Radiotherapy in the treatment of gastrointestinal stromal tumor

Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumors of the gastrointestinal tract. Up to one-third of GISTs are malignant with a high rate of metastasis. Surgical resection is the mainstay of care for patients with resectable disease. Imatinib mesylate, a selective tyrosine kinase inhibitor, is the current standard of care for GISTs that cannot be completely resected or in cases of metastatic GIST. Although often overlooked, radiation therapy is a viable option for select patients with GIST. We report the case of a patient with unresectable GIST who was treated with local radiotherapy and achieved long-term response. We also present a review of the literature regarding the use of radiotherapy in the treatment of GIST. GIST has been shown to be a radiosensitive tumor. Radiotherapy can offer long-term local control and should be considered in the adjuvant or palliative setting. The role of radiotherapy delivered concurrently with imatinib in the treatment of GIST may warrant further investigation

The effect of sublethal X-irradiation on erythropoiesis in the mouse

BALC/c female mice were exposed to 300 R of total body X-irradiation following which erythropoiesis was studied for the next 8 weeks. The data indicate that the initial effects of radiation injury on erythropoiesis is marked depression of both splenic and marrow erynthropoiesis and the development of ineffective release of maturing RBCs from these organs, as demonstrated by marked decreases in organ radioiron uptake and in radioiron reappearance in RBCs, respectively. The data suggest a complex interrelationship between splenic and marrow erythropoiesis following erythropoietic perturbation. We conclude that the mouse spleen may function in a booster capacity to marrow erythropoiesis in the attainment and maintenance of a new steady-state condition

Long-term survival in choroidal and ciliary body melanoma after enucleation versus plaque radiation therapy

This study aimed to determine whether the long-term melanoma-specific mortality rate of patients with a primary choroidal or ciliary body melanoma treated by enucleation is appreciably lower than that of similar patients treated by plaque radiation therapy. Retrospective, nonrandomized, comparative clinical trial. A previously reported group of 237 patients, 140 treated by enucleation and 97 treated by cobalt-60 (Co-60) plaque between May 1976 and June 1980, and a residual group of 122 patients, 51 treated by enucleation and 71 treated by Co-60 plaque, were identified by variable-by-variable range matching. Primary treatment by enucleation or Co-60 plaque radiation therapy was performed. Melanoma-specific mortality and duration of post-treatment survival were measured. The melanoma-specific mortality rate was substantially worse in the original enucleation subgroup over the entire 15-year follow-up interval; however, differences in baseline prognostic factors between the subgroups are likely to explain the difference in survival curves. After elimination of patients with nonoverlapping values of individual clinical variables to adjust for recognized intergroup differences at baseline, there was no significant or clinically important difference in the 15-year mortality curves of the residual subgroups. The relative rate ratio for the treatment effect in the residual patients was 0.97 (95% confidence interval, 0.51–1.86). There was no late downturn in the survival curve of the plaque-treated patients or late crossing of the curves. A large difference in survival between equivalent groups of patients with primary choroidal or ciliary body melanoma treated by enucleation versus plaque radiation therapy appears to be unlikely

Treatment of advanced and recurrent gynecologic cancer

In 1986 73,400 new cases of invasive gynecologic cancer and 45,000 new cases of in situ carcinoma of the uterine cervix (about 9% of all cancers in women) were diagnosed in the US. A significant proportion of these patients die of local failure. In dealing with the wide variety of gynecologic cancers, extreme care must be used in choosing the appropriate treatment program for each problem. Therefore, the full extent of the disease at the time of initial presentation and recurrence must be determined. It is only with these data that appropriate treatment programs can be designed with the maximum potential for long‐term control or cure and with the minimum in treatment complication. There are no groups of disease processes like those seen in advanced or recurrent gynecologic cancer that offer such a challenge to the clinical practitioner