS 5. Clinically significant prostate cancer was detected in 4 patients  (8.3 %) with 3 PI-RADS scores. Among patients with PI-RADS 4 — clinically significant prostate cancer found in 11 (34.4 %). In patients with PI-RADS 5, clinically significant prostate cancer detected in 33, which was 71.7 %. With the traditional biopsy technique, out of 115 invasive procedures, prostate cancer was detected in 41 patients (35.6 %), clinically significant prostate cancer was detected in 22, which was 19.1 %. Among 44 patients of the control group with 3 points on the PI-RADS scale who underwent a traditional biopsy, prostate cancer was diagnosed in 6 patients (13.6 %), in 12 patients (59.4 %) with 4 points on PI-RADS and in 23 patients (51.1 %) with a PI-RADS value of 5. Clinically significant prostate cancer detected in 2 patients (4.5 %) with 3 PI-RADS scores. Among patients with PI-RADS 4 — clinically significant prostate cancer was found in 5 (19.2 %). In patients of the control group with PI-RADS 5, clinically significant prostate cancer detected in 15 cases, which was 33.3 %.

   Conclusions: Transrectal prostate biopsy using 3D modeling based on multiparametric magnetic resonance imaging (MRI) with the marking of foci according to PI-RADS v2.1 makes it possible to effectively identify areas with a high probability of clinically significant cancer. The use of 3D models based on multiparametric MRI makes it possible to reasonably plan a targeted biopsy scheme and improve the diagnosis of clinically significant prostate cancer.

   Purpose: To compare the quality of irradiation planning for patients with esophageal cancer using Clinac iX (Varian) electron accelerators with external gantry and Halcyon (Varian). Compare quantitative indicators of irradiation plans for different algorithms and versions.

   Material and methods: A comparative assessment of the quality of irradiation planning for 90 patients with cancer of the esophagus was carried out using the indices of dose homogeneity and conformity within the target according to the data of dose-volume histograms and dose loads on critical organs. The comparison was carried out for two models of accelerators Clinac iX (Varian) with an external gantry and tunnel type Halcyon (Varian). The results of calculations of irradiation plans using different versions and algorithms for calculating planning systems are compared.

   Results: A comparison of the quantitative characteristics of the exposure plans made it possible to designate the IMRT technology as the preferred one in the treatment of esophageal cancer using accelerators of both types, with external and built-in gantry. At the same time, the influence of calculation algorithms and versions of the SP on the indices of homogeneity, conformity and dose loads on critical organs is not expressed, and the calculation results are comparable within the error.

   Introduction: One of the promising directions in the treatment of patients with malignant neoplasms is chemoembolization with microspheres, which consists in the local blocking of the blood flow by spherical particles and the release of a cytostatic drug by them in order to suppress the tumor. However, the pharmaceutical market is dominated by imported microspheres for embolotherapy, as a result of which they are characterized by a high cost. In this regard, the study of the properties of domestic embolisates is a popular topic for scientific research.

   Purpose: To study in vitro the kinetics of sorption and release of doxorubicin hydrochloride by polymeric microspheres of domestic production.

   Material and methods: Spectrophotometry was used to study the sorption kinetics and release of doxorubicin hydrochloride by polymeric microspheres. The appearance of the microspheres was examined by microscopy.

   Results and discussion: The study made it possible to establish the dependence of the rate of saturation of polymer microspheres «Sfera-Spektr» with doxorubicin hydrochloride on their size: the smaller the diameter of the microspheres, the faster they absorb the drug. The absence of dependence of the release rate of doxorubicin hydrochloride by polymeric microspheres on their size range was shown.

   Conclusion: The profiles of the sorption kinetics and the dynamics of the release of doxorubicin hydrochloride by polymeric microspheres have been established.

   A rare case of neuroendocrine pancreatic tumor is presented. The clinical, CT/MRI and morphological manifestations of the tumor are described. Some differential diagnosis’ problems among a spectrum of pancreatic tumor and tumor-like cystic lesions are being discussed.

   Purpose: Analysis of a clinical case of detection the primary focus in a patient with metastatic liver damage from cancer of unknown primary localization using PET/CT with ⁶⁸Ga-FAPI.

   Material and methods: A patient with metastatic liver damage from CUP underwent a set of diagnostic methods, according to the results of which the primary focus was not detected. PET/CT with ⁶⁸Ga-FAPI revealed the primary focus, which was localize in the left breast and did not accumulate ¹⁸F-FDG. According to mammography, the formation in the left breast was regard as benign changes (BI-RADS-2). According to the results of histological examination, the node in the left breast is invasive ductal cancer.

   Conclusion: PET/CT with ⁶⁸Ga-FAPI can potentially surpass PET/CT with ¹⁸F-FDG in the detection of primary tumors in metastases from cancer of unknown primary localization.