RESUMO
Cis-Dichlorodiammine platinum (II) (cis-DDP) was demonstrated to be a potentiator of radiation therapy (RT) in experimental tumor models and in cultured cells. To assess the effectiveness of a combined modality treatment including RT and a weekly low-dose administration of cis-DDP, from January 1986 to June 1987, 95 patients with unresectable locally advanced non-small cell carcinoma of the lung (stage IIIa, b) were randomized for study. Fifty patients received RT alone at doses of 50 Gy; 45 patients received the same RT plus cis-DDP 15 mg/m2 IV weekly. An overall response rate of 50% and 64% was observed in the RT and RT + cis-DDP group, respectively. No statistically significant differences were detected with regard to median survival time (11 months for RT v 16 months for RT + cis-DDP) and progression-free interval (7 months in the RT arm v 9 months in the RT + cis-DDP arm), but the patterns of the first failure appeared to be affected by treatment. In fact, a lower number of intrathoracic relapses was observed in the RT + cis-DDP arm (12 in the RT + cis-DDP v 23 in the RT arm). Toxicity was mild and the feasibility of this schedule must be remarked. A better local control of disease can be obtained using cis-DDP as a radiation potentiator, but the true influence of this combined modality treatment on the length of survival, and the optimal cis-DDP timing and dosage are still to be evaluated in further clinical trials.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Cisplatino/administração & dosagem , Neoplasias Pulmonares/terapia , Terapia Combinada , Humanos , Dosagem Radioterapêutica , Distribuição AleatóriaRESUMO
We have applied the cytokinesis-block micronucleus assay to peripheral blood lymphocytes of patients undergoing radiotherapy in pelvic and pulmonary sites, in order to evaluate the individual cytogenetic response. Our cytogenetic data correlated with the equivalent whole-body dose are homogeneous and compare well with the data presented by other authors. We have used an exponential mathematical formula to calculate the attenuation of the cytogenetic effect with time. The k coefficient (cytogenetic recovery factor) in the formula expresses the degree of attenuation. In lymphocytes from patients after radiotherapy, the trend of the micronucleus frequency observed after 2 Gy of in vitro X-irradiation demonstrates that the cytogenetic effect obtained in vitro is added to that obtained in vivo. The k coefficient is inversely proportional to the micronucleus frequency observed after 2 Gy in vitro. The micronucleus assay and the cytogenetic recovery factor are proposed as suitable diagnostic tools for application in the field of radiotherapy.
Assuntos
Linfócitos/efeitos da radiação , Testes para Micronúcleos , Radioterapia , Relação Dose-Resposta à Radiação , Humanos , Linfócitos/ultraestrutura , Tolerância a RadiaçãoRESUMO
In this preliminary study twenty-nine malignant glioma patients after surgery were treated using Cis-platin (CDDP) combined with etoposide (VP16). Superfractionated radiation therapy comes into chemotherapy. The time to tumor progression in GBM patients is encouraging result to continue in this treatment.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Astrocitoma/tratamento farmacológico , Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Adulto , Idoso , Astrocitoma/terapia , Neoplasias Encefálicas/terapia , Cisplatino/administração & dosagem , Terapia Combinada , Etoposídeo/administração & dosagem , Glioblastoma/terapia , Humanos , Pessoa de Meia-IdadeRESUMO
Doses and schedules for treatment of malignant glial tumors, using IFN are still uncertain and controversial. In this study preliminary results of treatment of 10 glioblastoma multiforme patients are shown. Six patients were treated with local injection of beta-IFN through an Ommaya reservoir: 4 with beta-IFN followed by systemic chemotherapy (CDDP-VP16); we found that IFN alone was ineffective. Results were improved when local immunotherapy was associated with systemic chemotherapy. New drugs and investigation of possible pharmacological synergism are needed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Adulto , Idoso , Neoplasias Encefálicas/terapia , Terapia Combinada , Glioblastoma/terapia , Humanos , Injeções Intralesionais/instrumentação , Interferon Tipo I/administração & dosagem , Pessoa de Meia-Idade , Taxa de SobrevidaRESUMO
Malignant brain tumors (primary and metastatic) are apparently resistant to most therapeutic efforts. Several randomized trials have provided evidence supporting the efficacy of radiation therapy. Attempts at improving the results of external beam radiotherapy include altered fractionation, radiation sensitizers and concomitant chemotherapy. In low-grade gliomas, all clinical studies with radiotherapy have employed conventional dose fractionation regimens. In high-grade gliomas, hypofractionation schedules represent effective palliative regimens in poor prognosis subsets of patients; short-term survival in these patients has not allowed to evaluate late toxicity. In tumors arising within the central nervous system, hyperfractionated irradiation exploits the differences in repair capacity between tumour and late responding normal tissues. It may allow for higher total dose and may result in increased tumor cell kill. Accelerated radiotherapy may reduce the repopulation of tumor cells between fractions. It may potentially improve tumor control for a given dose level, provided that there is no increase in late normal tissue injury. In supratentorial malignant gliomas, superiority of accelerated hyperfractionated over conventionally fractionated schedules was observed in a randomized trial; however, the gain in survival was less than 6 months. At present no other randomized trial supports the preferential choice for altered fractionation irradiation. Also in pediatric brainstem tumors there are no data to confirm the routine use of hyperfractionated irradiation, and significant late sequelae have been reported in the few long-term survivors. Shorter treatment courses with accelerated hyperfractionated radiotherapy may represent a useful alternative to conventional irradiation for the palliation of brain metastases. Different considerations have been proposed to explain this gap between theory and clinical data. Patients included in dose/effect studies are not stratified by prognostic factors and other treatment-related parameters. This observation precludes any definite conclusion about the relative role of conventional and of altered fractionation. New approaches are currently in progress. More prolonged radiation treatments, up to higher total doses, could delay time to tumor progression and improve survival in good prognosis subsets of patients; altered fractionation may be an effective therapeutic tool to achieve this goal.
Assuntos
Neoplasias do Sistema Nervoso Central/radioterapia , Fracionamento da Dose de Radiação , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Neoplasias do Sistema Nervoso Central/secundário , Neoplasias do Sistema Nervoso Central/cirurgia , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Glioma/radioterapia , Humanos , Radioterapia Adjuvante , Resultado do TratamentoRESUMO
The goal of this pilot study was to verify the efficacy of the association of cisplatin plus radiotherapy in the treatment of lung cancer. Thirty-seven consecutive patients entered the study. They were treated with radiotherapy (four weekly doses of 2.5 Gy for a total of 50 Gy) and cis-platin once weekly (12 mg/m2). Partial remission was obtained in 15 patients, and 1 patient had a complete remission. Three patients previously inoperable underwent surgical treatment. The actuarial survival curve of the 29 evaluable patients showed a mean survival of 8.5 months. The mean survival of the latter is not evaluable because half of the patients are still alive after 12 to 30 months. No hematologic or renal toxicity was observed with the above schedule.
Assuntos
Cisplatino/uso terapêutico , Neoplasias Pulmonares/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-IdadeRESUMO
Chloroimipramine in vitro on human lymphocytes stimulated by phytohaemoagglutinin at concentrations from 1 to 10 g/ml leads to mitotic block. Treatment of normal or suprarenalectomized rats with high doses of the drug administered orally leads to a reduction in the weight of the thymus. The hypothesis that chloroimipramine possibly plays a part in immunitary processes is put forward.
Assuntos
Clomipramina/farmacologia , Dibenzazepinas/farmacologia , Timo/efeitos dos fármacos , Administração Oral , Adrenalectomia , Animais , Clomipramina/administração & dosagem , Dose Letal Mediana , Mitose/efeitos dos fármacos , Tamanho do Órgão/efeitos dos fármacos , Ratos , Linfócitos T/efeitos dos fármacos , Timo/imunologiaAssuntos
Neoplasias Ósseas/diagnóstico , Cintilografia , Adolescente , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico , Osteossarcoma/diagnóstico , Osteossarcoma/diagnóstico por imagem , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/diagnóstico por imagem , Isótopos de Estrôncio , Tomografia por Raios XAssuntos
Neoplasias/fisiopatologia , Dor Intratável/terapia , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Anestesia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Medição da Dor , Dor Intratável/tratamento farmacológico , Dor Intratável/radioterapia , Serviço Hospitalar de RadiologiaAssuntos
Carcinoma de Células Escamosas/terapia , Cisplatino/uso terapêutico , Neoplasias Pulmonares/terapia , Radioterapia de Alta Energia , Carcinoma de Células Escamosas/mortalidade , Protocolos Clínicos , Ensaios Clínicos como Assunto , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias Encefálicas/radioterapia , Neoplasias da Medula Espinal/radioterapia , Neoplasias Encefálicas/cirurgia , Glioma/radioterapia , Glioma/cirurgia , Humanos , Métodos , Recidiva Local de Neoplasia , Cuidados Paliativos , Dosagem Radioterapêutica , Neoplasias da Medula Espinal/cirurgia , Técnicas EstereotáxicasRESUMO
The radiological signs characteristic of various forms of renal neoplasia are described and the diagnostic value of different radiological techniques is discussed. A rational procedure for the study of primary tumours of the renal parenchyma is proposed, and several cases are presented by way of illustration.
Assuntos
Neoplasias Renais/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Humanos , Cálculos Renais/patologia , Cálices Renais/patologia , Neoplasias Renais/patologia , Pelve Renal/patologia , Linfoma/diagnóstico por imagem , Linfoma/patologia , Métodos , Metástase Neoplásica , Radiografia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Ureter/diagnóstico por imagem , Ureter/patologia , Tumor de Wilms/diagnóstico por imagem , Tumor de Wilms/patologiaRESUMO
The largest portion of a radiation oncologist's practice is aimed at the palliative treatment of bone metastases. This trial investigated the impact of disodiumclodronate on radiation therapy results. Two groups of patients with bone metastases were compared: one (176 patients) treated by radiation therapy alone, the other (242 patients) by combined radiotherapy and disodiumclodronate. The evaluated parameters were changes in the volume of bone destruction, pain rating, performance status scale, and percentage of disease progression, as they appeared on pre and post-irradiation CT scans. In the disodiumclodronate group, a significant improvement was observed in the bone metastases from breast, prostate, and non-small cell lung cancers. As for bone metastases from urinary and gastro-intestinal cancers, disodiumclodronate did not prove to be much effective in improving radiation therapy results. Independent of primary tumor location, disodiumclodronate had a marked protective effect on both local disease progression and appearance of new lytic areas. In our experience, response duration was directly correlated with the actual time of disodiumclodronate administration. Toxicity was minimal, which makes it probable for disodiumclodronate to become an important adjunct to bone radiation therapy.
Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Ácido Clodrônico/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/radioterapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Various physical parameters are described for evaluation of the quality of the irradiation plane. Of these, the integral dose and the dose gradient index are regarded as particularly significant and their calculation is included in a computerised dosimetry programme. Examples are drawn from the comparison of various mediastinum irradiation techniques: 60Co, high energy X-rays, fast electrons.
Assuntos
Neoplasias do Mediastino/radioterapia , Dosagem Radioterapêutica , Radioisótopos de Cobalto/uso terapêutico , Elétrons , Humanos , Teleterapia por Radioisótopo , Radioterapia de Alta EnergiaRESUMO
Dosage and schedules for the treatment of malignant glial tumors using IFN (interferon) are still uncertain and controversial. In this study we give the preliminary results of treatment in 28 patients with glioblastoma multiforme (GBM). 6 patients were treated with local injection of beta-IFN through an Ommaya reservoir; 4 patients with beta-IFN followed by systemic chemotherapy (Cisplatin + Etoposide), and 18 patients with chemotherapy only. Two end points were evaluated: 1) Whether or not the patients responded to treatment. 2) Length of Time to Tumor Progression (TTP) after surgery. We found that IFN alone was ineffective. Results were improved when local immunotherapy was associated with systemic chemotherapy. New drugs and investigation of possible pharmacological synergism are needed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Interferon Tipo I/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/tratamento farmacológico , Cisplatino/administração & dosagem , Terapia Combinada , Etoposídeo/administração & dosagem , Glioblastoma/diagnóstico por imagem , Glioblastoma/tratamento farmacológico , Humanos , Imunoterapia , Interferon Tipo I/efeitos adversos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
The aim of this study was to verify the tolerability and efficacy of therapeutic chemotherapy protocols, employing different combinations of cisplatin, carboplatin, etoposide and carmustine in primary glioblastoma patients. The purpose was focused on 2 end points: the response index to treatment, the TTP (tumor progression) and the ST (survival time). Eighty-four out of a group of 99 consecutive glioblastoma patients, entered this study. Patients were divided into 4 disparate treatment groups: (A) BCNU alone; (B) CDDP + VP-16; (C) CBDCA + BCNU; (D) CBDCA + BCNU + VP-16. The effectiveness and the TTP of the protocols differed, but differences were not statistically significant. Data concerning platinum treatment compare favorably with the best literature results. At 18 months more than half the carboplatin-treated patients are alive. Moreover these patients had a significantly longer ST than those treated with BCNU. We conclude that platinum-based chemotherapy has a beneficial effect on glial tumors.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Glioma/tratamento farmacológico , Adulto , Neoplasias Encefálicas/mortalidade , Carboplatina/administração & dosagem , Carmustina/administração & dosagem , Etoposídeo/administração & dosagem , Glioma/mortalidade , Humanos , Pessoa de Meia-Idade , Análise de SobrevidaRESUMO
Hypopharynx and cervical esophagus represent a critical location for a squamous cell carcinoma, a neoplasm that usually requires extensive surgery. Although morbidity and mortality of resection have markedly decreased over the past decade, the major issue in these patients remains quality of life owing to the need for combination with a laryngectomy to provide radical treatment. Chemoradiation therapy has the potential to downstage and even cure the disease without altering quality of life dramatically. Today, in the absence of randomized trials, the choice between surgery and definitive chemoradiotherapy should be based on clear information and the patient's preference. Salvage surgery is feasible and effective in selected patients.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Hipofaringe/cirurgia , Neoplasias Faríngeas/cirurgia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/tratamento farmacológico , Neoplasias Faríngeas/radioterapia , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de SobrevidaRESUMO
In this preliminary trial we studied 29 patients with primary malignant glial tumors to investigate the effectiveness of cisplatin combined with etoposide on these tumors. Hyperfractionated radiation therapy was given in the course of chemotherapy. The time to tumor progression in these glioblastoma multiforme (GBM) patients encouraged us to continue this treatment in a phase III study.