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Title: Metronidazole in the treatment of cervical cancer using Cf-252 neutron brachytherapy

Abstract

Metronidazole was tested for its possible use in the Cf-252 brachytherapy of cervical cancer as a radiosensitizer and to deal with anaerobic pelvic infection. 15 patients were treated by only 14 were evaluable. All stages from stage IB-IVB were treated and complete local tumor regression was noted in all cases although it could take place very slowly. 5/14 (36%) are 1.5-3 year survivors but only among the patients with stage I-II disease. No unusual radio-enhancing action was observed but metronidazole appeared to be useful to treat the vaginal, cervix and uterine infections often associated with high stage disease and bulky, ulcerative or necrotic tumors.

Authors:
Publication Date:
Research Org.:
Dept. of Radiation Medicine, Radiation Therapy Oncology Center, Univ. of Kentucky Medical Center, Lexington, KY 40536
OSTI Identifier:
7063803
Resource Type:
Journal Article
Resource Relation:
Journal Name: Nucl. Sci. Appl.; (United States); Journal Volume: 2:3
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CALIFORNIUM 252; THERAPEUTIC USES; METRONIDAZOLE; NEOPLASMS; NEUTRON THERAPY; UTERUS; ANAEROBIC CONDITIONS; INFECTIVITY; NECROSIS; PATIENTS; PELVIS; RADIOSENSITIZERS; SURVIVAL TIME; ULCERS; ACTINIDE ISOTOPES; ACTINIDE NUCLEI; ALCOHOLS; ALPHA DECAY RADIOISOTOPES; ANTINEOPLASTIC DRUGS; AZOLES; BODY; BODY AREAS; CALIFORNIUM ISOTOPES; DISEASES; DRUGS; EVEN-EVEN NUCLEI; FEMALE GENITALS; HEAVY NUCLEI; HETEROCYCLIC COMPOUNDS; HYDROXY COMPOUNDS; IMIDAZOLES; ISOTOPES; MEDICINE; NITRO COMPOUNDS; NUCLEAR MEDICINE; NUCLEI; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; PATHOLOGICAL CHANGES; RADIOISOTOPES; RADIOLOGY; RADIOTHERAPY; THERAPY; USES; YEARS LIVING RADIOISOTOPES 550603* -- Medicine-- External Radiation in Therapy-- (1980-); 550604 -- Medicine-- Unsealed Radionuclides in Therapy-- (1980-)

Citation Formats

Maruyama, Y. Metronidazole in the treatment of cervical cancer using Cf-252 neutron brachytherapy. United States: N. p., 1986. Web.
Maruyama, Y. Metronidazole in the treatment of cervical cancer using Cf-252 neutron brachytherapy. United States.
Maruyama, Y. 1986. "Metronidazole in the treatment of cervical cancer using Cf-252 neutron brachytherapy". United States. doi:.
@article{osti_7063803,
title = {Metronidazole in the treatment of cervical cancer using Cf-252 neutron brachytherapy},
author = {Maruyama, Y.},
abstractNote = {Metronidazole was tested for its possible use in the Cf-252 brachytherapy of cervical cancer as a radiosensitizer and to deal with anaerobic pelvic infection. 15 patients were treated by only 14 were evaluable. All stages from stage IB-IVB were treated and complete local tumor regression was noted in all cases although it could take place very slowly. 5/14 (36%) are 1.5-3 year survivors but only among the patients with stage I-II disease. No unusual radio-enhancing action was observed but metronidazole appeared to be useful to treat the vaginal, cervix and uterine infections often associated with high stage disease and bulky, ulcerative or necrotic tumors.},
doi = {},
journal = {Nucl. Sci. Appl.; (United States)},
number = ,
volume = 2:3,
place = {United States},
year = 1986,
month = 1
}
  • From January 1977 to July 1984, 32 patients with Stage IIIB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy and external pelvic radiation. These patients received 4500 to 5000 rad external photon therapy and two or three outpatient Californium-252 (252Cf) implants, plus sidewall boost irradiation. Treatment results were compared retrospectively to those obtained in a historical control group of patients with Stage IIIB cervical cancer treated with external radiation and conventional photon brachytherapy from 1972 to 1976. Local or regional tumor recurrence developed in 53% of patients treated with neutronmore » therapy and an additional 9% experienced distant metastases. Thirty-eight percent of patients remain free of disease 12 to 96 months (mean, 51 months) after therapy. The 2-year and 5-year survival rates of patients treated with neutron therapy were 53% and 36%, which were not significantly different than those obtained with photon brachytherapy (2-year survival, 61%; 5-year survival, 34%). Complications of neutron therapy were minimal and included proctitis (19%) and vaginal stenosis (9%). There were no cases of enteric fistulae. Outpatient neutron brachytherapy was cost effective and was well tolerated by patients.« less
  • Purpose: A dosimetric study was conducted to compare intracavitary brachytherapy using both a conventional and a custom loading intended to cover a positron emission tomography (PET)-defined tumor volume in patients with cervix cancer. Methods and Materials: Eleven patients who underwent an [{sup 18}F]-fluoro-deoxy-D-glucose (FDG)-PET in conjunction with their first, middle, or last brachytherapy treatment were included in this prospective study. A standard plan that delivers 6.5 Gy to point A under ideal conditions was compared with an optimized plan designed to conform the 6.5-Gy isodose surface to the PET defined volume. Results: A total of 31 intracavitary brachytherapy treatments inmore » conjunction with an FDG-PET were performed. The percent coverage of the target isodose surface for the first implant with and without optimization was 73% and 68% (p = 0.21). The percent coverage of the target isodose surface for the mid/final implant was 83% and 70% (p = 0.02), respectively. The dose to point A was higher with the optimized plans for both the first implant (p = 0.02) and the mid/last implants (p = 0.008). The dose to 2 cm{sup 3} and 5 cm{sup 3} of both the bladder and rectum were not significantly different. Conclusions: FDG-PET based treatment planning allowed for improved dose coverage of the tumor without significantly increasing the dose to the bladder and rectum.« less
  • Female pelvic carcinoma is one of the common malignancies seen at the University of Kentucky Medical Center and often presents in an advanced stage. In 1976, the authors began to test californium-252 neutron brachytherapy (NT) for its efficacy for control of primary and recurrent advanced uterine, cervix, and vaginal cancers. The first protocol used was 5000-5500 rad of whole pelvis irradiation followed by 1-2 Cf-252 insertions using a single tandem placed in the utero-cervico-vaginal region. Of 27 patients with primary carcinomas treated, 10 are alive and well 5 year later (37%). Two of two recurrent tumors were locally controlled butmore » failed later. These patients had advanced cervical, vaginal, or endometrial carcinomas. In 1977, a transitional year, treatment of only unfavorable stages and presentations with NT was initiated. Similar results were obtained with NT as compared to conventional photon therapy (PT). Further improvement in treatment results can be anticipated as NT brachytherapy is used for advanced cancer therapy by more effective treatment schedules and radiation doses. Cf-252 can be used as a radium substitute and achieved similar rates of tumor control and 5-year survivals. 21 references, 2 tables.« less
  • The purpose of this study was to analyze the dosimetric outcome of 3D image-guided high-dose-rate (HDR) brachytherapy planning for cervical cancer treatment and compare dose coverage of high-risk clinical target volume (HRCTV) to traditional Point A dose. Thirty-two patients with stage IA2-IIIB cervical cancer were treated using computed tomography/magnetic resonance imaging-based image-guided HDR brachytherapy (IGBT). Brachytherapy dose prescription was 5.0-6.0 Gy per fraction for a total 5 fractions. The HRCTV and organs at risk (OARs) were delineated following the GYN GEC/ESTRO guidelines. Total doses for HRCTV, OARs, Point A, and Point T from external beam radiotherapy and brachytherapy were summatedmore » and normalized to a biologically equivalent dose of 2 Gy per fraction (EQD2). The total planned D90 for HRCTV was 80-85 Gy, whereas the dose to 2 mL of bladder, rectum, and sigmoid was limited to 85 Gy, 75 Gy, and 75 Gy, respectively. The mean D90 and its standard deviation for HRCTV was 83.2 {+-} 4.3 Gy. This is significantly higher (p < 0.0001) than the mean value of the dose to Point A (78.6 {+-} 4.4 Gy). The dose levels of the OARs were within acceptable limits for most patients. The mean dose to 2 mL of bladder was 78.0 {+-} 6.2 Gy, whereas the mean dose to rectum and sigmoid were 57.2 {+-} 4.4 Gy and 66.9 {+-} 6.1 Gy, respectively. Image-based 3D brachytherapy provides adequate dose coverage to HRCTV, with acceptable dose to OARs in most patients. Dose to Point A was found to be significantly lower than the D90 for HRCTV calculated using the image-based technique. Paradigm shift from 2D point dose dosimetry to IGBT in HDR cervical cancer treatment needs advanced concept of evaluation in dosimetry with clinical outcome data about whether this approach improves local control and/or decreases toxicities.« less
  • Tumor clearance pattern was studied for Stage IB carcinoma of the cervix using /sup 252/Cf neutron brachytherapy followed by fractionated radiotherapy as compared to conventional therapy using fractionated radiotherapy followed by /sup 137/Cs photon low-dose rate (LDR) implant therapy. Reduction in bulk of tumor was assessed by regular and frequent serial clinical observations. The tumor clearance pattern of the neutron-treated patients was greatly accelerated and radically different from those treated using conventional radiation.