George A. Plataniotis

Chemoradiotherapy combined with intracavitary hyperthermia for anal cancer: feasibility and long-term results from a phase II randomized trial.

Purpose:The purpose of this study was to investigate in a randomized way the clinical benefit of addition of intracavitary hyperthermia (ICHT) to a conventional chemoradiotherapy schedule in patients with T2-T3N0M0 anal cancer. Methods and Materials:Patients were randomly assigned to undergo chemotherapy with 5-fluorouracil (5-FU) and mitomycin-C combined with radiotherapy with (arm A: 24 patients) or without ICHT (arm B: 25 patients). A microwave applicator operating at 433 MHz inserted into the anal–rectal cavity was used for ICHT. Patients in both arms received 1000 mg/m2 per day of 5-FU on days 1–4 and days 28–31 plus 15 mg/m2 mitomycin-C on day 1. Radiotherapy was administered with a dose of 41.4 Gy (1.8 Gy per fraction) plus a booster dose of 14 Gy (2 Gy per fraction). Results:One patient from group A developed severe mucositis, whereas no severe morbidity was noted in the rest of the patients in both groups. The incidence of lower-intestine acute reactions was higher in the ICHT arm. After a 5-year follow up in the hyperthermia arm, 23 of 24 patients (95.8%) preserved their anorectal function and avoided permanent colostomy, whereas in the second arm, 17 of 25 (68.0%) had sphincter preservation. Local recurrence-free survival time was significantly higher in the ICHT arm (P = 0.0107, log rank test), whereas no significant difference in overall survival was noted. Conclusion:The addition of ICHT to the chemoradiotherapy schedule of anal cancer seems to offer a new effective and safe therapeutic modality. The preservation of anorectal function seems to be the significant clinical benefit of adjuvant ICHT.

Dermatitis during radiation for vulvar carcinoma: prevention and treatment with granulocyte-macrophage colony-stimulating factor impregnated gauze

The aim of this study was to determine the effectiveness of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) impregnated gauze in preventing or healing radiation‐induced dermatitis. Sixty‐one patients were irradiated for vulvar carcinoma. Thirty‐seven applied steroid cream at irradiated areas throughout radiotherapy (Group A) and 24 patients applied additionally GM‐CSF impregnated gauze (40μg/cm2 of skin‐irradiated area, twice per day) in addition to the steroid cream, after 20Gy of irradiation (Group B). The score of skin reactions (P=0.008, chi2 test) and the time interval of radiotherapy interruption (P=0.037, Mann‐Whitney U test) were statistically significantly reduced in Group B patients. Multivariate analysis of variance showed for this group not only a significant reduction in the Sum of Gross Dermatitis Scoring (P<0.001, adjusted for Duration of Dermatitis) but also a significant reduction of the healing time (P=0.02, adjusted for Sum of Gross Dermatitis Scoring). The pain grading was less (P=0.014, chi2 test) and pain reduction was noticed sooner after the application of GM‐CSF impregnated gauze (P=0.0017, Mann‐Whitney U test). Multivariate logistic regression analysis showed that the only significant effect on dermatitis score is due to Body Mass Index (P=0.034) and the application of GM‐CSF (P=0.008). GM‐CSF impregnated gauze can be effective in preventing and healing radiation‐induced dermatitis and in reducing the interruption intervals of radiotherapy for vulvar carcinomas.

A feasibility study of partially accelerated radiotherapy for invasive bladder cancer

Thirty-nine patients with histologically confirmed invasive bladder carcinoma (T2-3, N0, M0) were treated with a partially accelerated radiotherapy scheme. After 40 Gy/4 weeks of conventional fractionation we have accelerated the treatment in the last week giving two daily fractions of 2 Gy each, 4-6 h apart in the bladder only. Although the follow-up of some of the patients is not very long our results indicate that this relatively short radiotherapeutic scheme is feasible, convenient and probably safe for patients living in remote areas.

Radiation therapy alone for growth hormone-producing pituitary adenomas.

We present our experience in the treatment of growth hormone (GH)-producing pituitary adenomas using irradiation alone. Between 1983 and 1991, 21 patients suffering from GH-secreting pituitary adenomas were treated with radiotherapy alone. Two bilateral opposing coaxial fields were used in 10 patients and in the remaining 11 a third frontovertex field was added. Treatment was given in 1.8-2 Gy daily fractions and total dose ranged between 45 and 54 Gy. Treatment was given using a cobalt unit. Four patients treated with somatostatin prior to and 14 patients treated after the end of radiotherapy experienced symptom relief for 6-28 weeks. The 5-year actuarial rate of disease control was 72%. Five out of six failed patients had macroadenomas. Hypopituitarism was observed in 5/21 (24%) patients. Whereas RT alone is effective in the treatment of microadenomas, this is not true for large infiltrative macroadenomas.

Topical granulocyte‐macrophage colony‐stimulating factor for radiation dermatitis of the vulva

Sir, Psoriasis is a common chronic, relapsing, immunemediated disease that most often begins in the first half of life. Safe therapies are needed that can be repeated frequently and be administered for decades. They should not elicit shortor long-term adverse effects nor require hospitalization. Established therapies include dithranol, tar, ultraviolet (UV) B irradiation and, in severe cases, fumarates, retinoids, methotrexate, and psoralen combined with UVA. Topical vitamin D3 and vitamin A derivatives, although useful, rarely achieve complete remission of extensive chronic plaque psoriasis as single-agent therapies. Phototherapy of psoriasis using 311-nm UVB, in combination with topical vitamin D3 derivatives, is an effective and safe outpatient treatment. We compared combination therapy using the vitamin D3 derivative tacalcitol and 311-nm UVB with tacalcitol monotherapy for 3 weeks, and subsequently the response of psoriasis to tacalcitol and 311-nm UVB after pretreatment with tacalcitol alone. The study included patients of both sexes, aged 18 years or older, with moderately severe plaque-type or guttatetype psoriasis. After giving written informed consent, the patients applied tacalcitol [1,24(OH)2 vitamin D3] ointment (Curatoderm, Hermal, Reinbeck, Germany) once daily in the evening. UVB irradiation at 311 nm was administered three to five times a week to the side preassigned by randomization, in a Waldmann 7001 booth (Waldmann, Villingen-Schwenningen, Germany), equipped with Phillips TL-01 fluorescent bulbs. The 311-nm UVB therapy was started at 0 ́2±0 ́3 J cm and the 311-nm UVB dose was increased by 0 ́1 J cm after each treatment up to the maximum tolerable dose. The randomized right/left comparison was terminated after 21 days, and patients were offered continuation of the regimen judged to be more effective. The clinical efficacy was determined weekly by means of the Psoriasis Area and Severity Index (PASI), independently for the right and left side. Statistical analysis was performed using the Mann±Whitney test and the two-tailed Wilcoxon-(Pratt) test (idv, Gauting, Germany). Twenty-two of the 24 patients initially recruited (11 women, 13 men, mean age 44 ́3 years) were included in the study. One patient discontinued because of UV-induced erythema and another for reasons unrelated to the study. Two patients could not come to all the follow-up examinations. No side-effects attributed to topical therapy with tacalcitol were observed. At the start of the study, the right and left sides had a very similar mean ^ SD PASI (14 ́09 ^ 4 ́32; Fig. 1). Both treatment regimens, tacalcitol alone and tacalcitol in combination with 311-nm UVB, resulted in significant reduction of the PASI within 21 days (Fig. 1). In 86% of patients, the combination therapy led to . 50% reduction in PASI. This reduction was achieved in 38% of the body sides receiving tacalcitol monotherapy. The 311-nm UVB irradiation caused only slight pigmentation within 3 weeks; thus, there was no unacceptable difference in pigmentation due to the different treatment protocols. In all 22 patients, the combination of tacalcitol plus 311-nm UVB was superior and therefore was continued on both sides of the body for three further weeks. After another 3 weeks (day 42) the PASI was determined again. At this time both sides, whether treated initially for 3 weeks with tacalcitol alone or with the tacalcitol/311-nm UVB combination, showed comparable mean ^ SD PASI values (2 ́63 ^ 2 ́988 and 2 ́01 ^ 2 ́917, respectively; Fig. 1). Similarly, both treatment regimens led to response rates (. 50% reduction in PASI) greater than 80%. Treatment was unsatisfactory in four of 22 patients (18%). The data confirm that the vitamin D3 derivative tacalcitol is useful in the treatment of psoriasis and that the combination of tacalcitol with 311-nm UVB is superior to either monotherapy. The most interesting finding was that pretreatment with tacalcitol alone appears to prepare the skin, and promote a rapid and successful response to tacalcitol/311-nm UVB combination therapy. Even though unexpected, this result is not without precedent. More than 20 years ago Fritsch et al. demonstrated

Combined teletherapy and intracavitary brachytherapy boost for the treatment of nasopharyngeal carcinoma

For the non-metastatic nasopharyngeal carcinoma, external beam radiation therapy (median dose 64 Gy) and a boost of intracavitary irradiation (ICRT) has been given. Caesium-137 pellets of 40 mCi were used at a dose rate of 3-3.5 Gy/h, 1 cm from the sources. The median dose was 8.5 Gy. Overall 5-year actuarial survival for the 48 studied patients was 60.4% and LRFS was 64%. The procedure was well tolerated by our patients.

Pathological fracture in haemoglobinopathy: Treatment by irradiation

A patient suffering from thalassaemia, with extreme osteoporosis, coarse trabeculation and cortical thinning of the bones, developed a pathological fracture of the left hip. This was treated by a single dose of radiotherapy. It is suggested that the radiotherapy facilitated the healing process by eliminating the causative factor of the fracture, which was the expanding and over-proliferating bone marrow.