Radiation therapy for biliary carcinoma of the extrahepatic biliary system: an analysis of 63 cases

Article Abstract:

Cancer of the gallbladder and cancer of the bile ducts outside the liver are not common. The prognosis for these cancers is poor, and less than 10 percent of these patients will survive five years. In contrast to some other cancers, however, death usually results from spread of the primary cancer to the local region rather than metastatic spread to distant parts of the body. The cancers invade the liver in up to half the cases, and this spread often makes surgical treatment of the cancer impossible. In such cases, radiation therapy is often the treatment of choice. In a review of 63 patients, factors affecting the outcome of such cases were tabulated. Eight patients had gallbladder cancer and 55 had cancer of the extrahepatic bile ducts. Sixty patients received external beam radiation, while three patients received brachytherapy, in which the radiation is administered by implanting a small radioactive pellet in the affected region. Of the 60 patients receiving external beam radiation, nine received brachytherapy as well. A total of 12 patients were given liver transplants. The median survival overall was seven months, and all patients who died did so within 39 months of treatment. The prognosis for gallbladder cancer was particularly grim; the median survival was three months, and no patients survived more than half a year. Two patients with extrahepatic bile duct cancer are alive 50 months after radiation therapy; both these patients received transplanted livers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Reports, Gallbladder cancer, Combined modality therapy

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Incidence of cerebral infarction after radiotherapy for pituitary adenoma

Article Abstract:

A number of previously reported cases suggest that irradiation of the head increases the risk of cerebral infarction. To determine whether irradiation for pituitary cancer increases risk for stroke, the records of 156 patients who had received radiation for pituitary adenomas between 1964 and 1987 were studied. Seven patients had strokes at intervals ranging from 3.2 to 14.4 years after treatment. However, statistical analysis provided conflicting results. The overall incidence of stroke was not significantly different from the expected value of 3.5. However, six of the seven stroke victims had received high doses of radiation, indicating the effect may be dose-dependent. Although the relation between dose and stroke risk was statistically significant, when additional factors were considered, this relation was no longer remarkable. Specifically, when age was considered in a multivariate analysis, the increase in stroke risk correlated with age but not with radiation dose. Since the occurrence of stroke is a relatively rare event, a mildly increased risk may require a larger study for detection. Although an increased risk for stroke could not be conclusively demonstrated, it is suggested that radiation doses to the head be limited to the minimum that is consistent with tumor control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Brain, Infarction, Brain infarction

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Radiotherapy of nonfunctional adenomas of the pituitary gland: results with long-term follow-up

Article Abstract:

Nonfunctional adenomas of the pituitary gland are tumors which do not secrete any pituitary hormones. A review of the records of 112 patients treated for nonfunctional adenoma revealed that radiotherapy in proper doses is safe and effective. Beyond 2.7 years, the adjusted survival rate was 97 percent; adjusted survival considers only those deaths directly related to the tumor, in contrast with actuarial survival which counts all causes. No differences could be detected between those patients undergoing both surgery and radiotherapy and those receiving radiotherapy alone. Multiple regression analysis showed no differences among different radiation doses, age, sex, and a number of other parameters. The only significant correlation was a relationship between poor tumor control and a larger irradiated field size. Since the larger field shows worse tumor control, it seems likely that larger fields tend to be used in those cases involving some tumor spread or larger masses. Numerous studies have indicated that increased doses of radiation to the head bear a significant risk; since higher radiation doses did not prove to be more effective, treating pituitary adenoma cases with doses greater than 4750 cGy in 25 fractions is not justified. (Consumer Summary produced by Reliance Medical Information, Inc.)

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