Assessment of the usefulness of hemibody irradiation in painful bone metastasis.

Bone pain due to skeletal metastasis causes significant morbidity among cancer patients. A single large hemibody radiation field is shown to be effective in alleviation of pain for patients with wide-spread bone metastasis. Fifty documented cases of disseminated bone metastasis due to malignancy were evaluated to assess the efficacy of hemibody irradiation for pain control. Intensity of the pain was scored according to the 10th visual analogue score. The upper and/or lower segment of the body was exposed to a radiation dose of 6 Gy and 8 Gy respectively in single fraction applying extended SSD-technique, using a telecobalt unit. The sample consisted of 23 male and 27 female patients with a median age of 48 years. The primary malignancy was distributed as breast, myeloma, prostate, lymphoma and miscellaneous tumours. Thirteen patients were offered upper hemibody irradiation, 21 cases lower hemibody, and 16 patients were offered sequential double hemibody irradiation. The mean radiation field size was 2000 cm2. Thirty per cent of the patients achieved complete and 70% achieved good partial pain relief within 24 to 36 hours post-treatment and the relief was maintained for 2 to 3 months. The benefit of hemibody irradiation in disseminated bone metastasis with pain is described.

Adjuvant treatment in colorectal cancer. Experience from a referral center in eastern peninsular Malaysia.

BACKGROUND: Colorectal cancer is one of the most common malignancies in the West, but in Asia the incidence is low. However in Malaysia, colorectal cancer is increasing with a reported figure of 15% of all cancer cases. Adjuvant chemo and radiotherapy are now more frequently used in such patients. The present retrospective analysis was performed to document the effect of such therapy among patients with colorectal cancer in Malaysia. MATERIALS AND METHODS: This is a retrospective study on the use of adjuvant treatment in colorectal cancers. Patients with histopathological evidence of risk factors were subjected to adjuvant radiotherapy and/or chemotherapy. Cancers confined to rectum and rectosigmoid were subjected to pelvic radiotherapy to a tumor dose of 45 Gy in 20 fractions over 4-week period. 5-flurouracil based chemotherapy was predominantly offered for colonic cancers. RESULTS: One hundred thirty patients with colorectal cancers received adjuvant treatment with a median age of 58 years (range 22-76 years). The male to female ratio was 1.4:1. There were 76% Malays, 19% Chinese, 2% Indians and 3% Siamese subjects in this study. Modified Dukes' stage B2 (28%) and C (38%) constituted the majority, which were distributed in rectum (40%), rectosigmoid (19%), and in the remaining colon (41%). Thirty-one patients received 5-fluorouracil with folinic acid based regime and 35 patients received 5-fluorouracil with levamisole based regimen. Locoregional radiotherapy was offered to 56 (43%) patients. Following treatment, the 2-year actuarial survival was 28% and 54% in colon and rectum cancer respectively. CONCLUSIONS: This study showed that colorectal cancer is not infrequent among Malays in this region and rectal cancers had better survival than the colonic cancers.

Management of retinoblastoma with radiation.

OBJECTIVE: To evaluate the role of radiation therapy in the management of retinoblastoma. DESIGN: Retrospective analysis. METHOD: From January 1993 to March 1994, one hundred and eleven children (150 eyes) of retinoblastoma were referred for radiotherapy. The diagnosis was based on clinical examination and ocular ultrasonogram for both the eyes. The radiation treatment policy involved 40 Gy in 20 fractions over 4 weeks delivered with sedation for children under 1 year of age, 36 Gy in 9 fractions over 3 weeks under ketamine anesthesia for 1-4 years of age and for >4 years of age, a dose of 50 Gy in 25 fractions over 5 weeks. The initial tumor regression was evaluated by A and B mode ultrasonography and/or CT scan. RESULTS: The age distribution ranged from two months to six years (median - 20 months). Bilaterality was observed in 39 out of 111 cases (35%). The male to female ratio was 1.8:1. Eighty two of the 111 children were treated by definitive external beam radiation to one or both eyes. Fifteen cases received adjuvant radiotherapy after enucleation, and 14 had extensive disease for which palliative radiotherapy was offered. We observed a complete response in 54% of cases, partial response in 32%, and none in 14% of cases. Forty per cent (40%) eye survival was documented at the end of 28 months. The complication rate encountered was about 15%. CONCLUSION: Radiotherapy is an effective modality of treatment in significant number of patients with retinoblastoma. However, it requires appropriate fractionation, precise colimation and careful immobilization with general anesthesia.

Human leucocytic antigens (HLA) in breast cancer.

HLA frequencies of fifty (50) female breast cancer patients were compared with 200 age matched female controls. A total of 20 HLA-A locus, 35 HLA-B locus and 8 HLA-C locus antigens were studied. The HLA-A2, A11, Aw19 and A30; HLA-B8, B14 and HLA Cw6 were found significantly higher than the controls. The HLA-A11, HLA-Aw19 and HLA-B8 were found protective whereas, HLA-A2, HLA-B14 and HLA-Cw6 were a risk for breast cancer. The prective antigens' probable involvement through immunogenic mechanism in breast cancer is emphasized in this article.

Brain metastasis as first presentation on carcinoma of the esophagus--a case report.

Cancer of the esophagus can metastasize to lymph nodes, lungs, liver etc. Brain accounts for less than 1% of cases. We encountered one unique case of carcinoma of esophagus who presented with brain secondaries as an initial manifestation. Cancer of the esophagus accounts for less than 1% of the cancers. Due to its inaccessible anatomical location, the diagnosis often gets delayed till late. Initially it tends to spread locally followed by metastasis to the lymph nodes and then to the distant organs. Distant metastasis per se is a relatively rare phenomenon, as locally advanced disease is a common cause of death.

Role of radiotherapy in cavernous hemangioma liver.

OBJECTIVE: To study the effectiveness of local radiotherapy for controlling cavernous hemangioma of liver. METHODS: This is a retrospective analysis of four diagnosed cases of cavernous hemangiomas of the liver treated with radiotherapy. Hepatic irradiation was given in a tumor dose of 30 Gy in 15 fractions over 3 weeks period. RESULTS: Three of the four cases showed a complete clinical regression of the liver lesions over a period of 8-14 months, but in one case there was only 75% regression of the mass at 12 months of follow up. CONCLUSIONS: Localized radiotherapy is effective in the treatment of giant cavernous hemangiomas of the liver and a tumor dose of 30 Gy is optimum with minimal morbidity.