[Radiosurgery for recurrent glioblastoma]. / Radiokhirurgicheskoe lechenie retsidivov glioblastom.

BACKGROUND: Despite the combined treatment in accordance with modern standards, recurrent glioblastoma usually occurs within several months after resection and causes low relapse-free and overall survival. One of the most effective methods for malignant glioma progression is repeated radiotherapy. Indications for this approach have expanded after introduction of stereotactic irradiation into routine clinical practice. OBJECTIVE: To evaluate the results of radiosurgery in patients with recurrent glioblastoma and to identify the factors determining its effectiveness. MATERIAL AND METHODS: Radiosurgery has been carried out in 168 patients with relapses of glioblastoma between 2005 and 2021. This study enrolled 88 patients with 180 foci of local and distant progression. Mean age of patients was 42.8±2.1 years (range 4-73). Mean period between diagnosis and repeated irradiation was 12.7 months. Mean volume of focus was 2.4 cm3, mean dose - 20 Gy. Median follow-up period after radiosurgery was 11.2 months. RESULTS: Repeated irradiation with correction of systemic therapy improved progression-free survival and overall survival with insignificant radiation-induced toxicity. Annual overall survival was 62.2%, median of overall survival after radiosurgery - 15.1 months. Significant factors of local control were marginal dose of at least 18 Gy and distant relapse. Median of progression-free survival in the group of distant progression of glioblastoma was only 3.6 months vs. 9.1 months in patients with local recurrence. CONCLUSION: Repeated irradiation in radiosurgery mode with a dose of 18 Gy and higher is an effective option for local treatment increasing progression-free and overall survival in patients with progression of glioblastoma.

[Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia]. / Izmenenie paradigmy lecheniya neirokhirurgicheskikh patsientov v epokhu stereotaksicheskogo oblucheniya. K 15-letiyu neiroradiokhirurgii v Rossii.

INTRODUCTION: Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery. MATERIAL AND METHODS: Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center. RESULTS: Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia. CONCLUSION: Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.

[Radiosurgical hypophysectomy in cancer pain treatment. Literature review and clinical case]. / Radiokhirurgicheskaya gipofizektomiya v lechenii farmakorezistentnoi onkologicheskoi boli. Obzor literatury i opisanie klinicheskogo sluchaya.

Cancer pain is one of the main problem in modern medicine. According European Society for Medical Oncology data, cancer pain prevalence is 64% among patient with terminal stage of disease and in 46% standard pain therapy was ineffective. Radiosurgical hypophysectomy is one of the important and perspective method in cancer pain treatment. This method could be offered patient with chronic disease. According literature review, endocrinology complications were very rare and occurred 10 months after therapy. Value of analgesic effect was 70-90%. In some trials, procedure was effective not only nociceptive, but also in neuropathic pain. More trials require for determination of indications and mechanism of action. The case of successful relief of resistant pain in patient with pancreatic cancer by means of radiosurgical hypophysectomy is described.

Measurement of the activity of 11C and 22Na sources using a 4pi-beta-gamma coincidence system.

Many radiation applications, including positron emission tomography (PET) studies and activation dosimetry, require the knowledge of the activity of short-lived radionuclide samples, whereas relative measurements may be hampered by the absence of a reference source. Using 11C radionuclide as an example, an analytical model based on a probabilistic approach has been set up to predict the activity of a pure positron emitter measured using the 4pi-beta-gamma coincidence technique. The model has been extended to describe the measurement on a 22Na source used to test the measurement technique. Comparison of the modeled results with the measurements confirms the general validity of the model. The model has also been studied for the effect of the variation of key measurement conditions, such as nominal source activity, detector efficiency, detector background levels, and coincidence resolving time. The 4pi-beta-gamma coincidence technique and the results of modeling allow the activity measurements on 22Na and 11C sources with an estimated relative standard uncertainly on the order of one percent.

A compact ridge filter for spread out Bragg peak production in pulsed proton clinical beams.

A number of designs have been proposed for ridge filters and range modulators used in proton therapy to modify the beam in order to spread out the Bragg peak. Despite the variety of solutions, no simple design capable of providing large fields and easy variation of the spread out Bragg peak (SOBP) length in a pulsed beam has been developed. We propose a compact ridge filter that can be used in a proton beam of any time structure. It allows the production of depth dose distributions that meet the requirements of therapy dose fields.

Investigation of applicability of alanine and radiochromic detectors to dosimetry of proton clinical beams.

Cancer therapy studies using proton accelerators are underway in several major medical centers in the U.S., Russia, Japan and elsewhere. To facilitate dosimetry intercomparisons between these laboratories, alanine-based detectors produced at the National Institute of Standards and Technology and commercially available radiochromic films were studied for their possible use as passive transfer dosimeters for clinical proton beams. Evaluation of characteristics of these instruments, including the LET dependence of their response of proton energy, was carried out at the Institute of Theoretical and Experimental Physics. Results of absolute dose measurements were regarded as a preliminary step of dose intercomparison between ITEP and NIST. Measurements made in a number of experiments showed average agreement between the ITEP and NIST dosimetry standards to 2.5%.

Relative biological effectiveness of proton medical beam at Moscow synchrotron determined by the Chinese hamster cells assay.

PURPOSE: Assessment of relative biological effectiveness (RBE) of the proton medical beam at Moscow synchrotron. METHODS AND MATERIALS: The study was performed at Moscow proton medical facility (Institute for Theoretical and Experimental Physics). Relative biological effectiveness of the synchrotron proton beam was assessed at the entry of the unmodulated 179 MeV beam and in the center of spread out Bragg peak (SOBP), from measurements of the survival of Chinese hamster cells (clone 431). Gamma-radiation of 60Co was used as a reference source. RESULTS: According to the linear regression model, mean RBE values at 37% survival level were found to be 1.10 +/- 0.04 at the beam entry and 1.14 +/- 0.05 in the center of SOBP. Values of RBE obtained using the linear-quadratic model for 10% and 37% survival levels were 1.09 and 1.07, respectively, at the beam entry and 1.07 and 1.08, respectively, in the center of SOBP. CONCLUSIONS: The data obtained indicate that (a) the RBE values at the entry of the unmodulated beam and at the center of the SOBP are in close agreement, with an average of about 1.10; (b) protons are radiobiologically somewhat more effective than 60Co gamma rays; and, (c) high pulse dose rate of the medical beam does not significantly affect biological effects of the beam.