Radiation therapy in metastatic spinal cord compression: a prospective analysis of 105 consecutive patients

Article Abstract:

A metastatic tumor in the spinal canal can press against the spinal cord, and can create a variety of neurological symptoms as it grows. The current trend is to rely heavily upon radiation in the treatment of metastatic spinal cord compression. The authors designed a treatment protocol for cancer patients with such spinal cord compression, and now report the results of the first three years of applying this protocol. When metastatic spinal cord compression is identified, the patient is immediately placed on steroids, and radiotherapy is begun within 24 hours. (Metastatic spinal cord compression is usually diagnosed on the basis of myelography, magnetic resonance imaging, or CT scan.) In some cases, the result of imaging is inconclusive, and surgery is performed prior to radiotherapy to obtain an accurate diagnosis. Some cases may also show signs of deterioration of vertebrae and may require surgery for that reason. Otherwise, radiotherapy is the primary treatment. In a series of 130 consecutive patients, 12 required surgery in addition to radiotherapy, and 118 received only radiotherapy. It was not possible to evaluate 13 patients due to early death, leaving 105 patients receiving only radiotherapy for evaluation. Among these patients, the most important prognostic factor was the condition at diagnosis. Up to 75 percent of the patients who were walking at the time of diagnosis remained ambulatory. However, of the patients who had already become paraplegic, only 10 percent recovered walking ability. Eighty percent of the patients with back pain experienced improvement, as did 49 percent of the patients with motor dysfunction. Similarly, 40 percent of patients with autonomic dysfunction improved. The results indicate that radiotherapy can provide effective relief of neurological symptoms of patients with metastatic spinal cord compression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Complications and side effects, Radiotherapy, Cancer invasiveness, Spinal cord compression, Nervous system tumors

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Pharmacokinetics of vincristine in cancer patients treated with nifedipine

Article Abstract:

Vincristine (VCR) is an antitumor drug which exerts its action by interfering with the reproductive apparatus of cells. The use of vincristine is complicated by its toxicity, particularly for the nervous system, and resistance to the drug. Although VCR resistance seems to arise from a number of different causes, it is believed to be related to a decrease in the accumulation of vincristine inside the cells. Tissue culture experiments using human cells and experiments in mice have indicated that the use of calcium entry blockers such as nifedipine (NIF) can increase the cytotoxic effect of VCR. The combined use of VCR and NIF may yield improved results in the treatment of certain cancers. Before beginning formal studies, the pharmacokinetics of VCR with and without NIF were measured. Twenty-six patients with a variety of solid tumors were injected with 2 milligrams (mg) of VCR; 12 patients received 10 mg of NIF three times daily three days before and seven days after VCR. Blood samples were taken after VCR injection, and a sensitive radioimmunoassay was used to measure the concentration of VCR in the blood. The results indicated that the presence of NIF increased the rate at which VCR was distributed in the tissues, and decreased the rate at which it was eliminated from the body. The excretion of VCR in the urine was significantly reduced in the presence of NIF. Although the use of NIF may improve the efficacy of VCR in treating cancer, it might also increase VCR toxicity. Appropriate care should be taken in designing treatment protocols in VCR and NIF clinical trials. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Cancer, Chemotherapy, Nifedipine, Vincristine

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Treatment of metastatic malignant melanoma with dacarbazine plus tamoxifen

Article Abstract:

Dacarbazine plus tamoxifen rather than dacarbazine alone should be standard for patients with metastatic malignant melanoma. This drug combination extends life expectancy and has a better response rate in women than in men. However both men and women on the combined therapy had better outcomes than those on dacarbazine alone. Median survival was 29 weeks in the dacarbazine group and 48 weeks in the group receiving both drugs. There was no difference in the two groups in the frequency of gastrointestinal side effects. The interaction of tamoxifen, estrogens manufactured by the body and dacarbazine could be the reason for improvement. Specifically why women react more favorably to the combined therapy is unknown. This gender difference suggests the possible role of estrogens in melanoma growth.

Dosage and administration, Cancer metastasis, Melanoma, Tamoxifen, Dacarbazine

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