Colin Bull

Role of bipedal lymphangiogram in radiation treatment planning for cervix cancer

PURPOSEnThe role of bipedal lymphangiogram in tailoring radiation portals in radical radiation therapy for Stages II or III cervix cancer is investigated.nnnMETHODS AND MATERIALSnThe records and simulation films of 87 patients with Stage II or III carcinoma of the cervix treated with radical radiation therapy alone have been retrospectively reviewed.nnnRESULTSnSixty-two percent of patients who had a bipedal lymphangiogram, subsequently had their radiation fields altered from a standard portal. The most frequently altered fields were the lateral margin of the postero anterior field and the anterior margin of the lateral fields. In order to cover the lymphatic channels in the pelvis in 90% of cases as outlined by the bipedal lymphangiogram, the lateral margins of the postero anterior fields would need to be 2.5 cm lateral to the pelvic brim and the anterior border of the lateral field, 0.5 cm anterior to the pubic symphysis.nnnCONCLUSIONnStandard fields adequately cover the median distribution of lymphatics, but may result in a geographic miss in some patients. Bipedal lymphangiograms allow a more accurate tailoring of pelvic lymphatic fields.

Concurrent 5-fluorouracil, mitomycin C and irradiation in locally advanced cervix cancer.

We reviewed 177 patients treated with radical radiotherapy for locally advanced (FIGO stages IIB, IIIA, IIIB) cervix cancer between January 1979 and December 1989. The radiotherapy was given by external beam treatment to the pelvis and by an intracavitary caesium insertion. Ninety-three patients also received chemotherapy which consisted of infusional 5-fluorouracil during the first and last weeks of the external beam component of the radiotherapy, combined with bolus mitomycin C (group A, 64 patients) or without mitomycin C (group B, 29 patients). These groups were compared with patients treated by radiotherapy alone (group C, 84 patients). The median follow-up was 7.2 years. The median survival time for all patients was 47 months, but was significantly higher (87 months, p = 0.004) for group A. Rates of relapse-free survival and local control were also higher in group A. Toxicity was assessed in detail using the Franco-Italian glossary. There was a relatively high rate of complications, particularly in group A, with 36% of patients having grade 3 or 4 complications. This increase in toxicity persisted through all follow-up time intervals. Patients in group B also demonstrated a higher rate of toxicity than group C, but this increase was limited to the first 6 months of follow-up. The use of mitomycin C in addition to radiotherapy and 5-fluorouracil should be regarded with caution, as other studies have also shown that toxicity is increased, but without improvements in survival.

Laser palliation of inoperable malignant dysphagia: initial and at death☆☆☆★★★♢

BACKGROUNDnNd: YAG laser therapy has been shown to be highly effective in the palliation of dysphagia due to inoperable esophageal malignancy. However, the duration of response and the degree of palliation present at death have not been adequately addressed.nnnMETHODSnSeventy consecutive patients with inoperable malignant dysphagia (mean age, 70 years; 48 men, 22 women) underwent palliative laser therapy. Dysphagia was assessed on a 5-point scale (0, normal; 4, complete dysphagia) before and after laser therapy and within 2 weeks of death.nnnRESULTSnNinety-six percent of patients were palliated initially (70% successful, 26% partial). Mean swallowing score improved from 2.3 to 1.1 (p < 0.001) with a mean of 1.9 initial treatment sessions. Swallowing score remained improved in the last two weeks of life at a mean of 1.7 (p < 0.001). Seventy-three percent of patients were palliated at death (36% successful, 37% partial); median survival was six months. The mean total number of laser sessions was 3.4, with a mean time interval between laser sessions of 27.2 days. Complications included one perforation (1.4%) resulting in death.nnnCONCLUSIONnEndoscopic laser therapy provides safe and effective initial palliation of inoperable malignant dysphagia. In the majority of patients the palliation is maintained until death.

Etoposide, carboplatin, cyclophosphamide and vincristine in previously untreated patients with small-cell lung cancer

SummaryThe efficacy and toxicity of 120 mg/m2 etoposide and 100 mg/m2 carboplatin given i.v. daily x 3 together with 750 mg/m2 cyclophosphamide and 14 mg/m2 vincristine given i.v. on day 1 (ECCO) in a regimen given every 28 days for 6 courses was assessed in 90 (40 limited stage, 50 extensive stage) previously untreated patients with small-cell lung cancer. Mediastinal irradiation using 50 Gy in 25 fractions was given to limitedstage patients without progression after 3 courses of chemotherapy. Cranial irradiation with 30 Gy in 10 fractions was given to all patients attaining a complete response (CR). Objective responses were seen in 83% [CR, 60%; partial response (PR), 23%] of patients with limited and 76% (CR, 22%; PR, 54%) of those with extensive disease. The median relapse-free survival for objective responders with limited disease was 13.4 months, with a median of 8.0 months for extensive-stage patients. The median relapse-free survival for patients achieving a CR was 13.4 months, with a median of 7.8 months for those undergoing a PR. The median survival was 13.3 months for patients with limited disease, with a median of 9.6 months for those with extensive disease. The median survival following a CR was 18.2 months, with a median survival of 9.9 months for those showing a PR. The combination was well tolerated, with either no nausea or nausea only (WHO grade 0 or 1) in 56% of patients and minimal mucositis, renal toxicity, neurotoxicity or ototoxicity. Neutropenia measuring <1.0×109 WBC/l (WHO grade 3 or 4) was seen in 74% of patients, with two deaths due to infection occurring during neutropenia. Thrombocytopenia of <50×109 platelets/l (WHO grade 3 or 4) occurred in 24% of patients. ECCO is a new, active, welltolerated program for previously untreated patients with small-cell lung cancer.

Uterine papillary serous carcinoma: Patterns of failure and survival

Objective: To evaluate the outcome in patients with uterine papillary serous carcinoma (UPSC).

The management of oesophageal carcinoma: radiotherapy or surgery? Cost considerations.

A cost comparison has been made between two treatment modalities used with curative intent for carcinoma of the oesophagus, for 144 patients seen between December 1979 and December 1985. Forty-two patients were selected for radical oesophagectomy. In this paper these are compared with 50 patients who underwent radical radiotherapy. The median survival of both groups was identical (12 months). The remaining 52 patients underwent a variety of palliative procedures and are not considered further. Components of management were identified and costed on the basis of direct resource use by the hospital. Surgically treated patients on average cost

A ‘Catch Up’ Plan for radiotherapy in New South Wales to 2012

A13,638 in 1987 dollars, whereas those treated by radiotherapy cost

Synchronous cisplatin infusion during radiotherapy for the treatment of metastatic melanoma

A3533. The major factors accounting for this cost difference were the necessary perioperative intensive management in the surgical group, the inevitable perioperative complications and the subsequent prolonged hospitalization of a proportion of patients. The cost of the management of the complications of radiation therapy are included but were not a major factor in overall costs for the irradiated group. This cost differential must influence the continuation of current strategies in which radical surgery, rather than irradiation, is the selected routine curative approach for oesophageal cancer particularly in the absence of evidence of higher survival.

Persisting cyclical uterine bleeding in patients treated with radical radiation therapy and hormonal replacement for carcinoma of the cervix

In New South Wales (NSW) from 1996 to 2006, only 34–37% of newly diagnosed cancer patients were treated with radiotherapy instead of the 50% proposed by NSW Health in Radiotherapy Plans released in 1991, 1995 and 2003. As a consequence, over 50u2003000 cancer patients were not treated and has resulted in the estimated premature death of over 8000 patients and over 40u2003000 years of life lost. In 2008, there were 42 linear accelerators in NSW rather than the 62 recommended. Based on cancer incidence projections, NSW will require 69 linear accelerators in 2012 – a shortfall of 27 linear accelerators. Already 15 linear accelerators have been approved. NSW Health has funding for seven extra linear accelerators, and eight extra linear accelerators are to be funded by the private sector. To make up the shortfall, a ‘Catch Up’ Plan is proposed for an additional 12 linear accelerators by the end of fiscal year 2012. This is estimated to cost

Evaluation of patient preferences towards treatment during extended hours for patients receiving radiation therapy for the treatment of cancer: A time trade-off study

200 million over 4u2003years for one‐off establishment costs for buildings and equipment plus