[Possibilities of systemic radiotherapy with high-purity 89Sr chloride in the treatment of bone metastases].

OBJECTIVE: To study the efficiency of treatment via single administration of high-purity 89Sr chloride in the standard activity of 150 MBq for pain syndrome in patients with multiple bone metastases. SUBJECTS AND METHODS: The authors carried out clinical trials of high-purity 89Sr chloride used to treat 30 patients with multiple bone metastases from cancers at various sites. The results of treatment were analyzed in 30 patients with multiple bone metastases, who had received systemic radiation therapy with high-purity 89Sr chloride in the standard activity of 150 MBq. These were assessed using some indicators: the intensity of pain syndrome and the blood concentrations of hemoglobin, leukocytes, and platelets. RESULTS: There was evidence for the use of high-purity 89Sr chloride in the therapy of patients with cancer at various sites with multiple bone metastases. The major indicators (pain syndrome, the blood concentrations of hemoglobin, leukocytes, and platelets) were compared before and after the treatment. These were also compared with those obtained with the use of usual 89Sr chloride. CONCLUSION: The therapeutic action of high-purity 89Sr chloride is comparable with that of 89Sr chloride in the standard activity; moreover, the analgesic effect of high-purity 89Sr chloride is being significantly higher. It has less significant myelotoxic activity than usual 89Sr chloride. High-purity 89Sr chloride is an effective radiopharmaceutical agent and may be used for systemic radiotherapy in patients with multiple bone metastatic lesion.

[Strontium chloride (89Sr-chloride) fractional injection method for bone metastases treatment].

The study was designed to compare the effectivnes of 89Sr-chlorid injections by 50 Mbk fractions with standard 150 Mbk injection in patients with bone metastases. Fifty patients with bone metastases were included in the study, 25 of them received 89Sr-chloride by fractional and 25 (control group) by single injection. The pain intensity, white blood cells and thrombocytes concentration values were evaluated in both groups before and after treatment. The study proved the possibility of using systemic 89Sr-chloride fractional radiotherapy in patients with bone metastases and concurrent stage 2-3 myelosupression. The method of fractial 89Sr-chloride injection is effective in symptomatic treatment of patients with bone metastases.

[Systemic radiotherapy options in the treatment of metastatic skeletal involvement].

OBJECTIVE: To evaluate the efficiency of treatment using various systemic radiotherapies for metastatic skeletal involvement in patients with breast or prostate cancer. MATERIAL AND METHODS: The case histories of 350 patients treated at the Department of Radiation Medicine in 2006 to 2010 for multiple metastatic skeletal involvement in cancers at various sites were analyzed. The efficiency of treatment for pain syndrome and the magnitude of a myelosuppressive effect were estimated in the use of various systemic radiotherapies. For this, the authors compared: 1) two patient groups treated by 89Sr chloride monotherapy in the standard activity of 150 MBq or by that in combination with teleradiotherapy (TRT); 2) two patient groups treated by the monotherapy in the standard activity of 150 MBq or by 89Sr chloride fractional injection. RESULTS: The efficiency of treatment using various systemic radiotherapies was estimated. That was comparatively evaluated in the patient groups having various treatments. Algorithms of indications were elaborated to choose a systemic radiotherapy option depending on the clinical situation. An 89Sr chloride injection procedure was developed for patients with significant myelosuppression. CONCLUSION: 1. Various systemic radiotherapies as second-line therapy may be used to treat metastatic skeletal involvement in patients with cancer at various sites. 2. The most pronounced analgesic effect was found when 89Sr chloride in the standard activity of 150 MBq had been injected in combination with TRT (a 36% reduction in the intensity of pain syndrome); a less pronounced effect was produced by 89Sr chloride monotherapy (27%). The lowest analgesic effect was observed when 89Sr chloride had been fractionally injected (14%). 3. The levels of white blood cells and platelets were decreased in all the groups. 4. 89Sr chloride fractional injection is the method of choice when its single administration is impossible in patients with evident leukocyto- and thrombocytopenia.

[Radionuclide diagnosis of upper urinary tract patency in patients with cancer of the cervix uteri ].

The experience with dynamic renal scintigraphy has shown its high informative value and safety in evaluating the degree of intrarenal urine outflow disorders. However, failure to make an objective assessment of ureteral patency considerably limits its study. The set of studies, which is given in this paper, is devoted to precisely this, highly urgent, problem. The authors have developed an original procedure for diagnosing impaired urine outflow along the ureters during dynamic renal scintigraphy. The visual and digital characteristics of normal and impaired urine outflow in the supravesical segment are defined. The criteria characterizing severe impairments of renal urine derivation along the ureters are denoted. Risk factors for urine outflow disorders are identified in patients with cancer of the cervix uteri, who receive various treatment modalities.

[Genotype dependence of cytogenetic and epidemiological characteristics in the liquidators of the accident at the ChNPP].

The dependence of the level of unstable chromosome aberrations and nononcological diseases on the genotype in 57 liquidators of the ChNPP accident was studied. Candidate genes presumably affecting radiosensitivity were highly polymorphic loci of xenobiotic detoxication genes (glutathione-S-transferases GSTM1, GSTT1, GSTP1) and the 5,10-methylenetetrahydrofolate reductase gene (MTHFR) involved in DNA methylation and synthesis. An increased frequency (0.014 +/- 0.001 per cell) of unstable chromosome aberrations, including radiation-specific dicentrics and centric rings (0.0015 +/- 0.0002 per cell), has been found to be preserved in the group of liquidators examined in 2006-2007. No associations of polymorphism for each of the studied genes with cytogenetic parameters were revealed. Increased frequencies of chromosome aberrations were recorded in homozygous carriers of a deletion at the GSTM1 locus in combination with homozygosity for minor alleles at the MTHFR and GSTP1 loci (p = 0.00002 and p = 0.0233, respectively). The number of homozygous carriers of the minor allele GSTP1 was increased among patients with chronic obstructive pulmonary disease and in liquidators with acute circulation disturbances (p = 0.014 and p = 0.04, respectively). Double homozygotes for GSTM1 and GSTT1 deletions were significantly more frequent among subjects with benign tumors (cysts, polyps, p = 0.015) and with benign thyroid tumors (p = 0.017). This genotype has proved to be protective for patients with severe cardiovascular diseases (acute circulation disturbances, p = 0.027).

[Renal function after radical nephrectomy].

For determination of indications and contraindications to radical treatment of renal cell carcinoma, it is necessary to have information about functional activity of renal parenchyma of the contralateral kidney while methods of examination predicting functional activity of postoperative renal parenchyma after radical nephrectomy are not recently available. The Russian Research Roentgenoradiology Center utilizes 99m-Tc-DMCA static scintigraphy for assessing renal parenchyma function. This radiopharmaceutical demonstrates the highest tropism for epithelium of the proximal convoluted tubules, most functionally active nephron segment. Focal lesions of the renal parenchyma cause metabolic alteration of 99m-Tc-DMCA transport through membrane of proximal tubule epithelium leading to foci of low activity of the radiopharmaceutical in pathologically affected zones. For prognosis of renal function integral catch index is used (in healthy subjects this index is at least 45 units for each kidney, lower values point to reduction of the volume of viable renal tissue). Static renal scintigraphy with determination of expected integral catch of the radiopharmaceutical is minimally invasive, significant, reproducible test for viability of renal parenchyma. The absence of significant differences in expected and actual values of the integral catch index refers static scintigraphy to methods able to prognosticate functional activity of the renal parenchyma after surgical treatment for renal carcinoma.

[Results of testing of MINISKAN mobile gamma-ray camera and specific features of its design].

The main results of engineering, biomedical, and clinical testing of MINISKAN mobile gamma-ray camera are presented. Specific features of the camera hardware and software, as well as the main technical specifications, are described. The gamma-ray camera implements a new technology based on reconstructive tomography, aperture encoding, and digital processing of signals.

[Evaluation of axillary lymph nodes from the results of radioisotopic study].

The purpose of the investigation was to study the pattern of 99mTc (MIBI) technitrile uptake in the metastatically involved lymph nodes in breast cancer, by applying the plain scintigraphic technique. The scintigraphic study of the breast and regional metastatic areas by means of the radionuclide 99mTc (MIBI) technitrile was made on a Millennium GE tomographic gamma chamber. The radiotracer 550 (MBq) dissolved in 10-20 ml of saline solution was intravenously injected into the arm cubital vein contralaterally to the lesion. Following 20 minutes of injection of the agent, plain scintigraphy was carried out in three standard projections: frontal and two oblique ones. The scintigraphy was performed using a high-resolution collimator recording a 128 x 128 matrix image. The detector was maximally approximated to the organ being examined. A plain scintigraphic scan was recorded on each side for 10 minutes. By the degree of axillary lymph nodal involvement, the patients were divided into 3 groups in accordance with the international TNM classification: N0 (n = 55), N1 (n = 13), N2 (n = 4). Among 72 patients, axillary lymph nodes could be detected in 6, in 2 of them changes were not diagnosed by X-ray and ultrasound studies. The final pathomorphological study of intraoperative materials revealed axillary lymph nodal metastatic involvement in 17 patients. A micrometastasis in one lymph node was found in 1 patient. None of the radionuclide studies showed tumor spread in 5 cases. The sensitivity, specificity, and precision of the technique were 35.3, 100, and 84.7%, respectively. Thus, a combination of the high cost of the procedure, its radiation load on a patient, and its low sensitivity make the use of plain scintigraphy of axillary regions inexpedient in the complex of studies of the extent of breast cancer in the present development of technology.