Steven C. Carabell

Misonidazole and radiotherapy to treat malignant glioma: A phase II trial of the radiation therapy oncology group

Abstract Fifty-four patients with Grade III or IV malignant glioma were treated with the hypoxic-cell radiosensitizer misonidazole, and radiation therapy (RT) in a Phase II trial of the Radiation Therapy Oncology Group (RTOG). The median survival was 39 weeks. Toxicity was acceptable. Almost all toxicities were reversible and self-limited. The were no significant changes in hematologic, hepatic or renal parameters. The median survival obtained is similar to the results with conventional radiotberapy. A Phase III trial is under way comparing standard radiation and BCNU chemotherapy (1,3-bis (2-chloroethyl)-1-nitrosourea) with sensitized radiation and chemotherapy (RT + misonidazole + BCNU). Additive toxicity between misonidazole and BCNU was not observed in a pilot group.

The role of radiation therapy in the treatment of pediatric non-Hodgkin's lymphomas

Between 1971 and 1976, 64 patients less than 18 years of age with non‐Hodgkins lymphoma were treated at Bostons Childrens Hospital Medical Center‐Joint Center for Radiation Therapy. A multimodality approach was used, consisting of radiation therapy (3500‐4500 rad), surgery, and chemotherapy. Since 1973, all patients have received a regimen initially comprising Adriamycin, Prednisone, 6‐Mercaptopurine, Vincristine, and L‐Asparaginase. Methotrexate was substituted for Adriamycin following a cumulative total dose of 450 mg/m2. The 5‐year actuarial survival for all patients was 61%, while relapse‐free survival was 54%. The actuarial and relapse‐free survival for patients presenting with localized disease was 75% and 72%, respectively. Median follow‐up was 40 months and all relapses occurred within 24 months of initial therapy. A multidisciplinary approach, such as the current regimen, offers a good prognosis for this disease. Cancer 42:2193–2205, 1978.

Sequelae of total body irradiation in the treatment of lymphocytic lymphoma

Seventy-eight patients with advanced lymphocytic lymphoma have been treated by total-body irradiation (TBI) since 1969. Fifty-one of these patients received TBI as their initial and only primary therapy, and of these, 36 had a nodular histology and 15 had a diffuse histology according to the Rappaport classification. Treatment consisted of 15 rads twice weekly to 150 rads total dose. Persistent local tumors were given local boost irradiation. None of these 78 patients experenced significant morbidity; toxicity was confined to thrombocytopenia, and in 40% of the patients treatment was administered over a prolonged course to allow platelet recovery. Of the 51 patients who received TBI as primary treatment, 80% achieved a complete response for a median relapse-free survival of 24 months and an actuarial 5-year survival of 68%. TBI is an effective therapy in advanced lymphocytic lymphoma and produces long remissions without maintenance in many patients. It should be considered a systemic agent, and its use in combination with chemotherapeutic agents deserves further investigation.