(133) PARA-AORTIC LYMPH NODE IRRADIATION IN ADVANCED CERVICAL CARCINOMA

W. Tak, M.D. B. Emami, M.D.,

W. Watring, M.D. A. Piro, M.D.

Department of Therapeutic Radiology Division of Gynecologic Oncology

Tufts University School of Medicine New England Medical Center Hospital

Boston, Massachusetts 02111

From 1970 until December, 1977, thirty-six patients with advanced car- cinoma of the uterine cervix and with iliac or para aortic nodes interpreted as unequivocally positive on lymphangiography have received radiation therapy (4500-5000 rad) to the para aortic area at the Department of Therapeutic Radiology at Tufts-New England Medical Center Hospital.

Of twenty-nine patients who received para aortic area irradiation as part of their initial treatment, local control was achieved in eighteen patients (62%). Of these, 11 patients are currently NED; 3 died without evidence of tumor. The remaining 15 patients died of their tumor (9 with locally uncontrolled tumor and 6 with distant metastasis).

Of seven patients in whom the para aortic area was treated because of retroperitoneal nodal recurrence, only two are alive without disease and the rest succumbed to their tumor.

Overall, five patients developed minor complications and five patients developed major complications requiring surgical intervention.

Detailed results will be presented, and our current pre treatment evaluation policy including lymphangiography, Chiba needle biopsy and selective extra-peritoneal lymph node biopsy will be discussed.

(134) EFFECTS OF MISONIDAZOLE AND HALF-BODY IRRADIATION FOR THE PALLIATION OF WIDESPREAD SYMPTOMATIC METASTASES.

A PRELIMINARY REPORT OF AN ONGOING RTOG PHASE I/II STUDY.

Michael Baird, M.D.' , P. Rubin, M.D.' , 0. Salazar, M.D.', T. Phillips, M.D.'

'Division of Radiation Oncol gy, University of Rochester Cancer Center, Rochester, New York 14642 and 9 Department of Radiation Oncology, University

of California Medical Center, San Francisco, California 94143

To date 12 patients with widespread symptomatic metastatic disease have been treated with half-body radiotherapypreceeded by the hypoxic cell sensi- tizer Misonidazole as part of an RTOG phase I/II study. All patients have been treated with 600 rad to either the upper half-body (10 patients) or tpe

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middle half body (2 patients). The dose of Misonidazole was either 5 gm/m (6 patients) or 4 gm/m (6 patients). All patients received a comprehensive premeditation program of oral Prednisone (40 mg. p.o. on day before treatment), antiemetics (Compazine 10 mg. before and after Misonidazole), and Solu-Cortef (100 mg. i.v. one-half hour before irradiation). Patients were hospitalized and hydrated with i.v. fluids before therapy. Serum Misonidazole levels were measured four hours after drug ingestion, concomitant with the administration of half-body therapy. Acute and chronic toxicity, normal tissue reactions, and tumor responses were monitored.

The patients represented varied primaries (6 lung Ca, 1 GI, 2 mesothel- iomas, 1 head and neck, 1 GU, 1 breast) and histologies (2 squamous cell, 7 adenocarcinFma, 3 others). The mean 4 hour blood level of the group treated with 4 gm/m (171+27 ug/ml) did not vary from those treated with 5 gm/m2 (173+51 pg/ml). Likewise, acute toxicity (nauseaand vomiting) did not differ in incidence (5/6 in each group) or degree (~33% "severe") between the two dosage groups. There was no central or peripheral neurotoxicity and blood chemistries pre and post treatment showed no other evidence of acute toxicity. Normal tissues within the irradiated volume did not show enhanced reactions. Five patients with painful lesions were treated and 2 had pain relief. No patient demonstrated an objective response to therapy by tumor measurements or radiographs while 3 patients showed progression of disease (new painful bony lesions or tumor growth) within 2 weeks of hemi-body therapy.

These results imply that there is an upper l'mit to oral absorption of Misonidazole and increasing the dose above 4 gm/m h as a single oral dose may not improve blood levels significantly. To achieve higher blood levels the intravenous route may be necessary. Since the level of G.I. toxicity seen with the combined treatment is already significant, increasing blood levels by intravenous administration may produce unacceptable toxicity. An alternative approach may be to use large but lower doses of Flisonidazole ccombined with a course of fractionated half-body irradiation.

(135) TOTAL BODY IRRADIATION AS A CONDITIONING AGENT PRIOR TO BONE MARROW TRANSPLANTATION FOR APLASTIC ANEMIA

Alan S. Tesler, M.D. for the UCLA Bone Marrow Transplantation Group

Department of Radiation Oncology, UCLA Center for the Health Sciences, Los Angeles, CA 90024

Thirty-two patients with severe aplastic anemia have received total body irradiation (TBI) in conjunction with high-dose cyclophosphamide (CPM) as conditioning prior to allogeneic bone marrow transplantation. TBI was administered in a single fraction using AP and PA fields from a single Cobalt-60 source at a midline dose-rate of 5-9 rad/minute. Nine of these patients (March to December 1976) received 60 mg/kg/day x 2 days of CPM, followed by 1000 rad TBI, and 23 patients (March 1977 to July 1979) re- ceived 50 mg/kg/day x 4 days of CPM, followed by 300 rad TBI. These groups were compared to a group of 11 patients (August 1973 to November 1975) treated with 50 mg/kg/day x 4 days of CPM without TBI.

158 ASTR 21st Annual Meeting