Iodine-125 interstitial implants as salvage therapy for recurrent gynecologic malignancies

Article Abstract:

Brachytherapy is radiation therapy in which the radiation source is placed very close to the tumor, to both maximize the radiation exposure of the tumor and minimize the exposure of adjacent healthy tissue. One method for accomplishing this is the implantation of a small pellet which contains the radioactive isotope of iodine, iodine-125. The authors present the results of their experience with this gamma-ray-emitting isotope (in pellet form) in the treatment of 20 women with pelvic recurrences after treatment for gynecologic cancers. Two patients did not respond, three had a partial response, and for 15 patients, the local response was complete. In seven patients, however, there were serious complications. Six patients developed fistulas (abnormal passageways between normal cavities or from a cavity to another tissue), and one patient developed rectal fibrosis (formation of fibrous tissue); these reactions represent the response of healthy tissues to the high levels of irradiation. It should be emphasized, however, that for all of these patients, the implantation of the radioactive pellet was simply the most recent of a series of exposures to radiation therapy for their cancer. The complete responses lasted for a median of 26 months. Eight patients sustained their complete response in the pelvic area but succumbed to metastatic disease elsewhere in the body; two patients have metastatic disease with no signs of local recurrence. Five patients remain alive without evidence of disease. The results suggest that implanted radioactive pellets are effective in the treatment of recurrent gynecologic cancer. Since the procedure spares the patient the rigors of major surgery, it may be especially useful in elderly patients, patients for whom major surgery is not indicated, or patients who, for whatever reason, decline to have major surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Cancer, Cancer treatment, Iodine, Genital cancer, Urogenital cancer, Radioiodine

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Intraoperative Ir-192 implantation for early breast cancer: techniques and results

Article Abstract:

For many years, radical mastectomy was virtually the only therapeutic choice available for treating breast cancer. Recently, however, a trend towards more conservative surgery and a greater likelihood of early diagnosis have combined to make other options available to the breast cancer patient. Conservative surgery generally relies on radiation to keep the cancer recurrence rate within acceptable limits. While this radiotherapy is generally externally applied, some investigators have directly implanted seeds of radioactive material directly into the affected region of the breast. The radioactive seed remains in place for 40 to 60 hours, giving the local area a prophylactic dose of radiation. Initial fears that the radiation would suppress the healing of the surgical wound (as well as any remaining cancer cells) have proven to be unjustified. In a review of 323 breast cancer patients with Stage I or Stage II breast cancer, the implantation of Ir-192, the radioactive isotope of iridium, has proven to be effective. It should be mentioned, however, that since most modern treatments for early-stage breast cancer have high survival rates, it is difficult to statistically demonstrate any actual superiority of the Ir-192 implantation. Six-year actuarial survival rates were 98 and 91 percent for stages I and II, respectively. Control of local recurrence of cancer was excellent after 6 years at 96 and 98 percent for stages I and II, respectively. The slightly higher percentage of local control observed in Stage II patients was not statistically significant. The technique was consistent with maintaining good cosmetic results for the patient; the cosmetic result was good or better in 95 percent of these cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Breast cancer

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Intraperitoneal P-32 after negative second-look laparotomy in ovarian carcinoma

Article Abstract:

Ovarian cancer is a major cause of cancer mortality in women, accounting for about 11,000 deaths per year. Surgery is the mainstay of treatment, but some differences of opinion exist on the appropriate follow-up. The surgery is usually followed by adjuvant chemotherapy; some believe a second-look laparotomy, which is reopening the abdomen for examination after the six-to-eight-month regimen of chemotherapy. However, others feel that the lack of treatment alternatives for those with positive findings makes the second-look operation unnecessary. Negative findings on the second look do not indicate a cure as been achieved; 5.9 to 50 percent of patients with negative findings will experience recurrence. To determine if the addition of radioactive phosphorous 32 (P-32) to the peritoneal cavity on the second operation has beneficial effects, 31 patients with negative findings on second-look laparotomy were studied. The patients were not randomized, and the 17 patients who did not receive P-32 were from the earlier part of the study. Fourteen patients were given 15 millicuries of P-32 in the form of chromic phosphate. There have been no local recurrences among the 14 patients receiving P-32 with a minimal follow-up of two years and an average follow-up time of four years. Four of 17 patients who did not receive P-32 have experienced recurrence. Although these results seem to indicate that the treatment is effective in preventing recurrence, it should be emphasized that, although the results are marginal, they are not statistically significant (p=0.076). The results do indicate, however, that the intraperitoneal infusion of radioactive phosphorous is well-tolerated by the patients, and may be beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ovarian cancer, Abdomen, Laparotomy

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