A meta-analysis of Stages I and II Hodgkin's disease

Article Abstract:

There is some controversy surrounding the treatment of Stages I and II Hodgkin's disease. Some clinicians favor radiotherapy alone, avoiding some of the side effects of chemotherapy, and reserving chemotherapy for salvage if the patient relapses. Proponents of chemotherapy point out that radiotherapy requires surgery to evaluate the stage of the cancer, and chemotherapy avoids secondary leukemia resulting from radiotherapy. Critics of radiotherapy also point out that salvage chemotherapy is not entirely effective. Unfortunately, many of the studies in the medical literature are too small to provide definitive answers of the most appropriate treatment. However, a group of researchers has now completed what they term a ''meta-analysis,'' in which they combine the results of 23 studies involving 2,999 patients and attempt to sift through the data for nuggets of medical insight. The combined results showed few differences in the overall survival of the patients regardless of treatment, although only 66 patients had received only chemotherapy, preventing a valid comparison of this treatment modality. It was observed, however, that when radiotherapy was employed, patients with an extended field of irradiation fared somewhat better than patients in whom only the involved field was irradiated. When the overall survival of the extended-field irradiation patients was compared with patients receiving combined radiation and chemotherapy, there was no statistically significant difference. The ten-year survival of patients with Hodgkin's disease was found to be 78.5 percent for extended-field radiotherapy and 78.9 percent for combined chemotherapy and radiotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hodgkin's disease, Lymphomas

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Hyperfractionation radiation and chemotherapy for unresected localized adenocarcinoma of the pancreas

Article Abstract:

Hyperfractionation therapy is based on the notion that several smaller doses may be better than one larger dose. At least a part of this rationale comes from understanding the cell cycle. Multiplying cells are not uniformly susceptible to radiation and chemotherapy throughout the cycle. A single dose may catch some cells at the most susceptible stage, and fail to dispatch those in a less susceptible stage of development. Waiting a relatively short time may allow the cells that slipped through the first round to be caught in a susceptible stage for the second. If too much time elapses between doses, variations in the cycle of the many cells results in a mixed population that is essentially no different in cycle distribution from the first round. Eighteen patients were used to evaluate the usefulness of hyperfractionation therapy in the treatment of adenocarcinoma of the pancreas, which is the fourth largest cause of cancer deaths among American men. These patients had pancreatic cancers that were not amenable to surgical removal. The radiation was administered in two daily doses of 120 cGy each to a total of 4,080 cGy (a Gy, or Gary, is 1 joule of energy absorbed per kilogram of tissue). An additional 960 cGy was given to the tumor bed. Chemotherapy was administered in association with the course of radiotherapy. Unfortunately the results of the trial were disappointing. The longest surviving patient waited 68 months to die, but the median survival was only 35 weeks. The one-year survival rate was 39 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pancreatic cancer, Adenocarcinoma

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