[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.

[Bioelectrical activity of the brain after proton therapy of hypophyseal adenoma]. / Bioélektricheskaia aktivnost' golovnogo mozga posle protonnoi terapii adenomy gipofiza.

In 37 patients with endosellar pituitary adenoma attended by the acromegaloid syndrome, a plasma STH level determined by a radioimmunoassay against a background of an insulin test was compared with EEG findings before and at varying time (up to 7 yrs.) after proton beam therapy using the synchrocyclotron of the Leningrad Institute of Nuclear Physics. EEG was shown to be an informative method of diagnosis of continuous pituitary adenoma growth and complications of proton beam therapy in the form of temporal paroxysms.

[Proton therapy: clinico-methodological aspects, treatment results]. / Protonnaia terapiia: kliniko-metodicheskie aspekty, rezul'taty lecheniia.

In the period of 1975-1986, 457 patients (81 with breast and prostatic cancer, 24 with endocrine ophthalmopathy, 20 with diabetic angioretinopathy, 206 with pituitary adenomas, 115 with arteriovenous and 6 with arterial brain malformations, and 6 with epilepsy) were given proton beam therapy at the Central Research Roentgenoradiology Institute using the 1000 MeV synchrocyclotron of the Leningrad Institute for Nuclear Physics. A prolonged remission was noted in 75-90% of the patients with pituitary adenomas. Angiography showed complete exclusion of aneurysm from the blood flow 2 yrs. after irradiation almost in 50% of the patients with arteriovenous malformations. A high efficacy and safety of the method was shown.

[Metabolic pool of free amino acids in the blood and cerebrospinal fluid of patients with pituitary adenoma before and after proton therapy]. / Metabolicheskii fond svobodnykh aminokislot krovi i spinnomozgovoi zhidkosti u bol'nykh adenomoi gipofiza do i posle protonnoi terapii.

A pool of free amino acids was studied in blood and cerebrospinal fluid of 34 patients with adenoma of hypophysis before proton therapy and within 3 years after the treatment. The course of proton therapy was shown to cause a regression of the disease, a decrease in content of somatotropic hormone in blood as well as to normalize the metabolic pool of amino acids in blood and cerebrospinal fluid.

[Serum anti-protease activity in the evaluation of results of proton hypophysectomy]. / Antiproteaznaia aktivnost' syvorotki krovi pri otsenke rezul'tatov protonnoi "gipofizéktomii".

The activity of the alpha 1-antitrypsin and alpha 2-macroglobulin were studied in 16 breast cancer patients and 25 hypophyseal adenoma patients prior to and at varying time after proton "hypophysectomy". A high alpha 1-antitrypsin level and a normal alpha 2-macroglobulin level were found in all the breast cancer patients. An increase in both blood serum inhibitors was detected in hypophyseal adenoma. The dependence of the alpha 1-antitrypsin content on a subclinical stage of generalized metastatic spread was revealed in the course of 2 years following "hypophysectomy" in the patients with disseminated breast cancer. In the hypophyseal adenoma patients the activity of both inhibitors returned to normal 1 year after treatment and remained within normal during 3 years of follow-up. It was regarded as a positive therapeutic effect. The above findings make it possible to propose the determination of the activity af alpha 1-antitrypsin in breast cancer and alpha 1-antitrypsin and alpha 2-macroglobulin in hypophyseal adenoma as an additional test for the evaluation of the results of proton "hypophysectomy".

[Proteinase inhibitor activity of blood plasma and cerebrospinal fluid in patients with pituitary adenomas before and after proton therapy]. / Aktivnost' ingibitorov proteinaz plazmy krovi i spinnomozgovoi zhidkosti u bol'nykh adenomami gipofiza do i posle protonnoi terapii.

35 patients with somatotropic adenoma of hypophysis were examined before proton therapy and within 3 years after the treatment. High initial level of alpha 1-antitrypsin(alpha 1-AT) and alpha 2-macroglobulin (alpha 2-MG) in the patients blood plasma as well as a decrease in alpha 1-AT activity in cerebrospinal fluid were observed. Within a year after the proton hypophysectomy activity of the proteinase inhibitors returned to the normal values in blood and cerebrospinal fluid simultaneously with clinical restoration and a decrease in content of growth hormone; their level were maintained at normal values within the last two years of observation. Estimation of alpha 1-At activity in blood plasma and cerebrospinal fluid might be used as an additional test in evaluation of the treatment course in the patients with somatotropic adenoma of hypophysis.

[Use of narrow photon beams to irradiate small intracranial targets]. / Ispol'zovanie uzkikh puchkov fotonov dlia oblucheniia malykh vnutricherepnykh mishenei.

Using a specially designed program, the authors managed to obtain dose distributions in irradiation by a rotation method in two planes of small intracranial targets with narrow photon beams (up to 1cm) with the energy of 0.2; 1.25; 15MeV. It has been shown that though these distributions less correspond to clinical requirements than those for proton beams the use of narrow photon beams seems promising in this field of radiology.

[Antiprotease activity of the blood serum of patients with the disseminated form of breast cancer before and after combined treatment]. / Antiproteaznaia aktivnost' syvorotki krovi bol'nykh rasprostranennoi formoi raka molochnoi zhelezy do i posle kompleksnogo lecheniia.

The paper discusses the results of a study on the blood-serum levels of alpha 1-antitrypsin and alpha 2-macroglobulin in 29 patients with an extensive breast cancer before and within 3 years after a combination therapy including proton "hypophysectomy". A correlation was established between the blood level of alpha 1--antitrypsin and the subclinical stage of generalized metastatic spreading. Consequently, the assay of the level of this inhibitor is suggested as another test for assessment of the efficacy of treatment of such patients and prediction of the results.