Brain metastases represent the first cause of malignant brain tumor. Without radiation therapy, prognosis was poor with fast neurological deterioration, and a median overall survival of one month. Nowadays, therapeutic options depend on brain metastases presentation, extra brain disease, performance status. Therefore, for oligometastatic brain patients with a better prognosis, this therapeutic modality is controversial. In fact, whole-brain radiation therapy improves neurological outcomes, but it can also induce late neuro-cognitive sequelae for long-term survivors of brain metastases. Thus, in this strategy for preserving good cognitive functions, stereotactic radiation therapy is a promising treatment. Delivering precisely targeted radiation in few high-doses in one to four brain metastases, allows to reduce radiation damage to normal tissues and it should allow to decrease radiation-induced cognitive decline. In this paper, we will discuss about therapeutic strategies radiation therapy for limited brain metastases patients. 

Neutron capture therapy (NCT) is a method of beam radiotherapy like conventional radiotherapy and proton therapy. The main advantage of NCT over other methods is its high self targeting tumor selectivity based on physical phenomenon of neutron capture. NCT has been used for curing cancer in patients in nine countries. Currently four countries continue treating patients with NCT. Most of the patients treated with NCT were treated in nuclear reactors. At present new accelerator-based neutron sources for NCT are being developed. Shift from nuclear reactor based neutron source to accelerator base neutron source can be observed all around the world. First clinical trials of NCT with accelerator based neutron sources are being held in Japan. Brain tumors and head and neck cancer are the major subject for NCT by now. Clinical outcomes of NCT are reviewed. Annual number of patient as well as number of tumor types are treated with NCT are increasing in Japan. Future prospects of NCT in curing malignancies are analyzed.

Purpose: To evaluate the diagnostic value of PET with ¹⁸F-choline in patients with glial brain tumors.

Material and methods: The analysis was based on data generated from PET/CT and MRI examinations of 30 patients with intracerebral tumors: glioblastomas – 9 (30 %) cases, anaplastic astrocytomas – 9 (30 %) cases, gliomas GrII – 7 (23.3 %) cases, benign astrocytomas GrI – 5 (16.7 %) cases. All patients with brain neoplasms underwent a selective brain ¹⁸F-choline PET/CT and MRI follow up at minimum two time points: for at least 6 months. All PET/CT studies were performed with Biograph mCT Siemens (multidetector (64) helical CT scanner, 120 kV, 300 mA, slice thick ness 1.2 mm; PET acquisitions occurred at 4 ring positions (48 lutetium orthosilicate based units each), scan slab – 21.6 cm, at the first stage 5 min / slab, the second 10 min / slab). The first registration was performed immediately after intravenous injection of the radiopharmaceutical (RP) using an automatic RP injector Intego 2010. Then patient were scanned again with the same protocol 45–55 min after injection. Administered activity was 300 MBq. Images visually and semiquantitatively assessment, with maximum standardized uptake value registration (maxSUV₁ – on the first stage and maxSUV₂ – on the second), was performed offline on a SyngoVia workstation using Oncology protocol.

Results: The highest average maxSUV₁ were observed in anaplastic astrocytomas and glioblastomas – 5.07 and 4.89, respectively, but the highest average growth (in %) of maxSUV₂ observed in glioblastomas – 15.46 %. The lowest maxSUV₁ 0.76 was registered in low-grade gliomas GrI.

Conclusion: PET using different radiopharmaceuticals, provides unique information on the functional status of tumors for a variety of biological processes. ¹⁸F-choline is a marker of cell membrane lipid metabolism, so it could allow estimating the activity of cell membranes formation. An unaffected brain substance almost does not accumulate ¹⁸F-choline. Two-stage PET technique of brain scanning with ¹⁸F-choline enabled us to assume the gradate of malignancy of intracranial tumors which depends on both the level of accumulation of tracer in the first stage (maxSUV₁) and the degree of uptake increase in the second stage (maxSUV₂). Thus, the increment of maxSUV₂ may be useful in the evaluation of tumor activity.

PET/CT with ¹⁸F-fluorocholine, based on the assessment of phosphatidylcholine biodistribution, is an effective method in the diagnosis of biochemical recurrence of prostate cancer. According to results of our study on 79 patients (PSA level 1.775 ng/mL), the sensitivity of two-stage PET/CT with ¹⁸F-fluorocholine was 66.7 % (CI 55.3–78.0 %), and specificity – 80 % (CI 44.9–100.0 %), the overall accuracy of the method ranged from 56.7 to 78.5 %. The results show the feasibility of two-staged PET/CT with ¹⁸F-fluorocholine in biochemical recurrence of prostate cancer.

Purpose: To determine the diagnostic and therapeutic prognostic possibilities of ^99mTc-MIBI scintigraphy in the study of soft tissue sarcomas.

Material and methods: The study included 37 primary patients. All conducted two-phase ^99mTc-MIBI scanning.

Results: It was defined the correlation between the level of accumulation of radiopharmaceuticals in the tumor from the degree of tumor differentiation. It was defined the relationship of the level of “washout” of the ^99mTc-MIBI from the tumor before treatment and the degree of therapeutic pathomorphosis.

Conclusion: 1. The relationship between 99mTc-MIBI affinity to the tumor and degree of differentiation is weak (r = –0,2177, p < 0.05).
2. The relationship between the rate of 99mTc-MIBI “washout” from the tumor and chemotherapy response is weak (r = –0,1964, p <0.05).

To specify the possibilities for application of the liver-specific contrast agent (gadoxetic acid) in MRI with diffusion-weighted images (DWI) in the diagnosis of hepatocellular carcinoma (HCC).

Results: On the basis of the data obtained, we identified a complex of semiotic features that allow the tumor to be correctly differentiated as a HCC, namely:

• hypointensity on T₁-weighted images (р > 0.1)
• hyperintensity on DWI (р < 0.001)
• diffuse heterogeneous enhancement in the early phases (р < 0.001)
• hypointensity in the hepatobiliary phase (р = 0.013)

Conclusions: The complex of revealed semiotic features based on the combination of the liver-specific contrast agent (gadoxetic acid) in MRI with DWI makes it possible to reliably recognize the HCC among other neoplasms of the liver (sensitivity 100 %, specificity 91.7 %, accuracy 97.1 %).

The article contains the main recomendations of the elastography recommendations of the World Federation of Specialists in Ultrasound Diagnostics in Medicine and Biology experts prepared in 2015. The main attention is paid to the discussion of 22 summarizing recomendations with an attempt to find ways to adapt the Recommendations to the possibilities of domestic radiology. It is emphasized that there is a close relationship between the parameters of the breast elastography and the BI-RADS system, where the diagnostic efficacy of different methods is evaluated from the perspective of evidence-based medicine.

Purpose: To evaluate the safety and efficacy of transarterial chemoembolization method (TACE) in the treatment of inoperable patients with uveal melanoma with isolated liver metastases with cured the primary focus.

Material and methods: In N.N. Blokhin NMRCO since 2000, 31 patients received treatment with metastatic uveal melanoma in the liver. Among them: men 13 (42 %), women 18 (58 %). The average age of 45.1 ± 13.2 years, range 23–71 years. Liver lesion volume was 25 % in patients 11 to 50 % in 13 to 75 % in 7 patients. Total 62 TACE intervention was performed. As used embolizing materials: 31 patients lipiodol 10 ml in 53 cases, microspheres – in 17 cases (particle sizes ranged from 100 to 500 microns), combinations presented embolizing materials have been used in 6 patients. As the chemotherapy Doxorubicin performed at a dosage of 100 mg, or Gemzar 1–2 g, or Carboplatin 450 mg.

Results: 100 % of the TACE was technically successful. Complications related to the technical implementation not observed. Local response was observed in 21/31 (67.7 %) patients with metastatic uveal melanoma. Duration of monitoring of patients after TACE was held from 2 to 60 months. Overall 1-year survival in this group of patients was 51.0 ± 9.5 %. 2-year 34.0 ± 15.2 %. The median survival – 12.9 month. 20 patients were alive at the time of the study, 11 died from progression.

Conclusions: In our study transarterial chemoembolization in patients with metastatic uveal melanoma in the liver has established itself as an effective and well-tolerated treatment. Objective response or stabilization process in the liver was observed in 68 % of patients. A median overall survival was comparable to that provided in the literature.

A home-produced vena cava filter after model Korona was implanted into more than one thousand two hundred oncologically sick people for preventive treatment the thromboembolism of pulmonary arteries. And only one patient (0.08 %) got complications which had set in perforation of the IVC wall and into clinically significant cropping out of cava filter›s radiates beyond the vein’s wall. The reimplantation of the device into the other part of IVC was necessary. After installation of a trap for emboli in IVC the thromboembolism of pulmonary arteries happened to 5 patients (0.4 %). The structural features of the implanted device Korona are being discussed and their data of effectiveness are also compared with the other models of cava filters on available literature. The achieved results testily to safety and effectiveness of the home produced model of cava filter.

Currently, in the treatment of the patients with HCC in the vast majority of cases, interventional radiological (IR) technologies are used. Locoregional technologies can be applied practically at all stages of the treatment of the patients with HCC. The performance of a particular IR intervention depends on the prevalence of the tumor lesion, the patient’s somatic status and the stage of the treatment. The most important are the IR techniques used as a special antitumor treatment, one of which is transarterial chemoembolization (TACE). Modern medical institutions have the main arsenal of therapeutic methods (including locoregional) and the choice of method of the treatment in each specific case largely depends on the technological capabilities of the clinic and the clinical experience of physicians. Despite the fact that locoregional techniques have been performed for quite a long period of time, an optimal algorithm for their application in the treatment of patients with HCC has not yet been developed.

Today, interventional radiological technologies used as locoregional therapy allow to expand the possibilities of potentially radical methods of the treatment (resection, liver transplantation) and to conduct special antitumor treatment in the majority of inoperable patients with HCC.

Brain metastases of colorectal cancer are a rare clinical event. According to the literature data, the overall survival rate in patients with colorectal cancer brain metastases is significantly lower than in patients with metastases in the brain of lung, breast cancer or melanoma. In this article the review of the literature data was analyzed according to the peculiarity of diagnostics and treatment of patients with metastases in the brain of colorectal cancer.

The incidence of prostate cancer with standard biopsy ranges from 31 to 42 %, but the number of false-negative results remains excessively high. Modern urological trends in the diagnosis of prostate cancer are reduced to the identification of the most malignant tumor node (index lesion), which in fact will determine the disease prognosis and treatment tactics of a particular patient. In this paper, the technique of the procedure and the first results of the MRI / US imaging fusion biopsy – technology is described, which allows to perform targeted biopsy of the prostate gland from the nodules, revealed during the multiparameter MRI, are demonstrated. The use of this technology can increase the number of detected cases of middle and high risk cancer (clinically significant cancer), which allows a more personalized approach to the treatment of this group of patients.

Practical application of photosensitizers for photodynamic therapy of tumors is limited with insufficient solubility in water and hepatic tropism of tetrapyrrole dyes. The work pursued study of possibility of using a model photosensitizer methylpyro-phaeophorbide α bearing a free carboxylic moiety (MPPPa) in complexes with artificial proteins derived from human alpha-fetoprotein ApE1 and ApE2. Properties of ApE1-MPPPa and ApE2-MPPPa complexes were compared with properties of MPPPa complex with serum albumin. A bathochromic shift of fluorescence maximum of MPPPa in complexes with ApE1 and ApE2 was found in comparison with free MPPPa. This shift gives an evidence of a tight contact between the dye and aromatic amino acids in the carrier proteins. This shift allows expecting a high photochemical activity in the complex photosensitizer in vivo. A high stability of non-covalent ApE1-MPPPa and ApE2-MPPPa complexes substantially exceeding stability of MPPPa complex with serum albumin was demonstrated. Such stability allows preparative purification of these non-covalent complexes with dialysis and/or chromatography.

The current state and prospects of ensuring radiation safety in Russian nuclear medicine units are analyzed. The most important literature data are presented, including the main results of their own research, on the solution of a number of radiation protection problems for patients, personnel, individuals from the population and the environment in radionuclide diagnostic units and radionuclide therapy. Other topical problems of ensuring radiation safety in nuclear medicine are also considered. The analysis of the regulatory documentation in force in the specified area inRussiais carried out and offers on its perfection are submitted.

Purpose: To demonstrate the diagnostic capabilities to control effects of radiotherapy and HIFU treatment in patient with osteosarcoma bone metastases by SPECT/CT method.

Material and methods. It was conducted SPECT/CT treatment monitoring of the patient with bone metastases of osteosarcoma after external radiotherapy, ultrasound ablation and cyber knife.

Results. It were detected changes in the SPECT/CT-images of treated bones osteosarcoma metastases in short time. The treatment effect induced by ultrasound ablation was manifested after 1 month observation. The SPECT/CT has proven as a reliable method of dynamic control at radiotherapy. The treatment effect all of these methods is to reduce or absence of accumulation bone-tropic radiopharmaceutical labeled with 99mTc.

Conclusion. SPECT/CT study is demonstrative method for early determination of pathological metabolism degree at bone metastases of osteosarcoma after radiotherapy and HIFU. SPECT/CT is an effective method of treatment monitoring of bone metastases after radiotherapy and HIFU therapies.

Pilocytic astrocytomas (PA) are the most common gliomas (WHO 1) in children. According to many authors stereotactic irradiation (radiotherapy and radiosurgery) (SI) is an effective method which provides a long time progression‑free survival in patients after incomplete tumor resection or with recurrence.

We present a case of midbrain PA, which has demonstrated a prominent tumor enlargement during the first 7 months after the irradiation with subsequent complete response in 12 months without any antitumor treatment. The follow up clinical and radiologic investigations in the case, similar cases observed and published data allow to assume that the enlargement in early period after irradiation usually represents pseudoprogression.

Understanding of this phenomenon provides the proper assessment of treatment results and allows to avoid unnecessary antitumor treatment.