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Metastases of primary tumors to the brain develop in 20–40 % of cancer patients. Historical information about the origin and development of the stereotactic radiosurgery method are shown, including GammaKnife and CyberKnife. The development of new centers of radiosurgery in the world makes the method more accessible for patients. The article examines the modern treatment algorithm for cerebral metastases and the place of stereotactic radiosurgery as a high-dose conformal ablative treatment of selected metastatic lesions in the management of these patients. It is shown that radiosurgery provides a high level of local control and survival, similar to surgical resection.The results of trails with combination of the stereotactic radiosurgery and total brain radiation therapy in patients with solitary and multiple lesions are reported. It is shown that the radiosurgery allows to avoid total irradiation in case of solitary metastasis, and also in case of multiple lesions, without affecting the survival. That, probably, helps to preserve neurocognitive function and quality of life for patients with good performance status according to Karnofsky scale (index ³ 70). We also discuss the possibility of stereotactic irradiation of postoperative cavity. The concept of radiosurgery is not divided upon the treatment platform.

The aim of this study was to study the effectiveness of stereotactic radiosurgery by Gamma Knife in kidney cancer with brain metastases. There were analyzed results in 112 patients with such spread of the disease who received treatment in the Gamma Knife Center, Moscow. The median age of patients was 58 years (range, 33-77 years). Total number of metastatic lesions was 444, and the average number of brain metastases in one patient 4 (from 1 to 30). A single brain metastasis had 28 patients (25 %). Median of total volume of brain metastasis for each patient was 5. 9 cm3 (from 0. 1 to 29,1sm3). Mean marginal dose for metastatic lesion was 22 Gy (from 12 Gy to 26 Gy) and the average value of isodose, on which planning was performed - 64% (from 39% to 99%). The overall survival after radiosurgery was 37,7%, 16,4% and 9,3% for 12, 24 and 36 months, respectively, with a median overall survival of 9,1 months (95% CI = 7,1-11,8). New brain metastases after radiosurgical treatment occurred in 44 (54,3%) patients with a median of 10,1 months. (95% CI = 7-18). Local recurrences after radiosurgical treatment were detected in 19 (17%) patients with a median of 6,6 months (95% CI = 4,0-9,6). The Karnovsky index was >80. Local control was achieved in 96% of metastatic lesions in 87% of patients. Side effects of radiosurgical treatment occurred in 33. 8% of patients (6% radionecrosis and 23. 8% an increase of perifocal edema). Thus stereotactic radiosurgery by Gamma Knife is an effective treatment option for brain metastases in kidney cancer providing a high level of local control of metastatic lesions with minimal neurotoxicity. In a case of distant recurrence reuse of such treatment provides good local control and improves overall survival compared with other methods of treatment.

Compared with surgical treatment the combined treatment of patients with non-small cell lung cancer accompanied by post-operative radiotherapy in the mode of hypofractionation from 3 Gy to SOD-36-39 Gy (EQD2 = 43,2-46,8 Gy) allowed statistically significant increasing a 5- and 10-year overall and disease-specific survival in patients with metastases to regional lymph nodes (pN1-2). The increase of overall and disease-specific survival was also observed in patients older than 60 years with the worst initial status (70-80 by the Karnofsky scale), II stage of disease, peripheral cancer and adenocarcinoma however for these groups survival differences did not reach a statistically significant level. The presented method of postoperative irradiation did not have severe toxicity and did not lead to a decrease in survival of elderly and functionally debilitated patients.

The results of surgical and combination therapy of 302 patients with benign tumors of the anterior and middle regions of the skull base with allowance for the functional outcomes (immediately after surgery and during the catamnestic follow-up) are reported. The Karnofsky and Rankin scales and the Anterior Skull Base Questionnaire (ASBQ) were used for the analysis. Radical tumor resection, as compared to partial resection, reduces the quality of life in the early postoperative period but increases it in future; the use of radiation therapy in combination treatment for patients with radically inoperable tumors does not worsen their quality of life in the late postoperative period.

In our study the analysis of significant predictors affecting the results of treatment of anaplastic astrocytoma brain (grade III) is showed. According to our data to assess the effectiveness of special treatment of these patients is possible with such clearly defined predictors such as age, volume of surgery, initial tumor size and functional status (the Karnofsky index). The study demonstrates that in patients who underwent radiotherapy using single focal dose of 3 Gy overall survivals was comparable with the group of patients who underwent radiation therapy using small dose fractionation. The use of adjuvant chemoradiotherapy in patients with grade III glioma does not increase overall survival rate compared with patients who received only adjuvant radiotherapy.

Introduction: Every year the number of cancer patients increases due to increased life expectancy. According to various sources, metastases in the spine are found during autopsy in 30-90% of patients with a history of cancer. So far, there have been no full-scale studies of the quality of life of patients with various metastatic tumors of the spine who underwent surgical treatment in Russian literature. The main objective of this study was to demonstrate the need for implementing the comprehensive treatment of patients with metastases in the spine and target setting as the main tool to identify the factors that adversely affect the patients' quality of life., Material and Methods: The quality of life of 56 patients aged 16 to 81 years was assessed, including 26 males and 30 females. Twenty-six patients underwent surgical treatment between 2002 and 2009, and thirty patients underwent surgical treatment between 2009 and 2014. Kidney cancer was a primary disease in 30.3% of patients, multiple myeloma was a primary disease in 23.1% of cases, and the primary source of a tumor was not identified in cancer screening in 10.5% of cases. There were also isolated cases of melanoma, thymoma, metastases of tumors of the gastrointestinal tract, uterus, ovary, lung, prostate, pancreas, and the thyroid gland, which on the average amounted to 3.5% (1.8 to 7.14%). The quality of life of patients was studied using the EORTC QLQ C30 scale. The patients were surveyed prior to the surgery and then 1, 3, 6 and 12 months after surgical treatment during 1 year or until death. Preoperative and postoperative contrast-enhanced SCT and MRI examinations were used to control the extent of decompression of neural structures., Results: On the basis of these findings, the authors identified the main factors affecting the quality of life of patients and formulated a range of treatment goals for patients with metastases in the spine., Conclusion: Surgical treatment has a positive effect on the quality of life of patients with metastases in the spine. However, it is not a key factor in the context of survival rate of these patients. Therefore, a decision on the possibility and necessity of surgical treatment should be taken in cooperation with the patient and oncologists of different specialties.

Background: Aim of this study was to evaluate the role of physical rehabilitation to improve the quality of life (QOL) of people after kidney transplantation., Patients and Methods: Analyzes the results of treatment of 57 recipients (mean age 35 +/- 9.65 years) donor kidney at different times of the postoperative period. Depending on the physical rehabilitation program allocated 3 groups of patients: group II--physical rehabilitation was carried out only in the first week after surgery to prevent early postoperative complications, in group I--during the year; in group III combined 30 relatively healthy people do not need an organ transplant and with a mean age 33.7 +/- 8.7 years, leading a normal life, not engaged in regular recreational physical culture. Quality of life was assessed using a questionnaire SF36 at 1, 3, 6 and a 12 months after surgery., Results: One year after surgery in both groups compared with preoperative indicators marked improvement according to all scales of the questionnaire. However, in group I indicators of quality of life were higher than in group II from 11.4 to 19.7%, and even some items questionnaire SF-36 is higher than in group III which is associated with the physical rehabilitation., Conclusion: It has been shown that exercises is an important component of treatment and rehabilitation after kidney transplantation and help improve both the psychological and the physical component of quality of life.

Brain metastases (BM) are the most frequent intracranial SOL and extremely heterogeneous group of tumours from morphological point of view. Nevertheless, studies devoted to BM up to now paid little attention to the histogenesis of the primary tumour. Lung carcinoma is the most common source of BM; morpologically this is a very heterogeneous group of tumors, and they demostrate different clinical pathway and outcome. The aim of present study was to evaluate clinical and morphological prognostic factors in 126 patients with lung carcinoma metastases to the brain, operated in 2004-2010 at Burdenko Neurosurgical Institute. Statistical analysis demonstrated that age, gender, amount and location of BM, primary operation and even histological tumour type were not significant prognostic factors, meanwhile absence of extracranial metastases and Karnofsky index above 70 were significant factors of the favorable prognosis.

One of the main gliomas treatment programs development criteria is still the morphology, the RPA classification with risk factors developed for high-grade tumors is rarely taken into consideration. In our study shows a high value on the criterion of overall survival identified in the classification of the six RPA classes. The most important factors in the RPA classification are patient's age and the Karnofsky performance scale value. RPA classification can be useful for new treatment strategies development.

The objective of the present study was to develop and introduce into clinical practice the method for the estimation of the quality of life in the patients with vestibular disorders as a measure of the efficacy of their treatment and as a diagnostic criterion to be used in regular medical examinations. Sixty eight patients presenting with total cochleovestibular syndrome were interviewed for the elucidation their quality of life using the questionnaire specially developed by the researchers of the Department of Otorhinolaryngology, I.I. Mechnikov Sankt-Peterburg State Medical Academy, in accordance with the internationally accepted guidelines. Special attention was given to the determination of significant changes indicative of the severity of the pathological process at different periods of time. It is concluded that the questionnaire designed to estimate the quality of life of the patients provides an efficacious diagnostic tool for the estimation of the health status of the subjects with vestibular dysfunction that reflects the patient's self-assessment. Such information is impossible to obtain by objective diagnostic methods, such as computed videooculography.

The treatment results of 396 patients with morphologically verified grade 3-4 malignant brain tumors receiving conventional irradiation regimen and irradiation by medium-sized fractions were analyzed to form institutional guidelines.The standard mode of fractionation with a single dose of 2 Gy and total focal dose (TFD) of 60 Gy is appropriate for patients with initial Karnofsky status of 60-100% and Recursive Partition Analysis (RPA) class I-III. TFD increase to 60-62 Gy in grade 4 gliomas and 54-56 Gy in grade 3 gliomas grants a significant improve in overall survival. An increase of a single irradiation fraction to 3 Gy may be used for patients with initially low functional status (Karnofsky 30-50%) and RPA classes IV-VI. In these cases it is advisable to use the TFD of 45 Gy or more (TFD of equivalent regimen with a dose greater than 54 Gy). The mentioned fractionation regimens could be recommended for the use in clinical practice to improve the results of high-grade gliomas treatment.

The retrospective study revealed the 15% relapse rate in patients with stage II-IV unfavorable prognosis Hodgkin lymphoma, 5-year OS in relapsed patients was 84%. Karnofsky score less than 80 (p=0,0001), more than 1 extranodal lesion (p=0,0004), extensive (equal to stage III-IV) involvement on relapse (p=0,001), b-symptoms on relapse (p=0,023), more than 5 lymph nodal lesions (p=0,027), albumin level less than 40 g per liter (p=0,037), detection of new nodal lesions (p=0,041) were shown by discriminative analysis as the therapy effect predictors in patients with Hodgkin lymphoma relapse. In patients with second-line therapy failure the actuarial survival rate was lower by 55% in comparison to patients with chemosensitive relapses (40% and 95%). The secondary therapy resistance was shown to be an unfavorable prognosis predictive factor (p=0,0001). The multifactorial overall survival analysis revealed the following adverse prognostic factors: failure of second-line treatment (p=0,0001), first early relapse (p=0,01), albumin level on relapse less than 40 g per liter (p=0,02), use of standard chemotherapy instead of irradiation (p=0,02). The relapse patients with 1 or less risk factors had 95% 5-year OS, the patients with 3 or more adverse risk factors had 70% OS (p=0,0002). The lowest 10-year OS was observed in patients with 2 or more adverse risk factors, 48% and 28% accordingly. Adverse risk factors must be considered while choosing the optimal treatment strategy aimed at better survival rate.

Effectiveness and safety of regional chemoinfusion in combination with radiation therapy in patients with breast cancer with metastases to the brain was clinically assessed. Cerebral angiography with chemoinfusion was fulfilled in six patients. The procedure could not be fulfilled completely in one patient because of transient vascular and neurological disorders. In the other five patients the regional superselective chemoinfusion was fulfilled successfully to the arteries feeding the metastatic foci in the brain with Carmustin in dosage 100 mg in combination with radiation therapy that was fulfilled in all six patients before the planned total focal dose. The incomplete response (n=5) to the treatment and stabilization of the process (n=l) were noted in six observations.

Brain metastasis is an important issue in modern neurooncology. Our results of combined treatment of brain metastases are presented and available approaches to brain irradiation and chemotherapy are discussed. There is strong evidence to suggest that maximum combinations of approaches might improve treatment efficacy and extend median overall survival to as long as 6 months (p < or = 0.05).

The investigation included 340 patients with cerebral gliomas. Under analysis there were age, gender, neurological status and Karnovsky status before and after operation, localization of the tumor, type and volume of surgical intervention, postoperative complications. It was shown that radical extirpation of glial formations facilitated more favorable course of the postoperative period. Partial ablation of gliomas is associated with greater risk of the development of postoperative complications and neurological dysfunctions. As the main method of surgical treatment of patients with gliomas located in the functionally significant and deep areas of the brain stereotaxic cryotomy is thought to be indicated.

In the paper we describe a rare case of intraventricular recurrence of melanoma metastasis treated by endoscope-assisted surgery. Total resection was performed using microsurgical approach with endoscopic assistance. Full regression of neurological deficit, physical rehabilitation and recurrence-free 6-month follow-up was achieved in this case.

The paper discusses pre- and intraoperative application of different guiding techniques (frameless neuronavigation, fMRI, electrophysiological monitoring). We performed comparative analysis of different combinations of these methods. 74 patients with intracerebral tumors involving eloquent areas (sensorimotor cortex in 56 and speech zones in 18) were operated. In 9 cases 'awake surgery' was applied. We found that frameless navigation combined with brain mapping allows to optimize planning of surgical approach and to decrease postoperative neurological deficit. Also in certain cases 'awake craniotomy' can be replaced by fMRI and neuronavigation.

Data on the treatment of 278 patients with brain tumors grade III-IV were evaluated, end-results compared and relevant prognostic factors identified. In our view, average fractionated radiotherapy is not inferior to standard fractionation modalities. It offers an advantage of using different single target doses. In primary patients with high-grade malignancies, an index (Karnofsky) of less than 60% appeared to be the most significant practical factor of prognosis. Both age and tumor size proved significant.

Our experience of kalumide (bikalutamide) administration in patients with prostatic cancer agrees with the data of other investigators on a good effect of the drug on quality of life of patients with prostatic cancer.

Our investigation was aimed at establishing a relationship between single metastases in the brain and a set of prognostic factors. It involved 278 patients treated at the Center in 1983-2003. The whole brain was irradiated in 273 while 159 of them (58.2%) received additional local irradiation of the brain. Single dosage of 2-2.5 Gy was administered to 158 (57.9%), 115--3Gy and more (42.1%). Mean total dosage was 36 Gy per metastasis for the whole brain and 46 Gy--for total plus local exposure. Among patients with favorable prognosis (RPA) were those aged up to 65, Karnofsky's index > or = 70%, with cured or controllable tumor and without extracranial metastases; poor prognosis--Karnofsky's index < or = 70%, irrespective of any other prognosticators, and intermediate prognosis--the remaining cases. The following four treatment modalities were used: 1) surgery --> radio- or radiochemotherapy (40); 2) chemotherapy > or = radiotherapy --> chemotherapy successively (56); (3) radiotherapy alone (110) and (4) simultaneous radiochemotherapy (72).

The authors summarize in the article experience of a new anticancer drug Polyplatillen use in the chemotherapy of advanced pancreatic cancer. Polyplatillen use in the palliative chemotherapy in the patients with advanced pancreatic cancer permits to realize a control of pain and stabilize an ECOG status. Tendency to the improvement of total survival during an early period was registered in the group of patients with advanced pancreatic cancer who were treated with Polyplatillen.

Central neurocytoma (CN) is a rare brain neoplasm which is characterized by certain clinical, radiological, and morphological characteristics. This tumor was first described in 1982 by J. Hassoun et al. who found neurosecretory granules and microtubules while microscopically studying 2 patients with oligodendrogliomas of lateral ventricles and concluded that these neoplasms were of neuronal origin. Materials and methods. In 1992 to 2004, a total of 84 patients diagnosed as having CN were treated at the Academician N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences. In most cases, the tumor showed a clinical picture as elevated intracranial pressure that was detected in 80 (more than 90%) cases. In this series, all neurocytomas were located in the ventricles, mainly in the pellucid septal region; tumor infiltration of the lateral ventricular ependyma and medullary substance invasion into the region of the thalamus and corpus callosum. Computed tomographic scans displayed central neurocytomas as space-occupying lesions of mixed (heterogeneous) density, which frequently contained single and multiple petrificates and cysts. TI-weighted magnetic resonance imaging (MRI) indicated that in most cases (n=56, 66%), the intensity of a signal from the tumor was mixed and similar to that of the white matter of the brain. These masses were characterized by the presence of tumor structural cysts that were better visualized on T2-weighted tomograms. The tumor was removed in 83 cases; 2 out of them had previously undergone stereotactic biopsy (STB). STB was performed alone in one case. Transcallous, transcortical-through-premotor-area, combined, and transcallous-transcortical approaches were applied when the neurocytomas were removed. Results. Total removal of a tumor (when its remains were not visualized by postoperative MRI) was achieved in 11 (13%) patients. Its subtotal removal was accomplished in 48 (58%) patients. Partial removal was done in 24 (29%) patients. In the early postoperative period after tumor removal, there was a worse health status along with a transient progression of cerebral and focal symptoms in most patients with CN. The magnitude, pattern, and duration of these changes differed. Conclusion. The long (from several months to several years) history of the disease and young age (14 to 59 years) are typical of patients with CN. The tumors are located intraventricularly, more commonly along the midline, and they have well-defined X-ray signs: these are well-circumscribed tumors of heterogeneous density, which frequently contain single and/or multiple cysts and petrificates; there is a moderate contrast enhancement. The basic way of improving the results of treatment in patients with CN is the latter's early diagnosis and surgery when the tumor is locally advanced within the ventricular system.

A retrospective cohort analysis of the results of treatment of patients with malignant gliomas was made in 2 groups, each comprising 43 patients. In Group 1, the tumors were radically removed under neuronavigation guidance ("Voyager SX"). In Group 2 where the patients were operated on by the same team of surgeons who did not employ computer-assisted navigation technologies. The results of different adjuvant therapy regimens were analyzed in patients after radical tumor removal under navigation guidance (Group 1). In its first subgroup, 24 patients with anaplastic astrocytes were postoperatively irradiated (60 Gy), followed by treatment with temodal (200 mg/m2 (mean 6 courses). In the second subgroup, 12 patients received chemoradiotherapy (temodal, 75 mg/m2 daily + irradiation), followed by courses (n=6) of temodal, 200 mg/m2). In the third subgroup, 7 patients were treated with fotemustin (200 mg/m2 (induction) + 5 cycles). The computer-assisted technologies substantially improve a postoperative outcome in patients with malignant glionas. Current chemoradiotherapy is relatively safe and prolongs a relapse-free interval with a high quality of life. Further studies call for the efficiency of different adjuvant therapy regimens after radical surgery.

The authors proposed a possible preoperative diagnostics of the degree of supratentorial brain gliom anaplasia using statistical analysis methods. It relies on a complex examination of 934 patients with I-IV degree anaplasias, which had been treated in the Institute of Neurosurgery from 1990 to 2004. The use of statistical analysis methods for differential diagnostics of the degree of brain gliom anaplasia may optimize a diagnostic algorithm, increase reliability of obtained data and in some cases avoid carrying out irrational operative intrusions. Clinically important signs for the use of statistical analysis methods directed to preoperative diagnostics of brain gliom anaplasia have been defined

The paper discusses the criteria of quantitative presentation of data on individual sensitivities and the body's vital systems potential used in treatment of cancer patients. An index is suggested to assess damage done to a system using an "automated classifier".

Results of treatment of 28 patients with locally advanced rectal cancer are analyzed. Abdomino-perineal extirpation of the rectum with colostomy was performed in 11 patients, abdomino-anal resection with colo-anal anastomosis--in 10, Hartmann's operation--in 7. In 18 cases resection of the posterior wall of the urinary bladder was performed simultaneously, in 3--resection of the ureter with allotransplantation, in 5--supravaginal amputation of the uterus. Eleven patients survive one year after surgery. General status evaluated with Karnovsky's scale was 80-90% in 5 patients, 60%--in 4, and 40% in 2 patients. Seven patients survive three years after surgery. Karnovsky's scale index was 80% in 3 patients of them, 60%--in 3, and 30%--in 1 patient. Four patients survive 5 years with 60% (3 patients) and 40% (1 patient) general status index. It is recommended to perform combined surgeries for rectal cancer in invasion of the tumor into neighbouring organs. They don't make worse immediate results of treatment and relieve patients of complications due to spread of rectal cancer into the urinary organs.

The report presents data on conservative treatment of pleuritis induced by metastases from tumors of different localization by bleomycetin. After the pleural cavity was drained dry in 24 patients, bleomycetin 45 mg was introduced into it. The latter procedure was repeated in 6 cases because profuse exudation continued. The results were evaluated by clinical and roentgenological means. Bleomycetin treatment was painless. Mean drainage duration was 3.8 days, admission time--6.2 days. Stable remission was recorded in 16 patients, partial--7. Pneumonia (2) and chronic empyema (1) were observed as complications. Bleomycetin-induced pleurodesis correlated with exudate pH: a pH value in excess of 7.3 made a patient good candidate for carrying out the procedure. According to Karnofsky index for long-term results, life quality of the patients improved. Eleven patients survived for 1 year after pleurodesis, and 2--more than two years.

A retrospective analysis of the results of treatment of 123 patients with large and giant basal extracerebral parastem tumors was made. The majority of the neoplasms (81%) were acoustic neuromas and meningiomas. The nearest results of the treatment were good in 103 patients and unfavorable results were noted in 20 patients. Postoperative mortality was 8.9%. Four factors negatively influencing the outcome were revealed during the statistical analysis (p < 0.05): low Karnofsky score at admission, regrowth (recurrence) of the tumor, previously performed radiation therapy and shunt surgery as the first stage of treatment. These prognostic factors must be taken into account when choosing the best treatment of patients with parastem tumors.

Recormon was given to 34 patients on hemodialysis. The drug's effects on quality of life were judged by the results of clinical, laboratory, experimental and psychological dynamic investigations. The highest effect occurred on the therapy month 6-12. Recormon contributed to relief of asthenic and depressive syndromes, to an increase of activity and improvement of well-being, quality of life by Karnofsky scale within the first year of treatment. The dynamics of life quality changes depended on initial psycho-physical condition of the patients, the age, blood pressure, hematocrit. Recormon treatment is associated with the risk of euphoria.

The paper analyses the reasons for different variations from the calculation of KT/V(ur) by using 9 mathematical models. Analysing the survey data on 120 randomly selected patients on chronic hemodialysis has led to the conclusion that the data obtained by models 1, 3, and 5 more greatly depend on the patient's body compartmentization during a dialysis session than those by models 2, 8, 9 and they generally lower KT/V calculations as they overestimate the urea distribution volume, while with models 2, 8, and 9 the resultant dialysis dose is calculated with less errors.