In a prospective multicenter study, 186 patients with squamous cell esophageal carcinoma, who after evaluation were considered suitable for surgery, were randomized to 4 treatment groups: Group 1, surgery alone; Group 2, pre-operative chemotherapy (cisplatin and bleomycin) and surgery; Group 3, pre-operative irradiation (35 Gy) and surgery; Group 4, pre-operative chemotherapy, radiotherapy, and surgery. Three-year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy. Comparison of the groups having pre-operative chemotherapy with those not having chemotherapy showed no significant difference in survival. Female patients had a significantly better survival than males. The results indicate that pre-operative irradiation had a beneficial effect on intermediate term survival, whereas the chemotherapy regime used did not influence survival.

Adult↗

PubMedDate not supplied

Influence of pancreatic secretion on late radiation enteropathy in the rat.

In female Wistar rats a 10 cm long exteriorized mid small intestinal segment was roentgen irradiated 3 weeks after a pancreatic duct-occluding operation/sham operation. Roentgen doses were 19 and 21 Gy as single exposures. Radiation injury was assessed 2, 8 and 26 weeks after irradiation using one macroscopic and 7 histopathologic parameters. The parameters were graded according to severity, and a radiation injury score was calculated by adding the scores for the individual parameters. Two and 8 weeks following irradiation there was no difference between pancreatic duct-occluded and sham operated animals. Twenty-six weeks after irradiation all parameters of radiation injury except the extent of vascular sclerosis were less marked in pancreatic duct-occluded rats than in controls. It is concluded that exocrine pancreatic secretions may influence the development of late changes following irradiation, and that these changes seem to be mainly independent of the degree of vascular sclerosis.

Animals↗

PubMedDate not supplied

Value of hydroxyproline measurements in the assessment of late radiation enteropathy.

In female Wistar rats roentgen irradiation of a 10 cm long temporarily exteriorized mid small intestinal segment was performed. Hydroxyproline, proline, aspartic acid and threonine were measured in intestinal samples 2 to 44 weeks after single or fractionated irradiation, and compared with a histopathologic radiation injury score in order to determine their value as assays of late radiation enteropathy. Two to 4 weeks after irradiation there was good correlation between the histopathologic injury score and the content of hydroxyproline. During the late observation period, there was no difference in hydroxyproline concentration between irradiated and sham-irradiated animals. There was no difference in hydroxyproline concentration in samples from the 1, 2 or 3 fractions groups, although the relative amount of non-collagen protein seemed to increase with fractionation. Determination of the hydroxyproline concentration may be used as an assay of early radiation injury, but it seems to be less suitable for late radiation enteropathy assessment.

Animals↗

PubMedDate not supplied

Late radiation enteropathy following split-dose irradiation of rat small intestine.

In female Wistar rats roentgen irradiation of a 10 cm long exteriorized mid small intestinal segment was performed. The radiation dose was 23 Gy, given as a single exposure or divided in two equal fractions separated by intervals of 4 to 96 hours. Radiation injury was assessed 2, 8 and 26 weeks following irradiation using a semiquantitative histopathologic scoring system. An increased fractionation interval led to a reduced degree of radiation injury at all 3 observation times. The greatest difference was found between the single dose and 4 hour groups, indicating a relatively large capacity for repair of sublethal damage. The degree of radiation injury also decreased significantly when the interval between fractions was increased from 4 hours to 96 hours. This suggests that the phenomenon of slow repair may occur in cells involved in the development of late radiation enteropathy. However, an indirectly protective effect due to mucosal repopulation between fractions may also explain some of the differences.

Animals↗

PubMedDate not supplied

Evaluation of serious adverse events in patients treated with protocols including methotrexate infusions.

During the period 1979 to 1992 we treated 141 children for various malignant diseases with protocols including methotrexate (MTX) infusions in doses ranging from 0.5 to 33.6 g/m2. During a total of 922 courses, there were no fatal complications associated with MTX treatment. Serum MTX concentration and pharmacokinetic data were monitored continuously during the infusions. In this study, we evaluated the occurrence of serious untoward reactions to MTX infusions. Impaired renal function with delayed drug elimination was seen in seven patients, all boys, especially after short infusion times. All recovered completely without any serious clinical symptoms. In three leukemia patients who later died from resistant disease, we observed late neurological disturbances and computer tomography (CT) brain scan abnormalities. Pharmacokinetic data from the patients with complications are described and confirm that serial MTX concentration monitoring is the most important early indicator of renal toxicity.

Adolescent↗