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.

Treatment of hypervascular formations is challenging surgery. The solution of this problem is due to use a multidisciplinary approach, involving complex endovascular and surgical treatments. Patho-morphological study of remote hypervascular formations in treatment was carried out. That treatment consisted of an endovascular embolotherapy and an endovasal sclerotherapy in various combinations. The embolization of blood vessels leads to a complete reduction of blood flow in the formation area, the development of diffuse inflammatory infiltration in the background on tissue ischemia. In the future, developing ischemic necrosis fol-lowed by scarring of tissue surrounding the vascular formation. Sclerotherapy causes damage to the vascular endothelium with fibrin formation and hemolysis of red blood cells in the lumen of the veins. Moreover, there are a significant fibrosis, hyalinosis and inflammatory reaction of the tissues surrounding the vessels. Further development of this process leads to a final sclerosis and fibrotic scarring of the surrounding tissues. The combi-nation of endovascular embolization and sclerotherapy allows to achieve a reduction of blood flow in the arterial vascular malformation department and to cause a tissue fibrosis in the cavernous malformations. Endovascular therapy reduces the risk of bleeding in surgery and develops the capacity of radical treatment.

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