Long term results of radioactive gold grain implantation for the treatment of persistent and recurrent nasopharyngeal carcinoma.

BACKGROUND: Brachytherapy is useful for the reirradiation of nasopharyngeal carcinoma. In the current study, the long term treatment results of permanent radioactive gold(198) grain interstitial implantation in patients with persistent and recurrent nasopharyngeal carcinoma were reviewed. METHODS: Gold grain implantation was performed under direct vision with a split palate approach to provide 60 grays (Gy) 0.5 cm away from the plane of implantation. Between August 1986 and May 1999, 106 patients were treated with gold grain implantation (45 patients for persistent disease, 53 patients for first recurrence, and 8 patients for second recurrence in the nasopharynx). All patients had histologically proven disease by biopsy before undergoing implantation. RESULTS: Patients with persistent disease and those with first recurrence did well with the gold grain implantation. The 5-year local control rates for patients with persistent disease, first recurrence, and second recurrence in the nasopharynx were 87.2%, 62.7%, and 23.4%, respectively (P = 0.0004). The 5-year metastasis free survival rates were 68.1%, 60.3%, and 40%, respectively, for the 3 groups (P = 0.048). The overall survival rates at 5 years for the 3 groups were 79.1%, 53.6%, and 42.9%, respectively (P = 0.0047). Patients with computed tomography evidence of disease extension outside the nasopharynx had a lower local control rate compared with patients whose disease was confined to the nasopharynx (5-year local control rate of 52% vs. 72.3%; P = 0.031). The size of the lesion was not found to be an independent prognostic factor for local control after implantation. Multivariate analysis showed only an indication for implantation (persistent disease, first recurrence, and second recurrence) to be a significant prognostic factor for local control. Complications attributed to gold grain implantation included headache, palatal fistula, and mucosal radiation necrosis at the site of implantation, and were reported to occur in 28.3%, 18.9%, and 16%, respectively, of patients. CONCLUSIONS: For selected patients with disease confined to the nasopharynx, gold grain implantation is an effective salvage treatment for persistent and recurrent nasopharyngeal carcinoma.

High-pressure liquid chromatographic analysis of eflornithine in serum.

Eflornithine [2-(difluoromethyl)-DL-ornithine monohydrochloride, monohydrate; DFMO] is an ornithine decarboxylase inhibitor used to treat Pneumocystis carinii pneumonia (PCP) in AIDS patients unresponsive or intolerant to conventional drug therapy. A reversed-phase HPLC method utilizing precolumn dansylation is described which permits the analysis of DFMO in serum of AIDS patients in support of pharmacokinetic studies. Norvaline (2-amino valeric acid) was added as the internal standard and the sample was extracted with three portions of ice-cold 80% ethanol. The supernatants were evaporated in a vacuum oven at 50 degrees C, and the residue was dissolved in base and derivatized at 25 degrees C for 4 h in the dark using dansyl chloride in acetone. Dilute base was then added and 25 to 50 microL was injected into the HPLC. Chromatography was performed on a C-8, 15-cm column with a linear gradient from a 95:5 solution of 10 mM pH 4 acetate buffer and THF, to a 90:10 solution of acetonitrile and THF over a period of 28 min. Detection was by UV at 330 nm, and DFMO and norvaline eluted at 14.7 and 17.7 min, respectively. The method was linear over a range of 5 to 950 micrograms/mL, and replicate analyses of a 25-micrograms/mL control specimen produced a between-run coefficient of variation of 6%. No interferences were encountered in a variety of patient and normal serum blanks.