[Clinical experience of radiosurgical treatment for metastatic brain lesion in malignant tumors].

The data on radiosurgical treatment of 97 (50 men and 47 women) patients with metastatic brain lesion are presented. At the time of radiosurgical treatment the control over extracranial foci was in 44 patients. According to ECOG- WHO the general status of patients was assessed as 0-1in 70, as 2 in 20 and as 3-4 in 7 cases. The most common sources of metastatic tumors were lung, breast and skin melanoma. The vast majority of patients had from 1 to 4 foci of brain lesions. Median overall survival in patients with metastatic brain damage after radiosurgical treatment was 10.5 months. The median time to progression in the brain was 5,3 months. Both parameters significantly depended on the type of primary tumor. They were the worst for renal cell carcinoma and small cell lung cancer, slightly higher for skin melanoma and non-small cell lung cancer and the highest for the group of tumors of other locations. Overall survival was significantly reduced from 47% to 35% in the absence of the control over the extracranial foci. It practically was independent of whether one or more brain lesions were in a patient. The time to progression in the brain was unreliable greater in solitary foci.

[The role of radiotherapy in the treatment for stage-IV Hodgkin lymphoma].

The study included 140 patients with Hodgkin's lymphoma stage IV. 90 patients were exposed to chemoradiotherapy. Only chemotherapy was carried out in 50 cases. Overall survival of patients, undergone only chemotherapy, was 55% by a five-year term and 49% by a ten-year term, disease-free survival was equal to 38% as after five and ten years of observation and treatment failure-free survival--37%. Survival of patients, in the treatment program of whom after 4 or more cycles of chemotherapy combined with irradiation, including all extranodal lesions, was the best: a five-year and ten-year overall survival reached 80%, disease-free survival--70 and 61%, failure-free survival--59% and 51% respectively. Irradiation of foci of extranodal lesions after 4 or more cycles of chemotherapy resulted in a significant increase of rates of overall survival and disease-free survival regardless the presence or absence of adverse prognostic factors. Expansion of irradiation in patients with Hodgkin's lymphoma stage IV does not lead to an increase of rates of overall, disease-free and failure-free survival.

[Role of single-photon emission-computed tomography and x-ray computed tomography in diagnosing lymphatic metastases in patients with non-small cell lung cancer].

Single photon emission tomography (SPECT) with 99mTc-MIBI was performed after conventional staging in 83 operated non-small cell lung cancer (NSCLC) patients. Diagnostic results of SPECT and conventional computerized tomography (CT) staging were validated by histological examinations of operation material. According to histological verification 35 of 83 evaluated patients had lymph node (LN) invasion by NSCLC. SPECT detected LN involvement in 28 of these 35 patients and was false positive in additional 16 patients. Pneumonia or atelectasis were detected in 12 of 16 patients with false positive SPECT results. Sensitivity (Sen), specificity (Sp), accuracy (Ac), positive (PPV) and negative (NPV) predictive values of SPECT in diagnosis of LN invasion by NSCLC was as follows: 80%, 66%, 72%, 65%, 82%. Diagnostic accuracy of CT for detection of LN involvement was inferior to SPECT: Sen--71%, Sp--62%, Ac--66%, PPV--58%, NPV--75%. Combination of SPECT and CT data offer promising solutions with Sen reached 94% or high Sp which in patients without atelectasis or pneumonia can reach 96%.

[Nuclear medicine in radiotherapy planning for patients with malignant neoplasms of different locations].

The performance of nuclear medicine methods in radiation therapy tactics determination was analyzed in patients receiving therapy for Hodgkin lymphoma (HL, n=556), breast cancer (BC, n=230), treatment-naive patients with non-small cell lung cancer (NSCLC, n=86). In HL patients the nuclear medicine methods were used to determine the irradiation fields for spleen irradiation (67%) and abdominal lymph nodes (27%). The bone marrow scan data had significant influence on radiation therapy tactics in 10-27% of cases. The visualization of primary tumor lymphatic drainage lead to changing the irradiation field topography in 75% cases of external BC and 85% of internal BC localization. Tumorotropic isotope mammal scan data lead to the changes in planned irradiation volume in 16% of BC patietns. In NSLC patients the results of "positive" scintigraphy with lipophilic 99mTc-marked cations lead to the change in irradiation tactics in 16% of cases. Therefore, the results of diagnostic investigations suggest the important role of nuclear medicine diagnostic methods in patients with various tumors of different localizations.

[The place of dendritic cells in the microenviroment in Hodgkin's lymphoma].

Dendritic cells (DCs) are the least studied microenvironment elements in Hodgkin's lymphoma (HL). Ninety-five lymph nodes were morphologically and immunohistochemically studied in patients with classical HL. The authors found CDla- and langerin-positive DCs in the presence of T lymphocytes, which were localized in the close proximity to neoplastic Reed-Sternberg cells (RSCs). There were also CD23-positive follicular DCs, which were typically located at the periphery of tumor foci, in the areas of residual follicular structures, were surrounded by B lymphocytes and were rarely associated with RSCs. There were two morphologically distinct groups among the CD 1a- and langerin-positive DCs; one had developed cytoplasmic processes, which formed a network around the RSCs (probably a more mature/functionally active form); the other had round cells with short cytoplasmic processes, loosely distributed around the neoplastic cells (a less mature/active form). The function and role of CD1a- and langerin-positive DCs in HL call for further investigation. The topographic closeness of these DCs to RSCs suggests that these cells play a considerable role in the pathogenesis of HL.

[New prognostic factors in the treatment of patients with stage-III Hodgkin's disease].

Our data are presented on evaluation of chemoradiotherapy of 365 patients with stage III Hodgkin's disease. Patients with stage IIIA tumors revealed the following significant differences of overall and relapse-free survival (p < or = 0.00001): 15-year overall survival (nodular sclerosis G1) - 95% vs.G2 - 45%; 15-year relapse-free survival: G1 - 86%, G2 - 32%. In stage IIIB group, overall survival (50%) was significantly lower as compared with 70%. Involvement foci significantly regressed by less than 75% (p = 0.044) after 2-4 cycles of preliminary combination chemotherapy. Our results suggest that differentiated criteria be used for prognosis of stage III Hodgkin's disease treatment.

[Can extended induction chemoradiotherapy be effective in the combined treatment of stage IIIB Hodgkin's disease ?].

The paper evaluates the results of chemoradiaton (2-4 cycles of preliminary treatment to suppress intoxication symptoms plus total, or subtotal exposure of the lymph nodes to tumor-killing doses in cases of intact iliac inguinal nodes) in 89 patients with Hodgkin's disease stage IIIB. The data are evaluated vis-à-vis regression in exposed foci as intoxication symptoms receded. Overall survival was significantly lower (p = 0.044) when tumor regression was well below 75%. Similar trends were reported with regard to relapse-free survival. It is concluded that, with our regimen, combined treatment will not be effective unless 75% or more regression of tumor is assured.

[Is irradiation of intact ileoinguinal lymph nodes necessary in radiochemotherapy for stage-III Hodgkin's disease?].

Data are presented on radiochemotherapy (1-4 cycles of combined therapy+total (TI) or subtotal (STI) irradiation of lymph nodes) given to 120 patients, with stage III Hodgkin's disease, whose ileoinguinal lymph nodes were intact. Analysis of overall survival of patients with stage III Hodgkin's disease showed that 87% of STI patients survived for 10-years as compared with 73% in TI (p=0.07). What is most important is that 10-year relapse-free survival in STI patients (92%) was significantly higher than that in TI (75%) (p=0.01).

[Clinical evaluation of combined treatment of stage III(B) Hodgkin's disease].

Patients with stage III Hodgkin's disease (110) received 2-3 courses of combination chemotherapy followed by total or subtotal irradiation, or exposure of primarily involved lymph nodes. The study did not include patients with persistent symptoms of intoxication. Overall 5- and 10-year survival rates were 78 and 68%, recurrence-free--75 and 74% respectively.

[Relevance of certain factors in the effectiveness of chemoradiotherapy for Hodgkin's disease].

The relevance of certain factors in therapy of Hodgkin's disease was evaluated in patients with stage III A (232) and III B (97). Among them were age above 45 years, an increase of more than 50% in blood-serum alkaline phosphatase, presence of at least five lesions, lymph node clusters of 5 cm in diameter and more, and male sex, when two introductory courses of combination chemotherapy were used in stage III A or 2-4 courses (stage III B), followed by total or subtotal irradiation of lymph nodes. The prognostic relevance of either factor was further demonstrated by its increased significance when their different combinations were used.

[Clinical evaluation of efficacy of chemoradiotherapy for Hodgkin's disease]. / Klinicheskaia otsenka éffektivnosti khimioluchevogo lecheniia limfomy Khodzhkina III (A,B) stadii.

Patients with stage III (A,B) Hodgkin's disease (366) received chemoradiotherapy consisting of 2-4 courses of combined modality treatment followed by total or subtotal irradiation of lymph nodes. Overall 10-year (84%) and 15-year (79%) and relapse-free 10-year (85%) and 15-year (82%) survival was reported in stage IIIA cases. Subtotal exposure proved relatively more effective in such patients without iliac and inguinal lymph node involvement. If, following combined modality therapy, intoxication symptoms were aborted in stage IIIB patients; fairly good results were obtained after total and subtotal irradiation of lymph nodes or involved areas (10-year (70%) and 15-year (65%) overall and 10-year (75%) and 15-year (75%) relapse-free survival.