Purpose: Nowadays the stereotactic radiotherapy (SRT) of patients with clinical stage I–II lung cancer is the choice of the treatment modality for functionally inoperable patients. It shows safety and high efficiency in reaching the local control. Though there is a range of unsolved issues connected with the prediction of treatment efficiency and frequency of complications, an integration of new technologies in the planning and treatment process allows to widen the search of the predictive factors.

Material and methods: Since 2014, 38 patients (T₁N₀M₀ – 16 patients, T₂N₀M₀ – 22 patients) with clinical stage I–IIa lung cancer have underwent SRT. The majority of patients (34) have been recognized as functionally inoperable due to the concurrent broncho-pulmonary pathology, 4 conditionally operable patients have refused an operation. 11 patients had the primary multiple tumors in their anamneses. 35 patients had a peripheral tumor. Used dose fractionation options were: 10 Gy × 5 fractions (n = 25) and 7 Gy × 8 fractions (n = 13) – BED = 100 Gy.

Results: The median follow-up was 26 months (range 3–38 months). The 2-year local control was 94 %. The isolated local recurrences were not registered. Overall and a 2-year recurrence-free survival rate was 84 % (95 % CI: 70–99) and 83.2 % (95 % CI: 70.5–99) respectively. During the first year 4 patients (10 %) had the locoregional and distant progression and 3 of them died. 7 patients had experienced ≥ grade 2 pulmonary toxicity. One patient with the central tumor died from the pulmonary hemorrhage (5-degree toxicity).

Grade 3 chest pain was observed in 2 patients, one of them had a rib fracture. During one-factor analysis a reliable influence on the prognosis of the fractionation regimen (р = 0,04) and, close to reliability, the initial SUV_max  level influence (р = 0,07) were revealed. A reliable relationship between the radiation toxicity level and dosimetric radiation index (V_{10 Gy}, V_{5 Gy}, MLD) was not registered. There was a tendency to the reliable correlation with the total lung capacity indices (р = 0,058).

Conclusions: With modern approaches to SRT treatment planning and delivery there should be a search for additional treatment efficiency and toxicity predictors. The total dose delivery regimen and initial tumor SUV_max can be predictive efficiency factors, while the pulmonary tissue volume can be a predictive toxicity factor.

Contents

Introduction

Physical peculiarities of proton beams

Treatment of brain metastases by protons

Protons for prostate carcinoma

Conclusion

Purpose: To determine the relative efficiency of bone scan and SPECT/CT in assessing the viability of the mandibular and maxillary bone fragments in the reconstruction of revascularized autografts.

Material and methods: 37 patients with vascularized autografts were examined. Bone scan and SPECT/CT were performed as monitoring methods after surgery. The viability of autotransplants was judged on the levels of accumulation of radiopharmaceutical on bone scan and SPECT/CT in a transplanted flap.

Results: Bone scan gave a reliable information  on the status of the autograft in 28 out of 37 cases in patients with uncomplicated postoperative course. Additionally SPECT/CT was performed. SPECT/CT showed an increased accumulation of radiopharmaceutical in all patients with uncomplicated postoperative course. If thrombosis of supplying autograft vessels were present, SPECT/CT showed no accumulation of radiopharmaceutical – 5 patients. Thus SPECT/ CT allow to obtain a reliable data in 100 % of clinical cases.

Conclusion: SPECT/CT is recommended  as a method  of choice for early monitoring  of patients undergoing reconstructive surgery with the formation of mandibular and maxillary autografts. SPECT/CT can adequately assess the effectiveness of blood flow and the viability of bone grafts.

A technology has been developed for radiometric monitoring of regional perfusion in order to ensure continuous monitoring of the possible leakage of a chemotherapy drug from a surgically isolated limb during high-dose chemotherapy in patients with melanoma or sarcoma of soft tissues. The technology is based on in vivo labeling of erythrocytes with ^99mTc eluate followed by continuous monitoring of changes in the activity of labeled erythrocytes as a chemotherapy simulator in a well vascularized body region. Its distinctive features are intravenous injection of a pyrfotech slice after giving inhalation anesthesia to ensure a sufficient level of red blood cell chelation, as well as using ^99mTc activity less than its minimum significant level, which allows working with an open source of ionizing radiation without violating the requirements of radiation safety regulations. At 106 regional perfusion procedures, the clinical efficacy of the proposed radiometric monitoring technology is shown.

Purpose: To increase local control of cervical tumors by developing and introducing into practice the optimization of dose distribution  in the primary tumor  during concomitant  chemoradiation  (CRT) and image-guided adaptive brachytherapy (IGABT) i.e. summing up the maximum dose to the tumor volume of HR-CTV> 85 Gy in the shortest possible period of time by the optimal fractionation regime, without increasing the tolerable doses to the organs of risk (bladder, rectum, sigmoid).

Material and methods: Data of the study was the of clinical observations of patients with locally advanced cervical cancer proven stage IIb–IIIb according to FIGO, treated with curative radiation therapy. After pelvi c ± para-aortic external-beam radiation therapy (2 Gy ×50 Gy with Cisplatin 40 mg/m²  weekly), they received high-dose rate intracavitary brachytherapy or in combination with interstitial component following GEC-ESTRO recommendations.

Results: We managed to achieve maximum dose to the tumor  volume of HR-CTV> 85 Gy without increasing the load on the risk organs. The “Clinical Contouring” at the time of primary diagnosis of cervical cancer and before brachytherapy session based on clinical and diagnostic data using MRI helps to optimize the brachytherapy process, develop patient management tactics and a clear sequence of actions in a complex program of brachytherapy.

Conclusion: The presented clinical cases indicate the prospects of using an individual approach in planning the brachytherapy of patients with locally advanced cervical cancer.

Comparison  of using different contrast media (iodinated iopamidol-370 for CT and gadodiamide for MRI) in patients with colorectal liver metastases are being discussed. Almost equal diagnostic accuracy of CT and MRI was achieved. Administration of Iopamidol-370 showed safety and well tolerance in included patients.

Purpose: There are some descriptions of different bones’s stress fractures in radiation therapy, among them fractures of os sacrum and femoral heads. We estimated radiotherapy dose on bones mentioned above and collated them with the revealed stress fractures in selected patients.

Material and methods: Since 2011 till 2015 129 patients with morphologically proven squamous cell anal cancer were treated with chemoradiotherapy – IMRT and mytomycin-based CT.

Results: Stress fractures of a sacrum without any symptoms was diagnosed on MRI scan in 5 (3,9 %) patients, aged 54–75, with stages IIIA/IIIB within one year since treatment finished. In our patients no one of those with stress fracture hadn’t radiotherapy dose more than 45 Gy on sacrum. For dose estimation on femoral heads they were contoured as separate structure in 10 patients: D_{2 %} was 41.62 ± 0.84 Gy, V₄₅ – 3.08 ± 1.75 cm³.

Conclusion: Stress fractures are rare but important complication of modern radiation therapy and call for modern diagnostic methods  (MRI). State-of-art  treatment  involves radiotherapy  and  chemotherapy,  and  higher  doses of radiotherapy on distinct regions of pelvic bones may increase the risk of stress fracture.

Klatskin tumor is a rare, difficult to treat tumor and their prognosis is poor. Klatskin tumors also named as proximal bile duct tumor (perihilar) or hilar cholangiocarcinoma. Tumor named after American doctor Gerald Klatskin. He was first reported about this tumor in 1975. It is usually classified according to the extent of ductal involvement by tumor, which has been described by Bismuth et al in 1988. There are many termis and classifications of this tumor. In this review article, most of the currently existing termis and classifications of cholangiocellular carcinoma are collected and summarized.

The basics of boron neutron capture therapy of malignant tumors are presented, a brief history of its development is presented, and an analytical review of the status of boron neutron capture therapy in the field of developing sources of epithermal neutrons based on charged particle accelerators is presented.

Presented two cases of urinary bladder wall and surrounding  tissue necrosis following bilateral superselective embolization of internal iliac artery branches due to unmanageable haematuria associated with aggressive bladder tumor. Paper include patients pre-operative state and test results, procedure technical features and post-operative outcome.

Purpose: To estimate the diagnosis value of PET/CT with ¹⁸F-choline and ¹⁸F-FDG in case of mixed hepatocellular (HCC) and cholangiocellular cancer (CCC).

Material and methods: PET/CT with ¹⁸F-choline and ¹⁸F-FDG was performed on 56 years old patient with diagnosed liver cancer. Contrast-enhanced CT and MRI, histological and immunohistochemical studies of postoperative material were also performed.

Results: Difference of the accumulation of ¹⁸F-choline and ¹⁸F-FDG in some areas of mixed hepatocellular and cholangiocellular cancer was detected: in the field of CCC and in the field of poor-differentiated HCC.

Conclusions: ¹⁸F-choline has a low diagnostic value in the detection of CCC and poor differentiated HCC, in contrast to ¹⁸F-FDG.