Objective: demonstration of possibilities of18F-prostate specific membrane antigen-1007 (18F-PSMA-1007) positron emission tomography/computed tomography (PET/CT) for diagnostic prostate cancer recurrence.The article presents clinical observation of the patient with prostate cancer biochemical recurrence after the multiple treatment.18F-PSMA-1007 PET/CT demonstrates high sensitivity in prostate cancer recurrence diagnostic, in particular with low prostatic specific antigen level.

Контакты: Наркевич Борис Ярославович, narvik@yandex.ru реферат Проведена функциональная оптимизация состава радиофармацевтических пар на основе простат-специфического мембранного антигена (PSMA) для радионуклидной тераностики кастрационно-резистентного рака предстательной железы. Проведен анализ радиационно-физических и дозиметрических характеристик 9 радионуклидов для диагностических компонент тераностических пар и 6 радионуклидов для терапевтических компонент. Показано, что оптимальными для диагностики и контроля эффективности лечения следует считать позитронно-излучающие радионуклиды 18 F и 68 Ga, а для радионуклидной терапии -бета-излучающий радионуклид 177 Lu и альфа-бета-излучающий радионуклид 225 Ac. Рассчитаны значения общего и органного радиационного риска возникновения вторичных радиационно-индуцированных раков у больных, прошедших по нескольку курсов радионуклидной терапии. Показано, что для 2 тераностических пар на основе 177 Lu-PSMA радиационный риск выше существенного, тогда как для 2 тераностических пар на основе 225 Ac риск укладывается в диапазон существенного уровня. Рассчитанные радиологические критерии выписки больных после курса тераностики из подразделений ядерной медицины показывают принципиальную возможность выполнения лечения в амбулаторном режиме при использовании любой из 4 рассмотренных тераностических пар. ключевые слова: рак предстательной железы, радионуклидная тераностика, тераностические пары радионуклидов, ПСМА, радиационный риск, радиационная безопасность для цитирования: Наркевич Б.Я., Долгушин М.Б., Крылов В.В., Мещерякова Н.А., Невзоров Д.И. Функциональная оптимизация радионуклидных пар в тераностике рака предстательной железы. Онкологический журнал: лучевая диагностика, лучевая терапия. 2020;3(1):38-56

Introduction. Gestational trophoblastic neoplasias are rare tumors, which consist of about 1% of gynecological cancers. High rate of diagnostic and treatment mistakes leads to late diagnosis, metastatic appearance, resistance to chemotherapy, poor prognosis. Aim. To demonstrate possibilities of 18F-FDG PET/CT to find resistant lesions of gestational trophoblastic neoplasias. In the article, we analyze several medical reports to illustrate advantages of 18F-FDG PET/CT for evaluation of resistant gestational trophoblastic neoplasias.

Introduction. Nowadays the stereotactic radiotherapy (SRT) of patients with clinical stage I-II lung cancer is the choice of the treatment modality for functionally inoperable patients. It shows safety and high efficiency in reaching the local control. Though there is a range of unsolved issues connected with the prediction of treatment efficiency and frequency of complications, an integration of new technologies in the planning and treatment process allows to widen the search of the predictive factors.Materials and methods. Since 2014, 42 patients (T1N0M0 – 16 patients, T2N0M0 – 26 patients) with clinical stage I-IIa lung cancer have underwent SRT. The majority of patients (38) have been recognized as functionally inoperable due to the concurrent broncho-pulmonary pathology, 4 conditionally operable patients have refused an operation. 11 patients had the primary multiple tumors in their anamneses, 3 patients had a сentral tumor. Used dose fractionation options were: 10 Gy х 5 fractions (n = 29) and 7 Gy х 8 fractions (n = 13) – BED = 100 Gy.Resuts. The median follow-up was 32 months (range 6–56 months). The 3-year local control was 94%. The isolated local recurrences were not registered. Overall 3-year survival rate was 74% (95% CI, 60–90) and a 3-year tumor-specific survival rate – 84% (95% CI, 71–98). During one-factor analysis a reliable influence on the prognosis of the fractionation regimen (р = 0,04) and, close to reliability, the initial SUVmax level influence (р = 0,07) were revealed. Grade 3 pulmonary toxicity was observed in 4 (9%) patients, one patient with a Central tumor died from pulmonary hemorrhage (grade 5 toxicity). Grade 3 chest pain was observed in 3 (7%) patients, two of them had a rib fracture.Conclusions. With modern approaches to SRT treatment planning and delivery there should be a search for additional treatment efficiency and toxicity predictors. The total dose delivery regimen and initial tumor SUVmax can be predictive efficiency factors, while the pulmonary tissue volume can be a predictive toxicity factor.

PET/CT offers the most advanced possibilities for visualization of non-small cell lung cancer (NSCLC) nowadays. 18F-FDG PET/CT plays a significant role in staging of NSCLC, choosing of treatment strategy, planning of radiation therapy and evaluation of its efficacy. Clinical observation of the patient with non-small cell lung cancer with response assessments by 18F-FDG and 18FFLT PET/CT during the course of chemoirradiation is demonstrated. There was a correlation between 18F-FDG and 18F-FLT PET/CT with advantage of 18F-FLT PET/CT for early response evaluation. The combination of 18F-FDG and 18FFLT PET/CT will be helpful to personalize chemoirradiation and to predict response more accurately. The presented clinical case demonstrated the possibilities of 18F-FDG and 18F-FLT PET/CT for assessment of treatment efficacy in patient with non-small cell lung cancer.