Local failure of tumor control is extremely frequent in advanced carcinomas of the cervix. Local or pelvic failure is also extremely frequent with carcinomas of the uterus, vagina, prostate or recta-sigmoid. It is believed that the use of high LET radiotherapy may overcome some of the radioresistance presumed to be due to tumor hypoxia. The use of high LET therapy for such tumors may greatly reduce the local failure rate and lead to more frequent cure of such tumors. It is known that increased local treatment success may allow distant failure to be unmasked and be manifest. We have examined boost of Cf-252 pelvic brachytherapy for advanced tumors of the cervix, endometrium and vagina. The treatments have been performed as boost implants on a basic prescription of high dose, low LET, megavoltage x-ray therapy. Three basic schedules have been studied for effectiveness: 1) neutron therapy only; 2) mixed neutron and Cs-137 implant therapy; 3) Cs-137 therapy only. We have treated Stage II-B (resistant), III and IV cervix cancers, barrel-shaped carcinomas of the cervix, given preoperatively, in medically inoperable Stage I and II endometrial cancers, slow regressor tumors and recurrent tumors. The preliminary results show that Cf-252 used in the above methods are well tolerated without major complications in early follow-up, and lead to local control at least comparable to low dose brachytherapy. The combination of external beam radiotherapy with Cf-252 neutron brachytherapy were well tolerated and led, in most cases, to tumor destruction. Cf-252 implant therapy may be a simple means of dealing with common and frequently radioresistant group of tumors.
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