Clinical recommendations.
INTRODUCTION: Navigational transcranial magnetic stimulation (NTMs) is used in neurosurgical practice to identify functionally important motor areas of the brain for the purpose of safe resection of a tumor focus. At the same time, when planning radiation therapy (LT) and determining the amount of irradiation, until recently, functionally significant zones of topical representation of skeletal muscles in the cerebral cortex were not taken into account. This study evaluates the use of mapping motor areas of the cerebral cortex using NTMs when planning LT in patients with malignant gliomas affecting the motor cortex.OBJECTIVE: To evaluate the possibilities of navigational transcranial magnetic stimulation in the pre-radiation preparation of patients with brain tumors.MATERIALS AND METHODS: The study included 31 patients with gliomas of a high degree of malignancy who received radiation and/or chemoradiotherapy at the RSCRT from 2020 to 2022. The median follow-up was 12.1 months (3.0–24.5 months), while all patients were followed up to the control, 3-month follow-up period after the end of the course of radiation therapy, 23 patients showed up for control after 6 months (two patients died between 3-month and 6-month control).Statistics: analysis was performed using the Statistica 10.0 software (StatSoft, Inc., USA).RESULTS: Three out of 31 patients had improved motor function, while eight out of 31 patients had decreased motor function. Moreover, when comparing the preoperative condition with the condition during control examinations six months after radiation therapy, motor function improved in three patients, and decreased in eight. Maps of motor zones of NTMs overlapped PTV by 41.2%. The average dose of Dmean maps of NTMs was 42.3 Gy (3.7–61.1 Gy) and 37.0 Gy (3.6–55.8 Gy) with a limit of 45 Gy per motor zone. Thus, the average dose of Dmean according to the maps of the motor zones of NTMs was significantly reduced by 5.3±3.3 Gy (14.3%, p<0.05). The average dose of Dmean on NTMs cards was reduced by 4.6±3.5 Gy (12.8%, p<0.05) to 37.8 Gy. The average volume of NTMs cards receiving a dose equal to or greater than 45 Gy and 55 Gy can be significantly reduced by 11.3% and 8.4%, respectively, with dose restriction (p<0.001). Anatomical ORS (optic nerve chiasm and brain stem) were not affected in relation to the average dose of Dmean or the maximum dose with an increase in the dose to GTV.DISCUSSION: In our study, it was shown that maps of the motor zones of NTMs can be used in the planning of LT patients with gliomas of high malignancy. To date, the primary motor cortex has not been considered as an OR in such patients. The results of the study demonstrated that the dose in relation to the maps of the motor zones of NTMs can be significantly reduced without affecting the therapeutic doses for PTV.CONCLUSION: LT planning using NTMs motor maps can help reduce the radiation dose to the motor cortex in primary LT, although the motor cortex appears morphologically rather insensitive to LT compared to speech zones and areas of high-order cognitive processes, such as the temporal and limbic cortex.
Aim. The observational program was aimed at obtaining data on classical Hodgkin’s lymphoma (cHL) incidence in the Russian Federation, therapy options, and clinical outcomes of treatment. The aim of the prospective part of the program was to standardize the approaches to therapy and to compare its outcomes with off-protocol treatment. Materials & Methods. The prospective-retrospective observational program for Hodgkin’s lymphoma treatment engaged 32 regional and federal centers. It included 218 patients, 21 out of them were included into the prospective part of the RNWOHG-HD1 (Russian North-West Oncology and Hematology Group - Hodgkin Disease Study 1) program. The median age was 36 years (range 22-87 years). cHL stages I/II were identified in 48 % of patients, III/IV stages were reported in 52 % of patients. The prospective part of the program used escalating protocol in patients with stages I/IIA and without risk factors and de-escalating protocol in patients with advanced stages. Overall (OS) and progression-free (PFS) survivals were analyzed in 160 and 152 patients, respectively. PET-CT was used to assess the response in 33 % of patients. Results. The study used the following first-line chemotherapy regimens: ABVD in 42 %, BEACOPPst in 11 %, BEACOPP-14 in 17 %, BEACOPPesc in 25 %, and EACOPP in 1 % of cases. After the completion of first-line therapy objective response rate was 91 % including 61 % of complete responses. Response structure did not significantly differ in the groups of non-intensive therapy (ABVD and BEACOPPst), intensified regimens (BEACOPP-14, BEACOPPesc, and EACOPP), and treatment according to the RNWOHG-HD1 protocol (91 %, 92 %, and 96 %, respectively; p = 0.7226). In the total cohort the 3-year OS was 97 % (95% confidence interval [95% CI] 94-99 %), PFS was 87 % (95% CI 80-92 %). The 3-year PFS did not differ in ABVD, BEACOPPst, BEACOPP-14, BEACOP-Pesc, and RNWOHG-HD1 recipients (р = 0.37). International Prognostic Score (IPS) yielded significant results in PFS prediction for patients with IPS score of 5-6, but not for those with IPS score of 1-4 (p = 0.0028). Conclusion. The observational program showed that the majority of participating centers use the risk-adapted ABVD/ BEACOPPesc approach which explains no difference in PFS being found with the use of these chemotherapy options. The study demonstrated the need for PET-CT to assess the response since the CT alone cannot distinguish between complete and partial responses in a considerable number of patients. The prospective unified program for cHL treatment may well be implemented in the Russian Federation.
INTRODUCTION: Skin reactions negatively affect a patient’s quality of life and may require radiation therapy premature interruption, what impairs illness control. Numerous agents determine tissue radiosensitivity, but demographic and lifestyle factors remain poorly understood. Those kind of patients herapeutic algorithm demands studies.OBJECTIVE: Radiation-induced skin reactions (RISR) formation and severity prognostic factors determination for primary malignant skin lymphomas patients.MATERIALS AND METHODS: 45 patients malignant T-cell skin lymphoma study, aged 38 to 82 years (29 mycosis fungoides patients, 2 lymphomatoid papulosis, 14 patients with primary anaplastic large cell skin lymphoma) received fast electrons total skin irradiation on the basis of the Federal State Institution «Russian Radiology and Surgical Technologies Scientific Center named after Academician A.M.Granov» of the Ministry of Health of the Russian Federation from 2012 to June 2022. Radiation therapy performed in the usual fractionation mode on linear electron accelerators Elekta Precise with 4–6 MeV bremsstrahlung total doses from 14 to 30 Gy (22±2.4 Gy). In order to identify the role of possible prognostic factors of skin toxicity — gender, age, body mass index (BMI), smoking status, lymphoma body surface area (BSA), the presence of concomitant diseases (diabetes mellitus and arterial hypertension) and previous chemotherapy.Statistics: Statistical analysis was performed using the IBM SPSS Statistics v. 26 program (developed by IBM Corporation). The value of p<0.05 was considered statistically significant. Verification of the sample belonging to the normal general population was carried out using the Shapiro–Wilk criterion. Spearman's rank correlation coefficient was used for correlation analysis. The regression parameters were estimated using the least squares method.RESULTS: The analysis revealed positive associations between the severity of RISR and predictor factors: BMI (r=0.799, p<0.01), smoking status (r=0.655, p<0.01), age (r=0.534, p<0.05), presence of diabetes mellitus (r=0.456, p<0.05), arterial hypertension (r=0.227, p<0.05), previous chemotherapy (r=0.422, p<0.01) and lymphoma body surface area (r=0.378, p<0.01). Severity of RISR scale value increase by those parameters. Negative links found between the severity of RISR and the total focal dose (SOD) of the beginning of their formation (r=–0.109, p<0.05).CONCLUSION: Formation and severity prognostic factors for the RCC upon fast electrons total skin exposure for patients with primary malignant T-cell skin lymphomas (mycosis fungoides, lymphomatoid papulosis, primary anaplastic large cell lymphoma of the skin) were identified.
RosaiDorfman disease (RDD) is a rare variant of the nonlangergans histiocytosis. Various presentation, systemic and localised forms and limited publications make diagnostics and prompt management difficult. Aim. Literature review and presentation of the patient with cutaneous form of RDD. Results. The patient is a 56 y.o male. In October 2019 he noticed a tumour in the left temporal area. After 3 weeks the tumor was removed. During the next two weeks the tumour recurred within the post-operative scar. After the review of the specimen and staging the skin form RosaiDorfman disease was diagnosed. Irradiation (total dose 36 Gr) was conducted. The tumor lessened. Through the next 4 months response is stable. Сonclusion. Radiation therapy as a second line of treatment of the skin RDD led to a stable response.
Efficiency of first-line immunopolychemotherapy schemes was comparable. Long-term results were better with immunochaemoradiotherapy; the presence of PET-negative data after the first line of immunopolychemotherapy is a favourable prognostic sign. Radiation therapy executed in proper time helps to reduce the systemic cytostatic stress.
Introduction: Radiation therapy is effective in treating mediastinal lymphomas, but the question of its long-term radiation effects, such as induced breast cancer, lung cancer, and heart disease, has been increasingly raised in recent years. The aim of our work was to
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