Radiotherapy In Treatment Of Carcinoma Research Articles

A prospective randomised study on comparison of weekly versus 3 weekly cisplatin chemotherapy as an adjunct to radiotherapy in treatment of carcinoma of the uterine cervix

Background: The present study attempted to compare concurrent weekly and three weekly cisplatin with radiotherapy in locally advanced cervical cancer. Methods: This prospective randomised study was conducted in 40 patients with locally advanced cervical cancer randomised into 2 arms. Arm A patients received external beam Radiotherapy (EBRT) to pelvis with concurrent weekly cisplatin at dose of 40 mg/m2 and arm B patients received EBRT to pelvis with concurrent cisplatin at dose of 75 mg/m2 three weekly followed by brachytherapy. Acute haematological, gastrointestinal (GI) and genitourinary toxicities and response rates were assessed. Results: All the patient and disease characters were comparable in both arms. There was no significant difference in both arms in terms of upper GI toxicity (75% Vs 80%; P = 0.208), haematological (25% Vs 10%; P = 0.195) and nephrotoxicity (10% Vs 25%; P = 0.212). Compliance to chemoradiation was better in three weekly cisplatin arm but not statistically significant. After a median follow up of 12 months, tumor response rates in both arms were almost similar (85% Vs 90%; P = 0.128). Conclusions: Our observations suggest that either concurrent weekly or three weekly cisplatin chemoradiation is equally effective in treatment of cervical cancer. However randomised trials with larger sample sizes and longer duration of follow up are required.

Outcome and Toxicity for Patients Treated with Intensity Modulated Radiation Therapy for Localized Prostate Cancer

We evaluate long-term disease control and chronic toxicities observed in patients treated with intensity modulated radiation therapy for clinically localized prostate cancer. A total of 302 patients with localized prostate cancer treated with image guided intensity modulated radiation therapy between July 2000 and May 2005 were retrospectively analyzed. Risk groups (low, intermediate and high) were designated based on National Comprehensive Cancer Network guidelines. Biochemical control was based on the American Society for Therapeutic Radiology and Oncology (Phoenix) consensus definition. Chronic toxicity was measured at peak symptoms and at last visit. Toxicity was scored based on Common Terminology Criteria for Adverse Events v4. The median radiation dose delivered was 75.6 Gy (range 70.2 to 77.4) and 35.4% of patients received androgen deprivation therapy. Patients were followed until death or from 6 to 138 months (median 91) for those alive at last evaluation. Local and distant recurrence rates were 5% and 8.6%, respectively. At 9 years biochemical control rates were 77.4% for low risk, 69.6% for intermediate risk and 53.3% for high risk cases (log rank p = 0.05). On multivariate analysis T stage and prostate specific antigen group were prognostic for biochemical control. At last followup only 0% and 0.7% of patients had persistent grade 3 or greater gastrointestinal and genitourinary toxicity, respectively. High risk group was associated with higher distant metastasis rate (p = 0.02) and death from prostate cancer (p = 0.0012). This study represents one of the longest experiences with intensity modulated radiation therapy for prostate cancer. With a median followup of 91 months, intensity modulated radiation therapy resulted in durable biochemical control rates with low chronic toxicity.

Radiotherapy in treatment of carcinoma of the parotid gland, an approach for the medically or technically inoperable patient

Initial surgical resection is considered the standard of care for patients diagnosed with tumours involving the salivary glands. We reviewed our institutional outcomes of patients treated with initial radiation therapy (RT) for diagnosed carcinoma of the parotid gland. This review examined seventeen patients that received RT as initial therapy for tumours involving the parotid gland. Fifteen patients had primary salivary gland cancer, and two patients had metastatic carcinoma to the parotid gland. Sixteen patients (94.1%) following surgical evaluation had operative risk of facial nerve impairment or sacrifice with initial surgery, four (23.5%) had clinical objective evidence of nerve involvement at evaluation, five (29.4%) were poor surgical candidates and three (17.6%) refused initial surgery. Primary tumour stages ranged T2-T4b, and disease stages ranged II-IVb. RT median dose was 70 Gy, and median follow-up was 12 months. Eleven patients (64.7%) achieved a clinical complete response (CR) to therapy. Of these CR patients eight (72.7%) received definitive RT and three (27.3%) underwent surgery following RT. Two surgical patients avoided facial nerve impairment while one required nerve sacrifice. The other six patients (35.3%) achieved an unfavourable response to RT and had unresectable or metastatic disease at follow-up. No long-term complications were reported. Initial radiation therapy for tumours involving the parotid gland is effective to achieve clinical CR, eliminate surgical resection for many patients, and decrease risk of facial nerve impairment or sacrifice for those patients requiring surgery following RT.

Radiation treatment of carcinoma of the thyroid.

Radiation treatment of carcinoma of the thyroid.

Dosimetry and radiobiologic model comparison of IMRT and 3D conformal radiotherapy in treatment of carcinoma of the prostate

Introduction Intensity-modulated radiotherapy (IMRT) has introduced novel dosimetry that often features increased dose heterogeneity to target and normal structures. This raises questions of the biologic effects of IMRT compared to conventional treatment. We compared dosimetry and radiobiologic model predictions of tumor control probability (TCP) and normal tissue complication probability (NTCP) for prostate cancer patients planned for IMRT as opposed to standardized three-dimensional conformal radiotherapy (3DCRT). Methods and materials Segmented multileaf collimator IMRT treatment plans for 32 prostate cancer patients were compared to 3DCRT plans for the same patients. Twenty-two received local-field irradiation (LFI), and 10 received extended-field irradiation (EFI) that included pelvic lymph nodes. For LFI, IMRT was planned for delivery of 2 Gy minimum dose to the prostate (≥99% volume coverage) for 35 fractions. The 3DCRT plans, characterized by more homogenous dose to the target, were designed according to a different protocol to deliver 2 Gy to the center of the prostate for 37 fractions. Mean total dose from 35 fractions of IMRT was equal to mean total dose from 37 fractions of 3DCRT. For EFI, both IMRT and 3DCRT were planned for 2 Gy per fraction to a total dose of 50 Gy to prostate and pelvic lymph nodes, followed by 2 Gy per fraction to 20 Gy to the prostate alone. Treatment dose for EFI-IMRT was defined as minimum dose to the target, whereas for EFI-3DCRT, it was defined as dose to the center of the prostate. TCP was calculated for the prostate in the linear-quadratic model for two choices of α/β. NTCP was calculated with the Lyman model for organs at risk, using Kutcher-Burman dose–volume histogram reduction with Emami parameters. Results and conclusions Dose to the prostate, expressed as mean ± standard deviation, was 74.7 ± 1.1 Gy for IMRT vs. 74.6 ± 0.3 Gy for 3D for the LFI plans, and 74.8 ± 0.6 Gy for IMRT vs. 71.5 ± 0.6 Gy for 3D for the EFI plans. For the studied protocols, TCP was greater for IMRT than for 3D across the full range of target sensitivity, for both localized- and extended-field irradiation. For LFI, this was due to the smaller number of fractions (35 vs. 37) used for IMRT, and for EFI, this was due to the greater mean dose for IMRT, compared to 3D. For all organs, mean NTCP tended to be lower for IMRT than for 3D, although NTCP values were very small for both 3D and IMRT. Differences were statistically significant for rectum (LFI and EFI), bladder (EFI), and bowel (EFI). For both LFI and EFI, the calculated NTCPs qualitatively agreed with early published clinical data comparing genitourinary and gastrointestinal complications of IMRT and 3D. Present calculations support the hypothesis that accurately delivered IMRT for prostate cancer can limit dose to normal tissue by reducing treatment margins relative to conventional 3D planning, to allow a reduction in complication rate spanning several sensitive structures while maintaining or increasing tumor control probability.

Radical radiotherapy for carcinoma of the uterine cervix using external beam radiotherapy and a single line source brachytherapy technique: the Clatterbridge technique.

At the Clatterbridge Centre for Oncology, a single line source brachytherapy technique using the Selectron (Nucletron) low dose rate remote afterloading equipment has been developed for use in conjunction with homogenous whole pelvis external beam radiotherapy in the radical treatment of carcinoma of the cervix. The technique incorporates several modifications aimed at reducing treatment related morbidity while maintaining satisfactory local tumour control and cure rates. A flexible dose prescription system has been devised to allow individualization of the brachytherapy isodose distribution according to the clinical findings and the estimated normal tissue doses. Modifications of source loading distributions are carried out to limit the point "A" dose rate to a narrow range to take into account the dose rate effect on the risk of complications. Source loading distributions are also modified according to the estimated normal tissue doses in order to respect normal tissue tolerance. This paper describes the technique and its underlying principles.

A retrospective study of the effects of pelvic irradiation for gynecological cancer on anorectal function

Purpose: To evaluate the prevalence of anorectal dysfunction following therapeutic pelvic irradiation. Methods and Materials: Anorectal function was evaluated in 15 randomly selected patients (aged 47–84 years) who had received pelvic irradiation for treatment of carcinoma of the uterine body and cervix 5 and 10 years earlier. The following parameters were assessed in each patient: (a) anorectal symptoms (questionnaire), (b) anorectal pressures at rest and in response to rectal distension, voluntary squeeze, and increases in intraabdominal pressure (multiport anorectal manometry with concurrent electromyography of the anal sphincters), (c) rectal sensation (rectal balloon distension) and, (d) anal sphincteric morphology (ultrasound). Results were compared with those obtained in nine female control subjects. Results: Ten of the 15 patients had urgency of defecation and 4 also fecal incontinence. Basal anorectal pressure measured just proximal to the anal canal ( p = 0.05) and anorectal pressures generated in response to voluntary squeeze measured at the anal canal were less ( p < 0.01) in the patients. The fall in anal pressures in response to rectal distension was greater in the patients ( p < 0.05) and the desire to defecate occurred at lower rectal volumes ( p < 0.05). The slope of the pressure/volume relationship in response to rectal distension was greater ( p < 0.05) in the patients, suggestive of a reduction in rectal compliance. In 14 of the 15 patients at least one parameter of anorectal motor function was outside the control range. There was no difference in the thickness of the anal sphincters between the two groups. Conclusion: Abnormal anorectal function occurs frequently following pelvic irradiation for gynecological malignant diseases and is characterized by multiple dysfunctions including weakness of the external anal sphincter, stiffness of the rectal wall, and a consequent increase in rectal sensitivity.

Altered fractionation and extended-field irradiation of carcinoma of the cervix.

Conventional radiotherapy for treatment of carcinoma of the cervix consists of five daily fractions of 1.80-2.00 Gy, 5 days/week, up to 40.00-50.00 Gy, followed by intracavitary brachytherapy to complete a paracentral dose ranging from 70 to 90 Gy and a lateral pelvic wall dose ranging from 50 to 60 Gy. This results in tumor control in the pelvis for at least 91% of patients with Stage IB disease. However, survival rates at 5-year follow-up have ranged from 49% to 69% for patients with Stage III disease and 25% to 34% for patients with Stage IVA disease. Attempts to improve clinical results for patients with more advanced stages of disease have included hypofractionated and hyperfractionated radiotherapy, accelerated fractionation, and concomitant boost. However, no improvement of tumor control or survival has been obtained. Hyperfractionated external pelvic radiation remains undefined as a method of improving results. Extended-field prophylactic irradiation of the paraaortic lymph nodes has shown significant value in a study group setting. Early diagnosis and prevention continue to be the most promising approaches in the control of carcinoma of the cervix.

A retrospective study of the effects of pelvic irradiation for carcinoma of the cervix on gastrointestinal function

Purpose : To evaluate the prevalence of disordered gastrointestinal function following therapeutic irradiation. Methods and Materials : Gastrointestinal function was evaluated in 30 randomly selected patients who had received pelvic irradiation for treatment of carcinoma of the cervix between 1 and 6 years previously. Each patient underwent evaluations of (a) gastrointestinal symptoms (b) absorption of bile acid, vitamin B12, lactose and fat (c) gastrointestinal transit: gastric emptying, small intestinal transit and whole gut transit and (d) intestinal permeability. Results were compared with those obtained in 18 normal volunteers. Results : Stool frequency was above the control range in five patients and had increased ( p < 0.001) since radiotherapy treatment. Bile acid ( p < 0.001) vitamin B12 ( p < 0.01) and lactose ( p < 0.01) absorption were less in the patients when compared with the control subjects. Bile acid absorption was below the control range in 14 of the 30 patients. Dietary calcium intake was lower ( p < 0.05) in those patients with lactose malabsorption. Gastric emptying ( p < 0.01) and small intestinal transit ( p < 0.01) were more rapid in the patients. Both small intestinal (r = −0.39, p < 0.05) and whole gut (r = −0.45) transit were inversely related to stool frequency. Either bowel frequency, bile acid absorption, vitamin B12 absorption was outside the control range in 19 of the 30 patients. Conclusion : Abnormal gastrointestinal function is essentially an inevitable long-term sequel of pelvic irradiation.

Results of radiotherapy in carcinoma of oesophagus

Results of radiotherapy in 50 patients of carcinoma of oesophagus are presented. Of these, 28 patients were in stage I and stage II disease and were treated with curative doses of radiotherapy. 22 patients received palliative doses of radiation because of their advanced disease. Radiation treatment in carcinoma of oesophagus showed good palliative response with minimal complications. However, there was high incidence of failure of radiotherapy to cure the disease locally in oesophagus. Six months’ survival rate in the curative treatment group was 75% and in the palliative treatment group 31%. One year survival rate was about 29%.

The pathogenesis of post-irradiation chronic diarrhoea: Measurement of SeHCAT and B 12 absorption for differential diagnosis determines treatment

The absorption of vitamin B12 and of a synthetic bile acid analogue 75SeHCAT was measured simultaneously in 26 patients presenting with persistent diarrhoea following pelvic irradiation for treatment of carcinoma of the cervix. Four groups were identified, namely patients with isolated bile acid malabsorption, patients with isolated B12 malabsorption, patients with malabsorption of both and those with malabsorption of neither compound. The therapeutic implications are different for each. Measurement of B12 and bile acid absorption comprises an important new test for the management of patients with this disabling and unpleasant complication of radiotherapy.

Radiation treatment in carcinoma of the esophagus

Radiation treatment in carcinoma of the esophagus

Radiation treatment of carcinoma of the cervix with extension into the endometrium: a reappraisal of its significance.

During the period from 1969--1974, 561 patients with proven invasive squamous cell carcinoma of the cervix were treated by irradiation only in the Department of Radiation Therapy, University of Maryland Hospital. Of these, 82 patients were identified as having D & C positive for squamous cell cancer present in the curettings with or without endometrial tissue. Clinical staging was done using FIGO guidelines and the treatment of endometrial extension was the same as with regular cervical cancer. Of 82 cases who are eligible for a minimum five-year follow-up, the absolute five-year survival is as follows: Stage I, 68%, (17/25); Stage II, 62% (18/29); Stage III, 40% (10/25); Stage IV, 0% (0/3). The most interesting features are the local and distant failures in Stage I and II disease. Local failure in Stage I and II in this study is in line with other series. Distant metastasis, however, occurs at the rate of 20% in Stage I between 1--2 years after treatment (as compared to the control of 5%). In Stage II, the distant disease increases to 24% with a substantial number of local failure with distant metastasis. Based on our findings and others, it seems appropriate to suggest D &nd C be done routinely in order to identify the extension of cancer into the endometrium and treat them properly. Also it appears appropriate to re-examine our policy of the treatment to minimize both local and distant failures with suggestions outlined in Schema I and II along with possibility of a future chemotherapeutic management to minimize the distant disease.

Results of radiation treatment in carcinoma of the oral cavity.

Treatment results in 391 patients with oral carcinoma after radiation therapy are reported. In the total series 5- and 10-year actuarial survival were 30.8 and 25.2 per cent, respectively. After irradiation alone the corresponding figures were 21.5 and 18.5 per cent, after combined radiologic and surgical treatment 33.3 and 28.7 per cent, and after interstitial radium therapy 56.1 and 43.8 per cent, respectively. These differences were mainly an expression of selection factors. Tumor doses above 60 Gy gave a higher survival than lower doses. The presence of neck node metastases was prognostically unfavourable.

External beam irradiation in the definitive treatment of carcinoma of the prostate

External beam irradiation in the definitive treatment of carcinoma of the prostate

Preoperative Irradiation in Treatment of Carcinoma of the Oesophagus

Australasian RadiologyVolume 16, Issue 3 p. 250-257 Preoperative Irradiation in Treatment of Carcinoma of the Oesophagus Hisao Yamashita, Hisao Yamashita Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this authorJotaro Okura, Jotaro Okura Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this authorTatsuo Yoshioka, Tatsuo Yoshioka Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this authorYukifusa Tanaka, Yukifusa Tanaka Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this author Hisao Yamashita, Hisao Yamashita Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this authorJotaro Okura, Jotaro Okura Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this authorTatsuo Yoshioka, Tatsuo Yoshioka Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this authorYukifusa Tanaka, Yukifusa Tanaka Department of Radiology, Medical School, h'eio University, Tokyo, Japan.Search for more papers by this author First published: September 1972 https://doi.org/10.1111/j.1440-1673.1972.tb01361.xCitations: 8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume16, Issue3September 1972Pages 250-257 RelatedInformation

Intrapulmonary hemorrhage with anemia after lymphography.

LYMPHOGRAPHY is commonly followed by a febrile period associated with roentgenographic evidence of oil emboli in the pulmonary arterioles. More serious delayed complications have been reported.1 2 3 In the following case the development of severe anemia was due to intrapulmonary hemorrhage following lymphography. Case Report A 41-year-old woman was admitted to the hospital because of gynecologic complaints 19 years after radiation treatment for carcinoma of the cervix. There was no history of hemoptysis, cough or respiratory disease; she had smoked 20 cigarettes daily for 20 years. There was no evidence of chest or pelvic disease on physical examination. Lymphography was performed . . .

Experimental study of a new combination of surgery and radiotherapy for treatment of carcinoma of cervix uteri.

An experimental series of 12 patients consisting of 10 cases with carcinoma of the cervix uteri and 2 with carcinoma of the corpus uteri were treated by a new method combining surgery and radiotherapy. The purpose was to study the safety of the method, in other words, whether its use could be continued. It had been found to be safe theoretically. During the follow‐up period of 3 years the incidence of complications due to the new therapy was not even on the scale common with the conventional combined method of treatment.

Irradiation for treatment of carcinoma of the lung in indigent and private patients.

Irradiation for treatment of carcinoma of the lung in indigent and private patients.

An Integrated Recording Film Densitometer and Isodose Plotter

IN THE RADIATION treatment of carcinoma through either a single portal or 1800 opposed portals, the problems of calculation of isodose distribution and depth dose are not particularly difficult. They become more complex, however, if one adds ports at other angles or inserts wedges or bolus. With full rotation therapy or arc or skip rotation therapy over uneven body contours, the problem of accurate isodose calculation becomes tremendous. A similar question arises in the determination of dose about an intracavitary applicator. To surmount some of the difficulties of determining and recording dose about a radioactive applicator or a therapy beam and to permit rapid calculation of dose distribution produced by multiple beams, an integrated system was designed and built, consisting of an isodose plotter with a photodensitometer and a scintillation probe to be used as alternative methods of measuring dose. Information obtained by the measuring devices is fed through special electronic circuits and is recorded ...