Biomedical subjects

M V Pilepich

Publications and source records attributed to M V Pilepich.

At least 55 records · Page 3Linked to original sources

PubMed1988

Elective pelvic irradiation in stage A2, B carcinoma of the prostate: analysis of RTOG 77-06.

From 1978 to 1983 the Radiation Therapy Oncology Group conducted a study to evaluate the role of elective pelvic lymph node irradiation in carcinoma of the prostate. Eligible patients were those with clinical Stage A2 (occult disease with more than 3 positive chips and poorly differentiated tumor) and Stage B without clinical (lymphangiogram) or biopsy evidence of lymph node involvement. The patients were randomized to receive 6.5 weeks of either prostatic bed irradiation only 6500 cGy at 180-200 cGy per treatment or pelvic node irradiation to 4500 cGy with a boost of 2000 cGy to the prostatic bed bringing the total dose to 6500 cGy. As of February, 1988, the median follow up has been 7 years and there were 445 analyzable cases who were evaluated for local control, incidence of distant metastases, ned (no evidence of disease) survival and survival. The results of the study revealed no statistically significant benefit of elective pelvic irradiation.

Aged↗

PubMed1988

Regional hyperthermia--assessment of tolerance to treatment.

To assess the patient's tolerance and the complications of treatment associated with delivery of regional hyperthermia using APAS BSD equipment, the data on 30 patients who received regional hyperthermia at the Radiation Oncology Center, Washington University School of Medicine, St. Louis, Missouri, has been reviewed. Most patients presented with advanced or recurrent tumors not amenable to conventional treatment modalities. Hyperthermia was administered in combination with either radiotherapy or chemotherapy. Cardiovascular evaluation was a standard part of pre-treatment work-up. Temperatures were obtained through interstitial probes, catheters inserted into the body cavities and (to record core temperature) esophagus. Local discomfort, anxiety, systemic temperature elevation, and tachycardia were the predominant factors limiting the number of sessions, the duration of sessions and the deposition of power, in 18, 6, 3, and 2 patients, respectively. The complications of treatment were rare. Significant injuries of the superficial tissues were recorded in two patients in whom this could be attributed to contact of urine and stool with the skin surface. Neuropathy was observed in two patients, both of whom had pelvic masses adjacent to or invading into the affected nerves. Both patients had received pelvic irradiation. Neuropathy developed within several days after the first hyperthermia session and proved reversible within several months. No injuries of the visceral organs that could be clearly attributed to hyperthermia have been recorded.

Adipose Tissue↗

PubMed1988

Radiation Therapy Oncology Group studies in carcinoma of the prostate.

From 1976 to 1983, the Radiation Therapy Oncology Group (RTOG) conducted 2 large-scale phase III trials of extended field irradiation in patients with carcinoma of the prostate. The first, RTOG 75-06, was designed to test the value of elective periaortic irradiation in patients in whom the tumor extended beyond the gland, but remained limited to the pelvis, and the second, RTOG 77-06, was designed to test the value of elective pelvic irradiation in patients without evidence of spread beyond the prostate. The results indicated no apparent benefit from elective periaortic irradiation in patients with detectable disease confined to the pelvis and no apparent benefit from elective pelvic irradiation in patients with detectable disease confined to the prostate. Patients with extracapsular extension of the primary tumor and evidence of pelvic lymph node involvement demonstrated an outcome comparable to that in patients without evidence of lymphatic involvement. This observation may reflect a beneficial effect of pelvic irradiation in patients with nodal involvement. In contradistinction to elective irradiation of regional lymphatics, therapeutic irradiation (of the involved lymphatics) may prove strongly indicated. A prospective study testing this contention needs to be conducted. No significant correlation of treatment-related morbidity and treatment volume could be identified. Analysis of the various types of treatment-related morbidity as to the time of onset and clinical course indicated that these behave as different disease entities characterized by a specific pattern of appearance, clinical course, and prognosis. Of particular interest is the observation that most appear reversible. Doses in excess of 7,000 cGy to the prostate were associated with a significantly increased incidence of bowel morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1988

Definitive radiation therapy in carcinoma of the prostate localized to the pelvis: experience at the Mallinckrodt Institute of Radiology.

Definitive radiation therapy was administered to 577 patients with histologically confirmed carcinoma of the prostate localized to the pelvis between January 1967 and December 1983. All patients were available for a minimal 3-year follow-up, and the median period of observation is 6.5 years. The actuarial survival without tumor in stages A2 and B at 5 years was 78% and at 10 years 60%. In stage C, the corresponding survival figures were 60% at 5 and 40% at 10 years. The overall actuarial survival in stage B patients was 76% at 5 and 56% at 10 years, which is similar to the life expectancy of a comparable cohort of normal males. In stage C, the actuarial survival was 65% at 5 and 35% at 10 years. The pelvic failure rate in stage A2 was 12% (5 of 41), 17% in stage B (31 of 185), 28% (93 of 328) in stage C, and 48% (11 of 23) in stage D1. Distant metastases were noted in 12% of the patients with stage A2, 20% stage B, 42% stage C, and 65% stage D1. In stage B, patients who had control of the pelvic tumor exhibited an 85% actuarial 5-year survival and a 60% one at 10 years. This compares with an actuarial survival of 30% at 5 and 10 years when there was evidence of pelvic recurrence alone or combined with distant metastases. In stage C patients with pelvic tumor control, actuarial survival was 81% at 5 and 50% at 10 years, in comparison with 25% at 5 and 10% at 10 years when there was development of pelvic recurrence or distant metastases or a combination of both. There was a strong correlation between the survival and appearance of distant metastases with the histologic degree of differentiation of the tumor in all stages. However, the probability of tumor control in the pelvis was not significantly correlated with this parameter. The administration of hormones concomitantly with radiation therapy did not significantly influence the probability of tumor control, appearance of distant metastases, or survival. Major sequelae of therapy were noted in 2.2% of the patients, whereas minor sequelae were observed in approximately 12% of the patients. Radiation therapy has been shown to be an effective therapeutic alternative to radical prostatectomy or hormonal manipulation in patients with carcinoma of the prostate.

Humans↗

PubMed1987

Prognostic significance of nodal involvement in locally advanced (stage C) carcinoma of prostate--RTOG experience.

A total of 500 patients with extracapsular extension (clinical Stage C) carcinoma of the prostate received definitive radiotherapy directed to the prostate and the regional lymphatics. Pretreatment evaluation of the regional lymphatics was optional and was done in 245 patients who underwent either staging laparotomy or lymphangiography. The remaining 255 patients had no nodal evaluation. In 72 of the node-evaluated patients there was evidence of spread to the pelvic lymphatics and in 173 patients lymph nodes were negative. The three populations (lymph nodes-not evaluated, lymph nodes-involved, and lymph nodes-not involved) were analyzed as to the distribution of the recognized prognostic variables and compared as to the study end points (locoregional failure, incidence of distant metastases, disease-free survival, and survival).

Carcinoma↗

PubMed1987

Radical prostatectomy or radiotherapy in carcinoma of prostate. The dilemma continues.

Evaluation of the efficacy of radical prostatectomy versus radiotherapy in carcinoma of the prostate has been compromised by the scarcity of data in comparable populations. A nationwide search was conducted to compile the available data on the use of radiotherapy in lymphadenectomy-staged patients. The assessed population consists of patients with tumor confined to the gland (Stages A2 and B), negative staging lymphadenectomy, negative bone scan, and normal serum acid phosphatase level who received external beam radiotherapy with curative intent. To provide a broad spectrum of experiences, the search included patients from a large number of institutions including Stanford University, Washington University (St. Louis), those participating in the Radiation Therapy Oncology Group, and a broad range of radiotherapy practices surveyed by the PCS (Patterns of Care Study). A total of 209 patients were identified. No selection criteria other than the aforementioned were applied. The patients were treated consecutively during the survey period. In sharp contradistinction to the reported results of the VA Uro-Oncology Group the analysis indicates a less than 10 per cent probability of progression within the first five years after completion of treatment. Nationwide, the outcome of radiotherapy-treated patients appears to be equivalent to the comparable surgically treated population.

Humans↗

PubMed1987

Prognostic factors in carcinoma of the prostate--analysis of RTOG study 75-06.

A total of 566 evaluable patients were accessioned to a phase III RTOG study of extended field irradiation in carcinoma of the prostate from 1976 to 1983. Eligible patients were those with locally advanced disease, either clinical Stage C or clinical Stage A2 or B with pelvic lymph node involvement. The treatment consisted of irradiation of the regional lymphatics followed by a boost to the prostate. The data have been analyzed extensively to identify variables of potential prognostic significance. The assessed factors include tumor size, clinical stage, the degree of histological differentiation, nodal status, serum acid phosphatase status, hormonal management status, age, and race. These factors have been assessed as to their interdependence and correlation with the clinical course (study endpoints) using univariate analyses and Cox's Regression model. Significant interdependence of tumor size and Gleason score and tumor size and acid phosphatase was identified. The population receiving hormonal management either prior to or during radiotherapy had a significantly higher proportion of high grade tumors. Correlation of the assessed variables and the study endpoints (local control, incidence of distant metastases, NED survival, survival) singled out the degree of histological differentiation as the most powerful prognostic factor for all the endpoints. Age proved a useful predictor of local control (younger patients failed at a significantly higher rate), as did tumor size. Elevation of serum acid phosphatase correlated well with the incidence of metastatic disease but was not a useful predictor of survival. Tumor size and hormonal management status correlated well with the incidence of metastatic disease but only when analyzed separately from other factors. Their prognostic value was absent when Cox regression analysis was applied. Nodal status did not correlate well with any of the study endpoints, indicating then that in patients with clinical Stage C disease, treated with definitive radiotherapy to the prostate and regional lymphatics, this parameter may have limited prognostic usefulness. Although patients who received concomitant hormonal management had a significantly higher proportion of high grade lesions, their clinical course fared favorably in comparison with the population not receiving concomitant hormonal management. This may indicate a beneficial effect of adjuvant hormonal treatment which needs to be tested in a prospective study.

Acid Phosphatase↗

PubMed1987

Correlation of radiotherapeutic parameters and treatment related morbidity in carcinoma of the prostate--analysis of RTOG study 75-06.

Treatment related morbidity, recorded in patients entered onto a RTOG phase III study (testing the value of periaortic irradiation in locally advanced carcinoma of the prostate), has been correlated with radiotherapeutic parameters to identify and quantify the relationship with treatment volumes, doses, and techniques. Between 1976 and 1983 a total of 526 analyzable cases were entered onto the study. The study design entailed randomization to either pelvic irradiation followed by a prostate boost or pelvic and periaortic irradiation followed by a prostate boost. Periaortic irradiation was not associated with a significantly increased incidence of bowel injuries manifested by diarrhea. No correlation between the total dose to the regional lymphatics (ranging from 4400 to 5100 cGy) and the incidence of bowel and bladder injuries could be established. Doses to the prostate in excess of 7000 cGy have not resulted in a significantly increased incidence of bladder injuries, but have been associated with a significant increase in the incidence of bowel injuries manifested by diarrhea. The techniques of pelvic irradiation did not seem to significantly influence the incidence of bowel or bladder complications. The technique of delivery of the prostatic boost did seem to influence the incidence of bowel injuries. This refers to the lateral boost technique and the perineal boost technique which have been associated with a higher incidence of diarrhea. All of the conclusions based on this analysis are applicable only to treatment volumes and dose ranges used in this study and to conventional fractionation of 180 to 200 cGy per day.

Cystitis↗

PubMed1987

Correlation of radiotherapeutic parameters and treatment related morbidity--analysis of RTOG Study 77-06.

The current report is an updated and detailed analysis of treatment related morbidity in RTOG 77-06, a Phase III randomized study comparing prostatic irradiation versus pelvic irradiation followed by a prostatic boost, in patients with Stage A2 and B carcinoma of the prostate without evidence of nodal involvement. A total of 453 analyzable cases were accrued from 1978 to 1983, when the study was closed. All cases of treatment related morbidity were classified as to severity (using a clinical severity grading system). The data were then correlated with a number of radiotherapeutic parameters including treatment volumes (fields), doses, and techniques. Overall, pelvic irradiation, compared to prostate irradiation only, was not associated with a significantly increased incidence of treatment related morbidity. Within the range of pelvic doses used in this study a significant dose effect could not be detected. Total doses to the prostate of more than 7000 cGy were associated with an increased risk of rectal bleeding. Certain treatment techniques, (AP/PA irradiation of the pelvic lymphatics) were associated with an increased incidence of bowel complications.

Humans↗

PubMed1987

Correlation of pre-treatment transurethral resection and prognosis in patients with stage C carcinoma of the prostate treated with definitive radiotherapy--RTOG experience.

Four hundred and ninety-four patients with clinical Stage C carcinoma of the prostate, who were entered onto a phase III RTOG study, have been analyzed as to the potential effect of the pre-treatment transurethral resection (TUR) of the tumor. Treatment consisted of definitive irradiation to the prostate (6500-7000 cGy) and regional lymphatics (4500-5000 cGy). A total of 202 patients underwent pre-treatment TUR. This population was compared with the remaining 292 patients as to the rate of locoregional failure, incidence of distant metastases, disease-free survival, and survival. The TUR population fared significantly worse for all four end-points. To account for uneven distribution of recognized prognostic factors the results were then adjusted using stratified Mantel-Haenszel tests. The stratification process resulted in a reduced level of significance in the differences between the two populations. However, a trend toward a higher incidence of distant metastases could be observed within most strata. The trend was most pronounced in subpopulations characterized by Gleason score 6-7 and normal serum acid phosphatase (SAP). For the population characterized by Gleason score 6-10 and normal SAP, the differences in the incidence of distant metastases retained statistical significance. Whether these findings are secondary to tumor dissemination during TUR or are due to incompletely identified selection biases remains to be demonstrated in future (prospective) studies.

Clinical Trials as Topic↗

PubMed1987

Definitive radiotherapy in resectable (stage A2 and B) carcinoma of the prostate--results of a nationwide overview.

To evaluate the efficacy of definitive radiotherapy in a population of patients with carcinoma of the prostate who satisfy the customary selection criteria for radical prostatectomy, a nation-wide search was conducted. The assessed population consists of patients with clinical Stage A2 and B carcinoma of the prostate, negative staging lymphadenectomy, negative bone scan, and normal serum acid phosphatase. The search included patients from Stanford University, Washington University in St. Louis, those participating in the Radiation Therapy Oncology Group and a broad range of radiotherapy practices surveyed by the PCS (Patterns of Care Study). A total of 209 patients satisfying the selection criteria received definitive radiotherapy during the surveyed period. The end-point of analysis was the time to progression (distant metastases). The results of the analysis indicate a very low (less than 10%) probability of progression within the first 5 years after completion of treatment. Contrary to the recent report from the VA Uro-Oncology Group the study demonstrates a comparable outcome in radiotherapeutically and surgically treated patients.

Humans↗

PubMed1987

Postoperative radiation therapy in the management of lung cancer.

Postoperative radiation therapy for lung cancer is still controversial. In a 9-year period, 69 patients with non-oat-cell carcinoma of the lung (16% stage I, 26% stage II, and 58% stage III) received such therapy. The radiation dose was less than 5,000 cGy in 42 patients, 5,000-5,900 cGy in 16, and 6,000 cGy or more in 11; follow-up ranged from 24 to 64 months. Actuarial survival at 2 and 4 years was 50% and 16%, respectively, for squamous cell carcinoma, and 40% and 26% for adenocarcinoma. The 5-year survival for stages I, II, and III cancer was 29%, 17%, and 19%, respectively. Histologic findings and type of surgery did not affect survival, but the radiation dose apparently did. The 3-year survival for patients who received less than 6,000 cGy was 35%, compared with 73% for patients who received higher doses. In eight patients, treatment failed within the irradiated volume: all had received doses of less than 6,000 cGy, and the volume in three was judged to be inadequate.

Adenocarcinoma↗

PubMed1987

Malignant melanoma: analysis of dose fractionation in radiation therapy.

Thirty-five patients with 67 measureable cutaneous or lymph node metastases from malignant melanoma were treated with radiation therapy in a variety of total doses and dose fractions. There was no correlation between total dose and response rate. However, there was a strong correlation between fraction size and response rate. There were four (9%) complete responses in 43 lesions treated with fractions less than or equal to 500 rad (5 Gy) compared with 12 (50%) complete responses in 24 lesions treated with fractions greater than 500 rad (5 Gy) (P = .0006). Initial response rate was found to correlate strongly with local control at 1 year. The results were then analyzed with respect to lesion size, cutaneous versus nodal lesions, and site of cutaneous lesion (trunk, head and neck, or extremity). Correlation between fraction size and response rate was independent of lesion size, although there were fewer complete responses with increasing lesion size. Correlation was not seen in nodal lesions but was particularly striking in cutaneous lesions. This correlation was statistically significant only for cutaneous lesions of the extremities.

Dose-Response Relationship, Radiation↗

PubMed1987

Radiation therapy in the treatment of chemodectomas.

Twenty-six patients with chemodectomas were treated with radiation therapy from 1961 to 1983 and followed for at least 4 years. In 16 glomus tympanicum lesions treated primarily with radiation, long-term control was achieved in all (follow-up 4-24 years, mean 10.5). Fifteen of 16 had no clinical evidence of disease at time of death or last follow-up, and one patient had recurrent but stable disease at 10 years and died of an unrelated illness 19 years after treatment. Eight of the glomus tympanicum lesions were referred for radiation therapy with persistent disease after multiple surgical procedures. Two had extensive skull and intracranial involvement at the time of radiation. Six patients with glomus jugulare lesions were treated with radiation. Four achieved long-term control, and two died of their disease. In addition, two glomus vagal and one carotid body tumor were treated with palliative intent. One glomus tympanicum lesion was treated with preoperative radiation and resection. Chemodectoma was the cause of death in 4 of 25 patients--3 from intracranial extension and 1 from lung and mediastinal metastases. All four patients were referred for radiation with metastases or extensive bone involvement at the skull base. Radiation appears to be effective in achieving long-term clinical control of chemodectomas. Adequately treated volume should be determined with arteriography and/or contrast-enhanced computer tomography, allowing for geometric margins. Doses in the range of 4,500 to 5,000 cGy delivered in about 5 weeks are recommended.

Adult↗

PubMed1987

Assessment of tumor control following definitive radiotherapy in carcinoma of the prostate--a continuing dilemma.

Following completion of radiotherapy, clinically detectable (palpable) and histologically identifiable prostate carcinoma may persist for an extended period before it undergoes complete resolution. Although in most patients treated with adequate radiotherapy tumor resolution by both clinical and histological criteria occurs in the first 2 years, in a proportion of patients complete resolution may occur during the third year or even later. Since the proportion of patients with late resolution appears to be quite small, it seems reasonable to use the histologically identifiable tumor in the biopsy specimen beyond the second postirradiation year as a criterion for the diagnosis of treatment failure. The available data are insufficient to establish, by histological evaluation, the true pattern of tumor resolution. To achieve such a goal one would need to assess a substantial population of patients, adequately irradiated in a standardized manner, by systemic periodic biopsies over several years. To avoid selection biases, all patients, regardless of the clinical findings, would need to undergo biopsies. To avoid sampling errors, particularly in patients without palpable abnormalities, multiple specimens would need to be obtained from several quadrants of the prostate. The studied population should not receive hormonal management in conjunction with radiotherapy. Only completion of this ideal, hypothetical study and correlation of the biopsy results with long-term follow-up data on local failure, the incidence of distant metastases, and survival would make possible meaningful interpretation of the biopsy results in the future. Only then would it become possible to assign a statistical probability of local and/or distal failure as a function of the biopsy status at a certain point in time.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗

PubMed1986

Tumor control in definitive irradiation of localized carcinoma of the prostate.

At the Mallinckrodt Institute of Radiology, Washington University, 343 patients with carcinoma of the prostate were treated with definitive radiotherapy. All patients are available for minimal 3 year follow-up; the median period of observation is 5.2 years. The incidence of pelvic recurrence with or without distant metastases was 0% in 10 patients with Stage A2, 11% in 113 patients with Stage B, 34% in 204 patients with Stage C, and 40% in 16 patients with Stage D1. There was no significant difference in pelvic tumor control when correlated with the degree of differentiation of the tumors in each stage. In Stage B, patients who exhibited complete regression 3 months after completion of therapy had a pelvic failure rate of 5%, those with 50-75% regression-8% and less than 50% regression-18%. In Stage C, patients with more than 50% tumor regression had a pelvic failure rate of 25%, in contrast to 37% when less than 50% regression was noted at 3 months after completion of irradiation. However, there was no correlation between tumor regression and NED survival. In patients with Stage B, there was no significant correlation between doses of irradiation ranging from 6000 to 7000 cGy and pelvic tumor control. In Stage C, patients receiving doses higher than 6500 cGy had a probability of failure rate in the pelvis of 25% (40/173), in comparison with 44% with doses between 6000-6500 cGy (15/32). The 10 year NED survival for Stage A2 was 100%, Stage B-70%, and Stage C-40%. In Stage B, there was no correlation between local tumor control and 5 year overall survival. However, at 10 years 88 patients without evidence of local failure or distant metastases had a survival rate of 70% in contrast to only 25% if they recurred. In Stage C, 110 patients without local recurrence or distant metastases had a 40% 10 year survival in contrast to 20% in 55 patients who had pelvic recurrence (with or without distant metastases) and 39 patients with distant metastases only. In 105 patients with Stage B tumor controlled in the pelvis, the incidence of distant metastases was 16%, in contrast to 50% in eight patients with pelvic failure. In Stage C, only 26% of 149 patients with pelvic tumor controlled developed distant disease, versus 60% in 55 patients failing in the pelvis. Ninety-five percent of the pelvic failures and 80% of the distant metastases appeared within 5 years after therapy. The administration of hormones did not significantly influence either the probability of pelvic tumor control or the appearance of distant metastases.

Adenocarcinoma↗

PubMed1986

Extended field (periaortic) irradiation in carcinoma of the prostate--analysis of RTOG 75-06.

From 1976 to 1983 the Radiation Therapy Oncology Group conducted a study of extended field (periaortic) irradiation in carcinoma of the prostate. Eligible patients were those with clinical Stage C tumor with or without evidence of pelvic lymph node involvement and also those with Stage A-2 and B with evidence of pelvic lymph node involvement. The stratification criteria included histological grade, clinical stage, absence or presence of hormonal manipulation, and method of lymph node evaluation (lymphangiogram vs. laparotomy vs. no nodal evaluation). The patients were randomized to either receive pelvic irradiation followed by a boost to the prostate or pelvic and periaortic irradiation followed by a boost to the prostate. The prescribed daily dose was 180-200 rad to a total midplane dose to the regional lymphatics to 4000-4500 rad. The prostatic boost target volume was to receive additional 2000-2500 rad bringing the total dose to that area to a minimum of 6500 rad. A total of 523 analyzable patients have been accessioned to the protocol. Four hundred forty-eight of these are known to have received treatment per protocol. Median follow-up is 4 years and 3 months. The analyzable patients were evaluated for the incidence of distant metastases, NED survival and survival as a function of treatment arm. No statistically significant differences between the treatment arms could be documented. Similarly, no significant difference between treatment arms could be documented within a number of subpopulations such as those characterized by a particular grade, hormonal status, stage, age, acid phosphatase level, etc. The results of the study revealed no apparent benefit of elective periaortic irradiation in patients with detectable disease confined to the pelvis.

Aged↗

PubMed1986

Adjuvant chemotherapy with adriamycin, cytoxan, and cis-platinum in high-grade carcinoma of the prostate treated with definitive radiotherapy (RTOG pilot 81-12).

In a phase I-II trial, a regimen of Adriamycin, Cytoxan, and cis-Platinum has been tested as an adjuvant to definitive radiotherapy in patients with high-grade (Gleason score 8-10) locally advanced carcinoma of the prostate limited to the pelvis. The patients had no evidence of distant disease, were in good general condition, and had satisfactory cardiac, hepatic, and renal function. Radiation therapy consisted of 4,320-4,500 rad in 23-25 fractions to the pelvis followed by a boost to the prostate to a total of 6,480-7,020 rad in 36-39 treatments. Chemotherapy was scheduled to start 4 weeks after completion of radiotherapy and consisted of 300 mg/m2 of Cyclophosphamide, 30 mg/m2 of Adriamycin, and 50 mg/m2 of cis-Platinum cycles given at 4-week intervals. The primary aim of the study was evaluation of toxicity of the combined regimen. Nine patients were evaluable. No adverse effects of chemotherapy on the incidence and severity of radiation-related toxicity in the pelvis have been observed. Myelosuppression has been significant and has prevented delivery of full doses of chemotherapy. Although planned, no dose escalation was possible. Further reduction of dosage was necessitated in 67% of the patients. Delays in the delivery of chemotherapy were necessary in four patients; the delays ranged from 1 to 14 weeks. Although the regimen had been reported to produce a high rate of response in disseminated disease and has not been associated with an increased incidence of radiation-chemotherapy toxicity in the irradiated pelvis, it does not appear suitable for further testing in an adjuvant setup in patients treated with definitive radiotherapy.

Aged↗