Диагностика и лечение опухолей мочеполовой системы. Рак предстательной железыВведение В последнее время активно ведутся разработка и внедрение в клиническую практику методов радио-терапии в лечении злокачественных заболеваний. С развитием новых технологий в лечении рака пред-стательной железы (РПЖ) методу радиотерапии отда-ют все большее предпочтение. Тем не менее, по дан-ным мировой литературы, биохимический рецидив после дистанционной радиотерапии (ДРТ), брахите-рапии в монорежиме и в сочетании с ДРТ при РПЖ достигает 40 % [1][2][3][4]. В 20-30 % случаев биохимиче-ский рецидив связан с локальным прогрессированием (локальные рецидивы), что говорит о возможности рассмотрения вопроса проведения спасительной (сальважной) терапии [5]. Однако лишь небольшая часть (0,9-2,0 %) этих случаев фактически поддается контролю с помощью спасительной радикальной про-статэктомии, тогда как большинство больных в конеч-ном итоге получают андрогендепривационную тера-пию, вне зависимости от степени распространенности опухолевого процесса [6,7].Назначение андрогендепривационной терапии, как правило, является методом выбора при лечении таких больных. Тем не менее стабильный контроль РПЖ не может быть полностью достигнут только при-менением андрогендепривационной терапии в связи с развитием в конечном итоге кастрационно-рези-стентной фазы заболевания. В таком случае пациенты умирают в течение 1-2 лет с начала признаков про-грессирования заболевания [8]. Однако андрогенде-привационная терапия у большинства больных РПЖ эффективна и может проводиться при любых формах заболевания [5,6]
Introduction. One of the main problems of modem on-courology is treatment for prostate cancer of intermediate and high risk of progression. Modern radiotherapy in this category of patients has an advantage over surgical methods of treatment. One way to improve the effectiveness of radiotherapy is to escalate the dose in the prostate gland. For this purpose a combination of brachytherapy and remote radiotherapy is used. This combination allows increasing the dose of radiation, thereby providing better local control, reducing complications from neighboring organs. Purpose of the study. To conduct a comparative analysis of efficacy and safety of radical treatment of patients with prostate cancer at medium and high risk of progression using a combination of high and low dose rate brachytherapy with external beam radiotherapy. Materials and methods. 107 patients with prostate cancer of the group of medium and high risk of progression combined treatment (brachytherapy with external beam radiotherapy) was conducted. 53 patients underwent combined treatment (HDR-brachytherapy and external beam radiotherapy). 54 patients underwent combined treatment (LDR-brachytherapy and external beam radiotherapy). The observation period was 5 years. Conclusion. In a comparative analysis in groups of combined radiotherapy with the use of high-dose and low-dose-rate brachytherapy, the same effectiveness of immediate and long-term results of treatment was demonstrated. A significant reduction in early and late toxic reactions in patients with high-power brachytherapy has been demonstrated.
The technology of direct dosimetry was examined during a session of automated high-power interstitial gamma therapy for prostate cancer with a source of iridium-192 using a MKD-04 scintillation multi-detector dosimeter developed at the JSC ROSATOM. Miniature detectors of up to 5 pieces allow simultaneous measurements in areas of medical interest - the urethra and the rectum at different distances from the intrastats. The technology of direct dosimetry with rigid fixation of detectors is aimed at increasing quality assurance and reducing the frequency of complications. The dosimeter MKD-04 can be used for all types of automated brachytherapy, as well as in bundles of gamma-therapeutic devices to monitor the dose prescribed and actually received by the patient.
Introduction. According to autopsies, the frequency of unilateral kidney dystopia ranges from 1:660 to 1: 1000, with an average of 1:800 newborns, and lumbar dystopia is more common, mainly in boys. The left kidney is dystopian more often than the right. Bilateral dystopia is rare. In the structure of cancer incidence in the Russian population, bladder cancer ranks 9th among men and 17th among women. When analyzing the literature data, we did not find any recommendations for methods of urine derivation in patients with diagnosed bladder cancer in pelvic kidney dystopia. Materials and methods. Clinical case. A patient with a diagnosis of bladder cancer сT3bN0M0G1 associated with concomitant abnormality of the kidneys and urinary tract (pelvic kidney dystopia with shortening of the ureters) was admitted to the Department of oncourology of the Federal state budgetary institution RSCRR. The decision was made on the implementation of laparoscopic radical contractattachments, with an attempt of derivation of urine (formation ureteroileostomy) by Bricker. Intraoperatively: given the short length of the ureters, the location of the kidneys, it was decided to impose an end-to-end anastomosis of the ileoconduit with the pelvis of the right kidney, ureteroileoanastomosis end-to-side on the left. Based on the results of histological examination, the final clinical diagnosis was made: рТ2bN1М0G1R-. Results. 3 months after surgical treatment, no complications were observed, according to control studies, both anastomoses are passable. The planned adjuvant pоlichemotherapy (PCT) has been completed. There are no data for disease progression in the control examination. Conclusion. The method of urine removal is determined intraoperatively. In this patient, the condition and length of the right ureter did not allow performing classical ureteroileoanastomosis (end-to-end), and therefore pyeloileoanastomosis was performed on the right. On the left, the length of the ureter made it possible to perform end-to-side ureteroileoanastomosis, but only if the ileoconduit was removed to the left side.
Introduction. Pheochromocytoma is a tumor that develops from the chromaffin tissues of the sympathetic nervous system. The most frequent localization is the adrenal medulla. However, in about 10% of cases, pheochromocytomas can occur in ectopic or extrarenal localities (the brain and up to the pelvic organs). An ectopic pheochromocytoma is called a paraganglioma. It may be difficult for doctors to determine an accurate diagnosis due to the fact that the disease emits bladder cancer in its clinical manifestation. The rare localization and poorly understood structure of the tumor also makes it difficult for specialists to determine the correct treatment strategy. This article describes a rare clinical case that clearly demonstrates all stages of the clinical course, diagnosis, and treatment of bladder parganglioma. Materials and methods. We are looking at a clinical case that occurred in the clinic of the Federal state budgetary institution RSCR. This article describes in detail all stages of the clinical course, methods of diagnosis and treatment of paraganglioma of the bladder. Clinical practice and results. Paragangliomas are rare tumors of the bladder. They may have clinical, radiological, and pathological features similar to bladder cancer. Typical symptoms are catecholamine secretion, especially associated with periods of urination. Conclusions. The optimal method of treatment is laparoscopic or open resection of the bladder. Other methods of treatment, such as transurethral resection, can be considered as effective diagnostic methods, but as an independent treatment option, they are associated with non-radicality and a high risk of intraoperative complications. In the future, it is critical to standardize the principles of examination, treatment and follow-up of patients with paraganglioma of the bladder.
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