[The role of radiation therapy in treating hypophyseal adenomas]. / Mesto luchevoi terapii v lechenii adenom gipofiza.

The article reviews various methods for the exposure of pituitary adenomas to the effect of radiation applied either as the only measure or in combination with surgery and drug therapy. The indications for radiotherapy are discussed according to the size and hormonal activity of the tumor.

[The place of radiotherapy in the treatment of pituitary adenomas]. / Mesto luchevoi terapii v lechenii adenom gipofiza.

The paper is devoted to an analysis of the present-day role of radiotherapy of pituitary adenomas with relation to tumor spreading and the patient's neuroendocrine status. The authors made use of data obtained from the N. N. Burdenko Research Institute of Neurosurgery, USSR Academy of Medical Sciences. They analyzed the results of gamma-beam therapy, proton-beam therapy and radiosurgical implantation of 90Y granules used alone as well as in combination with surgical intervention. Based on the analysis of the clinical data on 320 patients, a conclusion is made on the indications for one or another method depending on the stage and course of the disease.

[Proton therapy in clinical neurosurgery]. / Protonnaia terapiia v neirokhirurgicheskoi klinike.

The use of proton beam irradiation in neurosurgical clinical practice helps to find a solution to the problem of the treatment of inoperable malformations employing this method in some cases as an alternative to surgical intervention. Hypophyseal tumors, tumors of the cavernous sinus, arteriosinusal anastomoses in the cavernous sinus area, and arteriovenous malformations are irradiated at the N. N. Burdenko Institute of Neurosurgery, USSR, AMS using the medical proton beam of the Institute of Theoretical and Experimental Physics. Methods of "piercing" irradiation and methods with the use of Bragg's peak are being developed. At present over 200 patients with hormonally active hypophyseal tumors, 30 patients with tumors of the cavernous sinus, 23 patients with deep seated arteriovenous malformations, and 10 patients with spontaneous arteriosinusal anastomoses in the cavernous sinus area have been irradiated. This method seems to hold promise in neurosurgical practice. Extension of the range of clinical applications of proton beam therapy in neurosurgery requires the development of various techniques of irradiation, all possible approaches to various targets on the basis of contemporary methods of computerized diagnosis, topometry and irradiation design.

[Effect of proton irradiation of Tolosa-Hunt syndrome]. / Effekt protonnogo oblucheniia pri sindrome Tolosy-Khanta.

The authors have analysed a case of Tolosa-Hunt syndrome with a persistent recurring course and a gradual development of resistance to steroid therapy. Computerized tomography revealed a high density zone in the affected cavernous sinus of the patient. Differential diagnosis between a tumor and Tolosa-Hunt syndrome was made. The patient received 3 fractions of proton beam irradiation by the "piercing" method (the beam being 15 mm in diameter) at a dose of 60 Gy. After irradiation computerized tomography showed complete recovery of disturbed functions and disappearance of the focus. Four-year remission was observed. In our experience, it was the first case of the use of radiation therapy in Tolosa-Hunt syndrome.

[Proton irradiation of spontaneous arterio-sinus anastomoses in the cavernous sinus region]. / Protonnoe obluchenie spontannykh arteriosinusnykh soustii oblasti kavernoznogo sinusa.

Altogether 10 patients with spontaneous arteriosinusal anastomoses in the cavernous sinus area have been irradiated at the N. N. Burdenko Institute of Neurosurgery, USSR AMS. since 1983 using the synchrotron of the Institute of Theoretical and Experimental Physics. A "piercing" method with a proton beam of 12 mm in diameter (in one case 10 mm) was employed. Nine patients had unilateral anastomoses with the blood supply from branches of the internal and/or external carotid arteries, and one patient had a bilateral anastomosis. Irradiation was given in 2 fractions, in 2-3 days, the maximum total dose was 50-60 Gy. Regression of ophthalmological symptoms was noted 2-3 months after irradiation. Convalescence was noted in 8 patients, a follow-up period in 2 patients was insufficient. Of 7 patients examined by angiography complete thrombosis of the anastomosis was noted in 4, considerable reduction of the blood flow was noted in 3.

[Pre-radiation care in proton irradiation of tumors of the cavernous sinus]. / Predluchevaia podgotovka pri protonnom obluchenii opukholei kavernoznogo sinusa.

The authors described methods of the individual precision anatomodosimetric planning of proton-beam irradiation of tumors of the cavernous sinus. The results of computerized tomography in 2 planes (axial and frontal) were used for planning. Manual tumor reconstruction with subsequent dose planning was done on direct and lateral telecraniograms. The procedure was tested in 25 patients. Complications and noticeable radiation reactions in adjacent tissues were undetectable during 3.5 yrs.

[Proton therapy of pituitary adenomas]. / Protonnaia terapiia adenom gipofiza.

The authors present the results of proton therapy in 59 patients with different hypophyseal adenomas. The period of observation lasted from 6 mos. to 5 yrs. Irradiation was done using a multifield-convergent method and a proton beam of the ITEF synchrotron. The beam energy was 200 MeV, the beam diameter 7-15mm. Radiation response and immediate results were evaluated for all the patients. The least favorable results were noted in the patients with prolactinomas, for which, in addition to irradiation, parlodel therapy is needed. No marked radiation reactions, neurological complications and manifestations of hypopituitarism were observed with the chosen doses and schemes of irradiation.

[Mathematical model of normal tissue involvement in gamma teletherapy]. / Matematicheskaia model' porazheniia normal'nykh tkanei pri distantsionnoi gamma-terapii.

A model of normal tissue injury as a result of exposure to ionizing radiation is based on an assumption that the degree of tissue injury is determined by the degree of destruction by certain critical cells. The dependence of the number of lethal injuries on a single dose is expressed by a trinomial - linear and quadratic parts and a constant, obtained as a result of the processing of experimental data. Quantitative correlations have been obtained for the skin and brain. They have been tested using clinical and experimental material. The results of the testing point out to the absence of time dependence on a single up to 6-week irradiation courses. Correlation with an irradiation field has been obtained for the skin. A conclusion has been made as to, first, time lag blurring time dependence within a certain range of courses, second, the presence of a component of true regeneration of which the degree depends on the volume irradiated. Proceeding from such an understanding of injury-regeneration processes a conclusion has been made that the concept of isoefficacy of irradiation courses is conditional. Volume-time fractionation is a promising direction in the development of radiation therapy.