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Despite the wide possibilities of applying various methods of local and systemic treatment and their continuous improvement, the results of treatment of patients with hepatocellular cancer in general remain unsatisfactory. Based on the latest achievements of science and technology, modern radiation therapy can be used as an effective method of local exposure to liver tumors because of its relative effectiveness and acceptable tolerability. Radiation treatment in the mode of stereotactic body radiation therapy is a promising direction in the complex treatment of patients with hepatocellular carcinoma. It makes it possible to apply ablative doses with a significant reduction of the doses on healthy organs and tissues in a short period of time and the combination of this technique with other approaches of antitumor treatment.

Ïå÷åíüЦель. Определить эффективность применения стереотаксической радиотерапии у пациентов с метастатическим поражением печени. Материал и методы. Стереотаксическая радиотерапия метастатических новообразований в печени проводилась за три фракции в течение 5-8 дней с разовой очаговой дозой 10, 12, 15 или 20 Гр. Метод применили 66 пациентам: 40 (60,5%) женщинам и 26 (39,5%) мужчинам. Возраст больных варьировал от 37 до 82 лет (средний возраст 60 лет). У 24 (36,5%) больных первичные опухоли были представлены колоректальным раком, у 12 (18%) -раком молочных желез, у 7 (10,5%) -раком яичников, у 23 (35%) -другими злокачественными опухолями. Результаты. Медиана наблюдения составляет 14,5 мес (1,8-53,5 мес). Трое больных не представили результаты контрольного обследования. Среди остальных 63 больных у 16 (25,5%) был зафиксирован полный эффект, у 30 (47,5%) -частичная регрессия метастазов, у 11 (17,5%) -стабилизация, у 6 (9,5%) -прогрессирование. Таким образом, показатель локального контроля составил 90,5%. Лучевые повреждения III степени были зафиксированы в 2 (3%) наблюдениях, II степени -в 7 (11%). Заключение. Стереотаксическая радиотерапия пациентов с метастатическим поражением печени представляется высокоэффективным, безопасным методом и может быть рекомендована к применению у больных с ограниченным поражением печени, которым было отказано в оперативном лечении.Клю че вые сло ва: печень, метастазы, колоректальный рак, рак молочной железы, рак яичников, стереотаксическая радиотерапия, локальный контроль. Aim.To determine the effectiveness of stereotaxic radiotherapy in patients with liver metastases. Material and Methods. Stereotaxic radiotherapy of liver metastatic tumors was carried out in three fractions for 5-8 days with single focal dose of 10, 12, 15, or 20 Gy. The procedure was performed in 66 patients including 40 (60.5%) women and 26 (39.5%) men. The average age was 60 years (37-82). In 24 (36.5%) cases primary tumor was presented by colorectal cancer, in 12 (18%) -breast cancer, in 7 (10.5%) -ovarian cancer and in 23 (35%) -other malignant tumors. Results. Median follow-up was 14.5 months (range 1.8-53.5). 3 patients did not present data of control examination. Among other 63 patients full effect was established in 16 (25.5%) cases, in 30 (47.5%) patients -partial regression of metastases, in 11 (17.5%) -stabilization, in 6 (9.5%) -progression of tumoral process. Thus, local control rate was 90.5%. Degree III of radiation damage was reported in 2 cases (3%), II -in 7 cases (11%). Conclusion. Stereotaxic radiotherapy seems highly effective and safe method of the treatment of patients with liver metastases and can be recommended for use in patients with limited liver metastases who have been denied in surgery.

Modern advances in oncology can achieve significantly better results in terms of life expectancy in patients with metastatic brain disease. The combination of surgery, systemic therapy, whole brain irradiation and local methods of radiation therapy lead to good indicators for controlling the manifestations of the disease in the brain. Of course, intensification of treatment increases the risk of iatrogenic complications. The use of aggressive stereotactic radiotherapy regimens leads not only to high local control of irradiated metastases, but also to the risk of so-called radiation necrosis. The use of the most up-to-date diagnostic methods does not always allow one to unequivocally differentiate radiation necrosis from continued metastasis growth. The above example shows the need for a careful assessment of such situations and a multidisciplinary approach to interpreting the results of stereotactic radiotherapy.