Diffuse midline glioma of the brain is a rare but very aggressive and resistant glial tumor. This pathology is characterized by impossibility of radical surgical treatment, radioresistance, resistance to drug treatment, high morbidity in children, low quality of life of the patients, frequent complications in the form of neurologic deficit, and unfavorable prognosis. The absence of effective treatment scheme for diffuse midline glioma requires identification of other methods (oncolytic virus therapy, immunotherapy) but there is not enough data on this topic leading to the necessity of its further investigation.

Glioblastoma is the most frequently detected primary brain tumor (pGB), the prognosis of which significantly depends on the magnitude of residual GB (rGB), for which magnetic resonance imaging (MRI) is used in the postoperative period. Purpose: To analyze the data of ASL perfusion MRI (ASL-pMRI) performed prior to adjuvant radiation therapy (aRT), 6 to 8 weeks after resection of pGB, in terms of their prognostic significance for survival in this group of patients. Material and methods: The study included 54 patients (median age ‒ 58 years; gender: 29 men, 25 women). The Karnovsky index in 81.5 % of patients was ≥80 %. To visualize and calculate the dimensions of the rGB, ASL-pMRI was used according to the type of pseudo-continuous three-dimensional marking of arterial spins. The focus/foci of hyperperfusion (CBFmean > 64 ml/100g/min) in the area of the wall of the postoperative cyst were considered as rGB. Results: Survival in the total group of 54 patients with pGB was 18 months (95 % CI:14.23) . The use of ASL-pMRI made it possible to visualize rGB in 37 (68.5 %) patients. The probability of visualization of rGB was significantly higher (p=0.02) in the case of temporal localization of the tumor. Age (HR:1.04; 95 % CI: 1.01‒1.07; p=0.007), the maximum diameter of the rGB (HR:1.04; 95 % CI: (1.01‒1.07); p=0.03) and localization of pGB in the temporal lobe (HR:2.00; 95 % CI: 1.05‒3.80; p=0.034) had a significant negative impact on survival. The use of the multifactorial Cox model showed that only the age ≥60 years (HR:2.78; 95 % CI:1.26‒6.15; p=0.012) and the maximum diameter of rGB ≥25 mm (HR:3.35; 95 % CI:1.36‒8.22; p=0.008) retained their significant negative impact on the survival of patients with pGB. Conclusions: the use of ASL – pMRI 6 to 8 weeks after resection of pGB indicates that the results obtained can become an effective tool for predicting survival in this group of patients.

Despite the improvement of treatment methods, survival of patients with glioblastoma is still low. Glioblastoma is the most common brain tumor.OBJECTIVE:To study carbohydrate metabolism in patients with glioblastoma during adjuvant external beam radiation therapy and its impact on survival.MATERIAL AND METHODS:The study included 66 patients with glioblastoma (Karnofsky score ≥80%) who underwent hypofractionated adjuvant external beam radiation therapy (single focal dose 2.5-3Gr). Patients received dexamethasone 4-8 mg daily throughout the entire course of irradiation.RESULTS:High level of glycated hemoglobin (HbA1c) was observed in 33.3% of patients with glioblastoma undergoing irradiation. Cumulative survival was 17 months (95% CI 13.7-20.3). Two indicators had a significant negative impact on cumulative survival: age of patients (HR 1.04; 95% CI 1.01-1.08; p=0.02) and level of HbA1c (HR 1.94; 95% CI 1.23-3.06; p=0.005). Cumulative survival was significantly (p=0.022) higher in patients younger 53 years compared to older people (18 months and 14 months, respectively). Cumulative survival was 20 months among patients whose HbA1c did not exceed the upper reference value (<5.8%). Survival was higher (p=0.017) in these ones compared to patients with HbA1c ≥5.8% (13 months). According to multivariate Cox regression model, high HbA1c was the only significant negative predictor of cumulative survival (HR 3.35; 95% CI 1.14-9.81; p=0.027).CONCLUSION:High HbA1c is unfavorable predictor of cumulative survival in patients with glioblastoma and Karnofski score ≥80% undergoing adjuvant hypofractionated irradiation regardless their age.

Introduction. Despite the treatment methods’ improvement, the brain glioblastoma (GB) patient survival remains at the level of 12–14 months. In this regard, it is very relevant to optimize the choice of the treat-ment of recurrent GB, including using stereotactic radiosurgery (SRS). Materials and methods. Comparative analysis of the endothelial cells in the capillaries of blood vessels of the brain peritumoral zone (PZ) before (1 group – 32 capillaries) and 12 – 14 months after (2 group – 75 capillaries) adjuvant external radiation therapy (AERT) was performed using transmission electron micros-copy (TEM). Results. Apoptosis of endotheliocytes was observed in the capillaries of the brain PZ from 2 group much more often than from 1 group (60% and 12.6% of capillaries, respectively, p<0.001). Capillary death and thrombosis occurred in 4% and 1.4% of 2 group capillaries. An important finding was that only 69.3 of capillaries from 2 group revealed thickening of the basement membrane (BM), and 26.9% of them also revealed its peak deformation. Conclusion. 12–14 months after AERT, the brain PZ remains ischemic due to apoptosis of the capillary endothelium, thickening and peak deformation of the BM. The detected signs of revascularization of the brain PZ after previously performed AERT suggest that it is possible to consider SRS as a method of treat-ment for recurrent brain GB. Keywords: brain glioblastoma, peritumoral zone, endotheliocyte apoptosis, thickening of the basement membrane, stereotactic radiosurgery, glioblastoma relapse

A high blood D-dimer level is often diagnosed in patients with malignant brain glioma (MBG), with 24% of these patients being detected with deep vein thrombosis of the leg and/or pulmonary embolism (PE). The cause of an elevated blood D-dimer level in most other cases remains unclear. The purpose of this study is to identify the features associated with an increased blood D-dimer level in patients after MBG resection, which may be used to improve the efficacy of adjuvant radiation therapy (ART).RESULTS:The study included 50 patients. Three to four weeks after resection of malignant brain glioma (MBG), the blood D-dimer level was determined in patients immediately before the onset of ART. An increase in the blood D-dimer level more than by 0.25 μg/mL was detected in 78% of patients. More often, a high D-dimer level was detected in patients aged 60 years or more. In the same age group, an increase in the D-dimer level was significantly larger (p<0.05) than in younger patients (1.2 and 0.6 μg/mL, respectively). The degree of brain tumor malignancy did not affect the rate and value of an increase in the blood D-dimer level.CONCLUSION:Our findings indicate that an increased blood D-dimer level in patients without symptoms of venous thrombosis after craniotomy for MBG is more pronounced in patients aged 60 years and over. The degree of glioma malignancy has no significant effect on this indicator.

Pulmonary embolism in breast cancer is one of the causes of major deterioration of health status of the patients. Pulmonary artery occlusion is most often a consequence of venous thromboembolism; this condition is referred to as "pulmonary thromboembolism". Significantly less common cause of occlusion of the pulmonary artery branches can be embolism by a cluster of tumor cells, accompanied by development of pulmonary tumor thrombotic microangiopathy. This paper reviews data on the etiology and pathogenesis of pulmonary embolism in breast cancer, and approaches to its prevention and treatment.

The risk of pulmonary embolism (PE) in cancer patients is 4–7-fold, compared to other patient categories. PE is the second most frequent cause of death in the first year after cancer diagnosis. PE is diagnosed in 7.5% of patients with malignant brain tumors, in 1 to 25% of those with gastrointestinal tumors, in 4.5 to 17.5% of those with breast cancer and in 4 to 10% of lung cancer patients. The risk of PE is higher with surgical interventions and chemotherapy, as well as in metastatic tumors. In 13% of cases, PE may be the first symptom of cancer manifestation. For prevention and treatment of PE low molecular weight heparin (LMWH) and warfarin are used. The risk of recurrent PE is 2-fold lower with LMWH. The frequency of bleeding with LMWH and warfarin treatment is from 14 to 19%. Placement of a cava filter is indicated only if anticoagulation is inefficient. New oral anticoagulants, which act as selective thrombin or Factor Xa inhibitors, are not used in cancer patients. Thus, diagnostics and treatment of PE is a very urgent problem in oncology that requires new approaches to be looked for.

Pulmonary embolism in breast cancer is one of the causes of major deterioration of health status of the patients. Pulmonary artery occlusion is most often a  consequence of venous thromboembolism; this condition is referred to as "pulmonary thromboembolism". Significantly less common cause of occlusion of the pulmonary artery branches can be embolism by a  cluster of tumor cells, accompanied by development of pulmonary tumor thrombotic microangiopathy. This paper reviews data on the etiology and pathogenesis of pulmonary embolism in breast cancer, and approaches to its prevention and treatment.