Utility of serum CA 19-9 monitoring in preoperative radiotherapy for pancreatic cancer.

BACKGROUND/AIMS: Pancreatic cancer is extremely refractory even to aggressive treatments including surgery, resulting in early metastasis and/or local recurrence. We investigated changes in serum tumor marker CA 19-9 levels during preoperative radiotherapy in conjunction with initial treatment failure. METHODOLOGY: Twenty-three patients presenting with localized disease and an increased serum CA 19-9 level, who were slated to undergo pancreatectomy and/or intraoperative radiotherapy following preoperative radiotherapy were reviewed. CA 19-9 response, the ratio of post-radiotherapy level before laparotomy to pre-radiotherapy level, was analyzed in relation to disease-control time and survival. RESULTS: Eleven patients revealed metastasis at restaging or laparotomy; 12 patients (52%) completed aggressive treatments. Initial failure was identified at the liver (52%), peritoneum (52%), or local site (26%) with a median disease-control time of 91 days; 7 patients showed combined failure. All but 1 patient died of cancer with a median survival time of 264 days. CA 19-9 response (range: 0-1185%) did not correlate with disease-control time or survival; 8 progressive-disease patients (> 140% response), however, showed significantly shorter disease-control time than 15 nonprogressive-disease patients (< or = 140% response). CONCLUSIONS: CA 19-9 monitoring is useful in preoperative radiotherapy for identifying patients who will not benefit by succeeding aggressive treatments by predicting early metastasis.

Exfoliative tumor clearance following radiotherapy estimated by comparing radioresponse between primary esophageal cancer and its lymph node metastasis.

BACKGROUND/AIMS: We estimated the capacity for exfoliative mechanical clearance which could occur in shrinkage of esophageal tumors following radiotherapy; both mechanical clearance and phagocytotic biological clearance of another clearance mechanism could participate in primary diseases located on outer tissue surfaces, whereas only biological clearance can participate in lymph node metastases surrounded by normal tissues which prevent mechanical clearance. METHODOLOGY: Twenty-one patients with primary esophageal cancer and lymph node metastasis both treated by radiotherapy with the same dose were reviewed. The extent of tumor shrinkage was estimated by measuring the size on computed tomography scans before and after radiotherapy. The capacity for biological clearance plus mechanical clearance (primary disease) or biological clearance alone (lymph node metastasis) was defined as the slope of a tumor shrinkage curve. The capacity for mechanical clearance was estimated by intra-patient subtraction. RESULTS: Extent of tumor shrinkage was consistently greater in primary disease than in lymph node metastasis for each patient, showing significant correlation in extent of shrinkage between them. The capacity was smaller for mechanical clearance than for biological clearance as a whole, showing no correlation between them. CONCLUSIONS: Mechanical clearance is highly likely to participate extra in the shrinkage of tumors located on outer tissue surfaces; therefore, these tumors will normally respond more highly than parenchymal tumors.

[Combined therapy of malignant tumors of the upper jaw and nasal cavity using pre- and post-operative radiation with metronidazol radiomodification]. / Kombinirovannye lechenie zlokachestvennykh opukholei verkhnei cheliusti i polosti nosa s ispol'zovaniem pred- i posleoperatsionnogo kyrsov oblucheniia v sochetanii s radiomodifikatsiei metronidazolom.

Seventy-five patients with malignant tumors of the upper jaw and nasal cavity have received combination therapy. Administration of metronidasol (5-8 g/m2 body surface) in combination with large doses of preoperative radiation was shown to significantly improve 3-year total and recurrence-free survival-from 50 to 60% and 32 to 57%, respectively. As a result, no postoperative radiotherapy was required. Postoperative radiation treatment is indicated when means of radiosensibilization are not used. The use of radiomodifiers is mandatory in combination therapy of non-differentiated cell carcinoma, cylindroma, transitory-cell papilloma and non-epithelial neoplasms.