Introduction: Renal cell cancer accounts for 2 % of all cancers. The gold standard for managing patients with no evidence of distant metastasis renal cell cancer remains is complete surgical resection. Renal cell cancer is radioresistant tumor for conventional radiation therapy. Although renal cell carcinoma is related to radioresistant tumors, in recent years new promising directions in radiation therapy have become apparent.

Preoperative and postoperative irradiation: The clinical data investigating preoperative radiotherapy failed to reveal benefited from this methods. The role of routine postoperative radiotherapy in the management of renal cell cancer is not established in patients with localized disease after complete surgical resection.

Primary irradiation for localized renal cell cancer:

To overcome the radioresistance of renal cell carcinoma, the use of modified radiation therapy regimens with high doses per fraction is justified. А new technologies of radiation therapy, which include stereotactic radiation therapy (SRT) allows to accurately deliver doses of ionizing radiation to a tumor, without the risk of damage to neighboring tissues and organs.

Conclusion: Recent data showing that with the use of high-precision methods, such as SRT, unresectable local renal cell carcinoma can successfully be treated with durable local control and low toxicity. Nonetheless, prospective, randomized trials and comparative-effectiveness studies are needed to further evaluate this ablative modality in the treatment of renal cell carcinoma.

Relevance: Chemo-radiotherapy of patients with locally advanced forms of NSCLC is the standard of treatment and, with all modern approaches to planning and implementing radiotherapy applied, a median survival of more than 28 months can be achieved. Ways to increase the effectiveness of treatment are now associated with local escalation of radiation dose to the tumor and implementation of the personalized approach concept in chemo-radiotherapy.

Material and methods: Since 2013 chemo-radiotherapy has been performed for 51 patients with lung cancer of inoperable III stage: IIIA stage - 15; IIIB - 36 patients. The treatment was carried out using high-tech radiotherapy (simultaneous integrated boost - SIB-IMRT) and dose escalation up to the zones of hypermetabolism from PET / CT to BED₁₀ = 70-74 Gy for 22-25 fractions. The fractionation regimen for SIB-IMRT was determined by dosimetry: the average dose for lungs was MDL < 20 Gy and V₂₀ ≤ 30 %. Concurrent chemotherapy (carboplatin AUC 5 + Paclitaxel 175 mg / m²) was conducted with a consolidation course after the end of CLT.

Results: With a median follow-up of 42 months 1-, 2-, and 3-year local control rates were 94, 76, and 61 %, respectively. The maximum registered effect after chemo-radiotherapy in 6 (12 %) patients was complete regression of the tumor and, in the remaining cases, partial regression (29-57 %) and stabilization (16-31 %). Overall 1-, 2- and 3-year survival in the group of patients who received CRT was 80.8 % (95 % CI, 69.7-93.7); 64.6 % (95 % CI, 50.4-82.9); 54.2 % (95 % CI, 38.3-76.9), respectively. In 2 patients (5 %), isolated local relapse was noted at the time of 9 months and 13 months. In the remaining cases there were a simultaneous combination of all types of progression - 17 patients (39 %) and distant progression (24 patients (56 %)). The third degree pulmonary toxicity was noted in 7 (14 %). third degree radial esophagitis was observed in 4 (7 %) patients. Single-factor analysis revealed the significant effect on the prognosis of an isolated local recurrence and a near-certain effect on the outcome of treatment of the level of SUV_max in the tumor.

Conclusion: With modern high-tech approaches to the planning and implementation of radiotherapy a personalized local escalation of the irradiation dose is possible, taking into account the predictor effect of SUV_max in the tumor.

Purpose: Standard liver transarterial chemoembolization (TACE) response evaluation criteria are based on lesion and necrotic areas sizes, however, in the particular case of metastatic neuroendocrine tumor (mNET) these criteria lack accuracy and prognostic significance; so additional MRI parameters are proposed in the paper for TACE efficiency assessment in these patents.

Material and methods: 31 liver mNET patients that undergone 61 TACE procedures were enrolled in the study. 108 MRI studies performed 3-86 days before (median - 28 days) and 17-108 days (median - 54 days) after TACE were analyzed. We acquired diffusion weighted images (DWI) with maps of apparent diffusion coefficient (ADC), T₁-weighted images (T₁-WI) fat-saturated (FS) before i.v. contrast injection and after on arterial, portal and delayed phases. TACE effect was estimated according to RECIST 1.1 (2008). Before and after TACE, we measured: maximum necrotic/fibrotic zone diameter and solid component thickness on its periphery at the largest targeted lesion, ADC and its standard deviation (SD) in the tumor solid component; MR contrast agent (MRCA) uptake dynamics and signal intensity (SI) SD on T₁-WI FS on portal phases at same regions.

Results: TACE effect was evaluated according to RECIST 1.1 as progressive disease in 4 (6.8 %), stabilization in 54 (88.4 %) and partial response in 3 (4.9 %) patients. The diameter of the fibrotic/necrotic areas after TACE demonstrated no changes, but thickness of the solid component on the periphery of the fibrotic/necrotic areas decreased significantly. ADC values and its SD increased, lesion MRCA accumulation on arterial and portal phase decreased, lesion MRCA wash-out time and SI SD on T_{1-WI FS} on portal phase increased in solid portions of mNETs after TACE. Positive prognostic factors associated with the time to progression were an increase in ADC values and its SD, a decrease in MRCA accumulation on portal phase.

Conclusion: Mentioned above parameters may be useful for increasing the predictive value of MRI-assessment of TACE response in patients with liver mNETs and for determining the intervals of post-TACE MRI follow-up schedule.

Examination data of X-Ray of 106 pathological vertebral fractures were studied. The sensitivity of the method was 92.9 %. This indicates the high accuracy of X-Ray in determining the group with osteoporotic vertebral fractures. The specificity is lower and amounts 81 %, indicating the limitations of this method in determining the group with pathologic fractures on the background of the tumor lesion.

Purpose: To evaluate the possibility of ultrasound examination of parasternal lymph nodes in patients with breast cancer and to study the ultrasound semiotics of the parasternal region to improve the results of diagnosis of breast cancer metastases.

Material and methods: The study included 35 patients aged 29 to 83 years, of which 22 primary patients diagnosed with breast cancer and localization of tumors in the central and medial departments, and 13 patients under dynamic observation, after previous treatment for breast cancer. All women underwent ultrasound examination, including examination of the breast, axillary, subclavian and supraclavicular zones, in addition, all patients underwent examination of the parasternal region. In addition, the patients underwent mammography in 2 projections, as well as computed tomography with intravenous bolus contrast gain.

Results: Of the 35 patients examined, parasternal lymph nodes were visualized in 10 patients. 4 patients had specific lymph node lesions. In 2 patients from the group of primary patients and in 2 patients from the group of patients under dynamic control after previous treatment. In the remaining 6 patients lymph nodes according to the results of cytology had signs of nonspecific reactive hyperplasia. The minimum size of the visualized lymph nodes was 4±0.5 mm. In all cases of specific lesions, according to ultrasound, the lymph node had a rounded shape, reduced echogenicity, anatomical structures of the lymph node were not differentiated, in the mode of shear wave elastography, had a rigid consistency. In 6 patients with hyperplasia, lymph nodes had a flat, elongated shape, differentiation into anatomical structures was preserved, the rim, сentral echo complex and gates of the lymph node were visualized, when assessing stiffness by shear wave elastography, lymph nodes had a soft consistency. According to computed tomography in 25 cases, when lymph nodes could not be visualized by ultrasound, they were also not detected by CT. According to CT data, 4 patients showed signs of specific lymph node lesions, rounded shape and intensive accumulation of contrast agent.

Introduction: Cancers that are known collectively as head and neck cancers can vary in their histological form and localization. This disease has a high social significance thus it require well-timed and delicate approach, especially in children. We can improve the accuracy of our methods by using new algorithms and technologies. We were the first to implement ^99mTc-MIBI SPECT/CT imaging in evaluation of children with head and neck cancer and introduce it as a routine method in Russia.

Purpose: Improve the accuracy in diagnostics of children with head and neck cancer by practical application of hybrid SPECT/CT method. To determine diagnostic value of planar scintigraphy and ^99mTc-MIBI SPECT/CT in children with head and neck cancer.

Material and methods: This study was performed as a prospective clinical study. Between January 2017 and December 2017, 53 patients which met the inclusion criteria were examined. The inclusion criteria were patients with histologically proven malignancy, age 1-18, weight more than 10 kg, up to date CT or MRI scans (less than two weeks passed from scanning), for initial patients a tumor findings (more than 20 mm in the largest scale). We concluded 61 whole body planar scintigraphy followed by head and neck ^99mTc-MIBI SPECT/CT examinations. 10 patients were examined twice, 1 patient was undergoing for this procedure for three times. Initial patients - 23, dynamic - 30. We performed scanning using a hybrid SPECT/CT (SymbiaT2 [Siemens, Germany]) after 15 min ^99mTc-MIBI was injected. First stage was standard whole-body planar scintigraphy, second stage SPECT/CT (head and neck).

Results: We evaluated diagnostic accuracy of planar scintigraphy and ^99mTc-MIBI SPECT/CT.

Planar scintigraphy sensitivity, specificity, NPV and PPV were 68.8, 96.6, 73.7, 95.7 %.

SPECT/CT - 87.5, 96.6, 87.5, 96.6 %.

The verification method was histological examination or follow-up imagining (CT or MRI) during a 12 month period. Additional imagining using hybrid SPECT/CT method allows us to increase sensitivity and NPV of isotope scanning.

Most of false-negative results were obtained after planar scintigraphy, it can be related with image interpretation difficulties caused by equivocal image, especially, in patients during therapy. Six of such patients were correctly diagnosed with SPECT/CT and we revealed the presence of active tumor tissue.

With CT we additionally detected destruction of skull bones in 10 patients.

Conclusion: 1. Diagnostic accuracy of scintigraphy with ^99mTc-MIBI is high.

2. We can increase diagnostic accuracy using hybrid methods, and so it plays an important role in final diagnosis.

3. SPECT/CT additionally detected destruction of skull bones even with negative scintigraphy results.

4. A strict clinical reasoning is needed in each individual case.

5. A further evaluation of the diagnostic capabilities of ^99mTc-MIBI SPECT/CT in a larger number of patients appears justified.

Purpose: Evaluation of ¹⁸F-FDG uptake in different histological subtypes of Hodgkin lymphoma; analysis of primary cases of Hodgkin lymphoma with low ¹⁸F-FDG avidity and researching of the causes of low tracer uptake in baseline PET-scan.

Material and methods: 131 baseline PET/CT scans of patients with Hodgkin disease was investigated.

Results: Nodular sclerosis was most ¹⁸F-FDG avid, nodular lymphoid predominant Hodgkin disease had lowest ¹⁸F-FDG avidity, but these differences doesn’t allow to distinguish histological subtypes of Hodgkin lymphoma basing on ¹⁸F-FDG uptake properties. Tumor burden in patients with B-symptoms had a highest levels of ¹⁸F-FDG uptake.

Conclusion: 4 % of Hodgkin lymphoma is non-avid for ¹⁸F-FDG at baseline. It can be explained with severe immunodeficiency or indolent disease pattern.

Hepatocellular adenomas are rare benign liver tumors with extremely variable pathology, molecular and etiology features.

Their molecular and genetic correlations help to stratify patients for further follow-up and help to make clinical decisions because of natural behavior of different HCA’s subtypes.

In the review we try to compile the last available information about hepatocellular adenomas.

SPECT / CT of skeletal bones refer to diagnostic studies with increased radiation exposure to the patient. In this regard, such studies require monitoring the risks of radiation-induced lesions, especially the risk of secondary cancer. For 65 patients with verified metastases of the skeletal bones, comparative studies of individual radiation risk assessments were performed, calculated on three different radiation-epidemiological models based on previously obtained values of effective internal dose from the radiopharmaceutical with SPECT and external exposure with X-ray CT. Two of these models are based on the recommendations of the ICRP, one of which is implemented in the form of a specialized calculator, and the third is based on the recommendations of the BEIR Committee (USA). It is shown that almost all individual radiation risk assessments calculated by these models are within the categories of low and very low risk. Despite some overestimation of radiation risk assessments, for simple and quick determination of individual estimates of current and accumulated radiation risk, it is recommended to use a radiological automatic calculator, accessible via the Internet.

A clinical case of hemoptysis in lung cancer is presented. The article describes the principle of a multidisciplinary approach in the treatment of such life-threatening complications in patients with cancer. A detailed preoperative analysis of the anatomy of the lesion was studied. The article comes with a short literature review.

Chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation.

A case of a 58-year-old woman with verified carcinoma of the left breast, which was treated in 2008-2009, is presented. In 2017, a focus suspicious of metastasis was detected in the left half of manubrium of the sternum by osteoscintigraphy. According to the changes in computed tomography and osteoscintigraphy, with ambiguous results of core biopsy, a decision to perform surgical treatment was made. A pathomorphological examination revealed chronic osteomyelitis of manubrium.

The case is interesting because of the complexity of the differential diagnosis of metastatic lesions in breast cancer and chronic osteomyelitis according to computed tomography.

The method of positron emission tomography combined with computed tomography (PET/CT) makes it possible to evaluate not only anatomical and structural, but also metabolic changes in tumor. PET/CT with ¹⁸F-fluoroethylthyrosine (¹⁸F-FET) is based on the evaluation of ¹⁸F labeled tyrosine amino acid transport from the bloodstream into the tumor tissue.

Clinical case of a patient with the brain tumor newly diagnosed by MRI presents ¹⁸F-FET PET/CT findings in it. This clinical case demonstrates the possibilities of ¹⁸F-FET PET/CT in assessment of true volume and degree of anaplasia of brain neoplasm, which influenced to treatment tactics.