Brachytherapy for oesophageal cancer.
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Brachytherapy↗
Biomedical subjects
R K Sur
Publications and source records attributed to R K Sur.
Initial experience with telebrachytherapy treatment in palliation of advanced oesophageal cancer.
Ten patients with advanced metastatic squamous cell carcinoma of the middle third of the oesophagus were treated with palliative external radiotherapy and intraluminal brachytherapy. All patients had long lesions, 8-15 cm in length, and narrow lumens that did not allow the passage of a guidewire for dilatation. Improvement in dysphagia by more than 2 grades was seen in 9 of 10 patients. This finding was correlated with an increase in the size of the oesophageal lumen at the end of 6 weeks following treatment by barium swallow. No complications of treatment were noted in any patient. Low doses of external beam radiotherapy and high-dose-rate intraluminal brachytherapy can provide quick and effective palliation in advanced metastatic oesophageal carcinoma.
Adult↗
Carotid body tumour--a case for radiotherapy?
Carotid body tumours are rare tumours in the head and neck region. Treatment has been surgery with little or no role for radiotherapy. We describe 5 patients with carotid body tumours seen in our department in the last 10 years. Two patients were treated with postoperative radiotherapy after incomplete surgery, 2 had inoperable tumours and were treated with radiotherapy alone, and 1 had a complete excision and required follow-up only. In the 4 patients who received radiotherapy, the disease was stable in 1 patient at 1,1 years and progressive in 2 at 0,6 and 5,6 years respectively; 1 patient did not complete treatment. The patient who had surgery alone for a small tumour was free of disease at 1 year. Small carotid body tumours should be treated with surgery alone. When the tumour is large or the patient is older we propose radiotherapy as initial treatment because of the high morbidity of surgery. A review of the literature and the results with radiotherapy alone in varying doses support this view.
Adolescent↗
Jugulotympanic paragangliomas.
Eleven patients with glomus jugulotympanicum tumours were seen in our department between January 1983 and December 1993. Nine patients received a full course of radiotherapy with doses ranging from 35 to 54 Gy. Four patients were available for assessment after 48 months. All were alive and asymptomatic at the time of writing. In 4 other patients, pain had improved although cranial nerve function had not at the last follow-up (1-9 months). One patient died 1 month after treatment. Radiotherapy can provide long-term local control and survival in the treatment of glomus jugulotympanicum tumours. The details of clinical presentation, follow-up and the methods of investigation are presented together with a review of the literature.
Adult↗
Fertility in patients treated with radiotherapy following orchidectomy for testicular seminoma.
This study evaluated the effect of paraaortic and ipsilateral pelvic node irradiation on the fertility of a group of 50 patients with Stage I and II testicular seminoma. Eleven patients were infertile before the start of treatment, and another 23 were unable or unwilling to father a child after radiotherapy. From the remaining 16 patients, 11 pregnancies resulted. It has been shown that fertility can be preserved if the dose to the remaining testis can be reduced to less than 2 Gy. No genetic abnormalities were seen in the offspring of any patient.
Adult↗
Oral sucralfate in acute radiation oesophagitis.
Eighty patients with carcinoma in the middle third of oesophagus and with acute radiation oesophagitis following external beam and intracavitary radiotherapy were managed by two different schedules. Group 1 (n = 40) received an antacid containing sodium alginate whereas Group 2 (n = 40) were given a 10% sucralfate suspension during 4 weeks. In Group 2, 32 patients had significant relief of symptoms within 7 days of treatment and most ulcers had healed by 12 days of treatment as seen on endoscopy. Patients in Group 1, on the other hand, showed little improvement of symptoms and had persistent ulcers even after 4 weeks of therapy. We conclude that sucralfate is useful in the management of acute radiation oesophagitis.
Administration, Oral↗
Ewing's sarcoma of the foot bones: an analysis of seven cases.
Seven cases of Ewing's sarcoma presenting with primary lesions of the foot bones are described. Difficulty and delay in making the initial diagnosis are the hallmarks of the problems encountered at this site. Although radiation therapy plays an important role for control of disease in Ewing's sarcoma, surgery along with chemotherapy appears to give better results. Lesions of the forefoot are amenable to surgery; however, no guidelines are available in the literature for hindfoot lesions. Chemotherapy has revolutionized the outcome, and its use along with surgical intervention is recommended in all cases of Ewing's sarcoma of foot bones.
Adolescent↗
Treatment of non-small-cell lung cancer by high-dose-rate intraluminal brachytherapy.
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Aged↗
Metastatic tumour of the iris: a rare presentation.
Metastasis to the iris is less frequent than that to the ciliary body and choroid. This might be the presenting feature. We report a 40 years male patient, a chronic smoker, who presented with pain, redenss and photophobia in the right eye. On detailed examination and investigations it turned out to be a case of primary squamous cell carcinoma of the bronchus metastasising to the iris. The presentation, difficulty in the diagnosis and management is discussed with review of the relavent literature.
Adult↗
Changes in target volume during radiotherapy treatment of invasive bladder carcinoma.
Ninety patients with stage T3 Nx Mo carcinoma of the urinary bladder were treated with radical megavoltage external beam radiotherapy. Planning for treatment was undertaken on a treatment planning system utilizing CT scan slices to define the target volume and patient outline. All patients underwent a second CT scan half way through their course of treatment to assess any change in target volume and the continued adequacy of the original treatment plan. Seventy-two patients (80%) had no spatial shift in target volume, but, of the 18 patients with such a shift, treatment plans were changed in seven. The majority of patients had no delay in continuing their treatment after replanning, but one patient had a gap of 5 days before restarting treatment. An analysis of the factors possibly associated with a change in target volume showed that a primary tumour at the bladder base, rather than elsewhere in the bladder, was the single most important criterion for predicting target volume changes. There was no correlation between the size of the initial tumour, or the size of the prostate gland in male patients, and the occurrence of a shift in volume outside the initial target volume. Some method of regularly assessing the continued relevance of the target volume may be needed in this group of patients to improve the precision of treatment and also improve results.
Aged↗
Radiation therapy of esophageal cancer: role of high dose rate brachytherapy.
Fifty untreated cases of squamous cell carcinoma arising from the middle one-third of the esophagus, with no apparent extraesophageal spread on a computed tomography (CT) scan and with a Karnofsky performance status of over 70, were treated by external beam irradiation to a dose of 3500 cGy/15 fractions/3 weeks. Twenty-five patients (Group A) received treatment with further external beam irradiation to a dose of 2000 cGy/10 fractions/2 weeks. Another group of 25 patients (Group B) received treatment with high dose rate intracavitary irradiation to a dose of 1200 cGy delivered in two sessions of 600 cGy each a week apart. All patients were assessed symptomatically, endoscopically, and radiologically every 3 months. There was marked difference at the end of 1 year in relief of dysphagia (37.5% in Group A vs. 70.6% in Group B), local control (25% in group A vs. 70.6% in group B) although the results were statistically insignificant (p greater than 0.05) and actuarial survival (44% in group A vs. 78% in group B) which was, however, significant statistically (z = 2.83). The cumulative radiation effect (CRE) by external beam irradiation was 1729 reu and by external beam and intracavitary irradiation 1741 reu, but the biological dose effect was better with external beam and intracavitary irradiation. Eight percent of patients treated by external beam and intracavitary irradiation had strictures in contrast to 4% treated by external beam irradiation alone. Moderate doses of external beam and intracavitary irradiation can give a better local response than external beam irradiation alone for the same biological dose in the treatment of esophageal carcinoma.
Brachytherapy↗
Patellar metastasis: a rare presentation.
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Bone Neoplasms↗
Evaluation of radical treatment of carcinoma esophagus using a combination of external beam and intracavitary irradiation.
Twenty five patients with squamous cell carcinoma arising from the middle third of the esophagus were treated radically, with external radiation, to a dose of 55-60 Gy. All patients had lesions less than 6 cm in length with no extra-esophageal spread on computed tomography scan. Eleven of these patients received additional intracavitary radiation to a dose of 12 Gy, 1 cm from the source axis in two sessions of 6 Gy each, a week apart. There was no significant difference in the relief of dysphagia and survival among these receiving and those not receiving intracavitary radiation. Addition of intracavitary radiation to radical external radiation was associated with significant complications like stricture and fistulae formation, which accounted for the poor results.
Brachytherapy↗
Primary lymphoma of the bones of the foot: management of two cases.
Non-Hodgkin's lymphoma rarely presents with an osseous lesion in the foot. Two cases of primary lymphoma of the foot are reported. The patients presented with a history of pain and swelling of the foot. Radiographs revealed a lytic lesion in the calcaneus of one patient, and in the second metatarsal of the other. Open biopsy revealed high grade lymphoblastic non-Hodgkin's lymphoma of the diffuse variety. The patients were treated with localized radiation therapy and have been disease free for more than a year.
Adult↗
High dose rate intracavitary therapy in advanced carcinoma esophagus.
Nine patients with advanced squamous cell carcinoma of the middle third of the esophagus were treated by high dose rate intracavitary therapy. The dose delivered was 12 Gy in two sessions at 1 cm from the center of the source. All nine patients were alive after 9 months. Six months after treatment, 4 patients had strictures which were dilated. At the end of nine months, 6 patients had dysphagia, four of whom had strictures and two had recurrence which was treated by further intracavitary irradiation. Intracavitary radiation using high dose rate, remote controlled afterloader has a significant role in palliation in patients with advanced esophageal carcinoma and avoids intubation.
Brachytherapy↗