[Economic and logistical problems of radiation oncology].

An analysis of economic and logistical problems of radiation oncology is presented based on domestic and foreign literature. Despite the high efficacy of radiotherapy this branch of oncology is not financed enough in most countries. As a consequence, it is ubiquitously marked radiotherapy capacity deficit that does not allow to fully realize its therapeutic potential. Medical electron accelerators and related equipment have become increasingly complex and expensive and radiotherapy techniques more consuming. Even in developed countries growing waiting times for radiotherapy, not using the most modern and efficient radiotherapy technologies (image guiding, etc.) has become a daily reality. Based on these data, we assessed the prospects and possibilities of upgrading the technical base of radiation oncology in Russia including the development of hadron therapy.

[The optimal radiation volume after first-line chemotherapy in Hodgkin lymphoma].

Radiation therapy has evolved from extended-field radiation therapy (EFRT) to involved-field radiation therapy (IFRT), reducing toxicity while maintaining high cure rates. Recent publications recommend a further reduction to involved-nodal radiation therapy (INRT); however, this has not been clinically validated. The need for irradiation or optimal radiation volume after chemotherapy are not defined. The treatment results of 296 Hodgkin's disease patients receiving ABVD or BEACOPP-21 chemotherapy with consequent EFRT demonstrate CR/PR > or = 80% and 99% local disease control rate. Beam therapy with EFRT is possible to use if dose levels don't exceed 30 Gy. Higher doses demands reduction of volume of radiating target. In our opinion the optimum program of beam therapy involves 2 stages with maximal possible dose level EFRT followed by additional INRT. Those approaches offer perspectives for Hodgkin's disease treatment.

[Role of response to first-line chemotherapy and of the primary lesion in Hodgkin lymphoma].

Based on the results of combined treatment with inclusion of ABVD and BEACOPP-21 chemotherapy regimens the basic principles of therapy depending on the nodal relaps criterium were developed. The most rational approach to treatment results evaluation concerns the lesions with the least response to chemotherapy. The groups of "adequate" and "inadequate" response to chemotherapy should be formed. The initial lesion localisation doesn't play an important part in the modern chemotherapy settings and should not be concerned while choosing tactics of radiation therapy. The method described should interest oncologists and radiologists involved in the treatment of Hodgkin lymphoma.

[The optimal total focal radiotherapy dosage after first-line chemotherapy in patients with Hodgkin lymphoma].

Based on the treatment results of 300 Hodgkin lymphoma patients the authors formulated the basic approaches for radiation treatment in ABVD and BEACOPP-21 chemotherapy regimens recipients. In patients with complete response to chemotherapy any dose regimen (26 to 44 Gr) leads to 100% local disease control. In patients with major response to chemotherapy (PR> or =80%) the 36 Gr total focal dose allows an adequate local control, more intensive local control doesn't yield better results. In patients with PR 0-79% the implication of total focal doses less than 40 Gr leads to statistically significant increase of nodal relapse rate. These treatment approaches may be implied by specialists conducting chemotherapy and radiation therapy in Hodgkin lymphoma patients.

[The role of adjuvant radiotherapy in the complex treatment of stage III-IV aggressive non-Hodgkin's lymphoma].

Immediate and end results of chemoradiotherapy of 225 patients (average age--43 years) with primary aggressive non-Hodgkin's lymphomas stage III-IV were evaluated. Stage 1 of treatment included 4-8 cycles of chemotherapy (ACOP and other standard protocols); stage 2--irradiation of residual foci with 20-50 Gy, or 20-36 Gy for originally extensive and extralymphatic foci when in full remission. The latter's rate rose from 24 to 65% (p < or = 0.05) following adjuvant radiotherapy although that of failures remained unchanged. The disease is specific, so relapse-free survival in cases of generalized primary aggressive lymphoma in full remission remained unchanged too whatever the stage at which full remission emerged.

[Multivariate analysis of risk of cardiac complications in Hodgkin's lymphoma].

A computer database was created to take care of a wide range of protocols for combined treatment of Hodgkin's disease stage I-IV (n=1,573). Early-onset radiation-related injuries (pneumonitis) and exposure of lung tissues to radiation were identified as the main risk factors for cardiopathology development. It is suggested that total focal dosage used after chemotherapy be reviewed since total dosage for the entire lymph collector in excess of 30 Gy might contribute to hazards of cardiopathology. However, a locally administered TTD ranging 36-44 Gy to deal with residual tumor offers best advantage in preventing local relapse. Nor does it increase the risk of future complications. Our approach might promote individualization of prognosis as far as cardiac complications involved in Hodgkin's lymphoma are concerned.

[Design of automatic radiotherapy of locally spread cancer of the urinary bladder]. / Planirovanie avtomatizirovannoi luchevoi terapii mestnorasprostranennogo raka mochevogo puzyria.

How to apply information obtained with modern methods of visualization of urinary bladder (UB) primary cancer and regional metastatic zones (ultrasound investigation, computer tomography, NMR-tomography, urography, cystoscopy) in design of radiotherapy is demonstrated as well as contribution of each of these methods to design of individual regimens of computer gamma-therapy. This advanced method of radiotherapy makes use of computer design and programs of multicenter and multiposition static and dynamic techniques of calculation of total dose distributions which comply with topographic anatomy of the tumor and radiobiological programs of radiotherapy of UB cancer.