RESUMO
PURPOSE: To compare (1) clinical staging and irradiation alone versus staging laparotomy and treatment adaptation in patients with a favorable prognosis (H6F); (2) two combined modalities in patients with an unfavorable prognosis (H6U). PATIENTS AND METHODS: The H6F trial (n = 262) consisted of randomization to clinical staging plus subtotal nodal irradiation (STNI) or to staging laparotomy plus treatment adaptation (adjuvant chemotherapy [CT] only in the 33% with negative laparotomy). The H6U trial (n = 316) consisted of no laparotomy, randomization to mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), and mantle irradiation. RESULTS: In the H6F trial, 6-year freedom from progression (FFP) rates (78% v 83%; P = .27) were similar in clinical and laparotomy stagings, respectively. Survival rates were 93% and 89%, due to laparotomy-related deaths. In the H6U trial, the ABVD arm had superior results (6-year FFP rate, 88% v 76%; P = .01), but they were not significant for survival (91% v 85%; P = .22). CT discontinuation due to hematologic intolerance occurred more often with MOPP (14.5% v 7.3%). Decrease of the pulmonary vital capacity ([VC] < 70% of the theoretic value) was observed more frequently after ABVD than after MOPP (12% v 2%; P = .08), with two lethal pulmonary insufficiencies occurring in the ABVD arm. No modification of the isotopic left ventricular ejection fraction (LVEF) occurred. Gonadal toxicity was less in the ABVD arm. CONCLUSION: Early-stage patients benefit from treatment adaptation to initial characteristics in terms of tumor control and late toxicities. Staging laparotomy before STNI may be deleted even in favorable patients at no cost to survival or FFP. In unfavorable patients, ABVD achieved better results than MOPP, at lower hematologic and gonadal cost. Therefore, despite its pulmonary toxicity, ABVD is the best choice to design improved CT regimens associated with mantle irradiation.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Laparotomia , Adolescente , Adulto , Idoso , Bleomicina/administração & dosagem , Terapia Combinada , Dacarbazina/administração & dosagem , Árvores de Decisões , Doxorrubicina/administração & dosagem , Feminino , Doença de Hodgkin/radioterapia , Humanos , Masculino , Mecloretamina/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Projetos de Pesquisa , Resultado do Tratamento , Vimblastina/administração & dosagem , Vincristina/administração & dosagemRESUMO
PURPOSE: To determine whether the delay between surgery and the beginning of radiation therapy influences survival or the risk of local-regional relapse in oropharyngeal or hypopharyngeal squamous cell carcinomas. METHODS AND MATERIALS: From 2052 patients referred to the Henri Becquerel Center for the radiation therapy of an oropharyngeal or hypopharyngeal cancer between January 1, 1981 and December 31, 1992, 420 were included in a retrospective study. Exclusion criteria were another cancer, metastasis, incomplete resection, lack of homolateral lymph node resection, or previous chemotherapy. Radiation therapy delivered 45 to 75 Gy on initial location and lymph node. Follow-up was performed until December 31, 1997. A Cox proportional hazard regression analysis was used to evaluate the prognostic factors. RESULTS: The delay between surgery and radiation therapy was not found to be a significant prognostic factor for survival or risk of local-regional relapse. The only parameters found to influence local-regional and survival control were margins' pathologic state (respectively p < 0.0001 and p = 0.015) and T (p < 0.0001) and N (respectively p < 0.0001 and p = 0.0004) stages. In terms of local-regional relapse only, age was a prognostic factor (p = 0.048), and a trend was noted for tumor emboli in vessels or nerves (p = 0.061). CONCLUSION: In patients with oropharyngeal or hypopharyngeal squamous cell carcinoma, the delay between surgical procedure and radiation therapy does not influence survival or risk of local-regional relapse. Radiation therapy might be subjected to complete healing in these patients.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Orofaríngeas/radioterapia , Análise de Variância , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/cirurgia , Prognóstico , Modelos de Riscos Proporcionais , Dosagem Radioterapêutica , Radioterapia Adjuvante , Recidiva , Análise de Regressão , Estudos RetrospectivosRESUMO
The value of cell kinetic measurements in head and neck tumors in predicting which patients will benefit from accelerated fractionation radiotherapy regimens is being tested in a multicenter European trial (EORTC trial 22851). This paper reports on the first analysis of the correlation of kinetics with outcome in this trial. A proportion of patients in both the accelerated arm (72 Gy in 5 weeks, 1.6Gy per fraction, 45 fractions) and the conventional arm (70-72 Gy in 7-8 weeks, 1.8-2.0 Gy per fraction, 35-40 fractions) were given an i.v. injection of 100 mg/m2 IUdR (iododeoxyuridine) before treatment, and a tumor biopsy was taken several hours later. The potential doubling time of the tumor (Tpot) was obtained from a flow cytometric analysis of tumor cell nuclei using an anti-IUdR antibody. From a total of 260 patients entered in the trial, 53 have undergone kinetic analysis. Adequate IUdR labeling was seen in 47 patients (88.7%), from which the mean value for Tpot was found to be 4.5 +/- 2.5 days (+/- S.D.). Of the IUdR labeled patients, 30 have now been followed up for at least 1 year, 17 with conventional and 13 with accelerated radiotherapy. These patients were split into those with fast and those with slowly growing tumors, the dividing line being the median Tpot value of 4.6 days. After conventional 7-week radiotherapy, 2 of 6 patients with "fast" growing tumors obtained local control compared with 8 of 11 with "slow" growing tumors. A small difference in local control was seen been fast and slow tumors in the accelerated arm (5/9 vs. 3/4). These preliminary data support the hypothesis that patients with fast growing tumors do poorly with conventional radiotherapy and that pretreatment kinetic measurements can select patients at risk. The predictive power of the method must await the final analysis of trial results.
Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Divisão Celular , DNA de Neoplasias/biossíntese , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Idoxuridina/metabolismo , Dosagem RadioterapêuticaRESUMO
EORTC protocol 22791 compared once daily fractionation (CF) of 70 Gy in 35-40 fractions in 7-8 weeks, to pure hyperfractionation (HF) of 80.5 Gy in 70 fractions in 7 weeks using 2 fractions of 1.15 Gy per day, in T2-T3 oropharyngeal carcinoma (excluding base of tongue), N0,N1 of less than 3 cm. From 1980 to 1987, 356 patients were entered. In the final analysis (June 1990), the local control was significantly higher (p = 0.02 log-rank) after HF compared with CF. At 5 years, 59% of patients are local disease-free in the HF arm compared to 40% in the CF arm. The superiority of HF was demonstrated in patients staged T3N0,T3N1 but not in T2. The Cox model confirmed that the treatment regimen was an independent significant prognostic factor for locoregional control (p = 0.007 log-rank). This improvement of locoregional control was responsible for a trend to an improved survival (p = 0.08 log-rank). There was no difference in late normal tissue damage between the two treatment modalities.
Assuntos
Carcinoma/radioterapia , Neoplasias Orofaríngeas/radioterapia , Dosagem Radioterapêutica , Carcinoma/patologia , Radioisótopos de Cobalto/uso terapêutico , Europa (Continente) , Seguimentos , Humanos , Linfonodos/efeitos da radiação , Irradiação Linfática , Metástase Linfática/prevenção & controle , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Faringe/efeitos da radiação , Prognóstico , Radiação , Lesões por Radiação/etiologia , Tolerância a Radiação , Radioterapia de Alta Energia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Between 1971 and 1989, 59 patients received external radiation therapy with a curative intent. There were 25 females and 34 males, ranging in age from 19 to 87. No patients had distant metastasis at the onset of treatment. The majority of patients had a total thyroidectomy (55/59), generally combined with neck dissection. Residual tumour was left in 11 cases, and 44 patients had positive cervical nodes. Using megavoltage radiotherapy, the whole neck and the upper mediastinum area were most often irradiated through a large anterior Y-shaped field without laryngeal shielding. The mean dose to the tumoral bed was 54 Gy. Dysphagia was observed in 32 patients (11, 17 and 5 scores were grade 1, 2 and 3, respectively). Dyspnea occurred in five cases and in two of these cases, it was considered to be severe. Local recurrences were noted in 18 (30%) patients, most of them occurring within the fields of irradiation. Parameters such as age, sex, total dose, irradiated volumes or cervical node enlargement did not modify the local control rate. The same conclusions can be drawn for distant failures. Thirty five patients are still alive and among them, 24 have no evidence of disease. The average length of survival is 70.5 months and is shortened by the occurrence of distant failures except in patients with bone metastases.
Assuntos
Radioterapia de Alta Energia , Neoplasias da Glândula Tireoide/radioterapia , Adulto , Idoso , Feminino , França , Humanos , Irradiação Linfática , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
BACKGROUND AND PURPOSE: A 5 week-hyperfractionated and accelerated radiotherapy regimen without reduction of the total dose was developed to fight tumour repopulation during treatment and tumour hypoxia. The purpose of the study was to try to improve loco-regional control in high risk head and neck carcinoma treated with curative radiotherapy. METHODS AND MATERIALS: From 1985 to 1995, a randomised controlled trial of the EORTC Cooperative Group of Radiotherapy (EORTC 22851) compared the experimental regimen (72 Gy/45 fractions/5 weeks) to standard fractionation and overall treatment time (70 Gy/35 fractions/7 weeks) in T2, T3 and T4 head and neck cancers (hypopharynx excluded). The end-point criteria were local and loco-regional control, overall and disease-free survival, and acute and late toxicities. Five hundred twelve patients were accrued. RESULTS: Patients in the AF (accelerated fractionation) arm did significantly better with regard to loco-regional control (P = 0.02) resulting at 5 years in a 13% gain (95% CI 3-23% gain) in loco-regional control over the CF (conventional fractionation) arm. This improvement is of larger magnitude in patients with poorer prognosis (N2-3 any T, T4 any N) than in patients with more favourable stage. Multivariate analysis confirmed AF as an independent prognostic factor of good prognosis for loco-regional control (P = 0.03). Specific survival shows a trend (P = 0.06) in favour of the AF arm. ACUTE AND LATE TOXICITIES: Acute and late toxicity were increased in the AF arm. Late severe functional irradiation damage occurred in 14% of patients of the AF arm versus 4% in the CF arm. Two cases of radiation-induced myelitis occurred after doses of 42 and 48 Gy to the spinal cord. CONCLUSIONS: This trial shows that accelerated radiotherapy improves loco-regional control in head and neck squamous cell carcinomas. A less toxic scheme should, however, be investigated and documented before using accelerated radiotherapy as a standard regimen of curative radiotherapy for head and neck cancers.
Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Adulto , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Radioterapia/efeitos adversos , Radioterapia/métodos , Taxa de SobrevidaRESUMO
121 serum samples from African adults previously immunised with 17 D yellow fever vaccine alone (control group) or simultaneous yellow fever and cholera vaccines were tested for yellow fever antibodies by seroneutralization and haemagglutination inhibition assays. Comparison of the rates of seroconversion and antibody titers between the groups vaccinated the same day or into a short (less than or equal to 10 days) or a long time interval with both vaccines and the control group gave no significant difference. The association of cholera and yellow fever vaccines do not influence the long-term efficiency of yellow fever vaccination.
Assuntos
Anticorpos Antivirais/sangue , Vacinas contra Cólera/administração & dosagem , Vacinas Virais/administração & dosagem , Vírus da Febre Amarela/imunologia , Adulto , Vacinas contra Cólera/imunologia , Feminino , Testes de Inibição da Hemaglutinação , Humanos , Masculino , Testes de Neutralização , Estudos Retrospectivos , Fatores de Tempo , Vacinas Virais/imunologiaRESUMO
A 70-year-old man was admitted to the orthopaedic ward for severe sciatic pain and motor deficit. Diagnosis of a unique aneurysm of the right medial iliac artery and compression of the neighbouring elements was based on CT scan, echography and angiography imaging. This observation emphasizes the importance of a through physical examination. Unique aneurysm of the medial iliac artery is rarely observed. Effective treatment and satisfactory results can be obtained with simple ligature.
Assuntos
Aneurisma Ilíaco/complicações , Doenças Neuromusculares/etiologia , Ciática/etiologia , Idoso , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Ligadura , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , UrografiaAssuntos
Neoplasias do Ânus/patologia , Neoplasias Primárias Múltiplas/patologia , Doença de Paget Extramamária/patologia , Neoplasias do Colo Sigmoide/tratamento farmacológico , Neoplasias do Colo Sigmoide/patologia , Idoso , Neoplasias do Ânus/tratamento farmacológico , Neoplasias do Ânus/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Invasividade Neoplásica/patologia , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/cirurgia , Doença de Paget Extramamária/tratamento farmacológico , Doença de Paget Extramamária/cirurgia , Neoplasias do Colo Sigmoide/cirurgiaAssuntos
Epiglote , Neoplasias Laríngeas/terapia , Neoplasias da Língua/terapia , Isótopos do Cobalto/uso terapêutico , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/radioterapia , Excisão de Linfonodo , Metástase Linfática , Recidiva Local de Neoplasia , Prognóstico , Teleterapia por Radioisótopo , Dosagem Radioterapêutica , Rádio (Elemento)/uso terapêutico , Neoplasias da Língua/mortalidade , Neoplasias da Língua/radioterapia , Neoplasias da Língua/cirurgiaAssuntos
Neoplasias Nasofaríngeas/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Isótopos do Cobalto/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Neoplasias Nasais/tratamento farmacológico , Neoplasias Nasais/cirurgia , Neoplasias Nasais/terapia , Neoplasias Faríngeas/tratamento farmacológico , Neoplasias Faríngeas/cirurgia , Neoplasias Faríngeas/terapia , Prognóstico , Fatores SexuaisAssuntos
Neoplasias Otorrinolaringológicas , França/epidemiologia , Humanos , Metástase Linfática , Neoplasias Otorrinolaringológicas/diagnóstico , Neoplasias Otorrinolaringológicas/epidemiologia , Neoplasias Otorrinolaringológicas/patologia , Neoplasias Otorrinolaringológicas/terapia , Prognóstico , Fatores de Risco , Fatores de TempoRESUMO
Mahoney, MEF and Saukett poliovirus strains were grown on human diploid cells (MRC 5) and concentrated on Amicon filter. Concentrated viral suspensions containing 3H-uridine labelled virus were mixed with 14C-amino acid labelled cell extracts containing calf serum and passed through a DEAE-Sepharose column. Fractions eluted at various ionic strengths were analyzed for infectivity, radio-activity and serum content by counter immunoelectrophoresis in the presence of a rabbit anti-calf serum. A peak containing 40--60% of the input infectivity was easily obtained by elution with 0.01 M phosphate buffer at pH 7. The virus peak did not contain 14C or calf serum and its purity was controlled by PAGE-SDS electrophoresis and electron microscopy. This technique may be useful in the large-scale purification of viruses used in the preparation of inactivated vaccines.
Assuntos
Cromatografia/métodos , Poliovirus/isolamento & purificação , Linhagem Celular , Diploide , Humanos , Poliovirus/patogenicidade , Poliovirus/ultraestrutura , SefaroseRESUMO
Preoperative radiotherapy vs postoperative radiotherapy in the management of patients with primary tumors of the hypopharynx was evaluated by a prospective, randomized clinical trial. A statistically significant difference (p less than 1%) existed in favor of postoperative radiotherapy relative to survival rates, complications, and quality of survival. The postoperative radiotherapy group showed a 56% 5-year survival rate compared to 20% in the preoperative radiotherapy group. An analysis of the results is discussed.