MOLECULAR IMAGING AND INTRAOPERATIVE RADIONAVIGATION IN PROSTATE CANCER

Introduction. Prostate cancer is one of the most common malignant neoplasms. Strategies to improve early diagnosis and subsequent therapy are being improved. An emphasis is placed on maintaining the quality of life and working capacity of patients after treatment. This can be achieved by improving methods of focal therapy, which depends on the accuracy of topical diagnosis and classification of the tumor. Hybrid molecular imaging (pet/ct and spect/ct) is used in addition to the methods of structural imaging (ultrasound, ct, mri). Intraoperative imaging using radionavigation systems is also used in open and endoscopic surgery for prostate cancer. Currently, it is a tool capable of reducing the invasiveness of surgery, localizing the area of metastatic lesions with a sensitivity and specificity of up to 95 %.Objective of the study: an overview of current and promising future methods of intraoperative radio navigation in the surgical treatment of prostate cancer.Material and methods. The review presents the methods of intraoperative radionavigation in the surgical treatment of prostate cancer. Radionavigation in the context of using tumarotropic radiopharmaceutical based on a prostate-specific membrane antigen, in which the drug accumulates in all tumor foci expressing this receptor, is also considered.Conclusion. The use of preoperative hybrid imaging and radio-guided surgery facilitate lesion identification and resection. Gamma probing allows detection of psma-positive tumor foci regardless of their depth. Fluorescence imaging methods (icg, photodynamic diagnostics, autofluorescence) are also used for intraoperative detection of pathological foci in real time. Multichannel gamma probing and cherenkov radiation detection, which combine the advantages of indirect and direct intraoperative imaging, have enormous potential.

Photodynamic diagnostics of nonmuscle invasive bladder cancer

The review is devoted to the application of photodynamic diagnosis of non-muscle invasive bladder cancer. The recent data on the mechanism of action of photosensitizers, the method of performing fluorescence cystoscopy are presented, and the results of clinical studies of the application of photodynamic diagnostics in practical medicine are presented. It has been shown that photodynamic diagnostics significantly increases the efficiency of detecting bladder cancer in comparison with standard cystoscopy. The application of this method is especially valuable in cases of carcinoma in situ and multifocal growth of urothelial tumors. Improvement in diagnostics makes it possible to increase the radicality of surgical treatment and to increase the duration of the relapse-free period.

Deciding When to Omit Repeat Transurethral Resection of Superficial Bladder Cancer: Do Photodynamic Diagnostics help?

BACKGROUND: Repeat transurethral resection of bladder tumor is recommended when certain risk constellations are present on initial resection. Current evidence is conflicting, leading to dissenting recommendations in multinational guidelines around the world. Photodynamic diagnostics (PDD) is a tool which has been shown to increase diagnostic accuracy, but evidence is still lacking if this may permit omission of repeat resections in certain cases. OBJECTIVE: To evaluate whether the use of photodynamic diagnostics has an impact on resection quality and residual tumor rate, and to explore which parameters may have an impact on the necessity of repeat transurethral resections. METHODS: We retrospectively evaluated 373 patients in the timeframe of ten years, in whom a repeat transurethral resection of bladder tumor has been performed following initial resection at our department. About half of those resections were performed using photodynamic diagnostics. RESULTS: When PDD was used, more tumor mass was revealed and resected, but the shown trend toward a lower residual tumor rate was non-significant. Muscularis was shown more often on PDD resections. While being a rare occurrence, upstaging on repeat resection happened significantly less often after initial PDD use. Furthermore, tumor size and multifocality significantly influenced residual tumor rate in Ta high-grade stage. CONCLUSIONS: PDD use may lead to a more accurate initial staging but this may not have an impact on short-term residual tumor rate. Tumor size and multifocality should be granted more weight in the decision-making process as when to perform a repeat resection.

Multi-course photodynamic therapy of basal cell skin cancer of the central face area (clinical study)

The results of an 11-year clinical observation and treatment of a patient with stage II basal cell carcinoma of the face (Т2N0M0) are presented. History of the illness is associated with a long (from 2001 to 2008) inadequate treatment, due to the incorrect diagnosis. After the proper diagnosis was established, from 2008 to 2019 at the Center for Laser and Photodynamic Diagnostics and Tumor Therapy of P.A. Herzen Moscow Oncology Research Center, the patient underwent organ-preserving treatment using the multi-course photodynamic therapy (PDT) and drug targeted therapy. In total, 23 courses of PDT were conducted with photosensitizers of the chlorin series and 5-aminolevulinic acid during this period. Since 2018, the patient is in the process of targeted drug treatment with Vismodegib. In the course of targeted drug treatment, a follow-up examination in 2019 revealed continued growth of the residual tumor, and another course of PDT was carried out. Throughout the observation period, the patient tolerated the treatment well, without complications, with a good quality of life and satisfactory cosmetic effect.

METHODS OF SPECTRAL DIAGNOSTICS IN MODERN PREVENTION OF ONCOLOGICAL DISEASES

This paper contains structured information on photodynamic diagnostics. Photodynamic diagnostics is a young diagnostic modality used in the detection of pre-neoplastic and very early neoplastic lesions. A characteristic feature of the presented method is its completely non-invasive nature and thus the possibility of multiple repetitions at the same patient. This is very important in modern health care and in preventive measures. Aim of the paper: The article aims to present technical and diagnostic possibilities of a photodynamic method as one of the possible modalities of screening diagnostics in patients with ambiguous clinical picture of early neoplastic lesions.