16 MAY 2001 Wake Forest University Baptist Medical Center. 
<b>Wake Forest first in world to perform new brain tumor treatment</b>
WINSTON-SALEM, N.C. - Physicians at Wake Forest University Baptist Medical Center are the first in the world to treat a brain tumor patient with the newly FDA-approved GliaSite" Radiation Therapy System (RTS). The GliaSite RTS delivers site-specific, internal radiation to malignant brain tumors, treating the target area while minimizing exposure to healthy tissue.
Stephen B. Tatter, M.D., Ph.D., assistant professor of neurosurgery at Wake Forest University School of Medicine, performed the procedure on a 27 year-old patient with a glioblastoma multiforme. "GliaSite represents an important new treatment option for malignant brain tumors," said Tatter. "Until now, treatment for patients with recurrent brain tumors has been extremely limited. Radiation combined with surgery is the single most effective treatment, and the GliaSite RTS will enable these patients to receive additional radiation, while minimizing the risks associated with external beam radiation." The device is a balloon catheter that is inserted into the cavity created by surgical removal of the malignant brain tumor and filled with liquid radiation. Over a course of three to seven days, GliaSite delivers radiation directly to the tissue surrounding the cavity, where tumors are most likely to recur. ...
Traditionally, patients are first treated with external beam radiation therapy, in which the radiation travels from outside the body to the tumor site, passing through healthy brain tissue. While this treatment is proven to delay tumor regrowth, a second course of external beam radiation is rarely an option due to the high risk of damage to healthy tissue. 
"It's a significant advancement to be able to offer an improved therapy that delivers radiation directly to the site of the cancer, while maintaining the quality of life for patients by completing the treatment in just one week," said Tatter. In addition, study results suggest that the survival rate of these patients is favorable in comparison to the next best secondary treatment, which is surgery plus chemotherapy wafers.
Safety and performance of the device were demonstrated in a National Cancer Institute (NCI)-sponsored, multi-centered study. Tatter was the principal investigator for the national study, which involved patients with recurrent brain tumors. All of the patients had undergone previous surgery and radiation therapy, and more than half had received chemotherapy. <b>The median survival rate of the patients is currently 14 months</b>, with patients still being followed, a substantial improvement over the results historically seen with other treatments....


15 MAY 2001 University of Maryland Medical Center
<b>UM physicians report promising results for TheraSphere, new treatment option for inoperable liver cancer</b>
Cancer specialists from the University of Maryland Greenebaum Cancer Center report that early results of a new treatment for inoperable liver cancer, known as TheraSphere, are promising. They will report their findings at the 37th annual meeting of the American Society of Clinical Oncologists on May 15. ...Forty-five patients have undergone the procedure there since its introduction last fall, according to David Van Echo, M.D., professor of medicine at the University of Maryland School of Medicine and director of the New Drug Development Program at the Greenebaum Cancer Center. Most patients have shown a positive response, as marked by a reduction in tumor size or number of lesions, with minimal side effects,ö says Dr. Van Echo. 
TheraSphere is a unique new targeted therapy that spares healthy tissue while providing radiation directly to liver tumors, says Dr. Van Echo. Millions of microscopic glass beads containing the radioactive element, yttrium 90, are delivered via catheter into the femoral and hepatic arteries and transported directly to the liver. This mechanism allows a more concentrated dose precisely where it is needed most. Preliminary results have been very promising.
The most dramatic improvements have been noted in patients with gastrointestinal carcinoid tumors --those that develop in certain hormone-making cells û also called neuroendocrine cells -- of the digestive system. Extremely interesting is the fact that of three neuroendocrine patients treated with TheraSphere, all had tumors that completely disappeared,ö says Dr. Van Echo. Also showing favorable response to TheraSphere are patients with colorectal tumors. Of seven patients in this category, two have died of progressive cancer outside the liver, but the other five are doing well six months after treatment, says Dr. Van Echo. They had not been helped by conventional chemotherapy and the average length of survival with this particular diagnosis is three to six months. With TheraSphere treatment, they are all healthy, living longer and enjoying a higher quality of life.
TheraSphere was approved by the U.S. Food and Drug Administration (FDA) last March for the treatment of liver cancer that cannot be treated surgically. The FDA granted MDS Nordion, which makes TheraSphere, a Humanitarian Device Exemption. This exemption, which permits the FDA to approve devices based on proof of patient safety alone, encourages further research and development for diseases that affect few patients. 
...  Those less responsive to TheraSphere as a treatment option are patients who have larger liver tumors, for example. 
TheraSphere is a non-surgical outpatient procedure. Patients can return home the same day and treatment poses no safety threat to caregivers or family members. Side effects can include vomiting, mild fever, abdominal pain and gastric ulcers. Toxicities are evident in about 20 percent of patients treated. And though patients initially were treated with a single dose, the procedure is being evaluated as a two-part process in which the right lobe of the liver is treated and the left lobe is treated two to four weeks later. 
We are delivering the same amount of treatment using the sequential approach, says Dr. Van Echo. But by splitting the dose, we are exposing the surrounding tissue to less radiation and decreasing the chance of the patient developing gastrointestinal toxicities. 
The University of Maryland Greenebaum Cancer Center remains the only institution nationwide treating patients, other than those with primary liver cancer, with TheraSphere. Though fewer than 10,000 Americans are diagnosed with liver cancer each year, it is a rapidly fatal disease with few treatment options, says Dr.Van Echo. Surgery remains the preferred treatment, but fewer than 15 percent of patients qualify for that option due to the advanced progression of the disease. ...


Int J Radiat Oncol Biol Phys 1990 Mar;18(3):619-23 
<b>Tolerance of the liver to the effects of Yttrium-90 radiation.</b>
Gray BN, Burton MA, Kelleher D, Klemp P, Matz L. University Department of Surgery, Royal Perth Hospital, Western Australia. 
 "These data indicate that the human liver may tolerate relatively large radiation doses when delivered by Yttrium-90 microspheres embedded in the liver parenchyma as a number of discrete point sources." 
&&url PMID: 2318695 


Int J Radiat Oncol Biol Phys 1994 Mar 30;28(5):1061-6 Comment in: Int J Radiat Oncol Biol Phys. 1994 Mar 30;28(5):1215-6 
<b>Clinical results of long-surviving brain tumor patients who underwent boron neutron capture therapy.</b> 
Hatanaka H, Nakagawa Y. Department of Neurosurgery, Teikyo University, Tokyo, Japan. 
PURPOSE: <b>The present report is a review of long-term survivors in the patients with malignant brain tumors treated by boron neutron capture therapy.</b> METHODS AND MATERIAL: One-hundred twenty patients with 119 intracranial tumors and one extracranial nerve-related tumor were treated by the current standard technique of boron-neutron capture therapy (BNCT) as of December 1992, using 10B-sodium-mercaptoundecahydrododecaborate. RESULTS: Out of 87 patients operated on before May 1987, 18 lived or have lived longer than 5 years. Nine of these 18 lived or have lived longer than 10 years out of 53 patients operated on before May 1982. Among more-than-10-year survivors, only two died at 17 and 12 years. All of the other are still alive. <b>The two died of delayed radiation damage because BNCT was applied to glioblastomas which recurred after their conventional radiotherapy. They lacked evidence of tumors when they died. Out of these nine more-than-10-year survivors, three had been previously treated by conventional external radiotherapy and they developed radiation damage which brought all patients ultimately to an incapacitated condition. Two of the three died. All the other 6 who were free from previous radiation history are active in their jobs and have no evidence of tumors. CONCLUSION: It can be suggested that BNCT is a radiotherapy that can produce "cure" of both malignant and benign brain tumors while preserving a good quality of life if conducted without conventional radiotherapy.</b> 
&&url PMID: 8175390 


No Shinkei Geka 1993 Dec;21(12):1089-95 
<b>[Prospective dose-escalation study in stereotactic radiotherapy utilizing a linear accelerator: report from East Hokkaido Radiosurgery Study Group (EHRSSG)]. [Article in Japanese]</b> 
Shirato H, Isu T, Shimizu Y, Nishioka T, Nonaka M, Abe S, Matsumura S, Shimizu T, Ichimura W, Suzuki K, et al. 
Department of Radiology, Obihiro Kousei Hospital. 
&&url PMID: 8259218 


Radiother Oncol 1993 Apr;27(1):22-9 
<b>Efficacy and toxicity of fractionated stereotactic radiotherapy in the treatment of recurrent gliomas (phase I/II study). </b>
Laing RW, Warrington AP, Graham J, Britton J, Hines F, Brada M. Neuro-oncology Unit, Institute of Cancer Research, Sutton, Surrey, UK. 
Twenty-two patients with recurrent glioma have been treated on a dose escalation protocol with fractionated stereotactic external beam radiotherapy (SRT). All had previously received radical radiotherapy (median dose 55 Gy) as part of the initial treatment. The dose of SRT was increased from 30 Gy in six fractions to 50 Gy in ten fractions. Median survival from the date of SRT was 9.8 months. There was no significant acute morbidity but five patients who received > or = 40 Gy developed steroid responsive neurological deterioration assumed to represent late radiation damage. The survival and toxicity in patients with recurrent glioma are comparable with interstitial therapy. Fractionated SRT is a noninvasive form of localised radiation which may be a suitable alternative to interstitial therapy in this group of patients. Publication Types: Clinical trial Clinical trial, phase i Clinical trial, phase ii 
&&url PMID: 8327729  

J Neurooncol 1992 Nov;14(3):255-62 ??????


Epilepsia 1999 Nov;40(11):1551-6 
<b>Gamma knife surgery for mesial temporal lobe epilepsy.</b> Regis J, Bartolomei F, Rey M, Genton P, Dravet C, Semah F, Gastaut JL, Chauvel P, Peragut JC. Stereotactic and Functional Neurosurgery Department, Timone Hospital, Orsay, France. jregis@ap-hm.fr 
PURPOSE: <b>Gamma knife radiosurgery (GK) allows precise and complete destruction of chosen target structures containing healthy and/or pathologic cells, without significant concomitant or late radiation damage to adjacent tissues</b>. ... 
&&url PMID: 10565582


Int J Radiat Oncol Biol Phys 1997 Jan 15;37(2):393-8 
<b>Hypofractionated stereotactic radiotherapy in the management of recurrent glioma.</b> 
Shepherd SF, Laing RW, Cosgrove VP, Warrington AP, Hines F, Ashley SE, Brada M. Neurooncology Unit, The Royal Marsden Hospital, Surrey, United Kingdom. 
.... Presumed radiation damage, defined as reversible steroid-dependent toxicity, was observed in 13 patients (36%) and required reoperation in 2 (6%). A total dose of >40 Gy was a major predictor of radiation damage (p < 0.005). ... Hypofractionated SRT is a noninvasive, well-tolerated, outpatient-based method of delivering palliative, high-dose, focal irradiation. 
&&url PMID: 9069312


<b>Multiple-fraction-per-day external beam radiotherapy for adults with supratentorial malignant gliomas.</b> 
Halperin EC. 
CNS Cancer Consortium, Durham, N.C. 
The prognosis following therapy for adults with supratentorial malignant gliomas is poor. Standard therapy of 60 Gy of external beam radiotherapy with chemotherapy achieves a median survival time of 35 to 51 weeks following surgery. A variety of innovative therapies have been considered for therapy of malignant gliomas. Multiple-fraction-per-day (MFD) external beam radiotherapy has been evaluated by many investigators. The rationale for MFD teletherapy is based upon exploiting differences in the recovery capacity for radiation damage between slowly and rapidly proliferating tissues and/or shortening the overall treatment time. A large number of clinical trials have, for the most part, failed to show any survival benefit from MFD radiotherapy. These trials have utilized b.i.d. and t.i.d. radiotherapy with fraction sizes of 0.89 to 2 Gy to total doses of 30-81.6 Gy. The linear quadratic model of the radiation cell survival curve suggests that a biological effective tumoricidal dose > or = 10% higher than standard daily radiotherapy, with approximately isoeffective normal tissue damage, could be achieved at 1.2 Gy b.i.d. to a total dose of approximately 72 Gy. Trials of low dose per fraction MFD radiotherapy, to total doses less than 72 Gy, would be predicted to be inadequate to the task. 
&&url PMID: 1460488  


Int J Radiat Oncol Biol Phys 1997 Jan 15;37(2):385-91 
<b>Stereotactic irradiation without whole-brain irradiation for single brain metastasis.</b> 
Shirato H, Takamura A, Tomita M, Suzuki K, Nishioka T, Isu T, Kato T, Sawamura Y, Miyamachi K, Abe H, Miyasaka K. Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan. 
... effectiveness of stereotactic irradiation (STI) alone without whole-brain irradiation (WBI) for a single metastatic brain tumor was analyzed retrospectively. ... The high response rate and short treatment period of STI alone are advantageous in the treatment of single brain metastasis in patients with active extracranial disease with WBI reserved for relapse. Because of the low complication rate, STI alone may be also useful in patients with good prognosis, without extracranial disease. 
&&url PMID: 9069311 


Int J Radiat Oncol Biol Phys 1985 Jul;11(7):1339-47 
<b>Precision, high dose radiotherapy. II. Helium ion treatment of tumors adjacent to critical central nervous system structures.</b> 
Saunders WM, Chen GT, Austin-Seymour M, Castro JR, Collier JM, Gauger G, Gutin P, Phillips TL, Pitluck S, Walton RE, et al. 
In this paper we present a technique for treating relatively small, low grade tumors located very close to critical, radiation sensitive central nervous system structures such as the spinal cord and the brain stem. A beam of helium ions is used to irradiate the tumor. The nearby normal tissues are protected by exploiting the superb dose localization properties of this beam, particularly its well defined and controllable range in tissue, the increased dose deposited near the end of this range (i.e., the Bragg peak), the sharp decrease in dose beyond the Bragg peak, and the sharp penumbra of the beam. To execute this type of treatment, extreme care must be taken in localization of the tumor and normal tissues, as well as in treatment planning and dosimetry, patient immobilization, and verification of treatment delivery. To illustrate the technique, we present a group of 19 patients treated for chordomas, meningiomas and low grade chondrosarcomas in the base of the skull or spinal column. We have been able to deliver high, uniform doses to the target volumes (doses equivalent to 60 to 80 Gy of cobalt-60) while keeping the doses to the nearby critical tissues below the threshold for radiation damage. Follow-up on this group of patients is short, averaging 22 months (2 to 75 months). Currently, 15 patients have local control of their tumor. Two major complications, a spinal cord transection and optic tract damage, are discussed in detail. Our treatment policies have been modified to minimize the risk of these complications in the future, and we are continuing to use this method to treat such patients. We are enthusiastic about this technique, since we believe there is no other potentially curative treatment for these patients. 
&&url PMID: 4008290  


Int J Radiat Oncol Biol Phys 1999 Mar 1;43(4):763-75 
<b>Figo IIIB squamous cell carcinoma of the cervix: an analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy.</b> 
Logsdon MD, Eifel PJ Division of Radiation Oncology, The University of Teaxs M. D. Anderson Cancer Center, Houston 77030, USA. [Record supplied by publisher] 
"Aggressive use of ICRT, carefully balanced with pelvic EBRT, is necessary to achieve the best ratio between tumor control and complications for patients with FIGO Stage IIIB carcinoma of the cervix. In our experience, the highest DSS rates and the lowest complication rates were achieved with a combination of 40-45 Gy of EBRT combined with ICRT." 
&&url PMID: 10098431 


Cancer Radiother 1998 Jan-Feb;2(1):34-41 
<b>[Low-dose postoperative vaginal brachytherapy of adenocarcinoma of the endometrium].</b> [Article in French] 
Charra-Brunaud C, Peiffert D, Hoffstetter S, Luporsi E, Guillemin F, Bey P Service de curietherapie, centre Alexis-Vautrin, Vandaeuvre-les-Nancy, France. [Record supplied by publisher] 

"Surgery is the primary treatment for endometrial carcinoma. Methods of complementary treatment are still debated, with the potential association of external radiotherapy and/or brachytherapy before or after surgery. This study was aimed at evaluating local control and complications rates in a series of patients treated by hysterectomy followed by postoperative vaginal low-dose rate brachytherapy (BT) combined with pelvic irradiation in case of poor prognosis factors". ..."Results obtained from this series are comparable with those of previous studies, particularly in regard to pre-operative BT. The complication rate is also satisfactory and depends on the irradiation precision and the definition of the target volume." 
&&url PMID: 9749094 


Eur J Gynaecol Oncol 1998;19(4):350-1 
<b>Brachytherapy in the presence of pyuria after pelvic irradiation for cervical cancer.</b> 
Ampil FL, Bell MC Department of Radiology, Louisiana State University Medical Center, Shreveport 71130-3932, USA. 

Little is known about the effects of intracavitary brachytherapy (ICB) performed in the presence of pyuria resulting from external beam pelvic irradiation for cervical cancer (CC). A retrospective study of one decade of ICB for CC showed that brachytherapy was performed in the presence of pyuria in 26 women. Twelve women without pyuria during ICB served as a control group. Antibiotic therapy was routinely administered during intracavitary application. The crude survival rate at 5 years was 39% in patients with pyuria and 42% in women without pyuria; the corresponding local recurrence rates were 23% and 17%; the serious complication rates were 12% and 0% respectively. <b>Intracavitary brachytherapy in the presence of pyuria may have a limited adverse effect on the outcome</b> of women with cancer of the cervix. 
&&url PMID: 9744724 


Bull Cancer 1997 Jun;84(6):625-9
<b>[Uterine sarcoma treated by surgery and postoperative radiation therapy.Patterns of relapse, prognostic factors and role of radiation therapy].</b>[Article in French]
Coquard R, Romestaing P, Ardiet JM, Mornex F, Sentenac I, Gerard JP. Service de radiotherapie-oncologie, Centre Hospitalier Lyon Sud, Pierre-Benite, France.

The objective was to evaluate the results of a combination of surgery and postoperative radiotherapy in patients with uterine sarcoma, to describe the patterns of relapse and to define prognostic factors. ... The survival in this study is higher than that described in series of patients treated with surgery alone. This study confirms the worse prognosis of uterine sarcoma in postmenopausal women. 
&&url PMID: 9295866  [NB This is sarcoma, not leiomyosarcoma. Ed.]


<b>The use of electron beams in treating local recurrence of breast cancer in previously irradiated fields.</b> 
Laramore GE, Griffin TW, Parker RG, Gerdes AJ. 
A retrospective study was performed to assess the efficacy of using electron beam therapy to treat locally recurrent breast cancer in previously-irradiated fields. In a group of patients who received postmastectomy nodal and chest wall megavoltage photon therapy to doses of 4000-5000 rads, an additional 4000-5000 rads were delivered to chest wall recurrences with 7-10 MeV electrons. Good tumor responses were obtained without unacceptable concomitant normal tissue damage. With a follow-up time of 9 months to 5 years, 62% (8 of 13) are alive and clinically free of disease in the irradiated volume. Two patients died at respective times of 5 and 6 months after retreatment, with only one showing evidence of chest wall recurrence. One patient showed no response to therapy and the remaining two patients recurred in the treated volume at 10 and 59 months. Morbidity was limited to dry and/or moist desquamation with no evidence of soft tissue necrosis. These results demonstrate that the first course of irradiation did not select for a subset of radioresistant tumor cells, and indicate that a second course of radiation therapy may have much to offer in controlling locally recurrent breast cancer. 
&&url PMID: 638986 


Radiother Oncol 1996 Dec;41(3):233-6 
<b>Clearance of parenchymal tumors following radiotherapy: analysis of hepatocellular carcinomas treated by proton beams.</b> 
Ohara K, Okumura T, Tsuji H, Min M, Tatsuzaki H, Chiba T, Tsujii H, Akine Y, Itai Y. Department of Radiology, University Hospital, University of Tsukuba, Japan. 
&&url PMID: 9027939 


Radiother Oncol 1996 Dec;41(3):209-14Related Articles, Books, LinkOut 
<b>Soft tissue sarcoma of the extremity. Limb salvage after failure of combined conservative therapy.</b> 
Catton C, Davis A, Bell R, O'Sullivan B, Fornasier V, Wunder J, McLean M. University Musculoskeletal Oncology Unit, Princess Margaret Hospital, Toronto, Canada. 
...Combined conservative surgery and re-irradiation provided superior local control to local re-excision alone and a functional outcome superior to amputation. Combined treatment with re-irradiation should be considered the primary salvage therapy for patients who fail combined therapy and who are suitable for conservative re-excision. Systemic relapse is a significant problem, and optimal therapy should minimize the risk of local relapse after the initial therapy. Eighteen patients (72%) had a history of intralesional excision as their initial intervention, and suggests that inappropriate initial management is a risk factor for relapse after combined conservative therapy. Improvements in therapy must include the appropriate education of the primary care physicians. 
&&url PMID: 9027935 


Ann Acad Med Singapore 1996 May;25(3):352-8 
<b>Kyoto University experience with intraoperative radiation therapy.</b> 
Takahashi M, Shibamoto Y, Sasai K, Nishimura Y, Abe M. Department of Oncology, Kyoto University. 

To date, intraoperative radiotherapy has been performed at Kyoto University Hospital in a total of 480 patients with malignancies various sites. ... For patients with soft tissue sarcomas of the extremities, intraoperative radiotherapy was performed after the tumours were surgically removed to the greatest e* possible. Operation curability had a great impact on the local tumour control rate (82% for curative resection versus 18% for non-curati resection) and on the long-term survival rates (65% versus 8%, respectively). ... 
&&url PMID: 8876900 


Br J Cancer 1995 Aug;72(2):287-92 
<b>Reversal of radiation-induced cisplatin resistance in murine fibrosarcoma cells by selective modulation of the cyclic GMP-dependent transduction pathway.</b> 
Eichholtz-Wirth H. GSF-Institut fur Strahlenbiologie, Neuherberg, Germany. 
Cisplatin resistance, induced in murine fibrosarcoma cells (SSK) in vitro or in vivo by low-dose irradiation, can be overcome by activation of the cyclic GMP(cGMP)-dependent transduction pathway. 
&&url PMID: 7640207


Hematol Oncol Clin North Am 1995 Aug;9(4):817-23 
<b>Preoperative therapy for soft tissue sarcoma.</b> 
Eilber F, Eckardt J, Rosen G, Forscher C, Selch M, Fu YS. University of California at Los Angeles School of Medicine, USA. 
Soft tissue sarcomas appear to be an ideal tumor type for delivering preoperative therapy. The rationale for preoperative therapy is that it is delivered to undisturbed tissue planes with well-oxygenated tissue. This is of great benefit for radiation therapy, because with new computed tomography scan treatment planning it is possible to completely delineate the tumor without surgical clips or postoperative hematoma (or both) obscuring the tumor margin.  
&&url PMID: 7490243 


Hematol Oncol Clin North Am 1995 Aug;9(4):733-46 
<b>Radiation as a therapeutic modality in sarcomas of the soft tissue.</b> 
Suit H, Spiro I. Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA. 
Management of the primary lesion in patients with soft tissue sarcomas is combined modality in the majority of instances. The modalities are surgery and irradiation. Radical surgery as currently practiced in major oncology centers does not achieve local control in an important proportion of patients. 
&&url PMID: 7490238 


Cancer 1995 May 1;75(9):2299-306 
<b>Preoperative regional therapy for extremity sarcoma. A tricenter update.</b> 
Wanebo HJ, Temple WJ, Popp MB, Constable W, Aron B, Cunningham SL. Department of Surgery, Brown University, Providence, RI 02908, USA. 

Combined therapy for extremity sarcoma in a multicenter setting using preoperative radiation with sensitizing chemotherapy and adequate resection was associated with an excellent local control rate (98.5%) and reasonable long term tumor control, although distant metastases continued to be a major challenge 
&&url PMID: 7712441 


Radiother Oncol 1993 Apr;27(1):46-54 
<b>Selectivity of boron carriers for boron neutron capture therapy: pharmacological studies with borocaptate sodium, L-boronophenylalanine and boric acid in murine tumors.</b> 
Gregoire V, Begg AC, Huiskamp R, Verrijk R, Bartelink H. Division of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam. 
&&url PMID: 8327732 


Int J Radiat Oncol Biol Phys 1993 Dec 1;27(5):1159-63 
<b>Reirradiation for rectal cancer and surgical resection after ultra high doses.</b> 
Mohiuddin M, Lingareddy V, Rakinic J, Marks G Department of Radiation Oncology and Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107. [Record supplied by publisher] 

Local recurrence of rectal cancer following high-dose pelvic radiation presents a difficult management challenge. Conventional wisdom suggests that reirradiation should be avoided and radical pelvic surgery is hazardous after ultra high-dose radiation. ... Based on this experience, we believe that in selected patients radical surgical resection after cumulative ultra high doses (70-90 Gy) of radiation can be performed safely. A viable anastomosis is also possible in spite of these high doses. Planned reirradiation for palliative relief of symptoms can be effective without unusual risks of complication. Long-term effects of such ultra high dose radiation and surgery continue to be monitored. 
&&url PMID: 8262842 


Surg Gynecol Obstet 1993 Mar;176(3):203-7 
<b>Preoperative irradiation for unresectable carcinoma of the rectum.</b> 
Whiting JF, Howes A, Osteen RT Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 

... Thirteen of the 20 patients were able to undergo resection with curative intent after radiotherapy. ...The incidence of complications in similar series is discussed and the need for better selection of patients is addressed. 
&&url PMID: 8438190 


Gynecol Oncol 1993 Mar;48(3):328-32 
<b>Intraoperative radiation therapy in gynecologic cancer: the Mayo Clinic experience.</b> 
Garton GR, Gunderson LL, Webb MJ, Wilson TO, Martenson JA Jr, Cha SS, Podratz KC Division of Radiation Oncology,Mayo Clinic, Rochester, Minnesota 55905. 

... Patients with microscopic disease had significantly higher 5-year disease-free and overall survival (70 and 67%, respectively). In summary, IORT in combination with maximum debulking surgery with or without external beam therapy in patients with paraaortic or pelvic sidewall recurrences of gynecologic malignancies appeared to improve long-term local control and survival. The addition of hyperthermia or hypoxic sensitizers may be a consideration to further improve local control in patients with gross residual disease. .... IORT-related toxicity was acceptable. 
&&url PMID: 8385058 


J Med Assoc Thai 1991 Sep;74(9):404-11 
<b>Multidisciplinary "limb salvage" treatment of osteosarcoma.</b> 
Pochanugool L, Nontasut S, Subhadharaphandou T, Hathirat P, Sirikulchayanonta V, Ratanatharathorn V, Yuktanonda P. Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 

Intraarterial plus systemic chemotherapy of cis-diamine dichloroplatinum-II and anthracycline together with preoperative radiation and "limb salvage" treatment have increased the chance of local control and facilitated the previous surgically nonresectable to be resectable. .... Late pulmonary metastases cause the need for future protocol for prophylactic lung therapy. 
&&url PMID: 1791395 


Neurosurg Rev 1990;13(3):247-52 
<b>Unusually long survival time after resection and irradiation of a brain metastasis from osteosarcoma.</b> 
Niedeggen A, Weis J, Mertens R, Rother J, Brocheler J. Clinic of Neurosurgery, Rhenisch-Westphalian Technical University (RWTH) Aachen, West Germany. 

Cerebral metastases of osteosarcomas are rare. The cases published up to now have manifested only a short relapse-free period of survival. Intracranial filia generation must be anticipated if metastasis formation takes place in the lung. We report here on a young patient who underwent operation for an intraparenchymal cerebral metastasis 76 months after amputation of the left leg due to an osteosarcoma chondroblasticum, and who is, at present, healthy, 13 months after resection. This unusually long survival time is attributed to the good neurological status before craniotomy, early diagnosis, and the improvement of the cytostatic therapy (COSS-80-scheme). 
&&url PMID: 1697937 


Strahlenther Onkol 1988 Jul;164(7):386-92 
<b>[Results of whole lung irradiation and chemotherapy in comparison with partial lung irradiation in metastasizing, undifferentiated soft tissue sarcomas].</b> [Article in German] 
Zamboglou N, Furst G, Pape H, Bannach B, Molls M, Schmitt G. Klinik fur Strahlentherapie und Radiologische Onkologie, Universitat Dusseldorf. 
&&url PMID: 3400046 


Cancer 1987 Mar 1;59(5):908-15 
<b>Clinical experience with intravenous radiosensitizers in unresectable sarcomas.</b> 
Kinsella TJ, Glatstein E. 
Traditionally, adult bone and soft tissue sarcomas have been considered to be "radioresistant." ... Adult high-grade sarcomas can be controlled with high-dose radiotherapy and intravenous radiosensitizers, although the precise role of these agents is unclear. 
&&url PMID: 3815269 


<b>Intraarterial chemotherapy of head and neck tumors.</b> 
Lee YY, Wallace S, Dimery I, Goepfert H. 
... Treatment with intraarterial chemotherapy using superselective catheterization before irradiation or surgery is beneficial in some patients. 
&&url PMID: 3082167


Gan No Rinsho 1985 Jul;31(9 Suppl):1063-72 
<b>[Multidisciplinary treatment of bone and soft tissue sarcomas].</b> [Article in Japanese] 
Furuya K, Wada N, Kawaguchi N, Amino K. 

... 1975 was the year when Adriamycin was introduced... The data of the group study of soft tissue sarcoma sponsored by Ministry of Health and Welfare show that in 318 cases of soft tissue sarcomas of extremities, the recurrence rate during the period between 1962 and 1976 is 52%, metastasis rate 69%, and overall survival at 5 years 42%. From 1972 to 1983, in 414 cases treated by the orthopaedic clinics of the same group the recurrence rate become as low as 23% metastasis rate 45% and overall survival at 5 years 56%. In our clinics, 89 patients with soft tissue sarcomas were treated by the curative wide resection and the recurrence rate is 12%, metastasis rate 25%, and overall survival at 5 years 78%. In this series, in 80% of cases limb salvage is succeeded. 
&&url PMID: 4057570 


Int J Radiat Oncol Biol Phys 1985 Jan;11(1):123-8 
<b>Intra-arterial infusion of radiosensitizer (BUdR) combined with hypofractionated irradiation and chemotherapy for primary treatment of osteogenic sarcoma.</b> 
Martinez A, Goffinet DR, Donaldson SS, Bagshaw MA, Kaplan HS. 

Combined modality treatment was given in nine patients of osteogenic sarcoma wherein the tumor was unresectable because of location or amputation was refused. This alternative to massive surgery comprised hypofractionated irradiation, intra-arterial infusion of the radiosensitizer 5'-bromodeoxyuridine (BUdR) and adjuvant systemic chemotherapy. .... On the basis of our experience, we believe that new approaches using modifications of external beam irradiation with different fractionation schedules or better radiosensitizing compounds may hold promise for patients with non-resectable osteosarcoma. 
&&url PMID: 3855408 


Recent Results Cancer Res 1983;86:204-8 
<b>Intra-arterial infusion of bromodeoxyuridine and radiotherapy in osteosarcoma and other bone malignancies.</b> 
Lejeune FJ, Regnier R, Nogaret JM, Jabri M. 

In order to avoid amputation, which does not seem to improve survival in osteosarcoma, we have initiated a limb-preservation program using intra-arterial radiosensitization.. 
&&url PMID: 6580684 


J Maxillofac Surg 1978 May;6(2):98-103 
<b>The effects of "BAR" therapy on oral malignant tumors.</b> 
Nagai T, Sakaizumi K, Asanami S, Lian SL, Tomita O, Hirayama T. 

"BAR" therapy is a combined therapy with BUdR (Radiosensitizer), Antimetabolites (5-FU, FT-207 etc.) and Radiation for malignant tumours. How radiation can be reduced as far as possible and how the effects of treatment can be increased as much as possible are the objectives of this study of combining radiation and BUdR therapy. 
&&url PMID: 353211 


Can J Surg 1977 Nov;20(6):530-6 
<b>Radiation treatment of Ewing's sarcoma and osteogenic sarcoma.</b>
Jenkin RD. 
... When the primary site makes resection impracticable, the response to irradiation and chemotherapy is encouraging. 
&&url PMID: 271036 


Rev Interam Radiol 1977 Jul;2(3):123-33 
<b>Recent advances in radiotherapy.</b> 
Munzenrider JE. 
Significant recent achievement in radiotherapy are presented, with brief discussions of brachytherapy, clinical dose-rate effects, ultrafractionation, and total and half-body irradiation. Reports on radiation modifiers, including hyperbaric oxygen, chemical radiosensitizers, and normal tissue protective agents are briefly summarized, while the potential of local and systemic hyperthermia is discussed in greater detail. Recent reports of local tumor control in so-called "radioresistant tumors," such as salivary gland tumors, adenocarcinomas of the breast, prostate and pancreas, malignant melanoma and malignant carcinoid, are summarized. Current status of heavy particle radiotherapy is discussed in detail. Results of initial clinical trials of neutron beam therapy are summarized, and a brief review of proton beam clinical trials and pion beam facilities is included. Recent reports defining the role of combined irradiation and surgery in rectal and breast cancer, and in soft tissue sarcomas, are discussed. Reports of enhanced radiation toxicity seen with concomitant or sequential chemotherapy and radiotherapy are detailed, including CNS toxicity seen with methotrexate and cytosine arabinoside, cardiotoxicity with adriamycin, and pulmonary toxicity with bleomycin. New or improved diagnostic techniques with special relevance to radiotherapy treatment planning, including CT scanning, histerography, internal mammary lymphoscintigraphy, and upper extremity lymphangiography are described. 
&&url PMID: 408898