Medical Radiology and Radiation Safety. 2022. Vol. 67. № 5

DOI: 10.33266/1024-6177-2022-67-5-86-93

W.Yu. Ussov^{1, 2}, S.P. Yaroshevskii^{2, 3}, E.E. Bobrikova^4,,
V.E. Sinitsyn⁵, Yu.B. Lishmanov²

PREDICTIVE ROLE OF CEREBRAL BLOOD FLOW STRESS-TEST
WITH ADENOSINTRIPHOSPHATE QUANTIFIED
WITH ^99m TC-HMPAO SPECT IN PATIENTS WITH
CAROTID ATHEROSCLEROSIS

¹Cardiology Research Institute, Tomsk National Medical Research Center, Tomsk, Russia

²National Research Tomsk Polytechnic University, Tomsk, Russia

³Loukh Central District Hospital, Karelia, Russia

⁴E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia 

⁵M.V. Lomonosov Moscow State University, Moscow, Russia

Contact person: W.Yu. Ussov, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Introduction: Previously, a functional test with intravenous administration of adenosine triphosphate (ATP) was proposed to assess the reactivity of cerebral circulation and the functional significance of internal carotid artery stenoses, with evaluation by brain SPECT (neuroSPECT) with ^99mTc-HMPAO. The types of the reaction of the cerebral blood flow during it were identified, with different ratios of internal carotid artery stenoses and the degree of ischemic brain damage assessed according to brain MRI data. However, the prognostic value of the results of the ATP test of cerebral blood flow in relation to disorders of cerebral circulation (NMC) remains unknown.

Purpose: In a retrospective study, we tried to study the prognostic value of the ATP test of cerebral blood flow in relation to the risk of subsequent disorders of cerebral circulation.

Material and methods: The retrospective study included 37 patients with atherosclerotic stenosis of the carotid arteries, who in 2002–2005 underwent functional studies of cerebral blood flow with a sample with intravenous administration of ATP solution. Brain damage was quantified according to MRI data (Magnetom Open, Siemens) in a T₂-weighted mode, according to a previously developed technique. Denoting I_liq – the intensity of the T₂ signal from the cerebrospinal fluid in the ventricles of the brain, I_insult – in the area affected by ischemia, and
I_norm – in the area of the unaffected brain, the volume of the damaged tissue (VDT) was calculated as the sum taken from all sections i, where the area of brain damage is visible: VDT=Σ_id·S_i∙[(I_insult ‒ I_norm)/(I_liq ‒ I_norm)]_i, where d is the thickness of the slice, and S_i is the area of the ischemia area on the slice i. The quota of damaged tissue in the physical volume of the lesion area is then obviously eqal to : QD={Σ_id·S_i∙[(I_insult ‒
I_norm)/(I_liq ‒ I_norm)]_i}/{Σ_id·S_i}. NeuroSPECT with ^99mTc-HMPAO (540 MBq) in each patient was carried out at rest and with intravenous administration of ATP solution (100 μg / kg of weight, intravenously slowly for 1 min under ECG control). The asymmetry of the cerebral blood flow was evaluated at rest and in a sample with ATP as the ^99mTc-HMPAO accumulation asymmetry index (AI) – the interhemispheric ratio of the average ^99mTc-HMPAO absorption score in the middle cerebral artery basin.

Results: In accordance with the previously presented classification, patients were assigned to one of three groups – with different types of brain blood flow reaction to a stress test with ATP.

In 14 individuals (type 1), a symmetrical distribution of blood flow at rest was noted (AI=0.98±0.01), while the ATP test caused an asymmetry in the uptake of ^99mTc-HMPAO (AI=0.91±0.04), due to a decrease on the side of the stenosis-dependent hemisphere (unilateral stenosis of the common and/or internal carotid arteries, exceeding 55 %), without signs of damage to the cerebral cortex.

In 11 patients with previous ischemic brain injuries (type 2), proven by MRI, the carotid arteries were patent, including after carotid endarterectomy (5 patients) or after correction of stenosis with a stent (three). Rest asymmetry of blood flow was present (AI=0.92±0.03). The ATP test increased blood supply on the side of injury if, according to T₂-weighted MRI in the ischemic area, QD<0.35. Due to this, in general, there was a significant decrease in the absorption asymmetry of ^99mTc-HMPAO (AI=0.96±0.03) during the ATP test.

In 12 patients (type 3) with predominantly unilateral 50‒90 % carotid artery stenosis and ischemic stroke on the same side (group III), the hemispheric asymmetry of blood supply to the brain, noted already at rest (AI=0.96±0.03), increased (AI=0.93±0.03) with an adenosine test.

When analyzing the results of a two-year follow-up, it turned out that frequent transient ishemic attacs, minor strokes and strokes developed only in patients in whom the adenosine test induced or increased the interhemispheric asymmetry of ^99mTc-HMPAO accumulation by more than 5 % – four with type 1 reactivity, and three with type 3 reactivity

Conclusions: Thus, perfusion neuroSPECT with ^99mTc-HMPAO and ATP stress-test can be employed to identify patients with a reduced reserve of cerebral perfusion, who have an increased risk of ischemic stroke. Quantitative analysis of T₂-weighted MRI gives an estimate of the proportion of viable brain tissue in the focus of the past ischemia, in which reactivity is preserved.

Keywords: ^99mTc-HMPAO, ATP test, neuroSPECT, cerebral blood flow, carotid atherosclerosis, ischemic stroke, prognosis

For citation: Usov WYu, Yaroshevskii SP, Bobrikova EE, Sinitsyn VE, Lishmanov YuB. Predictive Role of Cerebral Blood Flow Stress-Test with Adenosintriphosphate Quantified with ^99mTc-HMPAO SPECT in Patients with Carotid Atherosclerosis. Medical Radiology and Radiation Safety. 2022;67(5):86–93. (In Russian). DOI: 10.33266/1024-6177-2022-67-5-86-93

References

1. Gaydar B.V. Cerebral Ischemia as a Medical Problem. Vestnik Rossiyskoy Voyenno-Meditsinskoy Akademii = Bulletin of the Russian Military Medical Academy.1999;1:105-109 (In Russian).

2. Trofimova T.N., Kozlova O.V. Radiology in Saint-Petersburg` 2019. Luchevaya Diagnostika i Terapiya = Diagnostic Radiology and Radiotherapy. 2020;11;4:96-99 (In Russian).

3. Genkel B.B., Salashenko A.O., Alekseyeva O.A., Shaposhnik I.I. Integrated Assessment of Arterial Stiffness in Patients with Atherosclerosis of Peripheral Arteries. Ateroskleroz i Dislipidemii = The Journal of Atherosclerosis and Dyslipidemias. 2016;4:49-56 (In Russian).

4. Maksimova A.S., Bobrikova Ye.E., Bukhovets I.L., Plotnikov M.P., Usov V.Yu. The Structure of Atherosclerotic Plaque as a Defining Factor of Cerebrovascular Reactivity in Patients with Carotid Atherosclerosis. Sibirskiy Meditsinskiy Zhurnal = The Siberian Medical Journal (Tomsk). 2016;31;2:38-43 (In Russian).

5. Dudko V.A., Karpov R.S. Ateroskleroz Sosudov Serdtsa i Golovnogo Mozga = Atherosclerosis of Cardac and Cerebral Vessels. Tomsk, STT Publ., 2002, 416 p. (In Russian).

6. Zarya A.N., Kulikov V.P. Comparative Efficiency of Methods for Assessing Cerebrovascular CO₂ Reactivity. Ultrazvukovaya i Funktsionalnaya Diagnostika. 2016;2:94-97 (In Russian).

7. Usov V.Yu., Plotnikov M.P., Shipulin V.M. Functional Gamma-Tomographic Assessment of Cerebral Circulation in Atherosclerosis of Brachiocephalic Arteries: Radiopharmaceuticals, Methodology, Clinical Significance. Meditsinskaya Radiologiya i Radiatsionnaya Bezopasnost = Medical Radiology and Radiation Safety. 1997;42;4:35-47 (In Russian).

8. Kulikov V.P., Kalanova L.A., Tregub P.P. Potentiation of the Protective Effect of Hypercapnic Hypoxia in Combination with Pharmacological Neuroprotective Agents. Patologicheskaya Fiziologiya i Eksperimentalnaya Terapiya = Pathological Physiology and Experimental Therapy. 2021;65;3:21-25. DOI: 10.25557/0031-2991.2021.03.21-25 (In Russian).

9. Dzhibladze D.N., Barkhatov D.Yu. Hemodynamic Reserve. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova = The Korsakov’s Journal of Neurology and Psychiatry. Stroke. 2005;13;3:63-71 (In Russian).

10. Stulin I.D., Tardov M.V., Kunelskaya N.L., Shnayder Ya.E., Rudkovskiy A.I., Zaoyeva Z.O. Сerebral Hemodynamic Reserve in Different Pathologic States. Klinicheskaya Fiziologiya Krovoobrashcheniya = Clinical Physiology of Circulation. 2015;4:46-52 (In Russian).

11. Ussov W.Yu., Vorozhtsova I.N., Shipulin V.M., Lishmanov Yu.B., Plotnikov M.P. Detection of Cerebrovascular Disease by Adenosine [Tc-99m]-HMPAO SPET Test in Asymptomatic Carotid Stenosis. Eur. J. Nucl. Med. 1995;22;9:32.

12. Usov V.Yu., Vorozhtsova I.N., Krivonogov N.G., Krylov A.L., Lishmanov Yu.B., Plotnikov M.P., Shipulin V.M. Single-Photon Emission Tomography of the Brain with ^99mTc-HMPAO in Combination with an Intravenous Adenosine Test in Patients with Stenosis of the Internal Carotid Artery. Meditsinskaya Radiologiya i Radiatsionnaya Bezopasnost = Medical Radiology and Radiation Safety 1996;44;3:51-54 (In Russian).

13. Feng M.-G., Navar L.G. Afferent Arteriolar Vasodilator Effect of Adenosine Predominantly Involves Adenosine A2B Receptor Activation. Am. J. Physiol. Renal. Physiol. 2010;299;2:310–315.

14. Ivanov A.N., Popykhova E.B., Tereshkina N.Ye., Stepanova T.V., Zlobina O.V., Norkin I.A. Vasomotor Function of Endothelium. Uspekhi fiziologicheskikh nauk. 2020;51;4:82-104. DOI: 10.31857/S0301179820030066. (In Russian).

15. Mochula A.V., Zavadovskiy K.V., Andreyev S.L., Lishmanov Yu.B. Assessment of Myocardial Flow Reserve Index Using Dynamic Cardiac SPECT. Luchevaya Diagnostika i Terapiya = Diagnostic Radiology and Radiotherapy. 2017;2;8:107-108 (In Russian).

16. Plotnikov M.P., Usov V.Yu., Sokolov A.A. Assessment of the Hemodynamic Significance of Extracranial Stenoses of the Carotid Arteries by Andenosine-Induced Vasodilation in Combination with Perfusion Tomoscintigraphy of the Brain. Angiologiya i Sosudistaya Khirurgiya = Angiology and Vascular Surgery. 1997;7;3:36-45 (In Russian).

17. Soricelli A., Postiglione A., Cuocolo A., De Chiara S., Ruocco A., Brunetti A., Salvatore M., Ell P.J. Effect of Adenosine on Cerebral Blood Flow as Evaluated by Single-Photon Emission Computed Tomography in Normal Subjects and in Patients with Occlusive Carotid Disease. A Comparison with Acetazolamide. Stroke. 1996;26;9:1572-1576. 

18. Yefimova I.Yu., Belokopytova N.V., Triss S.V., Lishmanov Yu.B. Cerebral Perfusion in Patients with Arterial Hypertension Associated with Type 2 Diabetes. Klinicheskaya Meditsina = Clinical Medicine. 2007;85;3:33-37 (In Russian).

19. Usov V.Yu., Babikov V.Yu., Yaroshevskiy S.P., Sukhareva A.Ye., Yefimova I.Yu., Plotnikov M.P., Lishmanov Yu.B., Belichenko O.I. Comparison of Quantification Methods for Calculation of Cerebral Damage in Ishemic Stroke, Obtained from the Data of T2-Wighted MRI and of SPECT with ^99mTc-HMPAO. Vestnik Novykh Meditsinskikh Tekhnologiy = Journal of New Medical Technologies. 2020;27;4:44-50. DOI: 10.24411/1609-2163-2020-16752 (In Russian).

20. Usov V.Yu., Sinitsyn V.Ye., Obradovich V., Dragutinovich G., Yefimova I.Yu., Plotnikov M.P., Karpov R.S. Patterns of Cerebral Blood Flow Reactivity in Adenosine Stress-Test in Patients with Carotid Stenosis, Evaluated with MRI and ^99mTc-HMPAO SPECT Brain Study. Vestnik Rentgenologii i Radiologii = Journal of Radiology and Nuclear Medicine. 2000;6:4-9 (In Russian).

21. Ignatenko G.A., Mukhin I.V., Gavrilyak V.G., CHebotareva YE.N., Dzyuban A.S. Ishemic Preconditioning and Possible Hypoxic-Hyperoxic Therapy. Vestnik Neotlozhnoy I Vosstanovitelnoy Khirurgii = Bulletin of Urgent and Recovery Surgery. 2018;3;3:249-255 (In Russian).

22. Bukhovets I.L., Maksimova A.S., Plotnikov M.P., Kozlov B.N., Vorozhtsova I.N., Usov V.Yu. Ultrasonic Control of Cerebral Blood Flow in Patients with Stenosis of Brachiocephalic Arteries before and after Carotid Endarterectomy. Angiologiya i Sosudistaya Khirurgiya = Angiology and Vascular Surgery. 2018;24;1:66-71 (In Russian).

23. Kulikov V.P., Grechishnikov V.N., Sidor M.V. The Reaction of Cerebral Hemodynamics to Combined Stress Effects. Patologicheskaya Fiziologiya i Eksperimentalnaya Terapiya = Pathological Physiology and Experimental Therapy. 2005;49;1:7-8 (In Russian).

24. Kulikov V.P., Kuznetsova D.V. The Response of Cerebral Blood Flow and Systemic Arterial Blood Pressure to Hypercapnia and Hypocapnia in Humans. Patologicheskaya Fiziologiya i Eksperimentalnaya Terapiya = Pathological Physiology and Experimental Therapy. 2013;57;1:41-44 (In Russian).

25. Ussov W.Y., Plotnikov M.P., Yaroshevsky S.P., Shipulin V.M., Sokolov A.A. Evaluation of Hemodynamic Effects of Extracranial Carotid Stenoses by Adenosine-Induced Vasodilatation in Combination with ^99mTc-HMPAO SPECT. Nuclear Medicine Review of Central and Eastern Europe. 1999;2;1:15-19.  

 PDF (RUS) Full-text article (in Russian)

Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.06.2022. Accepted for publication: 25.08.2022.

Medical Radiology and Radiation Safety. 2022. Vol. 67. № 5

DOI: 10.33266/1024-6177-2022-67-5-52-58

L.I. Moskvicheva, S.V. Medvedev, L.V. Bolotina

POSSIBILITIES OF MODERN RADIATION THERAPY
IN PATIENTS WITH PANCREATIC CANCER

P.A. Hertsen Moscow Oncology Research Institute, Moscow, Russia

Contact person: Liudmila I. Moskvicheva, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Introduction: Until now, malignant neoplasms of the pancreas remain a very important oncological problem, which is determined by the long subclinical course of the disease, the primary diagnosis of most tumors already at advanced stages, as well as the pronounced effect of this pathology on the functional status and overall quality of life of patients. No more than a quarter of patients with pancreatic cancer can be operated on. The remaining significant part of patients receive palliative anticancer treatment and/or symptomatic therapy.

Purpose: The purpose of this work is to analyze the possibilities of modern methods of radiation therapy in patients with pancreatic cancer based on the analysis of scientific sources of the Internet resource National Center for Biotechnology Information.

Sections: This article describes the role of preoperative chemoradiotherapy using 3D-conformal techniques in patients with localized and borderline resectable pancreatic cancer, the effectiveness of chemoradiotherapy as an adjuvant component, and the possibilities of this method in patients with locally advanced disease. The advantages of modern radiotherapy regimens are demonstrated: with modulated intensity or volume intensity modulation by arches, stereotaxic technique, proton and adaptive MR-guided radiation therapy. The international experience of brachytherapy in patients with pancreatic cancer was analyzed.

Conclusion: Modern methods of radiotherapy are widely used in clinical practice for the treatment of patients with adenogenic pancreatic cancer. The implementation of various options for radiation or chemoradiation therapy can significantly increase the survival rates of patients with localized, borderline resectable and locally advanced process, the frequency of achieving local tumor control and its duration, as well as improve the quality of life of patients by reducing the severity of abdominal pain syndrome. Constant improvement in the technique of radiation treatment contributes to a natural decrease in the frequency of early and late radiation reactions.

Keywords: pancreatic cancer, radiation therapy, brachytherapy, proton beam therapy, intensity modulated radiation therapy, stereotactic body radiotherapy, adaptive magnetic resonance image-guided radiation therapy

For citation: Moskvicheva LI, Medvedev SV, Bolotina LV. Possibilities of Modern Radiation Therapy in Patients with Pancreatic Cancer. Medical Radiology and Radiation Safety. 2022;67(5):52–58. (In Russian). DOI: 10.33266/1024-6177-2022-67-5-52-58

References

1. Состояние онкологической помощи населению России в 2019 году / Под ред. Каприна А.Д., Старинского В.В., Шахзадовой А.О. М: МНИОИ им. П.А.Герцена, 2020. 239 с. [The State of Oncological Care to the Population of Russia in 2019. Ed. Kaprin A.D., Starinskiy V.V., Shakhzadova A.O. Moscow Publ., 2020. 239 p. (In Russ.)].

2. McGuigan A., Kelly P., Turkington R.C., Jones C., Coleman H.G., McCain R.S. Pancreatic Cancer: A Review of Clinical Diagnosis, Epidemiology, Treatment and Outcomes. World J. Gastroenterol. 2018;24;43:4846-4861. DOI: 10.3748/wjg.v24.i43.4846.

3. Москвичева Л.И., Петров Л.О., Сидоров Д.В. Возможности современных методов абляции при нерезектабельном местно-распространенном раке поджелудочной железы // Исследования и практика в медицине. 2018. Т.5, № 2 С. 86-99. [Moskvicheva L.I., Petrov L.O., Sidorov D.V. The Possibilities of Modern Methods of Ablation in Non-Resectable Locally Advanced Pancreatic Cancer. Issledovaniya i Praktika v Meditsine = Research’n Practical Medicine Journal. 2018;5;2:86-99 (In Russ.)]. DOI: 10.17709/2409-2231-2018-5-2-10.

4. Москвичева Л.И., Болотина Л.В. Возможности химиотерапии у больных местно-распространенным и метастатическим аденогенным раком поджелудочной железы // Исследования и практика в медицине. 2020. Т.7, № 4. С. 118-134. [Moskvicheva L.I., Bolotina L.V. Possibilities of Chemotherapy in Patients with Locally Advanced and Metastatic Adenogenic Pancreatic Cancer. Issledovaniya i Praktika v Meditsine = Research’n Practical Medicine Journal. 2020;7;4:118-134
(In Russ.)]. DOI: 10.17709/2409-2231-2020-7-4-10.

5. Robin T.P., Goodman K.A. Radiation Therapy in the Management of Pancreatic Adenocarcinoma: Review of Current Evidence and Future Opportunities. Chin. Clin. Oncol. 2017;6;3:28. DOI: 10.21037/cco.2017.06.12. 

6. Hong T.S., Ryan D.P., Borger D.R., Blaszkowsky L.S., Yeap B.Y., Ancukiewicz M., et al. A Phase 1/2 and Biomarker Study of Preoperative Short Course Chemoradiation with Proton Beam Therapy and Capecitabine Followed by Early Surgery for Resectable Pancreatic Ductal Adenocarcinoma. Int. J. Radiat. Oncol. Biol. Phys. 2014;89;4:830-838. DOI: 10.1016/j.ijrobp.2014.03.034.

7. Hall W.A., Goodman K.A. Radiation Therapy for Pancreatic Adenocarcinoma, a Treatment Option that must Be Considered in the Management of a Devastating Malignancy. Radiat. Oncol. 2019;14;1:114. DOI: 10.1186/s13014–019–1277–1.

8. Golcher H., Brunner T.B., Witzigmann H., Marti L., Bechstein W.O., Bruns C., et al. Neoadjuvant Chemoradiation Therapy with Gemcitabine/Cisplatin and Surgery Versus Immediate Surgery in Resectable Pancreatic Cancer: Results of the First Prospective Randomized Phase II Trial. Strahlenther Onkol. 2015;191;1:7-16. DOI: 10.1007/s00066–014–0737–7.

9. Versteijne E., Suker M., Groothuis K., Akkermans-Vogelaar J.M., Besselink M.G., Bonsing B.A., et al. Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial. J. Clin. Oncol. 2020;38;16:1763-1773. DOI: 10.1200/JCO.19.02274.

10. Hsu C.C., Herman J.M., Corsini M.M., Winter J.M., Callister M.D., Haddock M.G., et al. Adjuvant Chemoradiation for Pancreatic Adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic Collaborative Study. Ann. Surg. Oncol. 2010;17;4:981-990. DOI: 10.1245/s10434–009–0743–7.

11. Hammel P., Huguet F., van Laethem J.L., Goldstein D., Glimelius B., Artru P., et al. Effect of Chemoradiotherapy vs Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial. JAMA. 2016;315;17:1844-1853. DOI: 10.1001/jama.2016.4324.

12. Медведев С.В., Ткачев С.И. Рак поджелудочной железы // Терапевтическая радиология. Национальное руководство. Гл. 15 / Под ред. ак. Каприна А.Д., Мардынского Ю.С. М.: ГЭОТАР-Медиа, 2018. С. 155-159. [Medvedev S.V., Tkachev S.I. Pancreatic Cancer. Terapevticheskaya Radiologiya. Natsionalnoye Rukovodstvo = Therapeutic Radiology. National Leadership. Ch. 15. Ed. Kaprin A.D., Mardynskiy Yu.S. Moscow, GEOTAR-Media Publ., 2018. P. 155-159 (In Russ.)].

13. Krishnan S., Chadha A.S., Suh Y., Chen H.C., Rao A., Das P., et al. Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation. Int. J. Radiat. Oncol. Biol. Phys. 2016;94;4:755-765. DOI: 10.1016/j.ijrobp.2015.12.003.

14. Ткачев С.И., Медведев С.В., Знаткова Я.Р., Романов Д.С., и др. Возможности стереотаксической лучевой терапии при паллиативном лечении больных раком поджелудочной железы // Вопросы онкологии. 2015, Т.61, № 1. С. 121–124. [Tkachev S.I., Medvedev S.V., Znatkova Ya.R., Romanov D.S., et al. The Possibilities of Stereotactic Radiotherapy in Palliative Treatment of Patients with Pancreatic Cancer. Voprosy Onkologii = Problems in Oncology. 2015;61;1:121–124 (In Russ.)].

15. Reyngold M., Parikh P., Crane C.H. Ablative Radiation Therapy for Locally Advanced Pancreatic Cancer: Techniques and Results. Radiat. Oncol. 2019;14;1:95. DOI: 10.1186/s13014–019–1309–x.

16. Zhong J., Patel K., Switchenko J., Cassidy R.J., Hall W.A., Gillespie T., et al. Outcomes for Patients with Locally Advanced Pancreatic Adenocarcinoma Treated with Stereotactic Body Radiation Therapy Versus Conventionally Fractionated Radiation. Cancer. 2017;15;123;18:3486-3493. DOI: 10.1002/cncr.30706.

17. Dohopolski M.J., Glaser S.M., Vargo J.A., Balasubramani G.K., Beriwal S. Stereotactic Body Radiotherapy for Locally-Advanced Unresectable Pancreatic Cancer-Patterns of Care and Overall Survival. J. Gastrointest Oncol. 2017;8;5:766-777. DOI: 10.21037/jgo.2017.08.04.

18. Jung J., Yoon S.M., Park J.H., Seo D.W., Lee S.S., Kim M.H., et al. Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Cancer. PLoS One. 2019;14;4:e0214970. DOI: 10.1371/journal.pone.0214970.

19. Zhong J., Switchenko J., Behera M., Kooby D., Maithel S.K., McDonald M.W., et al. Chemotherapy with or Without Definitive Radiation Therapy in Inoperable Pancreatic Cancer. Ann Surg. Oncol. 2018;25;4:1026-1033. DOI: 10.1245/s10434–017–6322–4.

20. Herman J.M., Chang D.T., Goodman K.A., Dholakia A.S., Raman S.P., Hacker-Prietz A., et al. Phase 2 Multi-Institutional Trial Evaluating Gemcitabine and Stereotactic Body Radiotherapy for Patients with Locally Advanced Unresectable Pancreatic Adenocarcinoma. Cancer. 2015;121;7:1128-1137. DOI: 10.1002/cncr.29161.

21. Nichols R.C.Jr., George T.J., Zaiden R.A.Jr, Awad Z.T., Asbun H.J., Huh S., et al. Proton Therapy with Concomitant Capecitabine for Pancreatic and Ampullary Cancers is Associated with a Low Incidence of Gastrointestinal Toxicity. Acta. Oncol. 2013;52;3:498-505. DOI: 10.3109/0284186X.2012.762997.

22. Thompson R.F., Mayekar S.U., Zhai H., Both S., Apisarnthanarax S., Metz J.M., et al. A Dosimetric Comparison of Proton and Photon Therapy in Unresectable Cancers of the Head of Pancreas. Med. Phys. 2014;41;8:081711. DOI: 10.1118/1.4887797.

23. Hiroshima Y., Fukumitsu N., Saito T., Numajiri H., Murofushi K.N., Ohnishi K., et al. Concurrent Chemoradiotherapy Using Proton Beams for Unresectable Locally Advanced Pancreatic Cancer. Radiother Oncol. 2019;136:37-43. DOI: 10.1016/j.radonc.2019.03.012.

24. Henke L., Kashani R., Yang D., Zhao T., Green O., Olsen L., et al. Simulated Online Adaptive Magnetic Resonance-Guided Stereotactic Body Radiation Therapy for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages. Int. J. Radiat. Oncol. Biol. Phys. 2016;96;5:1078-1086. DOI: 10.1016/j.ijrobp.2016.08.036.

25. Bohoudi O., Bruynzeel A.M.E., Senan S., Cuijpers J.P., Slotman B.J., Lagerwaard F.J., Palacios M.A. Fast and Robust Online Adaptive Planning in Stereotactic MR-Guided Adaptive Radiation Therapy (SMART) for Pancreatic Cancer. Radiother Oncol. 2017;125;3:439-444. DOI: 10.1016/j.radonc.2017.07.028.

26. Rudra S., Jiang N., Rosenberg S.A., Olsen J.R., Roach M.C., Wan L., et al. Using Adaptive Magnetic Resonance Image-Guided Radiation Therapy for Treatment of Inoperable Pancreatic Cancer. Cancer Med. 2019;8;5:2123-2132. DOI: 10.1002/cam4.2100.

27. Jia S.N., Wen F.X., Gong T.T., Li X., Wang H.J., Sun Y.M., Yang Z.C. A Review on the Efficacy and Safety of Iodine-125 Seed Implantation in Unresectable Pancreatic Cancers. Int. J. Radiat. Biol. 2020;96;3:383-389. DOI: 10.1080/09553002.2020.1704300. 

28. Sun X., Lu Z., Wu Y., Min M., Bi Y., Shen W., et al. An Endoscopic Ultrasonography-Guided Interstitial Brachytherapy Based Special Treatment-Planning System for Unresectable Pancreatic Cancer. Oncotarget. 2017;8;45:79099-79110. DOI: 10.18632/oncotarget.15763. 

29. Zhang K., Liao A., Jiang P., Jiang Y., Ji Z. Expert Consensus Workshop Report: Guideline for Three-Dimensional Printing Template-Assisted Computed Tomography-Guided 125i Seeds Interstitial Implantation Brachytherapy. J. Cancer Res. Ther. 2017;13;4:607-612. DOI: 10.4103/jcrt.JCRT_412_17.

30. Guo J.H., Hu X.K., Teng G.J. Radioactive Seed Implantation Therapy Technology: Problems and Development. Natl. Med. J. China. 2017;97:1444–1445.

31. Gai B., Zhang F. Chinese Expert Consensus on Radioactive 125I Seeds Interstitial Implantation Brachytherapy For Pancreatic Cancer. J. Cancer Res. Ther. 2018;14;7:1455-1462. DOI: 10.4103/jcrt.JCRT_96_18.

32. Folkert M.R., Gottumukkala S., Nguyen N.T., Taggar A., Sur R.K. Review of Brachytherapy Complications - Upper Gastrointestinal Tract. Brachytherapy. 2021;20;5:1005-1013. DOI: 10.1016/j.brachy.2020.11.010. 

33. Han Q., Deng M., Lv Y., Dai G. Survival of Patients with Advanced Pancreatic Cancer after Iodine125 Seeds Implantation Brachytherapy: A Meta-Analysis. Medicine (Baltimore). 2017;96;5:e5719. DOI: 10.1097/MD.0000000000005719. 

34. Chi Z., Chen L., Huang J., Jiang N., Zheng Q., Huang N., Yang W. A Novel Combination of Percutaneous Stenting with Iodine-125 Seed Implantation and Chemotherapy for the Treatment of Pancreatic Head Cancer with Obstructive Jaundice. Brachytherapy. 2021;20;1:218-225. DOI: 10.1016/j.brachy.2020.09.009.

35. Bhutani M.S., Cazacu I.M., Luzuriaga Chavez A.A., Singh B.S., Wong F.C.L., et al. Novel EUS-Guided Brachytherapy Treatment of Pancreatic Cancer with Phosphorus-32 Microparticles: First United States Experience. VideoGIE. 2019;4;5:223-225. DOI: 10.1016/j.vgie.2019.02.009.

 PDF (RUS) Full-text article (in Russian)

Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.06.2022. Accepted for publication: 25.08.2022. 

Medical Radiology and Radiation Safety. 2022. Vol. 67. № 5

DOI: 10.33266/1024-6177-2022-67-5-94-97

V.D. Volodina¹, A.N. Bashkov², S.V. Lishchuk², A.P. Dunaev³,
Z.V. Sheykh³, M.V. Popov¹

CHONDROMYXOID FIBROMA OF THE TEMPORAL BONE SIMULATED CHRONIC INFLAMMATION (Case Report)

¹First I.M. Sechenov Moscow State Medical University, Moscow, Russia

²A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia

³Moscow City Clinical Hospital № 62, Istra, Moscow Region, Russia

⁴Russian Medical Academy of Continuing Professional Education, Moscow, Russia

Contact person: V.D. Volodina, е-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Purpose: To present a clinical case of a benign bone tumor of rare localization – chondromyxoid fibroma of the temporal bone, simulated chronic inflammation.

Material and methods: A clinical case of chondromyxoid fibroma of the right temporal bone is presented. X-ray computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bones were performed before and during hospitalization.

Results: Patient T., 29 years old, has been complaining about discomfort, congestion and noise in the right ear for the past 10 years without clear history of acute media otitis in anamnesis. According to the results of MRI of the temporal bones, a tumor of the right temporal bone was revealed. To clarify the diagnosis and for surgical treatment, the patient was referred to the clinic. During hospitalization CT of the temporal bones with contrast enhancement was performed and a tumor in the mastoid process of the right temporal bone with a ring-shaped accumulation of a contrast was determined, differential diagnosis included tumor and chronic abscess. According to the results of morphological examination after radical surgery of the temporal bone, chondromyxoid fibroma was diagnosed.

Conclusion: Localization of chondromyxoid fibroma in the temporal bone is extremely rare and having by chance some features can simulate chronic inflammatory process. The absence of a clear history of acute otitis allows more likely suggest the tumor.

Keywords: chonromyxoid fibroma, temporal bone, chronic inflammation, X-ray computed tomography (CT), magnetic resonance imaging (MRI)

For citation: Volodina VD, Bashkov AN, Lishchuk SV, Dunaev AP, Sheykh ZV, Popov MV. Chondromyxoid Fibroma of the Temporal Bone Simulated Chronic Inflammation (Case Report). Medical Radiology and Radiation Safety. 2022;67(5):94–97. (In Russian). DOI: 10.33266/1024-6177-2022-67-5-94-97

References

1. Jaffe H.L., Lichtenstein L. Chondromyxoid Fibroma of Bone. A Distinctive Benign Tumor Likely to Be Mistaken Especially for Chondrosarcoma. Arch Pathol. 1948;45:541-551.

2. Lingen M.W., Solt D.B., Polverini P.J. Unusual Presentation of a Chondromyxoid Fibroma of the Mandible: Report of a Case and Review of the Literature. Oral Surgery, Oral Medicine, Oral Pathology. 1993;75;5:615-21. DOI: 10.1016/0030-4220(93)90236-W.

3. Gasparyan T.G., Cherekayev V.A., Bekyashev A.Kh. Tumors of the Base of the Skull of the Chondroid Series (Literature Review). Opukholi Golovy i Shei = Head and Neck Tumors (HNT). 2012;3:42-56
(In Russ.).

4. Lang S. Adler C.P., Bone Diseases: Macroscopic, Histological and Radiological Diagnosis of Structural Changes in Skeleton, Springer-Verlag, 2000, Pages 589, DM 269, ISBN 3-540-65061-X. European Journal of Radiology. 2001;37;2:139. DOI: 10.1016/S0720-048X(00)00246-1.

5. Diab Kh.M., Daykhes N.A., Karneyeva O.A., Pashchinina O.A., Kondratchikov D.S., Panina O.S.. Removal of Rare Chondromyxoid Fibroma of Infralabirint Space Using Retrofacial Access. Vestnik Otorinolaringologii. 2021;86;4:106-110. (In Russ.). DOI: 10.17116/otorino20218604110.

6. Zheng Y.M., Wang H.X., Dong C. Chondromyxoid Fibroma of the Temporal Bone: a Case Report and Review of the Literature. World Journal of Clinical Cases. 2018;6;16:1210-1216. DOI: 10.12998/wjcc.v6.i16.1210.

7. Sharma M., Velho V., Binayake R., Tiwari C. Chondromyxoid Fibroma of the Temporal Bone: a Rare Entity. Journal of Pediatric Neurosciences. 2012;7;3:211–214. DOI: 10.4103/1817-1745.106483.

8. Liu T., Yao J., Li X., Qi X., Zhao P., Tan Z., Wang J., Li Y. Chondromyxoid Fibroma of the Temporal Bone: A Rare Case Report. Medicine. 2020;99;11. DOI: 10.1097/MD.0000000000019487.

9. Thompson A.L., Bharatha A., Aviv R.I., Nedzelski J., Chen J., Bilbao J.M., Wong J., Saad R., Symons S.P. Chondromyxoid Fibroma of the Mastoid Facial Nerve Canal Mimicking a Facial Nerve Schwannoma. The Laryngoscope. 2009;119;7:1380-1383. DOI: 10.1002/lary.20486.

10. Cappelle S., Pans S., Sciot R. Imaging Features of Chondromyxoid Fibroma: Report of 15 Cases and Literature Review. The British Journal of Radiology. 2016;89;1064:20160088. DOI: 10.1259/bjr.20160088.

11. Otto B.A., Jacob A., Klein M.J., Welling D.B. Chondromyxoid Fibroma of the Temporal Bone: Case Report and Review of the Literature. Ann. Otol. Rhinol. Laryngol. 2007;116:922-927.

 PDF (RUS) Full-text article (in Russian)

Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.06.2022. Accepted for publication: 25.08.2022.

Medical Radiology and Radiation Safety. 2022. Vol. 67. № 4

Effect of Dose Uncertainty on the Assessment of Radiation Risks of Solid Cancer Incidence
in a Cohort of Russian Participants in the Elimination of the Consequences of the Accident
at the Chernobyl NPP

V.K. Ivanov, S.Yu. Chekin, M.A. Maksioutov, A.I. Gorski, S.V.Karpenko , K.A. Tumanov, V.V. Kashcheev, A.M. Korelo, E.V. Kochergina A.F.

Tsyb Medical Radiological Research Center, Obninsk, Russia
Contact person: Sergei Yurievich Chekin, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT
Purpose: Investigation of the influence of the possible uncertainty of exposure doses of Russian participants in the liquidation of the consequences of the Chernobyl accident on the assessment of radiation risks of the incidence of solid cancer in this cohort.
Material and methods: Epidemiological and dosimetric data on a cohort of Russian participants in the liquidation of the consequences of the accident at the Chernobyl NPP, registered in the National Radiation and Epidemiological Register (NRER), are used as initial data for assessing radiation risks. The assessment of radiation risks is carried out by the statistical method of maximum likelihood in the framework of a linear non-threshold model of excess relative risk. Uncertainties in the liquidator’s exposure dose in the adopted risk assessment method are considered in the form of two error models. Dose estimates based on data from individual dosimeters are characterized by a classical model of measurement errors. In the case of estimates of unknown individual doses from group dosimetry data or group route doses, the Berkson assignment error model is used.
Results: A method for assessing radiation risks has been developed, accounting for the uncertainty in dose estimates, based on the observed likelihood function. When taking into account the uncertainty of estimates of individual doses in the cohort of Russian liquidators, the estimate of the coefficient of the excess relative rate per dose unit (ERR/Gy) for the incidence of solid malignancies decreases by 7%, compared with the estimate obtained directly from the doses registered in the NRER database. The ERR/Gy estimate derived from the doses recorded in the NRER database was 0.69 with a 95% confidence interval (CI) of 0.37–1.04. The estimate of ERR/Gy, obtained accounting for the uncertainty in estimates of individual doses of liquidators, was 0.64 at 95% CI (0.33–0.98). This estimate bias is not significant, since it is within 95% CI for both ERR/Gy estimates, the statistical range of which is of the order of magnitude of the estimates themselves.
Conclusions: Considering the uncertainty of individual dose estimates in the cohort of Russian liquidators, the estimate of the excess relative rate per dose unit (ERR/Gy) for the incidence of solid cancer does not statistically significantly differ from the estimate obtained directly from the doses registered in the NRER database. The bias in the estimate of the radiation risk coefficient observed, due to the dose uncertainty introduced into the calculation, is due to the statistical properties of the traditional radiation risk models used for radiation epidemiology. The results obtained confirm the high stability and validity of the radiation risk assessments obtained earlier from the doses registered in the NRER for the Russian cohort of Chernobyl liquidators. Further research will allow generalization of the developed method for assessing radiation risks, accounting for the uncertainty of dose estimates, based on the observed likelihood function, to other types of radiation epidemiological risk studies, including case-control and case-cohort studies.

Keywords: radiation risk, incidence, solid cancer, linear non-threshold risk model, liquidators of the accident at the Chernobyl nuclear power plant, external dose, dose uncertainty, bias in the estimate of radiation risk

For citation: Ivanov VK, Chekin SYu, Maksioutov MA, Gorski AI, Karpenko SV, Tumanov KA, Kashcheev VV, Korelo AM, Kochergina EV. Effect of Dose Uncertainty on the Assessment of Radiation Risks of Solid Cancer Incidence in a Cohort of Russian Participants in the Elimination of the Consequences of the Accident at the Chernobyl NPP. Medical Radiology and Radiation Safety. 2022;67(4):36-41. DOI: 10.33266/1024-6177-2022-67-4-36-41

References

1. Публикация 103 Международной комиссии по радиационной защите (МКРЗ) / Пер. с англ. Киселёва М.Ф., Шандалы Н.К. М.: Изд. ООО ПКФ «Алана», 2009. 312 с. [Электронный ресурс]. URL: http://www.icrp.org/docs/P103_Russian.pdf (дата обращения 15.01.2022).

2. Preston D.L., Ron E., Tokuoka S., Funamoto S., Nishi N., Soda M., Mabuchi K., Kodama K. Solid Cancer Incidence in Atomic Bomb Survivors: 1958–1998 // Radiat. Res. 2007. V.168, No. 1. P. 1–64.

3. Ozasa K., Shimizu Y., Suyama A., Kasagi F., Soda M., Grant E.J., Sakata R., Sugiyama H., Kodama K. Studies of the Mortality of Atomic Bomb Survivors, Report 14, 1950–2003: an Overview of Cancer and Noncancer Diseases // Radiat. Res. 2012. V.177, No. 3. P. 229–243.

4. Grant E.J., Brenner A., Sugiyama H., Sakata R., Sadakane A., Utada M., Cahoon E.K., Milder C.M., Soda M., Cullings H.M., Preston D.L., Mabuchi K., Ozasa K. Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958–2009 // Radiat. Res. 2017. V.187, No.5. P. 513–537.

5. Нормы радиационной безопасности (НРБ-99/2009). Санитарные правила и нормативы. СанПин 2.6.1.2523-09. М.: Федеральный центр гигиены и эпидемиологии Роспотребнадзора, 2009. 100 с.

6. Ivanov V.K., Tsyb A.F., Gorsky A.I., Maksyutov M.A., Rastopchin E.M., Konogorov A.P., Korelo A.M., Biryukov A.P., Matyash V.A. Leukaemia and Thyroid Cancer in Emergency Workers of the Chernobyl Accident: Estimation of Radiation Risks (1986–1995) // Radiat. Environ. Biophys. 1997. V.36, No. 1. P. 9–16.

7. Ivanov V.K., Rastopchin E.M., Gorsky A.I., Ryvkin V.B. Cancer Incidence among Liquidators of the Chernobyl Accident: Solid Tumors, 1986– 1995 // Health Phys. 1998. V.74, No. 3. P. 309–315.

8. Ivanov V.K., Kashcheev V.V., Chekin S.Y., Maksioutov M.A., Tumanov K.A, Vlasov O.K., Shchukina N.V., Tsyb A.F. Radiation-Epidemiological Studies of Thyroid Cancer Incidence in Russia after the Chernobyl Accident (Estimation of Radiation Risks, 1991–2008 Follow-up Period) // Radiat. Prot. Dosimetry. 2012. V.151, No. 3. P. 489–499.

9. Kashcheev V.V., ChekinS.Yu., Maksiutov M.A., Tumanov K.A., Kochergina E.V., Kashcheeva P.V., Shchukina N.V. Incidence and Mortality of Solid Cancer among Emergency Workers of the Chernobyl Accident: Assessment of Radiation Risks for the Follow-up of 1992–2009 // Radiat. Eviron. Biophys. 2015. V.54, No. 1. P. 13–23.

10. Кащеев В.В., Чекин С.Ю., Карпенко С.В., Максютов М.А., Туманов К.А., Кочергина Е.В., Глебова С.Е., Иванов С.А., Каприн А.Д. Оценка радиационных рисков злокачественных новообразований среди российских участников ликвидации последствий аварии на Чернобыльской АЭС // Радиация и риск. 2021. Т.30, № 1. С. 58–77.

11. Медицинские радиологические последствия Чернобыля: прогноз и фактические данные спустя 30 лет / Под ред. чл.-корр. РАН Иванова В.К., чл.-корр. РАН Каприна А.Д. М.: ГЕОС, 2015. 450 с.

12. Питкевич В.А., Иванов В.К., Цыб А.Ф., Максютов М.А., Матяш В.А., Щукина Н.В. Дозиметрические данные Российского государственного медико-дозиметрического регистра для ликвидаторов // Радиация и риск. 1995. № 2. С. 3–44.

13. Gillies M., Haylock R. The Cancer Mortality and Incidence Experience of Workers at British Nuclear Fuels plc, 1946–2005 // J. Radiol. Prot. 2014. V.34, № 3. P. 595–623.

14. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Effects of Ionizing Radiation. UNSCEAR 2006 Report to the General Assembly with Scientific Annexes. V. I. New York: United Nations, 2008. 392 p. [Электронный ресурс]. URL: https://www.unscear.org/docs/publications/2006/UNSCEAR_2006_Report_Vol.I.pdf (дата обращения 15.01.2022).

15. United Nations Scientific Committee on the Effects of Atomic Radiation UNSCEAR 2012 Report to the General Assembly, with scientific annexes. Scientific Annexes. New York: United Nations, 2015. 232 p. [Электронный ресурс]. URL: https://www.unscear.org/docs/publications/2012/UNSCEAR_2012_Annex-B.pdf (дата обращения 15.01.2022).

16. Breslow N., Day N. Statistical Methods in Cancer Research. V. II. The Design and Analysis of Cohort Studies. IARC Scientific Publication No. 82. Lyon: IARC, 1987. 406 p.

17. Международная статистическая классификация болезней и проблем, связанных со здоровьем, 10-й пересмотр (МКБ-10). Т. 1. Ч. 1. Женева: ВОЗ, 1995. 698 с.

18. Ivanov V.K., Gorsky A.I., Kashcheev V.V., Maksioutov M.A., Tumanov K.A. Latent Period in Induction of Radiogenic Solid Tumors in the Cohort of Emergency Workers // Radiat. Environ. Biophys. 2009. V.48, № 3. P. 247–252.

19. Stram D.O., Kopecky K.J. Power and Uncertainty Analysis of Epidemiological Studies of Radiation-Related Disease Risk in Which Dose Estimates are Based on a Complex Dosimetry System: Some Observations // Radiat. Res. 2003. V.160, No. 4. P. 408–417.

20. Wu Y., Hoffman F.O., Apostoaei A.I., Kwon D., Thomas B.A., Glass R., Zablotska L.B. Methods to Account for Uncertainties in Exposure Assessment in Studies of Environmental Exposures // Environ. Health. 2019. V.18, No. 1. P. 31. [Электронный ресурс]. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454753/pdf/12940_2019_ Article_468.pdf (дата обращения 15.01.2022).

21. Stayner L., Vrijheid M., Cardis E., Stram D.O., Deltour I., Gilbert S.J., Howe G. A Monte Carlo Maximum Likelihood Method for Estimating Uncertainty Arising from Shared Errors in Exposures in Epidemiological Studies of Nuclear Workers // Radiat. Res. 2007. V.168, No. 3. P. 757– 763.

22. Breslow N.E. Discussion of the Paper by D.R. Cox // J. R. Statist. Soc. B. 1972. No. 34. P. 216–217.

23. Lyn D.Y. On the Breslow Estimator // Lifetime Data Anal. 2007. No. 13. P. 471–480. [Электронный ресурс]. URL: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC6454753/pdf/12940_2019_Article_468.pdf (дата обращения 15.01.2022)

24. Breslow N., Day N. The Analysis of Case-Control Studies. V. I. // Statistical Methods in Cancer Research. IARC Scientific Publication No. 32. Lyon: IARC, 1980. 350 p.

25. Pierce D.A., Vaeth M., Cologne J.B. Allowance for Random Dose Estimation Errors in Atomic Bomb Survivor Studies: a Revision // Radiat. Res. 2008. V.170, No. 1. P. 118–126.

 PDF (RUS) Full-text article (in Russian)

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
Финансирование. Исследование не имело спонсорской поддержки.
Участие авторов. Cтатья подготовлена с равным участием авторов. 
Поступила: 15.03.2022. Принята к публикации: 11.05.2022.