Vitune Vongtama

Hydroxyurea: A radiation potentiator in carcinoma of the uterine cervix: A randomized double-blind study

From June, 1972, to December, 1976, 40 patients with FIGO (International Federation of Gynaecology and Obstetrics) Stage IIB carcinoma of the uterine cervix were entered into a prospective, double-blind, randomized study to evaluate the possible radiation-potentiating properties (i.e., improved survival) of the S-phase cell cycle-specific inhibitor of DNA synthesis, hydroxyurea. All patients were documented to be without aortic lymph node metastasis by pretherapy staging para-aortic lymphadenectomy. All 40 patients were followed up for longer than 5 years (5.2 to 9.2 years) or until death. The double-blind code was not broken until all patients had been followed up for a minimum of 2 to 5 years. Leukopenia (white blood cell count less than 2,500 mm3) was significantly increased in the patients given hydroxyurea as compared to those given placebo (P less than 0.0001). There was no statistically significant difference relative to anemia, thrombocytopenia, radiation-induced skin reaction, and radiation-induced intestinal reaction between the patients given placebo or those given hydroxyurea. Life-table survival for the patients given hydroxyurea was 94% as compared to 53% for the patients given placebo (P = 0.006). Only one (5%) patient given hydroxyurea died of cervical cancer. Of the other patients who died in the group given hydroxyurea, all were confirmed by postmortem examination to have been without recurrent cervical cancer. In contrast, 45% (nine) of the patients given placebo died of cervical cancer.

Hydroxyurea and radiation therapy in advanced cervical cancer

Abstract A prospective randomized double blind study on women with locally advanced cervical cancer was carried out to evaluate the combination of hydroxyurea and irradiation therapy. The results of the clinical trials are discussed as well as a method for improving similar future studies.

Hydroxyurea as a radiation sensitizer in women with carcinoma of the uterine cervix

Hydroxyurea was evaluated as a possible radiation sensitizer in 130 evaluable women with Stages IIB and IIIB (International Federation of Gynecology and Obstetrics) carcinoma of the uterine cervix. This was a prospective double-blind randomized study in which hydroxyurea or placebo was compared in conjunction with continuous or split-course radiation therapy. Of all patients with Stage IIB cancer without biopsy proof of aortic node metastasis, a significant improvement in survival (P less than 0.01) was achieved in the hydroxyura group (74.0%) as compared to the patients receiving placebo (43.5%). In women with Stage IIIB cervical cancer there was a trend toward longer survival in those receiving hydroxyurea (52.1%) as compared to those receiving placebo (33.3%). However, there was a statistically significant improvement in survival in those women with Stage IIIB cervical cancer who had staging done at operation, were found to have negative para-aortic nodes, and subsequently received continuous radiation therapy (90.9%) as compared to those receiving split-course therapy (29.4%) (P = 0.005).

Radiotherapy in the treatment of sarcomas of the corpus uteri

One hundred forty‐seven cases of sarcomas of the corpus uteri, including 71 leiomyosarcomas, 30 endometrial stromal sarcomas, 23 mixed mesodermal sarcomas, and 23 carcinosarcomas were treated at Roswell Park Memorial Institute. These tumors represent 6.7% of all cancers of the uterine corpus. Treatment varied from surgery (56 cases) to radiotherapy (37 cases) or combined surgery and irradiation (54 cases). The 5‐year crude survival rate of the entire series was 37% with no significant difference between the 4 histologic groups. The clinical extent of tumor was the most significant prognostic factor. Suggestive evidence of increased survival rates was seen in those treated by combined surgery and irradiation. A significant decrease in the recurrence rates followed this combined approach.

Sequential therapy for advanced ovarian adenocarcinoma: Operation, chemotherapy, second-look laparotomy, and radiation therapy

In an attempt to improve the survival rates in women with advanced ovarian adenocarcinoma (abdominal spread), they were treated with sequential therapy. This consisted of operation followed by chemotherapy, second-look exploratory laparotomy, and finally whole-abdomen irradiation. Only those patients who had a complete clinical response to chemotherapy and subsequently underwent a second operation and irradiation were evaluated. Seventy-five per cent of the patients had recurrent cancer within the treated area after sequential therapy was completed. Morever, of four patients with no gross residual cancer after the second operation, three had cancer recurrences within the treated area. It is concluded that methods of treating advanced ovarian adenocarcinoma other than sequential therapy must be found.

Hydroxyurea plus pelvic radiation versus placebo plus pelvic radiation in surgically staged stage IIIB cervical cancer

Forty‐five evaluable patients with stage IIIB carcinoma of the uterine cervix were entered into a prospective, double‐biind, randomized study to evaluate the possible radiation‐potentiating properties of hydroxyurea. All patients were documented to be without para‐aortic lymph node metastasis by pretherapy staging para‐aortic lymphadenectomy. The original plan of therapy was for continuous therapy (200 rads/day) of 6,000 rads of pelvic radiation for 6 weeks plus intrauterine radium. However, 16 patients received 6,000 rads in 8 weeks by split‐course therapy (2‐week rest after 3,000 rads) plus radium. Twenty‐nine patients received the planned continuous therapy. The median dose of pelvic radiation for patients who received continuous therapy or split‐course radiation was 6,000 rads. Leukopenia (WBC < 2,500/mm3) was significantly increased in the patients given hydroxyurea as compared to those given placebo (P < .001). There was no statistically significant difference relative to anemia, thrombocytopenia, radiation skin reaction, diarrhea, or radiation‐induced complications requiring surgical correction. The estimated 5‐year progression‐free survival rate for the combined, continuous, and split‐course radiation therapy hydroxyurea patients was 60 %, and its was 52 % for the corresponding placebo patients (P = .49). However, the estimated 5‐year progression free survival rate for the correctly treated patients (continuous therapy) was 91% for the hydroxyurea group and 60% for the placebo group (P < .06).

End results of radiation therapy, alone and combination with 5‐fluorouracil in colorectal cancers

The authors retrospectively analyzed the results of irradiation in 148 cases of primary inoperable and recurrent adenoearcinoma of the colon and rectum treated at the Department of Radiation Therapy, Roswell Park Memorial Institute between 1962 and 1970. This group includes 95 recurrences and 53 inoperable primaries. Uninterrupted radiotherapy was used in 118 cases and split‐course technique in 30 cases. Eleven patients received combined radiotherapy and surgery. Seventy‐eight patients received a combination of 5‐fluorouracil (5‐FU) and irradiation. The response rate and survival of individual groups is discussed in detail. This study indicated that perineal recurrences should receive whole pelvic irradiation in addition to perineum field. Split‐course technique appeared to yield a better survival than the uninterrupted course. The best 5‐year survival rate (64%) is found in the group treated with a combination of radiation and surgery. For locally advanced, inoperable cancers, split‐course technique, combined 5‐FU and irradiation gave the best results, achieving longer palliation with improved quality of life and sometimes yielding cure (5‐year survival).

Dysgerminoma of the ovary: Radiation therapy for recurrence and metastases

Nine cases of dysgerminoma are reported. Five patients developed recurrence of disease in either the pelvis or metastatic sites including the lung and brain. The metastatic disease was controlled by a radiation dose of 2,000 to 3,000 rads during three to four weeks in four of the patients. The excellent response of dysgerminoma to radiation warrants an optimistic prognosis and vigilant follow-up since metastatic disease can be controlled by moderate radiation doses.

Evaluation of Primary Radiation Therapy in Stage I, Group 2, Endometrial Carcinoma

TOTAL HYSTERECTOMY preceded by intracavitary radium therapy has been the treatment of choice in clinically operable Stage I carcinoma of the endometrium (3, 9, 11, 12). In about one-third of patients with Stage I tumors, the medical conditions are such as to preclude surgery (6, 7). In this group (Stage I, Group 2: International Classification), radiation has been the primary treatment and it is with this group and its radiotherapy that this study is primarily concerned. The role of external radiation will be discussed, and radium technics will be compared to evaluate the influence of the methods of radiation on the prognosis. In addition, the rate of post-treatment residual and recurrent tumors and the relative morbidity associated with each method will be assessed. Material And Method Between January 1940 and January 1963, 837 primary cases of Stage I endometrial carcinoma were treated at Roswell Park Memorial Institute, Buffalo, N. Y. This series included 285 (268 adenocarcinomas and 17 adenoacanthomas...

Para-aortic lymph node irradiation for carcinoma of the uterine cervix using split course technique☆

Abstract Twenty women with previously untreated cervical cancer received radical irradiation to the para-aortic lymph nodes and pelvis. Ninety percent received 6000 rads to the para-aortic nodes and pelvis in 8 weeks using split course technique. The mortality from complications of therapy, without evidence of recurrence, was 25%. Forty percent of the women were dead from recurrent cervical cancer (4–23M), and even with this short follow-up only 35% were surviving NED (6–29M). Methods for improving future trials of irradiation to the para-aortic nodes are discussed.