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Biomedical subjects

S Order

Publications and source records attributed to S Order.

10 recordsLinked to original sources
PubMed1992

High-dose local irradiation plus prophylactic hepatic irradiation and chemotherapy for inoperable adenocarcinoma of the pancreas. A preliminary report of a multi-institutional trial (Radiation Therapy Oncology Group Protocol 8801).

Adenocarcinoma of the pancreas is an extremely malignant neoplasm with a particular propensity to spread to the liver. In an effort to combine chemotherapy with high-dose local irradiation plus a modest dose of irradiation to suspected (subclinical) hepatic metastasis, patients with unresectable pancreatic carcinomas with no known distant metastasis were treated on a prospective multi-institutional Radiation Therapy Oncology Group (RTOG) Phase I/II trial. High total dose continuous radiation therapy to the pancreas (6120 cGy in 34 fractions over 7 weeks) and simultaneous prophylactic hepatic irradiation (PHI, 2340 cGy in 13 fractions for the last 2.5 weeks) were combined with administration of 5-fluorouracil 1000 mg/m2/day (maximum, 1500 mg) by intravenous continuous infusion for 5 days starting on day 1 and repeated on day 30 for 5 days, followed by a dose of 600 mg/m2 as a weekly bolus injection starting during week 9 for 6 months. In 18 months, 81 patients were enrolled in the study; 79 were evaluable with a minimum potential follow-up of 8.2 months. The patients ranged in age from 32 to 75 years (median, 64 years). Karnofsky performance status was 80 to 100 in 74% of patients. The tumor was confined to the head of the pancreas in 72% of patients. The planned radiation therapy for the pancreas was completed in 87% of patients, 80% received the planned PHI, and 85% completed the first two cycles of chemotherapy. Seventy-five percent of patients completed both treatments according to the protocol. Most patients who did not complete both treatments had tumor progression or refused additional therapy. During all cycles of chemotherapy and radiation therapy, 2 patients died of complications (Grade 5, 1 hepatic and 1 infection), 9 had life-threatening reactions (Grade 4, 7 hematologic, 1 neurologic, and 1 mucositis), and 31 patients had severe effects (Grade 3) according to the RTOG toxicity scale. Overall hepatic metastasis was documented in 32% (13% as the first site of failure), persistent or progressive pancreatic tumor was evident in 73%, and abdominal and extra-abdominal spread were reported in 27% and 8% of patients, respectively. Eighty percent (63 patients) died (median survival, 8.4 months). Although this study suggests that PHI may reduce the frequency of hepatic metastasis, failure to control the primary tumor and intraabdominal spread remain overwhelming.

Adenocarcinoma↗
PubMed1991

A randomized prospective trial comparing full dose chemotherapy to 131I antiferritin: an RTOG study.

A previously reported Phase I/II multimodality program for non-resectable hepatocellular cancer began with external beam-radiation and chemotherapy, followed by administration of 131I antiferritin-specific radioimmunoglobulin and led to a 48% remission (7% complete remission and 41% partial remission). Survival and response depended on alpha fetoprotein status. AFP+ patients had a median survival of 5 months; AFP- patients had a median survival of 10.5 months. No acute effects occurred relative to treatment with radiolabeled antibody. A randomized prospective study was designed to compare full dose chemotherapy consisting of 60 mg/m2, doxorubicin and 500 mg/m2 of 5-fluorouracil administered every 3 weeks, to 131I antiferritin administration every 8 weeks and allowed for crossover treatment if tumor progression occurred. Overall, radiolabeled antibody administration and full dose chemotherapy led to equivalent partial remission rates (22-30% vs 23-25%) and survival rates compared to chemotherapy (6 month median; AFP+ 5 months; AFP- 10 months). The most important new observations were the response in AFP- patients who, following chemotherapy failure, achieved remission using 131I radiolabeled antibody (7/11) and a subset of patients (7%) who were treated with radiolabeled antibody and converted from non-resectable to resectable status followed by surgical excision.

Adult↗
PubMed1990

Preoperative assessment of malignant hepatic tumors.

Over a 31-month period, 100 patients with malignant hepatic tumors were preoperatively evaluated with three imaging techniques. The results of intravenously enhanced computed tomography (CT) scan, selective hepatic arterial contrast CT, and magnetic resonance imaging (MRI) were compared with operative findings. A total of 227 lesions were identified, with the sensitivity for tumor detection being arteriographically enhanced CT 94% (p less than 0.01), MRI 70%, and CT 66%. This advantage for arteriographically enhanced CT was most marked for lesions less than 1 cm in diameter (82% versus 20% for MRI and 5% for CT; p less than 0.01). Arteriographically enhanced CT was also most sensitive in assessing tumor margins. MRI was clearly superior to arteriographically enhanced CT or CT in detecting vascular involvement (85% versus 30% and 8%, respectively; p less than 0.01). No imaging technique was sensitive in determining extrahepatic involvement. Arteriographically enhanced CT was also best at predicting the operative procedure. The combination of arteriographically enhanced CT and MRI was the best predictor of true disease. We conclude that both arteriographically enhanced CT and MRI should be used for preoperative assessment of hepatic malignancies.

Adolescent↗
PubMed1988

Treatment of experimental myasthenia gravis with total lymphoid irradiation.

Total lymphoid irradiation (TLI) has been reported to be effective in the immunosuppressive treatment of certain human and experimental autoimmune disorders. We have investigated the effects of TLI in Lewis rats with experimental autoimmune myasthenia gravis (EAMG) produced by immunization with purified torpedo acetylcholine receptor (AChR). The radiation is given in 17 divided fractions of 200 rad each, and nonlymphoid tissues are protected by lead shielding. This technique suppresses the immune system, while minimizing side effects, and permits the repopulation of the immune system by the patient's own bone marrow cells. Our results show that TLI treatment completely prevented the primary antibody response to immunization with torpedo AChR, it rapidly abolished the ongoing antibody response in established EAMG, and it suppressed the secondary (anamnestic) response to a boost of AChR. No EAMG animals died during TLI treatment, compared with six control animals that died of EAMG. TLI produces powerful and prompt immunosuppression and may eventually prove useful in the treatment of refractory human myasthenia gravis.

Animals↗
PubMed1980

The value of ultrasonic imaging and CT scanning in planning the radiotherapy for prostatic carcinoma.

Forty-four consecutive patients with potentially curable carcinoma of the prostate were localized with an Old Delft Simulator with the methods described by Bagshaw. The isocenter and the treatment portal were marked on the skin of the patient. Subsequently, the adequacy of the portal was checked by ultrasonography and/or CT scanning. Of 30 patients who underwent ultrasonography, five patients (17%) were found to have tumor extending beyond the initially simulated treatment portals. Using CT scanning, three of 22 patients were found to have tumor extending beyond the initially simulated portals. As a result, 1-2 cm were added to the initially simulated treatment portals for adequate coverage of the tumor volumes. Eight of our 44 patients underwent both studies and results were similar with ultrasonography and CT scanning. Only patients in the group presenting with clinical stage C disease had modifications of the initially simulated treatment portal. It is recommended that conventional simulation should be done first in order to establish the isocenter and treatment volume, which then should be confirmed by ultrasonography or CT scanning.

Aged↗
PubMedDate not supplied

Total lymphoid irradiation and antigen-specific tolerance: future therapy for experimental myasthenia gravis?

Total lymphoid irradiation (TLI) is effective in the immunosuppressive treatment of human and experimental autoimmune disorders, including experimental autoimmune myasthenia gravis (EAMG). Under certain circumstances. TLI may facilitate the induction of specific tolerance to antigens present during or shortly after the TLI treatment. This study was designed to determine whether TLI could induce or enhance tolerance to acetylcholine receptor (AChR), the antigen in myasthenia gravis, or to other antigens. We presented the antigens in various potentially tolerogenic forms to rats that were first pre-treated with TLI, or controls treated with sham irradiation. Injection of deaggregated human gamma globulin (HGG), a classical tolerogen, was most effective; it produced antigen-specific tolerance, which was significantly enhanced by pre-treatment with TLI. Injection of HGG coupled to rat peritoneal cells induced a moderate degree of specific tolerance; in this case, pre-treatment with TLI added only nonspecific suppression. In contrast, AChR, either in solubilized form with no adjuvant, or coupled to syngeneic rat peritoneal cells, failed to induce tolerance, and actually primed the immune system, when given alone or in conjunction with TLI. Subsequent challenge with AChR resulted in an enhanced (secondary) anti-AChR antibody response. These results show that the nature of the antigen itself may predispose to tolerance or to immune stimulation. AChR appears to be highly immunogenic. However, if a tolerogenic fragment or form of AChR can be identified, its use in combination with TLI may result in specific tolerance. If such specific tolerance can be induced during an ongoing autoimmune reaction to AChR, it would be an effective treatment for myasthenia gravis.

Animals↗
PubMedDate not supplied

Vascular abnormalities following radio- and chemotherapy of hepatic neoplasms: CT angiographic findings.

Four patients (three with hepatocellular carcinoma and one with colorectal carcinoma metastatic to the liver) previously treated with chemotherapy or radiotherapy or both in an attempt to reduce tumor bulk prior to surgical resection were examined by CT angiography (CTA). Areas of abnormal enhancement and irregular vessels simulating tumor involvement proved to be free of neoplasm at surgery. Perfusion abnormalities and vascular irregularity on CTA following radiotherapy or chemotherapy should not be automatically considered as neoplastic. Tissue confirmation in such cases should be obtained to rule out treatment related hepatic parenchymal changes.

Adolescent↗