Clinical results of LINAC-based stereotactic radiosurgery for pituitary adenoma

PURPOSE: We retrospectively evaluated our clinical results of stereotactic radiosurgery (SRS) for pituitary adenoma. MATERIALS AND METHODS: Between 1995 and 2000, 13 patients were treated with SRS for pituitary adenoma. In all cases, the tumors had already been surgically resected. The adenomas were functional in 5 and non-functional in 8 patients. The median follow-up period was 30 months. SRS was performed with the use of a dedicated stereotactic 10-MV linear accelerator (LINAC). The median dose to the tumor margin was 15 Gy. The dose to the optic apparatus was limited to less than 8 Gy. RESULTS: MR images of 12 patients revealed tumor CR in one case and PR in 9 cases; in the remaining two patients, tumor size decreased by less than 50%. There was no recognizable regrowth of any of the tumors. In two of four GH-secreting adenomas, hormonal overproduction normalized, while the other two showed reduced hormonal production. One PRL-secreting adenoma did not respond. Reduction of visual acuity and field was seen in one patient. This patient also had a brain infarction. None of the patients developed brain radionecrosis or radiation-induced hypopituitarism. CONCLUSION: Although further studies based on greater numbers of cases and longer follow-up periods are needed, our results suggest that SRS seems to be a safe, effective treatment for pituitary adenoma.     

Enhanced Renal Toxicity of Total Body Irradiation Combined with Radioimmunotherapy

PURPOSE: Total body irradiation (TBI) with and without additional radioimmunotherapy (RIT) was examined for renal toxicity after stem cell transplantation. PATIENTS AND METHODS: Serum creatinine levels of 35 patients (15 female, 20 male, median age 40.5 years, range 17-60 years) after TBI alone and of 23 patients (eight female, 15 male, median age 47, range 16-58 years) after TBI with additional RIT were determined between 10/1997 and 11/1999. TBI was performed by external-beam radiotherapy in six fractions over 3 days with renal doses of 12 Gy in the TBI-alone group and 6 Gy in the group with additional RIT. The mean kidney dose due to the (188)Re-radiolabeled antibody was estimated to be 8.3 Gy (2.3-11.6 Gy). RESULTS: Within 12 months after treatment, creatinine levels increased from 77 mmol/l (SD +/- 11) to 89 mmol/l (SD +/- 20) for TBI alone and from 78 mmol/l (SD +/- 13) to 144 mmol/l (SD +/- 52) for combined TBI and RIT. CONCLUSION: Despite a 50% reduction of the external-beam contribution to the kidney dose, the application of approximately 10 GBq (188)Re-labeled anti-CD66 monoclonal antibody with a calculated renal dose of 8.3 Gy (range 2.3-11.5 Gy) led to renal toxicity, as reported previously. In the absence of a positive dose-response relationship for the (188)Re-labeled antibody, the observation may be explained by an underestimation of the biologically effective dose and the inaccuracy of the dose determination at the glomerular level.     

Therapy using labelled somatostatin analogues: comparison of the absorbed doses with 111In-DTPA-D-Phe1-octreotide and yttrium-labelled DOTA-D-Phe1-Tyr3-octreotide

OBJECTIVE: We estimated the absorbed doses for (111)In-DTPA-D-Phe(1)-octreotide and (90)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide in the same patients in order to compare the potential effectiveness (tumour dose) and safety (kidney and red marrow dose) of these drugs for peptide-targeted radiotherapy of somatostatin receptor positive tumours. METHODS: Six patients with neuroendocrine tumours underwent quantitative (111)In-DTPA-D-Phe(1)-octreotide SPECT and (86)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide PET scan at intervals of 1 week. All studies were performed with a co-infusion of amino acids for renal protection. PET and SPECT were reconstructed using iterative algorithms, incorporating attenuation and scatter corrections. Tissue uptakes (IA%) were measured and used to calculate residence times. Absorbed doses to tissues were estimated and the maximal allowed activity, defined as either the activity delivering 23 Gy to the kidneys (MAA(K)) or 2 Gy to the red marrow (MAA(RM)), was calculated and the resulting tumour absorbed doses were computed. RESULTS: For the MAA(K) the mean absorbed dose to the red marrow was lower for (90)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide than for (111)In-DTPA-D-Phe(1)-octreotide (1.8+/-0.9 Gy vs. 6.4+/-1.6 Gy; P<0.001). The median absorbed dose to tumours for the MAA(K) was two-fold higher for (90)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide as compared to (111)In-DTPA-D-Phe(1)-octreotide (30.1 vs. 12.6 Gy; P<0.05). The median absorbed dose to tumours estimated for the MAA(RM) was 10-fold higher for (90)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide than for (111)In-DTPA-D-Phe(1)-octreotide (35.1 Gy vs. 3.9 Gy; P<0.05). CONCLUSIONS: This direct intra-patient comparison confirms that the use of (90)Y-DOTA-D-Phe(1)-Tyr(3)-octreotide is more appropriate for therapy of somatostatin receptor bearing tumours. When using (111)In-DTPA-D-Phe(1)-octreotide, the red marrow represents the major critical organ; this can result in significant toxicity if high activities have to be administered to obtain efficient tumour irradiation.     

Recurrent pterygia: results of postoperative treatment with Sr-90 applicators

Recurrent pterygia in 42 patients (48 eyes) were treated locally with strontium-90 irradiation from May 1967 to May 1988. The 31 male patients had an average age of 52 years; the 11 female patients, 46 years. All patients underwent surgical resection of the recurrent pterygia with use of the bare-sclera technique. During the immediate postoperative period the surgical site was treated with an Sr-90 applicator (beta irradiation). Doses ranged from 10 to 70 Gy (average, 50 Gy). Follow-up times ranged from 8 to 136 months (median, 14 months). The local control rate was 89%. Four of the five recurrences were in patients treated with doses of 1,000-1,500 cGy (P less than .0002). None of the patients developed cataracts or any other serious complications.     

Radioactive needle implants in the treatment of anorectal cancer

Radioactive needle implants were used to treat 44 patients with inoperable anorectal cancer. An implant dose of 60 Gy or higher was administered to 27 patients at a mean dose rate of 0.493 Gy/h (SE +/- 0.167 Gy/h). In five patients this was preceded by external beam irradiation. A further 17 patients received an implant dose of less than 60 Gy; this followed external irradiation in 10 patients. A complete response was achieved in 52% (16 out of 31) of patients assessed. Three of these patients later relapsed locally. The median duration of response was 23 months. A partial response of median duration 3 months was achieved by a further 13 patients. Five year actuarial survival was 23.9%. Serious morbidity occurred in six patients; three developed strictures and three necrosis. Features of the tumour and the treatment technique contributing to successful management are discussed. It is suggested that radioactive needle implants have an important part to play in the management of low-lying inoperable anorectal cancers.     

3-[123I]Iodo-alpha-methyl-L-tyrosine uptake in cerebral gliomas: relationship to histological grading and prognosis

3-[123I]Iodo-alpha-methyl-L-tyrosine (IMT) is employed clinically as a tracer of amino acid transport in brain tumours using single-photon emission tomography (SPET). This study investigates the role of IMT SPET in the non-invasive histological grading and prognostic evaluation of cerebral gliomas. The files of patients investigated by IMT SPET in our clinic between 1988 and 1996 were evaluated retrospectively. Complete follow-up was available for 58 patients with cerebral gliomas investigated by IMT SPET shortly after tumour diagnosis. Seventeen patients had low-grade gliomas (WHO grade II), 14 had anaplastic gliomas (WHO grade III) and 27 had glioblastomas (WHO grade IV). Thirty-six cases were primary tumours and 22 cases, recurrences. Maximal and mean tumour-to-brain (T/B) ratios of IMT uptake at the first IMT SPET investigation were related to histological grading and survival time. Patients with low-grade gliomas showed significantly longer survival than patients with high-grade (grade III or IV) tumours. Gliomas without contrast enhancement on computed tomography or magnetic resonance imaging scans were associated with longer patient survival than tumours with contrast enhancement. The T/B ratios of IMT SPET showed no differences in relation to histological grading [WHO grade II: 1.73+/-0.59; WHO grade III: 1.74+/-0.38; WHO grade IV: 1.59+/-0.35, (mean+/-SD, T/B ratios of mean tumour uptake)]. The median survival time of patients with a high T/B ratio on IMT SPET was not significantly different from that of patients with a low T/B ratio (T/B ratio <1.6, 14.8 months; T/B ratio > or =1.6, 13.0 months). Thus, no evidence could be found for a relationship between IMT uptake in cerebral gliomas and either histological grading or survival time. Nevertheless, IMT SPET constitutes a useful method for the detection of primary and recurrent gliomas, determination of tumour extent and individual follow-up.     

The relative biological effectiveness of fractionated doses of fast neutrons (42 MeVd----Be) for normal tissues in the pig. IV. Effects on renal function

The effects of fractionated doses of fast neutrons (42 MeVd----Be) on the radiation response of the pig kidney have been assessed and compared with those observed after X irradiation. Following X irradiation there was a marked increase in the total dose at which renal function was preserved with decreasing fraction size. The rate of this increase was dependent on the overall treatment time; for fractionated irradiation given over 18 or 39 days the exponents related to fraction number, N, were 0.36 +/- 0.03 and 0.48 +/- 0.003, respectively. In contrast, there was no significant change in the iso-effect dose for renal injury following fractionated irradiation with fast neutrons where there was also little effect of varying the overall treatment time. Analysing these data by means of the linear-quadratic (LQ) model, using both an Fe-plot and the Tucker test, gave alpha/beta ratios of 2.42 +/- 0.06 Gy and 2.99 +/- 0.16 Gy, respectively, for X-ray doses given in 18 days. For fractionated doses of X rays given in 39 days the alpha/beta ratios were 0.40 +/- 0.01 Gy and 0.47 +/- 0.02 Gy, respectively. The alpha/beta ratios for renal tissue following fast neutron irradiation obtained by the two methods were also similar, i.e. 15.00 +/- 0.60 Gy and 15.72 +/- 3.76 Gy, respectively. The pronounced fractionation effect seen with X irradiation, particularly for doses administered over 39 days as opposed to 18 days, coupled with the absence of any such effect with fast neutrons, resulted in a marked increase in relative biological effectiveness (RBE) with decreasing X-ray dose/fraction. The slopes of the resulting regression lines were -0.73 +/- 0.05 and -0.33 +/- 0.02, respectively. The lack of dose sparing associated with fractionation, or variation of the overall treatment time for fast neutron irradiation, suggests that doses administered to tumours adjacent to the kidney can be given as a few relatively large dose/fractions in a short overall treatment time without an increased risk of complications related to renal tissue. This may be of therapeutic advantage in the treatment of rapidly proliferating tumours where dose may be wasted using more conventional protracted fractionated irradiation schedules.     

Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma

PURPOSE: To study the efficacy of reirradiation as salvage treatment in patients with locally recurrent nasopharyngeal carcinoma. PATIENTS AND METHODS: Between 1993 and 2000, 20 consecutive patients (twelve males and eight females) with nasopharyngeal cancer, previously irradiated in different Hungarian institutions, were reirradiated for biopsy-proven locally recurrent tumor. Histologically, 85% of the patients had WHO type III, 5% type II, and 10% type I disease. Stages I-IV (AJCC 1997 staging system) were assigned to five (25%), seven (35%), five (25%), and three (15%) patients, respectively; none of them had distant metastases, and only eight (40%) displayed regional dissemination. The median time period between termination of primary treatment and local recurrence was 30 (range, 10-204) months.Brachytherapy was the method most frequently used: in ten cases alone (especially for rT1 tumors), and in eight cases in combination with external beam therapy. Two patients with locally advanced disease underwent external beam therapy only. The median dose in the event of brachytherapy alone was 20 Gy (4 x 5 Gy or 5 x 4 Gy, range, 16-36 Gy), and the dose range for exclusive external irradiation was 30-40 Gy. In cases of combined irradiation, a median 20-Gy brachytherapy (range, 16-40 Gy) was associated with 30-40 Gy of external irradiation. Radiotherapy was supplemented by neck dissection (six patients), nasopharyngectomy (one patient), or chemotherapy (eleven patients). RESULTS: 16 patients were reirradiated once, three twice, and one patient three times, with a median equivalent dose for tumor effect of 36 Gy (mean, 44 Gy; range, 19-117 Gy; the estimated alpha/beta-ratio was 10 Gy). The median equivalent dose of reirradiation for late effect on normal tissue (with an estimated 70% delivery of the tumor dose) amounted to 30 Gy (mean, 37 Gy; range, 13-101 Gy, estimated alpha/beta-ratio 3 Gy). After a median follow-up of 37 (range, 12-72) months, the overall survival was 60% (12/20). Seven of the twelve surviving patients are currently tumor-free. After primary irradiation, xerostomy occurred in all patients as an unavoidable side effect of treatment. Following reirradiation, a severe (grade 3 or higher) late toxicity (CTC criteria, version 2) has been observed in two tumor-free patients (10%) so far (necrosis of soft palate and paresis of glossopharyngeal nerve). CONCLUSION: Retreatment of nasopharyngeal carcinoma with radiotherapy (preferably a combined modality), can result in longterm local control and survival in a substantial proportion of patients, at the price of an acceptable morbidity.     

Relationships between angiographic findings and National Institutes of Health stroke scale score in cases of hyperacute carotid ischemic stroke

BACKGROUND AND PURPOSE: Stroke severity in cases of hyperacute carotid ischemic stroke may be related to site of arterial occlusion. We evaluated the relationships between National Institutes of Health Stroke Scale (NIHSS) scores and findings on intra-arterial digital subtraction angiograms (IA-DSA) of patients with ischemic stroke within 6 hr of stroke onset. METHODS: A total of 43 consecutive patients (38 men and five women; mean age, 69.4 +/- 8.7 years) with ischemic stroke in the carotid territory underwent IA-DSA within 6 hr of stroke onset. Baseline NIHSS score was assessed immediately before IA-DSA. Patients were divided into four groups according to site of arterial occlusion: 1) the internal carotid artery (ICA group, n = 10); 2) stem of the middle cerebral artery or stem of the anterior cerebral artery (Stem group, n = 14); 3) branches of middle cerebral artery or anterior cerebral artery (Branch group, n = 11); and 4) no arterial occlusion (Normal group, n = 8). RESULTS: Mean (+/-SD) NIHSS score was 14.7 +/- 7.4. The interval from stroke onset to IA-DSA study was 205 +/- 76 min. NIHSS score was higher in the ICA group (median, 23; range, 6-32) than in the Branch (median, 17; range, 11-25; P =.02) or Normal (median, 15; range, 2-17; P <.001) groups but was not higher than in the Stem group (median, 6; range, 1-11; P =.73). Sensitivity-specificity curve analysis suggested an NIHSS score > or = 10 as indicative of arterial occlusion of the carotid system. A total of 96.9% of patients with NIHSS scores > or = 10 displayed arterial occlusion, and 63.6% of patients with NIHSS scores <10 displayed no arterial occlusion. CONCLUSION: NIHSS score is related to site of arterial occlusion in cases of hyperacute carotid ischemic stroke. An NIHSS score of 10 seems to represent the cut-off for discriminating between patients with arterial occlusion and patients without.     

Management of epidural cauda equina disease of prostate cancer by radiotherapy

OBJECTIVE: Secondary prostate cancer affection of the cauda equina (SPCCE) can be an ultimate cause of morbidity and mortality. Since the results of management of this particular disease condition remain largely unknown, a retrospective case review was undertaken to determine the effects of treatment by radiation in SPCCE patients. METHODS: The records of 12 patients with SPCCE treated at the Division of Therapeutic Radiology during the period 1984 to 1998 were reviewed. The administered total radiation dosage ranged from 6 Gy to 32 Gy (average, 26.6 +/- 2.0 Gy). Two individuals underwent decompressive laminectomy and bilateral orchiectomy at the time of SPCCE and prostate cancer diagnoses. Ten patients had prior hormonal manipulative treatment (orchiectomy, estrogen, or Flutamide therapy). RESULTS: Pain was relieved in three of four symptomatic patients (75%). Five of nine patients unable to walk before therapy could walk after treatment. One of two individuals with anal or bladder sphincter dysfunction improved following irradiation. The overall mean duration of survival was five months. With treatment, survival was approximately three times as long for ambulatory versus non-ambulatory patients. CONCLUSION: We conclude that radiation treatment is efficacious in promoting palliation of SPCCE, although it may not prolong life.     

Prediction of cerebral infarct sizes by cerebral blood flow SPECT performed in the early acute stage

Cerebral infarct due to embolic stroke without recanalization was examined by cerebral blood flow (CBF) SPECT in the early acute stage, and the possibility of predicting the size it will reach in the later stages was evaluated. Twenty patients (67 +/- 13 years) were examined by CBF SPECT with 99mTc-ECD 4.5 +/- 3.1 hours after the onset of cardiogenic cerebral embolism. The ratio of the anteroposterior length of the cerebral hemisphere to that of the severe ischemic region, which was defined as an area of clear-cut severe reduction in CBF as observed by SPECT, was calculated. One week after the onset, the cerebral infarct was measured in the same manner by CT, and the relationship between the two measurements was evaluated. The CBF in the region of severe ischemia and the surrounding region was determined by the Patlak plot method, and the affected/non-affected (A/NA) ratio was calculated. In severe ischemic regions the CBF ranged from 1.7 ml/100 g/min to 20 ml/100 g/min (mean, 11 +/- 5 ml/100 g/min), whereas the A/NA ratio ranged from 4% to 45% (mean, 26 +/- 11%). On the other hand, the CBF in the surrounding regions ranged from 20 ml/100 g/min to 52 ml/100 g/min (mean, 34 +/- 8 ml/100 g/min) whereas the A/NA ratio ranged from 52% to 104% (mean, 77 +/- 11%). The coefficient of correlation between the infarct size predicted by SPECT and that measured by CT was r = 0.986, and the correlation equation was Y = 1.047X - 2.969. CBF SPECT performed in the early acute stage can be used to predict the size of cerebral infarct.     

Stage I and II non-Hodgkin's lymphoma: results of combined of THP-COP chemotherapy and radiotherapy

PURPOSE: We evaluated the usefulness of radiotherapy plus THP-COP chemotherapy consisting of cyclophosphamide, vincristine, pirarubicin (tetrahydropyranyl adriamycin, THP), and prednisone for stage I and II non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Between October 1998 and October 2001, 32 patients with Stage I or II NHL were treated with THP-COP plus radiotherapy. The patients consisted of 19 men and 13 women with a median age of 60 years (range, 23-81 years). The histological type was intermediate grade in 29, high in one, and unclassified in two. The number of cycles of THP-COP ranged from three to six (median, three cycles). Doses of irradiation ranged from 18.0 to 46.5 Gy (median, 40.0 Gy). The median length of follow-up was 19 months (range, 1-47 months). RESULTS: The 3-year overall survival rate and progression-free survival rate were 81.3% and 74.9%, respectively. Leukopenia of grade 3-4 was documented in 24 patients (75%) and thrombopenia of grade 3-4 in four (12.5%). CONCLUSION: THP-COP plus radiotherapy appeared to be feasible for stage I and II NHL patients. However, further evaluation is needed to determine the usefulness of this treatment.     

Radiation therapy for the esophageal carcinoma: external irradiation versus high-dose rate intraluminal irradiation.

From September 1977 through December 1989, 149 patients with esophageal carcinoma were treated with external irradiation (EI) with or without high-dose rate intraluminal irradiation (HDRII) using remote afterloading system. Two-year relapse-free survival rates were 52% in sage I (n = 23), 24% in stage II (n = 61) and 19% in stage III (n = 65). Two-year survival rates were 66% in complete response (CR) group (n = 65) and 7 to 9% in non-CR group (n = 84). Concerning CR group external irradiation alone (mean +/- S. D.: 66.5 +/- 5.2 Gy) showed higher local control rate than EI (60.0 +/- 0.4 Gy) + HDRII (10 Gy) (30/38 versus 15/27, p = 0.044), especially in ulcerative type (17/19 versus 5/11, p = 0.009). This preliminary result suggests that HDRII is not effective for the local control of the ulcerative lesion as a boost therapy.     

Strahlenspätveränderungen nach kleinvolumiger radiochirurgischer Bestrahlung des Rattenhirns Messung des lokalen zerebralen Blutflusses und histopathologische Untersuchungen

BACKGROUND: The goal of this study was to investigate late effects following stereotactic single fraction and small volume irradiation on cerebral blood flow and histologic alterations in the rat brain parenchyma. MATERIAL AND METHODS: 66 Copenhagen rats, separated into eleven groups of six animals each received single doses of 20, 30, 40, 50 and 100 Gy using a 15 MV linear accelerator. Six rats served as controls. Two cylindrical collimators of 2 mm and 3 mm aperture were used. The diameters of the spherical 80% isodose were 3.7 and 4.7 mm, respectively (Table 1). Irradiation was applied to a predefined area in the right frontal lobe. 19 months after irradiation local cerebral blood flow (LCBF) was measured by the autoradiographic method in one animal of each dose group between 20 and 50 Gy. 9 and 19 months after irradiation, half of the animals of each group were sacrificed for brain histology. All animals irradiated with 100 Gy were sacrificed 7 months after irradiation. RESULTS: An increase of local cerebral blood flow was measured in brain structures within the 80% isodose in animals irradiated with 50 Gy (Figure 3) compared to the contralateral hemisphere. Measurements close to necrotic areas showed a strong decrease of local cerebral blood flow (Figure 1). A volume increase of the irradiated hemisphere was seen after 19 months (Figure 2). The histologic examination after 19 months showed necrotic areas in the 30-50 Gy groups (Figure 4b) but not in the 20 Gy groups (Figure 4c). The animals who received 100 Gy demonstrated brain necrosis within 9 months after irradiation (Figure 4a). At both points in time the groups irradiated with the 3-mm collimator showed more pronounced histomorphologic and functional changes compared to the groups irradiated with the 2-mm collimator. CONCLUSION: Alterations of the local cerebral blood flow were measured as a late effect after single dose irradiation. The alterations of the local cerebral blood flow could be explained by the histomorphologic changes of the blood vessels. Using a semi-quantitative classification a dose, time and volume dependence for the endpoint radionecrosis was seen.     

Iridium-192 implantation for T1 and T2a carcinoma of the tongue and floor of mouth: retrospective study of the results of treatment at the Royal Berkshire Hospital

Carcinomas of the tongue and floor of mouth are relatively rare tumours, which may be treated using several modalities. We reviewed the results of iridium wire implants performed at the Royal Berkshire Hospital between 1994 and 2000. 24 patients had iridium wire implants as primary treatment for tongue and floor of mouth cancers. Four patients were treated after excision biopsy with close or involved margins. One patient was treated for a recurrence after surgery. The median age at treatment was 61 years. There were 18 men and 11 women. 21 patients had tumours of the tongue and eight of the floor of mouth. 13 had T1 tumours and 11 had T2a tumours. The median follow up was 42 months. The primary tumour was controlled in 22 of the 29 patients by the implant alone. Of the seven patients with local recurrence four were successfully salvaged with surgery. The acturarial 2 year survival rates were: overall survival 81%, disease specific survival 91%, local recurrence free survival 85% and nodal relapse free survival 76%. The recorded complication rate was low, one patient developing radionecrosis of the mandible at 7 years post implant. We believe these results show that brachytherapy remains a treatment option for patients with early tongue carcinoma with a high rate of local control and low toxicity.     

放射性125I粒子植入治疗头颈部肿瘤

目的 探讨超声或CT引导下放射性^125I粒子组织间植入治疗头颈部肿瘤的技术可行性和近期疗效。方法 40例头颈部癌和转移癌患者。4例采用全身麻醉，在CT引导下行^125I粒子植入术；36例采用局部麻醉，行超声引导下^125I粒子植入术。粒子针平行排列，间距1～1．5cm，原发肿瘤植入靶体积影像学边界外放lcm，转移瘤植入靶体积为影像学边界。粒子间距1cm。肿瘤周边匹配剂量（matched peripheral dose，MPD）90～145Gy，每颗粒子活度0．40～0．70mCi，每个病灶植入3～84颗粒子。5例患者术后1周加外放疗，每次200cGy，总剂量45～50Gy。术后24h拍头颈正侧位平片或CT，行质量验证。术后24～48h拍胸部x线片了解有无粒子移位或游走。结果 随访3～33月，10例舌癌3例完全缓解，3例部分缓解，3例稳定，1例进展；2例颈部淋巴结转移的患者经粒子治疗后完全缓解，局部控制率为60％，中位生存期11个月，1年和2年生存率分别为87．50％和35％。14例头颈部癌粒子治疗后，局部控制率为76．47％，中位生存期9个月，1年和2年生存率为66．08％和24％。16例头颈部转移癌粒子治疗后，局部控制率95．23％，中位生存期9个月，1年和2年生存率为54．55％和32．73％。没有1例发生严重的皮肤反应。结论 放射性^125I粒子粒子植入治疗头颈部癌疗效确切，尤其是为那些手术后或放疗复发患者提供了一种新的、可行的、安全和微创治疗手段。     

Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients

To determine the effect of cranial irradiation on hypothalamic blood flow, we performed 44 regional cerebral blood flow studies with 99mTc hexamethyl propyleneamine oxime (HMPAO) single-photon emission CT (SPECT) on four normal volunteers and 34 patients with pathologically proved nasopharyngeal cancer. Twenty-three men and 15 women, 30-65 years old, were divided into four study groups: group 1 served as a control and consisted of four normal volunteers and six patients studied prior to cranial irradiation; group 2 patients had cranial irradiation half a year before the SPECT study (n = 12, one from group 1); group 3 patients were irradiated 1 year before the study (n = 13, three from group 1 and two from group 2); and group 4 patients were irradiated at least 5 years before SPECT imaging (n = 9). Six patients were studied twice. Quantification of the 99mTc-HMPAO brain SPECT studies was done separately by three radiologists to obtain the hypothalamus/occipital (H/O) and hypothalamus/parasagittal (H/P) ratios. Endocrinologic studies were performed in all cases and the hypothalamus-thyrotroph-thyroid, hypothalamus-gonadotroph-testis (ovary), hypothalamus-lactotroph, hypothalamus-somatotroph, and hypothalamus-corticotroph-adrenal axes were evaluated separately. We determined that regional hypothalamic blood flow was reduced after cranial irradiation in patients with nasopharyngeal cancer. The H/O ratio of groups 3 and 4 did not differ from that of group 2 (one-half year after cranial irradiation). The H/O ratio was significantly reduced 6 months and 1 year after cranial irradiation; mean +/- SD = 0.5801 +/- 0.0829 (p less than .025), 0.5725 +/- 0.0791 (p less than .01) versus 0.6477 +/- 0.0458 before cranial irradiation, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

CT and MRI aspects of 28 patients with cerebral radiation necrosis irradiated for ORL tumors: correlation with the radiation technique

PURPOSE: To describe and correlate with radiation therapy the occurrence of cerebral radiation necrosis in patients irradiated for nasopharyngeal or ethmoidal tumor. Materials and Methods. From 1986 to 1998, 1 201 patients, 981 with nasopharyngeal tumors, and 220 with ethmoidal tumors were treated by radiotherapy. Twenty eight developed cerebral necrosis. MRI were performed in all patients and CT in 18 patients. Diagnosis was considered at imaging, and confirmed by follow-up. RESULTS: The incidence of cerebral radionecrosis was 2.33%. The time interval between treatment and necrosis ranged from 2 months to 9 years. CT showed edema and/or focal enhancement in all cases except for 4 patients with normal CT examinations. MRI showed edema and/or abnormal focal punctate or gyriform enhancement in all patients. Lesions were localized in the temporal lobe (n=18), frontal lobe (n=9), pons (n=3) and optic nerve (n=2). The doses related to the areas of necrosis ranged from 13 to 135Gy. In 2 cases necrosis was situated at the boundaries of the radiation field. Imaging follow-up showed complete (n=3) or incomplete remission (n=1), lesion progression (n=11), cerebral atrophy (n=5) and stability (n=7). CONCLUSION: MRI is useful to diagnose cerebral necrosis. New technologies may reduce the incidence of this complication.     

Radiosensitizing effect of misonidazole in fractionated gamma-ray treatment of a human malignant melanoma grown in athymic nude mice.

The effect of the hypoxic cell radiosensitizer misonidazole (Ro-07-0582) has been tested on a human malignant melanoma grown subcutaneously in the athymic mutant nude mouse. A 60Co therapy unit was used for local irradiation of the animals. The tumours were exposed daily to 3.75 Gy (375 rad) over four consecutive days, to a total dose of 15.0 Gy. Misonidazole in doses of 500 mg/kg bodyweight was administered intraperitoneally in the mice 45 minutes before each irradiation. The time necessary for the tumours to regrow to their original sizes was compared with that of tumours treated with four daily fractions of 3.75, 4.50 and 5.25 Gy without sensitizer. The enhancement ratio of misonidazole was found to be 1.05.