Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 6. P. 59 –64

RADIATION THERAPY

DOI: 10.12737/article_5c0b90d10ff212.78053112

V.A. Solodkiy, V.M. Sotnikov, S.D. Trotsenko, V.P. Kharchenko, V.D. Chkhikvadze, N.V. Nudnov, G.A. Panshin, A.A. Morgunov

Non-Small Cell Lung Cancer Recurrences After Surgical and Combined Modality Treatment with Postoperative Radiation Therapy

Russian Scientific Center of Roentgenoradiology, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

V.A. Solodkiy – Dr. Sci. Med., Prof., Academician of RAS, Director; V.M. Sotnikov – Dr. Sci. Med., Prof., Head of Lab.;
S.D. Trotsenko – PhD Med., Radiologist; V.P. Kharchenko – Dr. Sci. Med., Prof., Academician of RAS, Scientific Supervisor;
V.D. Chkhikvadze – Dr. Sci. Med., Prof., Head of Dep.; N.V. Nudnov – Dr. Sci. Med., Prof., Deputy Director;
G.A. Panshin – Dr. Sci. Med., Prof., Head of Dep.; A.A. Morgunov – Senior Researcher

Abstract

Purpose: To compare the patterns of the relapses after the surgical and combined modality treatment of non-small cell lung cancer (NSCLC) with the postoperative radiotherapy (PORT).

Material and methods: The comparative evaluation of the patterns of the relapses was carried out in 528 NSCLC patients with the IA–IIIB stage after surgical treatment (n = 174) and combined modality treatment (n = 354) using PORT in the hypofractionation regimen 3 Gy/fraction, 5 times a week, TD 36–39 Gy (EQD2 = 43.2–46.8 Gy, α/β = 3) and classical fractionation 2 Gy/fraction, 5 times a week, TD 44 Gy.

Results: The local and the regional relapses developed from 2 to 59 months after treatment, most often in the first three years of follow-up (median 15 months). The local and the regional relapses were statistically significantly more frequent in the surgical treatment group (31.6 % vs 7.1 %). The frequency of the distant metastases in the both groups was not statistically different (46.6 % vs 42.3 %), however, in the surgical treatment group, the distant metastases were more often combined with the locoregional relapses (18.4 % vs 4.5 %). Surgery+PORT in comparison with surgical treatment alone reduces the incidence of locoregional recurrence at the central location of the tumor (8.8 % vs 40.0 %), peripheral non-small cell lung cancer (5.2 % vs 26.0 %), with squamous histological type of tumor (8.4 % vs 37.5 %) and in adenocarcinoma (4.6 % vs 26.4 %), regardless of the volume of surgical treatment (pneumonectomy – 7.0 % vs 47, 1 %, p = 0.0002, lobectomy and bilobectomy – 7.1 % vs 20.6 %, p = 0.001, segmentectomy – 7.1 % vs 50.0 %, p = 0.0001). In the subgroup of patients undergoing adjuvant chemotherapy and PORT, the local, regional and locoregional relapses were statistically significantly less common than in the group of non-small cell lung cancer patients who received only adjuvant chemotherapy (3.9 % vs 17.5 %, p = 0.002, 5.4 % vs 23.8 %, p = 0.001, 6.2 % vs 36.5 %, p = 0.0001). The number of combined relapses (local and/or regional relapses + distant metastases) was actually four times less in all subgroups of patients with PORT (4.7 % vs 20.6 %, p = 0.001).

Conclusion: PORT as the part of combined treatment of non-small cell lung cancer statistically significantly reduces the incidence of the local, regional, locoregional and combined relapses in the squamous cell lung cancer and adenocarcinoma, central and peripheral localization of the tumor, after surgical treatment in the volume of pneumonectomy, lob-bilobectomy and segmentectomy, and when using with or without adjuvant chemotherapy.

Key words: lung cancer, surgical treatment, combined modality treatment, postoperative radiation therapy, the characteristic of recurrences

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For citation: Solodkiy VA, Sotnikov VM, Trotsenko SD, Kharchenko VP, Chkhikvadze VD, Nudnov NV, Panshin GA, Morgunov AA. Non-Small Cell Lung Cancer Recurrences After Surgical and Combined Modality Treatment with Postoperative Radiation Therapy. Medical Radiology and Radiation Safety. 2018;63(6):59-64. (Russian).

DOI: 10.12737/article_5c0b90d10ff212.78053112

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

Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 6. P. 71 –81

REVIEW

DOI: 10.12737/article_5c0eb50d2316f4.12478307

M.V. Vasin¹, V.Yu. Solov’ev², V.N. Mal’tsev², I.E. Andrianova², S.N. Luk’yanova²

Primary Radiation Stress, Inflammatory Reaction and the Mechanism of Early Postradiation Reparative Processes in Irradiated Tissues

1. Russian Medical Academy of Continuous Professional Education, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia.

M.V. Vasin – Prof. of the Department, Dr. Sci. Med., Prof.; V.Yu. Soloviev – Head of Lab., Dr. Sci. Biol., PhD Tech.;
V.N. Mal’tsev – Leading Researcher, Dr. Sci. Med., Prof.; I.E. Andrianova – Leading Researcher, Dr. Sci. Med.;
S.N. Luk’yanova – Сhief Researcher, Dr. Sci. Biol., Prof.

Abstract

The products of radiolysis released from cellular compartment under the influence of ionizing radiation: highly mobile groups of proteins, damaged nuclear and mitochondrial DNA, extracellular ATP and oxidized low density lipoproteins, cause stress activation in irradiated tissues through a pattern of the receptors with start of the cascade r53 and NF-κB of pro-inflammatory ways conducting to an expression of pro-inflammatory genes stimulating synthesis of cytokines of the IL-1 family. Excessive activation of pro-inflammatory way under the influence of a radioactive stress is limited to synthesis, anti-inflammatory cytokines: IL-4, IL-10, IL-11, IL-13 and also antagonists of IL-1 receptor and TGF-β. G-CSF and MG-CSF induced by action of pro-inflammatory cytokines have anti-inflammatory and anti-apoptotic properties decreasing level of pro-inflammatory cytokines IL-6 and TNF. Glucocorticoids participate in regulation of primary radioactive stress, suppressing an excessive expression of genes of pro-inflammatory cytokines. Increased IL-1 level stimulates secretion of corticosteroids through mechanism of feedback. Adrenergic stimulation is capable to raise a gene IL-1β expression.

The mechanism of radiation apoptosis of stem cells is implemented through p53-Puma way which blocks interaction anti-apoptotic proteins of Bcl-2 with pro-apoptotic proteins of Bax and Bak. After release from mitochondrion of cytochrome C and apoptosis-inducing factor there is an activation of effector cаspаses: caspases 3, 6 and 7 through caspase 9, and final cell destruction.

Wnt way is crucial for post-radiation repair. Potential of the regenerative response of hemopoietic tissue to radiation injury depends on catenin and ability of Wnt way to stimulate post-radiation bone marrow reparation. Mesenchymal stem cells of bone marrow play a large role in post-radiation regeneration of hemopoietic tissue. Their main action is carried out through TLR2 and TLR4 receptors. Mobilization of hemopoietic stem cells is bound to release proteases from bone marrow, including neutrophil elastase and cathepsin G, and a matrix metalproteinase-9.

Radioprotective properties of exogenous IL-1 aren’t limited only by induction of raised G-CSF and GM-CSF production. The larger role in radiation protection is played by the reaction induced by IL-1 in the form of feedback with production anti-apoptotic and anti-inflammatory factors. Primary radioactive stress limits time of radiomitigable effect of IL-1 by 1–2 h after its application after radiation.

Key words: primary radiation stress, proinflammatory cytokines, interleukin-1β, anti-inflammatory cytokines, granulocyte-colony stimulating factor, postradiation blood reparation

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For citation: Vasin MV, Solov’ev VYu, Mal’tsev VN, Andrianova IE, Luk’yanova SN. Primary Radiation Stress, Inflammatory Reaction and Mechanism of Early Postradiation Reparative Processes in Irradiated Tissues. Medical Radiology and Radiation Safety. 2018;63(6):71-81. (Russian).

DOI: 10.12737/article_5c0eb50d2316f4.12478307

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Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 6. P. 65 –70

RADIATION PHYSICS, TECHNOLOGY AND DOSIMETRY

DOI: 10.12737/article_5c0e7486915d55.10064971

A.O. Lisovskaya^1,2, A.A. Loginova¹, K.A. Galich², V.N. Belyaev², A.V. Nechesnyuk¹

Evaluation of the Dose Index Using Cone-Beam Computed Tomography for Pediatric Patients

1. Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. National Research Nuclear University MEPhI, Moscow, Russia

A.O. Lisovskaya – Medical Physicist, Post-Graduate Student; A.A. Loginova – Senior Medical Physicist, PhD Applicant;
K.A. Galich – Student; V.N. Belyaev – Dr. Sci. Phys.-Math., Prof.; A.V. Nechesnyuk – Head of Dep., PhD Med.

Abstract

Purpose: Cone-beam computed tomography (CBCT) is an indispensable procedure for accurate patient positioning during radiation therapy (RT) in many clinical cases. However, the patients get an additional dose using CBCT. This dose is neither therapeutic nor diagnostic. It is very difficult to obtain the reliable information about the dose distribution within the patient using the CBCT. Despite this, there is a need to control the additional dose for the pediatric patients and reduce it. There are different approaches of imaging dose evaluation. Most accurate methods are based on the Monte-Carlo calculation and thermoluminescent dosimeters-based measurements. However, the implementation of these methods is complex and cumbersome, that makes impossible their application in routine clinical practice. The evaluation of dose indexes is an accessible and convenient alternative. The purpose of this study is evaluation of the cone beam computed tomography dose indexes for different imaging protocols and object sizes.

Material and methods: The technique based on absolute and relative dose measurements for CBCT was used in this study. Absolute dose measurements were performed at the periphery and center of the FREEPOINT (CIRS) phantom using the Farmer type chamber FC65-P for each CBCT protocols. FREEPOINT (20 cm height, 30 cm width, 30 cm length) was used for imitation big chest and pelvis. Inner insert (16 cm diameter) of the phantom was used for imitation head, small chest and pelvis. The dose profiles were measured using I’mRT MatriXX (IBA) and analyzed by OmniPro-I’mRT software, dose indexes DLP (dose–length product) were calculated.

Results: The dose indexes were identified for five protocols corresponding three scanning areas (Head and Neck, Chest and Pelvis). The dose indexes were 51.82 and 90.25 mGy×cm using Head and Neck S20 and Head and Neck M20 protocols respectively. The lowest dose index was obtained 13.28 mGy×cm for Fast Head and Neck S20.
It was established that the scanning object size strongly affects on the dose index values and, as result, on the absorbed dose within the patient. The dose indexes were 305.42 and 187.53 mGy×cm using scanning protocol Chest M20 for small and big phantoms respectively. The similar results were obtained for scanning protocol Pelvis M15. The highest dose index was obtained 846.93 mGy×cm for the small phantom, while the dose index was 563.79 mGy×cm for the big phantom.
The necessity of several clinical protocols to scan different areas was shown. Using of the Pelvis M15 protocol for head scanning may increase the additional point dose 96 times in comparison with Fast Head and Neck S20 protocol.

Conclusion: The dose indexes were evaluated taking into account the size of the scanning object for different imaging protocols. Routine use of CBCT in clinical practice requires a sensible choice of the scanning protocol based on the results of the dose index estimation.

Key words: IGRT, CTCB, dose index, scanning protocols, visualization dose

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For citation: Lisovskaya AO, Loginova AA, Galich KA, Belyaev VN, Nechesnyuk AV. Evaluation of the Dose Index Using Cone-Beam Computed Tomography for Pediatric Patients. Medical Radiology and Radiation Safety. 2018;63(6):65-70. (Russian).

DOI: 10.12737/article_5c0e7486915d55.10064971

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Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 6. P. 82

DISCUSSION

DOI: 10.12737/article_5c0b8b4bcd76d1.44560283

A.R. Tukov, O.G. Kashirina

To the article of T.V. Azizova, E.V. Bragin, N. Hamada, M.V. Bannikova
«Risk Assessment of Senile Cataract Incidence in a Cohort of Nuclear Workers
of Mayak Production Association»

A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

A.R. Tukov – Head of Lab., PhD Med.;
O.G. Kashirina – Leading Researcher, PhD Med.

For citation: Tukov AR, Kashirina OG. To the article of T.V. Azizova, E.V. Bragin, N. Hamada, M.V. Bannikova «Risk Assessment of Senile Cataract Incidence in a Cohort of Nuclear Workers of Mayak Production Association». Medical Radiology and Radiation Safety. 2018;63(6):82. (Russian).

DOI: 10.12737/article_5c0b8b4bcd76d1.44560283

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