Three-dimensional conformal radiation therapy and periodic irradiation with the deep insipration breath-hold technique for hepatocellular carcinoma.

Nine cases of primary hepatocellular carcinoma were treated with 3D-conformal radiation therapy using computerized planning system. This technique permits the precise delivery of a high dose of radiation to the target while sparing most of the normal liver tissue. In order to decrease the effect of organ movement related to respiration, periodical irradiation was combined with the deep inspiration breath-hold technique. The radiation dose was equivalent to conventional radiation with a total dose of 50-70 Gy with 2 Gy, 5 times a week. Irradiation was given in 1-10 fractions which encompassed the target with 90 per cent isodose line. The patients tolerated the treatment procedure well without any complications inherent to the technique. The tumors were decreased in size, the pain symptom and abdominal discomfort were relieved for 3-20 months. This technique is an effective and safe treatment for palliation in hepatocellular carcinoma especially in locally advanced stages with large or multiple lesions. However, long term follow-up should be done to evaluate the late radiation effect and clinical outcome.

Serum tissue polypeptide specific antigen (TPS) in locoregional failure and distant metastasis of cervical carcinoma.

Tissue polypeptide specific antigen (TPS) was measured by the ELISA Technique in the sera of 51 patients with locoregional failure and metastasis of squamous cell carcinoma of the cervix in order to evaluate the serum level of TPS in known cases of metastasis and recurrence. There were 32 cases of local residual or recurrent disease and 19 cases of distant metastasis, including lymph nodes (paraaortic and supraclavicular lymph node) and visceral metastasis. The range of TPS levels in the locoregional failure group were 38.2 355.2 micro/l with a mean of 312.5 and 35.7 - 4822 micro/l with a mean of 833.36 micro/l in the metastatic group. With the cut-off value of 90 micro/l, the rates of TPS elevation were 27 in 32 cases (84.37%) of the loco-regional failure group and 16 in 19 cases (84.21%) of the metastatic group. Among the metastatic group, the mean of TPS level in visceral metastasis was much higher than the group of lymph node metastasis (1518.4 micro/l vs 215.1 micro/l). TPS level might be used as the follow-up guide for prediction of locoregional failure and metastasis in squamous cell carcinoma of the cervix after the completion of the treatment. In patients with a significantly high level of serum TPS, the distant metastases or local recurrence should be searched for. However, a prospective study of TPS levels in cervical cancer patients after completion of treatment should be done in order to evaluate the sensitivity and specificity of this tumor marker.

Phase II study of concurrent chemoradiotherapy for inoperable (bulky) stage III (A/B) non-small cell lung cancer (NSCLC): a preliminary report.

We designed a phase II study to determine the feasibility and toxicity of concomitant radiotherapy and Paclitaxel/Carboplatin followed by adjuvant chemotherapy of the same regimen in patients with newly diagnosed inoperable stage III A/B non-small cell lung cancer. Patients were irradiated with a total dose of 66 Gy. Weekly courses of Paclitaxel 45 mg/m2 and Carboplatin AUC 2 were administered intravenously during the irradiation period. After completion of concurrent chemoradiotherapy, adjuvant chemotherapy with Paclitaxel 175 mg/m2 and Carboplatin AUC 6 intravenously every 3 weeks for 4 cycles were given. Since March 1998, 15 patients have been enrolled. All patients were assessable for efficacy and toxicity after concurrent chemoradiotherapy. Eleven patients were assessable for efficacy and toxicity after adjuvant chemotherapy. After concomitant chemoradiotherapy, complete response (CR) was documented in 2 of 15 (13%). Partial response (PR) was documented in 9 of 15 (60%). After completion of adjuvant chemotherapy in 11 patients, the overall response rate was 91 per cent. (18% CR, 73% PR). There were 8 per cent gr. 3-4 neutropenia which occurred during adjuvant chemotherapy. Concomitant Paclitaxel/Carboplatin and radiotherapy are promising modalities in the treatment of inoperable stage III A/B non-small cell lung cancer.

Linac based radiosurgery (X-knife) for brain metastases.

Linac based stereotactic radiosurgery by X-knife, technique that permits the precise delivery of a high dose of radiation from 6 MV linear accelerator to intracranial target(s) while sparing the normal tissue, has been used as an alternative treatment for brain metastasis. Five patients with 9 metastatic lesions were treated with this technique. The radiation dose was 15-25 Gy with the 75-80 per cent isodose line encompassing the enhancing tumor according to the tumor volume, site and previous treatment. All metastatic lesions were evaluated at 4 weeks after treatment, there were 2 CR, 4 PR and 3 remained unchanged. The result showed a very distinct clear radiation effect margin between the target and normal tissue. The patient could tolerate the treatment procedure well without any complications inherent to the technique. All patients with neurological symptoms had a satisfactory recuperation. Radiosurgery with X-knife is an effective and safe therapy for brain metastases. It can be applied as a primary treatment, as a booster in combination with whole brain irradiation, or as treatment for patients with relapse in a previous irradiated area.

Hyperthermia conjunction with radiation therapy in breast cancer with chest wall recurrence: a preliminary report.

1. Hyperthermia is a very effective and valuable tool which produces a high degree of response in chest wall recurrent breast cancer, especially in cases, where curative doses of radiation could not be achieved, due to previous radiation treatment. 2. Hyperthermia once a week is sufficient to produce the enhancement of radiation neither increasing the burden to the patient nor increasing the workload to the department. 3. The effective radiation dose which causes no severe complication is 50 Gy in a small tumor and 60 Gy in a large tumor. 4. In small satellite nodules, whole chest wall irradiation should be considered to prevent recurrence in the adjacent area. 5. An air cooling system is effective and suitable for an ulcerative lesion. Further randomized study for long term local control and survival should be explored.

Intracavitary irradiation of nasopharyngeal carcinoma using Ir-192 in Foley's catheter.

1. HDR Ir-192 intracavitary insertion in Foley's catheter for a boostered radiation dose to the nasopharynx is a very simple and safe technique and may increase the local control and survival of the patients. 2. Intracavitary brachytherapy should be done in all cases of NPC after the completion of external irradiation to increase local control that may lead to long term survival of the patients.