[Brachytherapy as monotherapy for prostate cancer with the use of temporary sources].

The aim of this study was to investigate disease-free sur- vival and toxicity of high-dose rate brachytherapy (HDR-BT) in patients with prostate cancer at low risk of progression in monotherapy. With the use of advanced methods of imaging and planning brachytherapy allows achieving a high accuracy of radiotherapy delivering the adequate dose to the prostate and in the same time minimizing the toxic effects from adjacent organs. Brachytherapy by Ir-192 was carried out in 20 patients, in the form of monotherapy 3 fractions in a single focal dose 10 Gy with a two-week interruption between fractions to a total focal dose 30 Gy. Biologically effective dose was 230 Gy. The percentage of the prescribed dose on organ-target (V100) was not less than 95% (average 97.1 %). The critical dose on the urethra and the rectum was 110% and 70% of the prescribed dose respectively. The early and late radiation toxic reactions from genitourinary system and gastrointestinal tract in all of them were marked only as I grade. There were no adverse events of II-IV grades. Therefore HDR-BT as monotherapy has proved to be a safe and effective method of treatment prostate cancer patients of low risk of progression. Disease-free 5-year survival was 100% while minimizing toxic reactions from adjacent organs.

[Prognostic factors in treatment for low-grade brain supratentorial infiltrative gliomas].

The study showed the results of univariate and multivariate analyses of treatment of patients with low-grade brain supra- tentorial infiltrative gliomas. It was reaffirmed the importance of the most significance of such adverse prognostic factors as histology, tumor size, displacement of midline structures of the brain, age and neurological deficit. When assessing the prognostic significance of severity of the debut of clinical symptoms in this category of neuro-oncological patients as well as radical surgical treatment of the primary tumor there were obtained data confirming the absence of their independent prognostic significance.

[Results of surgical and combined treatment for nonsmall cell lung cancer with postoperative radiation therapy in a mode of hypofranctionation. Post II. Relapse-free survival and survival without locoregional recurrence].

Conducting postoperative radiotherapy in a mode of hypofranctionation with SFD-3Gy to TFD-36-39Gy (EQD2 = 43,246,8Gy) in combined treatment of patients with non-small cell lung cancer allows significantly increasing a 5-year disease-free survival at IIB-IIIB stages of the disease (pN1-2) as well as the central cancer, squamous cell morphological type of tumor after surgery in a volume of lob-bilobectomy. The clearest effect of postoperative radiotherapy is assessed by survival without locoregional recurrence where radiation therapy in the adjuvant setting allows achieving a statistically significant increase in local control of the disease to the level of 85-95% regardless of stage of the disease, tumor size, regional lymph nodes lesion and the surgical treatment.

Genetic disorders in primary brain glioblastomas.

Glioblastomas are characterized by a variety of genetic and epigenetic disorders, identification of which allows constantly expanding a list of genes directly involved in carcinogenesis, thus increasing molecular diagnostics, monitoring and predicting disease. Molecular-genetic studies of patients with glioblastomas allowed revealing changes relevant to this disease and determining their prognostic significance. In the future molecular-biological markers along with clinical and therapeutic factors may play a role of separate and independent factors of prognosis in patients with malignant brain lesions.

[Hodgkin's lymphoma and radiotherapy].

After a median observation time of 4,5 years, 440 patients with Hodgkin's lymphoma stage I-IV to the Ann Arbor classification were treated with radiotherapy (2200 lymph areas) and ABVD (n=204) or BEACOPP (n=117) or CEA/ABVD (lomustine, etoposide, adriamycine, bleomycine, vinblastine and dacarbacine; n=119) regimens in 1995-2012. Correct allocation of groups with "CR or PR ≥80%" and "PR: 0-79%", after first-line chemotherapy, is extremely important for following RT planning. Adaptation of patients with Hodgkin's lymphoma can take place only after successful treatment, the probability of relapse and fear of repeated courses strongly interfere with this process, especially in the first years after its closure. Duration of remission period, especially in young people, is no less important than the criteria for overall survival. It is impossible to build recommendations for treatment for Hodgkin's lymphoma, based only on long-term survival rates. Importance of radiotherapy in reducing the number of relapses is undeniable, so the idea that the development of the role of chemotherapy in the treatment of the ray method Hodgkin's lymphoma gradually becomes secondary is in serious doubt. Our findings suggest the importance of both maintaining a high disease-free survival and reducing long-term complications in designing treatments of Hodgkin's lymphoma.

[Results of combined and complex treatment for indolent and aggressive non-Hodgkin lymphoma of the stomach].

There were retrospectively assessed long-term outcomes of 125 patients with primary non-Hodgkin's lymphoma of the stomach (indolent--50, aggressive--75) using different programs of combined and complex treatment. The immediate results of the treatment in the group of indolent lymphomas were: complete remission 39 (78%), partial remission 7 (14%), the stabilization 3 (6%), progression 1 (2%) while in the group of aggressive lymphomas: complete remission 56 (74.7%), partial remission 8 (10.7%), without effect 3 (4%) and progression 8 (10.7%). It was revealed that primary indolent lymphomas of the stomach the efficiency of complex treatment is comparable to the efficiency of local methods of treatment (surgery, radiotherapy or its combination). The combination of chemotherapy and local methods of treatment gave better results compared with chemotherapy (a 5-year overall survival is 100% and 72% respectively). In the group of aggressive lymphomas the best rates in all types of survival were demonstrated by the subgroup of complex treatment as compared with the subgroup of local methods of treatment especially in terms of overall survival (100% and 65% respectively), and as compared with the subgroup where only chemotherapy was conducted, particularly in terms of disease-free survival (100% and 40% respectively). As an adjuvant therapy after surgical treatment it was preferable to use chemotherapy because such treatment program demonstrated the best rates of overall survival, which reached 92% on a 5-year and a 10-year milestone.

[Middle fraction radiotherapy for non-small cell lung cancer. Effect of increasing the total focal dose].

There were evaluated retrospectively the immediate and long-term results of radiotherapy in 259 patients with non-small cell lung cancer stages I-IV who had contraindications to surgery. Irradiation was carried out by middle fraction with single focal dose 3-4 Gr. We compared the results of treatment in two groups of patients differed in volume of total focal dose: I group (124 patients)--45 Gy, II group (125 patients)--60 Gy. An increase of total focal dose from 45 Gy to 60 Gy did not lead to an increase of the toxicity to vital organs including patients older than 60 years and patients with initially poorer somatic status. Disease-free survival significantly increased in total in the group with total focal dose 60 Gy and predominantly in tumors over 5 cm, in patients with ECOG 2-3 and in III-IV stage disease. An increase of total focal dose to 60 Gy in the group was significantly prolonged survival without local recurrences from 37% to 50% and by one-third reduced the frequency of locoregional recurrences. Identified benefits in overall and disease-specific survival the groups of non-small cell lung cancer patients with total focal dose 60 Gy compared with a group of non-small cell lung cancer patients who received radiotherapy in total focal dose 45 Gy at terms more than 5 years did not reach statistical significance.

[Analysis of predictors influencing the results of the combined treatment for anaplastic astrocytomas (grade III) of the brain].

In our study the analysis of significant predictors affecting the results of treatment of anaplastic astrocytoma brain (grade III) is showed. According to our data to assess the effectiveness of special treatment of these patients is possible with such clearly defined predictors such as age, volume of surgery, initial tumor size and functional status (the Karnofsky index). The study demonstrates that in patients who underwent radiotherapy using single focal dose of 3 Gy overall survivals was comparable with the group of patients who underwent radiation therapy using small dose fractionation. The use of adjuvant chemoradiotherapy in patients with grade III glioma does not increase overall survival rate compared with patients who received only adjuvant radiotherapy.

[The role of systemic radiotherapy in the combined treatment for hormone-resistant prostate cancer].

To relieve pain associated with multiple bone metastases radiopharmaceutical method of treatment is of great importance--the use of beta-emission isotope of strontium chloride-89 (metastron). Passing through the human skeletal system, strontium-89 accumulates in areas of high mineral density, which is it typical for osteoblastic metastases. In our institution in the frames of a randomized trial in 90 patients with metastatic hormone-resistant prostate cancer it was carried out systemic radiotherapy with strontium-89 chloride as a stage of complex treatment. Stabilization of pain syndrome during treatment was 72,7% and its progression was noted in 27,3% cases. Radiopharmaceutical therapy is well tolerated and can be used as a stage in complex treatment of patients with hormone-resistant prostate cancer.

[Results of surgical and combined treatment for non-small cell lung cancer with postoperative hypofractionated radiotherapy: overall and disease-specific survival].

Compared with surgical treatment the combined treatment of patients with non-small cell lung cancer accompanied by post-operative radiotherapy in the mode of hypofractionation from 3 Gy to SOD-36-39 Gy (EQD2 = 43,2-46,8 Gy) allowed statistically significant increasing a 5- and 10-year overall and disease-specific survival in patients with metastases to regional lymph nodes (pN1-2). The increase of overall and disease-specific survival was also observed in patients older than 60 years with the worst initial status (70-80 by the Karnofsky scale), II stage of disease, peripheral cancer and adenocarcinoma however for these groups survival differences did not reach a statistically significant level. The presented method of postoperative irradiation did not have severe toxicity and did not lead to a decrease in survival of elderly and functionally debilitated patients.

[Complications and effectiveness of treatment of patients with locally advanced prostate cancer after combined radiotherapy and radical prostatectomy with postoperative radiotherapy].

Treatment for prostate cancer remains a significant social problem due to the continuing trend of growth of morbidity and mortality in Russia from this disease. In recent years a real alternative to surgical treatment is radiotherapy. In treatment of locally advanced stages of prostate cancer radiotherapy plays a dominant role. At our institution from 2005 till 2011, 105 patients with locally advanced prostate cancer underwent complex and combined treatment comprising in the first group the concomitant radiotherapy with Ir-192 and the control group--radical prostatectomy followed by adjuvant remote radiotherapy. In patients treated with concomitant radiotherapy compared to the control group there were occurred fewer number of genitourinary complications according to the RTOG scale (5,8% vs. 32,7%). In patients who had undergone radical prostatectomy followed by adjuvant radiotherapy urinary incontinence was met significantly often.

[Radiation therapy of Kaposi's sarcoma with accelerated electrons]. / Luchevaia terapiia sarkomy Kaposhi uskorennymi élektronami.

Kaposi's sarcoma and AIDS-associated Kaposi's sarcoma resistant to chemotherapy were irradiated locally in 14 and 1 patient, respectively, and followed up for 1--6 years. The energy (10 MeV) in the total focal dose of 24--40 Gy was emitted as high-speed electrons from a medical accelerator. An immediate response was obtained in all the patients. The recurrence occurred in AIDS-associated sarcoma only. It is recommended that Kaposi's sarcoma should be treated by high-speed electron radiation covering the lesion and adjacent sites of the intact skin. Total focal dose must not exceed 30 Gy, in case of circulatory disturbances in the low limbs the dose is to be reduced to 20 Gy.

Combined treatment of colonic cancer.

One hundred seventy-eight patients with cancer of different segments of the colon were treated with preoperative radiation and surgery. Preoperative radiation with 25 MeV betatron was employed according to the method developed by the authors. Radiation treatment was tolerated by patients in the absence of manifest general and local reactions. No decrease below 3000 in the rate of leukocytes was observed after a total dose of up to 40 Gy. After radiotherapy, improvement in the general state was achieved in 72 percent and positive roentgenologic findings were seen in 70.8 percent of patients. The preoperative irradiation therapy was followed by 153 radical and 28 palliative operations. There was no increase in postoperative morbidity or mortality. The morphologic study of surgical specimens showed that considerable changes in the tumoral tissue, including disappearance of cancer cells, were seen in 75 percent of cases. The five-year survival rate of 112 patients after radical surgery indicates that it is worthwhile to use the combined treatment approach for tumors located in the right colon and in cases of suspected or existing infiltration into adjacent organs and tissues.

[Diagnostic value of ultrasonographic evaluation of thoracic and cervical organs in lymphogranulomatosis and lymphosarcoma]. / Diagnosticheskie vozmozhnosti ultrazvukovogo issledovaniia organov grudnoi kletki i shei pri limfogranulematoze i limfosarkome.

Examinations of 65 patients with Hodgkin's disease (n = 61) and with non-Hodgkin's (n = 4) by x-ray method, computer-aided tomography, and sonography were carried out and the potentialities of sonography in detection of the lymph node lesions in lymph collectors above the level of the diaphragm analyzed. Sonography helped detect signs of envolopment of small palpated and nonpalpated lymph nodes, differentiate individual nodes, conglomerations, specify the volume an localization of changes in the mediastinal lymph nodes and in the adjacent anatomical structures, and choose an approach to collection of material for morphologic examination. Ultrasonic examination is informative as a method for monitoring the treatment results and for disease recurrences during the period of postirradiation changes in the mediastinum.