[The radiobiological validation and clinical results of thermoradiotherapy in malignant tumors].
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Biomedical subjects
Publications and source records attributed to V G Andreev.
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Peripheral blood and bone marrow were studied in 46 patients suffering laryngeal cancer. Two schedules of radiotherapy with and without local hyperthermia were used. Complex hematologic study included electron microscopy of the bone marrow. Apart from general hematologic parameters, partial erythro- and granulocytograms of the bone marrow, mitotic index of karyocytes and morphologic anomalies of erythrokaryocytes were studied. Hematologic studies were conducted both before and after a course of radiotherapy. Adverse effect of hyperthermia and radiation therapy on cells of the granulocytic and immunologic component of hemopoiesis was established.
The paper is devoted to comparative estimation of radiation and combined therapy of laryngeal cancer patients using combined radiomodification including local hyperthermia, total hyperthermia, chemotherapy and a method of dynamic dose fractionation. Complete and significant tumor regression at a dose of 32 Gy was noted in the study group (77 patients) and in the control group (64%). Radiotherapy against a background of combined radiomodification tends to increase the 3-year survival up to 86% as compared to 66.7% in the control group.
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Potentiation of the effect of radiation and combined treatment of laryngeal cancer by local hyperthermia was studied in 43 patients. In 51 cases of the control group (radiotherapy), conventionally-dynamic fractionation of dose was used. At 32 Gy, complete or partial regression of tumor was observed in 72.1% in the study group and 64.7% of controls. An increased frequency of radiation-induced damage of the oral mucosa was observed whereas radiation epidermitis did not occur. Three-year relapse-free survival following a course of radical thermoradiotherapy was as high as 76.5% compared to 40% in controls. Overall three-year survival (including the results of combined treatment and treatment for relapse) increased from 66.7 to 83.3%.
The paper is concerned with comparative evaluation of the influence of some therapeutic methods, based on the use of different radiation sources, dose fractionation regimens and radiomodifiers, on thyroid function in laryngeal cancer patients. Thyroid function was retrospectively assessed with regard to a course of disease within 2 yrs. after a radical course of radiation or combined therapy. Concomitant gamma-neutron therapy and radiotherapy in combined radiomodification were shown to produce the most inhibitory effect. Irrespective of a course of disease after a therapeutic course thyroid function in laryngeal cancer patients is decreased within 2 yrs. of observation.
The authors discuss the use of donor blood after isolated exposure to X-rays in the complex treatment of 65 patients with various suppurative diseases. The therapeutic complex included in all cases transfusion of 250 ml of irradiated blood and subsequent antibiotic therapy. Study of antibiotic (penicillin) pharmacokinetics showed increase of its biological activity and prolongation of its presence in the blood in therapeutic concentrations for 24-48 hours. A scheme of antibiotic therapy in transfusion of irradiated blood is suggested. A formula for calculating the optimal irradiation dose is given. It is concluded that transfusion of irradiated blood followed by injection of an antibiotic raises the efficacy of antibiotic therapy, reduces the term of treatment, and increases the effect of postoperative management.
Indices of platelet function, plasmic coagulation and fibrinolysis were studied during gamma-beam therapy in patients with laryngeal, gastric and cervical tumors (potentially at risk for thrombosis) against a background of metronidazole administration. During the above therapy the thrombophilic status of gastric cancer patients was preserved. These patients were considered at risk for thrombosis. In patients with laryngeal and cervical cancer platelet capacity to adhesion was considerably reduced during radiotherapy with the use of metronidazole. As a result of it the thrombogenic blood potential and danger of intravascular thrombogenesis were decreased.
A radioimmunoassay of 3 tumor markers and 13 hormones was performed before therapy in 166 laryngeal cancer patients with relation to tumor spreading. The levels of these markers and hormones excluding testosterone, were within control indices recommended in instructions for certain test kits. At the same time direct correlation was found between the content of ferritin, calcitonin, parathormone and tumor spreading. Testosterone concentration in all the patients was below the control level. Control of the hormonal status of laryngeal cancer patients was recommended during therapy with the use of radiomodifying agents to determine the effect of various radiomodifiers on the endocrine system, for the assessment of therapeutic efficacy and, probably, the prediction of the course of the disease.
A study was made of the comparative results of radiotherapy of 332 laryngeal cancer patients of whom 237 were treated by routine methods and 95 by multifractionation (double fractionation of a daily dose by 1 Gy with a 4-5 h interval). The method of dose multifractionation was mathematically substantiated. Direct efficacy of radiotherapy was assessed in the delivery of a dose of 40 Gy. A radical dose of irradiation was 66-70 Gy. At 40 Gy complete tumor resorption in the patients of the control group was noted in 33.3% of the cases, in the study group in 58.9%. The 3-year recurrence- and metastasis-free survival rate after radical radiotherapy was 47.4% in the control group and 65.3% in the study group. A decrease in the number of late postradiation edema of the laryngeal mucosa from 28.7% in the control group to 8.7% in the study group was noted.
In DNA-synthesizing cells DNA is partially single-stranded. Anti-thymidine antibodies, while specifically reacting with this DNA, form a complex which may be revealed using indirect immunofluorescent technique. A comparative determination of DNA-synthesizing cell number in tumor tissue (larynx squamous cell carcinoma) was performed using immunofluorescent technique and radioautography. The former method showed the labeling index (LI) to vary from 1.2 to 9.9%, while the latter showed it to vary from 1.0 to 8.2%. The correlation ratio between the LI values obtained by the two techniques was 0.79. To eliminate a possible reaction of anti-thymidine antibodies with cellular RNA, specimens were preincubated in solutions with RNAase. No more than 6 hours were required to stain specimens using this LI estimation technique. This investigation allows to reveal DNA synthesizing cells not only in the periphery of a histological section, as does routinely radioautography, but also in its centre.
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The results of treatment of 192 patients with recurring and incurable laryngeal cancer after a previous course of radiotherapy were studied. Of the total number of patients 95 were treated by surgery only and 97 received a preoperative course of intensive radiotherapy. The study has shown that the irradiation of recurring and incurable by radiotherapy tumors of the larynx at a dose of 6 Gy on the eve and on the day of operation (a summary focal dose of 12 Gy, DMF--37 units) permits an increase of the index of uncomplicated healing of the laryngeal wound from 68.4 up to 86%; simultaneously the 3-year recurrence and metastasis-free survival rates increase from 47.8 up to 81.4%.
A study was made of the results of therapy of 66 patients with maxillary cancer, of them 31 (a control group) received routine therapy by a method of summary focal dose (SFD) fractionation--60-70 Gy. In the study group (35 patients) treatment was started with large fractions at a dose of 5 Gy 2 times a week up to SFD of 20 Gy using metronidazole 2.5-3 h before each of the first 4 large fractions and continued using a course with SFD up to 52 Gy by common fractionation. Staged assessment of the results of radiotherapy was done when the summary dose reached 40 Gy in the control group and 32 Gy in the study group. Complete regression of a tumor or a decrease in its volume by more than 50% at these doses were noted in 13 (41.9%) patients of the control group and in 23 (65.7%) patients of the study group. After combined treatment of a slightly decreased tumor preirradiated in a summary dose of 40 Gy and 32 Gy the 3-year recurrence-free survival was noted in 72.2% (13 patients) in the control group and in 91.7% (11 patients) in the study group. The results obtained are indicative of a marked radiosensitizing effect of metronidazole in radical radiation and combined radiation therapy of maxillary cancer improving long-term results.
The paper is concerned with the results of radiation and combined therapy of 153 laryngeal cancer patients. Of them 103 received radiotherapy combined with metronidazole at a dose of 5-8 g/m2 2.5-3 h before an irradiation session, 50 patients were controls. Radiotherapy was given by mean fractions at a dose of 5 Gy 2 times a week with a summary focal dose of 20 Gy with subsequent irradiation at a daily dose of 2 Gy up to a summary dose of 32 Gy. The efficacy of radiotherapy was evaluated after a 2-week discontinuation. In a complete resorption or lessening of a tumor volume by more than 70% radiotherapy was continued by conventional fractionation at a daily dose of 2 Gy up to a summary focal dose of 52 Gy. In insignificant lessening of a tumor volume the patients were operated on. The use of metronidazole in a radical course of radiotherapy of laryngeal cancer patients did not improve therapeutic results, however the number of postoperative complications caused by surgical treatment for tumor recurrences increased 3 times. In combined treatment of the laryngeal cancer patients after a summary focal dose of 32 Gy and 1.5-3 years of follow-up the number of the patients increased up to 75.7% as compared to 50% in the control group. A decrease in the number of postoperative complications was noted.
The authors described clinicomorphological correlations in the evaluation of the efficacy of preoperative radiotherapy combined with metronidazole (MZ) in laryngeal cancer patients. A study was made of the tumors from 61 laryngeal cancer patients following radiation exposure at a summary dose of 20 and 32 Gy with and without MZ. Histological change of a tumor confirmed a radiosensitizing effect of MZ. However the MZ effect was not equally noticeable in tumor central and peripheral parts. Microscopic foci of the affected epithelium of the larynx and gland mucosa, muscular cells and vessels were revealed. MZ produces a stimulating effect on collagen production by fibroblasts.
A total of 96 laryngeal cancer patients were studied. A comparative analysis of short-term therapeutic results was performed in 2 similar groups: patients receiving radiotherapy without GHM-10 (50) and those receiving radiotherapy with the use of GHM-10 containing 10% of oxygen and 90% of nitrogen (46). Irradiation methods and general tactics of the patients management in both groups were identical. No differences in the short-term results were noted. Radiation reactions of the healthy tissues were less pronounced and noted less frequently in the patients on radiotherapy with the use of GHM-10.