Cancer following radiotherapy for peptic ulcer.

BACKGROUND: Radiotherapy for peptic ulcer was used between 1937 and 1965 to control excessive gastric acid secretions (mean dose, 14.8 Gy). Patients with this benign condition live many years after treatment and are at risk for late effects. PURPOSE: Our purpose was to investigate the risk of death from cancer following radiotherapy for peptic ulcer. METHODS: A mortality study was conducted of 3609 patients with peptic ulcer; 1831 were treated with radiation and 1778 were treated by other means. Extensive methods were used to trace patients. Radiation doses to specific organs were reconstructed from the original radiotherapy records. RESULTS: Nearly 70% of patients were found to have died. The average period of observation was 21.5 years (maximum 51 years). Compared with the general population, patients treated with or without radiation were at significantly increased risk of dying of cancer and non-malignant diseases of the digestive system. Risk of death due to heart disease was slightly higher following radiotherapy. Cancers of the stomach, pancreas, lung, and prostate were increased in both irradiated and nonirradiated patients. Radiotherapy was linked to significantly high relative risks (RRs) for all cancers combined (RR = 1.53; 95% confidence interval [CI] = 1.3-1.8), for cancers of the stomach (RR = 2.77; 95% CI = 1.6-4.8), pancreas (RR = 1.87; 95% CI = 1.0-3.4), and lung (RR = 1.70; 95% CI = 1.2-2.4), and for leukemia (RR = 3.28; 95% CI = 1.0-10.6). Radiation combined with surgery, or given to treat gastric ulcer, appeared to increase the risk of stomach cancer 10-fold, which was greater than the sum of individual effects. Patients with gastric ulcers were at higher risk for stomach cancer than patients with duodenal ulcers. CONCLUSIONS: Patients with peptic ulcer are at increased risk of dying of cancer, related in part to lifestyle factors and treatment. Radiotherapy and surgery together appear to induce carcinogenic processes that greatly enhance the development of stomach cancer. The risk of radiation-induced stomach cancer was 0.25 extra deaths per 10,000 persons per year per Gy, somewhat lower than reported in other studies. High-dose radiation may have increased the risk of pancreatic cancer, a condition rarely found elevated in irradiated populations, but misclassified death notices may have contributed to the excess. Cancer mortality remained high for up to 50 years, indicating that radiation damage may persist to the end of life.

[The influence of low-intensive laser therapy on the aggregation properties of thrombocytes in patients with peptic ulcer].

The purpose of the study was to evaluate the influence of low-intensive laser therapy (LILT) on the aggregation properties of thrombocytes in patients with exacerbation of peptic ulcer (PU). The subjects, 111 patients aged 18 to 63, were divided into two groups: the main group (n = 81), and the control group (n = 30). In addition there were 15 healthy people who also underwent examination. Patients in the main group received complex treatment with untiulcer drugs and different methods of laser therapy: intravenous laser irradiation of blood, cutaneous irradiation, and a combination of both. The control group was treated with drugs only. The study found various changes in the aggregation properties of thrombocytes in patients with PU exacerbation, which consisted mostly in hyperaggregation. LILT had a normalizing effect on the aggregation properties of thrombocytes in patients of the main group.

Coronary heart disease after radiotherapy for peptic ulcer disease.

PURPOSE: To evaluate the risk of coronary heart disease (CHD) and cerebrovascular disease after radiotherapy (RT) for peptic ulcer disease. METHODS AND MATERIALS: Peptic ulcer disease patients treated with RT (n = 1859) or by other means (n = 1860) at the University of Chicago Medical Center between 1936 and 1965, were followed through 1997. The observed numbers of cause-specific deaths were compared with the expected numbers from the general population rates. During RT, 5% of the heart was in the treatment field and the remainder of the heart mostly received scattered radiation. A volume-weighted cardiac dose was computed to describe the average tissue dose to the entire organ. We used Cox proportional hazards regression analysis to analyze the CHD and cerebrovascular disease risk associated with RT, adjusting for confounding factors. RESULTS: Greater than expected CHD mortality was observed among the irradiated patients. The irradiated patients received volume-weighted cardiac doses ranging from 1.6 to 3.9 Gy and the portion of the heart directly in the field received doses of 7.6-18.4 Gy. The CHD risk increased with the cardiac dose (p trend = 0.01). The cerebrovascular disease risk was not associated with the surrogate carotid dose. CONCLUSION: The excess CHD risk in patients undergoing RT for peptic ulcer disease decades previously indicates the need for long-term follow-up for cardiovascular disease after chest RT.

[Biospectroscopy-based endoscopy with low-intensive laser radiation for differential diagnostics and treatment of peptic ulcer].

The article covers results of application of biospectrometry-based endoscopy with low-intensive He-Ne laser radiation in complex therapy of torpid esophageal, gastric, and duodenal ulcers. The authors are the first to offer a method based upon individual biophotometric control (autofluorescence, oxigination), which allows verification of the ulcerous process character, individual optimization of treatment and objective control of ulcer regression.

Malignant neoplasms after radiation therapy for peptic ulcer.

Most information on radiation-related cancer risk comes from the Life Span Study (LSS) of the Japanese atomic bomb survivors. Stomach cancer mortality rates are much higher in Japan than in the U.S., making the applicability of LSS findings to the U.S. population uncertain. A unique cohort of U.S. patients who were irradiated for peptic ulcer to control gastric secretion provides a different perspective on risk. Cancer mortality data were analyzed and relative risks estimated for 3719 subjects treated by radiotherapy (mean stomach dose 14.8 Gy) and/or by surgery and medication during the period 1936-1965 and followed through 1997 (average 25 years). Compared to the U.S. rates, stomach cancer mortality was significantly increased for irradiated and nonirradiated patients (observed/expected = 3.20 and 1.52, respectively). We observed strong evidence of exposure-related excess mortality from cancer of the stomach (RR 2.6, 95% CI 1.3, 5.1), pancreas (RR 2.7, 95% CI 1.5, 5.1), and lung (RR 1.5, 95% CI 1.1, 2.1), with commensurate radiation dose responses in analyses that included nonexposed patients. However, the dose responses for these cancers were not significant when restricted to exposed patients. Our excess relative risk per gray estimate of 0.20 at doses

The neoplastic potential of gastric irradiation. IV. Risk estimates.

No significant tumor increase was found in the initial analysis of patients irradiated for peptic ulcer and followed through 1962. A preliminary study was undertaken 22 years later to estimate the risk of cancer due to gastric irradiation for peptic ulcer disease. A population of 2,049 irradiated patients and 763 medically managed patients has been identified. A relative risk of 3.7 was found for stomach cancer and an initial risk estimate of 5.5 X 10(-6) excess stomach cancers per person rad was calculated. A more complete follow-up is in progress to further elucidate this observation and decrease the ascertainment bias; however, preliminary data are in agreement with the Japanese atomic bomb reports.

[Endoscopic laser therapy of stomach and duodenal ulcers]. / Endoskopicheskaia lazerterapiia iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

The authors analyse the results of the treatment of peptic ulcer of the stomach and duodenum by indestructible red laser radiation in 65 patients. Complete healing of ulcer was attained in 92.3% of the cases. In 7.7% of the patients, ulcer appeared resistant to laser radiation. Peptic ulcer relapsed in 6.2% of the patients. It is shown that the efficacy of laser radiation treatment is dependent on the ulcer localization.

[Comparative results of the treatment of gastroduodenal ulcers with low-energy laser and hyperbaric oxygenation]. / Sravnitel'nye rezul'taty lecheniia gastroduodenal'nykh iazv nizkoenergeticheskim lazerom i giperbaricheskoi oksigenatsiei.

In 90 patients with peptic ulcer of the stomach and duodenum, the times required for the healing of ulcerous defects were studied and compared after local irradiation with low-energy (infrared) laser and hyperbaric oxygenation. Analysis of the data obtained attests to the similar (in terms of the times of the healing of gastric and duodenal ulcers) clinical efficacy of the methods under comparison. This makes it possible to regard hyperbaric oxygenation and the local use of infrared laser as the methods of choice (with regard to individual tolerance) for the treatment of peptic ulcer.

[Possibilities of prognosis of the time of scar formation after laser therapy of peptic ulcer]. / Vozmozhnosti prognozirovaniia srokov rubtsevaniia pepticheskikh iazv pri lazeroterapii.

234 patients with gastroduodenal ulcer underwent clinical pretreatment examination according to 19 parameters. All of them were exposed locally to copper laser irradiation. Duration of the ulcer healing was correlated to the above parameters. A statistical analysis determined a relationship between 12 of the 19 parameters and duration of the ulcer cicatrization. A regression procedure shows feasibility of predicting effectiveness of the future phototherapy by baseline clinical-endoscopic data on the patient's condition.

[Effectiveness of the treatment of gastric and duodenal ulcers by low-intensity electromagnetic (laser) radiation]. / Effektivnost' lecheniia iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki nizkointensivnym elektromagnitnym (lazernym) izlucheniem.

The effectiveness of treatment of ulcer patients with various types of laser radiation by the argon, heliun-neon and crypton lasers was studied in 137 patients. The results of laser treatment were compared with those in controls constituting 60 patients who were treated with commonly used therapeutic methods. The sparing techniques of laser therapy promote much earlier cicatrization of gastric and duodenal ulcers, shorter terms of hospital stay and reduction of temporary working disability. Laser therapy leads to a decrease in the number of disease recurrences in the first two months and has no significant influence on the incidence of recurrences in the remote period.

[Effect of low-energy laser radiation on the levels of cyclic nucleotides and lactic acid of the mucous membranes in gastric and duodenal ulcers]. / Vliianie nizkoenergeticheskogo lazernogo izlucheniia na uroven' tsiklicheskikh nukleotidov i molochnoi kisloty v slizistoi obolochke pri iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

The level of cyclic nucleotides in biological material undergoes changes due to endoscopic treatment of gastric and duodenal ulcers with the help of helium-neon laser radiation which, in addition to dynamics of the clinical picture and gastroduodenoscopic data, makes it possible to diagnose the disease remission and in certain cases to predict the course of peptic ulcer.

[The effect of superhigh-frequency electromagnetic radiation on the course of Helicobacter pylori-associated peptic ulcer]. / Vplyv elektromahnitnoho vyprominennia nadvysokoï chastoty na perebih vyrazkovoï khvoroby, asotsiiovanoi z Helicobacter pylori.

The authors studied effects of microwave electromagnetic irradiation on the course of peptic ulcers and dissemination with Helicobacter pylori in 60 patients with various severity of the disease. Microwave irradiation not only hastens clinico-endoscopical remission of the disease but also considerably reduces dissemination of mucosa with Helicobacter pylori.

[The use of the immunomodulating action of intravascular laser irradiation of the blood in treating peptic ulcer patients]. / Ispol'zovanie immunomoduliruiushchego deistviia vnutrisosudistogo lazernogo oblucheniia krovi pri lechenii bol'nykh iazvennoi bolezn'iu.

Intravascular laser radiation of the blood was employed in 68 patients with ulcer disease in the complex treatment with antacid; cholinolytic, antioxidant agents. The employment of helium-neon laser as an immunomodulator resulted in an improvement of indices of cellular and humoral immunity, normalization of lipid peroxidation, increased resistance of the gastric and duodenal mucosa, reduction of the time of scarring of the ulcer defect against the background of rapid clinical remission, increase of the interrecurrence period.

[Ambulatory treatment of peptic ulcer by autologous transfusion of photo-modified blood]. / Lechenie iazvennoi bolezni autotransfuziiami fotomodifitsirovannoi krovi v ambulatornykh usloviiakh.

The authors have determined indications and contraindications for using the method of haemotherapy based upon their experience with more than 1200 transfusions of photomodified autoblood under conditions of the hospital and 84 AUVIBs under the ambulatory conditions. The treatment of non-complicated forms of ulcer disease of the stomach and duodenum is shown to be possible under the ambulatory conditions, cicatrization of the ulcers developing 2-3 times more rapidly than under the currently used treatment of the ulcer disease under conditions of the hospital.

[The treatment of patient with peptic ulcer using millimeter-range waves]. / O lechenii bol'nykh iazvennoi bolezn'iu volnami millimetrovogo diapazona.

A double-blind clinical trial of Iav'-I apparatus generating millimetric waves has been performed in 50 patients with peptic ulcer verified endoscopically. Of these 25 patients were exposed to millimetric waves. The control group of 25 patients underwent placebo treatment. Healing of the ulcer was recorded 28-30 days after the treatment in 40% of those subjected to either irradiation or placebo procedures.

[Effect of impulse infrared laser radiation on bioenergetic metabolism in gastric mucosa in patients with gastroduodenal ulcer]. / Vliianie impul'snogo infrakrasnogo lazernogo izlucheniia na bioénergeticheskii obmen slizistoi obolochki zheludka bol'nykh iazvennoi bolezn'iu.

Gastric mucosa and blood plasm were studied in 82 patients with gastroduodenal ulcer for content of adenylic nucleotides (AMP, ADP and ATP), histamine, amino acids. It was found that the above nucleotides occurred in the examinees in subnormal quantities. The necessary substrates, aspartate in particular, were deficient. This may lead to impairment of biosynthetic processes, to imbalance of defense factors. Photon therapy of gastroduodenal ulcer corrects bioenergetic metabolism in gastric mucosa thus producing a marked therapeutic effect.

[State of humoral immunity and phagocytic activity of neutrophils in patients with ulcer and effect of low-intensity laser therapy]. / Sostoianie gumoral'nogo immuniteta i fagotsitarnoi aktivnosti neitrofilov u bol'nykh iazvennoi bolezn'iu i vliianie na nikh nizkointensivnoi lazernoi terapii.

The aim of our investigation was to study the influence of low-intensity laser therapy at the immunologic parameters and Helicobacter pylori (HP) microbial contamination in patients with exacerbation of peptic and duodenal ulcer. 100 patients aged 18-65 were examined and divided into 2 groups. The experimental group (75 patients) underwent a complex drug and laser therapy of various therapeutic techniques. The control group (25 patients) underwent only drug therapy. The results of this study show the immunocorrective effect of different methods of low-intensity laser therapy in the exacerbation period and more essential decrease of HP microbial contamination in the experimental group.

A reanalysis of curvature in the dose response for cancer and modifications by age at exposure following radiation therapy for benign disease.

PURPOSE: To assess the shape of the dose response for various cancer endpoints and modifiers by age and time. METHODS AND MATERIALS: Reanalysis of the US peptic ulcer data testing for heterogeneity of radiogenic risk by cancer endpoint (stomach, pancreas, lung, leukemia, all other). RESULTS: There are statistically significant (P<.05) excess risks for all cancer and for lung cancer and borderline statistically significant risks for stomach cancer (P=.07), and leukemia (P=.06), with excess relative risks Gy(-1) of 0.024 (95% confidence interval [CI] 0.011, 0.039), 0.559 (95% CI 0.221, 1.021), 0.042 (95% CI -0.002, 0.119), and 1.087 (95% CI -0.018, 4.925), respectively. There is statistically significant (P=.007) excess risk of pancreatic cancer when adjusted for dose-response curvature. General downward curvature is apparent in the dose response, statistically significant (P<.05) for all cancers, pancreatic cancer, and all other cancers (ie, other than stomach, pancreas, lung, leukemia). There are indications of reduction in relative risk with increasing age at exposure (for all cancers, pancreatic cancer), but no evidence for quadratic variations in relative risk with age at exposure. If a linear-exponential dose response is used, there is no significant heterogeneity in the dose response among the 5 endpoints considered or in the speed of variation of relative risk with age at exposure. The risks are generally consistent with those observed in the Japanese atomic bomb survivors and in groups of nuclear workers. CONCLUSIONS: There are excess risks for various malignancies in this data set. Generally there is a marked downward curvature in the dose response and significant reduction in relative risk with increasing age at exposure. The consistency of risks with those observed in the Japanese atomic bomb survivors and in groups of nuclear workers implies that there may be little sparing effect of fractionation of dose or low-dose-rate exposure.

Analysis of dose response for circulatory disease after radiotherapy for benign disease.

PURPOSE: To assess the shape of the dose-response for various circulatory disease endpoints, and modifiers by age and time since exposure. METHODS AND MATERIALS: This was an analysis of the US peptic ulcer data testing for heterogeneity of radiogenic risk by circulatory disease endpoint (ischemic heart, cerebrovascular, other circulatory disease). RESULTS: There were significant excess risks for all circulatory disease, with an excess relative risk Gy(-1) of 0.082 (95% CI 0.031-0.140), and ischemic heart disease, with an excess relative risk Gy(-1) of 0.102 (95% CI 0.039-0.174) (both p = 0.01), and indications of excess risk for stroke. There were no statistically significant (p > 0.2) differences between risks by endpoint, and few indications of curvature in the dose-response. There were significant (p < 0.001) modifications of relative risk by time since exposure, the magnitude of which did not vary between endpoints (p > 0.2). Risk modifications were similar if analysis was restricted to patients receiving radiation, although the relative risks were slightly larger and the risk of stroke failed to be significant. The slopes of the dose-response were generally consistent with those observed in the Japanese atomic bomb survivors and in occupationally and medically exposed groups. CONCLUSIONS: There were excess risks for a variety of circulatory diseases in this dataset, with significant modification of risk by time since exposure. The consistency of the dose-response slopes with those observed in radiotherapeutically treated groups at much higher dose, as well as in lower dose-exposed cohorts such as the Japanese atomic bomb survivors and nuclear workers, implies that there may be little sparing effect of fractionation of dose or low-dose-rate exposure.