Komanduri Charyulu

Influence of exploratory celiotomy on the management of carcinoma of the cervix. A preliminary report.

The policy of treating patients with Stages IB and IIA carcinoma of the cervix by radical hysterectomy and pelvic lymphadenectomy led to the initiation of laparotomy staging of carcinoma of the cervix in 1970. Two‐hundred twenty patients were subjected to surgical staging at which time bilateral aortic lymphadenectomies and biopsies of perirectal and perivesical spaces were done. If these were negative, radical hysterectomy and pelvic lymphadenectomy were performed in patients with surgical Stage IB and IIA. Para‐aortic node involvement was seen in 7%, 14%, 18%, and 19% in patients with Stages IB, IIA, IIB, and IIIB, respectively, in the context of the surgical material being heavily weighed in favor of early stage disease. The methods of management in these patients were designed according to the findings at exploratory celiotomy. Twenty‐one patients were found to have positive para‐aortic nodes and received en bloc pelvis and para‐aortic irradiation. Four patients are alive and well at 63,23,20, and 19 months, respectively. One patient is alive with disease at 18 months. Two died from other causes at 34 and three months. There was no difference in the survival of the two groups of patients among 75 with negative para‐aortic nodes, who received either pelvic irradiation alone or pelvic and para‐aortic irradiation on the basis of possible presence of subclinical disease not dissected at the time of surgery.

Transperineal interstitial implantation of prostate cancer: A new method

A method of transperineal interstitial implant of prostate without the need for surgical exploration was used to provide a boost dose of 3200 rad to the implanted volume in patients with relatively advanced Stage C carcinoma of the prostate. All patients were initially given megavoltage teletherapy to a dose of 4320 rad in 24 treatments. Disease was locally controlled among all patients except one (96%). The morbitity was insignificant and the quality of life was good. The time of recurrence was from three to nine months in the seven patients who failed. No patient among those initially diagnosed by needle biopsy had failed whereas 50% of those whose diagnosis was by transurethral resection showed distant metastases.

Investigation of different combinations of estrogen therapy and radiation therapy on prostatic adenocarcinoma (R-3327).

The relative effectiveness of different combinations of estrogen therapy and radiation therapy against the R-3327 prostatic adenocarcinoma of the Copenhagen rat was studied. Because of similar actions of estrogens and radiation in the cell cycle, and possibly antagonistic effects reported in the clinical literature, we looked for an antagonism between these two therapeutic modalities. Radiation therapy consistently showed a greater tumor inhibitory effect than estrogen therapy alone at the dose tested. Combinations of radiation therapy with hormonal manipulation did not appear to show a greater inhibition of tumor growth than radiation therapy alone. There also did not appear to be an antagonistic effect between these two modalities in this system.

Preoperative extended field radiation with I-125 seed implant in prostatic cancer: a preliminary report of a randomized study

Abstract This study began in 1972, when randomly allocated patients received preoperative x-ray therapy to the pelvis and para-aortic areas to a dose of 3000 rad in 14 fractions; following this treatment retropubic extraperitoneal exposure of the prostate and node dissection were performed. Iodine-125 seeds were implanted in the prostate. Patients with positive nodes received postoperative radiation therapy to tolerance doses while those with negative nodes were only observed with no further therapy. In the alternate arm, the patients underwent straight retropubic extraperitoneal exposure of the prostate, node dissection, and Iodine-125 seed implant. If the nodes were positive, the patients received en bloc pelvic and para-aortic radiation to tolerance. Patients in this arm with negative nodes again received no further therapy. The aggregate dose was 5400 rad to the pelvis and was about 4400 rad to para-aortic nodes in both arms where the nodes were found to be metastatic. Thirty-two patients were evaluable for minimum of follow-up of two years with equal numbers in each group. Eight of 17 patients who had positive nodes in both the arms and who received extended field x-ray therapy, were disease-free with median survival of 312 years. Two patients in the preoperative radiation group and six in the alternate group had local failures. The pattern of survival and dissemination, otherwise were similar as of this writing.

A Randomized Clinical Trial in Bronchogenic Small-Cell Carcinoma Evaluating Alternating Maintenance Therapy of Vincristine, Adriamycin, Procarbazine, and Etoposide (VAPE) with Cyclophosphamide, CCNU, and Methotrexate (CCM) versus CCM Maintenance Alone in Complete Responders Following VAPE Induction and Late Intensification

Initially, 109 evaluable patients with locally advanced or metastatic small cell lung cancer (SCLC) were treated with vincristine, Adriamycin, procarbazine, and etoposide (VAPE). Partial (PR) or nonresponders (NR) were crossed to CCM (cyclophosphamide, CCNU, and mcthotrexate) and then to HMiVe (hexamethylmelaminc, mitomycin C, vin-blastine) sequentially at maximum response. Complete responders (CR) were intensified by 50% with VAPE primarily and randomized to VAPE, alternating with CCM or CCM alone during maintenance. CR patients with limited disease received local thoracic irradiation and prophylactic cranial irradiation (PCI), whereas those with extensive disease received PCI alone. There were 45 patients (41%) who achieved a CR to chemotherapy, and 27 patients were eligible for randomization. Of 12 CR patients randomized to alternating therapy (VAPE/CCM), the median survival was 25.9 months compared to 12.9 months for 15 CR patients randomized to continuous CCM (P = .049). In addition, 35 patients achieved a PR (32%) and 29 were NR (27%). Overall median survivals were significantly different for the CR patients (13.0 months) as compared to PR (7.6 months) and NR patients (6.4 months). Late intensification did not appear to add substantially to survival while contributing to toxicity. In summary, VAPE is a new outpatient regimen for SCLC, which is highly effective as an induction regimen with moderate hematologic toxicity and predominantly gastrointestinal nonhematologic toxicity.

Selective therapy for early cancer of the cervix: II. Surgically nonexplored cases

Abstract Of 337 patients with cervical cancer stages IB and IIA treated during 1967–1976, 46 or 13.6% were selectively excluded from surgical therapy in favor of radiation therapy. Major contraindications to surgery were age over 70 years, obesity, cardiovascular disease, diabetes, and lung disease. The corrected 3-year survival among those patients treated prior to March 1975 was 53% and the 5-year survival among patients treated prior to March 1973 was 48%. It is suggested that impaired oxygenation secondary to systemic complications of the mentioned medical conditions is primarily responsible for the relatively low cure rate. Other possible high risk factors are age and a large relative number of Stage IIA patients in the material.

Analysis of central failures of brachytherapy of carcinoma of cervix

Approximately over a hundred patients received brachytherapy during this period using the system. The central failures at our center have been analyzed with respect to the relative positions of the radioactive sources, the relative strengths of individual sources, and the relative doses of external versus brachytherapy. Dosimetric considerations indicate that some of the failures could be accounted in the light of relative strengths of radioactive sources. The laparotomy findings in a few of these patients who underwent an exenteration will be described in relation to the therapy administered to these patients.