Introduction: Primary cutaneous lymphomas represent a heterogeneous group of diseases, the treatment of advanced stages of which requires a comprehensive approach, including systemic therapy and skin-directed methods. Total skin electron irradiation (TSEB) demonstrates high efficacy due to the radiosensitivity of lymphoid cells. Despite the high overall response rate, the recommended dose ranges and fractionation schemes for TSEB vary, necessitating detailed investigation. Stratification of patients by clinical stage, type of lesions, and the extent of skin involvement is crucial for optimizing TSEB, improving outcomes, and reducing side effects.

Total skin electron beam radiotherapy: A Trend Toward Low Doses: TSEB with cumulative doses of 30ʹ36 Gy has established itself as an effective treatment method; however, there is growing interest in lower doses (10ʹ29 Gy) due to the high radiosensitivity of lymphomas and the need to reduce radiation-related side effects. Studies have confirmed a high overall response to low doses, especially in early stages, with less pronounced radiation reactions and a comparable median duration of response. To optimize the approach, further research is needed, including the development of patient selection criteria and dose individualization with a potential boost to large lesions.

Conclusions: The question of the optimal cumulative dose for TSEB in patients with primary cutaneous lymphomas remains insufficiently studied. Clinical cases confirm the efficacy of both standard doses (30ʹ36 Gy) and low doses (10ʹ20 Gy), demonstrating good clinical responses, symptom reduction, and lower toxicity. Low dose TSEB provides a comparable overall response to standard doses, reduces the number of treatment visits, and enables retreatment in case of disease relapse. The main tasks remain to study the factors influencing dose selection (disease stage, type of lesions, individual patient characteristics) and to develop patient management strategies. TSEB effectively controls disease manifestations even in complex cases. Data analysis highlights the need for unified patient selection criteria and optimization of irradiation techniques to improve outcomes and reduce treatment toxicity.

Purpose: The article is devoted to the history of the development of proton radiotherapy and the achievements of the Institute of Experimental and Clinical Oncology (now the Federal State Budgetary Institution ͞N.N. Blokhin National Medical Research Center of Oncology͟ of the Ministry of Health of the Russian Federation) in proton radiation therapy.

Matreial and Methods: Proton radiotherapy has been used in the treatment of patients since 1967 with tumors of the breast, prostate, thyroid gland, tongue, esophagus, larynx, cervix, vulva, malignant melanoma, osteogenic sarcoma, metastases to the liver, lungs, bones, soft tissues, skin, etc. Treatment was carried out at the Centes for Proton Beam Therapy of Dubna and Moscow.

Results: N.N. Blokhin National Medical Research Center of Oncology belongs to 2/3 of the total clinical experience proton radiоtherapy in Russia. This is 2351 patients. The greatest experience is useful in treating patients with breast cancer. This is 1243 patients.

Purpose: To determine the diagnostic effectiveness of PET/CT with ⁶⁸Ga-FAPI in gastric cancer.

Matreial and Methods:The study included 42 patients with histologically confirmed gastric cancer. All patients underwent PET/CT with ⁶⁸Ga-FAPI and PET/CT with ¹⁸F-FDG. The diagnostic accuracy of the methods was compared based on sensitivity and specificity parameters in detecting metastatic involvement of regional lymph nodes. Data assessment was conducted based on histologically verified disease and clinical follow-up data.

Results: PET/CT with ⁶⁸Ga-FAPI is a more effective diagnostic method for detecting metastases in regional lymph nodes compared to PET/CT with ¹⁸F-FDG. Our results support the clinical potential of PET/CT with ⁶⁸Ga-FAPI for improved diagnosis and treatment planning in gastric cancer.

Evaluation of the effectiveness of bone metastasis therapy is an important problem in patients with prostate cancer, mainly due to the relationship between bone metastases, survival and quality of life, which necessitates the correct interpretation of treatment response results. The use of additional imaging techniques in clinical practice, along with the assessment of PSA, aims to improve early prognosis of outcome and monitor response to therapy in patients with metastatic CRPC. For effective clinical management of patients receiving Ra-223, radiological response markers are needed to minimize the likelihood of disease progression during therapy and to stratify patients to select subsequent treatment options.

Objective: To study the automated bone scanning index (aBSI) as a quantitative radiological assessment of bone scintigraphy results in patients with metastatic castration-resistant prostate cancer (mCRPC) who received systemic radionuclide therapy (RNT) Ra-223.

Matreial and Methods: The study included 30 patients who underwent bone scintigraphy before treatment with Ra-223 and aŌer completion of the full course of treatment, laboratory data (PSA, LDH, ALP) obtained before each administration, and the clinical status (Karnovsky index, ECOG) and pain syndrome (VAS) were evaluated. aBSI was obtained at the initial stage and at the end of treatment.

Results: The average aBSI level before the start of Ra-223 therapy was 3.5 ц 4.0 (range 0.0ʹ14.7, median 1.9), moderately correlated with PSA (r с 0.482; р с 0.007) and high with alkaline phosphatase (r с 0.710; p ф 0.001). AŌer therapy, aBSI — 3.7 ц 4.8 (range 0.1ʹ19.8, median 1.55) was moderately correlated with alkaline phosphatase aŌer therapy (r с 0.435; р с 0.018). A decrease in the aBSI level was noted in 16/30 (53.3 й). A consistent decrease in LDH and aBSI values in 6/30 (20 й) patients, an increase of 10/30 (30 й). Decrease in both ALP and aBSI in 14/30 (46.7 й) patients, increase in 7/30 (23.3 й), decrease in both PSA and aBSI in 4/30 (13.3 й) patients, increase in 13/30 (43.3 й). A decrease in all parameters was observed in 3/30 (10 й) patients, an increase of 5/30 (16.7 й). An increase in aBSI aŌer completion of therapy was detected in 14/30 (46.7 й), of which 11/14 (78.6 й) were accompanied by an increase in PSA, 4/14 (28.6 й) by an increase in LDH, and 5/14 (35.7 й) by an increase in alkaline phosphatase. Also, in patients who noted an increase in bone pain syndrome, the aBSI increased at the end of therapy, and with a decrease and stabilization, the aBSI decreased (р с 0 . 0 4 7).

Conclusion: Both the initial aBSI index and its change after completion of Ra-223 treatment can be used as a radiological marker of response to assess the effectiveness of Ra-223 therapy in patients with mCRPC.

Neuroblastoma is the most frequent extracranial solid tumor of childhood. In 7 out of 10 cases, neuroblastoma is already disseminated at the time of diagnosis. Of the current nuclear medicine techniques, scintigraphy with methaiodobenzylguanidine, which is a ¹²³I-labeled noradrenaline analog or (¹²³I-MIBG), plays the most important role in the evaluation of neuroblastoma. Currently, a new PET-tracer, ¹⁸F-MFBG (¹⁸F-labeled benziguanidine analog), has emerged that can be used in the radionuclide diagnosis of neuroblastomas. Our clinical observations showed identical diagnostic efficiency to scintigraphy data with ¹²³I-MIBG with significantly faster blood clearance than ¹²³I-MIBG, which allows us to perform studies as early as 1 h after intravenous administration. In one case PET/CT with ¹⁸F-MIBG revealed additional tumor foci, which allowed to correct therapy, which is certainly of great importance in clinical practice.

Purpose: To study the effectiveness of magnetic resonance imaging of the mammary glands in detecting multicentric lesions in breast cancer.

Matreial and Methods: From 2022 to 2023, a prospective study was conducted, including 57 breast cancer patients, who underwent magnetic resonance imaging of the mammary glands for the purpose of clarifying the diagnosis of the process, followed by surgical treatment in the Department of Oncology and reconstructive Plastic Surgery of the breast and skin of the P.A. Herzen Moscow State Medical Institute. In the postoperative period, the data of magnetic resonance imaging of the mammary glands and the results of a pathomorphological examination of the surgical material were compared.

Results: Multicentricity was confirmed in 21 (38.9 й) patients out of 54 patients with breast cancer with multicentric lesion (sTm) according to magnetic resonance imaging of the mammary glands during a planned pathomorphological examination of the surgical material. In 3 patients (5.3 й), a multicentric lesion was revealed by the results of a pathomorphological examination, whereas magnetic resonance imaging determined one pathological focus. Surgical treatment in the volume of mastectomy, including subcutaneous /skin-preserving mastectomy with a reconstructive plastic component was performed in 44 (77.2 й), in 13 (22.8 й) cases organ-preserving surgery.

Conclusion: Thus, in most cases, multicentricity according to instrumental examination (magnetic resonance imaging) was not confirmed during the pathomorphological examination of the surgical material, which led to the performance of a larger volume of surgical intervention, namely mastectomies or mastectomies with reconstruction. A more careful selection of patients who are shown magnetic resonance imaging in the diagnostic search is needed.

Purpose: To compare the importance of different MRI sequences and enhancement phases in creation of a diagnostic radiomics model in MRI diagnostics of early hepatocellular carcinoma (HCC).

Material and methods: Data from 72 patients with 93 masses who underwent Gadoxetic acid-enhanced MRI scans was retrospectively analyzed, a comparative assessment of the indicators of four sequences and enhancement phases of MRI studies was performed.

Results: As a result of the study, machine- learning radiomics based models on various MRI sequences and enhancement phases with high discriminatory capabilities were created. The area under the ROC curve (Area Under Curve, AUC) ranged from 0.58 to 0.94 in various models; the best results were performed in Random Forest model based on MRI-hepatobiliary enhancement phase — AUC 0.949684, the combination of different enhancement sequences — AUC 0.914342.

Conclusion: The hepatobiliary phase of MRI study independently, as well as the combination of four enhancement phases and sequences of MRI study, have the greatest discriminatory capabilities for creating machine- learning radiomics based models on enhanced MR images in diagnostics of early HCC.

Report of a clinical case demonstrating aberrant hyperplastic renal lobule. The mass of the lower third of the left kidney revealed in the patient at the residential prophylactic medical examination at an ultrasound. The patient was sent to oncourology hospital with suspected renal tumor for a consultation and possible treatment. The contrast-enhanced MSCT of the abdomen was performed and it revealed soft tissue mass with pronounced and uneven enhancement in the cortico-medullary and parenchymal phase, with the subsequent gradual reduction of enhancement in the excretion phase. This resulted in left kidney resection. A resection of the kidney with tumor formation is performed within safe tissues. Later, taking into the account all clinical-morphological data the removed tumor-like node in the left kidney was characterized as an abnormality in the development of the kidney in the form of an aberrant hyperplastic renal lobule. In general, it can be considered that a correct preoperative and intraoperative diagnosis in this observation was practically difficult and even impossible. That is why the definitive diagnosis was only determined by pathomorphological study of the resected macrosection. This case demonstrates the difficulty of preoperative diagnosing. This clinical case demonstrates the complexity of pre-operative diagnosis of an extremely sparse and rarely described in the world literature anomaly of the development of urogenital system — local kidney hyperplasia. The possibilities of modern diagnostic methods are limited in differential diagnosis of this anomaly with malignant kidney tumors. In this situation we were able to isolate a single indirect sign of local hyperplasia: the prolapse of the medullary layer of the kidney into the formation.

Intraductal papillary mucinous neoplasm (IPMN) belong to benign epithelial tumors and precursors and are characterized by intracurrent papillary growths with abundant mucin secretion, leading to cystic expansion of the main or lateral pancreatic ducts. In some cases, the diagnosis of intraductal papillary mucinous neoplasm may be difficult in the absence of concomitant symptoms. Two clinical cases have been described. In the first case, patient N., 74 years old, was under dynamic observation for 5 years due to a single cyst in the pancreas (about 2 cm). During the next control study, single parietal soft tissue nodules accumulating a contrast agent were detected in the cyst cavity, which made it possible to suspect malignancy. Morphological examination of the resected pancreas revealed the diagnosis: IPMN of the pancreas associated with invasive ductal adenocarcinoma.

In the second case, patient A., 47 years old, had an acute onset of the disease after a deviation in diet. The preoperative diagnosis suggested the presence of either chronic (possibly paraduodenal) pancreatitis or a cystic tumor of the pancreatic head, but without obvious signs of malignancy of the process. After gastropancreatoduodenal resection and morphological examination of the removed macropreparation, IPMN of the pancreas was found in the head of the pancreas in association with a highly differentiated G1 ductal adenocarcinoma growing within the pancreatic parenchyma.

Thus, preoperative diagnosis of changes observed in the pancreas according to imaging research methods can be significantly difficult in the absence of alarming symptoms, which should be taken into account when formulating a preliminary diagnosis in difficult cases.

This article is dedicated to a rare embryonal tumor of the central nervous system with multilayer rosettes. In our article we discuss the diagnostic difficulties associated with atypical localization, similar imaging characteristics and similar cellular composition of the tumor. We are considering the modern capabilities of radiology techniques and radiological examinations by using multiparametric magnetic resonance mapping in the differential diagnosis of embryonal tumors of the central nervous system. We present a clinical case of embryonal tumor of the central nervous system with multilayer rosettes located in an atypical place — in the posterior fossa, which is a rare finding. The article is illustrated with original magnetic resonance imaging supplemented by histological and immunohistochemical verification.