Treatment of irradiation injury to the ureter by ileal substitution.

Ureteral obstruction following radiotherapy for cervical cancer is most often due to recurrent tumor. However, in a few patients ureteral stricture is secondary to radiation damage. Surgical treatment of this obstruction requires special consideration since many procedures for urinary diversion may be contraindicated in an irradiated pelvis. Ileal substitution (uretero-ileoneocystostomy) preserves renal function without resorting to external diversion of urine. A discussion of the method together with a report of 6 patients treated in this manner is presented. Results were excellent, with followup ranging from 11/2 to 4 years. A brief history of irradiation damage to the ureter and the use of small bowel as substitute ureter is discussed. Patient acceptance of this surgical approach was gratifying.

Computer-based system for adverse drug reaction detection and prevention.

An online computer-based system for monitoring patients for potential adverse drug reactions during their hospital stay is described. The adverse drug reaction monitoring system uses a Digital Equipment Corporation (DEC) PDP-11 computer which is programmed in MUMPS (Masschusetts General Hospital Utility Multi-programming System). Primary references from the medical and scientific literature are analyzed and evaluated before being included in the data base. The patient's adverse reaction history, obtained by nursing personnel during a patient interview, is entered into the computer by pharmacy staff. The computer screens new prescription orders for potential adverse reactions; any adverse reaction reports are sent to the patient's physician. Other special programs that are used in the patient monitoring system include medication profiles, drug-drug interaction screening and prescription discontinuation date entry. The computer system enable detection of potential adverse drug reaction and notification of the patient's physician prior to administration of the prescribed drug.

The effectiveness of prophylactic brain irradiation in small cell carcinoma of the lung: a Southwest Oncology Group study.

Brain involvement in small cell carcinoma of the lung is a common phenomenon occurring in from 29 to 45% of patients. Because of this, it was suggested that prophylactic brain irradiation be made a part of treatment plans for small cell carcinoma. In December 1974, the Southwest Oncology Group (SWOG) began treating patients with combination chemotherapy and irradiation of both the primary lesion and whole brain. In two years, there were 390 patients entered into the study. In patients with extensive disease only 6 of 152 prophylactically irradiated patients developed CNS signs or symptoms of CNS recurrence. In limited disease, 6 of 88 prophylactically treated patients had CNS recurrence and in only 4 was this the site of initial failure. We feel prophylactic brain irradiation in small cell carcinoma of the lung is of benefit.

Small-cell carcinoma of the lung: combined chemotherapy and radiation: a Southwest Oncology Group study.

Chemotherapy (doxorubicin, cyclophosphamide, and vincristine) was given in a sequential fashion with radiation of the primary tumor and brain to 358 patients with small-cell lung carcinoma (extensive disease in 250, limited in 108). Complete regression of tumor was obtained in 14% of patients with extensive disease and 41% of patients with limited disease, and complete or partial response in 57% and 75%, respectively. Median survival was 26 weeks for patients with extensive disease and 52 weeks for those with limited disease. Response duration was longer for patients in complete remission; one third had disease-free survival greater than 1 year. Toxicity from the combined treatment modalities was no greater than expected from the components given separately: fatal in 3.9%, and life-threatening but reversible in 8.4% of patients. Whole-brain radiation was effective in preventing isolated relapse at that site. This therapy appears both feasible and effective, with acceptable risks and some benefit to most patients.

5-Fluorouracil, methyl-CCNU, and radiotherapy with or without testolactone for localized adenocarcinoma of the exocrine pancreas: a Southwest Oncology Group Study.

Since August 1975, 69 patients with localized pancreatic carcinoma (extent of tumor confined to a 15 cm x 15 cm radiotherapy port) have received either Regimen A, comprising radiotherapy (6,000 rad) to the tumor area with simultaneous combination chemotherapy utilizing methyl-CCNU, 125 mg/m2 orally, every six weeks, and 5-fluorouracil, 400 mg/m2 intravenously, weekly; or Regimen B, comprising Regimen A with the addition of testolactone, 200 mg, orally every day. Thirty-eight patients on Regimen A and 30 patients on Regimen B are currently evaluable. Median survival, which appeared not to be affected by the addition of testolactone, was 38 weeks for those on Regimen A and 30 weeks for those on Regimen B (P = 0.677). The median survival time for all patients was 38 weeks. Good performance status did correlate with improved survival vs. poor performance status (46 weeks vs. 20 weeks, P = .008). Fifteen patients have survived for more than 52 weeks, with the longest survival time being 160 + weeks, and in 3 cases all therapy has been discontinued. However, most patients experienced moderate to severe hematologic toxic reactions. There was one treatment-related death and significant gastrointestinal bleeding developed in 6. Because of the toxic reactions of this program, it should not be considered in favor of similar less aggressive programs.

Online drug interaction surveillance.

An online computer-based system to monitor prospectively for potential drug interactions in a hospital setting is described. The system, developed at Stanford University Medical Center, is fully operational and is used to inform pharmacists, nurses and physicians as to the severity and speed of onset of potential drug interactions. In addition, the system can produce prescription labels and patient-drug profiles for the pharmacy and serves as a retrieval source of drug interaction information. Each report provides information regarnding the pharmacological effect and mechanism of the interactions, as well as statements involving relevant clinical findings associated with these interactions.

Influence of chest radiotherapy in frequency and patterns of chest relapse in disseminated small cell lung carcinoma. A Southwest Oncology Group Study.

The value of radiotherapy to the chest (RC) in disseminated small cell lung carcinoma (SCLC) has been questioned. Two protocols for disseminated SCLC from the Southwest Oncology Group (SWOG) have been compared. They were developed four years apart. The first one included radiotherapy (RT), 3000 rad in two weeks, to the primary tumor, mediastinum and supraclavicular areas, while the second one deleted any RC. Multidrug chemotherapy (CT) and brain RT were used in both protocols. Nonresponders to CT were removed from the study. Our main findings are as follows: (1) Initial chest relapses (patients with no initial extrathoracic relapse) have increased from 24-55% when RC is not given (P = 0.0001). Overall chest relapse (adding those patients that relapsed simultaneously in the chest plus other sites) in the second protocol was 73%. (2) Amount of response to CT does not influence the chances for relapse. Even complete responders to CT have a high chance for chest relapse. (3) Sites of relapse without RC are mainly in the primary tumor, ipsilateral hilus and mediastinum. (4) With RC, relapses shift to the chest periphery, mostly to the lung outside the radiotherapy field and to the pleura. (5) The two very different CT regimens have produced similar percentages and duration of response. (6) CT schema with periodic reinductions prolongs duration of response and survival over schema with continuous maintenance. Hence, interruption of CT to allow RC does not seem to adversely influence CT efficacy. From our results and the review of the literature we conclude that: (1) patients with disseminated SCLC that respond to CT should be given RC to decrease chest relapses. (2) A dose of 3000 rad in two weeks seems to be enough to produce a low percentage of chest relapse in disseminated SCLC, as survival of these patients is short and many will die prior to developing chest relapse. However, according to the literature, 4000-4800 rad is probably a more effective dose. (3) More studies and guidelines are needed to outline proper boundaries of radiotherapy fields, to decrease chances of peripheral chest relapses. (4) Median survival might not be a good parameter to evaluate the impact of RC in disseminated SCLC. The study of long-term survivors seems to be more important.