Primary vaginal cancer in adults. Apropos of 72 cases treated at the Fondation Curie from 1956 to 1968

Primary vaginal cancer are infrequent and amount to 2 or 3 per cent of the gynecological cancers. Their diagnosis is difficult, because many other cancers metastasize in the vagina. The primary vaginal cancer arise mostly after climateric. Adjuvant causes would be a total hysterectomy in the past, prolapsus, prolonged use a pessary or a previous irradiation. The squamous-cell carcinomas, by far the most frequent (91%), are mostly situated in the upper third of the vagina on the anterior and posterior walls. Surgery, being difficult and mutilating is rarely indicated. So the treatment is mainly radiotherapic: external irradiation and intracavitary curietherapy. The radiation techniques are a little different according to the site of the lesion in the lower third or not. The upper lesion can be treated like a cervix cancer. The lower ones are more difficult to handle; for curietherapy, one must use molded apparatus, loaded with Iridium wire, adapted to each special case. The therapeutic results are rather poor:43 per cent for the 5-year cure rate and 36 per cent for the 10-year cure rate: less than for the cervix uteri. The upper lesions have a better prognosis than the lower ones. Results should be improved with an earlier diagnosis, a more accurate radiotherapy and a more precise dosimetry. The non-squamous-cell cancers (adenocarcinomas, sarcomas, mallignant melanomas) are generally rather radio-resistant. They are rare and their prognosis is very poor.     

High-dose-rate intracavitary brachytherapy in the management of cervical and vaginal intraepithelial neoplasia

PURPOSE: To assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with grade 3 cervical intraepithelial neoplasia (CIN-3) and grade 3 vaginal intraepithelial neoplasia (VAIN-3). METHODS AND MATERIALS: This was a retrospective analysis in 20 patients with CIN-3 (n = 14) or VAIN-3 (n = 6), average age 61.9 years, managed with HDR-ICR at Kanagawa Cancer Center. Two patients with CIN-3 with microinvasive foci and 11 other patients with CIN-3 were treated with HDR-ICR for cervical lesions. Six patients with CIN-3 after hysterectomy received HDR-ICR for recurrent or residual VAIN-3 lesions. One patient received radiation therapy for both CIN-3 and VAIN-3 lesions. All these patients but one were postmenopausal. RESULTS: Seventeen patients were treated with HDR-ICR alone, and three with combined external radiation therapy. The dose was calculated at Point A located 2 cm superior to the external os and 2 cm lateral to the axis of the intrauterine tube for intact uterus. For lesions of the vaginal stump, the dose was calculated at a point 1 cm superior to the vaginal apex or 1 cm beyond vaginal mucosa. In the 14 patients treated for CIN-3 lesions, the mean total dose of HDR-ICR was 26.1 Gy (range 20-30). Six patients received HDR-ICR for VAIN-3 lesions with mean dose of 23.3 Gy (range 15-30). At follow-up (mean 90.5 months; range 13-153), 14 patients were alive and 6 had died owing to nonmalignant intercurrent disease. No patient developed recurrent disease. Rectal bleeding occurred in three patients, but this symptom subsided spontaneously. Moderate and severe vaginal reactions were noted in two patients, in whom the treatment had included the entire vagina. CONCLUSIONS: HDR-ICR can be employed as the primary management strategy for postmenopausal women with CIN-3. In intraepithelial neoplasia involving the vaginal wall after hysterectomy, HDR-ICR should be considered as an alternative to total vaginectomy.     

Local treatment of rectal cancer

While abdominoperineal resection with permanent colostomy is still required for most distal [corrected] rectal cancers, sphincter-saving local treatment by means of local excision, electrocoagulation or endocavitary contact radiation can be used for some highly selected distal tumors. Local treatment avoids a permanent colostomy and is associated with much lower morbidity and mortality rates than abdominoperineal resection. Strict criteria for patient selection are essential to successful local treatment. Optimal candidates include patients exhibiting the following features of rectal cancer: a distal rectal cancer less than 8 cm from the anal verge; a tumor with a diameter of 3 cm or less; a tumor that is well to moderately well differentiated histologically, and a tumor that is limited to the bowel wall. Preoperative studies such as transrectal ultrasonography enhance the accuracy of preoperative staging. In properly selected patients, the results of local treatment are equivalent to those of abdominoperineal resection of comparable tumors. Close follow-up is essential, and tumor recurrence can be treated for cure by abdominoperineal resection.     

How accurate is size measurement of pancreas cancer masses by computed axial tomography (CT) scanning?

With the advent of preoperative radiotherapy for pancreas cancers, their measurement by imaging is rendered more important, so that outcome data from various treatment programs may be compared. Two radiologists have examined tumor size measurements from 29 patients by CT scans obtained within a week of measurement in the Pathology Department after resection. The radiologists assessed these scans independently from one another and blinded from the pathologic measurement. The largest diameter of their readings was compared to the largest diameter of the tumor measured by the Pathology technician. The correlation between radiologists (P < 3 x 10(-8) was excellent. Correlation between the average of the two radiologic estimates of greatest tumor diameter and actual tissue measurement is excellent for tumors (n = 21) greater than 2 and less than 5 cm in diameter (P < 0.03), but of four specimens measured in the Pathology laboratory as less than 2 cm, all were measured by the radiologists as being at least 1.5 cm larger. Twenty of the 29 cancers (69%) were measured by two radiologists to be within 1 cm of the actual diameter. The nine specimens producing the greatest errors were two with diffuse mucinous tumors throughout the gland (radiologists undercalled by 2.5 cm), one 7 cm mass with a cystic center composed of necrotic cells (overcalled by 2.5 cm, perhaps because of deformity or release of fluid in Pathology), four small masses (1, 1.5, 1.5, and 1.5 cm in diameter), smaller than the normal diameter of the pancreas head, and two tumors with inexplicably inaccurate size estimates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postoperative radiation for cervical cancer with pathologic risk factors

PURPOSE: To examine the efficacy of postoperative radiation therapy for early-stage cervical cancer with pathologic risk factors. METHODS AND MATERIALS: We reviewed the charts of 83 patients who received postoperative radiation therapy at our facility from March 1980 to November 1993 for early stage cervix cancer with positive surgical margins, positive pelvic or periaortic lymph nodes, lymphovascular space invasion, deep invasion, or for disease discovered incidently at simple hysterectomy. Twenty-eight patients received low dose rate (LDR) intracavitary radiation with or without external beam pelvic irradiation and 55 patients received external beam pelvic irradiation with high dose rate (HDR) intracavitary implants. Of these 83 patients, 66 were evaluable--20 LDR and 46 HDR patients. All patients received 45-50 Gy external beam irradiation and 20 Gy LDR equivalent intracavitary irradiation prescribed to 0.5 cm below the mucosa. Ninety percent of the LDR group and 92% of the HDR group completed treatment within < 56 days. Treatment-related toxicities were scored according to the GOG toxicity scale. Mean and median follow-up times were 101 months and 111 months (3-172 months) for the LDR group and 42 and 40 months (3-98 months) for the HDR group. RESULTS: The 5-year disease-free survival was 89% for the LDR group and 72% for the HDR group. Local control was observed in 90% (18 out of 20) of the LDR patients and 89% (41 out of 46) of the HDR patients for an overall local control rate of 89.5%. Two of 20 LDR patients (10%) experienced recurrence (two pelvic with distant metastasis). Nine of 46 HDR patients (22%) had recurrence of disease (three pelvic, four distant metastasis, and two pelvic with distant metastasis). In the HDR group, 6 out of 16 (38%) with positive lymph nodes died of disease whereas, 27 out of 30 (90%) of the patients with negative lymph nodes remain free of disease. Three of 20 (15%) LDR patients and 4 out of 46 (9%) HDR patients experienced Grade 2 or 3 late treatment- related complications. No patient in either group had Grade 4 or 5 complications. Pathologic risk factors were analyzed. Lymph node positivity and lymphovascular space invasion were found to be significant (p = 0.01 and p = 0.02). Positive margins, deep invasion, and age were not significant. CONCLUSION: Our results demonstrate the efficacy of postoperative irradiation for cervical cancer with pathologic risk factors. Overall, the local control rate was 89.5% The HDR results demonstrate that this method can be delivered safely and effectively.     

Memory modulation by post-training glucose or insulin remains evident at long retention intervals

We started photodynamic therapy in gynaecologic tumors in 1988. Seven patients with endometrial carcinomas stage FIGO 1a (restricted to the endometrium) were treated primarily and also 4 patients with recurrences of vaginal and vault cervix carcinoma, carcinoma of the corpus uteri and the vulva. Residual tumors after conventional therapy of cervix and vulvar carcinoma were treated in 2 patients. Tumor illumination was performed by an Argon dye laser 24-72 h following the intravenous administration of haematoporphyrin derivatives (HPD) (Photosan III, 2 mg kg-1 body weight). The intracavitary tumor irradiation by means of a glass fibre was controlled by ultrasound. Superficial and small lesions of vaginal and vulvar carcinomas were subjected to superficial light irradiation; whereas tumors exceeding 1 cm in depth were treated interstitially. Tumor response was estimated 1 month after therapy. Complete remission was achieved in 8 patients, partial remission in 2, and no remission in 3 cases. Subsequent radiotherapy was performed in 3 patients with bleeding endometrial cancer with consecutive complete response.     

A quantified approach to the analysis of complications in combined external and intracavitary radiotherapy of uterine cervical neoplasms

A method is presented of calculating biological doses in combined external and intracavitary radiotherapy with long-lived radioisotopes. The method utilizes the well-known "nominal standard dose" concept combined with an original correction, based on a radiobiological model, to account for the nonhomogeneity of the external field therapy. Of practical interest are the points of maximal radiation dose sustained by the rectum and bladder in the treatment of carcinoma of the uterine cervix. Forty patients with malignant tumors of the uterine cervix who were treated at the Beilinson Hospital are described. A high degree of correlation was found between the biological dose and long-term regional complications. There appears to be a practical threshold dose, of about 4,000 rets, below which severe gastrointestinal and genitourinary complications are rare. A strategy of optimal treatment leading to limited complications is presented.     

Intracavitary afterloading therapy as a new technique of boost irradiation in anal canal carcinoma

PURPOSE: There are different techniques of boost irradiation in the treatment of patients with anal carcinoma. A new system of applicators is presented, which can be used for an intracavitary afterloading therapy. MATERIAL AND METHODS: Three different applicators are available, the first with a central catheter (K1), a second with 5 semicircular fixed catheters (K2) and an eccentric shield, a third with 8 circular fixed catheters and a central shield (K3). RESULTS: The adequate choice of applicator and catheters takes into consideration the individual localisation and extension of anal carcinoma in planning therapy. Thus, in circular growing tumors, an irradiation of the whole circumference of the anal canal is possible. In non-circular growing tumors, the dose applied in the non-affected part of the anal canal can be reduced to a quarter of the dose applied at the tumor. CONCLUSION: The new system of intracavitary afterloading therapy is a good alternative to previous techniques of boost irradiation in the treatment of anal carcinoma. By means of this technique, irradiation can be highly individualized, the tumor better included and non-affected sections of the anal canal saved.     

Extraordinary features in the Chlamydomonas reinhardtii chloroplast genome: (1). rps2 as part of a large open reading frame; (2). A C. reinhardtii specific repeat sequence

PURPOSE: To evaluate the clinical efficacy of local vaginal lidocaine application for pain relief during high-dose-rate (HDR) intracavitary brachytherapy for patients with cervical cancer, and to investigate sequential changes in serum levels of lidocaine during the procedures. METHODS AND MATERIALS: This prospective study was designed to examine the analgesic effect, physical response, and side effects of local anesthesia during HDR intracavitary brachytherapy. Forty patients were enrolled. All patients received 10-15 MV X-rays to the pelvis with a total dose of 45-59.4 Gy 5-6 weeks before undergoing HDR intracavitary brachytherapy. All patients underwent first intracavitary brachytherapy under general anesthesia. These patients were randomly allocated to receive one of two different treatment protocols as follows: (1) treatment session - control session - treatment session - control session; or (2) control session - treatment session- control session - treatment session. In the treatment sessions, topical anesthesia was administered using 4 ml of 10% lidocaine solution sprayed liberally on the cervix and vagina during intracavitary brachytherapy. In the control sessions, a placebo was administered in the same manner during brachytherapy. The Hensche's applicators for brachytherapy were inserted into the cervix and vagina 5 min after lidocaine application. The visual analogue scale (VAS) was used to assess pain and discomfort during brachytherapy. Blood pressure and heart rates were measured to evaluate the physiological response. Another prospective study was then performed to investigate the sequential changes of serum lidocaine levels during the anesthetic procedure. Eleven additional patients with similar disease state and demographic characteristics were enrolled and blood samples were obtained before, and 5, 15, 30, and 45 min after the initiation of lidocaine application. RESULTS: The mean VAS values recorded during the treatment sessions and control sessions were 49.9 +/- 24.1 versus 60.1 +/- 24.8, respectively. The value of VAS in the treatment session was significantly lower than that of the control session (p < 0.001). No statistically significant differences were found in the changes of blood pressure and heart rate and in the incidence of side effects during these two types of sessions (p > 0.05). In the drug-level study, serum levels of lidocaine reached a peak 5 min after the initiation of local anesthesia. The mean peak concentrations (Cmax) of lidocaine were 0.50 +/- 0.45 microg/ml. CONCLUSION: Local vaginal anesthesia with 10% lidocaine solution can significantly decrease the degree of painful sensation during HDR intracavitary brachytherapy, and is safe to administer for the procedure for cervical cancer.     

Expression and immunogenicity in rats of recombinant adenovirus 5 DNA plasmids and vaccinia virus containing the HTLV-I env gene

PURPOSE: To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachytherapy (HDRB) and external beam radiotherapy (EBRT) for patients found to have isolated vaginal recurrences from early-stage endometrial adenocarcinoma following total abdominal hysterectomy and bisalpingo-oophorectomy (TAH BSO). MATERIALS AND METHODS: Twenty patients originally diagnosed with early-stage endometrial adenocarcinoma (FIGO stage I or II) following TAH BSO developed isolated vaginal recurrences and were referred to our radiation oncology department for definitive treatment. The median time between TAH BSO and vaginal recurrence was 24 months. Thirteen patients received combined modality treatment (EBRT + HDRB) and seven patients received HDRB only. Median prescribed dose was 4400 cGy by EBRT and 2400 cGy to the vagina mucosa surface by HDRB in the combined modality group. Median prescribed dose was 3500 cGy to the vagina mucosa surface for the HDRB only group. These patients were followed for a median duration of 47.5 months following treatment for isolated vaginal recurrence. RESULTS: Eighteen of 20 patients (90%) achieved a complete response to therapy and the remaining 2 achieved a partial response. Four of 18 complete responders developed a second recurrence within 30 months following radiotherapy. Ten-year cumulative local control rate was 74%. Ten-year cumulative cause specific and disease-free survival rate was 71 and 46%. Overall late complication rate was 15%; there were no grade 3 or 4 late complications. Three patients developed grade 2 late complications from treatment; all 3 were from the combined modality group (HDRB + EBRT). CONCLUSION: The use of HDRB resulted in high complete response rates and durable long-term disease-specific survival in a substantial percentage of patients. To our knowledge, this study represents the first published results on treatment of vaginal recurrences with HDRB. Although the number of patients in this study is small, treatment results compare favorably to those obtained from patients treated with low-dose-rate brachytherapy +/- EBRT from other studies.     

Vaginal template implant for cervical carcinoma with vaginal stenosis

OBJECTIVE: For cervical carcinoma patients with poor geometry for conventional intracavitary radiotherapy, a simple vaginal template for interstitial implantation as a substitute was used. This is a report of the treatment results. METHODS: Patients with vaginal stenosis were treated over from July 1987 to June 1991 with this vaginal template implant as part of the treatment. The applicator consisted of a front piece and an end piece. Holes were drilled in the front piece to guide the implantation of the cervix or vaginal vault. The diameter of applicators varied from 2.0 cm to 3.5 cm. Depending on the diameter of the applicators, six to eight needles on the periphery, or eight peripheral plus one central needle were used. The activity of the needles were around 8 mCi with a total length of 5.5 cm. The end piece was locked onto the front piece by a bayonet-type locking device. The purpose of the end piece was two-fold: to make up the length of the whole applicator to fit the vagina and to keep the implanted needles in place without being extruded. The implantation was performed under general anesthesia. RESULTS: One of the twelve patients treated with the vaginal template implant for vaginal stenosis had relapsed centrally but subsequently died of intercurrent disease. Two other patients died of intercurrent disease at 26.2 and 41.9 months, respectively, without evidence of relapse. Nine other patients had been followed with no evidence of local relapse for 23.7 to 54.6 months. CONCLUSION: This vaginal template implantation is satisfactory in treating cervical carcinoma patients with vaginal stenosis.     

Radionuclide therapy of skin cancers and Bowen's disease using a specially designed skin patch

Skin cancer is the most common malignancy in humans. Therapeutic modalities for skin cancer are local destruction, radiotherapy and surgery. External radiation therapy leads to good results, however, generally 5-6 wk of treatment is needed to deliver optimal radiation dose to tumors. In this study, a beta-emitting radionuclide, 166Ho, impregnated in a specially designed patch, was used on superficial skin cancers and Bowen's disease for local irradiation. METHODS: Ten mice with chemically induced skin tumors were studied. Five-millimeter size patches containing 22.2-72.15 MBq (0.6-1.95 mCi) 166Ho were applied to the tumor surface for 1-2 hr. In a human trial, patients with squamous-cell carcinoma (n = 3), basal cell carcinoma (n = 1) and Bowen's disease (n = 1) were treated with patches containing 273.8-999 MBq (7.4-27 mCi) of 166Ho for 30 min to 1 hr. Pathologic examination was performed 4-7 wk after treatment in an animal model. Skin biopsy was performed 8 wk post-treatment in four patients. RESULTS: Tumor destruction was seen 1 wk post-treatment, however, radiation dermatitis or ulceration developed at the site of radionuclide application. Those reactions healed gradually with fibrosis or epithelialization, which was confirmed pathologically. No significant adverse reaction to radiation except subcutaneous fibrosis was found. CONCLUSION: Superficial skin tumors could be successfully treated by topical application of beta-emitting radionuclides.     

Outcome of treatment of upper third vaginal recurrences of cervical and endometrial carcinomas with interstitial brachytherapy

PURPOSE: To describe an original brachytherapy technique using a dedicated intravaginal template for the treatment of vaginal vault recurrences and to evaluate the results of such a treatment. METHODS AND MATERIALS: Between 1978 and 1993, 78 patients with isolated recurrence of cervical or endometrial carcinoma located in the vaginal vault have been treated in Lyon. Initial treatment was surgery alone in 49 cases and irradiation with surgery in 37 cases. Treatment of the vaginal recurrence was performed with interstitial Iridium 192 brachytherapy combined with pelvic external beam radiation therapy in 34 patients. The tumor was implanted with a dedicated intravaginal plastic template. Six parallel metallic needles were implanted in the vaginal vault and afterloaded with Iridium 192 wires of 4 to 6 cm long. The mucosa of the upper half of the vagina received the same dose as the one encompassing the tumor on the 85% isodose of the Paris system. RESULTS: At 5 years the local control rate was 70% and the overall survival rate 56%. Grade 3 complications occurred in 10% of the cases and only in patients who had received irradiation during the initial treatment of the primary tumor. CONCLUSIONS: This brachytherapy technique makes it possible to perform Iridium 192 implants in a difficult situation with a favorable long-term control rate and an acceptable rate of complications.     

Combined treatment of stomach neoplasms

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.     

Radiation in management of patients with dermatofibrosarcoma protuberans

PURPOSE: The preferred treatment of dermatofibrosarcoma protuberans (DFSP) is wide resection, namely, margins > or = 3 cm beyond the evident disease and histologically negative margins. We assess the success achieved by radiation combined with surgery for positive/close margins or by radiation alone for those tumors that are not resectable for technical/medical reasons. The literature on this point is virtually nonexistent. MATERIALS AND METHODS: The outcome of treatment of 18 patients with DFSP by radiation alone (n = 3) and radiation and surgery (n = 15) at the Massachusetts General Hospital was assessed. All of the lesions at the time of the treatment by radiation alone or combined with surgery were less than 10 cm. This was the maximum dimension. The actual tumor volume was much less than indicated by this maximum dimension, as the tumors were usually relatively flat. RESULTS: The 10-year actuarial local control rate was determined to be 88%. Local control was realized in the three patients treated by radiation alone, with follow-up periods of > or = 9 years. Among 15 patients treated by radiation and surgery, there have been three local failures; the 10-year actuarial local control rate was 84%. The three local failures occurred in 12 patients whose surgical margins were positive. One of these three local failures developed in the group of two patients whose lesions were scored as grade II. CONCLUSION: Radiation in well-tolerated dose schedules is an effective option in the management of patients with DFSP. This appears to be true for radiation alone or postoperatively for margin-positive disease (primary or recurrent).     

The effect of oral contraceptive use on the prognosis of node positive breast cancer patients. German Breast Cancer Study Group

The photon radiosurgery system is a miniature X-ray generator that can be placed stereotactically and intraoperatively into intracranial tumors to deliver a single fraction of high-dose interstitial irradiation. This battery-powered device produces low energy X-ray photons in a spherical and symmetrical pattern at the probe tip. Dose rates of up to 200 cGy/Mim are possible, allowing for the administration of 15 Gy to a lesion 3 cm in diameter in less than 1 hr. Background exposure is minimal, and no special shielding of the patient or health care personnel is required. Thirty-nine patients with brain tumor were treated in this method. There were no adverse effects. During the follow-up period of 1-30 months, 3 cases with 5 metastatic brain tumors died about 8 months after this treatment. Five recurrent cases of 21 malignant gliomas died about 4 months after treatment. Interstitial radiotherapy using photon the radiosurgery system promises to be a useful treatment for brain tumors.     

High-dose rate intracavitary radiation therapy for advanced head and neck tumors

Fifty-seven treatments were performed on 27 head and neck pateints with recurrent or residual tumors on a high dose rate, remote controlled afterloading unit: There were 16 cases of maxillary sinus tumors, 6 epipharynx, 3 alveolar ridge, 1 hard palate and 1 floor of mouth. All patients have been followed up more than 2 years except one. Five patients are alive without local recurrence for more than 2 years. In 13 patients local tumors disappeared once and normal mucosa covered the tumor sites. Two patients died from local bleeding. In six patients this method failed to destroy tumors. Our prupose was palliative local control: therefore, in two-thirds of cases treated we were successful with this easy method of nonfractionated acute intracavitary radiation. This result is favorable, considering that all cases treated here were failures following full dose external radiation, although the treatment had to be repeated more than twice in 15 cases. Relief of symptoms is excellent when this therapy is used.     

High-dose rate intracavitary irradiation for carcinoma of the uterine cervix. The adverse effect of treatment prolongation

AIM: To investigate the adverse effect of treatment prolongation on the local control and survival of the cervical carcinoma of the uterus. PATIENTS AND METHOD: Two hundred and sixteen patients with stage IIB and III cervical carcinoma treated with a combination of external radiation and high-dose rate (HDR) intracavitary irradiation between 1978 and 1989 were retrospectively studied. A multivariate analysis was used to determine the effect of treatment time on local control and survival. RESULTS: Overall treatment time was the most highly significant factors for local control in the multivariate analysis (p = 0.0005). The 5-year cumulative relapse rates were significantly different with the treatment times 35 to 42 days: 9% versus 43 to 49 days: 19% versus 50 to 62 days: 42% (p = 0.001). The second most significant parameter was stage classification (p = 0.02). Concerning relapse-free survival, stage classification (p = 0.0001), overall treatment time (p = 0.0035) and hemoglobin level (p = 0.0174) were the 3 most important prognostic factors, although there was no relationship between treatment time and late complications. CONCLUSION: These results suggest that prolongation of treatment time is associated with decreased local control and survival in patients treated with external radiation and HDR intracavitary irradiation.     

Internal radiation therapy for patients with primary or metastatic hepatic cancer: a review

BACKGROUND: The limited efficacy of current approaches to the treatment of patients with hepatic cancer, including external beam radiation therapy and cytotoxic chemotherapy, has reawakened interest in the use of internal radiation therapy. METHODS: The authors reviewed series of patients with liver metastases or hepatocellular carcinoma (HCC) treated with 1) interstitial irradiation and direct intratumoral injection of 90Y microspheres, 2) intraarterial infusion of (131)I-Lipiodol, 3) intraarterial infusion of 90Y microspheres, or 4) parenteral administration of radiolabeled monoclonal antibodies. RESULTS: High dose rate interstitial irradiation with afterloading of (192)Ir resulted in local control of hepatic metastases for a median of 8 months and complete tumor eradication in 2 patients. Direct intratumoral injection of 90Y microspheres reduced the size of 90.6% of tumors and completely destroyed them in 8 patients. Treatment with arterial (131)I-Lipiodol resulted in a 17-92% response rate as well as a case of complete remission of unresectable HCC. It was found to be most effective against small tumors. No response was observed with liver metastases from colorectal carcinoma. Partial response was commonly achieved when patients with unresectable liver metastases or HCC were treated with intraarterial 9OY microspheres. Among four patients whose HCC became resectable following treatment with 90Y microspheres, two cases of complete remission were documented. In a prospective randomized trial, (131)I-antiferritin combined with chemotherapy was no more effective than chemotherapy alone. CONCLUSIONS: The different approaches to internal radiation therapy that are reviewed in this article represent several ways in which radiation can be selectively targeted to hepatic tumors without undue radiation to the nontumorous liver. However, the efficacy of each of these therapies still needs to be evaluated in randomized controlled trials.     

Variants of fractionation of irradiation in intracavitary gamma-therapy

Under study was the efficacy of three schedules of dose fractionation in intracavitary gamma-therapy in cervical cancer patients treated on the machine "AGAT-B". Single doses were 1000, 700 and 500 rad, while total dosage at point A depending on the stage of the disease was within the range of 4000-5000 rad. The survival during the first, second and third years following termination of the radiotherapy was found to be identical for patients of all the groups under examination. No differences were noted in them also in the character of early radiation reactions on the part of the adjacent organs. The frequency and severity of late radiation injuries of the urinary bladder, rectum and vagina were related to the dose fractionation regimen.