[The results of proton radiosurgery for pituitary endosellar adenomas].

465 patients with pituitary endosellar adenomas have passed irradiation on the synchrocyclotron PNPI (1000 MeV). Due to the high energy of the proton beam the rotating-convergent shoot-through technique was used. The single dose of 80-100 Gy was given. In patients with prolactin adenomas clinical remission was detected in 80%, and the stabilization of the disease was achieved in 15%. Pregnancies in 21 patients ended in the birth of healthy children, and 4 of them gave the birth twice. Complete clinical remission was observed in 92% of patients with Cushing's disease. Sustained recovery and full normalization of growth hormone level were observed during long-term follow-up in 86% of patients with acromegaly. There was significant reducing of the high hormone level on the fifth year of follow-up in any clinical form of pituitary adenomas while the development of the secondary hypopituitarism was not defected in the most of the patients. Clinical remission in patients with non-secreting adenomas was 95%. Irradiation by the proton beam was not accompanied by serious life-threatening complications. Thus this type of treatment for pituitary endosellar adenomas is highly effective and safe and, sometimes, the only method.

[Preliminary experience with assessing the motor pathways and central inhibition in patients with malignant cerebral gliomas in preparation for conformal radiotherapy].

We investigated central motor pathways and central inhibition in patients with brain gliomas by transcranial magnetic stimulation (TMS). 10 glioma patients and 16 matching controls were enrolled. Central motor conduction time, MEP latencies and amplitudes and silent period were evaluated. In 90% glioma patients TMS parameters were abnormal, mostly MEP shapes and thresholds were affected. In 40% of the cases central inhibition in glioma affected hemisphere was abnormally high. We propose that TMS is safe and informative tool in glioma patients; central inhibition seems to be affected in some cases by the glioma presence in the hemisphere. One of the possible causes of that may be GABA system activation.

[Use of local induced hyperthermia in the treatment of malignant tumors].

The way of a local contactless hyperthermal induction heating for biological tissues is developed on the basis of implantation of substituting composite applicator made of a polymeric material with incorporated ferromagnetic particles. The simplified mathematical model of the physical processes proceeding at a sample heating is presented. Model results are used for approximation of the experimental data.

[First experience with intrasurgical brachytherapy in the combined treatment for locally advanced laryngeal cancer].

Results of combined radiosurgical treatment with larynx preservation, and pre- and postoperative distant external irradiation, were evaluated. Forty-eight patients with locally advanced laryngeal cancer received single-step individually-tailored tissue application, followed by high-dose brachytherapy. Discriminative function of the larynx was restored in all patients within 2 days involving swallowing disturbances in 8%. Breathing function was restored in 98% within 2 days to 6 months after completion of treatment. Three-year relapse-free survival was 95.8%.

[Stereotactic proton irradiation of cerebral arteriovenous malformations in patients with onset of disease in childhood].

The report discusses the results of proton stereotactic irradiation in 27 children, aged 6-15 (mean--12.5 yrs.), and 21 adults, aged 16-47 (mean--23 yrs.), with arteriovenous malformations (AVM) in the brain. The AVM volume ranged 0.2-37.7 cu cm; absorbed dosage at dose field maximum--40-80 Gy. Complete AVM obliteration was attained in 17 (35%) (mean AVM volume--3.1 cu cm); 50% decrease and more--12 (25%)(mean AVM volume--7 cu cm). When AVM volume was cut down to less than 50% (9) (19%) (mean AVM volume--9.2 cu cm) and 10 (21%) (mean AVM volume--19.6 cu cm), no effect was reported.

[Role of single-photon emission computer tomography in dynamic evaluation of combined treatment of malignant cerebral glioma].

Thirty-nine patients with malignant glioma of the brain were examined at the Center's Clinic. Tumor volume ranged 0.8-175.1 cu cm. Radionuclide diagnosis was obtained with the aid of single-photon emission tomography (E.Cam, Siemens). 99mTc-DTPA, 3-6 MBc/body, was injected intravenously. Smaller size of tumor and lower ratio of differentiated marker accumulation focus/contralateral area were registered in 34%. Simultaneously, a high index of the marker accumulation in the brain was reported, thus suggesting hyperimpermeability of the blood brain barrier. Another 26% revealed larger size of tumor and higher ratio of differentiated 99mTc-DTPA accumulation, likely due to lower impermeability of the blood brain barrier. Hence, use of single-photon emission tomography in diagnosis of malignant cerebral glioma provides a means of evaluating the level of the marker in a tumor node.

[Preoperative accelerated radiotherapy for breast cancer--is it a historical delusion or a legitimate method of treatment?].

An effective procedure for preoperative chemoradiotherapy is suggested to intensify treatment of patients with extensive, local and/or regional, metastases of breast cancer. It uses medication followed by accelerated radiotherapy which offers the combined advantages of "concentrated" and "conventional" irradiation. High local and systemic effect is produced right at the outset thus making use of high-cost "first-line" cytostatics unnecessary and avoiding delay of surgical intervention.

[Postoperative chemoradiotherapy for cerebral glioblastoma].

We developed a new method of accelerated chemoimmunoradiotherapy for cerebral glioblastoma and evaluated the immediate effects. A single focal dose of 3Gy was administered once a day 5 times a week until the total focal dose of 51 Gy was reached. Chemoradiotherapy was followed by a course of biotherapy with recombinant interleukine-2 (roncoleukine). On administering a total dose of 10 million units, a course of chemoimmunotherapeutic support was given after a 2-week break. Vincristine 1 mg was injected on day 1 and nitrosourea preparations (lomustine 160 mg or carmustine 100 mg) on day 2. Later on, the same regimen of roncoleukine was used. Our method was followed by longer survival as compared with standard treatment (control) and use of incomplete course chemoimmunotherapy.

[Proton magnetic resonance spectroscopy in postoperative radiochemotherapy of patients with cerebral glioblastoma].

The paper discusses the data from dynamic follow-up of immunohistologically confirmed glioblastomas of the brain using proton magnetic resonance imaging (+H MRI) (25). Study was undertaken before and after therapy and resumed for 6-8 months after. Cholin concentration peaks and N-acetyl-aspartate decrease in gliomas appeared to be higher than those in anaplastic astrocytomas. Moreover, N-acetyl-aspartate peaks were obliterated by large necrotic areas in glioblastoma. Instead, lipid and lactate concentrations peaked thus suggesting pathological changes. A necrotic area developed in the course of radiochemotherapy involving peaks for wide profile of lipid and lactate concentrations coupled with lowered levels of other metabolites.

[Accelerated postoperative chemoradiotherapy for malignant cerebral glioma].

Procedure of accelerated immunotherapy for cerebral glioma is presented. Large fractions of radiation ranged from 3 Gy, 5 times a week, to a total focal dose of 51 Gy. After accumulation of total doses of 18, 33 and 48 Gy, vincristine was injected intravenously. Urea derivatives were given on reaching 21, 36 and 51 Gy. Treatment with the immunomodulator roncoleukine was carried out on completion of radiotherapy. An evaluation of the immediate end results of accelerated immunotherapy showed improved survival as compared with standard treatment.

[Experience of proton stereotactic therapy for cerebral arteriovenous malformations in children].

The authors present the results of proton stereotactic therapy (using continuous double-axis pendulum irradiation) in 27 children with cerebral arteriovenous malformations (AVM). At the moment of therapy, the children's age was 6 to 15 years. The volume of AVM was 0.2 to 31.2 cm3. The absorbed doses in the maximum of a dose field were 40 to 80 Gy. Complete AVM obliteration (the mean volume in the group was 3.03 cm3) was obtained in 11 (41%) patients. A 50% or more reduction in AVM volume (mean volume, 10.6 cm3) was seen in 8 (30%) patients. There was a less than 50% reduction in AVM volumes (mean volume 9.6 cm3) in 2 (7%) patients and no effect could be achieved in 6 (22%) (mean AMV volume 19.7 cm3).

[Proton irradiation of the pituitary gland for alleviating pain in patients with disseminated prostate cancer].

Central Research Institute of Roentgeno-Radiology; Medical Academy for Further Education, St. Petersburg Stereotactic ablation of the frontal lobe of the pituitary with narrow beams of 1,000 MeV protons was performed in 80 patients to alleviate pain caused by bone metastases. Pain was aborted for a long time so that pain-relieving medication was suspended in 56 (70%) patients. The remaining patients cut down on taking analgetics: peripheral drugs were taken by 11(13.75%), non-narcotic opioids (tramal)--4 (5%), class III opioid narcotics--7 (8.75%), and morphine-type drugs--only 2. No untoward side-effects were reported.

[Current methods of radiation therapy in patients with prostatic cancer: subtotal body radiation, local hyperthermia]. / Sovremennye metodiki luchevoi terapii bol'nykh rakom predstatel'noi zhelezy: subtotal'noe obluchenie tela, lokal'naia gipertermiia.

The paper deals with the preliminary data of treatment of patients with prostatic cancer by using unconventional methods of radiation therapy (RT), such as subtotal radiation of the body (STRB) and thermoradiation treatment (TRT). Out of 72 patients receiving RT, 16 and 8 had STRB and TRT, respectively. Systemic and local drug therapies were made to prevent radiation reactions and injuries. In all cases, STRB and TRT showed a significant objective and subjective effect. To evaluate the long-term results of treatment needs further studies.

[Experience in the use of subtotal irradiation at different stages of therapy in lymphogranulomatosis]. / Opyt primeneniia subtotal'nogo oblucheniia na raznykh étapakh lecheniia limfogranulematoza.

A study was made of a possibility to use subtotal irradiation (STI) as an equivalent of chemotherapy for the treatment of 33 Hodgkin's disease patients aged 17 to 77 (of them 25 were treated during the 1st-19th yrs. of therapy, for 8 patients it was the 1st stage of antitumor therapy). ROKUS apparatus and a linear accelerator of 15 MeV were used for irradiation at a single dose of 1.5 Gy and a total dose of 3-6 Gy, at a 2-4 day interval. STI efficacy was assessed by a response of the peripheral and intrathoracic lymph nodes, tumor foci in the lungs, by a decrease in liver and spleen sizes, a decrease in body temperature and the end of night sweating. Of 25 patients a positive effect was achieved in 19, in 4 patients it was absent, and in 2 patients disease progression was observed. A marked positive effect was noted in 8 previously untreated patients, especially with respect to the elimination of signs of intoxication. A conclusion has been made that STI can be employed for the treatment of Hodgkin's disease patients as a method of general cytostatic action. STI causes a more noticeable and prolonged leukopenia than a cycle of polychemotherapy.

[Action of gutimine on the redox status of flavin and pyridine nucleotides in intact neurons]. / Deistvie gutimina na redoks-sostoianie flavinovykh i piridinovykh nukleotidov intaktnykh neironov.

Redox-reactions of flavine (FN) and pyridine (PN) nucleotides of the cell to guthimine were studied by the method of fluorescent microscopy without using any stains. The comparison was made of the kinetics of fluorescence intensity of FN and PN of the Retzius intact neuron under the action of guthimine, oxaloacetate, nembutal and succinate. It is suggested that guthimine may activate the switching of oxidative metabolism of the cell over to a more energitically profitable way.

[Radiotherapy of patients with stage III Hodgkin's disease using the method of continuous fractionated irradiation]. / Luchevaia terapiia bol'nykh limgogranulematozom III stadii s ispol'zovaniem metodiki nepreryvno rasshcheplennogo oblucheniia.

Clinical rationale for alternating split-course radiotherapy for stage III Hodgkin's disease is discussed. The procedure was employed in 54 such patients. It proved useful in total nodal irradiation for advanced disease, resulting in improved survival. The technique involves a shorter duration of treatment than that of the standard one.