Randomized double blind, placebo-controlled study of pilocarpine administered during head and neck irradiation to reduce xerostomia.

PURPOSE: Pilocarpine hydrochloride administered during head and neck irradiation was evaluated for its ability to relieve xerostomia and its adverse effects. MATERIAL AND METHOD: A total of 60 head and neck cancer patients were enrolled in a randomized, double blind, placebo-controlled trial. Each patient had both parotid glands treated with a radiation dose of at least 50 Gy. Patients received jelly containing pilocarpine or placebo 5.0 mg (1 cc.) tid at meal times during radiation. Pilocarpine was administered beginning on the first day of radiation and continued until radiation was completed. Patients were evaluated for symptomatic relief by responding to questionnaires using a Visual Analogue Scale (VAS). Questionnaires measured relief of oral dryness, oral discomfort, difficulty in chewing and swallowing, speaking, and sleeping. Evaluation was conducted preradiation as a baseline, weekly during radiation and monthly until 6 months after radiation was completed. RESULTS: The baseline characteristics, disease and radiation technique including field arrangement and total dose, were not significantly different between the two groups. There was no statistically significant subjective difference in xerostomia, including oral dryness, oral discomfort, inability to chew and swallow, speak and sleep, during and postradiation between the two groups. The adverse effects were non-specific symptoms such as nausea, vomitting, dizziness, urinary frequency, palpitation, sweating and tearing. The adverse effects during radiation and postradiation were not significantly different between the two groups. CONCLUSION: It was concluded that pilocarpine hydrochloride administered during head and neck irradiation produced subjectively insignificant benefit in relieving xerostomia with acceptable side effects.

Osteosarcoma: a study of 130 cases.

Multidisciplinary treatment of osteosarcoma in the Faculty of Medicine Ramathibodi Hospital, Mahidol University, using preoperative intraarterial and postoperative chemotherapy, with or without local irradiation, combined with surgery and prophylactic lung irradiation provided an excellent 5 years' survival of 55 per cent, the same rate as the 9 years' survival. The survival was stable after 4.4 years. The patients with local irradiation had more tumor destruction apparent on the surgical specimen. The administration of prophylactic whole lung irradiation provided an outcome without any undesirable complication. Sixteen per cent of the cases with PLI developed lung metastasis compared to 48 per cent without PLI. The most important prognostic factor was low level of serum lactic acid dehydrogenase. The unanswered question is what is the optimal treatment for osteosarcoma?