2019, VOL. XXVII, PUB. 2, PAGE 85
M. TKACHENKO1, P. KOROL1, 2
1 Bogomolets National Medical University, Kiev
2 Kiev city clinical hospital № 12
DIAGNOSTIC VALUE OF RENOSCINTIGRAPHY IN PATIENTS WITH TESTICULAR SERTOLIOMA AFTER CYTOSTATIC THERAPY
Aim. To determine the diagnostic role of renoscintigraphy in patients with testicular sertolioma after cytostatic therapy.
Materials and methods. Renoscintigraphy was performed in a dynamic mode after intravenous administration of 99mTc-pentatex at the rate of 0.7-1.0 MBq/kg, followed by the calculation of digital parameters reflecting the secretory-excretory function of the kidneys.
Results. With the help of renal scintigraphy, 64 male patients examined with testicular sertolioma aged 8 to 51 years were examined. In the group of patients taking Cisplatin, there was a significant suppression of indicators of the functional activity of the parenchyma and the secretory-excretory function of the kidneys (p <0.05) compared with the group of patients who did not use cytostatic therapy. In the group of patients taking Cisplatin, clinical signs of chronic nephrotoxicity were found, which, in turn, were not observed in the group of patients who do not use cytostatic therapy with Cisplatin for the aim of treatment.
Conclusion. Renoscintigraphy is a sensitive method of dynamic monitoring of the evaluation of the effectiveness of anticancer treatment of patients with testicular sertolioma and pathogenetic correction of cytostatic therapy.
Keywords: renoscintigraphy, testicular sertolioma, cytostatic therapy, nephrotoxicity.
2019, VOL. XXVII, PUB. 2, PAGE 88
I. NOVERKO, A. KHOKHLOV, M. SATYR, M. SHYMANKO
SI «Heart Institute Ministry of Health of Ukraine», Kyiv, Ukraine
RENAL SCINTIGRAPHY WITH 99mTc-DTPA IN EVALUATION OF THE KIDNEYS FUNCTION AFTER SURGICAL CORRECTION OF THE RENAL ARTERY STENOSIS IN PATIENTS WITH RENOVASCULAR HYPERTENSION
Summary. The analysis of the immediate and long-term results of renal artery stenting in patients with atherosclerotic etiology RVH was carried out in order to study the potential of 99mTc-DTPA in assessing the functional status of the kidneys. Scintigraphic studies were performed on 28 patients with RVH before and after stenting. It was established that in the first three months after stenting, the glomerular filtration rate (GFR) increased by 4.9 %, the excretory ability of the kidneys improved by 8.2 %. One year after stenting, the GFR increased by 13.6 %, two years later — by 19.4 %, while the excretory capacity of the kidneys improved by 24.7 % and 30.1 %, respectively.
Renal scintigraphy is a sensitive method of dynamic monitoring of the efficiency of renal artery stenting in patients with RVH.
Keywords: renovascular hypertension, renal artery stenosis, dynamic renal scintigraphy, glomerular filtration rate, 99mTc-DTPA.
2019, VOL. XXVII, PUB. 2, PAGE 93
YU. SEVERIN1, O. SHCHERBYNA1, N. CHURYKOVA2, O. GORBOVA2
1 P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv
2 Kyiv City Clinical Oncological Center
NUCLEAR DIAGNOSTIC METASTASES HIGHDIFFERENTIAL THYROID CANCER IN LUNGS
Purpose. Determination of specificity and sensitivity of scintigraphy 131-I with DTC.
Materials and methods. Scintigraphy with 131I was used in 21 patients with HDTC with possible metastatic in lungs. The procedure is standard.
Results. In most patients, metastases in the lungs are detected simultaneously with chest X-ray and 131-iodine scintigraphy. It was found that in 3 patients (14 %), who had primary hearths of the pathological accumulation of 131-I in the area of lung projection, after 2 courses of radioiodine, accumulation of the drug is not noted, but pathological hearths were determined in CT and MRI studies. This may indicate the development of radioiodine pathology, which causes the false negative results of the study. Two patients with a re-examination, the second course of radioiodine therapy, revealed a low-intensity uneven distribution of the radiopharmaceutical, but after an additional CT study, identified and confirmed by anamnesis — chronic diseases of the respiratory system. This gives grounds for suspecting false positive.
Results. The only indication for the appointment of a PET / CT with 18-FDG is a suspicion of a recurrence of the disease with iodine-negative scan and a high level of oncomarker — thyroglobulin (greater than 10 ng / ml).
Conclusions. In case of suspicion of metastases in the lungs of the DTC, the following principles of diagnosis should be followed: 1) X-ray of the chest organs should be as a screening method; 2) scintigraphy with 131-I should be performed by all patients with HDTC, with suspicion of lung metastases; 3) MSCT of the chest organs are at present the “gold standard” for the diagnosis of metastases in the lungs of the HDTC; 4) the determination of serum in conjunction with thyroglobulin antibodies to thyroglobulin to improve the accuracy of diagnostic studies; 5) PET / CT with 18-FDG should be based on the analysis of the results of all the above-mentioned survey methods.
Keywords: cancer of the thyroid gland, lung metastases, scintigraphy, radioiodiagnostics.
2019, VOL. XXVII, PUB. 2, PAGE 97
V. IVANKOVA1, E. DYOMINA2, L. MATVIEVSKA3, T. KHRULENKO1, L. BARANOVSKA1
1 National Cancer Institute, Ministry of Healthcare, Kyiv
2 RE Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Kyiv
3 CE «Zhytomyr Regional Oncology Center»
THE USE OF IRIDIUM-192 AT RADIATION TREATMENT OF VAGINAL CANCER WITH RADIOBIOLOGICAL ACCOMPANIMENT
Increasing of efficiency of chemoradiation therapy (CRT) of secondary vaginal cancer (metastatic forms) continues to remain an object of broad discussion.
We have performed complex conservative treatment in 98 patients with II-ІІІ stages of secondary metastatic vaginal cancer, T2-3N0-1M0. Average age of patients was 57,3±5,2 years old. 3 groups were formed depending on the source (192Ir, 60Со), radiation regimen, radiation activity of HDR (high dose rate — higher than 12 Gy/hr) brachytherapy in the background of chemosensibilization agents (oral fluoropyrimidines, platinum-based drugs).
2 study groups included 30 patients, who underwent HDR brachytherapy with 192Ir by single focal dose of 3 Gy х 3 times per week and 33 patients who underwent HDR brachytherapy with 192Ir by single focal dose of 5 Gy х 2 times. Control group included 35 patients who received НDR brachytherapy with 60Со by single focal dose of 5 Gy х 2 times per week. Total focal dose of combined radiation therapy was up to 80-90 Gy to tumor focality and 44-46 Gy to areas of regional metastases.
Radiobiological accompaniment included performing in vivo cytogenetic monitoring of lymphocytes in peripheral blood and comparative analysis of genotoxicity of different brachytherapy regimens.
Analysis of direct results of efficiency of the usage of HDR brachytherapy with 192Ir different regimens comparatively to patients of control group, who received НDR brachytherapy with 60Со, and dynamic surveillance data for 3 months showed, that positive tumor response (total + partial regression) after chemotherapy course increased to 20,3 % and 17,9 % in secondary metastatic vaginal cancer patients in study groups comparatively to the usage of НDR brachytherapy with 60Со. Toxic effects of treatment according to the number and degree of their manifestations in study groups of patients were no different from control group and did not exceed ІІ grade.
Therefore, proposed methods of high-energy brachytherapy in patients with secondary (metastatic) vaginal cancer are effective and do not have excessive toxicity. Radiobiological studies provide an opportunity to determine previous individual radiosensitivity of the patient’s organism based on the level of chromosomal aberrations of peripheral blood lymphocytes.
Keywords: high-energy brachytherapy, 192Ir, 60Со, secondary metastatic vaginal cancer.
2019, VOL. XXVII, PUB. 2, PAGE 103
N. LUKHOVITSKAYA1, 3, G. KULINICH1, Y. RADZISHEVSKA1, 2, L. VASIL’EV1
1 SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv
2 Kharkiv National Medical University
3 V. N. Karazin Kharkiv National University
RADIONUCLIDE TREATMENT OF WELL DIFFERENTIATED THYROID CANCER
The prognosis for a complete cure for a well differentiated thyroid cancer (WDTC) is quite favorable, however, the number of relapses and distant metastasis (from 10 to 30 %) make it necessary to optimize the treatment and the choice of radioiodine therapy (RIT).
The literature data were analyzed and the efficiency of RIT was evaluated in 899 patients who received treatment at the Grigoriev Institute for Medical Radiology and were divided into risk groups, depending on the stage of the process.
For 739 patients with a low risk of thyroid cancer, 100 % cure was achieved after two courses of RIT with medium activities (1,48-2,22 GBq, total of 3,30-4,81 GBq). Among 80 pat. intermediate risk, the choice of therapeutic activity RI for 1 course was carried out individually (total from 5.5 to 11.1 GBq) and in 95 % cure was achieved.
From 16 patients high-risk groups, cured by 50 % of patients, iodine-negative process was established in 0,5 %, 0,4 % of patients died from thyroid cancer generalization.
It has been proven that the use of medium RI activities for low-risk patients allows curing cancer, avoiding early and late post-radiation complications, and reducing the radiation load on the patient. The increase in the activity of RI and the number of courses of treatment in patients from the group of intermediate and high risk of recurrence of DTC is desirable to carry out individually, taking into account the numerous risk factors of possible complications.
Keywords: differentiated thyroid cancer, 131-I therapy, analysis of treatment.
2019, VOL. XXVII, PUB. 2, PAGE 112
M. KHVOROSTENKO, I. KIKHTENKO, J. KHVOROSTENKO, Y. GRABOVSKY
SI «Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine»
CLINICAL POSSIBILITIES OF PERTECHNETATE 99mTc AS A POTENTIAL MARKER OF LYMPHOVENOUS OUTFLOW IN CANCER PATIENTS WITH DISTAL EDEMA OF A LIMB AFTER THE COMBINED TREATMENT
Introduction. Most women who have undergone combination treatment for breast cancer develop secondary lymphostasis of the limb.
The purpose of the study is to determine the diagnostic capabilities of lymphovenousscintigraphy with an aqueous solution of 99mТс pertechnetate to identify the topographic and anatomical level of the lymphovenous outflow block in certain segments of the limb and subclavian region in oncological patients with distal limb edema after combined treatment.
Materials and methods. All 47 patients were injected subcutaneously with 99mTc pertechnetate into the tissue depots of various segments of the edematous limb. Using the gamma camera GCS 301-T, the dynamics of the drug were recorded at the points of injection and along the length of the arm.
Results. On the basis of the data obtained, a topographic-anatomical map of the rate of accumulation and removal of the drug in individual zones of limb segments was created. The change in dynamics from the accumulation of the drug to its elimination in the adjacent areas was defined as a lead unit.
Findings. The proposed method allowed us to objectively determine the level of the lymphovenous outflow block in certain segments of the limb.
Keywords: limfovenozny outflow, lymphedema limb, pertechnetate 99mTс.
2019, VOL. XXVII, PUB. 2, PAGE 117
M. IVANENKO, P. SOROCHAN, V. SHEVTSOV
SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv
METABOLIC DISORDERS IN BREAST CANCER PATIENTS TREATED WITH COMBINED ANTICANCER THERAPY
The aim of the study. To determine the particular properties of metabolic disorders during combined therapy in patients with breast cancer.
Materials and methods. A group of 45 breast cancer patients (IIB) with lymph nodes metastases was examined, the diagnosis was verified histologically. The examination was carried out in 3 steps: before treatment, after surgery and after the course of radiation therapy. Serum levels of insulin and cortisol were estimated via the enzyme-linked immunosorbent assay. Serum levels of C-reactive protein, triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were determined by the automated biochemical analyzer “RESPONS 910”. To evaluate the severity of insulin resistance the NOMA index was used.
Results. During the stages of combined anti-tumor therapy in breast cancer patients, we identified specific metabolic disorders: increased body mass index, the elevated levels of triglycerides, cholesterol, and insulin.
Conclusion. The atherogenic index of plasma in all post-operational groups of patients was increased and remained elevated after the completion of radiotherapy. Serum levels of C-reactive protein significantly increased after surgical treatment in patients of all groups. Reporting levels of protein after radiotherapy were comparable with indices attained before the treatment. Most patients with breast cancer had metabolic disorders: insulin resistance was reported in 60 % of patients, increased body mass index was found in 59 % of patients, increased triglyceride level was observed in 35 % of patients, and elevated cholesterol levels were observed in 65 % of patients.
Keywords: breast cancer, metabolic disorders, radiotherapy.
2019, VOL. XXVII, PUB. 2, PAGE 123
SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv
IMPACT OF CONCOMITANT UROLOGIC PATHOLOGY ON RADIOTHERAPY TOXICITY IN POSTOPERATIVE IRRADIATION OF PATIENTS WITH STAGE I-II ENDOMETRIAL CANCER
When a patient undergoes radiotherapy (RT), which is one of the main methods of treating genital cancer today, his/her healthy organs and tissues are also exposed; this leads to radiation reactions development.
The purpose of the study. Analysis of the status of the urinary tract before the RT and its effect on incidence and severity of early radiation cystitis in EC patients with stage I-II that receive RT in the postoperative period.
Materials and methods. The postoperative radiotherapy course was provided for 80 uterine carcinoma patients with stage I-II (T1а-2NхM0) by means of one of the following devices — either ROCUS-AM or CLINAC 600 C.
Cystoscopy was performed for patients before RT in order to diagnose urinary tract pathology.
Outcomes. In 10 (50.0 %) of 20 patients before the start of radiotherapy, cystoscopy revealed changes in the bladder. In postoperative remote radiotherapy course, 47 (58.8 %) out of 80 patients had a clinically marked radiation cystitis of grade 1-2 . Most commonly radiation cystitis occurred when treatment was provided by means of CLINAC 600 C apparatus. Grade 2 radiation cystitis was observed in those patients who had been diagnosed with the genitourinary system pathology prior to the initiation of radiotherapy.
Conclusions. The availability of information about the initial state of the urinary system organs is the most critical moment, since it makes it possible to avoid or in the future more effectively deal with the complications of combined treatment.
Keywords: endometrial cancer, radiotherapy, urogenital system, radiation reactions, radiation cystitis.
2019, VOL. XXVII, PUB. 2, PAGE 128
SI «Institute Heart Ministry of Health of Ukraine», Kyiv
THE APPLICATION OF RADIATION DIAGNOSTIC METHODS FOR THE DETECTION OF DEGENERATIVE-DYSTROPHIC AND INFECTION / INFLAMMATION PROCESSES OF THE LOCOMOTOR APPARATUS (A LITERATURE REVIEW)
This article is dedicated to the complex evaluation of the locomotor apparatus (LA) from the side of metabolic disorders in bone tissues (BT) on the most common benign bone conditions- degenerative-dystrophic (DD) and infection / inflammation (II) processes. The knowledge about the main principles and methods of the radiation diagnostics is necessary for their well-grounded application in corresponding clinical situations.
The processes of the bone turnover in normal BT, in DD and in II processes were considered. There were outlined opportunities and discovered application of the different radiation diagnostics methods considering pathogenetic changes BT in these processes.
We have analyzed current literature about efficiency and field of application of those methods in benign lesions of the LA.
Special attention is devoted to the nuclear medicine diagnostic methods — planar bone scan, 3-phase bone scan, SPECT, combined technologies (SPECT/CT, PET/CT).
Keywords: locomotor apparatus, degenerative-dystrophic processes, infection / inflammation processes, radiation diagnostics methods.
2019, VOL. XXVII, PUB. 2, PAGE 135
S. AMIRAZYAN, A. FATIEIEV
Kharkiv National Medical University
V. N. Karazin Kharkiv National University
HIGHER MEDICAL SCHOOL: PRO ET CONTRA
There is a crisis in current medical school education, caused in part by fundamental social contradictions. The medical school education programs must be constantly evolving, they cannot stand still as informational and high-tech technologies are rapidly developing. The expansion in medical research has reached a point, where further increases in the volume of theoretical knowledge taught in medical school, actually leads to a deterioration in the quality of medical training.
The solution is «practice-oriented» training, on a sound theoretical basis. It should provide an opportunity for young medical professionals to continuously improve their knowledge.
Keywords: medical school crisis, intensification of the educational process, «practice-oriented» training.
2019, VOL. XXVII, PUB. 2, PAGE 141
National Cancer Institute Ministry of Healthcare, Kyiv
MODERN TECHNOLOGIES OF RADIOTHERAPY IN ONCOLOGY
The article emphasizes that radiotherapy, along with surgery and chemotherapy, is one of the key methods of treating cancer tumors and this method is constantly being improved and updated with new techniques. Previously it was used mainly as an adjuvant therapy for the prevention of cancer recurrence, today some types of radiation therapy are prescribed as the main method of treatment for many types of malignant tumors. Radiation therapy is used to treat both of the tumors and metastases, and this method can be used in conjunction with such treatment methods as surgical, chemotherapeutic and hormonal. Radiotherapy is used in the treatment of any stage of cancer.
Сontraindications to this method of therapy are very minimal. In many cases, it can be used instead of crippling surgery. Today, the most well-known radiation technologies, ultramodern medical navigation systems and linear accelerators are ART (adaptive radiation therapy), SBRT (stereotactic body radiation therapy), IGRT (radiation therapy with visual control of the target), IMRT (image guided radiation therapy). With such technologies, high-precision topometry is applied with further calculations based on the obtained topographic-anatomical data of absorbed doses in the nidus and the pathways of metastasis, adjacent tissues, and critical organs. Such a technique of 3D CT-topometry combined with the use of individual fixing devices for radiation therapy on linear electron accelerators with a multi-leaf collimator, allows not only to carry out all modern methods of radiation therapy (IMRT, IGRT, VMAT), but also to ensure the maximum possible protection of adjacent healthy tissues to significantly improve quality. The introduction of conformal radiation therapy technologies, especially with beam intensity modulation, under image control, the use of PET data when planning exposure, correlated with images obtained by computed tomography, can improve the quality of life of patients and increase total focal doses. As a result, the role of radiation therapy in the treatment of cancer has grown. Whereas previously radiation exposure was considered only as palliative at certain locations of the tumor process, now in some situations, for example, with stereotactic radiation therapy of localized forms of lung cancer, local control can be achieved in 90 % of patients. The use of conformal ЗD radiation therapy in patients with malignant neoplasms leads to a decrease in the frequency of early and late radiation injuries, and it can significantly improve both immediate and long-term results of treatment.
Keywords: modern technologies, radiation oncology, radiotherapy, high-precision topometry.
2019, VOL. XXVII, PUB. 2, PAGE 146
M. TKACHENKO, G. ROMANENKO, O. MIRONOVA, I. HOROT
Bogomolets National Medical University, Kiev
SYSTEMIC IMPLEMENTATION OF SCIENTIFIC-RELATED EDUCATION ON CHAIR OF RADIOLOGY AND RADIATION MEDICINE OF THE A. A. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY
Requirements for graduates of medical universities today are extremely high, future physicians must be able to quickly navigate the information space, think clinically, clearly analyze the findings, provide sound conclusions, and validate the quality assessment of specific tasks in practice. The purpose of our study was to prove the need for scientifically-directed training for the absorption of radiology atthepre-graduation stage of education. The obtained results indicate that the use of SRE as one of the effective student-oriented approaches allows achieving higher learning outcomes than with wide spread traditional forms of learning (lectures, discussion of topics within practical and seminars).
Keywords: scientifically directed education, medical education, students.
2019, VOL. XXVII, PUB. 2, PAGE 150
O. ASTAPIEVA, O. PASKEVYCH, Y. FEDULENKOVA
Kharkiv National Medical University
MODERN TRENDS OF TEACHING IN HIGHER EDUCATION (ON MATERIALS OF THE TRAINING COURSE AND INTERNATIONAL CONFERENCE ON INTERNATIONALIZATION OF EDUCATION)
Changes in the system of health protection and education in Ukraine require the integration of the national education system, including higher medical, in the European and world educational space. To prepare for the integration process, various trainings, training courses, conferences are held. One of such events was the courses of pedagogical training of employees of higher educational institutions, which were held from 5 to 22 February 2019 in Krakow (Poland) on the basis of the University of Economics. In addition, the international scientific and practical conference “Internationalization of education as a challenge for higher education institutions: Ukrainian and Polish perspective was held within the boundaries of this conference.
The purpose of these activities was to improve the effectiveness of learning in higher education through the use of latest innovative technologies, discussing the issues of modernization of higher education in conditions of global Informatization of the society. Special attention was paid to the use of IT technologies in the modern pedagogical process. Also discussed were the prospects for the development of Ukrainian-Polish relations in the field of higher education and aspects of administration of internationalization of education.
Keywords: higher education, internationalization, IT technologies, innovative technologies, online communications.