Primary treatment of large and massive adult sarcomas with iododeoxyuridine and aggressive hyperfractionated irradiation

Article Abstract:

Surgical resection is the most effective treatment for sarcomas of both soft tissues and bone, and radiotherapy or chemotherapy may also be administered to destroy any residual tumor cells. However, sometimes because of tumor location, or because of large tumor size, surgery is not possible. Often, it is possible to effectively treat such tumors with radiation without achieving a clinical response. This seeming contradiction is due to the manner in which "response" is defined. A complete response is the disappearance of the symptoms of a tumor, which includes the disappearance of a visible or palpable mass. A partial response is at least a 50 percent reduction. However, it is possible to sterilize all the cancer cells in a large sarcoma without reducing the size of the mass. In such a case, the patient may, in fact, be cured without achieving a clinical response (decreasing the tumor size). The authors review their experience in the treatment of inoperable massive sarcomas in 36 adults; 32 of the 36 completed radiotherapy and were included in the analysis. Twelve of the 32 patients already had metastatic disease at the time of initial radiotherapy, and some of the patients were referred after failure of surgery or continued tumor growth following chemotherapy. The patients were treated with a combination of radiotherapy and iododeoxyuridine, a chemical radiosensitizer that improves the cell-killing action of the radiation. The radiotherapy consisted of a hyperfractionated dose of between 7,000 and 7,500 cGy (a Gy, or Gary, is one Joule of energy absorbed per kilogram of tissue). Hyperfractionated radiotherapy gives the radiation dosage in a larger number of individually smaller doses, and is designed to give the tumor maximum exposure to radiation. Of 32 patients, 5 are alive without evidence of recurrence, either local or metastatic, over follow-up periods of 18, 23, 50, 69, and 76 months. The results suggest that with only modest morbidity (illness), reasonable success may be attained using radiotherapy and radiosensitizing drugs in the treatment of massive sarcomas in adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

Clinical trials, Sarcoma

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Locally advanced paranasal sinus and nasopharynx tumors treated with hyperfractionated radiation and concomitant infusion cisplatin

Article Abstract:

Cancer within the nasal cavities and the back of the mouth (paranasal sinuses and nasopharynx) often spreads along the mucosal surface as the disease advances. Since in many areas, bone lies just under these surfaces, it is easy for the invading cancer cells to enter the bone. This sort of locally advanced cancer is often impossible to attack surgically. Furthermore, standard doses of radiation are often ineffective against cancer cells deep within bone, and especially high doses of radiation are necessary if treatment is to be successful. The tolerable dose of radiation may be increased if hyperfractionation is used. In this treatment scheme, the radiation is delivered in a larger number of doses, given twice daily, which add up to a greater total dose. This method also increases the so-called therapeutic index, which is the difference between the killing effect on tumor cells and the killing effect on normal tissues. Twelve patients were treated with a combination of hyperfractionated radiation and the simultaneous infusion of the chemotherapeutic drug cisplatin. All 12 patients had either T4 advanced stage cancer in the nasal cavity or surrounding areas or massively recurrent cancer after initial treatment. The patients were given a large dose of radiation; the most commonly used dosage was 6,750 cGy (a Gy, or Gray, is one Joule of energy absorbed per kilogram of tissue). Eleven of the 12 patients achieved complete responses, and seven of the 12 are still alive after follow-up periods ranging from 35 to 72 months (five of these seven are disease-free). Two other patients were treated with the intent of reducing their discomfort but not curing their advanced disease; they died two and eight months later, respectively. Since the number of patients in this study was small, the success of the treatment regimen used should be confirmed by a larger, randomized clinical trial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Cisplatin, Head and neck cancer, Nose cancer

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Hyperfractionated radiation therapy in brain stem tumors: results of treatment at the 7020 cGy dose level of Pediatric Oncology Group Study #8495

Article Abstract:

Hyperfractionation radiation therapy involves the delivery of a large dose of radiation in the normal amount of time, but with a larger number of doses, each one of which is smaller. The underlying principle involves the difference between the ability of normal cells and tumor cells to repair radiation damage. More frequent intervals between the doses of radiation permit normal cells to accomplish some repair, while the tumor cells cannot keep up with the damage. This method has been applied to treating childhood brain stem tumors. Since the brain stem is the location of centers critical for life, such as the control centers for breathing, heart rate, and the regulation of consciousness, surgical removal of the tumor is impossible, and radiation remains the only option. A group of 57 children with brain stem tumors were treated with a total dose of 7,020 cGy of radiation in 60 fractions over a six-week period. (A Gy, or Gray, is a dose of radiation equivalent to one joule of energy absorbed per kilogram of tissue. It is equal to 100 rads.) For comparison purposes, radiation doses around 6,000 cGy are considered high doses. Forty patients remained stable after this course of radiation therapy; one patient achieved a complete response, and an additional three children achieved partial responses. The average (median) time to progression of the brain tumor was six months, and the median survival time was 10 months. Although these statistics are still poor, they represent a small improvement over the results that have been achieved in the past using 6,600 cGy of radiation. A study is in progress to evaluate the effect of a hyperfractionated dose of 7,560 cGy of radiation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Brain cancer, Brain tumors, Intracranial tumors

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