PubMed · 8243244
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M Földi. 1993-11-19. [Lymph drainage].. https://pubmed.ncbi.nlm.nih.gov/8243244/
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PURPOSE: Genetic radiotherapy, the combination of gene therapy and radiation therapy, for cancer treatment is evolving from laboratory studies to clinical trials. Genetic radiotherapy involves the viral infection of cells that change the sensitivity of transduced cells to radiation. Because there is no patient outcome data for genetic radiotherapy, prospective models are needed to determine the expected benefit of this new modality. Such a prospective model has been developed in this work. METHODS AND MATERIALS: An existing tumor control probability (TCP) calculation model developed for external beam radiotherapy was modified for genetic radiotherapy. Specifically, the (1) transduced fraction and (2) enhancement factor of the transduced cells were included in the model. Parametric studies of the effects of these two variables on TCP for head-and-neck cancer were performed. RESULTS: Using reasonable transduction fraction and enhancement factor values (0.8 and 1.4, respectively), the model predicts an increase in the TCP for genetic radiotherapy over radiotherapy alone by up to 15% for the same radiotherapy dose. The theoretical limit of TCP increase was calculated to be near 70%, which may occur with improved techniques that increase the transduced fraction or because of a strong bystander effect. To maintain existing TCP, dose reductions from 5 Gy (reasonable values) to >30 Gy (ideal case) are predicted for genetic radiotherapy over radiotherapy alone. CONCLUSIONS: Our results indicate that genetic radiotherapy has the potential to significantly improve tumor control over radiotherapy alone.
Both pharmacologic and mechanical approaches designed to limit infarct size by recanalization of infarct-related arteries have reduced mortality associated with ST-segment elevation myocardial infarction (STEMI). Early efforts to combine the two were attenuated because of complications encountered. Primary percutaneous coronary intervention (PCI) and thrombolysis became viewed as alternative rather than complementary modalities. Time to recanalization and adequacy of restoration of perfusion were found to be pivotal determinants of a favorable outcome with either approach. Because pharmacologic intervention can be initiated immediately in virtually any hospital, it is a promising initial step. Because PCI proffers more complete recanalization, it may be a particularly salutary initial or subsequent step. Because of unavoidable delay often confronting implementation of PCI, optimal advantage may accrue from the use of both approaches in combination. We seek to emphasize the potential synergy by referring to the combined approach as "pharmacoinvasive recanalization" rather than by the conventional term "facilitated PCI." Virtually all patients with STEMI can benefit from prompt, sustained, and complete coronary recanalization. Thus, investigations focusing on identification of pharmacologic regimens that can safely initiate recanalization as early as possible, minimize bleeding, and broaden the temporal window available for efficacy of subsequent, optimally timed PCI should provide particularly valuable information.