[Narrow photon-beam radiation therapy unit]. / Ustanovka dlia stereotaksicheskoi luchevoi terapii uzkimi puchkami fotonov (pervyi opyt ispol'zovaniia).

The Central Research Institute of Roentgenology and Radiology and the Research and Production Complex, Radiation Training Center, D. V. Efremov Research Institute of Experimental Physics have been the first in Russia to design a narrow photon-beam unit for stereotactic radiation therapy of intracranial small formation. Fifty one patients were treated. Thirty six presented arteriovenous malformations, 4 had hypophyseal adenomas. The hypophysis was exposed to radiation in 11 patients with prostatic cancer. The unit has been found to have great operational and clinical capacities.

[Results of proton therapy in the treatment of pituitary prolactin-secreting adenomas]. / Rezultaty protonnoi terapii prolaktinsekretiruiushchikh adenom gipofiza.

The paper presents follow-up results of narrow-beam proton therapy (1000 MeV) in 75 female patients suffering from prolactin-secreting pituitary adenomas. Prolactin concentrations reduced both in macro- and microprolactinomas patients. The response was achieved in 96% of the cases in adenoma stages I-IIIa. Such results are superior to those reached with other treatment modalities. The efficacy of the above proton treatment can be raised by adjuvant use of chemotherapy.

[The effect of proton therapy on the protein-amino acid metabolism in Itsenko-Cushing disease]. / Vliianie protonnoi terapii na belkovo-aminokislotnyi metabolizm pri bolezni Itsenko-Kushinga.

The composition and blood concentration of free aminoacids and other aminocompounds were investigated using automatic aminoacid analysis by a physiological program in 12 patients with diagnosed corticotropin secreting hypophyseal disease (Itsenko-Cushing disease) before and 1-3 years after proton "hypophysectomy". Imbalance of components of the glucose-alanine cycle, expressed in hypoalaninemia and raised concentration of aminoacids with a bifurcated lateral chain, was detected against a background of marked hypercorticotropinemia and hypercorticolism. Single irradiation of the pituitary gland with a proton beam at absorbed doses of 100-120 Gy in the maximum of a deep field resulted in remission and normalization of aminograms of blood plasma (suggesting pathogenicity of proton-beam therapy) for 6-12 mos. The authors discussed probable mechanisms of the interrelationship of protein-amino-acid and carbohydrate metabolic derangements and their correlation with a type of changes in the hormonal balance.

[Proton stereotaxic therapy of epilepsy due to cerebral arteriovenous aneurysms]. / Protonnaia stereotaksicheskaia terapiia épilepsii pri arteriovenoznykh anevrizmakh golovnogo mozga.

The authors estimated the influence of proton-beam stereotaxic therapy on a course of epileptic fits in cerebral arteriovenous aneurysms (AVA). A stable disappearance of epileptic fits was noted in 16 of 29 patients (56%), in 12 of them (41%) positive angiography results were noted. The calculated D and V fields of irradiation for 16 patients without fits and for 13 patients with epileptic fits after proton-beam stereotaxic therapy have shown that with D being the same, the effect depends upon a fraction of an AVA irradiated area.

[The evaluation and choice of treatment methods (surgical removal, proton-beam irradiation) in endosellar hypophyseal adenomas]. / Otsenka i vybor metodov lecheniia (khirurgicheskoe udalenie, obluchenie puchkom protonov) éndoselliarnykh adenom gipofiza.

The article analyses the immediate and late-term results of treatment of endosellar pituitary adenomas: removal through a transsphenoidal approach--16 patients, transnasal stereotaxic administration of 90Y--14 patients, irradiation by proton beam--263 patients. Surgery as well as radiotherapy produced quite satisfactory results. Proton therapy on a Leningrad synchrocyclotron is not inferior to the modern surgical methods in efficacy and safety. It is indicated in endosellar pituitary adenomas when the sella turcica measures no more than 20 x 16 mm.

[Proton stereotaxic therapy of arteriovenous aneurysms of the brain]. / Protonnaia stereotaksicheskaia terapiia arteriovenoznykh anevrizm golovnogo mozga.

The paper is concerned with analysis of angiographic findings on 62 patients with arteriovenous aneurysms (AVA) of the cerebral vessels who received proton beam stereotactic therapy in the period of 1978-1986 depending on an absorbed dose value of an irradiated volume. Proton stereotactic therapy (PST) of brain AVA located deep in the functionally important regions, can be used as an independent radical therapeutic method in such cases including inoperable ones. Complete AVA elimination from the blood flow or considerable reduction of the AVA volume was achieved in 68% of the patients after delivering a dose of approximately 40 Gy, the AVA volume being approximately 30%. Significant (p less than 0.05) correlation of PST results, a dose of irradiation and a value of the AVA irradiated volume was established in the groups with positive results and in the nonresponding groups.

[Influence of ultrafractionation on the effect of whole body uniform irradiation with protons of 1000 MeV energy]. / Vliianie ul'trafraktsionirovaniia na éffekt obshchego ravnomernogo oblucheniia protonami s énergiei 1000 MéV.

In experiments with rats a study was made of the radiobiological influence of a pulse frequency (45.9 and 4.5 c-1) of a 1000 MeV proton beam. The estimates of metabolic parameters of the peripheral blood and spleen 24 h and the survival rate during 60 days following irradiation have demonstrated the increase in the biological effectiveness of the proton beam with decreasing pulse frequency. As to 60Co-gamma-radiation, RBE of protons was 1.10 +/- 0.04 at the pulse frequency of 9 c-1 and 0.98 +/- 0.03 at 45 c-1 as determined by the probit-logarithm dose 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.

[Effect of proton irradiation of the hypophysis on its gonadotropic and thyrotropic functions in patients with prolactinoma]. / Vliianie protonnogo oblucheniia gipofiza na ego gonadotropnuiu i tireotropnuiu funktsii u bol'nykh s prolaktinomami.

In order to study the effect of proton beam irradiation on prolactinoma cells and hypophyseal intact cells tests with i.v. administration of TRH (200 micrograms) and LH-RH (100 micrograms) were performed in 16 women with prolactin-secreting adenomas before and in 2 mos.-2 years after irradiation of the pituitary body with a high energy narrow proton beam (1000 MeV) at a dose of 40-120 Gy. A curative therapeutic effect of proton therapy which was low with respect to reproductive function recovery, was combined with lowered functional reserves of hypophyseal thyrotrophs and gonadotrophs. The informative value of the tests with the releasing hormones was shown for the determination of damage of hypophyseal intact cells. The results suggest refractivity of adenomatous lactotrophs to radiation exposure and the hypothalamic level of disorder of ovarian function regulation in this pathology.

[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.

[Proton stereotaxic therapy of cerebral arteriovenous aneurysms]. / Protonnaia stereotaksicheskaia terapiia arteriovenoznykh anevrizm golovnogo mozga.

Stereotaxic proton beam therapy using narrow beams (5-10 mm at 50% of isodose) at the energy of 100 MeV in single irradiation and the delivery of absorbed doses, the maximum dosage being 40-80 Gy, was provided to 99 patients with arteriovenous brain aneurysms. An analysis of the therapeutic results based on angiography data was performed in 50 patients with arteriovenous malformations with the volume up to 10 cm3. A positive effect was obtained in 31 of 50 patients.

[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.

[Estimation of the contribution of the dose rate to the effect of whole body uniform irradiation with 1000 MeV protons]. / K otsenke vklada moshchnosti dozy v éffekt obshchego ravnomernogo oblucheniia protonami s énergiei 1000 MéV.

Some biochemical indices of peripheral blood and spleen and the survival rate of albino rats after whole-body uniform irradiation with 1000 MeV protons delivered in two ways have been studied. The data obtained indicate that the dose rate contributes to the biological effect of impulse proton radiation.

[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".

[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.

[Status and developmental prospects of the medical proton channel in the synchrocyclotron in Gatchina]. / Sostoianie i perspektivy razvitiia meditsinskogo protonnogo trakta na sinkhrotsiklotrone v Gatchine.

The medical proton beam on the synchrocyclotron in Gatchina modernized in 1980, is characterized by a simplicity of the beam adjustment that amounts to standard operations, the time of adjustment reduced considerably. The optical scheme ensures a good reproducibility of all the beam parameters from session to session. A large "zone of convergence" makes it possible to select a necessary irradiation field size with the diameter from 3 to 10 mm. A new medical complex with a 2-room premises for irradiation is envisaged on the basis of the "second beam" to expand the medical program. The piercing technique of moving field irradiation with protons at an energy of 1 Gy and the utilization of the convergent beam ensure the ratio of the focal dose to the surface dose 200:1.