RESUMEN
Twenty-four patients with acquired immunodeficiency syndrome (AIDS) received 80 courses of radiation therapy for Kaposi's sarcoma (KS). Pain and other symptoms due to mass effects were well controlled, but KS lesions often persisted in irradiated sites. Acute radiation toxicity to doses of approximately 2,000 cGy in ten fractions to the oral cavity and/or the foot were significant and may limit the dose and the efficacy of radiotherapy in patients with the epidemic form of KS.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Sarcoma de Kaposi/radioterapia , Adulto , Humanos , Masculino , Persona de Mediana Edad , Radioterapia/efectos adversos , Dosificación Radioterapéutica , Sarcoma de Kaposi/mortalidadRESUMEN
Magnetic resonance imaging (MRI) was performed in 22 patients at various times (0-3) years) following radiation therapy to the spine. T1 and T2 weighted images were obtained at 0.5 Tesla. Increased signal was seen after 800-6000 rads (8-60 Gy). Marrow effects corresponded to radiation ports. Recurrent tumor was clearly separated from fatty replacement. This was much better seen on T1 weighted images. Five patients that had MRI during their course of radiotherapy (XRT) did not have increased signal on T1 images of the bone marrow. The earliest fatty marrow change was seen nine days following completion of 3000 rads (30 Gy) XRT over one month's duration. One patient who received 800 rads (8 Gy) to the upper thoracic spine for eosinophilic granuloma had no radiation effects on MRI when imaged 16 days following completion of XRT given over five days. Fatty marrow change was seen in this patient on MRI six months later. MRI was particularly useful in defining the extent of prior radiation effects when repeat therapy was needed.
Asunto(s)
Imagen por Resonancia Magnética , Neoplasias de la Columna Vertebral/radioterapia , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/secundarioRESUMEN
Twenty patients with solitary plasmacytoma of bone were treated by radiation therapy. Local control was achieved in 19 and most patients developed systemic myeloma. To evaluate disease progression, 65 patients, including 45 from published series, were analyzed. Younger patients seemed less likely to progress (P = .06), but other clinical characteristics including site of involvement and paraprotein status did not influence progression. After dissemination, patients had a clinical course similar to patients with stage I myeloma, with a median survival of 47 months. Overall, patients with solitary plasmacytoma of bone had an indolent course of disease, with a median survival of 10.7 years and a 5-, 10-, and 20-year survival of 75%, 52%, and 37%, respectively.
Asunto(s)
Neoplasias Óseas/radioterapia , Plasmacitoma/radioterapia , Adulto , Anciano , Neoplasias Óseas/mortalidad , Neoplasias Óseas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plasmacitoma/mortalidad , Plasmacitoma/cirugía , Pronóstico , Dosificación Radioterapéutica , Factores de TiempoRESUMEN
The neurologic dysfunction in 7 patients treated for small cell carcinoma (SCC) of the lung by combination chemotherapy and prophylactic brain irradiation was evaluated. The disease appeared to be a diffuse encephalopathy frequently affecting the higher cortical functions. Five out of seven patients had progressive dysfunction leading to death in 1 to 26 months; one patient had stabilization of symptoms followed by death in 21 months, probably from the neurologic disease as well as SCC; one patient's symptoms improved. The clinical course of the neurologic disorder seemed different from the known reactions to brain irradiation and from the other neurologic syndromes associated with lung cancer. The relative contributions of cranial irradiation and treatment with chemotherapeutic agents in producing the neurotoxicity are not known. Computed tomographic (CT) brain scans done after the onset of symptoms did not show any focal signs or necrosis. However, there was a suggestion of progressive increase in intracranial fluid volume on the scans. The incidence of the disorder, 10.2% among a group of 49 patients, suggests the need for prospective studies to evaluate the problem.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Encefalopatías/etiología , Neoplasias Encefálicas/prevención & control , Encéfalo/efectos de la radiación , Carcinoma de Células Pequeñas/terapia , Neoplasias Pulmonares/terapia , Adulto , Anciano , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/radioterapia , Terapia Combinada , Ciclofosfamida/efectos adversos , Doxorrubicina/efectos adversos , Etopósido/efectos adversos , Femenino , Humanos , Lomustina/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Mitomicina , Mitomicinas/efectos adversos , Procarbazina/efectos adversos , Vincristina/efectos adversosRESUMEN
One hundred forty-seven eligible patients with small-cell carcinoma of the lung (SCCL) have been randomized to receive alternating (A) or sequential (S) combination chemotherapy. Initial treatment was with three cycles of VAM (A) or two cycles of POCC (S). VAM consists of VP16-213 200 mg/m2 intravenously (IV) day 1, Adriamycin (Adria Laboratories, Columbus, Ohio) 50 mg/m2 IV day 1, and methotrexate 30 mg/m2 IV day 1 repeated at 21-day intervals. POCC consists of cyclophosphamide 600 mg/m2 IV days 1 and 8, vincristine 1.5 mg/m2 (maximum, 2 mg) IV days 1 and 8, CCNU 60 mg/m2 po day 1, and procarbazine 100 mg/m2 po days 2 through 15. After initial treatment, all patients received whole brain radiation therapy (3,000 rad/10 fractions/2 wk). Patients with limited disease in addition received irradiation encompassing the tumor, hilar, mediastinal, and supraclavicular regions (5,000 rad/25 fractions/5 wk). After radiation, patients on arm A received POCC alternating with VAM; patients on arm S received POCC until progression when they were to be treated with VAM. The alternating arm was superior with respect to rate of complete remission (CR), median disease-free survival (MDFS), and median survival (MS). The advantage of alternating therapy was not as clearly demonstrated in the limited disease groups when interposition of involved field radiation delayed the initiation of the alternating schedule. In limited disease alone, comparing arm A with arm S, no statistically significant differences were noted. The CR rate was 42% v 54%, MDFS was 14 v 10 months, and MS was 16 v 10 months. In extensive disease, the CR rate was 44% v 20% (P = .03), MDFS was 6 v 4 months (P = .003), and MS was 10 v 7 months (P = .001). Improved treatment outcome in SCCL is achieved when combination chemotherapy regimens of similar effectiveness are administered in an alternating rather than sequential schedule.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma de Células Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Análisis de Varianza , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Pequeñas/mortalidad , Carcinoma de Células Pequeñas/radioterapia , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Humanos , Lomustina/administración & dosificación , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Mitomicina , Mitomicinas/administración & dosificación , Procarbazina/administración & dosificación , Distribución Aleatoria , Vincristina/administración & dosificaciónRESUMEN
A group of 158 patients with small cell carcinoma of the lung were followed for 174.5 person-years of observation to determine the risk of acute leukemia. Three cases of acute nonlymphocytic leukemia were observed at 2.3, 2.7, and 3.0 years. The relative risk of developing leukemia was 316 (95% confidence limit, 76-818) and the actuarial risk was 25% +/- 13% at 3.1 years. The relative risk for leukemia was significantly increased in these patients (p less than 0.0001).
Asunto(s)
Carcinoma de Células Pequeñas/terapia , Leucemia/etiología , Neoplasias Pulmonares/terapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Ensayos Clínicos como Asunto , Terapia Combinada/efectos adversos , Femenino , Humanos , Leucemia Inducida por Radiación/etiología , Masculino , Persona de Mediana Edad , Radioterapia/efectos adversos , Distribución Aleatoria , Riesgo , Factores de TiempoRESUMEN
Fifty-four courses of radiotherapy were given to 33 patients with symptomatic extramedullary involvement by non-lymphocytic leukemia. Among them were 23 cases of granulocytic sarcoma. Analysis of the treatment response showed that age, hematopathologic type and quality of irradiation did not influence the radiation response. However, a dose response relationship could be demonstrated with a statistically significant difference in response among the four groups of patients treated to total doses of less than 1000 rad, 1000-1999 rad, 2000-2999 rad, and greater than or equal to 3000 rad (p = 0.003). We suggest irradiating all extramedullary lesions to at least 1100 ret.
Asunto(s)
Neoplasias Óseas/radioterapia , Neoplasias Encefálicas/radioterapia , Leucemia/radioterapia , Neoplasias de los Tejidos Blandos/radioterapia , Neoplasias de la Médula Espinal/radioterapia , Enfermedad Aguda , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Lactante , Leucemia Mieloide/radioterapia , Leucemia Mieloide Aguda/radioterapia , Masculino , Persona de Mediana EdadRESUMEN
The diagnostic accuracy of clinical studies done in 38 patients with small cell carcinoma of the lung was analyzed by comparing the test results to autopsy findings. The chest radiograph was accurate in 31 of 38 patients (82%). The accuracy of the chest radiograph was higher in evaluating the lung parenchyma and mediastinum than in evaluating the hilum and pleura. Computerized tomographic brain scan was accurate in 11 of 12 patients. However, all the diagnostic studies used for assessing the liver, including physical examination, serum liver enzyme and bilirubin measurements, and radionuclide liver scan, were only moderately accurate. More accurate studies for detecting liver metastasis in patients with small cell carcinoma are needed.
Asunto(s)
Carcinoma de Células Pequeñas/terapia , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/terapia , Pulmón/diagnóstico por imagen , Autopsia , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundario , Carcinoma de Células Pequeñas/sangre , Carcinoma de Células Pequeñas/diagnóstico por imagen , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Pronóstico , Cintigrafía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The initial sites and frequencies of disease progression in 97 patients with small cell carcinoma of the lung treated in a Northern California Oncology protocol were analyzed. Among the extensive disease complete responders (25 patients), the chest was the most frequent initial relapse site (18 patients), followed by the liver (nine patients) and bone (six patients). For those patients who had a partial or no response to treatment, the chest was the most frequent site of persistent disease and the majority progressed in the chest initially. The addition of chest irradiation (5000 rad/5 weeks) to patients with limited disease significantly reduced the incidence of relapse (25%) and prolonged the disease-free interval in the chest in the complete responders, but did not affect the failure pattern in partial and nonresponders. All patients received prophylactic cranial irradiation and three limited disease patients (10%) and three extensive disease patients (4%) progressed in the brain.
Asunto(s)
Carcinoma de Células Pequeñas/patología , Neoplasias Pulmonares/patología , Adulto , Anciano , Antineoplásicos/administración & dosificación , Neoplasias Óseas/secundario , Neoplasias Encefálicas/prevención & control , Neoplasias Encefálicas/secundario , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/radioterapia , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Distribución Aleatoria , Factores de TiempoRESUMEN
From 1969 to 1978, 11 patients with non-Hodgkin's lymphoma presenting as thyroid enlargement were evaluated and treated in the Division of Radiation Therapy at Stanford University Hospital. All patients were staged with lymphangiogram and bone marrow biopsy. Eight patients had Stage I-II disease and three patients had Stage III-IV disease. The histologic pattern of the biopsies was diffuse in nine cases, and eight cases were classified as histiocytic lymphoma. All eight patients with Stage I or II disease were treated with irradiation. There is an 83.3% survival at three years and a 75% relapse-free survival at two years. No instance of local recurrence was observed in this group of patients. The three patients with Stage III or IV disease were treated by either irradiation or chemotherapy. Two relapsed within one year and died with disease; the third remained free of disease for nine years before relapse and died with disease six months later. High dose regional irradiation is the recommended treatment for patients with Stage I-II lymphoma of the thyroid.