Purpose: We evaluate various approaches to target volume definition and boost delivery in breast cancer patients with pCR after neoadjuvant systemic therapy (NST) who were treated by radiotherapy without a surgery. Materials and methods: A pathological complete response (pCR) was diagnosed in 20 of 27 patients included in "surgery de-escalation" prospective observation study. Clips were placed in the primary tumor volume (PrTV) before NST and during the vacuum aspiration biopsy after NST. Twenty patients with pCR underwent the whole breast irradiation and a boost to the PrTV. High-dose rate brachytherapy (HDRB) was the basic technique for boost delivery. Finally, we identified the value of fused images (computed tomography [CT] before NST with simulation CT), clips and their combination for an accurate boost delivery. Results: A complete overlap between PrTV on pre-treatment CT with the localization of the clips on simulation CT was mentioned in 10, partial mismatch in three patients. In 12 of these 13 women, HDRB was successfully used for the boost delivery. In five cases we mentioned a marked discrepancy between the PrTV on fused images and the topography of the clips. In other two women we did not find clips on simulation CT. The fused images in five of these seven patients showed anatomical landmarks (scar, fibrosis) used for identification of the gross tumor volume. In all 20 women with pCR (average follow-up of 16.6 months), there were no locoregional recurrences. Conclusion: Combination of the clips with fusion of pre-NST and simulation CTs is important for an accurate boost delivery. Citation Format: Zhanna Bryantseva, Irina Akulova, Alexander Emelyanov, Olga Ponomareva, Pavel Krzhivitskiy, Sergey Kanaev, Nikolay Amirov, Viktoria Mortada, Petr Krivorotko, Sergey Novikov. Boost delivery to the tumor bed in breast cancer patients who have achieved pCR confirmed by VAB without surgery [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-01-03.

PURPOSE:We evaluate various approaches to target volume definition and boost delivery in patients with complete response to neoadjuvant systemic therapy (NST) who were treated by radiotherapy without a surgery.MATERIALS AND METHODS:A pathological complete response (pCR) was diagnosed in 21 of 27 patients included in "surgery de-escalation" prospective observation study. Clips were placed in the primary tumor volume (PrTV) before NST and during the vacuum aspiration biopsy. Twenty patients with pCR underwent the whole breast irradiation and a boost to the PrTV. High-dose rate brachytherapy (HDRB) was the basic technique for boost delivery. Finally, we identified the value of fused images (computed tomography [CT] before NST with simulation CT), clips and their combination for an accurate boost delivery.RESULTS:A complete overlap between PrTV on pre-treatment CT with the localization of the clips on simulation CT was mentioned in 10, partial mismatch in three patients. In 12 of these 13 women, HDRB was successfully used for the boost delivery. In five cases we mentioned a marked discrepancy between the PrTV on fused images and the topography of the clips. In other two women we did not find clips on simulation CT. The fused images in five of these seven patients showed anatomical landmarks (scar, fibrosis) used for identification of the gross tumor volume. In all 20 women with pCR (average follow-up of 16.6 months), there were no locoregional recurrences.CONCLUSION:Combination of the clips with fusion of pre-NST and simulation CTs is important for an accurate boost delivery.

This review discusses surgical management options, both radical and palliative surgical management for malignant pleural disease in lung cancer. No current clinical guideline recommends their routine implementation. Nevertheless, radical surgical management is used to improve the long-term results for patients with malignant pleural disease. The observational data suggest the effectiveness is not apparent, which is also associated with the patients’ heterogeneity and surgical methods. Most experts agree that it is impossible to draw well-grounded conclusions about the feasibility, efficacy, safety and optimal scope for surgical interventions in lung cancer patients with malignant pleural diseases. They advocate further research and randomised trials, considering the expected potential of using modern multidisciplinary approaches. When determining the tactics of malignant pleural disease management, an individual approach is required. It is crucial to consider the most significant prognostic and predictive factors: laterality, tumour spread (distant and regional metastases), sex, age, comorbidities, morphology, the presence of driver mutations, and the risk of postoperative complications. Personalisation of methods for managing malignant pleural disease in lung cancer is a promising area of modern oncology. However, many aspects of approaches to solving this problem remain unclear and require further research.

Purpose: To determine impact of various planning tumour volume (PTV) margins on final dose distribution in patients with maximal intrafraction prostate displacement. Materials: We analyzed data of 15 prostate cancer patients with maximal (значения) prostate intrafraction displacement registered during stereotactic body radiotherapy (SBRT) — 5 fractions of 7.25 Gy. Prostate displacement was determined by cone beam CT that was performed before and after each fraction. Modeling of dose distribution considering prostate displacement was performed for every fraction by isocenter shift. Final dose distribution was calculated as the sum of all fractions and was evaluated for PTV with various margins: 5-5-5-3, 3-3-3-1, 5-5-5 and cropped rectum. Results: The dosimetric impact of maximal intrafraction prostate motion was minimal for target coverage even for PTV with minimal margins (3 in all directions and 1 mm — posterior): CTV V100% varied from 97.5 to 100%. Prostate displacement reduced the dose to the rectum in all but minimal doses were detected for PTV 3-3-3-1: average D2cc — 31.87 Gy (28.41–34.05). For PTV 3-3-3-1 average bladder V100% volume slightly increased from 3.67 (SBRT plan) to 4.87 cc (simulation of intrafraction prostate displacement). Conclusions: The dosimetric impact of maximal intrafraction prostate motion was minimal for target coverage and doses in rectum and bladder even for PTV with minimal (3-3-3-1) margins.

Pleural effusion accompanying malignant lesions of the pleura is often a marker of the spread of the tumour process. Effusion is associated with the limited opportunities of the local control and as a consequence with poor long-term results. The morphological, immunohistochemical, and molecular features of the tumour are important prognostic and predictive factors that largely determine the therapeutic tactics. Clinical guidelines in the vast majority of cases with pleural effusion indicate that the treatment goal is palliation. The main goal in these patients is to reduce symptoms and improve quality of life. Asymptomatic pleural effusion does not require treatment. Thoracentesis or symptomatic drainage provides immediate relief. With low exudate volumes and accumulation rate, rare relapses and the expected response from the systemic treatment, or, on the other hand, a short expectancy of life, it is possible to limit the management of such cases with symptomatic drainage only. In selected individuals with pleural effusion minimally invasive or surgical interventions are also recommended. These include the installation of indwelling pleural catheters, the implementation of various pleurodesis techniques. In selected subgroups, the local control can reach 87-96%. The introduction of modern surgical techniques for pleural procedures has reduced the incidence of adverse events rate to 2,7-4%. There is no doubt that it is necessary to improve algorithms and search for alternate ve solutions, including those based on combined approaches to the treatment of patients with malignant neoplastic lesions of the pleura.

Lung cancer (LC) is a common malignant neoplasm (MN) with high lethality, often detected at late stages. The implementation of lung cancer screening can change the ratio in favor of the early stages. Screening could help diagnose early-stage LC in 60% of patients. Multiple primary LCs occur in 4–10% of patients within five years after treatment. The presence of oligo-metastatic disease only in the lungs (up to 5 nodules) occurs in 6-40% of patients with malignant tumors, and complete resection could increase 5-year survival to 20-40%. Due to functional limitations, surgical treatment can be performed only in 65-70% of patients. Stereotactic radiation therapy gives an opportunity to accurately deliver a high dose of radiation to the tumor with minimal damage to the surrounding healthy tissues. Local control is possible in 85–95% of cases, and 3-year overall survival is about 60–80%. New algorithms for fractionation and dose determination (BED10 ≥ 100 Gy) could improve the treatment results for early-stage lung cancer and oligometastatic lesions. In this non-systematic review, we analyze a recent publication and our own experience. We consider the effectiveness and safety of stereotactic radiotherapy and planning, modeling, fractionation, dose restrictions on critical organs, radiation reactions, and adverse events. We conclude that randomized controlled trials can reveal the stereotactic radiation therapy's potential in patients with primary and oligo-metastatic pulmonary tumors.

Soft tissue sarcomas (STS) are rare and heterogeneous group of mesenchymal cell tumors, accounting for only 1% of all malignances. Every year about 3700 new cases of STS are registered in Russia, while the annual increase rate was 6.45% in 2019. Randomized studies confirm the feasibility of combination therapy for STS. The review contains a comprehensive description of the proposed methods of combined treatment of STS. Advantages, disadvantages, directions and features of various methods of radiation therapy for STS are shown on the examples of scientific research of recent years.

Purpose. To evaluate immunological status in patients with metastatic forms of solid tumors before and at different intervals after stereotactic body radiation therapy (SBRT) of metastatic lesions depending on the dose and the number of irradiated metastasis. Materials and methods. A quantitative assessment and analysis of blood immunological parameters was conducted before irradiation, via 3-4 weeks and via 6-8 weeks after SBRT in patients with malignant tumors with oligometastases in the liver and lungs, in groups with a total focal dose (TFD ≤ 45 Gy ) and TFD> 45 Gy, and also in groups with irradiation of one metastases and two or more. All peripheral blood samples were analyzed by flow cytometry. Statistical analysis was performed using Friedman and Nemenyi criteria. Results. 3-4 weeks after the end of SBRT, when using higher doses (TFD> 45 Gy), we observed statistically significant increase of T-lymphocytes (CD3+CD19-); T-helpers (CD3+CD4+); activated T-helpers (CD3+CD4+HLA-DR+); activated cytotoxic T-lymphocytes (CD3+СD8+HLA-DR+). Decreasing of B-lymphocytes (CD3+CD19-) was observed in both dose groups (TFD ≤ 45 Gy and TFD > 45 Gy). We also noted the activation of the T-cell link of immunity both in the group with irradiation of one metastatic lesion, and in the group where 2 or more metastases were exposed to irradiation. Conclusion. Using of higher doses of SBRT is associated with a more activated antitumor T-cell immune response, while the analysis of groups of patients with different ammount of irradiated metastasis currently requires further research.

This article reviews the literature and summarizes single institution experience of applying different diagnostic algorithms for lung cancer. All diagnostic methods can be divided into three groups: non-invasive; minimally invasive and invasive. The non-invasive methods include clinical examination; imaging methods for anatomical, functional and multimodal visualization; sputum cytological, analysis of the exhaled breath, detection of various blood and sputum markers. Minimally invasive methods include endoscopy, percutaneous fine-needle and core-needle biopsy. Invasive methods include diagnostic thoracoscopy and laparoscopy, mediastinoscopy, parasternal mediastinotomy and diagnostic thoracotomy. While creating an individual diagnostic plan for each patient it is necessary to carefully analyze the effectiveness, safety, sensitivity, specificity and of different methods available among wide range of modern diagnostic techniques. Optimization of lung cancer diagnosis methods, which includes early cancer detection, is one of priority areas of modern oncology. Many aspects of this problem remain unresolved and require further research

In 5 year 180 patients (89 men and 91 women) underwent radiosurgery of brain metastases. Most patients had breast cancer and less than 5 lesions. Median overall survival (MOS) was 12,5 months, median progression free survival (MPFS) - 6,1 months. Both values were higher in patients with solitary lesions: 22.5 vs 10 months (р=0.00703) and 9 vs 6 months (р=0.02787), respectively.MOS was 18 in women with breast cancer, 12 months in patients with non small cell lung cancer. 8 - with melanoma and only 4 months - for small cell lung cancer. MPFS was significantly shorter for lesions volumes above 15 cm3. In field progression was detected in 37 (2-24 months after treatment) of 180 cases (20,5%). Second radiosurgery was performed in 24 cases.

Purpose: to determine accuracy of sentinel lymph node biopsy in patients with IAB-IIAB cervical cancer. Materials and methods: diagnostic performance of sentinel lymph node (SLN) biopsy was evaluated in 46 women with cervical cancer. SLN mapping was performed after peritumoural injection of 99mTc-labelled radiocolloids. All regional lymph nodes with uptake of radiocolloids were regarded as sentinel. SSLN biopsy was completed by standard lymph node dissection in all cases Results: SLN were visualized and detected in 42 of 46 (91.3%) cases. The monolateral pattern of lymph flow was determined in 19 women, bilateral localization of SLN revealed in remained 23 cases. Monolateral lymph flow characterized by high probability of metatstic involvement of regional lymph nodes (21.1%) and low sensitivity of SLN biopsy (0%). On the contrary, in women with bilateral lymph flow metastases in regional lymph nodes were mentioned in 2 of 23 cases (8.7%) and sensitivity of SLN biopsy was 100%. Conclusion: In patients with SLN localization on both sides of the pelvis SLN biopsy correctly predicted status of regional lymph nodes. In cases with monolateral localization of SLN biopsy characterized by high false negative rates.

Dual-energy contrast-enhanced spectral mammography (CESM) is a new promising method for visualizing pathological changes in breast, which combines digital mammography and a functional assessment of vascularization using intravenous contrast ehnancement. According to accumulated experience CESM is well tolerated by patients and is similar to magnetic resonance imaging with dynamic contrast enhancement (MRI with DCE), but at the same time, CESM is more affordable and can be performed in patients with contraindications for MRI. However, few studies have been conducted to evaluate the role of CESM. In the world literature, interpretation of contrast images is based only on the degree of accumulation of the contrast agent, but we propose a more detailed assessment of the structure of the hypervascular lesions by highlighting the contrast enhancement patterns. Objective: to determine the diagnostic effectiveness of CESM using the contrast enhancement patterns in malignant and benign lesions. Materials and methods. 239 women with suspicious for breast cancer lesions were examined from August 2018 to December 2019. The mean age of the women was 51 years. 322 lesions were revealed, 149 (46.3%) were malignant, 173 (53.7%) were benign. All lesions were histologically confirmed. As a result of the analysis of our data, 9 types of contrast enhancement patterns were distinguished: reticulate, granular, annular, diffuse-spherical, lacunar, cloud-like, heterogeneous-annular, point, cotton-like. Results. Using an additional diagnostic feature - contrast enhancement patterns in lesions, increased the sensitivity of CESM from 91.3% to 98.0% (p=0.26), specificity from 80.3% to 93, 6% (p=0.013), accuracy from 85.4 to 95.7% (p=0.004) in comparison with using of only one feature of contrast enhancement intensity in the differential diagnosis of malignant and benign lesions. Conclusion: thus, this approach of interpreting subtraction images allows to increase the efficiency of CESM in diagnosis of breast cancer.

Purpose: To evaluate the opportunities of single photon emission tomography/computerized tomography (SPECT-CT) for localization of axillary sentinel lymph nodes (ASLNs) and subsequent radiotherapy planning in women with early breast cancer. Material and methods: Individual topography of ASLN was determined in 151 women with clinical T1-2N0M0 breast cancer. SPECT-CT visualization of ASLNs was initiated 120 min after intra-peritumoral injection of 99mTc-radiocolloids. Doses absorbed by virtual ASLNs after the whole breast irradiation with standard and extended tangential fields were calculated on a treatment planning station. Results: SPECT-CT demonstrated a large variability of ASLN localization. They were detected in the central subgroup in 94 (61%) patients, in pectoral - in 77 (51%), and in interpectoral in 4 (3%) patients. Sentinel lymph nodes "lying on the chest" were revealed in 35 (23%) cases. We found that with standard tangential fields coverage of ASLNs was obtained only in 20% of evaluated women. Extended tangential fields can effectively irradiate ASLNs localized in all axillary sub-regions with the exception of ASLNs "lying on the chest". Conclusion: SPECT-CT mapping of ASLNs in women with cT1-2N0M0 breast cancer reveals their variable localization. This information can be important for planning of radiation treatment in women that underwent breast conserving surgery without an axillary surgery. (C) 2019 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.

In this literature review we analyze the effectiveness of radiotherapy (as an independent method and in combination with surgery and chemotherapy) in the treatment of locally advanced non-small cell lung cancer. The postoperative adjuvant radiotherapy can increase overall survival and reduce the frequency of local recurrences in IIIA / N2 stage of NSCLC, however, its positive effect can be offset by the damage to surrounding structures. Modern high-tech equipment, improved planning systems, methods radiation doses delivery, and the fractionation regimen can improve the outcomes of radiation therapy. No bimodal treatment has shown advantages over other combinations. Some improvement in survival was noted in a number of studies using three-modal treatment, but it was also associated with an increase in the proportion of postoperative complications, especially after pneumonectomies. The heterogeneity of the IIIA / N2 NSCLC group and criteria for their operability present certain difficulties for a correct comparison of the treatment results, which requires further discussion. In most studies, insufficient attention has been paid to the influence of multimodal treatment on the quality of life of patients, which, taking into account comparable results of treatment, can be crucial in determining indications and contraindications.

Purpose: to determine preoperative SPECT-CT localization of sentinel lymph nodes (SLN) in women with cervical cancer. Materials and methods: SPECT-CT visualization of SLN was performed in 44 women with clinical stage IB-IIB cervical cancer. SPECT-CT examinations started 120-240 min after peritumoural injections of 99mTc-radiocolloids (200-300MBq in 0.4-1ml). All visualized LNs with uptake of radiocolloids were regarded as SLN. In all women we determined topography of SLN and lymph-flow patterns. Results: SLN were successfully visualized in 93.1% cases (41/44 women). The bilateral pattern of lymph flow was mentioned in 26 (63.4%), monolateral - in 15 (36.5%) cases. SLN localized in external iliac region in 25 (60.9%), internal iliac - in 14 (34.1%), obturator - in 22 (53.6%), presacral - in 1 (2.4%), common iliac region - in 21 (53,8%) cases. Uptake of radiocolloids in paraaortal lymph nodes was mentioned in 14 (34.1%) women Conclusion: SPECT-CT visualization of SLN can give important information for surgery and radiotherapy planning.

Purpose: dosimetric comparison of high dose rate interstitial brachytherapy (HDR) and irradiation with electrons for radiation boost after whole-breast irradiation. Material and methods: in 62 patients with рТ1N0М0-рТ2№М0 breast cancer we used HDR brachytherapy for delivering boost to tumor bed. In all cases insertion of plastic needles was performed under CT control with subsequent 3D planning. Pre-insertion CT were used for 3D planning of boost delivery with electrons. Results: Boost delivery with HDR brachytherapy had several important advantages when compared with boost with electrons. HDR brachytherapy demonstrated more accurate irradiation of tumor bed: D90 HDR - 93,1 % (69,1 % - 118 %), D90 electrons - 86,2 % (47,6 % - 104,1 %). Boost delivery with HDR brachytherapy help to minimize radiation burden to left main coronary artery - Dmax electrons - 14.8 % (0.2 %-71.8%), Dmax HDR - 5.2 % (0.7 %-14.2 %). Radiation burden to left anterior descending artery is also decreasing: Dmax electrons - 21.9 % (0.8 %-94.1 %), Dmax HDR - 10.5 % (1.9 %-31.5 %). Radiation dose absorbed in ip-silateral lung also significantly lower with HDR brachytherapy: Dmed electrons - 6,5 % (0,5 % - 19,3 %), Dmed HDR - 2,3 % (0,8 % - 10,8 %). Conclusions: the present dosimetric analysis indicated that boost delivery with HDR brachytherapy is more accurate than irradiation with electrons.

An active introduction of screening programs potentially leads to a significant increase in the proportion of patients with early forms of non-small cell lung cancer. Surgical treatment, which is the standard of care for localized forms, due to functional limitations can be performed only in 65-70% of patients. The solution to this problem can be found in the improvement of the results of radiotherapy by using modern equipment, the planning systems, improved fractionation schemes and introduction of methods for summing radiation doses. Stereotactic radiotherapy allows high-precision delivery of high radiation dose to tumor with a minimal damage to surrounding healthy tissues. In this literature review based on the analysis of a large number of publications we show that it is not yet possible to make valid conclusions about the effectiveness and safety of stereotactic radiation therapy as an alternative to the surgical methods. It is necessary to plan and conduct randomized trials without further delay taking into account the expected high relevance of the method.

The aim of the study: to evaluate efficacy and toxicity of interstitial high-dose-rate prostate brachytherapy when it was used as monotherapy for low-, intermediate risk prostate cancer. Material and methods: 198 primary patients with low-, intermediate risk prostate cancer that were treated from 1.07.2012 to 01.07.2017 were included in the study. Two fractions of 13Gy were used in 67 men, 3 fractions of 11.5Gy -in the remaining 131 patients. The reported end points were overall/cancer-specific survival, biochemical control rates according to Phoenix definition. Toxicity was scored according to the RTOG scale. Results: The median follow-up time was 28.7 [19.3; 36.6] (10.9-58.9) months. The 3-year biochemical control (nadir+2) was reached in 94.1% cases. Late grade III genito-urinary toxicity was represented by urethral strictures in 1.6% of evaluated patients. Grade III rectal toxicity was not mentioned. IIEF score before treatment was below 16 in 28.8% patients and after brachytherapy - in 52.9% cases. Conclusion: high dose rate brachytherapy can be effectively and safely used for monotherapy of patients with low-, intermediate risk prostate cancer.

In 437 primary patients with breast cancer (BC) we compared diagnostic accuracy of mammography (MG) and mammoscintigraphy (MCG) with 99mTc-MIBI. All women, included in the study, had lesions suspicious for BC. In 108 suspicious lesions were less than 10 mm in diameter. On histology 33 (30,5%) patients had invasive BC, 20 (18,5%) - noninvasive BC, 6 (5,6%) - lobular carcinoma, 2 (1,9%) - mucinous BC, 8 (7,4%) - fibroadenoma and in remained 39 cases (36,1%) - localised fibrosis. In the group of women with lesions below 10 mm sensitivity, specificity and accuracy of MG in diagnosis of BC were 72%, 74%, 73%, for MCG - 62%, 51%, 57%. Combination of MG and MCG helped to increase sensitivity to 93,4%. In 53 women with dense breasts sensitivity, specificity and accuracy of MG were 40%, 71,4%, 64%; for mCg two times higher (82%) with specificity of 55% and 60% accuracy. Combination of MG and MCG allowed increasing the sensitivity of diagnosis of minimal BC 2 times more (up to 91%).

Cancer screening literature was discussed in this review publication. Broad spectrum of studies was used to make conclusion about effectiveness of screening methods in reaching its major objectives, perspective of screening methods for several cancer types were also discussed. Qualitative assessment of studies was done. Cervical cancer, breast cancer and colorectal cancer screening was proved to be effective. Effectiveness of prostate and lung cancer screening as well as population-based stomach cancer prevention is also discussed. Negative and inconclusive results of screening studies of the other cancer types were also mentioned and perspectives for future diagnostics option for cancer screening were given.