Background. The use of a combination of surgical decompression of the spinal cord and stabilization of the spine with subsequent conformal radiation therapy of tumor remnants in the treatment of patients with metastatic vertebral tumors makes it relevant to calculate and visualize the volume of a partially removed metastatic vertebral tumor without intraoperative X-ray computed tomography (CT). Objective. The purpose of the study was to evaluate the algorithm for calculating the volume of the cytoreductively removed part of the body of the vertebra affected by the tumor using optical navigation. Material and methods. On 6 human cadavers, a typical posterior approach and navigated resection of the vertebral body from a posterolateral transpedicular approach at several levels were simulated. A total of 15 patients underwent palliative surgical treatment for metastatic tumors of the spine, including decompressive and stabilizing intervention using a navigation system. During the anatomical experiment, the volume of the cavity after removal of a part of the vertebral body was calculated using a navigation system. Then, the volumes of the resected part of the vertebra, calculated during the anatomical experiment or during the surgical intervention, were compared with the results calculated later using the CT neuroimaging data. Results. When analyzing the data from the laboratory and clinical phases of the experiment, it was found that the calculated indicators of the volume of the removed part of the vertebral bodies at different levels, calculated on the basis of intraoperative measurements and according to the results of control CT, do not differ statistically significantly. Conclusion. The navigation system under the conditions of experimental interventions in biological models and in the surgical treatment of patients with metastatic spinal involvement showed high accuracy of software algorithms in calculating the volume of cytoreduction of tumor tissue.

Purpose of the study. To develop a diagnostic calculator for assessing the expression of profile microRNAs (miRNAs) that are significant for the oncogenesis of thyroid cancer, to introduce it into clinical practice and to evaluate the effectiveness of the proposed method for early diagnosis of malignant neoplasms of the thyroid gland in uncertain diagnostic situations after fine-needle aspiration biopsy (FNAB).Material and methods. The previously developed «Method for Diagnosing Malignant Neoplasms of the Thyroid Gland» (patent RU2820815 C1) was tested on 284 patients of the dispensary group with nodular formations of the thyroid gland according to the results of ultrasound and an uncertain conclusion after FNAB. The number of patients with papillary thyroid carcinoma was 83 (29,2%), follicular carcinoma 43 (15,1%) and with benign thyroid pathology (follicular adenoma) – 158 (55,6%) people. The expression of miRNA-146b and –574–3p in cytological samples of thyroid nodules after FNAB was assessed using the real-time PCR method.Results. In thyroid cancer patients, the expression of miRNA-146b was higher (p=0,007) compared to patients with benign pathology, while the expression activity of miRNA-574–3p was lower (p=0,013). To assess the index of reciprocal paired dysregulation of miRNA-146b and miRNA-574–3p expression in thyroid cells, it is recommended to determine the ratio of the expression values of the corresponding molecules. If the ratio index of miRNA-146b and miRNA-574–3p expression is higher than 4.5, then a conclusion is made about a malignant neoplasm of the thyroid gland. The diagnostic coefficient calculated by the developed formula using the logistic regression method also allows diagnosing malignant neoplasm of the thyroid gland when compared with the cutoff level. The proposed methods are highly informative.Conclusion. Evaluation of the expression of miRNA-146b and miRNA-574–3p in the cells of thyroid nodules obtained by FNAB allows improving the diagnosis of malignant pathology in mutation-negative thyroid nodules with uncertain FNAB results.

Aim. To create a collection of plasma samples of patients with brain tumors (BTs) for the development of a diagnostic microRNA (ribonucleic acid) panel of glial tumors.Material and methods. Plasma samples of patients with benign and malignant BTs were obtained by double centrifugation of whole blood and then frozen at -75оС.Fifty-nine RNA samples isolated from blood plasma were analyzed by next-generation sequencing (NGS).Results. Currently, the biobank contains samples from 339 patients with primary and secondary BTs and 10 control group individuals (698 samples — 2 plasma aliquots per individual), including 143 men and 206 women. The age of the patients ranged from 19 to 91 years (median — 56 years). Primary BTs (41%) included two following groups: benign (33,7%) and malignant (66,3%). Meningiomas constituted the bulk (91%) of the benign BTs. Among the malignant tumors, glioblastomas (46,7%) and astrocytomas (41,6%) prevailed, while oligodendrogliomas and ependymomas accounted for only 9,1 and 2,5%, respectively. Secondary BTs (59%) are represented by recurrent glial tumors (92,5%) and metastatic tumors (7,5%) of lung cancer (71,4%) and breast cancer (28.6%). A protocol for the primary preparation of liquid biopsy samples was implemented, which made it possible to obtain high-quality deoxyribonucleic acid libraries for the selected microRNA profiling platform.Conclusion. The creation of a plasma sample collection is the basis for searching circulating biomarkers of BTs.

Invasion and metastasis are well-known hallmarks of cancer, with metastatic disease accounting for 60% to 90% of cancer-related deaths [...]

УДК 616-006.3.04-036.8ВЛИЯНИЕ ВОЗРАСТНЫХ, ГЕНДЕРНЫХ И ГИСТОЛОГИЧЕСКИХ ХАРАКТЕРИСТИК НА ОТДАЛЕННУЮ ВЫЖИВАЕМОСТЬ БОЛЬНЫХ САРКОМАМИ МЯГКИХ ТКАНЕЙ 1 Кит О.И., 1 Аушева Т.В., 1 Максимов А.Ю., 2 Демидова А.А., 1 Алиханова С.С., 1 Шульга А.А., 1 Галина А.В., 1 Гурова С.В., 1 Ващенко Л.Н. 1 ФГБУ «Научный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, Ростов-на-Дону; 2 ФГБОУ ВО «Ростовский государственный медицинский университет» Министерства здравоохранения Российской Федерации, Ростов-на-Дону

Background. Retroperitoneal tumors are rare, heterogeneous malignant neoplasms. Due to the low sensitivity of tumor to chemoradiation, surgical resection is the only curative treatment method for retroperitoneal sarcomas. Performance of radical surgery improves the outcome for these patients. There are little data about the results of the treatment of the patients who underwent en bloc resection of the retroperitoneal tumors combined with the resection of large vessel. Aim. To analyze surgical and oncological outcomes of treatment retroperitoneal neoplasms with vascular involvement. Materials and methods. From 2019 to 2022, 27 patients with retroperitoneal sarcomas underwent surgical treatment with the resection of large vessels during the period. Results. The average diameter of the tumors was 17 (11–39) cm. The most common histological type was moderately differentiated liposarcoma (33.4 %), followed by pleomorphic liposarcoma (22.2 %), highly differentiated (18.5 %), undifferentiated sarcoma (18.5 %), leiomyosarcoma (7.4 %). Resection of the suprarenal segment of the inferior vena cava (IVC) with prosthetics was performed in 4 cases, resection of the renal segment with renal vein reimplantation – in 1 case, resection of the infrarenal segment of the IVC with prosthetics – in 8 cases. A synthetic prosthesis was used as a conduit in all cases. Tangential resection of the suprarenal IVC portion was performed in 1 patient, infrarenal portion – in 5 patients. A resection of the infrarenal IVC portion was performed without reconstruction in 1 case. Resection of the iliac vein was required in 6 patients; in one case the resection of the arterial iliac segment and prosthetics was added. Complete resection (R0–R1) was achieved in 85.2 % of the cases. The incidence of postoperative complications went as far as 25.9 % with no postoperative mortality. Despite ongoing anticoagulant therapy, the frequency of thrombosis in venous reconstruction zone in the early postoperative period (1 month) was 7.4 %. The median relapse-free survival was 16 months, and the median of overall survival was not achieved. Conclusion. Combined operations with the excision of retroperitoneal malignancies and angioplasty have explicitly acceptable level of postoperative complications and mortality. Eradication of retroperitoneal tumor with large vessels invasion allows to enlarge the life expectancy of patients often considered to be inoperable.

Введение. Корректная оценка стадии и прогноза является основой успешного лечения любой опухоли. Цель — оценить роль ряда иммунологических параметров локального иммунитета при раке ободочной кишки (РОК) в зависимости от распространенности процесса и на основании полученных данных разработать комплексную модель для определения вероятности лимфогенного метастазирования опухоли. Материалы и методы. В работу включено 50 пациентов РОК: c поражением лимфатических узлов (N+) — 27 пациентов (54 %), без поражения (N0) — 23 пациента (46 %). Из ткани опухоли, перитуморальной зоны (1–3 см от опухоли), линии резекции (~10 см от опухоли) была получена клеточная суспензия для выявления основных субпопуляций лимфоцитов, а также определения экспрессии TLRs (2, 3, 4) на CD45+(лимфоцитах), CD45-EpCAM+ (эпителиальные клетки). Статистический анализ результатов исследования проводился с помощью программы STATISTICA 13.3. Результаты. В тканях опухоли у пациентов с N0 увеличено количество T-лимфоцитов, натуральных киллеров (NK). В перитуморальной зоне при N0 отмечено более низкое содержание CD19+, а при N+ — двойных позитивных лимфоцитов (ДП), NK (p < 0,05). Для тканей опухолей группы N0, в отличие от N+, характерно уменьшение количества опухолевых клеток, экспрессирующих TLR3. В перитуморальной зоне обеих групп отмечено разнонаправленное изменение количества клеток, которые экспрессируют TLR2: уменьшение — при N0, увеличение — при N+(p < 0,05). При анализе относительного количества лимфоцитов во фрагментах тканей первичных опухолей пациентов с N0 отмечено уменьшение относительного количества клеток, экспрессирующих TLR2, и увеличение экспрессирующих TLR3,4, а для пациентов N+ отмечено увеличение количества клеток, которые экспрессируют TLR4 в 2,5 раз (p < 0,05). С помощью метода логистической регрессии была разработана комплексная модель для определения вероятности лимфогенного метастазирования РОК. Индивидуальные значения пациентов подставляются в математическую модель и рассчитывается вероятность N+ (диагностическая чувствительность — 89,1 %, специфичность — 88,2 %). Выводы. Предложенная модель позволит прогнозировать распространенность процесса на предоперационном этапе у больных РОК, а также может стать одним из методов уточняющей диагностики в стадировании процесса.

AIM: to evaluate results of rectal resection in metastatic rectal cancer. PATIENTS AND METHODS: a retrospective analysis of the results of treatment of 84 patients with symptomatic rectal cancer at stage IV, who underwent rectal resection in 2015-2020. RESULTS: anastomotic leak developed in 5 (5.9%) patients. Postoperative mortality rate was 1 (1.2%). Ileostomy closure was performed in 66 patients (78.6%) 17.9 months after initial surgery. Progression of the disease was detected in 60 (71.4%) patients at following organs: liver (42.9%), peritoneum (19%), lungs (15.5%). Stabilization was significantly higher after systemic chemotherapy before and after perioperative chemotherapy comparing to patients who had preoperative radiation (p = 0.013). Proportional Cox regression model risks showed that the chances of death in patients with advanced rectal cancer after surgery was 4.1 times higher for peritoneal carcinomatosis, 2.9 times for liver metastases and 1.5 for multi organ metastasis. CONCLUSION: low anterior resection with defunctioning ileostomy is associated with acceptable anastomotic leak rate (5.9%) and mortality (1.2%). Systemic chemotherapy in combination with target agents is preferable initial treatment in patients with metastatic rectal cancer.

AIM: to assess the risk of severe low anterior resection syndrome (LARS) in patients with rectal cancer after combined treatment.PATIENTS AND METHODS: from July 2022 to November 2023, 50 patients with rectal cancer underwent radiation with a total focal dose of 50–54 Gy with radiomodification with capecitabine and low anterior rectal resection with preventive ileostomy. The ileostomy was closed after 4 months. Prior to and after radiation, the anorectal function was assessed using high-resolution anorectal manometry (HRAM) and the LARS scale.RESULTS: the most significant predicting factors for severe LARS were maximal contraction pressure and first sensation volume. Three months after ileostomy closure, the patients were divided into groups depending on the HRAM parameters. Group 1: nine patients with severe LARS (34 points on the LARS scale), with a decrease in maximal contraction pressure by ≥ 30% and an increased first sensation volume by ≥ 60%, according to HRAM. Group 2: four patients out of 36 had severe LARS (31 points on the LARS scale), with a decrease in maximal contraction pressure by 5–29% and an increased first sensation volume by 10–59%, according to HRAM. Group 3: in 5 patients with a decreased maximal contraction pressure by ≤ 4% and an increased volume of the first sensation by ≤ 9%, LARS did not develop.CONCLUSION: a decrease in the maximal contraction pressure by 30% or more and an increase in the volume of the first sensation by 60% or more after radiation therapy can increase the risk of severe LARS. This group of patients requires prevention and correction of anorectal dysfunction.

Мета-анализ был направлен на оценку связи между полиморфизмами rs2107425, rs2839698, rs217727, rs3741219 гена H19 и риском развития рака молочной железы. Поиск публикаций проводили в базах данных Google Scholar и PubMed за последние 13 лет. Ассоциацию оценивали по статистическим критериям отношения шансов (ОШ) с 95% доверительным интервалом (ДИ). Для проведения мета-анализа использовали программное обеспечение RevMan (Cochrane Collaboration, 5.3. Копенгаген). Для оценки связи четырех полиморфизмов rs2107425, rs2839698, rs217727, rs3741219 с риском развития рака молочной железы в мета-анализ были включены 9 исследований случай-контроль с общей выборкой из 6572 пациентов с раком молочной железы и 6968 доноров в контрольной группе. В результате исследования мы наблюдали связь между rs2839698 H19 и риском развития рака молочной железы в аллельной модели (ОШ = 1,33, 95% ДИ: 1,00- 1,76, Pz = 0,005, Pi2 = <0.00001). Кроме того, в рецессивной модели риск развития рака молочной железы также был ассоциирован с мутантным аллелем rs2839698 (ОШ = 1,33, 95% ДИ: 1,03-1,71, Pz = 0,03, Pi2 = 0,05). Значимых ассоциаций с риском развития рака молочной железы полиморфизмов rs2107425, rs217727, rs3741219 не обнаружили. Настоящий мета анализ показал, что полиморфизм rs2839698 H19 ассоциирован с риском развития рака молочной железы. The meta-analysis was aimed to evaluate the association between polymorphisms rs2107425, rs2839698, rs217727, rs3741219 of the H19 gene and the risk of developing of breast cancer. Publications were searched in the Google Scholar and PubMed databases until August 2023. The association was assessed by statistical odds ratio (OR) criteria with a 95% confidence interval (CI). RevMan software (Cochrane Collaboration, 5.3. Copenhagen) was used for the meta-analysis. To assess the association of polymorphisms rs2107425, rs2839698, rs217727, rs3741219 with the risk of developing breast cancer, 9 case-control studies with a total sample of 6572 patients with breast cancer and 6968 donors in the control group were included in the meta-analysis. As a result of the study, we observed an association between rs2839698 H19 and the risk of developing breast cancer when calculating the allelic model (OR = 1.33, 95% CI: 1.00-1.76, Pz = 0.005, Pi2 = <0.00001). In addition, analysis of the recessive model also showed that the risk of developing breast cancer was significantly associated in individuals with a mutation in the polymorphic allele rs2839698 (OR = 1.33, 95% CI: 1.03-1.71, Pz = 0.03, Pi2 = 0.05). When calculating genetic models for the rs2107425, rs217727, rs3741219 polymorphisms, no statistically significant associations with the risk of developing breast cancer were found. The present meta-analysis showed that the H19 rs2839698 polymorphism associated with the risk of breast cancer.

Nowadays, there is a new concept that says that mitochondria naturally circulate in the blood and this is characteristic of both human and animal bodies. It is believed that circulating mitochondria can easily pass through tissue barriers due to their small size (50–400 nm). The phenomenon of mitochondrial intercellular transfer, which is bidirectional, has been observed in vitro and in vivo , under both physiological and pathophysiological conditions, and among a variety of cells, including malignant tumor cells. Circulating cell-free intact mitochondria are thought to play an active biological and physiological role, as mitochondria are already known to be systemic mediators of intercellular communication, transmitting hereditary and non-hereditary biological components, including MtDN A. Mitochondrial components of cellular origin, including mitochondrial DNA, were detected in the extracellular space. There are about 50,000 times more copies of the mitochondrial genome than the nuclear genome in the blood plasma of healthy people. The researchers confirmed that mitochondrial cell-free DNA (McfDNA) is stable enough for detection and quantification, implying that there are stable structures protecting these DNA molecules. The circulating mitochondrial genome, which is released as a cell-free mitochondrial DNA, is recognized as a new biomarker of mitochondrial stress and signal transduction. McfDNA has become an attractive circulating biomarker because of its potential use in diagnostic programs for various diseases, e. g., diabetes, acute myocardial infarction, and cancer. There is no doubt that detection of circulating mitochondria and their DNA in body fluids opens up a new promising scientific direction in biology and medicine. The article analyzes modern scientific data devoted to proving the existence of extracellular mitochondria, their functions outside the cell and diagnostic value.

Colorectal cancer (CRC) is the second in mortality among cancers with high incidence worldwide. About 5 % of patients had a previous oncopathology and 20 % develop a second malignancy. CRC molecular genetic mechanisms in primary multiple cancers (MPCs) are not fully understood. This study aimed to investigate mutational characteristics of primary CRC compared to MPCs with colorectal component. 336 CRC patients and 52 MPCs patients with a colorectal component (C97CRC) (TCGA-COAD data) were included. Comparative bioinformatics analysis of genetic mutations, their interactions, effect on signaling pathways, survival rate, and druggable categories was conducted. CRC was characterized by PIK3CA and APC mutations, while 17 mutations in other genes were identified in C97CRC. In CRC group, co-occurring somatic variants in TP53/APC and KRAS/APC were the most common, while in C97CRC, KRAS/SOX9 was specifically found. TP53/SYNE1, TP53/MUC16, and TP53/ TTN mutational combinations were associated with a decreased survival rate in CRC group. Collagen type VI alpha 3chain protease and its inhibitor were suggested as specific druggable targets in C97CRC group. The differences in mutational profiles between groups may indicate evolutionary features of CRC as a primary and secondary malignancy. Described druggable categories open up prospects for treatment development of CRC and MPCs with a colorectal component.

Metastatic lesions account for about 50–60 % of all cases of colorectal cancer (CRC). Currently, the prognosis for metastatic CRC has significantly improved due to the advent of effective drug therapy and the expansion of surgical treatment options. In this regard, the study of modern directions of treatment of metastatic CRC is of particular interest.In this study, both literature data and obtained treatment results of patients with metastatic colorectal cancer have been analyzed (PubMed, Scopus, eLibrary databases were used) at the National Medical Research Centre for Oncology.Currently, many factors should be taken into account when planning therapy for patients with metastatic CRC: the characteristics of the tumor itself (biology and localization of the tumor, tumor burden, RAS, BRAF mutational status), the patient (age, performance status, functional state of organs and systems, comorbidity, patient attitude, expectations and preferences) and the treatment itself (toxicity, flexibility of the treatment program, socio-economic factors, quality of life). With a resectable process, surgical treatment with adjuvant or perioperative chemotherapy, and with potentially resectable liver metastases, with massive prevalence, unfavorable prognosis - to carry out the most active drug therapy taking into account the mutational status of the tumor in order to transfer the process to a resectable one. In case of widespread colorectal cancer, drug therapy lines are consistently carried out, the selection of which is based on the goals of therapy, the type and time of primary therapy, the mutation profile of the tumor, and the toxicity of drugs.Patients with metastatic liver and/or lung lesions should be considered through the prism of surgical treatment, since it is surgical intervention that can significantly improve the results of treatment of patients. Therefore, patients with potentially resectable metastases should receive the most effective treatment and be operated on as soon as the process becomes resectable. At the same time, modern chemotherapy and targeted therapy are an integral part of the treatment of patients with metastatic colorectal cancer.

Purpose of the study. Development of a method for preventing hemorrhages during stereotactic biopsy of a brain tumor using liquid hemostatic matrices on the example of the drug "Floseal®".Patients and methods. The target of the biopsy is the most representative area of tumor tissue according to the data of various modalities of MRI neuroimaging, including contrast-enhanced ones. Out of 133 patients, 60 patients with signs of intraoperative bleeding along the biopsy needle cannula were included in the study group. Further, patients with signs of intraoperative bleeding along the cannula of the biopsy needle were divided into 2 subgroups by independent sequential randomization. Control subgroup (n = 45): cases with signs of intraoperative bleeding of varying severity were operated on, according to the standard technique, without the use of the liquid hemostatic drug Floseal®. The main subgroup (n = 15): in case of intraoperative signs of bleeding, the hemostatic fluid drug Floseal® was injected into the area of tumor material removal.Results. In 6.7 % of patients of the control subgroup, the formation of massive intracerebral hemorrhages was noted in the postoperative period. In 53.3 % of the observations of the control subgroup according to X-ray computer examinations of the brain, there were signs of minor hemorrhages at the point of tumor material collection, which did not require repeated surgical interventions. Postoperative hemorrhages after injection of the Floseal® liquid hemostatic matrix into the biopsy needle in the study subgroup were not detected according to neuroimaging X-ray CT.Conclusion. A method of hemostasis has been developed to prevent hemorrhages using liquid hemostatic matrices. If signs of bleeding from the biopsy needle appeare, the introduction of a hemostatic matrix in the volume of 2 ml helps to manage bleeding intraoperatively, as well as to prevent the occurrence of hemorrhage in the early postoperative period.

Background. Treatment of locally advanced malignant tumors of the tongue at the present stage of development of clinical oncology is a difficult task and is an important problem in oncology. The aim — to screen for genetic and epigenetic predictors of locally advanced tongue cancer sensitivity to platinum therapy. Methods. A comprehensive clinical and molecular genetic examination was carried out in 100 patients with locally advanced malignant tumors of the tongue, as well as 30 donors without oncological pathology. The study used a new method for the treatment of locally advanced squamous cell carcinoma of the tongue using 2-stage superselective embolization as a component of complex treatment. At the first stage, a screening bioinformatics analysis was carried out to form a panel of genetic loci associated with sensitivity to therapy with platinum drugs. The determination of the relative copy number and expression of these loci responsible for repair and for the proliferation regulation and apoptosis was performed by Real-Time qPCR. Results. Integration of RNA-seq datasets, copy number variation data, and relevant clinicopathological information from TCGA and GEO databases allowed us to identify 65 genetic loci associated with sensitivity to platinum therapy. These genes were validated in patient biological material. Laboratory screening showed differential expression of BRCA1, BLM, ERCC1, EXO1, RAD50, PIF1, LIG1, BCL2, ERBB2, MAGEH1, NGFRAP1, and CASP8 genes, correlating with changes in their tissue copy numbers, between groups of patients sensitive and resistant to platinum therapy. The profile of gene copy numbers of BRCA1, BLM, EXO1, RAD50, PIF1, LIG1, CASP8, MAGEH1 and NGFRAP1 was detected in the blood plasma of patients with squamous cell carcinoma of the tongue, which was differential for two groups of patients — sensitive and resistant to platinum therapy. Based on bootstrap models, the final gene panel was obtained: BLM/NGFRAP1, BRCA1/MAGEH1, EXO1/RAD50, BLM/CASP8, BRCA1/RAD50 and BRCA1/EXO1, providing diagnostic sensitivity at the level of 95% and specificity at the level of 90% (AUC 0.98) when dividing patients into a group sensitive and resistant to platinum therapy. Conclusion. Comprehensive bioinformatics analysis of RNA sequencing data, gene copy number data, and clinical and pathological information from the TCGA and GEO databases, as well as laboratory screening of potential predictors, allowed us to obtain a panel of genes — BLM/NGFRAP1, BRCA1/MAGEH1, EXO1/RAD50, BLM/CASP8, BRCA1/RAD50, and BRCA1/EXO1, the combination of which provides high diagnostic sensitivity and specificity in dividing patients into a group susceptible and resistant to platinum therapy.

Purpose of the study. Assessment of clinical safety and effectiveness of radium‑223 in patients with bone metastases from castration-resistant prostate cancer.Patients and methods. The study involved materials on 15 patients with bone metastases from castration-resistant prostate cancer aged 58–81 years, with the mean age of 67.2 ± 6.5 years, who were examined and received full treatment with 6 intravenous injections of radium‑223 chloride [223Ra] at the National Medical Research Centre for Oncology. Most patients (73.3 %) showed ECOG 1 performance status. Pain syndrome before the treatment was registered in 12 (80 %) patients.Results. Evaluation of the tolerability of radium chloride did not show hematological reactions such as anemia and thrombocytopenia. One patient had grade II intestinal toxicity after the 3rd injection managed with medication. Assessment of indirect signs of the treatment effectiveness demonstrated that 6 people showed an increase in PSA during treatment, while alkaline phosphatase levels were within normal range indicating no bone destruction. 8 of 12 patients with pain syndrome showed its relief during the therapy. The following results were obtained during a follow-up examination after 3 months in 15 patients who received the full treatment course: stabilization in 8 patients; improvement in 4 patients with decreased metabolic activity and lower numbers of metastatic foci; progression with the appearance of new metastatic foci in the bones in 3 patients.Conclusion. Radium chloride showed good results in the treatment of patients with bone metastases from castration-resistant prostate cancer. Low toxicity and improvement in the quality of life by pain relief make this treatment technique promising.

Central organelles in cells are mitochondria, which are essential for many fundamental biological processes. In the course of evolution, mitochondria have been transformed into signaling centers in biological systems that can cause changes in the cell via secreted factors and affect physiology of humans and animals. Along with performing many key functions for the cell, mitochondria have also evolved into active hubs that can both control cellular programs through interaction with other compartments, such as the endoplasmic reticulum, and affect tissues, determining the health of the body via mechanisms that we are only beginning to understand.

Purpose of the study . Evaluation of the effectiveness of extracranial stereotactic radiation therapy in various fractionation regimens in the treatment of patients with metastatic vertebral lesions. Patients and methods. The study included 12 patients with metastatic spinal lesions who underwent extracranial stereotactic radiation therapy (SBRT) on a Novalis Tx linear accelerator, Varian, in radiosurgery mode (SRS; in 1 fraction) and hypofractionation mode (SFD 5Gy, TFD 25Gy, 5 fractions) in the period from 01/01/2020 to 03/31/2022. The assessment of local control was carried out using positron emission tomography – computed tomography (PET-CT) from 18FDG. The intensity of the pain syndrome before and after radiation was assessed using a visual analog pain scale (VAS). Results. 19 vertebrae with metastatic lesions were irradiated in 12 patients. The SBRT technique in hypofractionation mode was used in 6 (50 %) patients, in radiosurgery (SRS) mode was used in 4 (34 %) patients, in 2 (17 %) patients a combination of irradiation techniques was used on various affected segments of the spinal column. The general tumor volume (GTV) averaged 30.56 = 7.8 km 2 . When using the radiosurgical irradiation regimen, SFD ranged from 16 to 18 Gy. When using the hypofractionation technique, the total focal dose (TFD) was 25 Gy, a single focal dose (SFD) was 5 Gy. Conclusion. Stereotactic radiation therapy and radiosurgery of metastatic vertebral tumors without compression of neural structures provides local tumor control in 92 % of patients within 6 months and in 83 % of patients within 1 year, regression of pain after irradiation – in 67 % of patients.

Introduction. The choice of treatment between extracranial stereotactic radiotherapy and surgery for metastatic vertebral body tumors with minimum or no epidural compression of the dura mater is yet to be clearly defined. Materials and methods. The study enrolled 41 patients who received treatment at the National Medical Research Centre for Oncology (Rostov-on-Don, Russia) from January 1, 2014 to December 31, 2022. The inclusion criterion was the presence of a metastatic vertebral tumor, with minimal or no epidural compression of the dura mater and the radicular infundibulum (ESCC 0–1b). Patients were divided into two groups: 21 patients (SBRT group) received only extracranial stereotactic radiation therapy and 20 patients who underwent surgery followed by adjuvant extracranial stereotactic radiation therapy 1 month after surgery (Op.+Аd.SBRT). Results. The early postoperative period revealed no deterioration in the neurological status of patients in the SBRT group, no improvement in the Karnofsky performance status and no regression of pain syndrome, in contrast to patients in the Op+Аd.SBRT group. In a month after the surgery, tumors continued to grow in 3 patients (21%) of the SBRT group and only in 1 patient (6%) of the Oр.+Аd.SBRT group. Discussion. In the early postoperative period, the Op.+Аd.SBRT group showed an improvement in the functional status and a significantly more pronounced regression of the pain syndrome in the patients of the SBRT group, which can be explained by direct decompression of the compressed spinal root and elimination of increasing instability of the spinal column. Conclusion. Surgical treatment complemented by adjuvant extracranial stereotactic radiation therapy constitutes the preferred treatment for patients with metastatic spinal lesion with minimal epidural spread, without epidural compression of the spinal cord, with severe pain syndrome and signs of increasing instability of the spinal column.