Medical Radiology and Radiation Safety. 2025. Vol. 70. № 4

DOI:10.33266/1024-6177-2025-70-4-78-81

A.N. Bashkov^{1, 2}, M.V. Shabalin¹, A.Yu. Veselkova¹, E.A. Dubova¹,
E.I. Matkevich^{1, 2}, A.P. Dunaev^{2, 3, 4} 

Computed Tomography of Neoplasms of Small Vessels of the Liver in the Differential Diagnosis of Hypervascular Tumors (Clinical Case)

¹ A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia

² Peoples Friendship University of Russia, Moscow, Russia

³ Central State Medical Academy of the Administration of the President of the Russian Federation, Moscow, Russia

⁴ Moscow City Clinical Hospital № 62, Istra, Moscow Region, Russia

Contact person: Andrey Nikolaevich Bashkov, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Purpose: To describe the semiotics of neoplasms of small vessels of the liver according to computed tomography, to present a possible differential diagnosis

Material and methods: Patient S., 52 years old, underwent computed tomography (CT) of the abdominal cavity with intravenous contrast due to a sharp increase in liver formation before the planned surgery. According to CT data, a large hypervascular formation measuring 198×146×247 mm was detected in the left lobe of the liver. The feeding extrahepatic arteries and draining hepatic veins are significantly dilated. Newly formed vessels and aneurysmally dilated arteriovenous shunts up to 29 mm in size were noted in the structure of the formation. A hemihepatectomy was performed. According to the results of morphological and immunohistochemical studies, a diagnosis of «Neoplasm of small vessels of the liver» was made.

Results: the disease «neoplasm of small vessels of the liver» (HSVN) became known in 2016 after the publication of an article by Ryan M. Gill et al. This is a vascular tumor that occupies an intermediate position between a hemangioma and an angiosarcoma. Currently, it is believed that the disease is benign. Several dozen confirmed cases are known. Due to hypervascularity, the tumor must be differentiated from angiosarcoma, hepa- and cholangiocellular cancer, hypervascular metastasis, as well as benign tumors such as hemangioma, focal nodular hyperplasia, and adenoma. In our case, the distinctive feature of the tumor was a significant expansion of the feeding extrahepatic arteries and draining main hepatic veins, aneurysmal expansion of arteriovenous shunts in the structure and the absence of signs of invasion of surrounding vessels and organs.

Conclusion: In the differential series of hypervascular liver tumors, in the presence of pronounced arterial blood supply, the presence of arteriovenous shunts in the structure and the absence of signs of infiltrative growth, neoplasm of small liver vessels should be considered.

Keywords: computed tomography, hepatic small vessel neoplasia, HSVN

For citation: Bashkov AN, Shabalin MV, Veselkova AYu, Dubova EA, Matkevich EI, Dunaev AP. Computed Tomography of Neoplasms of Small Vessels of the Liver in the Differential Diagnosis of Hypervascular Tumors (Clinical Case). Medical Radiology and Radiation Safety. 2025;70(4):78–81. (In Russian). DOI:10.33266/1024-6177-2025-70-4-78-81

References

1. Gill R.M., Buelow B., Mather C., Joseph N.M., et al. Hepatic Small Vessel Neoplasm, a Rare Infiltrative Vascular Neoplasm of Uncertain Malignant Potential. Human Pathology. 2016;54:143-151. doi:10.1016/j.humpath.2016.03.018. 

2. Goh I.Y., Mulholland P., Sokolova A., Liu C., Siriwardhane M. Hepatic Small Vessel Neoplasm – A Systematic Review. Annals of Medicine and Surgery. 2021;72;3:103004. doi:10.1016/j.amsu.2021.103004.

3. Cicala C.M., Monaca F., Giustiniani M.C., Di Salvatore M. Multifocal Hepatic Small Vessel Neoplasm with Spleen Dissemination. BMJ Case Rep. 2022 Mar 29;15;3:e248785. doi: 10.1136/bcr-2022-248785. 

4. Кармазановский Г.Г., Дунаев А.П., Нуднов Н.В. и др. Очаговые образования печени: дифференциальная диагностика при МСКТ и МРТ. М.: Крафт+, 2018. 230 с. [Karmazanovskiy G.G., Dunayev A.P., Nudnov N.V., et al. Ochagovyye Obrazovaniya Pecheni: Differentsial’naya Diagnostika pri MSKT i MRT = Focal Liver Lesions: Differential Diagnostics with MSCT and MRI. Moscow, Kraft+ Publ., 2018. 230 p. (In Russ.)]. ISBN 978-5-93675-258-2. 

5. Minami Y., Nishida N., Kudo M. Imaging Diagnosis of Various Hepatocellular Carcinoma Subtypes and Its Hypervascular Mimics: Differential Diagnosis Based on Conventional Interpretation and Artificial Intelligence. Liver Cancer. 2022 Dec 6;12;2:103-115. doi: 10.1159/000528538. 

6. Yi L.L., Zhang J.X., Zhou S.G., Wang J., Huang Y.Q., Li J., Yu X., Wang R.N. CT and MRI Studies of Hepatic Angiosarcoma. Clin Radiol. 2019 May;74;5:406.e1-406.e8. doi: 10.1016/j.crad.2018.12.013. 

 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: 20.03.2025. Accepted for publication: 25.04.2025.

Medical Radiology and Radiation Safety. 2025. Vol. 70. № 4

DOI:10.33266/1024-6177-2025-70-4-87-95

E.A. Nikolaeva¹, A.S. Krylov¹, A.A. Ryzhkov^{1, 2}, B.Ya. Narkevich¹, A.V. Filimonov¹

Indirect Radionuclide Lymphoscintigraphy in the Assessment of Upper Limb Lymphostasis after Breast Cancer Treatment

¹ N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia

² Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Contact person: E.A. Nikolaeva, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Purpose: To evaluate the significance of quantitative and qualitative parameters of lymphoscintigraphy, their correlation with each other and with the clinical stage of lymphedema in patients undergoing surgery for breast cancer with advanced lymphodissection.

Material and methods: 285 patients with lymphedema were examined from October 2022 to July 2023. After intradermal injection of the radiopharmaceutical ^99mTc-nanotope (particle size 5-80 nm) into the first interdigital spaces of both hands, 40 MBq per point, exercises with a rubber expander were performed for 30 minutes. Planar images were obtained 2 hours after injection on a gamma camera and a qualitative description of the images was performed. The quantitative asymmetry index (QIA) was also used, for which the areas of interest were outlined in ovals and shifted to the contralateral side: forearm, shoulder, axillary and subclavicular zones.

Results: In the first degree, lymph nodes of all groups are more often detected (p<0.001), there is no reflux in the shoulder and forearm (p<0.001), more often with intact lymph ducts. In the second degree, reflux in the shoulder and forearm is significantly more often visualized (p<0.001). In the third degree, lymph nodes of all groups are more often not detected and reflux into the subcutaneous lymph networks of the shoulder and forearm is not visualized (p<0.001), more often without visualization of the lymph ducts. The disease was statistically significantly diagnosed at an earlier stage at a younger age (p=0.01). Also, a more severe degree of lymphedema was detected with an increase in BMI (p<0.001). Statistically significantly, with a previous history of remote radiation therapy, lymph nodes in the supra/subclavian region were detected less frequently (p=0.007). In the presence of reflux in the forearm area, the median of the QIA values ​in the forearm area was significantly higher than in the absence of reflux: Me=5 versus Me=1. In the presence of reflux in the shoulder area, the QIA in the forearm area was significantly higher than in the absence of reflux: Me=3 versus Me=1, respectively. Also, in the presence of reflux in the shoulder area, the median of the QIA in the forearm area was significantly higher than in the absence of reflux: Me=6 versus Me=2, respectively.

Conclusions: Statistically significant correlation indicators were obtained between quantitative and qualitative parameters of lymphoscintigraphy with each other and with the clinical stage of lymphedema, which made it possible to develop criteria for staging the severity of lymphostasis based on them. Lymphoscintigraphy also allows you to determine the nature of the increase in the volume of the upper limb (lymphatic, fibrous), which is a necessary criterion for choosing a  plan of rehabilitation measures.

Keywords: lymphostasis, lymphoscintigraphy, radionuclide diagnostics

For citation: Nikolaeva EA, Krylov AS, Ryzhkov AA, Narkevich BYa, Filimonov AV. Indirect Radionuclide Lymphoscintigraphy in the Assessment of Upper Limb Lymphostasis after Breast Cancer Treatment. Medical Radiology and Radiation Safety. 2025;70(4):87–95. (In Russian). DOI:10.33266/1024-6177-2025-70-4-87-95

References

1. Soyder A, Taştaban E, Özbaş S, Boylu Ş, Özgün H. Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer. J Breast Health. 2014 Apr 1;10(2):92-97. doi: 10.5152/tjbh.2014.1973. PMID: 28331651; PMCID: PMC5351476.
2. Cemal Y., Pusic A., Mehrara B.J. Preventative Measures for Lymphedema: Separating Fact from Fiction. J. Am. Coll. Surg. 2011;213:543–551. doi: 10.1016/j.jamcollsurg.2011.07.001.
3. McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26:5213–5219. doi: 10.1200/JCO.2008.16.3725.
4. Executive Committee of the International Society of Lymphology The Diagnosis and Treatment of Peripheral Lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53:3–19.
5. Lee T.S., Morris C.M., Czerniec S.A., Mangion A.J. Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers. Lymphat. Res. Biol. 2018;16:85–91. doi: 10.1089/lrb.2016.0049.
6. Hwang JM, Hwang JH, Kim TW, Lee SY, Chang HJ, Chu IH. Long-term effects of complex decongestive therapy in breast cancer patients with arm lymphedema after axillary dissection. Ann Rehabil Med. 2013;37:690–697. doi: 10.5535/arm.2013.37.5.690.
7. Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, et al. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol. 2009;27:390–397. doi: 10.1200/JCO.2008.17.9291.
8. Nagy BI, Mohos B, Tzou CJ. Imaging Modalities for Evaluating Lymphedema. Medicina (Kaunas). 2023 Nov 16;59(11):2016. doi: 10.3390/medicina59112016. PMID: 38004065; PMCID: PMC10673374.
9. Polomska A.K., Proulx S.T. Imaging Technology of the Lymphatic System. Adv. Drug Deliv. Rev. 2020;170:294–311. doi: 10.1016/j.addr.2020.08.013. 
10. Kramer E.L. Lymphoscintigraphy: Defining a Clinical Role. Lymphat. Res. Biol. 2004;2:32–37. doi: 10.1089/1539685041690454. 
11. Tartaglione G. Advantages of the intradermal lymphoscintigraphy. World J Radiol 2024; 16(7): 241-246 DOI: https://dx.doi.org/10.4329/wjr.v16.i7.241.
12. Cusnir R, Leresche M, Pilloud C, Straub M. An investigation of aspects of radiochemical purity of 99mTc-labelled human serum albumin nanocolloid. EJNMMI Radiopharm Chem. 2021 Oct 11;6(1):35. doi: 10.1186/s41181-021-00147-8. PMID: 34633572; PMCID: PMC8505548.
13. Hwang JH, Choi JY, Lee JY, Hyun SH, Choi Y, Choe YS, et al. Lymphscintigraphy predicts response to complex physical therapy in patients with early stage extremity lymphedema. Lymphology. 2007;40:172–176. 
14. Yoo J, Choi JY, Hwang JH, Kim DI, Kim YW, Choe YS, et al. Prognostic value of lymphoscintigraphy in patients with gynecological cancer-related lymphedema. J Surg Oncol. 2014;109:760–763. doi: 10.1002/jso.23588. 
15. Stanton AW, Modi S, Mellor RH, Peters AM, Svensson WE, Levick JR, et al. A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphoedema following breast cancer treatment. Clin Sci (Lond) 2006;110:553–561. doi: 10.1042/CS20050277.
16. Yoo JN, Cheong YS, Min YS, Lee SW, Park HY, Jung TD. Validity of Quantitative Lymphoscintigraphy as a Lymphedema Assessment Tool for Patients With Breast Cancer. Ann Rehabil Med. 2015 Dec;39(6):931-40. doi: 10.5535/arm.2015.39.6.931. Epub 2015 Dec 29. PMID: 26798607; PMCID: PMC4720769.
17. Pecking AP, Alberini JL, Wartski M, Edeline V, Cluzan RV. Relationship between lymphoscintigraphy and clinical findings in lower limb lymphedema (LO): toward a comprehensive staging. Lymphology. 2008;41:1–10.
18. Vargo M, Aldrich M, Donahue P, Iker E, Koelmeyer L, Crescenzi R, Cheville A. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Med Oncol. 2024 Sep 5;41(10):241. doi: 10.1007/s12032-024-02472-9. PMID: 39235664; PMCID: PMC11377676.
19. Gebruers N, Truijen S, Engelborghs S, De Deyn PP. Volumetric evaluation of upper extremities in 250 healthy persons. Clin Physiol Funct Imaging. 2007;27:17–22. doi: 10.1111/j.1475-097X.2007.00708.x.
20. Szuba A, Strauss W, Sirsikar SP, Rockson SG. Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity. Nucl Med Commun. 2002;23:1171–1175. doi: 10.1097/00006231-200212000-00004.
21. Dalia RM, Martins GR, Barbosa R, de Lima CF, Siqueira CF. Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema. Braz Arch Biol Technol. 2005;48:159–162.
22. Chachaj A., Piller N., Boccardo F., Szuba A. In: Lymphedema: General Pathophysiology, Prevention, and Management in Invasive Cancer BT—Cancer Metastasis Through the Lymphovascular System. Leong S.P., Nathanson S.D., Zager J.S., editors. Springer International Publishing; Cham, Germany: 2022. pp. 261–271

 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: 20.03.2025. Accepted for publication: 25.04.2025.

Medical Radiology and Radiation Safety. 2025. Vol. 70. № 4

DOI:10.33266/1024-6177-2025-70-4-82-86

A.M. Zainagutdinova, E.N. Surovtsev, Yu.S. Pyshkina, A.V. Kapishnikov

Avascular Necrosis and Bone Marrow Infarction as a Manifestation of Postcovoid Syndrome

Samara State Medical University, Samara, Russia

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

ABSTRACT

Purpose: To assess the demographic and magnetic resonance imaging (MRI) manifestations of aseptic necrosis and bone marrow infarction in patients before, during, and after the COVID-19 pandemic (2019–2023).

Material and methods: The study included 229 patients diagnosed with aseptic necrosis and bone marrow infarction using MRI between 2019 and 2023. The average age of the participants was 50±10 years. All patients underwent MRI using T₂-weighted imaging (WI), T₁-WI, PD-FS, T₂-WI, and T₁-WI with fat suppression. In patients diagnosed with aseptic osteonecrosis, the following MRI signs were recorded: marginal subcortical pathological MRI signal, narrowing of the joint space, joint effusion, bone marrow edema around the necrosis zone. For bone marrow infarction, the following signs were observed: a pathological MRI signal resembling a “geographic map,” heterogeneous increased signal on T₂-WI and T₁-WI, hyperintensity on STIR, and bone marrow edema around the periphery. Statistical analysis of the data was performed.

Results: The results of the study showed that aseptic necrosis of the joints developed more frequently in young, working-age individuals after the pandemic. An increase in the number of male patients with these pathologies was also noted. The incidence of aseptic necrosis increased by 10 % between 2019 and 2022, while bone marrow infarction increased by 3.5 % between 2019 and 2023. The number of bilateral joint lesions in 2019 was significantly lower (p<0.05) than in the post-COVID period, accounting for 8 % of the total number of patients with aseptic necrosis and bone marrow infarction. An increase in the prevalence of stages II and III of the disease was observed between 2019 and 2023.

Conclusion: The more frequent development of the disease in the most economically active population group (working-age men) with bilateral lesions necessitates the development of preventive measures and a comprehensive rehabilitation program, including potential prosthetic interventions. These measures aim to restore patients’ quality of life and enable them to continue their professional activities.

Keywords: aseptic necrosis, bone marrow infarction, COVID-19, post-COVID syndrome, magnetic resonance imaging

For citation: Zainagutdinova AM, Surovtsev EN, Pyshkina YuS, Kapishnikov AV. Avascular Necrosis and Bone Marrow Infarction as a Manifestation of Postcovoid Syndrome. Medical Radiology and Radiation Safety. 2025;70(4):82–86. (In Russian). DOI:10.33266/1024-6177-2025-70-4-82-86

References

1. Vande Berg B.C., Malghem J., Lecouvet F.E., Noel H., Maldague B. MR Imaging of Bone Infarction and Epiphyseal Osteonecrosis. J Belge Radiol. 1997;80;5:243-50.

2. Торгашин А.Н., Родионова С.С., Шумский А.А., Макаров М.А., Торгашина А.В., Ахтямов И.Ф., Коваленко А.Н., Загородний Н.В., Миронов С.П. Лечение асептического некроза головки бедренной кости. Клинические рекомендации // Научно-практическая ревматология. 2020. Т.58. №6. С. 637-645 [Torgashin A.N., Rodionova S.S., Shumskiy A.A., Makarov M.A., Torgashina A.V., Akhtyamov I.F., Kovalenko A.N., Zagorodniy N.V., Mironov S.P. Treatment of Aseptic Necrosis of the Femoral Head. Clinical Guidelines. Nauchno-Prakticheskaya Revmatologiya = Scientific and Practical Rheumatology. 2020;58;6:637-645 (In Russ.)]. doi: 10.47360/1995-4484-2020-637-645.

3. Панин М.А., Загородний Н.В., Карчебный Н.Н., Садков И.А., Петросян А.С., Закирова А.Р. Современный взгляд на патогенез нетравматического остеонекроза // Вестник травматологии и ортопедии им. Н.Н.Приорова. 2017. №2. С. 69-75 [Panin M.A., Zagorodniy N.V., Karchebnyy N.N., Sadkov I.A., Petrosyan A.S., Zakirova A.R. Modern View on the Pathogenesis of Non-Traumatic Osteonecrosis. Vestnik Travmatologii i Ortopedii Im. N.N.Priorova = Bulletin of Traumatology and Orthopedics Named after N.N.Priorov. 2017;2:69-75 (In Russ.)]. doi: 10.17816/vto201724269-75.

4. Inneh A., Martinez K., Elizee J., Ganguli M., Turan A. COVID-19-Related Bilateral Avascular Necrosis of the Femoral Head. Cureus. 2023;15;8:e44034. doi: 10.7759/cureus.44034.

5. Darraz S., Omar M., Lachkar A., Abdeljaouad N., Yacoubi H. Aseptic Osteonecrosis of the Femoral Head: The Effect of Corticosteroid Therapy and Long COVID Syndrome. Cureus. 2024;16;2:e54327. doi: 10.7759/cureus.54327.

6. Murugesan L., Sivakumar N., Ramamoorthy L., Farooq U. COVID-19-Associated Bilateral Avascular Necrosis of Femoral Head in a Young Male Without Corticosteroid Exposure: a Case Report. Cureus. 2024;16;4:e57525. doi: 10.7759/cureus.57525.

7. Ji H.L., Zhao R., Matalon S., Matthay M.A. Elevated Plasmin(ogen) as a Common Risk Factor for COVID-19 Susceptibility. Physiol Rev. 2020;100;3:1065-1075. doi: 10.1152/physrev.00013.2020.

8. Chen Y., Miao Y., Liu K., Xue F., Zhu B., Zhang C., Li G. Evolutionary Course of the Femoral Head Osteonecrosis: Histopathological – Radiologic Characteristics and Clinical Staging Systems. J Orthop Translat. 2021;32:28-40. doi: 10.1016/j.jot.2021.07.004.

9. Parikh S., Gomez O., Davis T., Lyon Z., Corces A. Avascular Necrosis as a Sequela of COVID-19: a Case Series. Cureus. 2023;15;2:e35368. doi: 10.7759/cureus.35368.

10. Velchov V., Georgiev P., Tserovski S., Tsenkov T., Alexiev V. Corticosteroid-Associated Avascular Necrosis of the Femoral Head in Patients with Severe COVID-19: a Single-Center Study. Med Sci Monit. 2023;29:e940965. doi: 10.12659/MSM.940965.

11. Sakellariou E., Argyropoulou E., Karampinas P., Galanis A., Varsamos I., Giannatos V., Vasiliadis E., Kaspiris A., Vlamis J., Pneumaticos S. A Comprehensive Review of COVID-19-Infection- and Steroid-Treatment-Associated Bone Avascular Necrosis: a Multi-Study Analysis. Diagnostics (Basel). 2024;14;3:247. doi: 10.3390/diagnostics14030247.

 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: 20.03.2025. Accepted for publication: 25.04.2025.

Medical Radiology and Radiation Safety. 2025. Vol. 70. № 4

DOI:10.33266/1024-6177-2025-70-4-96-101

K.E. Medvedeva, A.I. Adarova, N.G. Minaeva, I.A. Gulidov, S.N. Koryakin

Comparative Assessment of Dose Distributions During Proton 
and Photon Therapy in Patients with Recurrent High-Grade Gliomas

A.F. Tsyb Medical Radiological Research Centre, Obninsk, Russia

Contact person: K.E. Medvedeva, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract 

Purpose: To compare treatment plans on the Prometheus proton therapy complex (PTC) and a linac in terms of dose distribution parameters and radiation doses on organs at risk.

Material and methods: The study included 20 adult patients who were treated on the Prometheus PTC in 2019–2020 for recurrent malignant gliomas. Comparative planning was carried out in the XIO radiation therapy planning system with the preparation of 3D-conformal photon radiation therapy plans using intensity modulated radiotherapy technology (IMRT) based on one set of contours of the irradiated volumes.

Results: Dose-volume histograms were constructed for all volumes, dose parameters were taken into account to assess the coverage of target volumes and compliance with safety criteria for organs at risk. The average dose to the entire brain volume during proton therapy ranged from 4.54 to 20.63 Gy, the median was 6.74 Gy. The average dose during photon therapy planning ranged from 5.9 to 32.48 Gy, the median was 21.2 Gy. The average difference in radiation load to the entire brain volume was 15.24 Gy (p < 0.001). The mean maximum dose to the brainstem during proton therapy ranged from 0.01 to 51.35 Gy, median 9.77 Gy. The mean dose when planning photon therapy using the IMRT technique ranged from 1.6 to 55.1 Gy, median 44.37 Gy. The mean difference was 34.6 Gy (p < 0.003). The mean maximum dose to the optic nerve during proton therapy ranged from 0 to 25.19 Gy, median 2.15 Gy. The mean dose in the photon therapy plan was
0 to 51.35 Gy, median 21.05 Gy. The reduction in the mean difference in dose load when using proton therapy was 18.9 Gy (p< 0.001).The average maximum dose to the chiasm during intensity-modulated proton therapy ranged from 0 to 32.9 Gy, median 0.38 Gy. A similar dose when calculating photon therapy doses ranged from 1.4 Gy to 54.3 Gy, median 28.47 Gy. The average difference in the dose load on the optic nerve in favor of proton therapy was 28.09 Gy (p< 0.001). The average value of the homogeneity index of protons was 0.16 (CI 95 % 0.14–0.18), photons – 0.13 (CI 95 % 0.11–0.14), p=0.00158.

Conclusion: Proton therapy during repeated courses of radiation therapy demonstrates a significant reduction in the dose load on risk organs when compared with photon therapy on a linear accelerator. Repeated irradiation of high-grade gliomas using an active scanning proton beam is a promising direction due to the reduction in overall toxicity of treatment and the possibility of delivering radiation doses close to radical ones.

Keywords: proton therapy, glioma, glioblastoma, re-irradiation, dosimetric planning

For citation: Medvedeva KE, Adarova AI, Minaeva NG, Gulidov IA, Koryakin SN. Comparative Assessment of Dose Distributions During Proton and Photon Therapy in Patients with Recurrent High-Grade Gliomas. Medical Radiology and Radiation Safety. 2025;70(4):96–101. (In Russian). DOI:10.33266/1024-6177-2025-70-4-96-101

References

1. Чойнзонов Е.Л., Грибова О.В., Старцева Ж.А., Рябова А.И., Новиков В.А., Мусабаева Л.И., Полежаева И.С. Современный подход к химиолучевой терапии злокачественных глиом головного мозга // Бюллетень сибирской медицины. 2014. Т.13. №3. С. 119-125 [Choynzonov Ye.L., Gribova O.V., Startseva Zh.A., Ryabova A.I., Novikov V.A., Musabayeva L.I., Polezhayeva I.S. Modern Approach to Chemoradiation Therapy of Malignant Gliomas of the Brain. Byulleten’ Sibirskoy Meditsiny = Bulletin of Siberian Medicine. 2014;13;3:119-125 (In Russ.)]. doi: 10.20538/1682-0363-2014-3-119-125.

2. Combs S.E., Debus J., Schulz-Ertner D. Radiotherapeutic Alternatives for Previously Irradiated Recurrent Gliomas. BMC Cancer. 2007;7:167. doi: 10.1186/1471-2407-7-167.

3. Lee J., Cho J., Chang J.H., Suh C.O. Re-Irradiation for Recurrent Gliomas: Treatment Outcomes and Prognostic Factors. Yonsei Med J. 2016 Jul 1;57;4:824–30. doi: 10.3349/ymj.2016.57.4.824.

4. Held K.D., Lomax A.J., Troost E.G.C. Proton Therapy Special Feature: Introductory Editorial. Br J Radiol. 2020;93;1107:20209004. doi: 10.1259/bjr.20209004.

5. Durante M., Flanz J. Charged Particle Beams to Cure Cancer: Strengths and Challenges. Seminars in Oncology. W.B. Saunders. 2019;46;3:219–225. doi: 10.1053/j.seminoncol.2019.07.007.

6. Kraft G. Progress in Particle and Nuclear Physics Tumor Therapy with Heavy Charged Particles. Progress in Particle and Nuclear Physics. 2000;45:473–544. doi: 10.1016/S0146-6410(00)00112-5. 

7. Schaub L., Harrabi S.B., Debus J. Particle Therapy in the Future of Precision Therapy. Br J Radiol. 2020;93;1114:20200183. doi: 10.1259/bjr.20200183.

8. Mayer R., Sminia P. Reirradiation Tolerance of the Human Brain. Int J Radiat Oncol Biol Phys. 2008;70;5:1350-60. doi: 10.1016/j.ijrobp.2007.08.015.

9. Nieder C., Milas L., Ang K.K. Tissue Tolerance to Reirradiation. Semin Radiat Oncol. 2000;10;3:200-209. doi: 10.1053/srao.2000.6593.

10. Desai B.M., Rockne R.C., Rademaker A.W., Hartsell W.F., Sweeney P., Raizer J.J, et al. Overall Survival (OS) and Toxicity Outcomes Following Large-Volume Re-Irradiation Using Proton Therapy (PT) for Recurrent Glioma. Int J Radiat Oncol Biol Phys. 2014;90;1:286. doi: 10.1016/j.ijrobp.2014.05.971.

11. Combs S.E., Edler L., Rausch R., Welzel T., Wick W., Debus J. Generation and Validation of a Prognostic Score to Predict Outcome after Re-Irradiation of Recurrent Glioma. Acta Oncol (Madr). 2013;52;1:147–52. doi: 10.3109/0284186X.2012.692882.

12. Baumert B.G., Lomax A.J., Miltchev V., Davis J.B. A Comparison of Dose Distributions of Proton Beams in Stereotactic Confopmal Radiotherapy of Brain Lesions. Int J Radiat Oncol Biol Phys. 2001;49;5:1439-1449. doi: 10.1016/s0360-3016(00)01422-x.

13. Bolsi A., Fogliata A., Cozzi L. Radiotherapy of Small Intracranial Tumours with Different Advanced Techniques Using Photon and Proton Beams: a Treatment Planning Study. Radiotherapy and Oncology. 2003;68;1:1-14. doi: 10.1016/s0167-8140(03)00117-8

14. Kosaki K., Ecker S., Habermehl D., Rieken S., Jäkel O., Herfarth K., et al. Comparison of Intensity Modulated Radiotherapy (IMRT) with Intensity Modulated Particle Therapy (IMPT) Using Fixed Beams or an Ion Gantry for the Treatment of Patients with Skull Base Meningiomas. Radiation Oncology. 2012 Mar 22;7;44:1. doi:10.1186/1748-717X-7-44.

15. Adeberg S., Harrabi S.B., Bougatf N., et al. Intensity-Modulated Proton Therapy, Volumetric-Modulated arc Therapy, and 3D Conformal Radiotherapy in Anaplastic Astrocytoma and Glioblastoma: a Dosimetric Comparison. Intensitätsmodulierte Protonentherapie, Volumenmodulierte Arc-Therapie and Dreidimensionale Konformale Radiotherapie Beim Anaplastischen Astrozytom und Glioblastom: Ein Dosimetrischer Vergleich. Strahlenther Onkol. 2016;192;11:770-779. doi: 10.1007/s00066-016-1007-7.

16. Poel R., Stuessi A., Unkelbach J., Tanadini-Lang S., Guckenberger M., Foerster R. Dosimetric Comparison of Protons vs Photons in Re-Irradiation of Intracranial Meningioma Br J Radiol. 2019;92;1100:20190113. doi: 10.1259/bjr.20190113.

17. Weber D.C., Lim P.S., Tran S., Walser M., Bolsi A., et.al. Proton Therapy for Brain Tumours in the Area of Evidence-Based Medicine. Br J Radiol. 2020;93;1107:20190237. doi: 10.1259/bjr.20190237.

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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: 20.03.2025. Accepted for publication: 25.04.2025.