Background. Salvage radiation therapy (SRT) is the main treatment option for patients with biochemical and/or locoregional recurrence of prostate cancer without signs of distant metastasis after radical prostatectomy (RP). This prospective study demonstrates the long-term results of SRT in this category of patients using modern technologies and radiotherapy techniques. Aim. To improve the effectiveness of SRT in patients with biochemical recurrence of prostate cancer and no signs of distant metastasis after RP through improvement of radiotherapy techniques and identification of prognostic factors. Materials and methods. A prospective single-center phase II cohort study included patients with biochemical recurrence of prostate cancer and no signs of distant metastasis after RP. All patients underwent traditional or hypofractionated SRT using modern technologies: 3DCRT, IMRT, VMAT, IGRT. Some patients underwent hormone radiation therapy. Results. Between 2009 and 2018, SRT was performed in 411 patients. Median follow-up was 43 (18–86) months. Three-year and 5-year progression-free survival were 81.3 and 77.6 %, respectively. The value of prostate-specific antigen at the time of treatment initiation, its short doubling period after RP, and recurrence in the regional pelvic lymph nodes are 3 significant adverse prognostic factors. Conclusion. SRT is the only radical method of treating patients with locoregional recurrence of prostate cancer after RP with favorable long-term oncological results.

Background. Hypofractionated radiation therapy is a standard radical approach for treatment of patients with localized prostate cancer of low and intermediate risk. Clinical practice of applying this approach in patients with high and very high risk of progression has not been established.Aim: improving the effectiveness of hormonal/radiation therapy in patients with high and very high risk prostate cancer using an original radiotherapy technique.Materials and methods. In 2012, a new technique of hypofractionated radiation therapy based on simultaneous integrated boost aimed at the prostate, seminal vesicles, and regional lymph nodes was developed at the Radiotherapy Department of the N.N. Blokhin National Medical Research Center of Oncology. The phase II single-center prospective cohort trial included 40 patients with high and very high risk prostate cancer who received combination hormonal/ radiation therapy between 2012 and 2018. Median follow-up was 96 (61–124) months.Results. None of the patients had grade III–IV adverse events (according to the RTOG/EORTC scale) in the distal parts of the gastrointestinal tract and urogenital system. Five-year biochemical and local controls were 80 % and 100 %, respectively.Conclusion. The results of this study show that the developed hypofractionated radiation therapy technique is safe with 5-year biochemical control outcomes matching reported in the literature. However, to determine true clinical significance of the technique, initiation of a randomized phase III trial is required.

The abscopal effect in oncology has been known for 70 years, but until recently its clinical significance was rather low. The development of immune response checkpoint inhibitors has led to an active study of this phenomenon. There is now evidence of improved survival among patients, in whom the abscopal effect has been documented, opening new perspectives for the treatment of cancers at different stages. This review presents data on the mechanisms of the abscopal effect, experimental and clinical data, current limitations and possible perspectives. The aim of the study was to investigate the current concept of the abscopal effect occurrence and to evaluate the prospects of using the abscopal effect in therapy of metastatic cancer. Material and Methods. We searched publications in Pubmed system from 2010 to 2023. Of 286 publications, 72 were used for writing the review. Results. In the era of widespread use of immune checkpoint inhibitors (ICIs) for cancer therapy, the abscopal effect appears to be an effective therapeutic approach with broad prospects of application in the treatment of patients with metastatic cancer. Conclusion. The incidence of the abscopal effect has increased with the advent of immune therapy, and the use of ICIs with radiation therapy (RT) has shown improved survival even in patients with advanced disease. More research is needed to establish standardized treatment protocols, including the optimal dose and timing of RT, as well as the efficacy and safety of combination therapy with different classes of ICIs. Further search for clinical and laboratory abscopal effect predictors, which could allow personalized treatment approaches, is required.

Relevance: Radiation therapy is one of the main local method of treatment for patients with prostate cancer and regional metastases of pelvic lymph nodes. However, unfortunately, some patients can be subject to development progression of disease as emergence regional lymph node’s metastasis of retroperitoneal space. Purpose: To develop a new more effective radical method of radiation therapy for patients with metastases in the regional lymph nodes. Material and methods: The radiotherapy department has developed a new method of radiation therapy for patients with prostate cancer and metastases in the regional lymph nodes, which includes prophylactic irradiation of retroperitoneal lymph nodes. Results: 20 patients with prostate cancer and metastases to the regional lymph nodes were treated from June 2020 to December 2022. The median follow-up was 17 months. In all patients, radiation therapy was carried out in combination with neoadjuvant, concomitant and adjuvant hormone therapy with analogues of luteinizing hormone releasing hormone. All patients received a course of radiation therapy without interruption. At the time of analysis, all patients are alive and stay by under active surveillance with no signs of progression. At the end of radiation therapy, all patients noted manifestations of toxicity of the I-II degree genitourinary and gastrointestinal systems. There is a gradual recovery of patients in the form of a decrease and relief of radiation reactions in 3-6 months after the end of radiation therapy. Conclusion: The first data evaluating the safety of the new developed method of radiation therapy by hypofraction mode with additional prophylactic irradiation of the retroperitoneal lymph nodes demonstrate good tolerability. However, further study and conducting the 3rd phase of randomized trial are required to determine clinical efficacy.

Background. Salvage radiation therapy is the “gold standard” of treatment for patients with recurrent prostate cancer after radical prostatectomy. However, the results of the effectiveness of salvage radiation therapy in patients with regional recurrences are significantly lower than in patients with local one of prostate cancer, and, as a rule, the progression of the disease more often continues lymphogenic, affecting the next barrier of lymph outflow – retroperitoneal lymph nodes. Aim. To develop a new more effective radical method of salvage radiation therapy in patients with regional relapses of prostate cancer after radical prostatectomy. Materials and methods. The radiotherapy department of the N. N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia has developed a new method of hypofractionation salvage radiation therapy of patients with regional recurrences of prostate cancer after radical prostatectomy, which includes treatment not only to regional recurrences, the bed of prostate and regional lymph nodes of the pelvis, but also and prophylactic radiation treatment to retroperitoneal lymph nodes. Results. 25 patients were treated with prophylactic radiation treatment to retroperitoneal lymph nodes from 2018 to 2021. The median follow-up of patients was 19 (7–22) months. In all patients, radiotherapy was performed in combination with hormone therapy with analogues of luteinizing hormone releasing hormone with a median duration of administration of 8 (6–10) months. All patients were treated without interruption according to the previously planned dosimetric treatment plans. At the end of the course of radiation therapy, none of the patients had any pronounced negative effects of the III–IV degree (according to the RTOG /EORTC scale). The 1-year local and biochemical control of the disease were 100 and 88 %, respectively. Conclusions. Initial data assessing the safety of the newly developed salvage radiation therapy technique in hypofractionation mode with additional prophylactic of retroperitoneal lymph nodes demonstrate good tolerability. However, further study and randomized phase III clinical trial are required to determine clinical efficacy.

Introduction. The increase in the number of cured patients with squamous cell anal carcinoma and the quality of life is directly related to the improvement of radiotherapy departments technical equipment in oncological clinics.Purpose. One of the main tasks of improving technics and technology is reducting duration of chemoradiation therapy, and also number and duration of interruptions, plus more accurate determination of the tumor volume by using modern diagnostic methods, such as MRI, and creating the possibility of maximum impact on the tumor and identified affected lymph nodes while limiting dose to organs at risk.Materials and methods. During the period from 2000 to 2015 year, 301 patients with squamous cell anal carcinoma, stage T1–4N 0–3M0–1, were treated by radiation therapy with 2D-RT, 3D-CRT, or IMRT in a total dose of 50–60 Gy, in combination with chemotherapy and local hyperthermia.Results. The use of IMRT with MRI in comparison with 3D-CRT resulted in an increase of frequency of complete tumor response (at the time of first diagnostic control) up to 67.5 % (p = 0.071); reduction of frequency of interruptions in the treatment course up to 48 % (p = 0.005); significantly increased the 3-year overall survival rate to 92.9 % (p = 0.050), distant metastases — free survival — 91.0 % (p = 0.049), with a trend of improvement in locoregional control — 89.9 % (p = 0.179).Conclusions. The use of radiation therapy in its modern version, modern methods of visualization of tumor lesions and critical structures has reduced the interruptions in the course of treatment, achieved high immediate and long-term oncological results.

Objective: to evaluate the effectiveness of salvage radiotherapy in patients with recurrent prostate cancer after radical prostatectomy.Materials and methods. In the period from March 2009 to January 2015, 92 patients with prostate cancer and biochemical recurrences after radical prostatectomy underwent salvage radiotherapy with classic fractionation and hypofractionation of the radiation dose.Results and conclusion. Median follow-up duration was 40 months (12–78 months). Overall survival was 100 %. Local control was 100 %. One (1), 2, and 3-year disease-free survival in the whole patient group was 96, 91, and 86 %; in the hypofractionation group it was 98, 95, and 89 %; in the classical fractionation group it was 95, 87, and 84 %, respectively. We have determined that the period of doubling of prostate-specific antigen level of ≤6 months (p = 0.035) after surgical treatment and prostate-specific antigen level >0.5 ng/ml (p = 0.037) at the time of salvage radiotherapy are significantly associated with worse prognosis for treatment effectiveness. There weren’t any differences in late toxicity between the 2 patient groups.

Objective. To identify the possibility of multiparametrical magnetic resonance imaging (mpMRI) in the diagnosis of clinical recurrence of prostate cancer, with the aim of optimizing salvage radiation therapy (SLT). Material and methods. In this prospective study, the results of 89 patients with marker relapse (PSA) of prostate cancer (PCa) after radical prostatectomy was examined. mpMRI of the pelvis was performed before the SLT and 6 months later. Separately, in 44 patients, the data of dynamic contrast enhancement (DCE) with different contrast agents (gadobutrol, gadodiamide and gadoversetamide) were analyzed. Results . According to the model of multiple linear regression, the area of the substrate of clinical recurrence is statistically significantly correlated with the PSA level (R=0.74, p<0.0008), regardless of the all type of DCE administered. The sensitivity of mpMRI in detection of clinical recurrence of PCa was 92%, specificity 81%, accuracy 88%, which was assessed by comparison with PSA level. The use of the hypofractive radiation dose to the area of clinical recurrence of PCa, detected with mpMRI, showed a more progressive drop of the marker (PSA), compared to the standard SLT scheme (McNemarre test, p<0.03). A statistically significant correlations (by the Mann–Whitney criterion with p<0.018) from the signal change in DCE after the injection of contrast agents (different types) and the substrate area. Conclusion. mpMRI has high sensitivity, specificity and accuracy to detecting the substrate of the clinical recurrence of PCa. The use of DCE for concentration of 1.0 mmol (gadobutrol) significantly increases the reliability of detecting clinical recurrence of PCa, especially when the substrate is found to small and ultrasmall sizes. The application of DCE with the contrast agents at the concentration of 1.0 mmol (gadobutrol) prior to initiation of SLT course, helps to plan the proposed radiation exposure zone, with the aim of providing the necessary for a complete resorption of the recurrent tumor, a high tumor dose of radiation to the clinical recurrence region.

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.

The purpose of study is to evaluate the role of dynamic contrast intensification as a constituent of multi-parametric MR-therapy in diagnostic of clinical recurrence of prostate cancer and optimization of salutary X-ray therapy. Materials and method. The sampling consisted of 89 patients with marker (prostate specific antigen) prostate cancer recurrence after radical prostate ectomy. The preliminary examination established no distant metastases. The multi-parametric MR-imaging of pelvis minor was applied both before salutary X-ray therapy and 6 months later after with purpose of applied treatment control. In 44 patients’ analysis was applied to data of dynamic MR-imaging with contrast intensification constituent to multi-parametric MR-imaging with intravenous injection of various MR-mediums (1M Gadobutrol, ½M Gadodiamid and ½M Gadoversetamid). The results. The model of multiple linear regression was applied to demonstrate that square of substrate of clinical recurrence statistically reliably correlates with level of marker of prostate specific antigen (R = 0,74; p < 0,0008) independently of type of injected various MR-mediums. The sensitivity of multi-parametric MR-imaging in detection of clinical recurrence of prostate cancer was evaluated by comparison with levels of prostate specific antigen and amounted to 92%, specificity - to 82%, accuracy - to 88%. The application of technique of hypo-fractionating of radiation dose on area of clinical recurrence of prostate cancer detected by multi-parametric MR-imaging demonstrated more progressive decreasing of marker of prostate specific antigen as compared with standard scheme of salutary X-ray therapy (according McNemarre criterion p < 0,03). The statistically reliable dependence (Mann-Whitney criterion p < 0,018) of alteration of signal in case of dynamic MR-imaging with contrast intensification after intravenous injection of various MR-mediums from square of substrate of clinical recurrence of prostate cancer and initial concentration of injected various MR-mediums between 1M Gadobutrol and ½M Gadodiamid and ½M Gadoversetamid. Conclusion. The multi-parametric MR-imaging has high sensitivity, specificity and accuracy in detection of substrate of clinical recurrence of prostate cancer. The application of in initial concentration of 1M (Gadobutrol) reliably increase validity of detection of local clinical relapse of prostate cancer especially in case of detection of substrate of recurrence of enough little and extra-little sizes. The application of multi-parametric MR-imaging using various MR-mediums marker in initial concentration of 1M (Gadobutrol) prior to course of salutary X-ray therapy enables to plan a supposed zone of X-ray impact with the purpose of more personalized brining of of high tumorocide dose of radiation at the area of clinical recurrence of prostate cancer needed for full resorption of recurrent tumor.

Purpose: to estimate the rate of locoregional recurrence and distant metastases, and the grade of chemoradiotherapy toxicity when in combination with local hyperthermia for treating squamous cell anal canal cancer T1-4N0,1-3M0-1. Materials and methods. 112 patients with squamous cell anal canal cancer were treated between 2011 and 2015 with chemotherapy, radiation therapy based on 3D CRT, intensity-modulated radiation therapy (IMRT) and volumetric intensity modulated arc therapy (VMAT), and local hypothermia. Staging was based on TNM (7th edition): I - 4 (3.6%) patients, II - 39 (34.8%) patients; IIIA - 33 (29.5%) patients, IIIB - 34 (30.3%) patients and IV - 2 (1.8%) patients. The median of mean follow-up was 32 months (range, 3-63 months). Local hyperthermia was performed in 81 (72.3%) patients. Results. 2-year local control was 73.2%. All recurrences, no matter which chemotherapy was performed, were in patients with advanced disease (IIIA/IIIB stages), from which 22.2% relapses were in group without local hyperthermia vs. 4.7% in group with radiomodification, p=0.038. Distant metastases were found in 9.4% patients with hyperthermia and in 11.1% patients without radiomodification, p=1. Usage of local hyperthermia is associated with increase II grade of dermatological toxicity (p=0.056). Conclusion. The combination of local hyperthermia and modern technologies of conformal radiation therapy has influenced the decrease of locoregional recurrences, but it is associated with lack of influence on distant metastases appearance regardless on chemotherapy regimen.

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.

The introduction of innovative technical developments: the three-dimensional planning, using multileaf collimator, simulated by the intensity radiation therapy, improved methods of fixation significantly improved ability of accurate delivering and escalating of doses of ionizing radiation to the selected volume of tissues. This has changed the perception of the role of radiation therapy in the treatment of liver metastases. Foreign authors data suggest the possibility of reaching 95% local control one year after stereotactic radiotherapy, 92% - after two years (and 100% for tumors smaller than 3 cm.) with the development third or higher degree of radiation damage near in 2%. In 2011, after the technical upgrading of Blokhin Cancer center, the method of stereotactic radiosurgery (SBRS) was introduced in clinical practice for the treatment of patients with liver metastases. This method allows to create a high-dose ionizing radiation in metastatic tumor and cause the destruction of the tumor. This is a promising direction in the treatment of metastatic liver cancer significantly expanded the capabilities of the combined treatment. The article provides an overview of the literature on the treatment of liver metastases, and we publish the results of the use of stereotactic radiosurgery at thirty-five patients with liver metastases and clinical case of successful application of this method in patient with significant co-morbidity.

Penile cancer (PC) is a rare tumor; its annual incidence rate in Russia is 0.18 % per 100,000. Active work is now underway to develop organsparing treatment options for PC when the disease is detected in its early stage. The paper describes a clinical observation of a 79-year-old patient G. with PC who has undergone comfort radiotherapy using waterbox technology for organ-sparing treatment at the Radiology Department, N.N. Blokhin Russian Cancer Research Center. This technology ensures homogeneous therapeutic dose radiation distribution and allows adjustment of the therapeutic dose required for ionizing radiation of the surface tissues of the organ.

The introduction of innovative technical developments: the three-dimensional planning, using multileaf collimator, simulated by the intensity radiation therapy, improved methods of fixation significantly improved ability of accurate delivering and escalating of doses of ionizing radiation to the selected volume of tissues. This has changed the perception of the role of radiation therapy in the treatment of liver metastases. Foreign authors data suggest the possibility of reaching 95% local control one year after stereotactic radiotherapy, 92% - after two years (and 100% for tumors smaller than 3 cm.) with the development third or higher degree of radiation damage near in 2%. In 2011, after the technical upgrading of Blokhin Cancer center, the method of stereotactic radiosurgery (SBRS) was introduced in clinical practice for the treatment of patients with liver metastases. This method allows to create a high-dose ionizing radiation in metastatic tumor and cause the destruction of the tumor. This is a promising direction in the treatment of metastatic liver cancer significantly expanded the capabilities of the combined treatment. The article provides an overview of the literature on the treatment of liver metastases, and we publish the results of the use of stereotactic radiosurgery at thirty-five patients with liver metastases and clinical case of successful application of this method in patient with significant co-morbidity.

Morbidity and mortality from pancreatic cancer is steadily increasing. Resectable cases are not more than 20%. Conventional schemes of chemoradiation and radiation therapy are durable over the time, have toxicity and low treatment outcomes. Many foreign authors consider as promising the technique of stereotactic radiotherapy, which is often used in pancreatic cancer and permit achieving high local control. At our institution there has been developed and introduced into clinical practice a method of stereotactic radiotherapy for the palliative treatment of patients with pancreatic cancer, which improved not only the duration but also the quality of life of patients.

Prostate cancer (PC) is the most common cancer among men. The risk of local recurrence of PC after radical prostatectomy (RP) remains significant. Multiparametric magnetic resonance imaging (mpMRI) is an effective method of local PC recurrence detection in the prostatic bed in patients after RP. Sensitivity of ultrasound examination and other radiological methods for detecting a small-sized relapse is very poor. Use of mpMRI in improving diagnostic accuracy in local relapse detection of PC after RP is of current importance, primarily in patients suitable for salvage radiation therapy.

Brain metastases in breast cancer develop for 24-32 months after the detection of the primary tumor. The study included patients with brain metastases who were divided into three groups: the first group--with early chemoradiotherapy (CRT) without induction chemotherapy (IC) by capecitabine; the second group--with delayed CRT with 4 or 8 courses of IC by capecitabine; the third group (a historical control) who received only whole brain radiation therapy. The median time to progression of intracranial metastases was 15.3, 12 and 5 months, respectively. The median time to the intracranial progression significantly less in the third group (5 months) compared with the first (15.3 months) (p = 0.0007) and the second (12 months) (p = 0.027) groups. The overall survival rate was 22.1, 15.1 and 6.8 months in three groups, respectively.