Post-radiation Complications Research Articles

Morphofunctional characteristics of the liver after administration of ascorbic acid in a model of radiation hepatitis

Introduction: Radiation-induced hepatitis develops both with direct irradiation of malignant neoplasms of the liver and abdominal organs. An important task of modern radiobiology is the development of methods for the prevention of acute and chronic post-radiation complications, for example, the injections of protectors. Materials and methods: Wistar rats (n = 40) were divided into groups: I – control (n = 10); II (n = 10) – electron irradiation; III (n = 10) – injection of ascorbic acid before electron irradiation; IV (n = 10) – injection of ascorbic acid. A biochemical blood test, oxidative status analysis, morphological, morphometric and statistical studies were carried out. Results: In group III, a less pronounced change in the main morphological and morphometric parameters was noted compared to group II; indicators of biochemical analysis and oxidative status approached control values. Conclusions: According to the results of the study, it was revealed that local irradiation with electrons after a week leads to disruption of the histoarchitecture of the liver, and the injection of ascorbic acid reduces the depth and range of radiation-induced hepatitis.

Еffect of Radiation Therapy on Breast Reconstruction in Breast Cancer Patients

Background. The surgical stage remains the main one in the combined and complex treatment of breast cancer. Radical mastectomy and reconstructive plastic surgery are the main option for surgical treatment of vast majority patients. Radiation therapy can lead to the development of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause technical difficulties for the radiologist to properly adjust the required dose of irradiation. Aim — to choose the optimal method of breast reconstruction using various implants, as well as endoprostheses to minimize post-radiation complications and maintain a high level of quality of life for patients after breast cancer treatment. Methods. The retrospective study was conducted in the department of oncology and reconstructive plastic surgery of the breast and skin in the P.A. Herzen Moscow Research Oncology Institute from June 2013 to November 2017. There were performed 132 operations: 111 subcutaneous mastectomy with one-stage reconstruction with an endoprothesis and 21 mastectomy with a one-stage reconstruction with an endoprothesis. The distribution by stages: I — 57, IIA — 39, IIB — 17, IIIA — 13, IIIC 4; 2 cases of breast sarcoma. Prophylactic mastectomy of the contralateral gland was performed in 22 patients, mastopexy in 8, augmentation in 20. Polyurethane implants were applied in 82 cases (62%). Radiation therapy was performed in 47 patients with total dose 45 Gy. Bilateral reconstruction was performed in 22 patients. Results. The mean follow-up period was 28.44 ± 14.66 months (from 6 to 48 months). The most frequent complication in the postoperative period was the development of capsular contracture: seroma — 20 patients, hematoma — 2, edge necrosis — 6, protrusion — 6, infection — 2 patients. The most common capsular contracture by Baker was III degree, n = 18. The average period of development of capsular contracture was 7.6 ± 11.65 months. Conclusion. Despite the greater number of complications during the one-stage reconstruction, the implants remain in advantage in choosing a method of treating breast cancer by both the patient and the surgeon.

EXPERIENCE OF EXPERIMENTAL RESEARCH ON RADIATION ONCOLOGY AT R.E. KAVETSKY INSTITUTE OF EXPERIMENTAL PATHOLOGY, ONCOLOGY AND RADIOBIOLOGY, NAS OF UKRAINE

This article briefly summarizes our long-term experience of research in the field of experimental and clinical radiation oncology unified by the key word "radiosensitivity". Consistently presented and interpreted here are the main results on biodosimetry of irradiation depending on doses and quality of ionizing radiation and determination of individual radiosensitivity of cancer patients. We justified the use of radiomitigators to reduce the frequency and severity of post-radiation complications in cancer patients, and for radiation protection of the general population. The radioprotective effect of the antioxidant inosine in the somatic cells of cancer patients in the range of low radiation doses was demonstrated. We established that in persons who are hypersensitive to irradiation, the reparative potential is reduced by about 60% compared to ones with normal indices of individual radiosensitivity. Cytogenetic predictors of radiosensitivity of healthy cells adjacent to the irradiated tumor have been determined. Unfortunately, they have not yet become a point of application for individual planning of irradiation courses and assessment of severity of post-radiation complications. The intensive development of selective radioprotectors that would selectively protect healthy tissues in the course of radiation therapy, reducing their radiosensitivity by activating reparation processes, is considered a priority direction of modern radiation oncology.

Outcomes with bevacizumab for radiation induced-brain necrosis.

e14006 Background: Radiation necrosis (RN) is post-radiation complication that leads to increased permeability and disruption of the blood brain barrier (BBB). This in turn leads to a pro-inflammatory state and an increased production of vascular-endothelial growth factor (VEGF). Bevacizumab is a monoclonal antibody against VEGF and is a potential treatment for RN. The objective of the study is to assess effectiveness of bevacizumab (BEV) for the treatment of brain RN in adults. Methods: Retrospective chart review of 22 patients with various solid malignancies including non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), metastatic melanoma and breast cancer with clinical or radiographic diagnosis of RN seen at Memorial Cancer Institute (MCI) in a 3-year period, from January 1st, 2019 to January 1st, 2023. Radiation doses ranged from 18-24 Gy (single fraction) or 24-27 Gy (3-fraction) for radiosurgery and 30-37.5 Gy for whole brain radiotherapy. Patients were identified that developed RN and VEGF inhibitors were subsequently given to assess effectiveness in the treatment of the condition. We evaluated the dose, frequency, number of treatments received, adverse effects and therapeutic benefits of BEV. Therapeutic benefit was defined as patients that received bevacizumab had a radiological and clinical improvement of the RN (clinical benefit). Brain imaging with MRI or PET/CT scan was completed both pre and post treatment to evaluate efficacy of treatment. Patients were initially given 4 cycles with a subsequent 4 more cycles if it was beneficial and tolerated treatment. Results: 22 patients were included in the study, 9 were males (41%) and median age 66 (range 31-81). 91% (20/22) had a diagnosis of lung cancer. 1 patient had a diagnosis of SCLC, while 19 were diagnosed with NSCLC. The study had a good representation of different races including Non-Hispanic Whites 7 (32%), Hispanics 10 (45%), Blacks 13% (3) and Asians 10% (2). Over 95% (21/22) of patients achieved a clinical benefit, while one patient did not (5%). Patients experienced improvement in cognitive function, headaches, dizziness, weakness, and other symptoms with BEV. MRIs showed improvement in edema and a reduction/stabilization of brain lesions. The most frequent dosing regimen used was BEV 10 mg/kg every two weeks. The median number of cycles given was 4 cycles (1-12). The most common adverse events were hypertension, minor nose bleeding, an occasional protein found in urine. There were no severe AEs or discontinuation of therapy with bevacizumab. Conclusions: This study demonstrated treatment with BEV 10 mg/kg every two weeks for a total of 12 cycles is well tolerated and has potential clinical benefit in RN in lung cancer patients with CNS metastasis. The therapeutic effects of VEGF inhibitors were seen in our small population study but warrants further investigation in a larger population study.

ЛУЧЕВАЯ ТЕРАПИЯ ПРИ РАКЕ МОЛОЧНОЙ ЖЕЛЕЗЫ рТ1–3N0–1М0 ПОСЛЕ МАСТЭКТОМИИ ИЛИ ПОДКОЖНОЙ КОЖЕСОХРАННОЙ МАСТЭКТОМИИ С РЕКОНСТРУКЦИЕЙ. ОБЗОР ЛИТЕРАТУРЫ

Purpose: The literature review analyzes publications over the past decades on the need for radiation therapy after mastectomy or subcutaneous/skin-preserving mastectomy with reconstruction. Results: Risk factors for breast cancer recurrence were analyzed. The effect of radiation therapy on the recurrence of breast cancer after mastectomy, subcutaneous and skin-preserving mastectomy with reconstruction was evaluated depending on the stage, lymph node lesions, and the presence of unfavorable molecular biological types. Indications for radiation therapy are described. The effect of radiation therapy on early and late complications of the reconstructed breast and options for reducing the percentage of complications were analyzed. Conclusion: The exclusion of radiation therapy from the breast cancer treatment plan is a decrease in the percentage of complications caused by radiation therapy, for example, during implant reconstruction – a decrease in capsular contractures. And, as a result, improving the quality of life of patients, reducing repeated operations in case of complications, which means it is economically profitable. In recent years, due to the increasing need for various breast reconstruction options, the surgeon and radiotherapist have faced the task of choosing the optimal sequence of breast reconstruction, as well as reducing the risk of post-radiation complications. Radiation therapy, along with reducing the risk of relapse of the disease, increases the risk of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause difficulties for the radiologist to correctly deliver the required dose of radiation. Minimizing the frequency and severity of complications after radiation therapy on the reconstructed gland without compromising oncological or cosmetic results is an important and common interdisciplinary goal for oncologists and radiotherapists.

MANAGING THE MOST COMMON COMPLICATIONS OF RADIATION THERAPY IN PATIENTS WITH HEAD AND NECK CANCER

Radiation therapy is widely used approach in treatment of head and neck cancer, unfortunately it leaves consequences that are influencing the patients’ life in a negative way. During and after the treatment with ionizing irradiation it affects not only the malignant area that is being treated, but also the surrounding tissues and organs that are located near the region that is targeted (oral mucosa, jaw bones, teeth, salivary glands, surrounding muscles and the temporomandibular joints), leaving changes in their structure and functions. Many of the patients that are treated, have not been prepared optimally for the radiation treatment, what also affects the post operative condition of their tissues and organs that are located nearby to the radiation treated area. The aim of this study was to define the most common postradiation complications in patients with head and neck cancer and to evaluate the efficiency of the solutions that are used to manage them. For this study were analyzed in details 37 published articles on the studied topic, the research was done online using the data bases NCBI, Cochrane Library, Medline, PubMed and Webmd. The inclusion criteria were: studies made in vivo; studies written in English; case reports on head and neck cancer patients; surveys on patients after radiation therapy; studies on patients with intraoral complications from after radiation therapy. Results showed that radiation induced complications in the head and neck cancer patients can be classified in three groups as early, intermediate and late changes. The most common changes were found in the tissues (mucosa, skin, subcutaneous connective tissues, salivary glands, the bone tissues and the teeth), resulting with: hyposalivation (xerostomia), mucositis, opportunistic infections, radiation caries, dysphagia, altered taste and difficulties with the chewing and swallowing. Many studies have shown that the percent of damage on the oral mucosa is strongly related to the radiation dose and the type of ionizing irradiation that patients are being treated with. Treatment consists of application of lubricants; usage of substitutes for saliva; and stimulants for the saliva production, with preparations like pilocarpine and cevimeline, and electro stimulation. The loss of the taste after the treatment can be partial or total. Mostly affected are the sour and bitter tastes, rarely the sweet and the salty taste, and very rare is total loss on all of the flavors. Fortunately in most of the studied cases has been show that the changes in the taste were reversible after a period of time, in some cases a few months and in others it can happen even up to a few years until it reaches total recovery. It is crucial to implement more solutions and to find new ways to manage the complications that follow after the irradiation, so the quality of the life in these patients can be spared in any possible way. Using the new approaches such as IMRT and VMAT on these patients, could also improve their condition after the treatment, and reduced dosage of the irradiation also could be tested and implemented if it is possible.

Long-term oncological outcomes of organ-sparing treatment of patients with early breast cancer aged 65 years and older who had no postoperative radiation therapy

Postoperative radiation therapy after breast-conserving surgery is a standard method of treating breast cancer, but recently the issue of its de-escalation in patients older than 65 due to concomitant pathology, lower life expectancy and possible development of post-radiation complications has been discussed. The results of some foreign studies prove the absence of a statistically significant difference in relapse-free and overall survival in patients with early breast cancer older than 65 years with relatively favorable clinical and morphological characteristics without postoperative radiation therapy. We analyzed the long-term oncological results in patients with breast cancer older than 65 years after breast-conserving surgery without postoperative radiation therapy. The results of the study showed that postoperative radiation therapy in patients over 65 years of age with stage IA pT1N0M0 breast cancer of luminal immunophenotype A does not improve long-term oncological indicators. Thus, the exclusion of postoperative radiation therapy from the treatment plan of this group of patients is oncologically safe and economically justified.

О ЦЕЛЕСООБРАЗНОСТИ ПРОВЕДЕНИЯ ПОВТОРНОЙ РАДИОТЕРАПИИ ПРИ РЕЦИДИВАХ И ПРОДОЛЖЕННОМ РОСТЕ РАНЕЕ ОБЛУЧЕННЫХ ОПУХОЛЕЙ РАЗЛИЧНОЙ ЛОКАЛИЗАЦИИ

Introduction: The development of a recurrence or a second tumor in previously irradiated patients requires, in some cases, repeated radiotherapy (reirradiation) of the previously irradiated tissue volume. In the past decades, it was widely believed that it was possible to irradiate one anatomical zone in curative doses only once (taking into account the tolerance of healthy tissues) and the issue of repeated irradiation was practically not discussed (there are only a few studies). This approach was due to the fact that the use of old technologies did not allow sufficient protection of healthy tissues surrounding the tumor, which led to severe complications. Due to the development of radiotherapy technologies and new advances in radiobiology, the number of studies on the re-irradiation of recurrent tumors has recently increased significantly, however, they are mainly retrospective in nature and do not have a sufficient evidence compared to indications for primary radiotherapy. However, reirradiation can be used not only for palliative purposes, but also to achieve long-term local control. Modern medical approaches and technical capabilities make it possible to re-irradiate tumors of any localization, up to the second curative dose. Purpose: To investigate the expediency of repeated irradiation of patients with different tumor localizations, taking into account the survival rates of patients, possible complications and subsequent quality of life. Materials and methods: For the first time in Armenia, an analysis of the results of reirradiation is carried out on the basis of the experience of one clinic. The results of treatment of 1300 patients, who received radiotherapy at the IRA MEDICAL Group Radiotherapy Center from March 2019 to March 2022 were studied. The study included 52 patients, who received the second course of RT, which accounted for 4% of the total number of patients. The median age of patients was 60.5 years (22 - 81), including 22 men, 30 women, based on pathologies: CNS tumors - 17 patients, brain metastasis - 10, gynecology - 6, head and neck tumors - 6, metastatic skeletal bone lesions - 4, breast cancer - 3, other localizations - 6. Stage of the disease: III - 7 patients, IV - 37, unclassified - 8. The mean interval between two courses of radiotherapy was 34.5 months (1.5 - 252). The median total equivalent dose from two irradiation courses is 99 Gy (56-121). Except of the patients, who received reirradiation for metastatic relapse, the total equivalent dose was 102 Gy (84–121), and the median follow-up time after reirradiation was 9 months (4–29.5). Results: The average life expectancy of patients, who died during the observation period was 6.5 months (1-23). In 7 out of 52 patients, who initially had low KPS (60%), survival was up to 3.5 months or less. After excluding these patients from further statistical analysis, the median survival of the remaining patients was 10 months (4 – 23). As of March 31, 2022, 31 patients (59.6%) are alive, with an average follow-up of 13 months (5 – 29.5). The number of post-radiation complications and the quality of life of patients were also assessed. There were no treatment related deaths or reduced quality of life in the early stages. The results of this prospective study demonstrate that the use of the latest technologies in repeat radiotherapy can improve survival and quality of life in these patients. Thanks to new technologies, it is possible to conduct a repeated course of radiotherapy even in curative doses. When planning the second therapeutic or palliative course of radiotherapy, it is necessary to carefully select patients, taking into account a number of factors related to the previous treatment and the individual characteristics of the patient. After completion of the study, we plan to create recommendations on the criteria for selecting candidates for re-irradiation.

One-stage breast reconstruction using textured implant and latissimus dorsi flap

About 50 000 new cases of breast cancer are registered annually in Russia. This is used systematically and requires a multidisciplinary approach to its appointment. The main thing in treatment it is a surgical stage, the result of which is the features of the quality of life of patients. This disease is found often in women in the prime of life and with a socially active life position. Today, there are many options for surgical treatment of breast cancer patients. Due to the rapid development of plastic surgery, it became possible to use both synthetic materials and autologous tissues in breast reconstruction, which include the latissimus dorsi flap. The use of tissues that cause deterioration of the condition of the reconstructed breast is a significant technique and allows preventing the development of developmental progression, both surgical and post-radiation complications in the reconstructed breast.

ФАКТОРЫ ПРОГНОЗА РАЗВИТИЯ ВТОРИЧНОЙ ГЛАУКОМЫ ПОСЛЕ СТЕРЕОТАКСИЧЕСКОЙ РАДИОХИРУРГИИ ПО ПОВОДУ МЕЛАНОМЫ ХОРИОИДЕИ

Stereotactic radiosurgery (SRS) demonstrates satisfactory results in terms of local tumor control and survival of patients with choroidal melanoma. At the same time, there are practically no studies aimed at establishing the dependence of the frequency and severity of SRS complications on the initial characteristics of the tumor and dose parameters of radiosurgery. The aim of this study was to analyze the incidence of post-radiation complications, as well as the relationship between the clinical characteristics of the tumor and the dosimetric parameters of stereotactic radiosurgery and secondary glaucoma. Material and methods. The prospective study included 43 patients with cT1-3N0M0 choroidal melanoma. The median prescribed dose per tumor margin at 50% isodose was 30 Gy, (23-35 Gy). The immediate effect of the treatment was assessed as positive in all the cases, except for increased blood flow according to Doppler ultrasound data, an increase in tumor size by more than 20% of the previously determined lesion according to MRI. Univariate and multivariate regression analyzes were performed using the Cox proportional hazards model, ROC analysis for statistically significant variables. Results. During the follow-up period (median was 16 months), an objective tumor response to treatment was recorded in 100% of cases. Secondary cataract after SRS developed in 4 (9.3%) cases, post-radiation retinopathy - in 9 (20.9%) cases, secondary retinal detachment - in 7 (16.3%) cases, secondary glaucoma - in 6 (14%) cases. After SRS during the observation period, the eyeball was preserved in 90.7% of patients. For the tumor volume parameter, the area under the curve was 0.92 (95% CI 0.84-1.00) with a cut-off point of 800 mm3. With a tumor volume less than this indicator, no cases of secondary glaucoma were detected. In the case of tumors with a volume equal to or greater than the calculated value, secondary glaucoma developed in 71% of cases. For the tumor thickness parameter, the area under the curve was 0.78 (95% CI 0.63-0.93) with a cut-off point of 7.6 mm. With a tumor thickness of less than 7.6 mm, the incidence of secondary glaucoma was 5% during the observation period, with a tumor thickness greater than this indicator - 72%. Conclusion. In the treatment of tumors with a volume of more than or equal to 800 mm3 and/or a thickness of more than or equal to 7.6 mm, radiosurgery as a monomethod is not recommended; it is necessary to resort to a combined method, including, along with SRS, tumor endoresection.

Prevention of radiation-induced rectal injuries with perirectal blocks in radiation therapy.

e17507 Background: The purpose of this study was to evaluate perirectal blocks in prevention of radiation-induced rectal injuries in patients with cervical cancer. Methods: The study included 18 patients diagnosed with stage III cervical cancer (T3bNxM0) receiving chemoradiotherapy. All patients showed pronounced inflammatory and dystrophic changes in tissue planes and organs of the small pelvis due to comorbidities (diabetes mellitus, hypertension, pelvic varicose veins, proctitis, inflammatory and adhesive processes in the small pelvis reducing chemoradiotherapy effectiveness due to impaired microcirculation and increasing the risk of post-radiation complications). All patients received brachytherapy with additional perirectal administration of drugs relieving pain and inflammation and improving neurotrophic processes and microcirculation in tissues (novocaine 0.25% -20.0; milgamma 2.0; ceftriaxone 1 g; dexamethasone 8 mg). The combined administration causes drug potentiation, positively affects the nervous and neuromuscular systems, restores microcirculation and venous outflow, decreases swelling, improves tissue trophism, reduces blood vessel permeability, and improves reflexes from interoceptors. Radiation therapy was completed on schedule with the introduction of radical doses in all patients, which is challenging in patients with comorbidities leading to impaired trophism and tissue hypoxia. Results: Complete tumor regression confirmed by MRI and ultrasound was observed by the end of the treatment in 90% of patients, apparently due to the radiosensitizing effect on cervical cancer and the radioprotective effect on surrounding tissues. Conclusions: Parametrial blocks during brachytherapy improve the status of tissues of the small pelvis which, in turn, prevents radiation damage, contributes to the timely radiotherapy completion, and improves the treatment effectiveness and the quality of life of patients. This technique is especially relevant in view of the increasing number of diseases that disrupt microcirculation, and hence the oxygenation of tissues, causing tumor radio- and chemoresistance.

Post-radiation complications in children with acute lymphoblastic leukemia who underwent a course of cranial radiation

Purpose of the study. To analyze the physical and neuropsychiatric development of pediatric patients who underwent cranial irradiation in the period from 2015 to 2020 in the radiotherapy department of the National Research Center of Oncology and to assess the risk of post-radiation complications.Materials and methods. 17 children aged from 3 to 17 years were hospitalized under medical supervision in the department of pediatric oncology of the National Medical Research Centre for Oncology. All the children underwent a course of conformal radiation therapy totally on the brain area and the first two cervical vertebrae in the radiotherapy department of the National Medical Research Centre for Oncology. 13 patients (76.7 %) underwent radiation therapy due to the prevention of neuroleukemia with a total dose of 12 Gy (a dose per fraction was 2 Gy), 2 patients with a confirmed relapse of acute lymphoblastic leukaemia (ALL) (11.65 %), 1 patient with a confirmed diagnosis of neuroleukemia (5.8 %) and 1 patient from the high-risk group (5.8 %) – with a total dose of 18 Gy (a dose per fraction was 2 Gy). Further 75 month regular medical checkup was carried out on the basis of the Regional Children's Clinical Hospital for.Results. None of the surviving patients showed growth retardation. Two patients (11.65 %) complained of increased fatigue, decreased concentration; one patient (5.8 %) showed unmotivated irritability and aggression during the examination. Intellectual development corresponded to age in all patients (100 %). One patient (5.8 %) experienced episodes of nausea and vomiting (grade 1 on the CTCAE scale), three patients (17.7 %) suffered from headache (grade 2 on the CTCAE scale), three patients (17.7 %) complained of fever up to 38 °C (1 degree on the CTCAE scale). Two out of 17 ALL patients died due to disease progression.Conclusion. Taking into account the different time intervals between treatment and the moment of the study (from 9 to 75 months), cranial irradiation demonstrates relative safety for patients undergoing treatment during critical periods of development of both physical and neuropsychic spheres. However, an objective assessment of the development prospects is difficult due to the relatively short time after undergoing therapy (from 9 to 75 months) and a small sample of patients.

Optimizing surgical outcome of auricular keloid with a novel multimodal approach

Various treatments are available for auricular keloids, but none has an absolute advantage. A practical and safe therapy to optimize the surgical outcome for auricular keloids is needed. We adopted a multimodal treatment of surgical enucleation, core fillet flap reconstruction, intraoperative corticosteroid injection, and immediate postoperative radiotherapy. There were no routine intralesional corticosteroid injections during follow-up. Keloid recurrences, complications, and risk factors for recurrences were analyzed. The outcome was compared with other published literatures. 45 auricular keloids were included in this study. 85.7% were female with an average age of 27.1 ± 7.5 years, and averaged size was 1.8 × 1.2 ± 0.9 × 0.6 cm. 71.1% were located at ear helix with 28.9% at the ear lobe. Nine keloids were classified as Chang-Park classification type I, 30 for type II, two for type III, and four for IV. The average radiation dosage was 1578.6 cGy. The recurrence rate was 6.7% at an average 24.1-month follow-up. There were no complications of surgery, radiotherapy, and intralesional corticosteroid injection. Our recurrence rate was lower than those in mono-adjuvant therapies of intraoperative corticosteroid injection or radiotherapy. This one-session multimodal approach optimizes treating auricular keloids with a low recurrence rate and minimal post-radiation and long-term corticosteroid injection-related complications.

СТЕРЕОТАКСИЧЕСКАЯ ЛУЧЕВАЯ ТЕРАПИЯ БОЛЬНЫХ ОПУХОЛЯМИ ГОЛОВЫ И ШЕИ. СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ

This publication provides an overview of the current state of the art in the use of stereotactic radiation therapy (SBRT) for patients with head and neck tumors. We have analyzed current trends, and also presented the features of radiobiology and the basic principles of radiation treatment. Special attention is paid to indications for SBRT, fractionation schemes and radiation planning. The use of SBRT for primary head and neck tumors, including boost, as well as relapses treatment are described. The results of the implementation of SBRT by various authors both as an independent option and in combination with drug therapy are presented. The efficacy and tolerance of radiation is described in a summary form with clarifying comments. The radiation therapy toxicity profile is detailed, including the main risk factors of postradiation complications.

Successful multi-stage treatment of post-radiation complications of cervical cancer. Clinical observation

Successful multi-stage treatment of post-radiation complications of cervical cancer. Clinical observation

Brachytherapy in organ-preserving treatment of choroidal melanoma: complications and the possibility of their prediction

This review analyzed the domestic and foreign literature on brachytherapy of choroidal melanoma using ruthenium ophthalmic applicators. The review highlights the historical aspects of radiation treatment, from the first experience of using ionizing radiation in the treatment of malignant neoplasms to modern methods of brachytherapy; presents the radiobiological foundations of radiation therapy; considers the issues of radiation pathomorphosis, reflecting the nature of pathological changes in the choroidal melanoma tissue during brachytherapy; shows the dependence of the effect of exposure ionizing radiation from the phase of the cycle of cell division; and also describes the presence of changes characteristic of the response to ionizing radiation in unirradiated tissues. The analysis of various post-radiation complications, both early and late, was carried out in some detail, with emphasis on the possibility of predicting and preventing them in real clinical practice. A comparison is made in terms of the frequency of development of various post-radiation complications in the works of domestic and foreign authors, as well as a comparison with the effect of ionizing radiation from other radioactive isotopes. Recommendations of experts are given regarding the correct calculation of the dose to the sclera and medication support, based on many years of experience in the use of ruthenium ophthalmic applicators for brachytherapy of choroidal melanoma. The risks of developing such late complications as radiation maculopathy and radiation neuropathy have been demonstrated, especially in pre-equatorial tumor localization. The possibilities of modern methods of instrumental diagnostics for studying the processes occurring in the area of the tumor, as well as changes in the surrounding tissues, are shown, which determines the feasibility and importance of further study of this issue.

РАЗРАБОТКА И АПРОБАЦИЯ МЕТОДА АДАПТИВНОЙ РАДИОХИРУРГИИ У ПАЦИЕНТОВ С МЕТАСТАТИЧЕСКИМ ПОРАЖЕНИЕМ ГОЛОВНОГО МОЗГА

Background. Intracranial metastases are detected in more than 20% of patients with advanced cancer; they dramatically worsen the prognosis for life and are one of the most common causes of death. Surgical resection and whole brain radiotherapy have been considered the standard treatments for cerebral metastases for many decades. Stereotactic radiosurgery (SRS) is increasingly used in the treatment of intracranial metastases. However, the treatment of large metastases by single-fraction SRS is problematic, since the administration of a dose that provides a sufficient level of local control is associated with a high risk of severe post-radiation complications. Purpose. To develop modes of fractionation for the use of SRS in irresectable patients with metastatic brain lesions and approbate the method of adaptive stereotactic radiosurgery (ASRS). Material and methods. The study included 39 patients with metastatic brain lesions, who in 2018-2021 underwent a two-fraction or three-fraction ASRS according to the developed method using the gamma-therapeutic complex "Gamma Knife Perfexion" (Elekta, Sweden). The average volume of metastases at the time of the first session was 11.9 cm3. Results. The median overall survival in the general cohort was 13.0 months, 1-year survival rate was 75.0%. When assessing local control, the absence of progression 6 months after irradiation was found in 33 out of 39 patients (84.6%). Conclusions. Analysis of literature data and our own preliminary experience demonstrate the relevance of the development and implementation of the ASRS method in the treatment of irresectable patients with metastatic brain lesions.

Prevention and correction of radiation dermatitis with basic skin care: doctor and patient consensus

External beam radiation therapy is widely used by doctors around the world as one of the most common form of cancer treatment. The radiotherapy can help reduce the treatment aggression as compared with the surgical intervention in a large number of clinical situations, which ensures that the patient's quality of life will be decreased to a lesser extent in the after-treatment period. However, like the vast majority of anticancer treatments, the radiation therapy has a number of side effects, which are classified into acute radiation reactions and post-radiation injuries. Among them is radiation dermatitis, which is one of the most common adverse reactions to the radiotherapy. This complication manifests as erythema, as well as hyperpigmentation, dry and itchy skin, hair loss. In addition to the obvious negative impact on the patient's quality of life, some of the above factors can result in the development of a secondary skin infection. As one of the most frequent post-radiation complications, radiation dermatitis places radiotherapists before a challenge to reduce the incidence rates of this side effect, as well as to decrease the intensity of its clinical manifestations if it occurs. This challenge suggests the search for targeted drugs aimed to prevent and treat clinical symptoms. To date, dermatocosmetic products that are used to relieve skin manifestations of radiation treatment complications is an alternate option of the effective solution to the problem of radiation dermatitis. In the described clinical case, we assess the experience of using some of the dermatocosmetic products in a patient with a florid form of radiation dermatitis.

Hearing Outcome After Linear Accelerator-Based Radiotherapy for Vestibular Schwannomas: A Retrospective Analysis of a Single Center.

Objective: To report our results on hearing preservation after linear accelerator (LINAC)-based stereotactic radiotherapy for vestibular schwannomas (VS) in a tertiary referral center.Methods: All patients who presented with VS in our center between 2010 and 2018 and who were treated with LINAC-based radiotherapy were retrospectively analyzed. Pure tone average and speech discrimination score represented hearing outcome, pre- and postradiotherapy. A Gardner-Robertson grade I or II hearing represented functional hearing.Results: In total, 35 patients were treated with LINAC-based radiotherapy. Median age was 55 years (range 18-86 years), 22 (63%) were female. Sixteen patients had a Koos grade III or IV tumor. Twenty-four patients were treated with radiosurgery (1 or 5 fractions; stereotactic radiosurgery), and eleven patients were treated with fractionated stereotactic radiotherapy. Mean follow-up was 4.8 years (range 1.8-8.4 years). In 34 patients, hearing was assessed pre- and post-radiotherapy. In seventeen patients, hearing remained stable. In eleven patients, a decrease in GR scale was observed, of which seven patients showed a decrease from a functional to a non-functional level (4 GR III, 2 GR IV, and 1 GR V). Tumor control was 95% (34/35), and except for hearing loss, all post-radiation complications and morbidity were transient.Conclusion: These data emphasize that although the rate of tumor control (the primary goal of radiotherapeutic treatment) is high, it is important to adequately manage patients’ expectations regarding the outcomes of the secondary possibly positive outcome; hearing preservation.

Magnetic resonance imaging in the diagnosis of brain arteriovenous malformations and in the evaluation of the results of stereotactic radiosurgery (review)

Arteriovenous malformations (AVM) are quite rare, but they are dangerous pathology due to the risk of rupture and intracranial hemorrhage, which leads to disability. This review enlights the epidemiology of AVM and their symptoms, current methods of diagnostics and treatment as well as prognosis and treatment outcomes. Nowadays microsurgical removal, endovascular embolization, stereotactic radiosurgery and combination of these methods are used in clinical practice for AVMs treatment. Stereotactic radiosurgery is a highly effective non-invasive technique resulting in high degree of AVM obliteration with low risk of complications. The results of magnetic resonance imaging usage in assessing the degree of obliteration and the development of post-radiation complications are presented in this article. The optimization of magnetic resonance imaging algorithm is necessary for determination of statistically significant factors affecting the obliteration process.