Введение. Увеальная меланома (УМ) является первичной злокачественной опухолью взрослых, которая демонстрирует агрессивное течение и высокий метастатический потенциал. В настоящее время общепринятым методом лечения УМ является брахитерапия. Однако в тех случаях, когда невозможно использование брахитерапии в лечении опухолей большого размера и ввиду отказа пациента от проведения энуклеации глазного яблока, в качестве альтернативы возможно использование стереотаксической радиохирургии «Гамма-нож» (СРХГН). Цель данного исследования — представить 10-летний опыт лечения пациентов с УМ методом СРХГН. Материалы и методы. Методом СРХГН за период с 2012 по 2023 гг. было пролечено 80 пациентов (80 глаз) в возрасте от 13 до 77 лет (средний возраст — 47 лет) с УМ. Среди них было 47 (58 %) женщин и 33 (42 %) мужчины, из них 3 — дети 13, 14 и 17 лет. Высота опухоли до лечения варьировалась от 3,1 до 10,8 мм (средняя — 8,0 мм), протяженность — от 8,7 до 20 мм (средняя — 13,8 мм). По международной системе TNM (2017 г.), у 56 (70 %) пациентов опухоль соответствовала стадии T3; у 16 (20 %) — T2; у 6 (7 %) — T4; у 2 (3 %) — T1. Предписанная доза в 5 случаях составляла 40 Гр, в 12 — 35 Гр, в остальных 63 случаях — 30 Гр, и предписывалась в среднем по 50 % изодозе (от 32 до 67 %). Результаты. В 94 % (n = 75) случаях удалось сохранить пролеченный глаз. Во всех случаях эти глаза, согласно КР-2020 по лечению УМ, подлежали энуклеации, из них 3 — единственные. В 5 случаях (6 %) глаза сохранить не удалось ввиду прогрессии опухоли на фоне проводимого лечения (n = 3) и развития осложнений (n = 2). У 16 (20 %) пациентов была отмечена полная регрессия, у 61 (76 %) пациента — частичная регрессия. Средняя высота опухоли после СРХГН составила 5,6 мм (от 1,6 до 11,5 мм), протяженность — 14,08 мм (от 8,7 до 20 мм). Степень регрессии опухоли в среднем составила 30 %. Осложнения имели место в 88 % (n = 70) случаев — лучевая ретинопатия (n = 48, 68 %), лучевая нейропатия (n = 6, 8 %), заднекапсулярная катаракта (n = 6, 8 %), гемофтальм (n = 4, 5 %), увеит (n = 3, 4 %), неоваскулярная глаукома (n = 3, 4 %). Выводы. Наш многолетний опыт проведения стереотаксической радиохирургии «Гамма-нож» в лечении УМ большого размера демонстрирует эффективность и безопасность данного метода.

Глиобластомы (WHO grade IV) – самые распространённые первичные злокачественные опухоли ЦНС с крайне неблагоприятным прогнозом. Несмотря на проводимое комбинированное лечение, включающее в себя максимально возможное удаление с последующей лучевой и химиотерапией, в абсолютном большинстве случаев прогрессирование глиобластом происходит в течение нескольких месяцев после операции. Проведение повторной лучевой терапии является одной из распространенных и эффективных терапевтических опций при выявлении прогрессии. Цель исследования: Изучить эффективность и безопасность стереотаксической лучевой терапии в лечении прогрессий глиобластом в режимах радиохирургии и гипофракционирования. Материал и методы: В исследование за период с 2005 по 2021 включено 163 пациента с прогрессированием глиобластомы (ГБ) после комплексного лечения. Все пациенты были пролечены в отделении радиотерапии НМИЦ нейрохирургии и Московском центре Гамма Нож. Возраст пациентов, включенных в исследование, составил от 18 до 73,9 лет. Медиана возраста составила 49,5 лет (95% ДИ 47 - 52,3). В режиме радиохирургии (за одну фракцию) было пролечено 180 очагов (расположенных «локально» - в пределах 3 см от предписаной изодозы при первичном облучении 123 и 58 - дистантных); в режиме гипофракционирования было пролечено 107 очагов (локальных 67 и дистантных 40). Средние объемы очагов: в режиме радиохирургии – 9,2 см3 (0,01-43,2 см3) при гипофракционировании – 17,84 см3 (0,1-72 см3). Медиана предписанной дозы в режиме радиохирургии – 20Гр по 50% изодозной кривой. Медиана суммарной очаговой дозы в режиме гипофракционирования – 30Гр. Результаты: При анализе результатов лечения в режиме радиохирургии выявлено, что при локальном типе прогрессии локальный контроль на сроке 3,6,12 составил 98,1%; 76,3%;38,5% соответственно, при дистантном на сроке 3,6,12 составил 100%; 80,1%;67,2% соответственно. В режиме гипофракционирования локальный контроль очагов локальной прогрессии на сроках 3,6,12 месяцев составил – 90,2%,73,2%,23,6%, дистантной прогрессии на сроках 3,6,12 месяцев – 97,6%,86,2%,59,4% соответственно. Постлучевая токсичность 3-й степени после радиохирургии была отмечена у 8,8% пациентов. Постлучевая токсичность 3-4 степени после гипофракционирования в виде отека наблюдалась у 18,2% пациентов, в виде постлучевого некроза у 13,4% пациентов. В режиме гипофракционирования в группе с постлучевой токсичностью средний объем очага составил 22,7 см3, в группе без постлучевой токсичности 15,. Заключение: Стереотаксическая лучевая терапия при прогрессировании глиобластом в режимах радиохирургии и гипофракционирования является эффективной и безопасной опцией лечения, приводящей к увеличению сроков локального опухолевого контроля. Проведение повторной лучевой терапии при дистантном прогрессировании глиобластом значимо повышает локальный контроль в сравнении с локальным прогрессированием.

Treatment of patients with brain metastases is an urgent problem that must be chosen as part of an integrated approach to detection, based on the characteristics of detection, the patient’s condition, and the severity of neurological deficit. The introduction of new techniques used with the use of neurosurgical and drug treatment, the original method of radiation therapy can increase the survival of patients, as well as improve the quality of life. This article presents the results of a retrospective analysis of the overall survival of patients with cerebral metastases of kidney cancer after neurosurgical resection. The aim of the study is to study the overall survival rates in patients with kidney cancer metastases in the brain after neurosurgical treatment. Material and methods. A retrospective analysis of the results of treatment of 114 patients with brain metastases from kidney cancer who received neurosurgical treatment at the National Medical Research Center of Oncology named after N.N. Blokhin. In the overall survival analysis, survival data were found in 102 (89.5%) of 114 patients. Of these, 80 (78.4%) patients died, and 22 (21.5%) patients are still being followed up. The extracranial disease status (ECM) at the time of surgical treatment was known in 82 (71.9%) patients, of which 45 (54.8%) patients underwent ECM, and 37 (45.1%) did not. In 92 (90.1%) patients, total removal of brain metastases (BM) with perifocal and perivascular zones was performed, in the rest of the patients; fragmentary resection of the focus was performed. Results. Overall survival (OS) after neurosurgical treatment 54.4%; 35.6%; 30.8% and 19% at 12, 24, 36, and 60 months, respectively, with a median OS of 13.8 months (95% CI, 10.29 to 18.6). Statistically significant predictors of overall survival were established: Karnofsky index ≥80% (p<0.0001) and absence of extracranial metastases (p=0.0107). The best survival rates were achieved in the group of patients with a history of nephrectomy and targeted or immunotherapy after neurosurgical treatment. Conclusion. Neurosurgical treatment, which is used with microsurgery and intraoperative navigation, allows a rapid reduction in neurological symptoms, good local control in the area of the remote focus with the course of postoperative complications. Neurosurgical intervention includes consideration of overall survival rates and, as part of anticancer drug therapy that increase overall survival rates.

Introduction. Treatment of patients with brain metastases is an important problem that should be considered in the framework of combination approach. Introduction of new techniques of drug therapy as well as radiotherapy and neurosurgical treatment allows to significantly increase patient survival. Effective drug therapy and local control of brain metastases are of utmost importance in prediction of overall survival and patient quality of life.Aim. To investigate the prognostic factors for overall survival and intracranial progression (local recurrences, distant metastases) in patients with brain metastases of renal cancer after neurosurgical resection.Materials and methods. Retrospective analysis of the treatment results of 114 patients with metastatic brain lesions due to renal cancer who underwent neurosurgical resection (NSR) at the N. N. Blokhin National medical Research Center of Oncology was performed. Clinical data of 102 (89.5 %) of 114 patients for whom data on survival was available were evaluated. Among them, 80 (78.4 %) of patients died, 22 (21.5 %) are under observation. Extracranial disease status at the time of NSR was known in 82 (71.9 %) patients: 45 (54.8 %) patients had extracranial metastases, and 37 (45.1 %) did not. Total resection of brain metastases with perifocal and perivascular zones was performed in 92 (90.1 %) patients; in other cases, fragmental lesion resection was performed.Results. median overall survival after NSR was 13.8 months (95 % confidence interval 10.3–18.6). per study data, factors affecting overall survival of patients with brain metastases of renal cancer after neurosurgical resection were presence / absence of extracranial metastases and patient’s functional status. Local recurrences in the postoperative cavity after NSR were observed in 24 (21 %) of 114 patients. median time of local recurrence was not achieved. Statistically significant factor of high risk of recurrence in the postoperative cavity was presence of lesions with maximal diameter ≥2 cm. Development of new (distant) metastases was observed in 31 (27.2 %) of 114 patients. median survival without distant metastases in patients with brain metastases after NSR was not achieved. frequencies of distant metastases at 6, 12 and 24 months were 15.5; 24.1 and 35.8 % respectively. per multifactor analysis, factors affecting development of distant metastases in the brain after NSR are multiple metastatic brain lesions and presence of extracranial metastases.Conclusion. Neurosurgical resection in patients with cerebral metastases of renal cancer in the total group leads to median overall survival of 13.8 months. predictors of better overall survival are absence of extracranial metastases and high functional status.

Despite significant progress in neuroimaging and introduction of new combined treatments for solid tumors, brain metastases are still adverse factor for overall survival. Brain metastases are diagnosed in 8-10% of patients and associated with extremely poor prognosis. These lesions result focal and general cerebral symptoms. Literature review highlights the current principles of surgical treatment of metastatic brain lesions in patients with solid tumors.

Hypothalamic hamartoma (HH) is a dysplastic lesion fused with hypothalamus and followed by epilepsy, precocious puberty and behavioral disorders. Up to 50% of patients become free of seizures after surgery, but various complications occur in 1/4 of cases. Radiofrequency thermocoagulation, laser interstitial thermal therapy and stereotactic radiosurgery (SRS) are alternative treatment options.OBJECTIVE:To define the indications for SRS in patients with HH and to clarify the irradiation parameters.MATERIAL AND METHODS:Twenty-two patients with HH and epilepsy underwent SRS at the Moscow Gamma-knife Center. A retrospective analysis included 19 patients with sufficient follow-up data. Median age of patients was 11.5 years (range 1.3-25.8). The diameter of irradiated HHs ranged between 5.5 and 40.9 mm. In 8 (36%) cases, the volume of hamartoma exceeded 3 cm3. Mean prescribed dose was 18±2.0 Gy, mean prescribed isodose - 48±4.2%. Median follow-up period was 14.8 months (range 3.4 - 96.1).RESULTS:Three (15.8%) patients were free of seizures. One patient (5.3%) improved dramatically after treatment with compete resolution of generalized seizures and experienced only rare emotional seizures (Engel IB). Eleven (57.8%) patients reported lower incidence of seizures. Severity and incidence of seizures were the same in 4 patients (21.1%). The best results were achieved in mean target dose over 20-22 Gy, minimal target dose over 7-10 Gy, covering by the prescribed dose of at least 70-80% of hamartoma volume, as well as in patients with the prescribed dose of 12 Gy delivered to almost entire volume of tumor. None patient had any complications after SRS.CONCLUSION:SRS is safe regarding neurological, endocrine or visual disturbances. Careful patient selection for SRS makes it an effective option for HH-related epilepsy. The best candidates for SRS are children with seizures aged over 1 year, hamartoma <3 cm3 and area of fusion with hypothalamus <150 mm2.

According to the literature, metastatic brain damage in kidney cancer occurs in 6.5 % of patients. The introduction of new techniques associated with the use of targeted drugs, immune checkpoint inhibitors and innovative radiation therapy techniques can significantly increase patient survival. Effective drug therapy and local control of brain metastases are of paramount importance for predicting overall survival and quality of life for patients. This literature review summarizes the scientific literature data on the use of local and systemic methods of treatment in patients with metastases of kidney cancer to the brain.

BACKGROUND:Despite the combined treatment in accordance with modern standards, recurrent glioblastoma usually occurs within several months after resection and causes low relapse-free and overall survival. One of the most effective methods for malignant glioma progression is repeated radiotherapy. Indications for this approach have expanded after introduction of stereotactic irradiation into routine clinical practice.OBJECTIVE:To evaluate the results of radiosurgery in patients with recurrent glioblastoma and to identify the factors determining its effectiveness.MATERIAL AND METHODS:Radiosurgery has been carried out in 168 patients with relapses of glioblastoma between 2005 and 2021. This study enrolled 88 patients with 180 foci of local and distant progression. Mean age of patients was 42.8±2.1 years (range 4-73). Mean period between diagnosis and repeated irradiation was 12.7 months. Mean volume of focus was 2.4 cm3, mean dose - 20 Gy. Median follow-up period after radiosurgery was 11.2 months.RESULTS:Repeated irradiation with correction of systemic therapy improved progression-free survival and overall survival with insignificant radiation-induced toxicity. Annual overall survival was 62.2%, median of overall survival after radiosurgery - 15.1 months. Significant factors of local control were marginal dose of at least 18 Gy and distant relapse. Median of progression-free survival in the group of distant progression of glioblastoma was only 3.6 months vs. 9.1 months in patients with local recurrence.CONCLUSION:Repeated irradiation in radiosurgery mode with a dose of 18 Gy and higher is an effective option for local treatment increasing progression-free and overall survival in patients with progression of glioblastoma.

The study objective is to present the results of the treatment of metastatic brain patients by the staged radiosurgery with the Gamma Knife.Materials and methods. The retrospective analysis included 31 patients (13 men and 18 women) with brain metastases, whose radiosurgery treatment was carried out in 2 sessions. The operation was contraindicated in all patients due to the risk of neurological deficits or due to the high anesthesiological risk.Results. Local control of metastases growth was achieved in 31 (96.9 %) of 32 foci 3 months after treatment, and in 92.5 and 83.8 %, after 6 and 12 months, respectively. The age <50 years were associated with higher progression-free survival respectively. The median time of grade I–II radiation complications was 3.0 months, complications were observed in 11 (45.8 %) of 24 patients. Radiation complications of grade II (perifocal edema) were observed in 8 (33.3 %) patients, grade III (radionecrosis) – in 2 (8.3 %) patients. Overall survival at 6 and 12 months was 55.6 and 40.8 %, respectively (median 6.9 months), in patients receiving antitumor drug treatment – 80.0 and 56.8 %, respectively. All patients who did not received antitumor drug therapy died within 6 months.Conclusion. Two-stage radiosurgery, carried out in 2 sessions with an interval of 2–4 weeks, provides satisfactory local control with an acceptable level of post-radiation complications. This method of treatment can be used in patients with large brain metastases who are not subject to surgical treatment.

The study objective is to study overall survival and the rate of intracranial recurrences in patients with brain metastases after radiosurgery as single treatment.Materials and methods. The results of radiosurgical treatment of 579 patients with brain metastases (248 men and 331 women) were analyzed. The sources of brain metastases were breast cancer (164 patients), non-small-cell lung carcinoma (162), melanoma (123), kidney cancer (87), colorectal cancer (43). Median cumulative tumor volume, maximal lesion volume, number of brain metastases in the studied patient group were 5.4 cm3, 3.6 cm3, and 4, respectively. Mean marginal dose of ionizing radiation was 22 Gy (15–24 Gy). Mean follow-up duration was 13.4 months.Results. Overall survival of patients at 12 and 24 months was 42.8 and 24.8 %, respectively, with median overall survival after radiosurgery of 9.8 months (95 % confidence interval: 8.5–11.3). Local control of metastatic lesions was achieved in 81.3 % patients. Survival without local recurrence at 12 months was 66.7 %. Distant metastases developed in 235 (52.4 %) of 449 patients for whom radiological data was available. Survival without distant metastases at 12 and 24 months was 41.5 and 20.9 %, respectively. Multifactor analysis has shown that prognostic factors for long-term survival in patients with brain metastases were presence of breast cancer metastases in the brain, limited (4 lesions or less) number of brain metastases, high functional status, and absence of extracranial metastases. Increased survival duration was also associated with targeted therapy (p = 0.0412) and repeated radiosurgery to treat intracranial recurrences (р <0.0001).Conclusion. Radiosurgical treatment of patients with brain metastases confers higher median overall survival (up to 9.8 months) than the same criterion (7.1 months) in the 1st class patients (per the recursive partitioning analysis scale) who received irradiation of the whole brain as single treatment. Repeated radiosurgery in cases of intracranial recurrences and targeted therapy confer increased overall survival of patients with brain metastases.

UNLABELLED:The study purpose was to evaluate the impact of gamma knife radiosurgery (GKRS) alone on the overall survival and rate of intracranial recurrences in brain metastasis patients.MATERIAL AND METHODS:Treatment outcomes in 502 patients (211 males and 291 females with 2782 brain metastases (BMs)) were retrospectively reviewed. Most patients (n=142; 28.2%) were diagnosed with breast cancer. Multiple BMs were detected in 259 patients (51.6%). The median of the total tumor volume and ВM number was 5.9 cm3 (0.09-44.5 cm3) and 4 (1-36), respectively. The mean marginal radiation dose was 21 Gy (15-24 Gy). The mean follow-up period was 10.6 months (0.2-47.2 months).RESULTS:The overall survival rate for 12 and 24 months was 37.6 and 19.1%, respectively. The median overall survival after GKRS was 8.6 months (95% confidence interval (CI) 7.0-10.0). Local control of metastatic lesions was achieved in 78.8% of patients. The median local recurrence-free survival was 6.8 months after radiosurgery. The development of new (distant) metastases was observed in 49.5% of patients. The median distant metastasis-free time was 8.8 months. The Karnofsky performance score (KPS) of ≥80 (HR 0.3935, 95% CI 0.2429-0.6376; p=0.0002), BM number of <3 (HR 0.6138, 95% CI 0.3993-0.9943; p=0.0269), and BMs of breast and lung cancers (HR 0.5442, 95% CI 0.3642-0.8071; p=0.0027) are predictors of better survival. In the case of intracranial metastasis recurrence, repeated radiosurgery provides the median overall survival of 19.6 months versus 9.6 months in patients without radiosurgery (HR 0.4026, 95% CI 0.2381-0.6809).CONCLUSION:Radiosurgical treatment of patients with multiple BMs provides the median overall survival of 8.6 months. A good functional status, non-extensive metastasis of the brain, and radiosensitive morphology of the primary tumor are the predictors of better survival. Repeated radiosurgical treatment for intracranial recurrences provides longer overall survival compared to that in patients without repeated radiosurgical treatment.