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Biomedical subjects

A Puthawala

Publications and source records attributed to A Puthawala.

At least 19 recordsLinked to original sources
PubMed2001

Interstitial low-dose-rate brachytherapy as a salvage treatment for recurrent head-and-neck cancers: long-term results.

PURPOSE: Recurrent cancers of the head and neck within previously irradiated volume pose a serious therapeutic challenge. This study evaluates the response and long-term tumor control of recurrent head-and-neck cancers treated with interstitial low-dose-rate brachytherapy. METHODS AND MATERIALS: Between 1979 and 1997, 220 patients with prior radiation therapy with or without surgery for primary tumors of the head and neck were treated for recurrent disease or new primary tumors located within previously irradiated volumes. A majority of these patients had inoperable diseases with no distant metastasis. There were 136 male and 84 female patients, and median age was 56 years. All patients had previously received radiation therapy as the primary treatment or adjuvant treatment following surgery, with a median dose of 57.17 cGy (range, 39-74 cGy). The salvage brachytherapy consisted of a low-dose-rate, afterloading Iridium(192) implant, which delivered a median minimum tumor dose of 53 Gy to a mean tumor volume of 68.75 cm(2). Sixty percent of the patients also received interstitial hyperthermia, and 40% received concurrent chemotherapy as a radiosensitizing and potentiating agent. RESULTS: At a minimum 6-month follow-up, local tumor control was achieved in 77% (217/282) of the implanted tumor sites. The 2, 5, and 10-year disease-free actuarial survival rates for the entire group were 60%, 33%, and 22%, respectively. The overall survival rate for the entire group at 5 years was 21.7%. Moderate to severe late complications occurred in 27% of the patients. CONCLUSION: It has been estimated that approximately 20-30% of head-and-neck cancer patients undergoing definitive radiation therapy have recurrence within the initial treatment volume. Furthermore, similar percentages of patients who survive after successful irradiation develop new primary tumors of the head and neck or experience metastatic neck disease. A majority of such patients cannot be treated with a repeat course of external beam irradiation because of limited normal tissue tolerance, leading to unacceptable morbidity. However, in a select group of these patients, salvage interstitial brachytherapy may play an important role in providing patients with durable palliation and tumor control, as well as a chance for cure.

Adolescent↗
PubMed1999

Interstitial brachytherapy for vaginal recurrences of endometrial carcinoma.

OBJECTIVE: The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma. METHODS: Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death. RESULTS: The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n = 18), Stage II (n = 7), and Stage III (n = 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n = 5) or at distant sites (n = 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n = 2), fistula (n = 2), and radiation stricture (n = 1). CONCLUSION: Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.

Aged↗
PubMed1999

Interstitial brachytherapy in the treatment of advanced and recurrent vulvar cancer.

OBJECTIVE: Our purpose was to evaluate the role of interstitial brachytherapy in vulvar cancer management. STUDY DESIGN: From 1985-1992 we performed a retrospective study of patients treated at the University of California, Irvine Medical Center, and Long Beach Memorial Medical Center. RESULTS: Eleven patients received interstitial brachytherapy, with (n = 5) or without (n = 6) external beam radiotherapy, for locally advanced (n = 5) or recurrent (n = 6) vulvar cancer. Local control was achieved in all patients. Ten patients have died of disease at a mean interval of 33 months from the time of treatment, with 9 patients having maintenance of local control at death. One patient is alive without disease after 77 months of follow-up. There were 2 cases of local necrosis (18%) and 1 case of rectovaginal fistula (9%). CONCLUSION: Local control of advanced vulvar cancer can be achieved with interstitial brachytherapy, with or without external beam radiotherapy. With improved systemic therapy this treatment modality may be used to salvage women with bulky, symptomatic tumors.

Aged↗
PubMed1992

Temporary iridium-192 implant in the management of carcinoma of the prostate.

The controversy about the treatment of carcinoma of the prostate has increased in the last decade, with most urologists favoring radical prostatectomy rather than primary irradiation. Several reports of persistent tumors in 50% to 90% of patients after external irradiation and permanent iodine-125 implantation of the prostate have been disturbing. From July 1977 to December 1985, 200 patients with adenocarcinoma of the prostate were treated by combining bilateral pelvic lymphadenectomy and temporary interstitial iridium-192 implantation of the prostate, followed by external irradiation. Seventy-four (36%) patients underwent biopsies of the prostate 4 months to 2 years after completion of the irradiation. Only 12 (16%) patients had persistent tumors. Complications were minimized subsequently by dose modifications.

Adenocarcinoma↗
PubMed1992

Followup prostate biopsy in patients with carcinoma of the prostate treated by 192iridium template irradiation plus supplemental external beam radiation.

We reviewed our experience with 81 patients who had undergone followup needle biopsies of the prostate between 12 and 27 months after 192iridium template radiotherapy combined with external beam radiation therapy. When broken down by stage 82% of the patients with stage A2, 92% with B1, 95% with B2 and 55% with C disease demonstrated a negative biopsy and adequate local control of the cancer. We believe that in elderly patients, poor risk patients with early stage disease and stage C lesions this low morbidity, low mortality therapy offers a viable option to other modalities of treatment.

Aged↗
PubMed1990

Endocurietherapy in pediatric oncology.

Endocurietherapy (brachytherapy) is the placing of radioactive sources directly into or near a solid tumor. This technique delivers a concentrated dose of radiation to a restricted volume while minimizing radiation effects on normal tissue. We have treated 11 patients (nine sarcomas, one carcinoma, and one Wilms') with endocurietherapy procedures as part of their multimodality treatment program. Six were treated as part of the primary management, and the other five were treated for recurrent or metastatic disease. Temporary afterloaded implants using ribbons embedded with radioactive iridium192 (Ir192) seeds delivered typical tumor doses of 4,000 cGy. Six patients, including four primary cases and two recurrent cases, are currently classified as no evidence of disease (NED) without further local regional treatment (follow-up of 11-62 months; median, 38 months), and one patient treated for metastasis also remains locally controlled. Two patients are classified as alive with disease (AWD), two died of disease (DOD), and one is now NED after surgical salvage. Special considerations were given to gonadal shielding, radioprotection techniques, and psychosocial issues in this pediatric population.

Adolescent↗
PubMed1989

Radical hysterectomy and tailored postoperative radiation therapy in the management of bulky stage 1B cervical cancer.

Ninety-two patients with Stage IB cervical cancers having a diameter equal to or greater than 4.0 cm were treated with radical surgery. Thirty-two patients received postoperative radiotherapy because of operative findings suggestive of high risk of pelvic recurrence. All 32 irradiated patients were treated with a standard pelvic field. Four patients also received paraaortic radiotherapy, and ten received intravaginal brachytherapy. Postoperative complications were seen in five patients (two nonirradiated, three irradiated). Projected 5-year survival is 79% (71% 5-year survival in irradiated patients, and 83% 5-year survival in nonirradiated patients). Preoperative evaluation of tumor volume was not found to reliably predict histologic high risk factors such as depth of stromal invasion, risk of lymph node metastases, or presence of extracervical/uterine involvement. A primary surgical approach in this group of patients with large-diameter Stage IB cervical cancers allows definition of those patients who might benefit from a combined surgical and radiotherapeutic approach to treatment based on findings at operation.

Adenocarcinoma↗
PubMed1989

[A new multi-channel LDR/MDR-afterloading-system (Inter-Pal-C38)].

The methods of temporary interstitial implantation of iridium-192 seed chains have been applied in Erlangen for two years in many cases of squamous cell carcinoma in the head and neck area, the cervix uteri or the anal duct. The afterloading procedure which at the beginning had to be performed manually involved partially considerable radiation-exposures of medical and nursing staff. Therefore we have developed a 38-canal machine for remote control afterloading with iridium-192 seed chains in LDR and MDR therapy which is working in a similar way as the already established methods of remote control afterloading in HDR therapy. Special technical features are the automatic afterloading procedure, the disconnecting of patient and machine for any length of time, the possibility to use the machine for several succeeding patients, and the modern computer control by an IBM PC with color monitor and alpha-numerical keyboard. The new machine is fast and easy to handle, protects the staff completely against radiation and, due to the possibility of disconnection and free mobility, makes it easier and more comfortable for the patient to stay within the radioprotection room.

Anus Neoplasms↗
PubMed1988

Treatment of advanced and recurrent squamous carcinoma of the uterine cervix with constant intraarterial infusion of cisplatin.

Twelve patients with primary or locally recurrent squamous carcinoma of the cervix were treated with constant internal iliac artery infusion of cisplatin (CDDP) via a totally implantable chemotherapy pump. Seven previously untreated patients received standard external and interstitial radiotherapy (RT) in conjunction with CDDP infusion. Five patients with isolated pelvic recurrences received CDDP therapy only. The chemotherapy pump was refilled weekly on an outpatient basis. All nine evaluable patients developed unilateral or bilateral lower extremity pain which responded to dosage reduction. No renal or marrow toxicity was seen. Both of the evaluable patients treated for recurrent tumor died 32 and 60 weeks after initiation of treatment. The seven patients treated primarily with RT + CDDP infusion include one who expired with persistent tumor and one with no evidence of disease (NED) after exenteration for a pelvic recurrence at 48 and 85 weeks respectively. The five remaining patients are NED at 12 to 60 weeks. Constant internal iliac artery infusion of CDDP via an implantable chemotherapy pump can be performed with acceptable toxicity. The preliminary results suggest that further study in previously untreated undergoing concurrent radiotherapy is warranted.

Carcinoma, Squamous Cell↗
PubMed1983

Treatment of prostatic carcinoma by pelvic lymphadenectomy, temporary Iridium-192 implant, and external irradiation.

Forty patients with clinically localized adenocarcinoma of the prostate have been treated by a combination of pelvic lymphadenectomy, temporary Iridium-192 implantation, and external irradiation with follow-up of one to five years. 192Ir implant delivers a minimum tumor dose of 3,000 rad to A2 and B1 lesions and 3,500 to B2 and C lesions. Two weeks later patients receive 4,000 rad of external irradiation to the prostate over four to five weeks. Patients with pelvic nodal metastases receive 5,000 rad to the pelvis with a midline block at 4,000 rad. All patients have had a complete local response as judged by clinical criteria. Prostate needle biopsies have been performed on 16 patients one year or less after treatment, with 15 biopsies benign. The technique appears to offer excellent local control of prostatic adenocarcinoma with acceptably low morbidity.

Adenocarcinoma↗
PubMed1983

Integrated external and interstitial radiation therapy for primary carcinoma of the vagina.

Twenty-seven patients with the diagnosis of primary carcinoma of the vagina were treated by definitive radiotherapy. Twenty-three patients received a combination of external and interstitial iridium-192 implant irradiation and four patients received only interstitial irradiation. Twenty-one patients had squamous cell carcinoma and six had adenocarcinoma. All patients were staged according to the FIGO classification. More than 70% of patients had relatively advanced local disease and conventional intracavitary irradiation was unsuitable. Local tumor control was observed in 85% (23 of 27 patients), and 56% of the patients remain alive and free of disease for a median follow-up period of 50 months to a maximum follow-up period of 84 months. Fifteen percent of the patients suffered from treatment-related complications.

Adenocarcinoma↗
PubMed1983

Management of prostate carcinoma. Combination of pelvic lymphadenectomy, temporary Ir-192 implantation, and external irradiation.

Forty patients with prostate adenocarcinoma had bilateral pelvic lymphadenectomy, temporary Ir-192 implantation, and external irradiation. With the implant, the prostate received less than or equal to 3,000 rad (30 Gy) for A2 and B1 and 3,500 rad (35 Gy) for B2 and C lesions in 40-45 hours. Ten days to 2 weeks later, 4,000 rad (40 Gy) external irradiation was given in 4-5 weeks using AP and PA parallel opposed fields, a "box," or rotation. Patients with positive nodes were given 5,000 rad (50 Gy) to the pelvis with a midline block at 4,000 rad (40 Gy) so that the prostate received 7,000-7,500 rad (70-75 Gy). All patients were free of local recurrence. Treatment was tolerated well, with rapid regression and few complications.

Adenocarcinoma↗
PubMed1980

Combination of external and interstitial irradiation in the primary management of breast carcinoma.

The authors treated 83 patients with carcinoma of the breast using a combination of external and interstitial irradiation at Los Angeles County--University of Southern California Medical Center and Southern California Cancer Center between February 1, 1974, and May 31, 1977. All 30 patients who had T1 and T2 lesions, and who were followed for a minimum period of 24 months (24-50 months) are clinically still free of disease. Thirty-nine of 53 patients with T3 and T4 lesions, who were followed for a minimum of 30 months (30-56 months) are still alive with local control. Details of treatment techniques, dosimetry, results and complications are presented.

Adult↗
PubMed1980

Afterloading interstitial implant in head and neck cancer.

Seventy-nine patients with head and neck malignancies were treated using afterloading interstitial iridium 192 techniques at Los Angeles County-University of Southern California Medical Center and Southern California Cancer Center from Feb 1, 1974 to Nov 30, 1975. Twelve of the 13 T1 and T2 lesions and 17 of 25 T3 and T4 lesions remain locally controlled to a minimum follow-up period of 24 months. Surgical salvage in case of treatment failure is possible with low morbidity because of relatively low external irradiation to the total volume. Twenty of 41 patients who were reirradiated for persistent or recurrent cancers still have local control to a minimum follow-up period of 24 months. We discuss sites of involvement, implantation techniques, reactions, and complications.

Brachytherapy↗
PubMed1980

Description of an afterloading 192Ir interstitial-intracavitary technique in the treatment of carcinoma of the vagina.

This is a preliminary report of an afterloading 192Ir interstitial-intracavitary technique used in the treatment of carcinoma of the vagina. Thirteen cases of carcinoma of the vagina, stages I through III, were treated at the Southern California Cancer Center and University of Southern California Radiation Medicine Unit between November 1976 and February 1978. The Syed-Neblett perineal template is described in detail, as are the precise clinical application techniques. The hallmarks of the method are: 1) ease of use by the physician, 2) homogeneous radiation dose distribution, and 3) differential radiation dose delivery capabilities. The technique is believed to be an improvement over previous modalities of therapy reported in the literature.

Adult↗
PubMed1980

Carcinoma in situ of the vagina: past and present management.

The experience of the Southern California Cancer Center with carcinoma in situ of the vagina has been analyzed. Thirty-five patients were treated over 22 years. Patients with carcinoma in situ of the vagina are usually asymptomatic and most often have no visible or palpable lesions; diagnosis therefore depends upon directed biopsy in patients with abnormal routine vaginal cytology. Local radium application was the most frequent modality of treatment in this study group of patients, and excellent results were obtained. The need for cytologic evaluation after hysterectomy is emphasized. Colposcopy is a valuable aid in the diagnosis and follow-up of these patients.

Adult↗