Advances in radiotherapy in the gynecologic malignancies.

We review, for their wider applicability, four advances in the radiotherapeutic management of the gynecologic malignancies. Attempts at improving upon results obtained with radiotherapy by the addition of chemotherapy have usually followed one of two temporal strategies: Sequential chemotherapy-radiotherapy (so-called neo-adjuvant chemotherapy), or chemotherapy given concurrently with radiotherapy. The pros and cons of both models are discussed.

Consensus statement on the investigation and management of testicular seminoma 1989.

In the past 10 years, many developments have allowed us to understand more fully the natural history and routes of spread of testicular seminoma. The development of radiological tests such as CT scanning has allowed us to better assess the extent of disease. The availability of serum tumor markers AFP and beta HCG has facilitated the recognition of the presence of occult non-seminomatous elements.

Progress and controversies in the management of seminoma.

A series of controversies in the management of testicular seminoma were raised in this paper. Some of these issues have been discussed in more detail while others such as the optimal dose of radiation in stage II disease, and the management of residual masses post-chemotherapy are discussed in the consensus statement generated from the conference. It is important to consider these controversies in the context of the excellent outcome of current therapy.

Inpatient narcotic infusions for patients with cancer pain.

Morphine and hydromorphone infusions of 6 or more (average 25.75) days in duration were used with increasing frequency (up to 7%) by our oncology inpatients. Eighty-six percent of the 135 inpatients we reviewed realized good pain control with dose rates up to 700 morphine-equivalent (ME) mg/h.

The use of endocrine therapy.

Endocrine therapy is still a mainstay in the treatment of metastatic breast cancer. It has been observed that about one third of women with metastatic breast cancer will respond to endocrine therapy. This response rate is surprisingly consistent for a wide variety of endocrine approaches, with a few exceptions, such as the use of corticosteroids, androgens, or danazol for which the response rate appears lower.

Concurrent radiation and chemotherapy in vulvar carcinoma.

Between June 1984 and February 1988 the role of radiation with concurrent infusional 5-fluorouracil with or without mitomycin C (CT-RT) was examined in 33 patients with vulvar cancer. The median duration of follow-up is 16 months (range 5 to 45 months). Nine received adjuvant postsurgical CT-RT and none has relapsed in the radiation field.

Osteoradionecrosis of the mandible: a review.

Osteoradionecrosis (ORN) is a complex metabolic and tissue homeostatic deficiency created by radiation-induced tissue injury. Although infection was initially felt to play an important role in its pathogenesis, the role of microorganisms has been relegated to that of a contaminant. Trauma in some cases may provide a possible initiating factor for the process, or in the case of spontaneous ORN, the use of radioactive implants and the higher doses of radiation therapy as practised in the megavoltage era, may have an influence.

A head swivel technique for breast tangents.

Two of the major problems with treating breast tangents are the difficulties in simulating the treatment and the reproducibility of the setup on a day to day basis. This paper describes a simple technique which takes advantage of the head swivel capability of certain cobalt-60 units to allow simulation and treatment of the breast and chest wall based upon a setup at the field edges which are normally not on mobile breast tissue. The technique offers some of the advantages of half block techniques but does not require the use of half blocks or bridges.

Observer error in the characterization of hepatic lesions in patients with neoplastic liver disease.

Sixteen patients with known neoplastic liver disease underwent 20 ultrasound examinations by two separate teams to determine the level of agreement in the measurement of lesion size and sonographic characteristics. The intraclass correlation coefficient for the observations on lesion size was r = 0.97 (95% lower confidence limit r = 0.

Continuous narcotic infusion with patient-controlled analgesia for chronic cancer pain in outpatients.

Study Objective: To determine the feasibility and safety of outpatient continuous narcotic infusions with additional bolus capabilities (patient-controlled analgesia) in patients with cancer pain.

Design: A single arm (non-randomized) series.

Setting: Outpatient with contact by telephone and through outpatient clinic.

The cost of radiation treatment at an Ontario regional cancer centre.

The cost of radiation treatment in 1985 at an Ontario regional cancer centre accruing 2500 new patients annually was examined. The radiation treatment department was equipped with three high-energy treatment machines, a treatment simulator and a treatment planning computer and was appropriately staffed. The total average annual cost of operating one high-energy treatment machine was $668,963.

Re-evaluating the cost of outpatient cancer chemotherapy.

Chemotherapy for common malignant tumours has historically been considered relatively expensive. An examination of costs at the Toronto-Bayview Regional Cancer Centre and Sunnybrook Medical Centre, Toronto, suggests that this perception is not accurate. The cost of chemotherapeutic agents administered on an outpatient basis over 4 to 6 months in established drug protocols ranged from $260 to $5374 (mean $2224).

Measurements in high-intensity beams from medical linear accelerators.

There is a potential to produce very high doses and dose rates on dual mode (electron and x-ray capability) medical electron accelerators [C. J. Karzmark, Br.

Drug extravasation along the route of a peritoneal catheter during intraperitoneal chemotherapy.

A patient receiving intraperitoneal chemotherapy with cisplatin and cytosine arabinoside developed an abdominal skin rash similar in appearance to Cullen's sign. She subsequently received intraperitoneal mitoxantrone, which became visible in the skin close to the peritoneal catheter tract in the region of the skin rash within 24 hours of drug administration. There was no evidence for drug extravasation from the entry portal of the peritoneal catheter or visible fluid leakage.

Correlation of tumor volume with local control in laryngeal carcinoma treated by radiotherapy.

An analysis of 37 patients with laryngeal carcinoma (T2 or greater) treated with radical radiotherapy, with surgery reserved for failure, was performed to determine if tumor volume, alone or in association with other prognostic factors, accurately predicted the probability of local control. Patient records were reviewed retrospectively and the following data extracted: age, sex, laryngeal region and number of sites involved by tumor, T and N categories, and success or failure of radiotherapy. Tumor volume for each patient was calculated from pretreatment computed tomograms by summing the products of the cross-sectional tumor area on each CT cut and the interval in millimeters between sequential CT cuts.

Phase I and pharmacokinetic study of high volume intraperitoneal aclacinomycin-A (Aclarubicin).

Aclacinomycin-A (Aclarubicin) is a relatively new anthracycline antibiotic with potential activity against ovarian cancer. Eight patients with various malignancies (4 ovary, 1 breast and ovary, 1 breast, 1 colon, 1 leiomyosarcoma) and intraperitoneal disease were treated in a Phase I trial with escalating doses of intraperitoneal Aclacinomycin. Drug treatments were administered through a peritoneal catheter in a 2 liter fluid volume (1.