This article, based on an analysis of the results of the work of leading cancer centers in the world, provides an overview of the possibilities of brachytherapy in the treatment of malignant tumors in children, presents indications for brachytherapy at the present stage of development of pediatric oncology. Malignant neoplasms in children are relatively rare, with an annual frequency of 13–14 cases per 100,000 children under the age of 15 years and make up less than 1 % of all cancer cases in developed countries.

In the treatment of tumors in children, as a rule, a multimodal (integrated) approach is used. A treatment program usually includes surgery, chemotherapy, and external radiation therapy. Treatment strategies aimed at reducing late side effects have significantly increased interest in brachytherapy, in particular in the treatment of soft tissue sarcoma and clear cell adenocarcinoma, since in these malignant neoplasms only a limited target volume should receive a significant radiation dose, often exceeding the tolerant doses of the surrounding swelling of normal tissues and structures.

The article contains the following sections:

•  Introduction

•  Methodological aspects of brachytherapy in children

•  Clinical indications for the use of brachytherapy in children, depending on tumor localization

› Brachytherapy of clear cell adenocarcinoma in children

› Technique for brachytherapy in children

› Total focal dose, dose rate and fractionation of brachytherapy in children

•  Conclusions

The given review of the literature is devoted to a role brachytherapy in treatment of patients with malignant tumor. More than 70 % patients with malignant tumor are treated with radiotherapy in as monotherapy or in combination with other methods of treatment. There are external beam radiotherapy and brachytherapy. Conformal high-dose rate brachytherapy is an alternative means of precise dose escalation that offers similar tumoricidal effects as 3-dimensional (3D) conformal external beam radiotherapy with potential additional advantages. Brachytherapy is used in as monotherapy or in combination in a combination with external beam radiotherapy. Brachytherapy is the gold standard of treatment women with gynecological tumors. Brachytherapy is an alternative treatment option radical prostatectomy. Brachytherapy is the best therapeutic option in the treatment of nonmelanoma skin cancer are localized on anatomical curves and near critical organs (nasal bridge, periorbital region) due to the excellent results and very good cosmetic effects. It is applied also in treatment of patients with head and a neck, esophagus, Klatskin tumor providing high local control.

Purpose: To perform dosimetric comparison of interstitial high dose rate brachytherapy (HDRB) and electron boost to the tumor bed after breast conserving therapy.

Material and methods: In 62 patients with stage IA–IIIA breast cancer (pT₁N₀M₀–pT₂N₂M₀) HDRB was used to deliver a boost to the tumor bed. In all the cases preimplantation CT with markers on the scar and nipple was used for planning of the procedure. Tumor bed was determined by markers that were implanted during surgery with consideration of the tumor localization determined on pre-surgery staging CT. Insertion of the needles was performed under CT navigation. Postimplant CT was used for final planning with inverse and graphical optimization.

All brachytherapy plans were compared according to the following dosimetric parameters: V₉₀ (%) – percentage of СTV receiving 90 % of prescribed dose;); D_mean  – mean dose at organ at risk; D_max  – maximum dose in the organ at risk (heart, left main coronary artery and its descending branch, ipsilateral lung, breast, skin and subcutaneous tissue, liver). Other parameters (V₁₀₀, DNR, CI, COIN) were calculated but not reported in this abstract.

Results: The use of brachytherapy with a high dose rate ¹⁹²Ir source makes it possible to more accurately irradiate the bed: the mean value of D₉₀ using brachytherapy was 93.1 % (69.1 % –118 %), while D₉₀ was lower than 80 % in only 8 patients. The use of high-dose brachytherapy allows reducing the radiation load on the organs at risk: the myocardium and coronary vessels, especially during left-side localization of the process. D_med for these structures – 2.2 %; 3.4 % for the main trunk of the left coronary artery; 6.9 % for anterior descending branch of the left coronary artery; on the ipsilateral lung D_max  – 26.8 % (4.7 % – 76.7 %), D_med  – 2.3 % (0.8 % – 10.8 %). Also during CT scan, in 71 % of cases, there was a discrepancy between the topography of the cutaneous scar and the radiopaque interstitial marks established by the surgeons during the operation.

Conclusions: The use of brachytherapy improves the accuracy of irradiation of the tumour bed and significantly reduce radiation dose to the organs at risk: main trunk of the left coronary artery, descending branch of the left coronary artery, ipsilateral lung, skin and subcutaneous tissue.

With radionuclide therapy of cancer, there is a risk of extravasal administration of significant activity of the radiopharmaceutical. The ingress of the radiopharmaceutical not into the lumen of the ulnar vein, but into the surrounding soft tissues causes a significant local irradiation of these tissues with short-range beta particles, as a result of which radiation-induced skin lesions of one degree or another may occur. According to the conservative scenario, the Monte Carlo method performed dosimetric modeling of the internal irradiation of the dermal layer of the skin after extravasal administration of 4 beta and beta-gamma-emitting therapeutic radiopharmaceuticals. It was shown that, depending on the radiation-physical characteristics of the radiopharmaceutical and the effective time of resorption of the lesion formed after injection, the absorbed dose of internal skin irradiation varies from 0.2 to 182 Gy. In this dose range, clinical manifestations of radiation complications can occur from erythema to radiation necrosis. Recommendations are presented on the prevention and suppression of the negative medical consequences of extravasal administration of therapeutic radiopharmaceuticals.

Purpose: Assessmen of the capabilities of ultrasound elastography, elastometry in the diagnosis of thyroid cancer recurrence.

Material and methods: In order to assess the capabilities of ultrasound elastography and shear wave elastometry in the diagnosis of thyroid cancer recurrence, a complex study was conducted using 50 patients with suspected recurrence of the disease. All the patients were examined using the B-mode, as well as ultrasound elastometry in black and white or color coding and shear wave elastometry. The results of the study were analyzed and compared with traditional methods of the ultrasound research. Ultrasound examination was performed by means of the Acuson S2000 Siemens and Avius hi vision Hitachi devices using a linear sensor with a frequency of 5–12 MHz.

Results: Ultrasound elastography improves visualization of relapses of thyroid cancer, increases the sensitivity of ultrasound diagnostics to 95 %. The elastography allows to reach specific indicators of shear wave velocity in the areas of interest.

Conclusion: The results obtained allow the timely detection of disease recurrence, to assess the prevalence of the process, the need for reoperation, as well as its complexity and planned details, to reduce the time and cost of examining of the patients.

Interventional radiology (IR) is the field of a multidisciplinary professional activity of a doctor, which can be used in various medical specialties and combined according to the principle of using means and methods of radiation control by performing diagnostic and treatment interventions. The basic multidisciplinarity and the wide range of applied research methods creates obvious difficulties when trying to formalize the requirements for the training of specialists working in this field. In this regard, authors considered it appropriate to present the current state of the regulatory frameworks for research in the Russian Federation, as well as return to the discussion about the feasibility or inappropriateness of an independent specialty – interventional radiology (X-ray surgery).

Purpose: It is evaluation of the effectiveness and study of the results of interventional procedures application in diagnostic and treatment of malignant neoplasms of hepatopancreatoduodenal organs complicated by obstructive jaundice.

Material and methods: Interventional procedures were used in 417 patients with malignant neoplasms of hepatopancreatoduodenal organs, complicated by mechanical jaundice syndrome. The causes of mechanical jaundice were: pancreatic head cancer – 246 patients (59.0 %), cholangiocarcinoma of common bile duct – 59 patients (14.1 %), cholangiocarcinoma of common bile duct – 39 patients (9.4 %), gall bladder cancer – 23 patients (5.5 %), duodenal cancer – 11 patient (2.6 %), regional metastasis – 39 patients (9.4 %).

Results: All patients underwent antegrade access to the bile-excreting tracts under ultrasound and fluoroscopic control. Through the drainage channel, fluoroscopy spectroscopy method was used for assessing the block area for pathological changes and the condition of bile duct wall at different levels. A total of 546 interventional procedures were performed. The kinds of the interventions were: external percutaneous-transhepatic cholangiostomy – 63.0 %; antegrade endobiliary stenting – 22.3 %; external-internal percutaneous-transhepatic cholangiostomy – 12.3 %; percutaneous transhepatic microcholecystostomy – 2.4 %. Complications after the interventions occurred in 89 cases (21.3 %). Lethal outcomes occurred in 25 patients (6.0 %) and were due to the progression of the underlying disease and the increase in multi-organ failure.

Conclusion: Interventional procedures are important modern surgical strategy for malignant neoplasms of hepatopancreatoduodenal organs complicated by obstructive jaundice. Thus, the use of interventional technologies makes it possible to early clarify the nature of bile duct obstruction, effectively reduce biliary hypertension and determine a further tactical position in the treatment of this category of patients.

Purpose: To determine the diagnostic role of compression elastography in endosonography in the algorithm for patients with bile duct diseases examining.

Material and methods: 80 patients were examined, among them 27 (33.7 %) men and 53 (66.3 %) women: 64 (80 %) patients with benign pathology and 16 (20 %) with malignant pathology. We used ultrasound examination of the abdominal organs with color Doppler mapping of v. portae and v. lienalis, multislice computed tomography, magnetic resonance imaging of the hepatopancreatoduodenal zone organs, compression elastography in endosonography and magnetic resonance cholangiopancreatography (MRCP).

Results: Compression elastography in endosonography and MRCP for bile duct diseases have very high diagnostic and prognostic significance in assessing the prevalence of the pathological process (AUROC = 0.889, CI 0.887–0.903 and AUROC = 0.941, CI 0.95–0.997, respectively), in comparison with endosonography; the diagnostic significance of compression elastography during endosonography increases when you select the zone of interest for conducting a fine needle aspiration biopsy (AUROC = 0.925, CI 0.904–0.931). The integrated use of radiation diagnostic methods promotes an individual approach and the interchangeability of methods.

A short glossary on nuclear medicine is presented, which contains all the most commonly used terms in this field and semantic explanations for each of them. When developing the glossary, the possibility of its use by both professionals working in nuclear medicine and other specialists who have no prior training in this field was taken into account.

Radiotherapy plays important role in radical treatment patients with soft tissue sarcomas. Currently, research is underway different fraction size and its preoperative use. We present a case of radiation therapy using both standard and hypofractional protocol.