METHOD OF DIAGNOSTICS OF RELAPSES STATES OF PILOCYTIC ASTROCYTOMA OF THE BRAIN AFTER THE RADIOTHERAPY AND TREATMENT AT DETECTION OF RELAPSES OR OTHER CONDITIONS Russian patent published in 2019 - IPC A61B5/55 

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, radiology, radiosurgery in oncology, diagnostics using magnetic resonance imaging with relapsed states of pilocytic astrocytomas of the brain after radiation therapy and treatment for the detection of relapses or other conditions. With the revealed pilocytic astrocytomas of intracranial localization after the course of treatment in the form of radiation therapy and/or radiosurgery during the first 12 months after the course of radiotherapy and/or radiosurgery according to the MRI data of the head with contrast enhancement (c/e) in the case of an increase in the tumor volume by more than 20–25 %, in the absence of clinical deterioration, the tumor pseudo-progressive condition is diagnosed. During the first 12 months after the course of radiotherapy and/or radiosurgery according to the MRI of the head with c/e in the case of an increase in tumor volume by more than 20–25 %, taking into account both cystic and a solid component of the tumor, and reveal the expansion of the zone of accumulation of contrast on T1-weighted images (WI), and also with the expansion of the zone of the altered signal on T2-WI, the state between tumor progression and pseudo-progression is diagnosed. Further, if a clinical deterioration is recorded in the dynamics with a further increase in tumor volume, a recurrence of the pilocytic astrocytoma of the brain is diagnosed. If a further increase in tumor volume is recorded in the absence of clinical deterioration, a pseudo-progression is diagnosed. For the treatment of patients diagnosed by this method, the following is used. In the state of pseudo-progression, specific antitumor treatment is not prescribed and further dynamic monitoring examination of the MRI of the head with c/e is carried out. With an increase in tumor volume on MRI with deterioration of the condition in the form of focal and/or cerebral neurological symptoms – a state on the Karnofsky score of 80 points and above, perform anti-edematous therapy using dexamethasone 0.15 mg/kg of body weight per day, dividing into 2–3 doses for 10–15 days, stabilizing the patient's condition, conduct further dynamic monitoring. In the absence of the effect of anti-edematous therapy and further deterioration of the state – according to the Karnofsky score, less than 80 points, and also in the presence of signs of increased intracranial pressure and/or occlusive hydrocephalus, the mass effect is surgically eliminated.

EFFECT: inventions provide detection of pseudo-progression in patients with pilocytic astrocytomas, who have undergone radiotherapy, which allows the transfer of more than 90 % of patients with signs of an increase in the tumor volume in the early periods after irradiation from the category of patients with tumor recurrence to the category of patients with pseudo-progression, and exclude them from further antitumor treatment that they do not need (repeat operations, chemotherapy, repeated radiation therapy), exclude patients from the category of relapses after radiation treatment, increasing the effectiveness of stereotaxic radiation in the treatment of such patients with this pathology; in patients with clinical impairment against the background of pseudo-progression, to maintain the sufficiency of minimally invasive surgery for the removal of symptoms of mass effect.

4 cl, 2 dwg, 2 ex