Natalio Walach

The palliative efficacy of a single high dose of radiation in treatment of symptomatic osseous metastases

Radiation therapy is effective for palliation of painful metastatic osseous lesions. Various fractionation doses have been previously described. The present study was initiated to evaluate the efficacy of a high single dose of radiation on pain relief, with the goal of reducing the number of radiation sessions to a minimum. Treatment consisted of a high single dose of radiation ranging between 6 to 10 Gy administered to painful osseous metastases. Prior to radiation therapy response to conservative analgesic therapy was minimal in most cases. Response to radiation therapy thereafter was 71.3% lasting up to 6 and 12 months in 37.3% and 20.9% of cases respectively.

Meningiomas after radiotherapy for tinea capitis--still no history.

Aims and background To review the clinical, radiological and histological findings of 19 patients with radiation-induced intracranial meningiomas treated at our neurosurgical department between 1981 and 1996. Method The records of 18 patients with intracranial meningiomas who underwent low-dose radiation for tinea capitis in childhood, and of one patient irradiated for pituitary adenoma, were analyzed in respect of the previously reported features of postradiation meningiomas. Results The mean age of the patients with low-dose radiation-induced meningiomas was 58 years and the mean shortest onset latency was 48 years. The male to female ratio was 1.1:1. Forty-seven percent of patients presented with mental changes and/or focal neurological signs, 21% with signs of increased intracranial pressure and 26% with seizures. Calvarial location of the meningiomas was found in 54% of patients and in one patient the tumor arose from the skull base. Multiple tumors were present in 15% of patients and 29% of the meningiomas displayed malignant features on histological examination. A significantly lower meningioma recurrence rate was found in our series compared to the recurrence rate in the reported series of postradiation meningiomas. Five patients had a history of a second neoplasm other than meningioma. Conclusion Our series of low-dose radiation-induced meningiomas represents one of the largest of its kind in the English literature. The patients did not differ substantially in sex ratio, tumor localization, multiplicity and histological features from the previously reported postradiation meningioma patients, except for the significantly lower tumor recurrence rate. It would seem that over the next years we will be further witnessing the deleterious effects of low-dose radiation administered in childhood.

Intravesical Chemotherapy in a Controlled Trial with Thio-Tepa Versus Doxorubicin Hydrochloride

AbstractWe treated 25 patients with recurrent transitional cell carcinoma of the bladder with intravesical chemotherapy. The 2 drugs used were doxorubicin hydrochloride and thio-tepa introduced at 3-week intervals and checked for efficacy by repeated cystoscopy after every 3 instillations. The clinical data and results of both groups are presented, and the importance of intravesical treatment with minimal toxicity in this relatively benign condition is discussed.

Clinical Determinants of Long-Term Survival in Patients with Glioblastoma Multiforme

Repeated reports of more than ten years postoperative survival in patients with glioblastoma multiforme (GM) have appeared in the literature over the last decades. Authors have tried to identify the clinical, therapeutic and histological features determining long-term survival. We present two patients in whom, after radical removal of the tumor followed by conventional radiation, there has been no recurrence for at least ten years. The young age of the patients and the radical surgical approach were in accordance with previous reports of long-term survival. Nevertheless, one tumor originated from the thalamus, a location considered to be of unfavorable prognosis. We therefore further discuss the value of clinical signs as determinants in the prognosis of GM.

Medical staff attitudes: views and positions regarding blood transfusion to terminally ill cancer patients.

Blood transfusion is a widely used supportive treatment of cancer patients, most of whom are anemic. In the particular subset of cancer patients that undergoes chemotherapy, blood transfusion is viewed as an essential part of supportive care. However, the place of blood transfusion in anemic terminally ill cancer patients is far less established. There are no well-defined blood transfusion guidelines (“transfusion trigger”) for these patients. Hence, transfusion decisions are greatly influenced by the personal views of the medical team. Therefore, a mail survey of 500 physicians (from several specialties) and nurses was initiated to assess their personal opinions on this topic. The overall response rate was relatively high (70%). There was broad agreement that blood transfusions, as a rule, should not be withheld from terminal cancer patients. On the other hand, only nurses were of the opinion that these patients should be transfused “as usual.” Significantly, there was but a slight majority (53% of participants) that was of the opinion that transfusions to these patients do not prolong suffering. There emerged a short list of agreed-on suggestions for blood transfusion—namely, Hb level ≤ 7 mg/dL, active bleeding (acute and/or occult), functional deterioration of the patient, presence of anemia resulting from chemotherapy, anginal symptoms, dyspnea, and worsening congestive heart failure. The agreed-on suggestions for transfusions in terminally ill cancer patients may serve as a reasonable physician standard for this complex clinical, medical-legal, and emotional issue.

Leukocyte Alkaline Phosphatase and Carcinoembryonic Antigen in Lung Cancer Patients

Leukocyte alkaline phosphatase (LAP) scores in peripheral blood and plasma carcinoembryonic antigen (CEA) levels were determined in 58 lung cancer patients and compared with those of 22 healthy persons, who served as controls. In the control group we found LAP scores of 54 +/- 28 and CEA levels of 4 +/- 3 ng/ml. The 97.7% confidence intervals are: LAP score < 110 and CEA level < 10. In the patients with limited lung cancer we found LAP scores of 152.4 +/- 36.7 and CEA levels of 22.7 +/- 48 ng/ml. The 97.7% confidence intervals are: LAP score > 78.6 and CEA level > 0. In the patients with extensive lung cancer we found LAP scores of 272 +/- 49 and CEA levels of 47.5 +/- 80.4 ng/ml. The 97.7% confidence intervals are: LAP score > 174 and CEA level > 0. The sensitivity of each marker is discussed, here as percent of false-negative results, denoted PFN, and meaning that with a chosen threshold for the marker level, only PFN% of the patients with a given condition (e.g. extensive lung cancer) might have a marker level less than the chosen threshold and could therefore be assumed healthy. The sensitivity of the LAP score is 0.05% PFN for the group of patients with extensive lung cancer, and we conclude that indeed LAP score < 110 indicates a very low probability of having extensive malignancy. The sensitivity of the CEA level is 32% PFN. The sensitivity of the LAP score to limited lung cancer is 12% PFN for the group of patients with that condition compared with 40% of CEA. The specificities of both LAP score and CEA levels, expressed as percent of false-positive results in the control group, are fair (2.3%), provided that the common conditions, other than cancer, that elevate LAP score and/or CEA levels are well known and can be eliminated by the physician. It is concluded that the LAP score is considerably more useful than the CEA level as a marker for extensive lung cancer.

LEUKOCYTE ALKALINE PHOSPHATASE, CA15-3, CA125, AND CEA IN CANCER PATIENTS

Peripheral blood leukocyte alkaline phosphatase (LAP) scores and CA15-3, CA125, and CEA levels in plasma were measured in 57 patients with metastatic breast, ovarian, and colorectal cancer, respectively, and in 79 patients with the same types of nonmetastatic cancer. The mean LAP scores of the metastatic cancer patients (261, 272 and 275 for breast, ovary and colon, respectively) were significantly higher than those of the nonmetastatic cancer group (70, 68 and 57, respectively). There was no overlap between the 95% confidence intervals of the two groups (i.e., metastatic versus nonmetastatic), and no patient known to be metastatic had a LAP score within the normal range. The mean levels of other markers in the metastatic patients (CA15-3, 63.4 μ/ml; CA125, 104.8 μ/ml; and CEA, 51.8 ng/ml for metastatic breast, ovarian, and colon cancer, respectively) were also higher than in the nonmetastatic patients (CA15-3, 24 μ/ml; CA125, 25.3 μ/ml; and CEA, 5.8 ng/ml for nonmetastatic breast, ovarian, and colon cancer, respectively). However, the 95% confidence intervals of the nonmetastatic and the metastatic patients overlapped so that there were false-negatives and/or false-positives when the other markers were used. We therefore conclude that the addition of the LAP score to conventional cancer markers could be helpful for the diagnosis of recurrence and follow-up of cancer patients and suggest that our results be confirmed by further studies on a larger series of patients.