Intraoperative radiation therapy for recurrent head and neck cancer

Article Abstract:

Recurrent cancer is invariably a serious challenge for the clinician treating a cancer patient. In the case of patients with cancer of the head and neck, the initial treatment usually consists of either irradiation alone or irradiation in combination with surgery. As a result, if the cancer recurs, it recurs within an area already altered in structure and appearance, making further surgery difficult. In addition, it is difficult to deliver a high enough dose of radiation to the recurring cancer without causing unacceptable damage to the surrounding tissues. Often, patients with recurrent head and neck cancer may be offered only palliative treatment (intended to reduce discomfort but not to cure disease). However, one therapeutic option is intraoperative radiation therapy. In this procedure, the surgeon directs the precise placement of radiotherapy while the cancer surgery is taking place. The advantage to this method is not only that radiation can be precisely directed at the cancer, but also that adjacent normal structures may be protected by the surgeon in ways not possible during conventional radiotherapy. In a series of 126 patients treated with intraoperative radiotherapy, 47 patients were treated for cancer which had recurred after they had previously received a radiation dose of at least 45 Gy (a Gy, or Gray, is one Joule of energy absorbed per kilogram of tissue). During the surgery for the recurrent cancer, these patients received additional radiation of from 15 to 25 Gy. After an average follow-up of 29 months, 20 patients are alive and 15 of them are alive without disease. Four patients died of complications in the month following surgery, yielding a perioperative mortality rate of 8.5 percent. In all cases, these deaths were unrelated to the use of the intraoperative radiotherapy. Considering that without treatment these patients are virtually guaranteed to experience a disfiguring and painful death, a perioperative mortality rate of 8.5 percent does not seem unacceptable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Cases, Cancer, Head and neck cancer, Cancer recurrence, Intraoperative radiotherapy

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Measuring the cost-effectiveness of hematopoietic growth factor therapy

Article Abstract:

Hematopoietic growth factors are finding their way out of the laboratory and into clinical practice. Erythropoietin, which stimulates the development of red blood cells, is being successfully used to prevent the anemia which accompanies advanced kidney disease. This substance is also finding potential application in oncology, in the prevention of anemia resulting from chemotherapy. Other growth factors will most likely be first applied in the treatment of cancer patients. To date, there is no chemotherapeutic drug which kills cancer cells without having seriously damaging effects on normal cells as well. Among the normal cells which suffer the most are the cells of the bone marrow. The decimation of these cells robs the body of some of its ability to replace the important immune cells which fight infection. In principle, growth factors may be used to replace the protective cells more rapidly. However, in light of the rapidly rising cost of health care, it must be asked if these growth factors are truly cost effective. If a growth factor results in a four-day acceleration of the recovery of the immune system, how many actual infections will be prevented? Are the growth factors more economical than simply keeping a close watch on the patient? These questions cannot be answered except by the careful analysis of objective data. For instance, the growth factors are not without their own side effects, such as fever and low blood pressure. Will monitoring these side effects erase the savings which might come from a decrease in the infection rate? Will patients treated with growth factors as a part of their chemotherapeutic regimen actually survive longer? Will the introduction of growth factors into cancer treatment increase or decrease the average hospital stay? Before clinicians place too much hope in growth factor treatment, these questions must be answered by careful research and analysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Economic aspects, Medical care, Cost of, Health care costs, Hematopoietic growth factors

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