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Purpose: Set out and substantiate basing on contemporery data and personal experience the key features and nuances of topometric preparation and contouring of the irradiated volumes when planning external beam radiation therapy in breast cancer patients after immediate reconstruction with usage of synthetic materials. Materials and methods: In terms of this article are outlined the main provisions regarding topometric preparation, the need of expander deflation, the determination of irradiated volumes, and the effects of the metal port of the expander on the dose distribution. Results: Evidence-based recommendations on the implementation of such stages of the technological chain of external beam radiation therapy, as topometric preparation and contouring of irradiated volumes in patients with breast cancer after immediate reconstruction with synthetic materials, are briefly presented.

For patients with the metastatic subtype of luminal HER-2-negative (HR+/HER2-) breast cancer (mBC) in the absence of visceral crisis, the gold standard of treatment is a combination of CDK4/6 inhibitors and aromatase inhibitors, regardless of their menopausal status and the sites of metastasis. The effectiveness of this approach was confirmed in the MONARCH, PALOMA, MONALEESA study cycles for the drugs abemaciclib, palbociclib and ribociclib, respectively. Metastasis in the central nervous system (CNS) in breast cancer complicates the treatment of patients and leads to the search for new approaches to the choice of therapy. To date, neurosurgical and radiosurgical techniques are actively used, however, drug therapy still stands for the leading positions. Data on the use of CDK4/6 inhibitors or aromatase inhibitors in patients with CNS metastases are limited. Most studies did not include patients with CNS metastases, only PALOMA-2,3 and MONALEESA-3 studies allowed the inclusion of patients with either “inactive” CNS metastases or after exposure to local treatment methods (for example, radiosurgery, radiotherapy, or surgery). In the study of real clinical practice of combined endocrine therapy with ribociclib (CompLEEment-1) allowed the inclusion of patients with active brain metastases (n = 51), while the subgroup analysis demonstrated the benefits of using a combination of ribociclib and aromatase inhibitors in patients in this difficult clinical situation. In the article, the authors review the available data from randomized clinical trials and real clinical practice, and also illustrate with their own observation.

Usage of therapeutic doses in radiotherapy for breast cancer to the breast or chest wall after surgery may be associated with an increased risk of complications from adjacent organs at risk, so careful monitoring of doses to organs at risk and the usage of different dose reducing methods are required. Within the clinical case described below we are trying to figure out if complex technologies of radiation therapy can be useful in treatment of breast cancer patients after radical mastectomy while it is needed to reduce the doses to organs at risk.

Pleural mesothelioma (PM) remains a disease with a poor prognosis, despite the use of the newest achievements of multimodal treatment. Radiation therapy for PM is traditionally used in some directions: in radical treatment as a part of a three-modal approach, for reducing the risk of chest metastasis in areas of invasive interventions and during palliative treatment. The lack of reliable randomized trials has led to an absence of consensus about the optimal radical treatment strategy. Mordern global recommendations for the treatment of PM are controversial regarding the use of adjuvant radiotherapy in multimodal treatment. Although the role of radiation therapy in the treatment of PM remains unclear, significant successes in planning and conducting radiotherapy are showing that long-term survival can be achieved for these patients, for whom, until recently, only palliative treatment was considered as appropriate treatment. For many years, preventive irradiation of areas of invasive interventions has been used as a method to prevent implantation metastasis. However, a number of randomized trials and recent meta-analysis have not demonstrated the benefits of this treatment approach. Due to the rarity of PM, the severe state of patients and tumor localization, the importance of radiation therapy in the palliative treatment of patients with pleural mesothelioma remains controversial. Recent completed and planned studies allow to commend the role of palliative radiation and recommend it in order to reduce pain.

Accurate determination of the tumor with the use of modern diagnostic methods which make the maximum exposure to the tumor and the identified affected lymph nodes possible lead to careful attitude to healthy tissues and critical structures. During the period 2000-2015 301 patients with squamous cell carcinoma of the anal canal stage T1-4N0-3M0-1 completed complex treatment which consisted of radiation therapy in a conventional or conformal mode, including the use of modern technologies - radiation therapy with intensity modulation - IMRT and arch volume-modulated radiation therapy - VMAT. The use of IMRT andVMAT in comparison with conformal radiation therapy allowed to reduce the frequency of unplanned interruptions up to 48 % (p = 0.005), which led to increase in 5-year rates of local regional control - 83.7 % compared with the group where the interruption was applied - 74.2 % (p = 0.049); also increased the frequency of complete responses in the range of the total dose of 50-54 Gy to 28.5 %, 56-58 Gy to 44.3 % and 60-64 Gy to 26.1 %. The achievement of a complete response led to a significant increase in the 92.1 % 5-year locoregional control compared to the group with the absence of a complete response - 76.5 % (p = 0.001). Modern conservative treatment is based on continuous radiation exposure with the absence of intervals between courses, which is the radiobiologically considered the most effective treatment regimen.

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.

Late radiation injuries that occur after a significant period from the moment of completion of the radiation treatment can affect any anatomical structure within the irradiated area and thereby significantly impair the quality of life of cancer patients. Modern technologies of radiation therapy and scientifically based dose fractionation modes of radiation exposure have contributed to a significant reduction in the incidence of late radiation damage, but the risk of their appearance remains. The review presents literature data on both the treatment and the possibilities of drug prevention of late radiation damage, such as radio-induced soft tissue fibrosis.

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.

The problem of primary multiple tumors is relevant to current clinical oncology because of increasing of number of patients with multiple malignant tumors and unsolved issues of treatment. Primary multiple malignant lung tumors is a common oncological situation requires an individualized, differentiated approach to treatment. The results of treatment are associated with the prevalence of the process, stages of tumor development, spare capacity of patients. There is presented clinical example of a patient with metachronous primary multiple malignant tumors of one lung.

Aim: the problem of postradiation lung injury is extremely topical, because of the close proximity to vital organs and the need of the significant part of tissue to receive the high dose of radiation in patients with breast cancer (BC). The aim of the analysis is to determine the frequency, severity of radiation damage to the lung tissue in women with BC, the frequency dependence on the technology of radiation therapy (RT) and the dose of radiation exposure, using 2D-conventional and 3D-conformal radiation therapy.materials and methods: we analyzed the data concerning the studies of thoracic organs (X-ray and computer tomography investigation) in 513 Tis-2N0-2M0 BC patients, receiving complex organ sparing treatment between 1996 and 2013 years. 318 patients were treated with postoperative 2D-conventional radiotherapy to a dose of 50 Gy, 195 patients - with 3D-conformal radiotherapy.results: we indicated that radiologically detected lung injury occur equally often in case of using 2D and 3D radiation therapy: 27,4 and 28,7%, respectively ( p >0,05); their frequency was significantly increased by 20-24% during radiotherapy only of the mammary gland and 37-41% - when doctors added the radiotherapy of cervical, supra - and infraclavicular regions. We showed that the risk of radiation pneumonitis in the ipsilateral lung was more than 25% and was significantly increased on the V20 increasing of the average dose to the lung more than 15 Gy.

Increased survival of patients with squamous cell carcinoma of the anal canal due to improved technical equipment radiotherapy separated to oncology clinics. Creating conditions accurately summarizing the planned dose decrease absorption substituted doses to critical structures, reducing unscheduled interruptions in the course of chemoradiotherapy with modern technology conformal radiotherapy (3D CRT, IMRT, VMAT).Radiotherapy with intensity modulated (IMRT) and intensity modulation arches VMAT («Rapid Arc») held respectively at 9 and 5 paintion of squamous cell carcinoma of the anal canal. At the same time the primary tumor and lymph node involvement is further subjected to daily exposure Simula mutant integrated boost (SIB).Application of these technologies allowed: 1) get high oncological result (complete tumor regression in all patients); 2) to reduce the radiation dose to critical organs (small intestine - the average minimum dose, Dose Mean) 34,0 Gy (with IMRT); 37,2 Gy (with 3D CRT); bladder - (Dose Mean) 24,2 Gy (with IMRT); 26,2 Gy (with 3D CRT), respectively; 3) reduce the frequency and intensity of acute radialdamage critical organs: toxic heavy early mucositis (III-IV degree) from the rectum and bladder were observed in any observation. Early proctitis degree I was diagnosed in 4 (28,6% of patients), proctitis Grade II in 5 (35,7%) patients. Early cystitis degree I was diagnosed in 3 (21,4%) patients, cystitis II degree in 6 (42,8%) patients; catarrhal mucosal epithelium of the female genital organs occurred in 8 (57,1%) patients; 1 month after the end of radiotherapy proctitis degree I recorded in 5 (35,7%) and cystitis I degree in 4 (28,6%) patients; 4) reduce the number of patients with forced interruptions termoradiohimioterapii: only 6 patients (42,8%) due to hematological toxicity grade I-II, II degree cystitis made a short break in treatment, the duration of which was 5-8 days; 5) Use simultanting integrated boost (SIB) has led to a reduction in duration of the full course termoradiohimioterapii 7 working days compared to traditional small fraction 3D CRT radiation therapy; 6) the use of space modulated radiotherapy arches (VMAT - «Rapid Arc») has allowed to reduce the time of a session of radiotherapy with IMRT compared with 20-30 minutes to 3-5 minutes.Volume modulated radiation therapy technology using SIB reduce the time the patient’s treatment, the number of complications and achieve complete tumor regression.

During recent decades radiotherapy is the basis, on which it is built a medical complex that is the first-line treatment of patients with squamous cell carcinoma of the anal canal. An increase of overall and disease-free survival and quality of life of patients with squamous cell carcinoma of the anal canal at the present stage of development of a comprehensive medical treatment is largely due to the improvement of technical equipment of radiotherapy departments of oncology clinics. The use of modem linear electron accelerators and systems of computer dosimetric planning to create a 3D program of isodose distribution, diagnostic devices (computed tomography and magnetic resonance imaging) as well as a number of other conditions permit accurate summarizing of proposed dose, reducing of absorbed dose to critical structures, diminishing unplanned interruptions in chemoradiotherapy course by means of modern technologies of conformal radiotherapy (3D CRT, IMRT, VMAT). The paper presents the preliminary results of a comprehensive medical treatment of 14 patients with squamous cell carcinoma of the anal canal.

Despite of improvement of radiotherapy techniques and increasing usage of conformal radiation therapy which provides decrease of dose for normal tissues and organs, cases of radiation-induced injuries are still registrated. The aim of this study is to determine frequency and severity of lung toxicity in 513 breast cancer patients with Tis-2N0-2M0 disease after breast conserving surgery and chemotherapy depending from radiation therapy technique and irradiation volume. It is quite clear that in breast cancer patients frequency of lung toxicity after breast conserving surgery and RT increases from 20-24% when irradiating only breast to 37-41% when irradiating breast and regional lymph nodes. In our analysis the frequency of lung toxicity was quite similar for 2D conventional therapy (27,4%) and for 3D conformal therapy (28,7%). The risk of developing radiation pneumonitis increases dramatically with extension of V20 for ipsilateral lung more than 30%, mean lung dose more than 18 Gy, in patients with initial small volume of the lung (less than 110 cm3).

Objective To determine the effectiveness of radiation therapy for local control of nonmetastatic osteosarcoma of the extremities after induction chemotherapy. Patients and Methods Of 187 patients with nonmetastatic osteosarcoma of the extremities treated with induction chemotherapy since 1986, 31 refused surgery and underwent standard, fractionated external beam radiotherapy for local control. The median radiation dose to the limb was 60 Gy (range 40-68 Gy). Records were reviewed through April 2002, and outcomes including radiologic and biochemical response, local control, limb function, and survival were analyzed. The end points were local progression-free survival, metastases-free survival, and overall survival. Results Overall survival, local progression-free survival, and metastases-free survival at 5 years were a mean ± SD of 61%±11%, 56%±12%, and 62%±10%, respectively. The outcome correlated significantly with patients' imaging and biochemical response. In patients who had a pronounced response, overall survival and metastases-free survival at 5 years were 90%±9% and 91%±9%, respectively, but it was only 35%±15% and 42%±13% in the nonresponders ( P =.005 and P =.005, respectively). Local control was also related to response after induction chemotherapy. None of the 11 patients with both a good imaging and a good biochemical response had local relapse; median follow-up was 67 months. The estimated local progression-free survival among nonresponders was 31%±16% at 3 years and 0% at 5 years. Of 22 patients surviving without local disease progression, 19 (86%) had excellent limb function (Enneking score between 90% and 100%) at the time of most recent evaluation. Conclusion When used after effective induction chemotherapy for osteosarcoma of the extremities, radiation therapy can be a reliable modality to control local disease and preserve limb function.