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Summary: the article discusses the reasons for the possible ineffectiveness of radioiodablation in patients with differentiated thyroid cancer when using adequate individually calculated activities of 131I. Based on a prospective analysis of post-therapeutic whole-body scintigraphy, laboratory parameters, dosimetric control and clinical manifestations after radionuclide therapy, significant criteria for the possible failure of standard combination therapy are identified and a change in treatment tactics in this group of patients is proposed.Purpose: search for the reasons for unsatisfactory results of radionuclide treatment in patients with differentiated thyroid cancer. Materials and Methods: analysis of 2260 patients with differentiated thyroid cancer who received combined treatment using traditional preparation methods using thyrotropin alpha, from which a group was identified with a high level of 131I. that was unexpected at the pre-therapeutic stage against the background of early radiation diseases and low dosimetry indicators. In patients, laboratory parameters of TSH, thyroglobulin and thyroglobulin antibodies were assessed using radioimmunoassay and clinical manifestations of radiation conditions, taking into account the prescribed therapy; The scintigraphy of the thyroid bed with 99mTc-pertechnetate, post-therapeutic scintigraphy with 131I upon exiting the «closed mode» and dosimetric control under standard conditions every 24 hours after taking the therapeutic activity were performed.Material and methods: prospective single-center analysis of data from 2260 patients with differentiated thyroid cancer who received combined treatment using the traditional preparation method and the use of thyrotropin alfa, from which a group with an unexpected high RP uptake at the pre-therapeutic stage was identified against the background of the absence of early radiation complications and low dosimetry indicators. In patients, laboratory parameters of TSH, TG and AT-TG were assessed using radioimmunoassay and clinical manifestations of radiation reactions, taking into account the prescribed therapy; scintigraphy of the thyroid bed with 99mТс-sodium pertechnetate, post-therapeutic scintigraphy with 131I upon exiting the «closed mode» and dosimetric monitoring with an assessment 48 hours after ingestion of therapeutic activity. Results: analyzed the data of a group of patients in whom there was a marked discrepancy between the usually interdependent results of scintigraphy before and after RIA, which subsequently changed the treatment tactics in their relation. A statistically significant difference was found between the selected groups in terms of the level of stimulated TSH (in patients with predictable (73,9±31,8 mU/L) and unexpected (114,1±30,5 mU/L) uptake of 131I (p=0,0218); by the values of the dose rate 48 hours after the intake of the calculated activity of 131I (p=0,000005). In addition, we additionally analyzed the effect of traditional and drug methods of stimulating thyrotropinemia during preparation for radionuclide ablation. Withdrawal of levothyroxine and with the use of rhTSH, TSH indices were 80,7±27 mU/L and 123,3±75,8 mU/L, respectively (p=0,035), and the levels of stimulated thyroglobulin were 10,2±4,0 ng / ml and 3,2±2,5 ng / ml (p=0,041). Conclusion: the obtained results show that the recommended empirical level of TSH > 30 mU/L is not synonymous with the activation of sodium iodine symporter and the viability of RIA, and also make it possible to distinguish a group of patients with delayed/ partial activation of the symporter. In the continuation of this study, we plan to change the protocol for preparation for radioiodablation and find criteria for pre-therapeutic diagnosis of this group of patients

Recent years have been marked by serious breakthroughs in the drug therapy of malignant neoplasms. The results of new successful studies are received almost constantly, which affect both clinical practice and the fate of patients. The studies in oncourology are also actively conducted: over the past 12 months, another batch of data from clinical studies has been obtained, in particular, comparing various combinations of chemotherapy drugs, the possibilities of combined targeted and immune therapy. The article deals with issues related to the treatment of metastatic renal cell carcinoma, urothelial cancer, the use of radiopharmaceuticals in the treatment of castration-resistant prostate cancer, as well as adjuvant therapy of urothelial cancer, which has not yet found an unambiguous solution. Phases II and III data of clinical trials in combination with the leading experts’ opinions should help to improve the approach to the treatment of oncourology diseases, especially in the late stages. KEYWORDS: renal cell carcinoma, urothelial cancer, metastatic castration-resistant prostate cancer, immunotargeting therapy, chemotherapy, adverse events. FOR CITATION: Solodkiy V.A., Pavlov R.A., Dzidzaria A.G. et al. The most significant achievements in the drug therapy of oncourology diseases in 2020–2021. Russian Medical Inquiry. 2021;5(8):545–547 (in Russ.). DOI: 10.32364/2587-6821-2021-5-8-545-547.

PURPOSE:To compare the outcome of high-dose-rate interstitial brachytherapy (HDR-BT) and low-dose-ratebrachytherapy (LDR-BT) as monotherapy for localized prostate cancer of low and intermediate risks progression. METHODS AND MATERIALS: The study included 165 patients with localized prostate cancer in low and intermediate progression risk groups. We compared 65 patients treated with HDR-BT and 100 patients with LDR-BT as monotherapy. LDR-BT treated advanced disease with more hormonal therapy than HDR-BT. All patients were in low and intermediate risk groups for prostate cancer progression. HDR-BT as monotherapy was delivered in 2 fractions of 15 Gy, two weeks apart. LDR-BT was performed in a standard mode of 145 Gy. The median observation was 32 months. All patients gave written informed consent. RESULTS: Overall biochemical free survival rate (BFSR) is 95,8%. There are 7 people having a growing prostatic specific antigen (PSA) while the case follow-up (in the group HDR-BT - 2 patients, LDR - 5 patients). Two recurrence cases with metastases in lymph nodes and bones were brought out as a result of 68Ga-PSMA PET examination in the group of HDR-BT. In 4 cases out of 5 LDR-BT, a local recurrence was detected (p=0,085). All cases of relapse were found in patients at intermediate risk (p = 0,041). LDR-BT showed a higher incidence of genitourinary (GU) toxicity grade >2 than that of HDR-BT in the acute phase and grade 1 toxicity in late phase. Accumulated incidence of late grade >2 GU and GU toxicity was equivalent between HDR-BT and LDR-BT. CONCLUSION: HDR-BT monotherapy showed an equivalent outcome to that of LDR-BT for low and intermediate risk patients. LDR-BT showed equivalent incidence of grade >2 late GU toxicities and higher grade >2 acute GU toxicity as that of HDR-BT as a monotherapy.

Introduction. One of the main problems of modem on-courology is treatment for prostate cancer of intermediate and high risk of progression. Modern radiotherapy in this category of patients has an advantage over surgical methods of treatment. One way to improve the effectiveness of radiotherapy is to escalate the dose in the prostate gland. For this purpose a combination of brachytherapy and remote radiotherapy is used. This combination allows increasing the dose of radiation, thereby providing better local control, reducing complications from neighboring organs. Purpose of the study. To conduct a comparative analysis of efficacy and safety of radical treatment of patients with prostate cancer at medium and high risk of progression using a combination of high and low dose rate brachytherapy with external beam radiotherapy. Materials and methods. 107 patients with prostate cancer of the group of medium and high risk of progression combined treatment (brachytherapy with external beam radiotherapy) was conducted. 53 patients underwent combined treatment (HDR-brachytherapy and external beam radiotherapy). 54 patients underwent combined treatment (LDR-brachytherapy and external beam radiotherapy). The observation period was 5 years. Conclusion. In a comparative analysis in groups of combined radiotherapy with the use of high-dose and low-dose-rate brachytherapy, the same effectiveness of immediate and long-term results of treatment was demonstrated. A significant reduction in early and late toxic reactions in patients with high-power brachytherapy has been demonstrated.

Studies salvage interstitial radiation therapy for recurrent prostate cancer, launched at the end of the XX century. In recent years, more and more attention is paid to high-dose-rate brachytherapy (HDR-BT) as a method of treating local recurrence.The purpose of research – preliminary clinical results of salvage high-dose-rate brachytherapy applied in cases of suspected local recurrence or of residual tumour after radiotherapy.Preliminary findings indicate the possibility of using HDR-BT, achieving local tumor control with low genitourinary toxicity.

Main idea of this article is to make a short overview of modern MALT lymphoma treatment approaches. Historically, surgery was the leading treatment modality. Discovery of H.pylori involvement, invention of new drugs and chemotherapy protocols, wide use of monoclonal antibodies, significantly raised the effectiveness of conservative treatment. Routine use of CT scanning, invention of conformal, precise radiotherapy techniques allowed to achieve fine radiotherapy treatment results, especially in the case of combined chemo – radiotherapy protocols. That is why nowadays conservative treatment plays more significant role. However, complete remission cannot be achieved in all the cases. More research is required and thorough analyze of advantages and disadvantages of every technique and their combinations.