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 BED 10 = 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 V 20 ≤ 30 %. Concurrent chemotherapy (carboplatin AUC 5 + Paclitaxel 175 mg / m 2 ) 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.

Objective: to evaluate the prognostic value of clinical and pathomorphological stages in patients with rectal cancer after preoperative chemoradiotherapy and to assess the effectiveness of adjuvant chemotherapy in these patients. Materials and methods. We conducted a retrospective analysis of the data from a prospectively maintained database for patients with rectal cancer. The study cohort included patients with stages I–III rectal cancer that underwent preoperative chemoradiotherapy followed by surgical treatment performed in the Department of Proctology and Clinical Pharmacology and Chemotherapy between 2004 and 2013. The relapse-free and overall survival rates were assessed to estimate treatment efficacy. Results. A total of 457 patients were eligible for the study; of them 98 patients (21.4 %) received adjuvant chemotherapy. The following independent factors were found to negatively affect relapse-free survival: perineural invasion (р <0.01; hazard ratio (HR) 3.1; 95 % confidence interval (CI) 1.43–6.89), preoperative neutrophil-lymphocyte ratio ³ 3 (р = 0.01; HR 1.8; 95 % CI 1.37–2.42) and pathomorphological stage (р <0.01; HR 1.82; 95 % CI 1.37–2.42) (but not clinical stage). The pathomorphological stage (р <0.01; HR 1.9; 95 % CI 1.30–2.65), invasion into lymphatics (р <0.01; HR 2.4; 95 % CI 1.27–4.59) and white blood cell count ³ 11 000/µL (р <0.01; HR 13.1; 95 % CI 1.33–7.33) were independently associated with poorer overall survival. We observed a trend towards a decline in the relative risk of death in patients with stage yp3N0M0 cancer in response to adjuvant chemotherapy (р = 0.1; HR 0.4; 95 % CI 0.01–37.6). There was also a trend towards better relapse-free and overall survival in adjuvant chemotherapy-treated patients with stage ypT0–4N1–2 (р = 0.1; HR 0.65; 95 % CI 0.4–1.1 and р = 0.3; HR 0.3; 95 % CI 0.4–1.4 respectively) and stage yр T0–4N2M0 (р <0.01; HR 0.3; 95 % CI 0.14–0.70 and р = 0.03; HR 0.5; 95 % CI 0.2–1.0) cancer. Conclusion. In patients with rectal cancer, the pathomorphological stage appears to be a more reliable prognostic parameter compared to the clinical stage; this should be considered when prescribing adjuvant chemotherapy to patients that underwent preoperative chemoradiotherapy.

Objective. There are some descriptions of different boness stress fractures in existing literature, 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. Materials and methods. Since 2011 till 2015 year 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: D2 % was 41.62 ± 0.84 Gy, V45 was 3.08 ± 1.75 cm 3 . Conclusion. Stress fractures are rare but important complication of modern radiation therapy and call for modern diagnostic methods. 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.

Objectives: to assess the feasibility of a combination of the intensity-modulated radiation therapy (IMRT) with a triplet chemotherapy with paclitaxel, capecitabine, and mitomycin C in the treatment of patients with anal cancer, and to evaluate the toxicity of the proposed treatment regimen.Materials and methods. All patients included in the study had stage I–IIIB anal cancer. All patients underwent IMRT radiotherapy 52–58 Gy (the dosage is calculated according T symbol) by 1.8 to 2.2 Gy fractions daily. The proposed chemotherapy scheme includes mitomycin C 10 mg/m2 on day 1, paclitaxel 45 mg/m2 on days 3, 10, 17, 24, 31, capecitabine 625 mg/m2 during radiotherapy. A complete response to treatment after 26 weeks, and the compliance to the study protocol were the primary end points of the study.Results. The study included 38 patients. Among patients stage I anal cancer occurred in 1 (2.6 %) case, II – in 5 (13.2 %), IIIA – 15 (39.5 %) and IIIB – in 17 (44.7 %). A significant deviation from the protocol reported in 6 (15.8 %) patients, in 11 (28.9 %) patients a slight alteration from the treatment was documented, and 21 (55.3 %) patients completed the treatment of chemoradiotherapy with full compliance to the study protocol. The high profile of toxicity (grade III–IV) was recorded in 23 (60.5 %) patients. An incomplete clinical response at 26 weeks after treatment was reported in 5 (13.2 %) patients, one whom continued watchful waiting and achieved complete response at 9 months posttreatment. Median followup was 27 months. 1 patient developed a local recurrence 1 year posttreatment.Conclusions. The proposed triplet chemotherapy regimen using IMRT is feasible and has acceptable toxicity. For further assess the continuous research is needed. Целью исследования явилась оценка эффективности лучевой терапии с модулированной интенсивностью (intensity-modulated radiation therapy, IMRT) с трехкомпонентной химиотерапией паклитакселом, капецитабином и митомицином С в лечении пациентов, больных раком анального канала, а также изучение профиля токсичности предложенной схемы лечения.Материалы и методы. Все пациенты, включенные в исследование, имели I–IIIB стадии опухолевого процесса. Больным была проведена лучевая терапия по технологии IMRT последовательными фракциями от 1,8 до 2,2 Гр ежедневно до суммарной очаговой дозы 52–58 Гр (в зависимости от исходной стадии Т). Предложенная схема химиотерапии включала прием митомицина С 10 мг/м2 внутривенно (в/в) в 1-й день, паклитаксела 45 мг/м2 в/в в 3, 10, 17, 24 и 31-й дни, капецитабина 625 мг/м2 2 раза в сутки перорально в дни лучевой терапии. Полный ответ на лечение через 26 нед и соблюдение протокола исследования являлись основными оцениваемыми параметрами.Результаты. В исследование были включены 38 пациентов. Опухолевый процесс I стадии был выявлен у 1 (2,6 %), II – у 5 (13,2 %), IIIA – у 15 (39,5 %) и IIIB – у 17 (44,7 %) больных. Значительное отступление от протокола зарегистрировано у 6 (15,8 %) пациентов, у 11 (28,9 %) отмечено незначительное отступление от схемы лечения, 21 (55,3 %) больной завершил режим химиолучевой терапии в полном соответствии с протоколом исследования. Высокий профиль токсичности (III–IV степени тяжести) зарегистрирован у 23 (60,5 %) пациентов. Неполный клинический ответ через 26 нед после окончания лечения был отмечен у 5 (13,2 %) больных, из них 1 пациентке продолжено динамическое наблюдение, полный ответ достигнут через 9 мес, остальным 4 предложено хирургическое лечение. Медиана наблюдения составила 27 мес. У 1 больной развился рецидив заболевания через 1 год после завершения химиолучевой терапии.Выводы. Предложенный режим трехкомпонентной химиотерапии по протоколу IMRT имеет допустимую токсичность и позволяет достичь высоких результатов лечения у прогностически неблагоприятной группы пациентов. Для дальнейшей оценки необходимо продолжение исследований.

Цель: оценка уровня локорегионарного рецидивирования и отдаленного метастазирования, степени токсичности химиолучевой терапии при ее сочетании с локальной гипертермией (ГТ) у больных плоскоклеточным раком анального канала в стадии T1-4N0, 1-3M0-1. Материалы и методы. С 2011 по 2015 г. 112 больным плоскоклеточным раком анального канала проведено комплексное лечение, включающее химиотерапию, 3D-конформную лучевую терапию и ее варианты - с модулированной интенсивностью (IMRT), объемно-модулированную лучевую терапию арками (VMAT) и локальную ГТ. Стадирование опухолевого процесса выполнялось по системе TNM (7-я редакция). I стадия установлена у 4 (3,6%) больных, II - у 39 (34,8%) больных; IIIA - у 33 (29,5%) больных, IIIB - у 34 (30,3%) больных и IV - у 2 (1,8%) больных. Медиана средней продолжительности прослеживания составила 32 мес (диапазон 3-63 мес). Локальная ГТ проведена 81 (72,3%) пациенту. Результаты. В течение 2-летнего периода наблюдения опухоль не определяется у 82 (73,2%) больных. Все рецидивы, вне зависимости от варианта комплексного лечения, возникли при местно-распространенной форме (IIIA/IIIB стадии болезни), из них достоверно чаще 22,2% в группе без применения ГТ и 4,7% - в группе с применением радиомодификатора, p=0,038. Отдаленные метастазы выявлены в 9,4% случаев у пациентов, получивших ГТ, и в 11,1% случаев при отсутствии радиомодификатора, p=1. Установлено также, что применение локальной ГТ ассоциируется с достоверным увеличением ранней дерматологической токсичности 2-й степени, p=0,056. Выводы. Локальная ГТ и усовершенствованные технологии конформной лучевой терапии повлияли достоверно на уменьшение частоты локорегионарных рецидивов. Однако их влияние на уменьшение отдаленного метастазирования отсутствует вне зависимости от комбинации в схемах химиотерапии. Переносимость сочетанного использования химиолучевой терапии с ГТ не вызвала дополнительных осложнений.

Analysis of the last data shows that there is a steady rise in colorectal morbidity not only in Russian Federation, but also in other developed countries. In rectal cancer treatment there are no standarts by the moment. Last years all over the world there are tendencies to use multicomponent complex modalities of treatment wich include not only surgery, but also radiation therapy and chemotherapy. Recurrent cancer is considered as radioresistent, and local treatment with high doses of radiation is frequently limited by normal tissues’ tolerance and by dose received in previous course. Reirradiation is always a risk because of cumulative radiation dose to organs at risk and normal tissues. Highly precise techniques of radiation therapy, such as IMRT, brachytherapy, IORT, stereotactic radiation therapy can be used in reccurent cancer treatment because of toxicity decrease and sparing of normal tissues. Some data shows that usage of modern technologies is effective when using CyberKnife. Stereotactic radiation theapy (SBRT) is a variant of aggressive treatment which is able to provide good local control with minimal toxicity. Innovative approach in reirradiation for patients with recurrent cancer is proton therapy and carbon ion therapy. Dose distribution in proton therapy with its practically no exit dose clears the way to new abilities in reirradiation, leads to dose decrease in tissues outside irradiated volume, and it’s very important in patients who got virtually maximal dose while treating initial disease.

Squamous-cell anal cancer is a rare disease that requires a comprehensive approach in treatment and skilled professionals. Modern diagnostics is important for rational choice of treatment tactics. Radiotherapy is the cornerstone of sphincter-sparing anal cancer treatment. Radiotherapy dose, volume and duration are the key factors affecting treatment efficacy and toxicity. 3D-conformal radiotherapy is a priority treatment allowing exact reproduction of treatment conditions, controlled by OBI (on-board imager) and kV X-Ray and cone-beam CT analysis. Intensity-modulated radiation therapy (IMRT) is a next-generation treatment with improved technologies, allowing better protection of normal tissues. Our experience with 21 squamous-cell anal cancer patients treated with IMRT during Nov 2011 March 2013 is presented in this article.

The paper presents outcomes of radiation and thermoradiation therapies of 83 patients with extraabdominal soft-tissue desmoid tumors. The patients received conservative treatment during 1987 to 2002. Changes in neoplastic disease following radiation versus thermoradiation therapies are compared in 67 patients followed up for at least 5 years after discontinuation of conservative treatment. Most patients presented with regression of desmoid tumors within 3 years after discontinuation of conservative treatment, though tumor regression time was longer in some cases. 5-year disease-free survival was greater in patients receiving thermoradiotherapy as compared to irradiation: 71.4 versus 27.7% (p<0.05), while continuing growth and disease recurrence rates were higher after radiation therapy: 6.1 versus 44.4% (p<0.05).