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K Pigott

Publications and source records attributed to K Pigott.

8 recordsLinked to original sources
PubMed1999

A feasibility study of continuous hyperfractionated accelerated radiotherapy (CHART) and brachytherapy in patients with early oral or oropharyngeal carcinomas.

Overall time is important in the curative treatment of head and neck cancer (Dische, S., Saunders, M.I., Barrett, A., Harvey, A., Gibson, D., Parmar, M., 1997, Radiother. Oncol., 44:123-136). Results are presented on outcome and morbidity in ten patients with head and neck cancer treated with external beam irradiation (CHART protocol) and interstitial implantation, completing treatment in 12 days. Local control and overall survival at 5 years was 67%. Acute and late morbidity was acceptable giving scope for dose escalation.

Adult↗
PubMed1998

Experience with dose escalation using CHARTWEL (continuous hyperfractionated accelerated radiotherapy weekend less) in non-small-cell lung cancer.

Results from the multicentre randomized trial of CHART (continuous, hyperfractionated, accelerated radiotherapy) in non-small-cell lung cancer (NSCLC) showed a significant increase in survival (P=0.004) compared with conventional radiotherapy and a therapeutic benefit relative to late radiation-induced morbidity. However, 60% of patients died because of failure to control locoregional disease. These findings have stimulated interest in assessing the feasibility of dose escalation using a modified CHART schedule. Acute and late morbidity with a CHARTWEL (CHART WeekEnd Less) schedule of 54 Gy in 16 days was compared with that observed with 60 Gy in 18 days in patients with locally advanced NSCLC. The incidence and severity of dysphagia and of analgesia were scored using a semiquantitative clinical scale. Late radiation-induced morbidity, namely pulmonary, spinal cord and oesophageal strictures, were monitored using clinical and/or radiological criteria. Acute dysphagia and the analgesia required to control the symptoms were more severe and lasted longer in patients treated with CHARTWEL 60 Gy (P< or = 0.02). However, at 12 weeks, oesophagitis was similar to that seen with 54 Gy and did not lead to consequential damage. Early radiation pneumonitis was not increased but, after 6 months, there was a higher incidence of mild pulmonary toxicity compared with CHARTWEL 54 Gy. No cases of radiation myelitis, oesophageal strictures or of grade 2 or 3 lung morbidity have been encountered. CHARTWEL 60 Gy resulted in an enhancement of oesophagitis and grade 1 lung toxicity compared with CHARTWEL 54 Gy. These were of no clinical significance, but may be important if CHARTWEL is used with concomitant chemotherapy. These results provide a basis for further dose escalation or the introduction of concurrent chemotherapy.

Aged↗
PubMed1997

Accelerated radiotherapy, carbogen and nicotinamide (ARCON) in locally advanced head and neck cancer: a feasibility study.

BACKGROUND AND PURPOSE: ARCON (Accelerated Radiotherapy, CarbOgen, Nicotinamide) achieves a large therapeutic gain in rodents. A phase I/II study was therefore undertaken to determine its feasibility in patients with locally advanced head and neck cancer. MATERIALS AND METHODS: The accelerated regime CHART was used in 35 patients given carbogen and/or nicotinamide with 11 small volume fractions. Eight patients received carbogen, 12 received nicotinamide and 15 were treated with ARCON. Treatment compliance, side-effects and acute mucositis were monitored in all cases. RESULTS: All patients underwent CHART as intended. In the 23 patients receiving carbogen, two failed to complete treatment. Compliance with nicotinamide was much lower. Out of 25 patients, only 52% received 10-11 doses of the 80 mg/kg/day of the drug. The most common side-effect was nausea and vomiting, which responded to standard anti-emetics in almost half of the patients. Historical comparisons with the CHART head and neck trials indicate that there was no increase in the severity of acute mucositis in any of these patients. Although the observation period is not sufficiently long to be definitive (median 20 months) there is no evidence of an increase in late normal tissue reactions. CONCLUSIONS: ARCON using CHART as the radiotherapy protocol is feasible in patients with advanced head and neck cancer. However, we are concerned about the low compliance rate in our patients, which is far lower than that reported elsewhere. The implications are discussed together with identifying strategies for increasing compliance.

Administration, Oral↗
PubMed1997

Intradural drop metastases in oligodendrogliomas.

The case history is presented of a patient with primary intracerebral oligodendroglioma, who received multiple therapies for local recurrence. Four years following the initial diagnosis, the patient presented with spinal cord compression due to intradural metastases. The patterns of recurrence and metastases in oligodendroglioma are discussed.

Adult↗
PubMed1997

Pure small cell carcinoma of the prostate.

Pure small cell carcinoma of the prostate is a rare anaplastic tumour. This report presents the clinicopathological findings of two patients presenting with this disease. Immunohistochemistry was positive for protein gene product 9.5, neurone specific enolase and calcitonin. Staining was negative for prostate specific antigen and prostate acid phosphatase. androgen ablation has no place in the management of this lesion and patients with this disease should be managed as if they have a neuroendocrine tumour.

Aged↗
PubMed1995

Where exactly does failure occur after radiation in head and neck cancer?

Loco-regional recurrence in squamous cell carcinoma of the head and neck can occur at the site of the original primary tumour or in the marginal zone at its periphery. While nodal recurrence may occur in previously involved nodes or in uninvolved nodes within or outside the treatment volume. The exact site of failure was determined in 89 patients treated with radical radiotherapy for carcinoma of the head and neck. Of 73 patients who failed at the primary site 71 (97%) did so within the site of the original tumour; only two patients developed a marginal recurrence. Of the 30 (93%) patients with N1-3 disease who later showed failure in the lymph nodes, 28 (93%) did so at their original site of disease. These results support the view that when radiation fails it usually does so in the centre of the tumour. In order to improve our results we need to deal with radioresistance at the site of mass disease. Ways of approaching this include the combination of surgery with radiotherapy, the addition of a sensitiser or an increase in the dose to the tumour mass by boosting a 'mini' volume using conformal techniques.

Adult↗
PubMed1995

Short communication: the addition of carbogen and nicotinamide to a palliative fractionation schedule for locally advanced breast cancer.

Tumour cell hypoxia is a recognized cause of resistance to radiotherapy. Using clinically relevant dose-fractionation schedules in a mouse tumour model, the addition of carbogen and nicotinamide to overcome chronic and acute hypoxia results in a marked increase in radioresponsiveness with a lower degree of sensitization in normal tissue. Carbogen and nicotinamide were added to the palliative radiation treatment given to six patients with locally advanced breast cancer. The aim of the pilot study was to determine if patients tolerated the addition of carbogen and nicotinamide and to assess if there was any increase in radiosensitivity of the skin. Patients received 30 Gy prescribed to the intersection dose in six fractions over 17/18 days with full skin bolus to the tumour. All patients were given 6 g of nicotinamide orally 90 min before radiation treatment. Carbogen breathing was started 5 min prior to treatment and continued during it. Patients tolerated the treatment well, with vomiting in one patient being the only side effect that could be related to the nicotinamide, and this settled with an anti-emetic. No increase in skin reaction was noted with the addition of carbogen and nicotinamide, and good tumour regression was achieved.

Aged↗