Radiation therapy as local treatment in Ewing's sarcoma: results of the Cooperative Ewing's Sarcoma Studies CESS 81 and CESS 86
Article Abstract:
Ewing's sarcoma is a cancer which most often arises in the long bones. For successful treatment, it is critical to prevent local recurrence, the recurrence of tumor in its original site. Treatment for Ewing's sarcoma usually consists of chemotherapy, plus either surgery to remove the primary tumor or radiation to destroy it. Two major European studies involved treatment of a total of 215 patients; 93 were treated in the Cooperative Ewing's Sarcoma Study 81 (CESS 81) and 122 were treated in the study CESS 86. The patients were all given four courses of chemotherapy plus some form of local therapy. Patients were not randomized to receive the local therapy; decisions on its use were made on a case-by-case basis. Local therapy consisted of either radical surgery, surgery plus irradiation, or radiotherapy alone. The overall three-year relapse-free survival of the patients was 59 percent. In the first study, the local recurrence rate following treatment with radiation alone was high, affecting half of all patients. In the second study, the results had improved significantly; 67 percent of the patients treated with radiotherapy alone were survivors without relapse at three years. The three-year relapse-free survival rates were 65 percent and 62 percent, respectively, for patients treated with surgery only or surgery plus radiation. One of the most likely explanations for this observed change is improvement in the selection of patients for the different local treatments. Treatment with radiation alone is recommended in cases where the surgical removal cannot be complete, as well as cases in which the removal of the affected bone would produce especially undesirable consequences. The doses of radiation employed in the second study were also higher than in the first study, and the results suggest that for Ewing's sarcoma, the highest doses consistent with minimal adverse effects should be used. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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A Phase I trial of cisplatin in hypertonic saline and escalating doses of 5-fluorouracil by continuous intravenous infusion in patients with advanced malignancies
Article Abstract:
Cisplatin has been shown to be an effective chemotherapeutic agent in the treatment of a several different solid tumors, including lung cancers, squamous cell carcinomas of the head and neck, and cancers of the genitourinary tract. One of the limiting factors of cisplatin dosage is toxicity to the kidney. Researchers have found, however, that with proper preparation of the patient prior to chemotherapy and appropriate administration of the agent, they can actually increase the dose of cisplatin without incurring serious kidney toxicity. Briefly, the method consists of loading the patient with excess water prior to chemotherapy by the infusion of glucose with half the normal concentration of salt. Cisplatin is given in 3.0 percent sterile saline (which is a hypertonic solution; normal saline is about 0.9 percent). This method enables the body to tolerate very high doses of cisplatin, between 160 and 200 milligrams per meter squared of body area. A total of 34 patients with advanced solid tumors of a variety of types were treated in this manner. The patients received a combination of cisplatin and 5-fluorouracil. None of the tumors were considered curable by surgery or radiotherapy. Of the 34 patients, only 2 achieved a complete response; one patient had a non-small cell lung cancer and the other had a sweat-gland carcinoma. The sweat-gland cancer relapsed after six months, while the lung cancer patient remains disease free three years after the initiation of chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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