The aim of this study was to determine the most effective approach to the treatment of patients with continuous growth of brain glioma.Material and Methods. The study included 200 patients with progression of primary brain glioma, who were treated at the Chelyabinsk Regional Center of Oncology and Nuclear Medicine in the period from 2001 to 2021. The average age of patients was 47.86 ± 11.47 years. The ratio of men to women was 1:1. The continuous growth of high-grade glioma was detected in 125 cases. The progression of lowgrade glioma was observed in 40 patients. Transformation of low-grade glioma into high-grade glioma was found in 35 patients. Re-surgery was performed in 92 patients. Repeated radiation therapy was given to 140 patients. Chemotherapy as the method of choice was administered to 60 patients.Results. The median overall survival (OS) time was 36 months. The 1and 2-year survival rates were 96.0 % and 59.4 %, respectively. The method-specific overall survival time was 15 months. There was a tendency towards an increase in OS in all subgroups of patients who underwent re-surgery. The highest method-specific overall survival rates were observed in patients who received stereotactic radiation therapy (STRT) and combined photon-neutron therapy (CPNT): 23 and 47 months in patients with high-grade glioma and 60 and 72 months in patients with continuous growth of low-grade glioma, respectively (p>0.05). In patients with the transformation of low-grade glioma into high-grade glioma, the method-specific OS was higher in patients who received combination of chemotherapy and radiation therapy compared to those who received chemotherapy or radiation therapy alone: 32, 12, and 24 months, respectively (p>0.05).Conclusion. Repeated surgery is the optimal treatment approach for patients with continuous growth of primary brain glioma. In cases with repeated radiotherapy courses, CPNT or STRT can be the methods of choice. Treatment of patients with transformation of low-grade gliomas

Целью исследования явилось определение места и роли нейтронной лучевой терапии в лечении пациентов с рецидивами высокозлокачественных глиом головного мозга. Материал и методы. Были проанализированы результаты лечения 40 больных, получивших лечение с 2005 по 2015 г. на базе ГБУЗ «Челябинский областной клинический центр онкологии и ядерной медицины» и Центра нейтронной терапии (г. Снежинск). Средний возраст пациентов -45 лет. Соотношение мужчин и женщин -1:1. У 19 пациентов был рецидив глиобластомы, у 21 -анапластической астроцитомы. В 20 случаях проведена нейтронная терапия в самостоятельном варианте, 20 больным проведен курс сочетанной нейтронно-фотонной лучевой терапии. Результаты. Медиана общей выживаемости для всех пациентов с рецидивами высокозлокачественных глиом головного мозга после проведенного лечения составила 50 мес, показатели 1-летней общей выживаемости -94,1 %; 2-летней -77,8 %; 3-летней -66,7 %. Медиана выживаемости после лечения рецидива -27 мес. Основными прогностическими факторами, влияющими на результаты лечения, стали возраст пациентов, гистологическое заключение, а также время до возникновения рецидива. Метод-специфическая выживаемость была достоверно выше у пациентов с проведением сочетанной нейтронно-фотонной терапии: 48 мес против 20 мес при проведении нейтронной терапии в самостоятельном варианте (р=0,05).Ключевые слова: нейтронная лучевая терапия, рецидивы опухолей головного мозга, повторное облучение.

The aim of the study was to determine and analyze the most significant risk factors for developing cardiac, pulmonary and skin toxicities among patients who received concurrent radiation therapy and chemotherapy with trastuzumab.Material and methods. The study included 66 patients with histologically verified invasive intermediate or low-grade breast carcinoma, who received radiation therapy and chemotherapy with trastuzumab from 2018 to 2019. The average age of the patients was 53.1 ± 4.2 years. Locally advanced stage iii a and iii b breast cancer was the most common (52 %) followed by stage ii a and ii b cancer (36 %). The lvef of all patients was ≥50 %. All patients received neoadjuvant chemotherapy with anthracyclines and/or taxanes. Radiation-induced side effects were assessed using the rtog/eortc scoring criteria. Dose-volume histogram (dvh) of radiotherapy planning was matched to the quantec criteria.Results. Radiation-induced pulmonitis was observed in 2 patients within 2 to 6 months after the completion of radiation therapy. A 10 % reduction in lvef was observed in 3 patients, while a 20 % decrease in ef was not found. Long qt syndrome was observed in 3 patients, and it was accompanied by clinical manifestations in 2 patients. When evaluating the echo-cg protocols after treatment, normal lv diastolic function was recorded in 39 patients, moderate diastolic dysfunction (lv dd) in 27, and 1 patient had severe lv dd. When assessing the dose received by the lv myocardium, the excess of the average dose to the myocardium was present both on the left and on the right. Only in 16 % of cases, left myocardial irradiation met criterion v 25. Clinically, arrhythmias, unstable angina pectoris, and other manifestations of coronary artery disease were mostly observed among patients with left-sided breast cancer. Significant factors for the development of cardiotoxicity were left-sided breast cancer, previous chemotherapy with anthracyclines and/or taxanes, as well as myocardial doses. The occurrence of radiation pulmonitis did not show an obvious relationship with any factor, while the body mass index (bmi) of >30 was a significant factor for the occurrence of radiation-induced skin damage.Conclusion. The combination of radiation therapy and trastuzumab was associated with an acceptable risk of cardiotoxicity. Monitoring of the cardiovascular system parameters during treatment and detection of early signs of cardiotoxicity were shown to be of great importance.

Purpose of the study: to evaluate the overall survival and local control in patients with inoperable kidney cancer treated with stereotactic body radiotherapy (SBRT). Material and Methods. From 2011 to 2021, 42 patients with histologically verified kidney cancer underwent SBRT to a total dose ranging from 30 to 45 Gr in 3 fractions using the CyberKnife robotic radiosurgical system. SBRT was performed for inoperable patients, taking into account various factors (age, severity of concomitant pathology, ASA IV physical status level), patients’ refusal of surgical treatment, and tumor size of ≤5.0 cm in diameter. SBRT was not performed for patients with tumor size of ≥5.0 cm in diameter, impaired renal function, generalization of cancer and decompensation of concomitant pathology. The median age of the patients was 67.9 years. 93 % of patients had stage I kidney cancer. The primary tumor was diagnosed in 37 cases, recurrence after previous surgical treatment in 6, including 1 patient with recurrence of cancer of both kidneys. The average tumor volume was 28.1 cm3. Results. The median overall survival (OS) was not reached due to the fact that the majority of patients (n=36) were alive at the time of the study. The 1-, 3- and 5-year OS rates were 94.1 %, 88.7 %, and 72.6 %, respectively. The 1-year local control rate was 93 %. At 3-6 months, 26.2 % of patients showed partial response, 66.8 % had stable disease and 7 % had disease progression (according to the RECIST 1.1 criteria). Renal toxicity occurred in 23.8 % of patients 3 months after radiation therapy; however, kidney function was restored in these patients within a year. Conclusion. SBRT has demonstrated high efficacy with minimal toxicity in the treatment of inoperable patients with kidney cancer.

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