The use of interstitial radiation therapy in the treatment of persistent, localized, and unresectable cancer in children

Abstract

Two children With cancer that persisted after multiple exploratory laparotomies, external beam radiation therapy, and muitidrug chemotherapy had gold 198 (ImAu) seeds implanted into their localized but unresectable tumor. Both children are alive, are receiving no therapy, and are disease-free more than 2 years later. These two cases indicate the value of interstitial implant therapy in the treatment of some children with cancer.Cancer 57:951-954,1986.ERsISTENT, localized, and unresectable cancer after P surgery, external beam radiation therapy, and multidrug chemotherapy is a difficult therapeutic problem with a grim prognosis. Additional radiation in the form of an interstitial implant inserted at operative exposure of the tumor has been used successfully under these circumstances in This article reports two children who became tumor-free after the insertion of a gold 198 (I9*Au) implant into their residual cancer and advocates the use of interstitial radiation in the occasional child who has localized but unresectable cancer. Report of Cases Case 1A 10-year-old girl experienced acute right lower quadrant pain on July 10, 1981. She underwent a laparotomy for acute a p pendicitis at another hospital. A large tumor was found arising from the left side of the pelvis. The mass displaced the bladder anteriorly and to the right, and pushed the rectum posteriorly and to the right. The tumor was not resectable, and biopsy could only be performed through the posterior wall of the opened bladder. Light microscopy showed neoplastic cells that resembled rhabdomyoblasts. The cytoplasm often contained rounded hyaline inclusions (Fig. IA). Electron microscopy showed that these inclusions were composed of tightly packed filaments, rather characteristic for "whorled filamentous bodies" (Fig. IB). A diagnosis of malignant rhabdoid tumor was made; this was subsequently confirmed by J. B. Beckwith, MD. The patient was treated at monthly intervals with vincristine, Adriamycin (doxorubicin), and Cytoxan (cyclophosphamide). A computerized tomographic (CT) scan performed after four cycles of chemotherapy demonstrated a 50% reduction in the volume of the tumor and no evidence of any metastases. A second-look laparotomy performed on December 7, 198 1 revealed an 8 X 10-cm tumor mass that extended along the left pelvic side wall between the vagina and the obturator foramen from the brim of the pelvis to the ischial tuberosity. The rectum and uterus were free; however, dense adherence of the tumor to the bony pelvic side wall precluded en bloc resection. The tumor capsule was opened, and much of the tumor was scooped and scraped out.The patient's pelvis was then given 4577 cGy of 4 MeV photons via parallel-opposed portals in 26 fractions. Multiple-drug chemotherapy was continued at monthly intervals. A CT scan obtained in March 1982 demonstrated a persistent 5 X 3 X 3-cm tumor, but no evidence of metastases was found. A thirdlook laparotomy was d e d out on March 27,1982. 19"Au seeds were ordered in advance because it had not been possibl...

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Renaissance of nuclear medicine through green nanotechnology: functionalized radioactive gold nanoparticles in cancer therapy—my journey from chemistry to saving human lives

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