Purpose: To evaluate the quality of radiation planning for breast cancer patients with implants with a built-in metal port. Conduct a quantitative analysis of the quality of planning, assess the dose load on critical organs for this category of patients.

Material and methods: Homogeneity and conformity indices were calculated, and dose loads in critical organs were assessed for irradiation plans using 3D conformal RT (3D CRT) technology for 23 breast cancer patients with a built-in metal port implants. Calculations were carried out both taking into account (outlining) the metal port and artifacts from it on CT images, and without taking it into account.

Results: Based on the results of the analysis of the calculated values of conformity and homogeneity indices, doses in critical organs of irradiation plans for 23 patients with breast cancer, it was shown that the presence of a metal port and artifacts from it affects the nature of the dose distribution.

Conclusions: When creating a 3D CRT treatment plan, it is necessary to delineate the metal port and artifacts and assign true densities.

Purpose: To demonstrate the capabilities of various hybrid methods for studying the skeletal system in diagnosing the primary focus and metastases of osteosarcoma. To acquaint specialists with the prospects of using radionuclide therapy in the treatment of patients with osteosarcoma.

Material and methods: The material consisted of the most demonstrative cases from the clinical practice of the N.N. Blokhin National Medical Research Center of Oncology.

Results: The given examples showed the need to involve all possible radionuclide modalities for diagnosis and, especially, monitoring of patients with osteosarcoma for earlier detection of relapses and metastases.

Conclusions: The wider use of modern hybrid research methods (SPECT/CT and PET/CT) makes it possible to expand the possibilities for earlier detection of osteosarcoma metastases not only in bones, but also in other organs and tissues.

Introduction: ²²⁵Ac-PSMA is a promising drug for radioligand therapy (RLT) in patients with metastatic castration-resistant prostate cancer (mCRPC). Despite the large number of studies in this area, the optimal therapeutic activity of the drug is a debatable issue. The purpose of this study is to evaluate the safety of a single dose of ²²⁵Ac-PSMA at a fixed dosage (regardless of patient weight) of 6, 9 and 12 MBq.

Material and methods: The study included 9 patients, 3 in each group, with mCRPC progressing against the background of standard treatment (from 1 to 6 lines of mCRPC therapy in history). The observation period was 5 weeks, instrumental, laboratory and clinical indicators were used to assess safety. ²²⁵As-PSMA was manufactured directly in the clinic in accordance with the order of the Ministry of Health of Russia 1218n dated 11/12/2020.

Results: During the observation period, one patient from the group with the lowest administered activity had a serious adverse event (hospitalization due to pneumonia). When discussing this case, it was concluded that there was no connection with the drug, since pneumonia in this patient was not accompanied by leukopenia or neutropenia. All patients experienced dry mouth. In patients who received 9 and 12 MBq a decrease in the salivary gland function was recorded by scintigraphy. In two patients, severe weakness was revealed, in one of them the weakness could be associated with pneumonia, in the other patient, the weakness was most likely caused by the therapy. No cases of nephrotoxicity were recorded. Hematological toxicity was temporary reversible; no additional treatment was required in any of the cases. The most common adverse event: leukopenia, neutropenia (78 % of patients), grade III leukopenia was observed in two (22 %) patients, grade III neutropenia in one (11 %) patient.

Conclusions: A single administration of ²²⁵Ac-PSMA in the studied range of activities was safe, dose-limiting toxicity was not achieved.

Purpose: Visualization of periductal infiltrative hilar cholangiocarcinomas in general and their changes in response to endobiliary photodynamic therapy (PDT) in particular is not an easy diagnostic task because of their small size, infiltrative growth pattern, and absence of clearly circumscribed margins with adjacent tissue. This caused most researchers to give up the study of criteria for objective response to locoregional treatment, and to use only the survival rate as performance criteria. The aim of this study is to determine the criteria of objective response in Klatskin tumor after PDT based on the analysis of preand postoperative MRI.

Material and methods: The study covered 42 patients (26 male (62 %) and 16 female (38 %)) with morphologically verified Klatskin tumor aged 21-76 (median 55) after 104 sessions (from 1 to 10, median 2) of percutaneous endobiliary PDT over the period of 2007-2020. All patients had percutaneous transhepatic or intraoperative drainage of bile ducts from 1 week to 2 years before PDT. Chlorine photosensitizers were used for PDT. The LAHTA-MILON programmable laser unit with 662 nm wavelength was used for photo-irradiation. The specific dose varied from 4.6 to 232,2 J/cm2 (median 29) and the total dose was 64.6-3890 J (median 950), depending on the extent of lesion and the patient’s tolerance to interventions. 220 abdominal MRI were done at various times before and after PDT. Preoperative MRI were completed 1-101 days (median 13.5 days) before the intervention. Postoperative MRI scans were split into groups based on the time following the intervention: 1) after 1–5 days, 2) after 2 months, 3) after 3 months, and 4) after 4 months. Examinations were carried out with the Siemens Magnetom Avanto/Espree 1.5 Tesla MRI scanner. To compare the indicators at different times, the Kruskal–Wallis test was used, p < 0.05 were considered significant.

Results: As a result of the analysis, the following statistically significant changes in the Klatskin tumor after PDT were obtained at various times: the largest transverse size of the tumor infiltrate decrease at the proximal hepaticocholedochus level 1 month after PDT; the infiltrate longitudinal size increase at the bile ducts confluence level 4 month after PDT; T₂-WI signal intensity increase at the photodynamic area in 1–5 days after PDT; T₁-WI signal intensity decrease in various contrasting phases at the photodynamic area in 1–5 days after PDT; ADC signal intensity increase at the photodynamic and conditionally healthy tissues areas 1 month after PDT; T₁-WI signal intensity increase in venous and delayed contrasting phases at the photodynamic area 1 month after PDT; T₁-WI signal intensity decrease in porto-venous and delayed contrasting phases at the photodynamic area 2 month after PDT; ADC signal intensity decrease at conditionally healthy tissues 4 month after PDT.

Conclusion: Changes in MR signal intensity after endobiliary PDT with different pulse sequences (DWI + ADC, T₂-WI with and without suppression of signal from adipose tissue, T₁-WI before and after intravenous injection of contrast agent in 4 phases of contrasting) in pathological and conditionally healthy intraand periductal tissues and the tumor dimensions (largest crosssectional dimensions and thickness measured in axial and coronal projections in T₂-WI) may be used as the criteria of objective response. Determination in the early postoperative period of periductal segments in the area of photodynamic treatment that do not accumulate contrast agent is the most informative, displayable and convenient for practical use criterion of objective response indicating the ischemia of tumor tissue.

Tumors of the heart are rare entities characterized by the absence of specific signs and symptoms. A biopsy is necessary for verify the diagnosis and determine the most correct treatment tactics. Endomyocardial biopsy (EMB) is a modern and relatively safe approach for biopsy of cardiac tumors. Usually this procedure performs under the control of fluoroscopy and echocardiography (intracardiac, transthoracic, transesophageal). However, this procedure is rarely used in patients with suspected cardiac malignancy.

We present two clinical cases of endomyocardial biopsy of cardiac tumors by the endovascular approach under the control of cone-beam computed tomography (CBCT). The biopsy was successful in both cases and pathological diagnosis was established.

The incidence of primary multiple malignant neoplasms (PMMN) in Russia is steadily increasing due to the increasing frequency of detection of metachronous tumors. A similar trend is observed in esophageal cancer (EC). Advances in the diagnosis and treatment of cancer have led to an increase in the life expectancy of patients after a cured primary tumor and, in turn, to an increase in the detection rate of a second tumor. The longer life expectancy of patients with cancer, the higher the likelihood of developing a second tumor. PMMN of the esophagus is one of the least studied problems in modern oncology, which complicates the choice of treatment tactics, since there are no standards for the management of such patients. This article reflects a multidisciplinary and individual approach to the treatment of a patient with primary multiple metachronous inoperable squamous cell carcinoma of the middle and lower thoracic esophagus. The patient underwent chemoradiotherapy (CRT) with full effect, with no post-radiation damage and improved quality of life.

Lung cancer remains a global cancer problem. Recent studies have focused on the effectiveness of new combinations of immunological and targeted drugs. A clinical observation of the successful use of a combination of locally destructive effects — endobronchial photodynamic therapy and radiation therapy with immunostimulation with domestic recombinant interleukin — 2 in the treatment of a patient with late‑stage lung cancer is presented. To date, 41 months (3.5 years) have passed since the patient’s treatment and diagnosis. The patient’s condition is satisfactory, he does not complain, physical activity is completely preserved.

A significant role in improving the prognosis of differentiated thyroid cancer (DTC) in the presence of bone metastases is determined by early diagnosis of metastases, timely and correctly selected treatment tactics for the patient. During dynamic follow-up of patients with DTC after combined treatment (thyroidectomy with radioiodine therapy) are determination of the level of oncomarkers (serum thyroglobulin and antibodies to thyroglobulin) and ultrasound diagnostic of the neck, scanning with radioactive iodine (if clinically indicated). In some cases, patients have TENIS-syndrome (Thyroglobulin Elevated Negative Iodine Scintigraphy, hereinafter TENIS-syndrome), characterized by high serum thyroglobulin level in blood and absence of radioactive iodine accumulation on post therapeutic scintigraphy. According to the research studies, PET/CT with ¹⁸F-FDG has high sensitivity and specificity (89 % and 72 %, respectively) in visualization of metastatic radioiodine refractory foci in TENIS-syndrome.

This article presents a clinical case of a patient, a 52-year-old woman with Gurtle cell thyroid cancer (pT_3aN₀M₀, stage I) with established TENIS syndrome. Thyroidectomy was performed in September 2019 and radioiodine therapy was performed in January 2022 due to suspected disease progression given high thyroglobulin levels. Given the absence of pathologic accumulation of ¹³¹I according to post-therapy radioiodine scanning, PET/CT with ¹⁸F-FDG was performed, which revealed a solitary metastasis in the left iliac bone (41×35×42 mm with SUV_max 17.25). In November 2022, radical treatment of the solitary bone metastasis was performed in the scope of resection of the left iliac bone with reconstructive-plastic component. According to the data of control examinations in June 2023, the patient has a complete biochemical and radiologic remission of the disease.

Purpose: To report a clinical case demonstrating difficulties of diagnosis and successful surgical treatment of myomatous type of angiomyolipoma of the liver without simultaneous damage to the kidneys.

Material and methods: A female patient, 49 years old, was admitted to the hospital in August 2023, had no specific complaints, an abdominal ultrasound revealed extraperitoneal extraorgan mass in the epigastrium and mesogastrium and masses in the right lobe of liver, most likely hemangioma. The contrast-enhanced MSCT was performed on admission. Patient was rehospitalized for a surgery in September. During the operation the tumor was removed and sent for histological examination, a further immunohistochemical study was also carried out.

Results: According to the results of MSCT in S3, S4, S5 of the liver oval-shaped mass (198×104×177 mm) with heterogeneous density and solid, cystic and fat features was found. Three hypovascular hypodense inclusions sizes up to 11 mm was also identified in S7/8. There was no pathologic formation in the kidneys. The liver tumor was surgically removed, the resected material was directed to a scheduled histological examination. To confirm the diagnosis an IHC analysis was also done and it revealed the expression of melanocytic (HBM-45) and smooth muscle (SMA) markers.

Discussion: In this case we encountered very sparsely described in the world literature localization of angiomyolipoma — isolated hepatic one (without kidney damage). Like other authors we encountered the similarity of muomatous tumor type to the HCC and adenoma of the liver due to the characteristic features of visualization: hypervascularity, early contrast enhancement into an arterial phase and reduced density relative to the preserved parenchyma of the liver into a delayed phase of contrast.

Conclusion: This case demonstrates the difficulty of diagnosing the myomatous type of AML simulating the HCC. As one of the most informative methods of diagnosis, we single out MSCT, which allowed us to think about the possibility of a benign nature of the tumor. In our case the main features excluding HCC were the absence of rapid “washout” of contrast drug, the presence of lipomatous areas and no accumulation of contrast agent by the capsule.