Unveiling the multifarious developments in the treatment of cervical cancer for over a centenary.
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Combined Modality Therapy↗
Biomedical subjects
G K Rath
Publications and source records attributed to G K Rath.
Orbital neurofibrosarcoma: a case report.
Malignant peripheral nerve sheath tumours of orbit is rare entity. Only sixteen cases are reported in world literature. Bengin schwannomas of the orbit are found in 1.5 to 18 percent of patients with von Recklinghausen's disease (VRD) and form 1 percent of all orbital tumours1. The incidence of malignant transformation in VRD is varies from 5-15 percent of all the cases1.
Female↗
Chemotherapy followed by radiotherapy versus radiotherapy alone in locally advanced cervical cancer: a randomized study.
Between August 1990 and January 1992, 184 patients with squamous cell carcinoma of the cervix, FIGO stage IIB-IVA, were randomized to receive either two cycles of bleomycin, ifosfamide-mesna, and cis-platinum (BIP) chemotherapy (CT) followed by radiotherapy (RT) ("CT-RT group," n = 94) or RT alone (RT group, n = 90). In the CT-RT group, of 89 evaluable patients, 64 responded: complete response (CR) 4 (4.5%) and partial response 60 (67.5%). Of the remaining 25 patients, 23 had stable disease and 2 progressed. Eighty of 89 patients completed RT as planned. Following RT 56 (70%) achieved CR, 19 (23.7%) had residual disease, and 5 (6.3%) had progressed. CT responders had a better response to RT: 83% (49/59) vs 33.3% (7/21), P < 0.01). The stage of disease, histologic grade, duration of symptoms, and history of smoking had no influence on the response to CT. Patients aged > 45 years and those with Hb > 10 g/dl had significantly better response. Nausea/vomiting, alopecia, grade I-II myelosuppression, diarrhea, and mucositis were the major side effects of CT. Two patients died of CT toxicity. In the RT group, 88 patients were evaluable: 61 (69.3%) patients achieved CR, 25 had residual disease, and 2 progressed. The side effects of RT were cystitis, proctitis, and local skin reaction. These were equally distributed between the two groups. There was no significant difference in overall and disease-free survival in the two groups.
Adult↗
Management of intracranial metastases of differentiated carcinoma of thyroid.
Brain metastases in differentiated carcinoma of the thyroid is a rare occurrence. We treated five documented cases of carcinoma of thyroid with brain metastases out of 400 cases of thyroid cancer treated between 1972 to 1993. 4 were females out of which one was pregnant during the appearance of brain metastases. All cases were treated with thyroidectomy, and radioiodine as primary therapy. Brain metastases developed 6 months to 11 years following treatment of the primary and were treated with radiotherapy and suppressive levothyroxine. We observed the beneficial effect of suppressive thyroxine and the poor prognosis associated with pregnancy and withdrawal of thyroid replacement therapy. 3 of the 5 patients are alive 12-23 months after treatment for brain metastases, while 2 patients died at 4 months and 7 years post brain metastases due to pulmonary and hepatic failure, respectively.
Adenocarcinoma, Follicular↗
Results of radical radiotherapy in carcinoma of the uterine cervix stage I-III.
A retrospective analysis is described of 271 diagnosed cases of carcinoma of the uterine cervix who were treated with radical radiotherapy between January 1987 and July 1988 at the Institute Rotary Cancer Hospital. The mean age at presentation was 49 years and 89% of the tumours were FIGO Stage II and III. The median duration of follow-up was 60 months. The early cases were treated with two intracavitary insertions of 34 Gy each to point A with a Selectron LDR intracavitary system, followed by 36 Gy external radiotherapy to the parametrium. Late stage disease was treated with 50 Gy of external radiotherapy, followed by a single intracavitary insertion of 30 Gy to point A. To compensate for the higher dose rate of the Selectron (180 cGy/h) a dose reduction factor of 15% was applied over the intracavitary dose. There were 2.5% and 4.7% of late Grade III bladder and bowel complications, respectively, requiring surgical intervention. There was no relationship between haemoglobin level at diagnosis and the development of late complications. The actuarial 5-year survivals were 65%, 63% and 35% for Stages I, II and III disease, respectively. This study from the Indian subcontinent shows the effectiveness of radiotherapy in Stages I, II and III carcinoma of the uterine cervix, with acceptable morbidity rates.
Actuarial Analysis↗
Olfactory neuroblastoma: results of combined therapy.
Olfactory neuroblastomas are seldom encountered in otolaryngologic practice. Eleven such patients were treated by combined therapy over a nine year period. Two cases who initially underwent surgery only required salvage for a local recurrence by a combined modality. Nine patients were disease-free at the end of two years, with four of them being so for five years. Adjuvant chemotherapy was used in four cases, one of whom developed distant cutaneous metastasis after two years. Craniofacial resection was performed on three patients. A combined therapy is recommended for all stages of olfactory neuroblastoma.
Adolescent↗
Brain metastasis as the site of relapse in germ cell tumor of testis.
BACKGROUND: Brain metastases occur in approximately 8-15% of patients with testicular germ cell tumors and invariably are associated with relapse at other sites, most commonly the lungs, or as a terminal event. METHODS: The authors, from the Institute Rotary Cancer Hospital, a regional cancer center in northern India, did a retrospective analysis to determine how many previously treated patients had isolated cerebral metastasis develop. RESULTS: Three of 123 patients with testicular germ cell tumor seen during a 6-year period starting in January 1986 had isolated cerebral metastasis develop during remission after initial treatment. Two patients who had pure seminoma were treated with radiation therapy and are alive and symptom free at 15 and 18 months. The third patient had a combined tumor, the major component of which was embryonal cell carcinoma, that required debulking surgery and radiation therapy, and the patient died with recurrent cerebral metastases. CONCLUSIONS: Review of the literature reveals that although cerebral metastasis is well recognized in testicular cancer, particularly nonseminomatous germ cell tumor (NSGCT), it is invariably preceded by systemic metastasis. Cerebral metastasis is extremely rare as the sole and presenting feature of relapse. This complication must be recognized and treatment defined because it may become more frequent as patients survive for longer periods with modern disease management.
Adult↗
Clinical profile and problems of management of 108 cases of germ cell tumours of testis at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences New Delhi 1985-1990.
A retrospective analysis of 108 cases of primary germ cell tumours of testis seen over a 6 year period at Institute Rotary Cancer Hospital of All India Institute of Medical Sciences, New Delhi is presented. There were 45 (42%) cases of seminoma and 63 (48%) of non-seminomatous germ cell tumours (NSGCT). The median age at presentation was 35 and 30 years respectively. Almost half (56) patients presented in advanced stage (stages IIc-IV). Tumours in undescended testis formed an important subgroup (14%). The standard approach of treatment was radiotherapy in stages I & II seminomas and chemotherapy in bulky seminomas and metastatic NSGCT. Chemotherapy protocols used were VAB-6 and PVB. Although a policy of surveillance has been practised for stage I NSGCT, it is debatable whether it is universally suitable for our patients. The results of treatment in low volume disease are comparable to that in the west but the management of bulky disease requires a more aggressive approach. Unfortunately only 74 out of 108 (68.5%) patients were able to complete the treatment prescribed. Most of the defaulters were from the chemotherapy group because of inability to afford the drugs. The probability of survival of those who completed treatment was 0.77 at 4 years. Since testicular tumours are largely curable, a more vigorous policy of detection, follow up and treatment needs to be pursued. Better screening of children with undescended testis will reduce cancer in this group. Failure to provide chemotherapy to all patients is particularly unfortunate for a curable disease like testis cancer.
Adult↗
Primary radiation therapy in the management of glomus tumours.
The records of five patients who received local irradiation for incompletely excised or inoperable glomus tumour were retrospectively reviewed. Age ranged from 25 to 46 years. There were two female and three male patients. Two patients who were solely treated by radiation therapy remain clinically disease free at 30 and 42 months respectively. Of the remaining three patients, where radiotherapy was delivered post operatively, one achieved complete remission and is well and alive at 60 months, whereas the other two patients were lost to follow up at 22 and 26 months respectively after showing an early clinical improvement. We advocate the efficiency of radiation therapy as primary treatment in the management of primary glomus tumour.
Adult↗
Carcinoma of the soft palate.
During a 10 year period 30 patients with carcinoma of the soft palate were treated. There were 22 cases in stages I and II. A curative dose of irradiation was used in 25 cases, four of whom required surgical salvage. Another five cases were treated by a combined modality of surgery and postoperative radiation. Seven cases had nodal metastases. A mean two-year disease-free survival of 83 per cent was obtained. The probability of five-year disease free survival was 65 per cent.
Carcinoma, Squamous Cell↗
Combined therapy in advanced head and neck cancers.
The results of single modality treatment using surgery or radiotherapy alone in advanced head and neck cancers are known to be unsatisfactory. The present study analyses 252 cases with stage III and IV resectable cancers of the head and neck region selected to be treated by a combined regime of pre- or post-operative radiation and radical surgery. Only 193 patients completed the treatment protocol. There were 58 cases (33.5 per cent) who failed either at primary or regional sites or both. Nine cases (five per cent) developed distant metastasis. Absolute and determinate four year disease-free survival was 55 per cent and 61 per cent respectively. Early lesions (stage I and II) have been excluded from the study. The study indicates that a reduction in primary and regional failures correlates well with a combined therapy, though prolonged treatment may affect patients' compliance to some extent.
Adult↗
Bone metastasis in ovarian cancer.
Bone involvement in carcinoma of ovary occurs rarely. In a review of 103 patients over last 3 years we have seen 4 such patients (serous-2, mucinous-1, mixed germ cell tumour-1). Patients presented with severe localized bone pain, bony swelling and difficulty in walking. The common sites of involvement were vertebrae, pelvic bones and skull. Radiologically the osteolytic lesions were commonest. Bone lesions were associated with abdomino-pelvic disease in 3 patients. Cisplatinum based chemotherapy in addition to local radiation resulted in significant response in 2 patients; one complete and one partial response. The median survival was 7.5 months (range 6-39 months) after bone metastasis. We conclude bone involvement in cancer ovary is associated with poor prognosis.
Adenocarcinoma, Mucinous↗
The role of radiation therapy in the management of spinal cord compression due to extramedullary haematopoiesis in thalassaemia.
Extramedullary haematopoiesis associated with thalassaemia leading to spinal cord compression is an extremely rare event in the course of the disease. The efficacy of radiation therapy is advocated in the management of such a complication. Two patients with thalassaemia, who had presented with spinal cord compression, were successfully treated by a modest dose of local radiotherapy. In one of the patients, however, radiotherapy was resorted to after an initial decompressive laminectomy and partial removal of the intraspinal haematopoietic mass proved unsuccessful. The other patient was managed solely by radiation therapy.
Adult↗
Efficacy of intrathecal methotrexate with and without cranial radiotherapy in preventing central nervous system relapses in acute lymphocytic leukemia.
Introduction of CNS chemoprophylaxis was a major milestone in the development of current therapy for acute lymphocytic leukemia. However, controversies are still existing for ideal form of CNS chemoprophylaxis. The present study was conducted to determine the efficacy of intrathecal methotrexate (IT-MTX) with and without cranial radiotherapy in preventing CNS relapses in Indian children. CNS chemoprophylaxis comprising of six injections of intrathecal methotrexate (12 mg/M2) was administered alone or along with cranial radiotherapy (2000 GY) in 76 children each after successful induction remission. Cranial radiotherapy (RT) with intrathecal methotrexate (IT-MTX) was observed to be more effective as CNS relapses were seen in 11.8% of children as compared to 16.8% of children receiving IT-MTX alone. IT-MTX along with cranial RT delayed the occurrence of CNS relapses and prolonged the event free survival periods.
Adolescent↗
Bone metastases in the patients of carcinoma cervix.
Seventeen of 620 patients (2.7%) of cancer cervix were diagnosed to have bone metastasis (BM). In three bone metastasis were seen at initial presentation; remaining 14 developed BM in 3 to 36 months after the diagnosis of cancer cervix. Backache (8), localised pain (8), in thigh/hip/neck paraparesis (1) were main symptoms. The duration of symptoms ranged from 1 to 4 (median 2.5) months. Lumber spine, pelvic bones and long bones were the commonest site of involvement. The lesions were single in 12 and at multiple sites in five patients. Radiologically the lesions were osteolytic in all except three where Tc99m bone scan showed increased uptake of radionuclide. Palliative radiotherapy resulted in significant symptomatic relief.
Adult↗
Etiology of febrile episodes in children with acute lymphocytic leukaemia.
In 53 children (aged 5 months to 11 yr) with acute lymphoblastic leukemia, 68 febrile episodes were investigated for determining the etiology. Microbial organisms were isolated in 33 episodes. Bacteraemia was seen in 24 patients and in three of them Clostridium species were isolated. Escherichia coli was the commonest isolate and was seen in 11 (18.6%) febrile episodes. Other common organisms isolated were Staphylococcus aureus in nine (15.2%), and Klebsiella pneumoniae and coagulase negative Staph. in 6 (10.2%) episodes each. Pseudomonas aeruginosa and Acinetobactor were isolated in 5 (8.5%) episodes each.
Bacteremia↗
Primary breast lymphoma.
Primary breast lymphoma (PBL) is a rare tumor of the breast. Three cases of PBL are being described. All three cases achieved remission following biopsy, chemotherapy, and/or radiotherapy. The literature is extensively reviewed with emphasis on true incidence of PBL and survival rates.
Adult↗
Neoadjuvant chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) or cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in 69 cases of locally advanced (stage IIIb) breast cancer.
Sixty nine patients with a median age of 45 years, 62.3 per cent of whom were premenopausal, with locally advanced breast cancer (T 4, N 0-3, M 0; Stage IIIb) were treated with 3 cycles of either neoadjuvant cyclophosphamide, doxorubicin and 5-fluorouracil, being the CAF group: 36 patients, or cyclophosphamide, methotrexate and 5-fluorouracil, being the CMF group: 33 patients. Patients achieving complete response or with residual disease of less than 2 cm in diameter received radical radiotherapy while those with more residual disease underwent radical mastectomy. Nine cycles of adjuvant chemotherapy were administered. Complete responses and disease control by radiotherapy with complete breast preservation were more frequently observed after CAF than CMF, being 25 per cent vs 3 per cent (p = 0.025) and 48.5 per cent vs 12 per cent (p = 0.002), respectively. Overall response rates, adverse effects, disease control following radiotherapy/surgery, local relapses and metastases were similar for both regimes. Relapsing patients were young, with a median age of 38 years, 68.4 per cent of relapses occurred at metastatic sites and 42 per cent of relapses occurred during adjuvant chemotherapy. This study suggests that in locally advanced breast cancer, a greater proportion of patients can be rendered disease free after neoadjuvant CAF and radiotherapy compared to neoadjuvant CMF and radiotherapy.
Antineoplastic Combined Chemotherapy Protocols↗