ABSTRACT
The tolerance of mediastinal structures to intraoperative radiotherapy (IORT) was investigated in 3 separate animals trials using 49 adult foxhounds and one limited Phase I trial in 4 patients with Stage II or III non-small cell lung cancer (NSCLC). The 1- to 2-year results of these trials have been previously reported with significant toxicity found at dose levels over 20 Gy. We now report the results of five dogs reserved for long term studies and one Stage II NSCLC patient alive at 5 years. Two dogs received 20 Gy IORT and one received 30 Gy IORT to the esophagus, all three to a single 6 cm field with 9 MeV electrons. One control dog underwent surgery without irradiation. One dog received 20 Gy IORT to a single 5 cm mediastinal field with 13 MeV electrons following left pneumonectomy. At 5 years, all five dogs reserved for a long term evaluation were alive and evaluable with minimal endoscopic and radiographic abnormalities. The one patient alive at 5 years for evaluation received 25 Gy IORT to two matched 6 cm fields with 13 MeV electrons. She has stable dyspnea on exertion and there is no evidence of cancer by endoscopy. We conclude, based on these limited data, that IORT in the mediastinum may be safe at dose levels that do not exceed 20 Gy, and further careful evaluation at these lower treatment doses is warranted to determine efficacy.
Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Esophagus/radiation effects , Lung Neoplasms/radiotherapy , Lung/radiation effects , Mediastinum/radiation effects , Animals , Bronchi/radiation effects , Dogs , Follow-Up Studies , Humans , Intraoperative Period , PneumonectomyABSTRACT
Great strides have been made in the treatment of pediatric solid tumors over the last three decades. A multimodality approach involving a combination of surgery, radiation therapy, and chemotherapy is now used in the treatment of these diseases. This article reviews the principles that guide the use of these modalities and the multidisciplinary approach used to integrate them into a coordinated treatment plan. The role of each modality in the control of local and systemic disease is described. Radiation treatment planning, dose fractionation, and toxicity are also discussed.
Subject(s)
Neoplasms/therapy , Antineoplastic Agents/adverse effects , Antineoplastic Agents/pharmacokinetics , Antineoplastic Agents/therapeutic use , Child , Combined Modality Therapy , Drug Resistance , Humans , Radiotherapy DosageABSTRACT
The isolated occurrence of reversible acute sensorineural hearing loss associated with thrombocytosis without other neurologic or hematologic manifestations has not been previously reported in the English literature, to our knowledge. We treated a patient with essential thrombocytosis who developed acute sensorineural hearing loss associated with marked thrombocytosis and in whom the hearing loss reversed after plateletpheresis.
