phosphorus-radioisotopes and chromic-phosphate

Topics: Antineoplastic Combined Chemotherapy Protocols; Chromium Compounds; Combined Modality Therapy; Female; Humans; Injections, Intraperitoneal; Neoplasm Staging; Ovarian Neoplasms; Palliative Care; Phosphates; Phosphorus Radioisotopes; Radiopharmaceuticals; Radiotherapy; Radiotherapy Dosage; Randomized Controlled Trials as Topic; Salvage Therapy; Technetium Tc 99m Sulfur Colloid

Intraperitoneal radioactive chromic phosphate was administered to 69 patients with Stage I and II ovarian carcinoma who had undergone comprehensive surgical staging. Intestinal obstruction requiring surgical intervention occurred in four patients and was the most severe complication. Abdominal pain was the most common post-therapy complaint. Attention to time and technique of drug administration could minimize complications.

Topics: Adolescent; Adult; Aged; Chromium; Chromium Compounds; Female; Follow-Up Studies; Humans; Injections, Intraperitoneal; Melphalan; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prospective Studies; Radiotherapy

The objectives of this prospective randomized study of consolidation therapy were to evaluate recurrence-free survival (RFS), overall survival (OS), and the morbidity of intraperitoneal (IP) chromic phosphate suspension (32P) therapy in patients with stage III epithelial ovarian carcinoma who have no detectable evidence of disease at the second-look laparotomy (SLL) procedure after primary chemotherapy.. In a multi-institution clinical cooperative trial, 202 eligible patients with a negative SLL were randomly selected to receive either 15 mCi IP 32P (n = 104) or no further therapy (NFT; n = 98).. With a median follow-up of 63 months in living patients, 68 patients in the IP 32P group (65%) and 63 patients in the NFT group (64%) have developed tumor recurrence. The relative risk of recurrence is 0.90 (IP 32P to NFT) (90% confidence interval [CI], 0.68 to 1.19). The 5-year RFS rate is 42% and 36% for the IP 32P and NFT groups, respectively; the difference is not statistically significant (log-rank test, P =.27). There was no statistically significant difference in OS (P =.19). The relative risk of death is 0.85 (IP 32P to NFT) (90% CI, 0.62 to 1.16). Sixteen patients (8%) experienced grade 3 or 4 adverse effects, with eight in each respective group.. Intraperitoneal chromic phosphate did not decrease the risk of relapse or improve survival for patients with stage III epithelial ovarian cancer after a negative SLL. Despite complete pathologic remission at SLL after initial surgery and platinum-based chemotherapy, 61% of stage III ovarian cancer patients had tumor recurrence within 5 years of negative SLL. This indicates a need for more effective initial therapy and further studies of consolidation therapy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Chi-Square Distribution; Chromium Compounds; Combined Modality Therapy; Female; Humans; Infusions, Parenteral; Laparotomy; Middle Aged; Neoplasm Recurrence, Local; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Proportional Hazards Models; Prospective Studies; Survival Analysis; Treatment Outcome

To conduct a prospective study of intraperitoneal radioactive chromic phosphate (32P) versus cyclophosphamide-cisplatin (CP) in women with early ovarian cancer at high risk for recurrence (International Federation of Gynecology and Obstetrics stage Ia or Ib grade 3 or Ic or stage II, no macroscopic residual disease) and to compare cumulative incidence of recurrence, overall survival, and relative toxicity.. A total of 251 patients were randomly assigned to treatment with 32P or CP. Twenty-two (8.7%) were ineligible following centralized pathology review. Of the 229 patients included in the analysis, 110 received 32P, and 119 received CP.. The cumulative incidence of recurrence at 10 years was 35% (95% CI, 27% to 45%) for patients receiving 32P and 28% (95% CI, 21% to 38%) for those receiving CP. Patients receiving CP had a recurrence rate 29% lower than that of those receiving 32P (P =.15, two-tail test). The death rate for patients treated with CP was 17% lower than that for patients treated with 32P (difference not significant). Combining both arms, the 10-year cumulative incidence of recurrence for all stage I patients was 27% (95% CI, 20% to 34%) compared with 44% (95% CI, 32% to 56%) for stage II patients (P =.01). Both regimens were reasonably well tolerated, but problems with inadequate distribution (7%) and small-bowel perforation (3%) make the otherwise less toxic 32P less acceptable.. Although there are no statistically significant differences in survival, the lower cumulative recurrence seen with CP and complications of 32P administration make platinum-based combinations the preferred adjuvant therapy for early ovarian cancer patients at high-risk for recurrence.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Endometrioid; Chemotherapy, Adjuvant; Chromium Compounds; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cystadenocarcinoma, Serous; Disease-Free Survival; Female; Humans; Injections, Intraperitoneal; Middle Aged; Neoplasm Recurrence, Local; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prospective Studies; Survival Rate; Treatment Outcome

In this early Phase II study, the authors investigated the efficacy of intratumoral injection of P-32 chromic phosphate in 17 patients with refractory solid tumors or solitary metastases in terms of response rates and overall survival.. Seventeen patients (median age, 60 years) with either cytostatic drug-resistant tumors or tumors known to be primarily chemotherapy-resistant were entered into the study. After sonographic determination of the tumor volume, P-32 chromic phosphate (74-555 MBq) was injected into the central part of the tumor under sonographic guidance. Follow-up investigations included serial scintigraphy, sonographic examinations, and hematologic studies.. Injection of P-32 chromic phosphate into refractory tumors resulted in remarkable regression. The median survival of all patients was 13 months (range, 8-25 months). The response rate was 71% (12 patients). A complete remission was seen in 7 patients (41%), and the rate of partial remissions was 29% (5 patients). However, 5 patients (30%) did not respond to the treatment. In one patient thrombocytopenia was observed, but no other side effects were apparent. Important pathologic and anatomic changes within the tumor tissue were demonstrated in solitary liver metastases of gastrointestinal malignancies excised in second-look operations. In all cases examined, formation of a cyst within the area of central activity, surrounded by a centrifugal necrotic ring and a marginal fibrotic structure, was found.. Lack of persistent systemic or local side effects, as well as noteworthy efficacy, are properties of this optimal regional treatment modality with P-32 chromic phosphate. This modality deserves consideration for further clinical trials.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma; Carcinoma, Hepatocellular; Chromium Compounds; Digestive System Neoplasms; Drug Resistance, Neoplasm; Female; Head and Neck Neoplasms; Humans; Injections, Intralesional; Lung Neoplasms; Male; Middle Aged; Neoplasms; Phosphates; Phosphorus Radioisotopes; Survival Rate

The purpose of this study was to validate a previously reported body contour measurement using Compton backscatter sources with bremsstrahlung SPECT imaging.. Bremsstrahlung SPECT imaging was performed with 32P using a dual-headed camera system fitted with medium-energy, parallel-hole collimators. Two sources of 99mTc were placed directly on each collimator. Energy windows of 100 keV +/- 25% were used to image the 32P and also to record the Compton scatter from the 99mTc sources. Eleven patients enrolled in clinical Phase I therapeutic protocols were injected with 32P-chromic phosphate and SPECT images were acquired and reconstructed in the transaxial plane. The 32P distribution and the patient body contour were both visualized in these slices. The anteroposterior and lateral patient dimensions were measured by generating count profiles parallel to the anteroposterior and lateral body contour, respectively, at the midline in a transaxial slice. The distance in centimeters between the two centroids of each profile is representative of the anteroposterior and lateral dimensions and was determined for each patient. These anteroposterior and lateral dimensions were compared to the same distance measurements made in these patients by CT in an anatomically comparable transaxial slice. A cylindrical SPECT phantom was also studied to further validate the contour measurements.. The mean percent difference in the patient dimension measurements between SPECT and CT was -0.8% with a range of -8.5% to 9.9%. The percent difference between the known and SPECT measured dimensions in the cylindrical phantom was 0.5%.. The two external Compton scatter source method is accurate for determining the body contour.

Topics: Chromium Compounds; Head and Neck Neoplasms; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Lung Neoplasms; Pancreatic Neoplasms; Phantoms, Imaging; Phosphates; Phosphorus Radioisotopes; Scattering, Radiation; Technetium; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

This study addressed the technique of intraperitoneal distribution imaging (IDI). A literature search (MEDLINE database) revealed wide variations in IDI techniques without a basis for comparison. From April 1990 to September 1992, the authors studied 8 patients (age 43-65 years) with ovarian cancer. A total of 1000 ml of normal saline and 1 mCi of Tc-99m SC was infused intraperitoneally for IDI. In one patient loculation was observed, but only 250 ml of normal saline was infused with Tc-99m SC. A repeat study using our standard technique rendered free intraperitoneal distribution in this patient, as well as in the other seven cases. Some investigators recommend low volumes, but in our experience this produced the finding of pseudoloculation, which could change treatment inappropriately. Although the number of patients studied at our institution was small, administration of 1 liter intraperitoneally provided consistent IDI results.

Topics: Chromium Compounds; Female; Humans; Infusions, Parenteral; Middle Aged; Ovarian Neoplasms; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Radionuclide Imaging; Sodium Chloride; Technetium Tc 99m Sulfur Colloid; Tissue Distribution

Thirty-four patients with epithelial carcinoma of the ovary were entered into a trial of adjuvant intraperitoneal P-32 following induction chemotherapy and a negative second-look laparotomy. The breakdown by initial Stage was Stage IC, 5; Stage II, 3; Stage III optimal, 22; and Stage III suboptimal, 4. Previous treatment consisted of 4-12 cycles (median 6) of cisplatin or carboplatin-based combination chemotherapy. Fifteen millicuries of P-32 were instilled via a Tenckhoff catheter placed at the time of second-look laparotomy. Because of a 22% incidence of bowel injury in the first 23 patients, the P-32 dose was reduced to 12 mCi in the last 11 patients. To date, there have been no bowel injuries at the lower dose. Eighteen of the 34 (53%) patients have relapsed with a median time to relapse of 20 months and a median follow-up for all patients of 31 months. There has been no difference in the relapse rate between a dose of 12 and 15 mCi. Intraperitoneal P-32 does not appear to reduce the relapse rate following a negative second-look laparotomy. The incidence of bowel injury is dose dependent and is higher than that seen in patients treated as an adjuvant following initial surgery without subsequent chemotherapy or second-look laparotomy.

Topics: Adult; Aged; Brachytherapy; Carcinoma; Chromium; Chromium Compounds; Combined Modality Therapy; Dose-Response Relationship, Radiation; Female; Humans; Intestines; Life Tables; Middle Aged; Neoplasm Staging; Ovarian Neoplasms; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Radiation Injuries; Reoperation; Survival Analysis

Intraperitoneal radioactive chromic phosphate was administered to 69 patients with Stage I and II ovarian carcinoma who had undergone comprehensive surgical staging. Intestinal obstruction requiring surgical intervention occurred in four patients and was the most severe complication. Abdominal pain was the most common post-therapy complaint. Attention to time and technique of drug administration could minimize complications.

Topics: Adolescent; Adult; Aged; Chromium; Chromium Compounds; Female; Follow-Up Studies; Humans; Injections, Intraperitoneal; Melphalan; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prospective Studies; Radiotherapy

Two hundred fifty-seven eligible patients with stage I, IIA "high risk" ovarian carcinoma and IIB, IIIO (disease confined to pelvis), were randomized to either total abdominal radiotherapy (arm A) 2,250 rad in 20 fractions (107 patients), melphalan (arm B) 8 mg/m2/d X 4 every 4 weeks X 18 courses (106 patients), or intraperitoneal chromic phosphate (arm C) 10 to 20 mCi (44 patients). All patients were initially treated with pelvic radiotherapy; arm A, 2,250 rad in ten fractions; and arms B and C, 4,500 rad in 20 fractions. Entry to arm C was discontinued early because of toxicity. In a multifactor analysis using proportional hazards models, no significant difference in survival was observed although there was a marginally significant difference in disease-free survival (P = .015) with arm B being superior to arm A. Stage (P less than .0001), grade (P less than .0001), and histology (P less than .008) were predictors of survival in the multifactor analysis. Performance status, age, and residual disease were significant predictors in the single factor analysis but were not predictive when correction was made for the effects of stage, grade, and histology. Five-year survival rates are 62% for arm A, 61% for arm B, and 66% for arm C. Median duration of follow-up is 8 years. Long-term complications of radiotherapy were seen in 19 patients on arm A, 11 on arm B, and 11 on arm C. Four patients who had received melphalan developed either a myelodysplastic syndrome or acute leukemia. Violations in covering the whole abdominal target volume were correlated with survival.

Topics: Chromium; Chromium Compounds; Clinical Trials as Topic; Combined Modality Therapy; Female; Humans; Melphalan; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis; Random Allocation

As part of a randomized trial evaluating several treatment programs in the management of poor prognosis, early stage ovarian cancer, 53 patients were randomized to receive a combination of pelvic external beam radiation, 4000 rad plus 10-20 millicuries of radioactive chromic phosphate given intraperitoneally. Only 35 patients (66%) actually received the chromic phosphate. The other 18 did not enter this phase of treatment for a variety of reasons documented in this report. Ten (29%) of the 35 patients receiving the full course of treatment had significant long term side effects with the median time to onset of symptom being 9 months after the chronic phosphate was given. There were no treatment-related deaths. The complications could not be related to the dose of the isotope, the technique of administration, nor any other definable predisposing factors. This combination is not recommended for further study.

Topics: Brachytherapy; Chromium; Chromium Compounds; Female; Humans; Melphalan; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes

Topics: Animals; Brachytherapy; Chromium Compounds; Glioma; Half-Life; Heterografts; Humans; Mice; Microscopy, Electron, Scanning; Phosphates; Phosphorus Radioisotopes; Polylactic Acid-Polyglycolic Acid Copolymer; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

Abstract Background: Radiotherapy is an important treatment for the patients with advanced pancreatic cancer. Emerging studies determined apurinic/apyrimidinic endonuclease 1/redox factor-1 (APE1/Ref-1) might associate with the resistance of human pancreatic cancer cells to radiotherapy.. To investigate whether downregulation of APE1/Ref-1 expression by ribonucleic acid interference would increase the sensitivity of chromic-P32 phosphate to pancreatic cancer cells.. The plasmids containing APE-specific and unspecific short hairpin were transfected into Patu-8898 cells. Stable cell clones were selected by G418. The mRNA expression of APE1/Ref-1 was detected by semiquantitative reverse transcription-polymerase chain reaction and the protein expression of APE1/Ref-1 was detected by Western blot analysis; cell proliferation was studied by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) and colony formation assay; apoptosis was detected by flow cytometry.. After 24 hours irradiation, APE1/Ref-1 mRNA and protein expression were upregulated, in a concentration-dependent manner. Suppression of APE1/Ref-1 by siRNA increased the pancreatic cancer cells hypersensitive to (32)P-CP. In the combination of (32)P-CP and siRNA group, MTT assay showed that the cell inhibition increased to (74.33%±9.02%), the surviving fraction in the colony formation assay was only 25.00%, and the apoptosis rate was up to (16.77%±0.98%).. Knockdown APE1/Ref-1 gene expression may significantly sensitize the Patu-8988 cells to radiotherapy, which may be a useful target for modifying radiation resistance of pancreatic cancer cells to irradiation.

Topics: Apoptosis; Blotting, Western; Cell Proliferation; Chromium Compounds; Colony-Forming Units Assay; DNA-(Apurinic or Apyrimidinic Site) Lyase; Flow Cytometry; Humans; In Vitro Techniques; Pancreatic Neoplasms; Phosphates; Phosphorus Radioisotopes; Radiation Tolerance; Real-Time Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; RNA, Small Interfering; Tumor Cells, Cultured

The aim of this study was to investigate the safety and toxicity of biodegradable (32)P-chromic phosphate-poly L lactic acid ((32)P-CP-PLLA) particles interstitially implanted into Beagle dog livers.. Eighteen healthy Beagle dogs were randomly divided into 6 groups (n=3), and were treated with drugs of different formulations or doses, as well as controls. At different time points after surgery, the experimental dogs were weighed. Detection of indicators of blood chemistry and liver fibrosis, SPECT bremsstrahlung imaging, computed tomography, histological examination, continuous blood measurement, and counting of urine and fecal radioactivity were performed for these dogs.. SPECT imaging showed that after implantation of radioactive particles into livers, radioactivity continuously accumulated in the implanted sites, while no radioactivity imaging was found in the nonimplantation sites. The mean absorbance doses in the implantation sites were 89.8-178.7 Gy. Local spherical lesions were observed in tissues. The average effective half-life time of (32)P-CP-PLLA was 11.8 days. Within 4 weeks after surgery, slight or moderate swelling and degradation of liver cells were detected, while in 8 weeks after surgery, they are normal. For the blood chemistry, liver fibrosis, and other indicators, no significant differences were found between the control groups and particle implantation groups (F=1.378, p=0.232).. (32)P-CP-PLLA particles have advantages including good targeting, immobile, being degradable in vivo, easy to be protected, and so on. It is suitable for treating solid tumors with blood supply. (32)P-CP-PLLA particles are a kind of safe, novel, radioactive implantation drug.

Topics: Animals; Chromium Compounds; Dogs; Drug Implants; Female; Half-Life; Lactic Acid; Liver; Male; Phosphates; Phosphorus Radioisotopes; Polyesters; Polymers; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

This study aims to develop a new agent, the ³²P-chromic phosphate-poly(l-lactide) (³²P-CP-PLLA) seed and to explore its anticancer effect against prostate cancer (Pca) with local lymphatic metastasis in nude mice. ³²P-CP-PLLA seeds of sustained release and nude mouse models of Pca with lymphatic metastasis were prepared. After 4 weeks, the tumor nude mouse models were randomly assigned into five groups. ³²P-CP-PLLA seeds (3.7, 7.4, 14.8, and 0 MBq) and ³²P-CP (14.8 MBq) were implanted in the tumor tissues of the nude mouse models. The following were discussed in this study: (1) the distributions of ³²P-CP-PLLA, (2) the pathological and morphological changes in the tumor and regional lymph nodes, and (3) the changes in white blood cell (WBC) and platelet counts in peripheral blood for toxic reactions. The homemade ³²P-CP-PLLA seed was a regular green cylinder, with an even distribution of mass and radioactivity. After implantation, single-photon emission computed tomograph (SPECT) showed that ³²P was mainly gathered in the tumor and regional lymph nodes. Morphological examinations revealed that necrosis and hemorrhage were around the tumor and focal lymph nodes. The tumor inhibition rates of the five groups were 70.16% ± 5.48%, 80.18% ± 5.84%, 84.97% ± 4.79%, (-), and 78.81% ± 3.13%, respectively. These values were all positive when compared with the control group. As a new homemade agent of pure β-ray, local implantation of the agent increased the focal retention of radioactivity at the target. Moreover, effective half-life showed an obvious damage to the tumor and metastatic foci of Pca.

Topics: Animals; Brachytherapy; Cell Line, Tumor; Chromium Compounds; Humans; Lactic Acid; Lymphatic Metastasis; Male; Mice; Mice, Inbred BALB C; Mice, Nude; Microscopy, Electron, Transmission; Phosphates; Phosphorus Radioisotopes; Polyesters; Polymers; Prostatic Neoplasms; Xenograft Model Antitumor Assays

The purpose of our study was to retrospectively examine the efficacy of intralesional injection of 32P chromic phosphate, a beta-emitting colloidal radiopharmaceutical, in the treatment of aneurysmal bone cysts of the axial skeleton. Five patients with large aneurysmal bone cysts were managed with injection of 32P chromic phosphate into their tumors under CT guidance. With only a single minor complication, all lesions were observed to ossify on follow-up CT, with an average follow up of 2 years.. CT-guided injection of axial aneurysmal bone cysts with 32P chromic phosphate leads to excellent local lesion control. In addition, the morbidity associated with this procedure is lower than that associated with surgical or other nonsurgical treatments.

Topics: Adolescent; Bone Cysts, Aneurysmal; Child; Chromium Compounds; Female; Humans; Injections, Intralesional; Male; Phosphates; Phosphorus Radioisotopes; Radiography, Interventional; Radiopharmaceuticals; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

The aim of this study was to observe the biological distribution and anticancer effect of (32)P-chromic phosphate colloid (Cr(32)PO(4), (32)P-CP) after intratumoral injection to Pc-3 human pancreatic carcinoma-bearing nude mice.. Eighty-four (84) BALB/c nude mice with transplanted tumor were allocated to 11 groups. Groups 1-5 (n = 6) were intratumorally injected with 14.8 MBq of (32)P-CP and sacrificed at 2, 24, 48, 72, and 168 hours, respectively. Groups 6-11 (n = 9) received injections of 3.7, 7.4, 14.8, 18.5, 29.6, and 0 MBq of (32)P-CP, respectively, and the tumor volume on body surface was measured daily. The animals (n = 6) were sacrificed at 14 days after administration. The dynamic distribution of radioactivity in body (percentage of injected dose per g), morphological changes, the tumor-inhibiting rate (TIR), proliferating index (PI), proliferating cell nuclear antigen (PCNA) tumor microvascular density (MVD), continuous counting of white blood cells (WBCs) and platelets (PLTs) in venous blood, body weight, and toxic reactions were observed.. The injected (32)P-CP mainly accumulated in the tumor mass and was retained for a long time. The TIR of each dosage group in order was 21.68%, 39.73%, 50.43%, 71.18%, and 74.09% (F = 159.74; p < 0.001), PI was 70.85, 67.90, 46.70, 20.66, 10.75, and 90.11 (F = 509.54; p < 0.001), and MVD count was 39.19, 28.33, 17.45, 8.89, 8.10, and 64.80 (F = 643.26; p < 0.001), respectively. The data for WBC, PLT, and body weight observed for 28 days in the treatment groups did not indicate significant differences compared with those of the control group.. Interstitial injection of (32)P-CP seems to be a safe and effective interventional nuclide therapy for pancreatic carcinoma-bearing nude mice.

Topics: Animals; Chromium Compounds; Humans; Injections, Intralesional; Mice; Mice, Inbred BALB C; Mice, Nude; Pancreatic Neoplasms; Phosphates; Phosphorus Radioisotopes; Tissue Distribution; Treatment Outcome; Tumor Cells, Cultured; Xenograft Model Antitumor Assays

The purpose of this study was to design and evaluate a 32P patch for brachytherapy of skin diseases. We employed Phosphoric-32P-acid and Chromic 32P-phosphate in combination with natural rubber or silicone to produce the patches. Stability studies in vitro to evaluate the leakage of radioactivity, autoradiographic studies to evaluate homogeneity and shielding, as well as therapeutic efficacy in an animal model of skin cancer of the selected 32P patch were performed. The 32P-silicone-patch demonstrated its safety for external application. Tumor growth was arrest and complete regressions of tumors were seen in some other cases with 40 Gy applied in a single-dose scheme. In conclusion, the 32P-silicone-patch is easy to prepare and use in the treatment of skin diseases.

Topics: Animals; Brachytherapy; Chromium Compounds; Drug Delivery Systems; Female; Histocytochemistry; Mice; Mice, Inbred SENCAR; Phosphates; Phosphoric Acids; Phosphorus Radioisotopes; Radiotherapy Planning, Computer-Assisted; Random Allocation; Rubber; Silicones; Skin Neoplasms

The principal medical consequence of haemophilia is the development of arthropathy, initiated by a haemarthrosis giving rise to chronic synovitis. Traditional methods of synovectomy include open excision and arthroscopy each of which require substantial amounts of clotting factor concentrate for several weeks, and in the case of open synovectomy, is often associated with loss of range of motion and arthrofibrosis. Radiosynovectomy, the intra-articular injection of low penetration radiocolloids, has been utilized outside the United States for over 20 years. Since 1988, our centre has performed 170 radiosynovectomies utilizing 32P chromic phosphate (32P). This study reports results of 130 32P radiosyovectomies with an average follow-up of 36.5 months (6-140 months). For primary procedures, excellent and good results (haemarthrosis reduction from 75 to 100%) were obtained in 79.2% of cases at 6 months to 8 years. For repeat procedures a combination of excellent and good results were obtained in 62.4% of cases at 6 months to 3 years. Regression analysis showed no correlation between results and age or degree of arthropathy. Radiation was well contained within the joint. There were no observed or identified complications. The procedure is highly cost effective in comparison to open surgical or arthroscopic synovectomy.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Chromium Compounds; Chronic Disease; Combined Modality Therapy; Follow-Up Studies; Hemarthrosis; Hemophilia A; Hemorrhage; Humans; Injections, Intra-Articular; Middle Aged; Phosphates; Phosphorus Radioisotopes; Retrospective Studies; Risk Assessment; Synovectomy; Synovitis; Treatment Outcome

We report the nonoperative treatment of a recurrent, multilevel spinal aneurysmal bone cyst by injection of 32P chromic phosphate colloid into the cyst. The patient was then followed up with serial CT examinations, which showed stabilization and progressive ossification within the lesion. The rationale, alternatives, and possible contraindications to radionuclide ablation of spinal aneurysmal bone cysts are discussed.

Topics: Adolescent; Bone Cysts, Aneurysmal; Chromium Compounds; Female; Humans; Injections; Magnetic Resonance Imaging; Phosphates; Phosphorus Radioisotopes; Radiopharmaceuticals; Spinal Diseases; Tomography, X-Ray Computed

A patient with postoperative Stage I ovarian carcinoma received 15 mCi of 32P-chromic phosphate suspension in normal saline intraperitoneally as part of her therapy. The following day, a portion of the infused radiopharmaceutical and normal saline had passed transdiaphragmatically into the patient's right pleural cavity. Thoracentesis removed as much fluid as possible and this fluid contained radioactive material. In the ensuing 4 yr, the patient has not manifested any detectable pleural or pulmonary abnormalities attributable to the radioactivity. Retrospective review of 100 consecutive patients receiving 32P-chromic phosphate intraperitoneal therapy resulted in 43 patients in whom the hemithoraces could be evaluated scintigraphically. Three of the 43 patients (7%) had right pleural fluid radioactivity. This is similar to the percentages reported in patients with cirrhosis with ascites in whom hepatic hydrothorax is identified.

Topics: Chromium Compounds; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Infusions, Parenteral; Middle Aged; Ovarian Neoplasms; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Pleura; Pleural Effusion; Technetium Tc 99m Sulfur Colloid; Time Factors; Tissue Distribution

Trends in CA-125 levels after completion of therapy in ovarian cancer patients who received intraperitoneal radioactive chromic phosphate therapy (32P) after primary surgical resection or second-look surgery were evaluated. Ninety patients who underwent surgical exploration and 32P were reviewed. Twenty-nine patients were excluded due to insufficient number of CA-125 levels or recurrence within 12 months, with 61 patients with serial CA-125 levels and no evidence of disease for 12 months available for analysis. 32P followed initial resection in 24 patients (16 Stage I, 3 Stage II, 5 Stage III). 32P followed chemotherapy and second-look procedures in 37 patients (4 Stage I, 3 Stage II, 27 Stage III, 3 Stage IV). Elevated CA-125 levels were present in 25 (41%) patients within 12 months of 32P (46% after primary exploration, 38% after second-look). The degree of CA-125 elevation (U/ml) was 30-100 (23%), 100-200 (11%), and >200 (7%). Of the 25 patients with an elevated CA-125, the elevation persisted more than 4 months in 11 (44%). All but two patients had normal CA-125 levels by 12 months. An abnormal elevation in CA-125 was seen in 33% of patients 4 months after receiving 32P and abdominal surgery, with values ranging as high as 500 U/ml. Although elevations in CA-125 are reported following surgery alone, the duration of elevation appears to be longer with 32P. Therefore, persistent elevations of CA-125 following 32P between 4 and 12 months should be judged with caution as they may not reflect recurrent disease.

Topics: CA-125 Antigen; Chromium Compounds; Female; Humans; Injections, Intraperitoneal; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Postoperative Period; Reoperation; Retrospective Studies

In order to evaluate the effectiveness of an intratumorally single dose of chromic [32P] phosphate for the treatment of solid tumors, studies of bioelimination, biodistribution, and therapeutic action were carried out. Only for comparative purposes were similar studies undertaken using a solution of sodium [32P] orthophosphate-gelatin. Results show that when sodium [32P] orthophosphate-gelatin was intratumorally injected, the percentage of total elimination, after 32 days of treatment, was equal to 85.90 +/- 8.70%, with a higher percentage in urine (64.50 +/- 13.70%) than in feces (21.40 +/- 4.50%). In biodistribution studies, the greater percentage was found in bone (15.54 +/- 2.21%), whereas only 2.51 +/- 0.39% remained in the tumor. When chromic [32P] phosphate was intratumorally injected, we found that the total elimination was equal to 51.70 +/- 6.90%, with a higher amount in feces (32.70 +/- 4.80%) than in urine (19.00 +/- 3.60%). Biodistribution studies demonstrated that 28.93 +/- 1.30% was still in the tumor and 19.01 +/- 1.30% of the injected activity was found in the liver. On the other hand, when therapeutic action was evaluated, no tumoral regression was observed. These results demonstrate that the colloid of chromic [32P] phosphate cannot be used in the treatment of solid tumors as it mobilizes from the injection point, delivering a high dose to the entire organism.

Topics: Adenocarcinoma; Animals; Chromium Compounds; Colloids; Female; Mammary Neoplasms, Experimental; Metabolic Clearance Rate; Phosphates; Phosphorus Radioisotopes; Rats; Rats, Sprague-Dawley; Tissue Distribution

Topics: Carcinogens; Chromium Compounds; Colloids; Humans; Injections, Intra-Articular; Phosphates; Phosphorus Radioisotopes

For many years, 32P-chromic phosphate (32P-CP) intraperitoneal instillations and platinum analogue chemotherapy have been used to treat disseminated ovarian cancer. To investigate possible enhancement of 32P-CP irradiation due to the concomitant administration of chemotherapy, in vitro studies were undertaken. Based on those laboratory investigations, a clinical regimen of combined 32P-CP and platinum analogue chemotherapy was developed.. In vitro enhancement of 32P-CP cytotoxicity by cisplatin was studied in cultured human ovarian adenocarcinoma (CHOA) cell lines and in a fibroblast cell strain. In addition, ovarian cancer cells obtained from the malignant abdominal ascites and pleural effusions of 10 individual patients were also studied ex vivo. As part of routine clinical care, 30 patients with disseminated ovarian adenocarcinoma underwent up to eight monthly cycles of platinum analogue chemotherapy with concomitant intraperitoneal instillation of 5 mCi of 32P-CP at each monthly chemotherapy cycle.. There was an enhanced and possibly supra-additive effect of cisplatin on the cytotoxicity from 32P-CP irradiation. For the 30 patients, the survival rate at 3 yr was 63%.. Phosphorus-32 CP low-dose intraperitoneal treatments in conjunction with platinum analogue chemotherapy is a promising approach for the treatment of disseminated intraperitoneal ovarian cancer.

Topics: Adenocarcinoma; Cell Survival; Chromium Compounds; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Female; Humans; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Radiotherapy Dosage; Survival Rate; Tumor Cells, Cultured

Topics: Chromium Compounds; Drug Labeling; Humans; Medication Errors; Phosphates; Phosphorus Radioisotopes; Suspensions

Women diagnosed with early stage ovarian cancer may be considered for adjuvant therapy. Intraperitoneal chromic phosphate (P-32) is commonly used in these patients with few complications. A woman found to have early stage ovarian cancer was given intraperitoneal P-32 in the presence of a lingering pelvic infection, which is usually not mentioned as a contraindication to its use. Radiation damage to the small bowel and cecum developed as did damage to the ureter and bladder, which then required surgery.

Topics: Adult; Chromium Compounds; Contraindications; Cystadenoma, Mucinous; Female; Humans; Hysterectomy; Instillation, Drug; Ovarian Neoplasms; Pelvic Inflammatory Disease; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Radiation Injuries; Radiotherapy, Adjuvant

Bremsstrahlung SPECT imaging and activity quantitation have been performed using 32P-chromic phosphate.. Attenuation correction was applied to the reconstructed transverse SPECT slices using a commercially available first-order postprocessing algorithm. The patient's body contour was defined through the use of four externally placed sources and attenuation correction was then performed with an experimentally determined effective linear attenuation coefficient for 32P. Phantom studies were performed to determine the activity needed in the four external sources and also to validate absolute activity analysis on the reconstructed SPECT slices. A computer algorithm was written to facilitate ROI activity determination based on a fixed threshold method. Four cancer patients enrolled in clinical Phase I protocols were injected with 2.5 million particles of macro-aggregated albumin followed by colloidal 32P-chromic phosphate by direct interstitial injection into the tumor-bearing region under CT guidance. The in vivo 32P activity distribution was restricted to a small volume with minimal background activity. SPECT images were obtained in these patients and the activity of 32P present in the tumors was calculated from their attenuation-corrected reconstructed SPECT slices.. The effective linear attenuation coefficient for 32P was determined to be 0.13 cm-1. A fixed 39% threshold was best for activity calculation since it provided the best correlation between known and measured activity levels in the phantom. The calculated activities were within 16.9% of the actual activities in the patients studied.. Accurate quantitative bremsstrahlung SPECT imaging with a commercially available postprocessing attenuation correction algorithm can be performed in a clinical setting.

Topics: Chromium Compounds; Humans; Models, Structural; Neoplasms; Phosphates; Phosphorus Radioisotopes; Tomography, Emission-Computed, Single-Photon

Between 1977 and 1992, we performed ninety-two synoviortheses (destruction of synovial tissue by intra-articular injection of a radioactive agent) on forty-eight patients who had a severe congenital disorder of hemostasis and chronic hemophilic synovitis that was resistant to conventional treatment. Colloidal 32P chromic phosphate was injected intra-articularly: 1.0 millicurie for knees and 0.5 millicurie for other joints. The duration of follow-up ranged from one to fifteen years. The frequency and importance of bleeding decreased in most of the patients. The range of motion of half of the joints remained stable or improved and that of the other half continued to decrease. Radiographic scores worsened progressively despite the decreased frequency of hemarthrosis. In most patients, the extra-articular leakage of the radioactive agent was slight. Chromosome breakages were observed almost exclusively in patients who were seropositive for human immunodeficiency virus and in whom the CD4-lymphocyte count was decreased from normal. The patients' level of satisfaction with the results was high.

Topics: Adolescent; Adult; Child; Chromium Compounds; Chromosomes, Human; Colloids; Hemarthrosis; Humans; Injections, Intra-Articular; Joints; Male; Phosphates; Phosphorus Radioisotopes; Prospective Studies; Range of Motion, Articular; Synovial Membrane

Intraperitoneal (IP) radioactive chromic phosphate (P32) remains investigational in the treatment of patients with ovarian and/or endometrial cancer. Single-use percutaneously placed catheters offer the advantage of therapy without additional surgery.. Between August, 1986 and October, 1992, 25 patients underwent bedside percutaneous catheter placement under local anesthesia without ultrasonographic or radiologic guidance, using a specialized central venous catheter.. Catheter insertion was successful in 22 of 25 patients (88%) with good IP distribution. Of these, 18 of 22 patients (82%) underwent successful catheter placement with one attempt and 4 of 22 (18%) after one to three additional attempts. The technical failure rate was 12%. Multiple catheter placement attempts were associated with an increased incidence of complications (r = 0.63). Bowel entry occurred in 4 of 25 patients (16%) during 5 of 43 attempts at catheter placement (12%) but was without clinical sequelae. The likelihood of bowel entry significantly increased with more than two attempts (P = 0.02). A median of 39 days (range, 7-156 days) elapsed between the preceding laparotomy and catheter insertion.. Percutaneous catheter placement is successful and well tolerated in the majority of patients and should be considered for patients receiving IP P32.

Topics: Adult; Aged; Catheterization; Catheterization, Central Venous; Chromium Compounds; Disposable Equipment; Endometrial Neoplasms; Female; Humans; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Retrospective Studies

To evaluate the clinical usefulness of phosphorus-32 chromic phosphate synoviorthesis in patients with hemophilia, recurrent hemarthrosis, and synovitis.. Forty-four P-32 colloid synoviorthesis procedures were performed in 38 patients with these abnormalities. P-32 colloid was injected intramuscularly in a dose of 1.0 mCi (37.0 MBq) in adult knees and 0.5 mCi (18.5 MBq) in adult elbows. A thin-window Geiger-Müller counter was used to survey treated joints, lymph nodes, and liver in order to detect leakage from the joint. Follow-up extended to a maximum of 4 years after treatment.. No evidence of clinically significant leakage was seen. Twenty-two of 28 treatments (78%) with longer than 6 months follow-up were associated with improvement in range of motion and frequency of hemorrhage. Of 15 treatments with longer than 2 years follow-up, 10 (67%) were associated with improvement in range of motion; 12 (80%), with improvement in frequency of hemorrhage; and 12 (80%) with improvement in quality-of-life activities.. P-32 colloid synoviorthesis is a clinically useful out-patient procedure in patients with hemophilia, recurrent hemarthrosis, and synovitis in whom hemostatic therapy has failed.

Topics: Adolescent; Adult; Child; Chromium Compounds; Colloids; Follow-Up Studies; Hemarthrosis; Hemophilia A; Humans; Injections, Intra-Articular; Middle Aged; Phosphates; Phosphorus Radioisotopes; Recurrence; Synovial Membrane; Synovitis

To suppress cyst formation in 42 brain tumors, 32P has been stereotactically instilled in doses calculated to deliver 20,000-40,000 rad to the cyst wall, assuming uniform dispersal of the radioisotope. However, samples of cyst fluid obtained at varying intervals after injection showed lower than expected activity levels, suggesting early 'plating' of 32P. To accommodate this phenomenon, a surface-area-dependent dosimetric calculation is compared with a volume-dependent calculation which assumes uniform dispersal. These two approaches represent lower and upper extremes. It appears that in small cysts there is less difference in the required administered dose, but in larger cysts potentially very large differences exist and caution should be exercised if uniform suspension is assumed.

Topics: Brain Neoplasms; Chromium; Chromium Compounds; Colloids; Cysts; Glioma; Humans; Phosphates; Phosphorus Radioisotopes; Radiosurgery; Stereotaxic Techniques

Forty-nine women with apparent Stage I and II ovarian carcinoma received intraperitoneal phosphate 32 as the only adjuvant therapy after primary surgery. In addition to bilateral salpingo-oophorectomy, 40 (82%) had analysis of peritoneal cytology, and 35 (71%) underwent omentectomy. Random peritoneal biopsies and retroperitoneal lymph node sampling were not done in any of these patients. The overall and disease-free survival rates were 86% and 75%, respectively, with no significant differences by stage, histologic grade, histologic type, or low-risk versus high-risk subsets recognized in patients who received comprehensive surgical staging. Seven (58%) of 12 patients had lymph node metastasis as the first site of recurrence, including two of three with late recurrences. Significant morbidity related to intraperitoneal chromic phosphate (32P) occurred in one (2%) woman. These results emphasize the need for comprehensive surgical staging of women with apparent early ovarian carcinoma to aid in the selection of appropriate initial adjuvant therapy.

Topics: Chromium; Chromium Compounds; Combined Modality Therapy; Female; Humans; Infusions, Parenteral; Neoplasm Staging; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Retrospective Studies; Survival Analysis

A 68-yr-old male with agnogenic myeloid metaplasia was given phosphorus-32-colloidal chromic phosphate intrapericardially for the treatment of malignant pericardial effusion. Technetium-99m-sulfur colloid was used to verify catheter placement and to visualize distribution within the pericardium. Estimated dosimetry for this mode of therapy is presented, and it is suggested that pericardial administration of phosphorus-32-colloidal chromic phosphate is the treatment of choice for malignant pericardial effusion.

Topics: Aged; Chromium; Chromium Compounds; Colloids; Humans; Male; Pericardial Effusion; Phosphates; Phosphorus Radioisotopes; Primary Myelofibrosis

Treatment of P388 leukemia cells with poly-DL-lysine (Poly-lys) considerably increases the binding of colloidal chromic phosphate (32P). This augmentation of the number of particles that are bound is in direct relationship with Poly-lys concentration, and very significantly with its degree of polymerization. Treatment with Poly-lys molecular weight 77,000 shows a 100% increase of binding with 200 micrograms and of 50% with 100 micrograms. Poly-lys M.W. 8,000 presents no significant increase, and for the other molecular weights the binding is intermediate.

Topics: Adsorption; Animals; Chromium; Chromium Compounds; Colloids; Leukemia P388; Leukemia, Experimental; Mice; Mice, Inbred Strains; Phosphates; Phosphorus Radioisotopes; Polylysine

Between March 1977 and December 1985, 59 patients were treated with intraperitoneal chromic phosphate at The University of Alabama Birmingham Hospitals and its affiliates. Twenty-seven patients received primary adjuvant therapy. Thirty-two patients were treated "secondarily" after tumor recurrence or after a "positive" second-look laparotomy. Associated morbidity was noted to be 12% with reoperation required in 7%. Early stage and grade tumors demonstrate a good prognosis. Little, if any, benefit was demonstrated in "secondary" therapy of advanced stage and grade tumors.

Topics: Chromium; Chromium Compounds; Female; Humans; Instillation, Drug; Neoplasm Recurrence, Local; Ovarian Neoplasms; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes

From 1975 to 1982, 25 evaluable patients with FIGO Stage I ovarian cancer were treated with intraperitoneal chromic phosphate (32P). All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy with (28%) or without (72%) omentectomy, with no other surgical staging procedures prior to referral. Patients were restaged by laparoscopy (inspection of diaphragms, abdomen, and pelvis), biopsy of suspicious lesions, and peritoneal cytologic washings prior to intraperitoneal chromic phosphate therapy. For the 25 patients, the estimated 5- and 10-year recurrence-free rates and the 5- and 10-year survival rates are 84% and 75%, respectively. Excellent 10-year recurrence-free rates were achieved for Stages IA and IC, nonruptured cysts, and Grade I and II tumors. In contrast, very low 10-year survival rates were achieved for patients with Stage IB, ruptured cysts, or Grade III tumors.

Topics: Adenocarcinoma; Adult; Aged; Chromium; Chromium Compounds; Female; Humans; Injections, Intraperitoneal; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prospective Studies; Time Factors

Between 1978 and 1986, 243 patients (all stages) had peritoneal fluid cytology performed while undergoing total abdominal hysterectomy for endometrial carcinoma; 39 (16%) were found to be positive. At 3 years (median follow-up of 30 months) the disease-free survival (DFS) for the 165 negative cytology clinical Stage I patients was 91% compared to only 56% for the 25 positive cytology patients (p less than .001). Of the 25 Stage I positive cytology patients, 14 with greater than one-third myometrial invasion had a DFS of 30% at 3 years as compared to 87% for negative cytology patients with comparable depth of invasion (p less than .001). There was no difference in DFS between the negative and positive cytology Stage I patients who had one-third or less myometrial invasion. Stage I patients with histologic Grade 2 and 3 had a lower 3 year DFS when cytology positive, 49% and 22%, versus 92% and 79% when cytology negative (p less than .001 and p = .03 respectively). In clinical Stage II patients the 3-year DFS was 21% for those with a positive cytology and 59% with a negative cytology. Fourteen of the 25 clinical Stage I positive cytology patients received 15 mCi of intraperitoneal 32P. At 3 years they had a 68% DFS as compared to 27% for those not receiving 32P (p = 0.01). All 11 patients with superficial myometrial invasion (9 received 32P) remained disease-free. The 4 Stage I patients with deep invasion who received 32P therapy had an improvement in abdominal/pelvic control and DFS when compared to 9 similar patients who did not receive 32P (p = .02). For histologic Grade 2 and 3 patients, there was a 64% 3-year DFS in the 32P treated group and 16% for those not receiving 32P (p = 0.02). Although 32P therapy improved DFS in Stage I positive cytology patients its use along with pelvic radiation therapy can lead to complications. Of 9 Stage I patients receiving 32P as well as pelvic irradiation, 4 experienced serious bowel complications requiring surgery. None of the 5 patients receiving 32P only had a complication.

Topics: Ascitic Fluid; Chromium; Chromium Compounds; Combined Modality Therapy; Female; Humans; Hysterectomy; Injections, Intraperitoneal; Phosphates; Phosphorus Radioisotopes; Prognosis; Uterine Neoplasms

Between 1973 and 1985, 118 patients in clinical remission after initial surgery and postoperative chemotherapy for epithelial ovarian carcinoma underwent second-look laparotomy at the University of North Carolina. No evidence of disease (NED) was found in 57 of these patients; 43 patients received 15 mCi of radioactive chromic phosphate (32P) suspension given intraperitoneally in the immediate postoperative period. In 29 other patients, only microscopic or minimal residual disease (nodules less than 2 cm in size) was found, seven received 32P alone, ten received 32P and further chemotherapy, and 12 received chemotherapy alone. The 4-year postsecond-look survival of the patients with NED at second-look was 89% for those receiving 32P and 67% for those who had not. The respective figures for patients with minimal residual disease at second-look are 59% versus 22%. Irrespective of treatment, a group at high risk for failure after negative second-look laparotomy has been identified; those with an initial International Federation of Gynecology and Obstetrics (FIGO) stage greater than I and histologic grade greater than 1. A comparison of our data with 18 previously published series, indicates that use of postsecond-look intraperitoneal 32P can improve the progression-free interval, and possibly overall survival, of patients with NED or minimal residual disease without adding significant complications.

Topics: Carcinoma; Chromium; Chromium Compounds; Female; Humans; Infusions, Parenteral; Laparotomy; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis; Reoperation

Radioisotopes have been employed in the therapy of chronic arthritis, in particular, rheumatoid arthritis for many years. A variety of isotopes have been popularized, and in the last ten years a colloidal solution of radioactive chromic phosphate 32P has been in use apparently with equivalent efficacy to others such as 169erbium, 90yttrium, and 165dysprosium. No controlled studies on this modality have been reported and few animal studies were found. The efficacy of therapeutic doses of 32P as a medical synovectomy and its effect on rabbit joints with antigen-induced arthritis were observed in 62 arthritic knee joints in 31 adult rabbits treated on one side with 0.1 microCi of 32P, the opposite serving as control. The animals were observed over a period of 11 months and examined by histologic and biochemical means. The synovium showed no evidence of radiation necrosis in treated joints. Cartilage of treated and control joints showed similar changes consistent with chronic arthritis, persistent synovitis, progressive chondrocyte degeneration, and decreased matrix metachromasia. The radiosynovectomy had neither removed synovium nor protected the cartilage. Its efficacy in humans is therefore questionable.

Topics: Animals; Arthritis; Arthritis, Experimental; Autoradiography; Cartilage, Articular; Chromium; Chromium Compounds; Colloids; Evaluation Studies as Topic; Knee Joint; Methods; Phosphates; Phosphorus Radioisotopes; Rabbits; Radiation Injuries, Experimental; Synovial Membrane; Time Factors

The use of intraperitoneal radioisotopes in the management of women with ovarian cancer is controversial. We analyzed the experience with intraperitoneal chromic phosphate P 32 at our institution, from October 1979 to February 1983, in 22 patients with various stages and grades of ovarian malignancy. Survival in stage I is 87.5% and in stage II, 50%. Survival is 88.9% among patients with grade 1 tumors and 33.3% for those with grade 3 lesions. Morbidity related to chromic phosphate P 32 was minimal; small bowel obstruction occurred in only one patient who had also received external pelvic irradiation. Our results suggest that chromic phosphate P 32 is a safe, well tolerated, inexpensive, and effective adjuvant to surgery in the management of selected patients with ovarian malignancy.

Topics: Adenocarcinoma; Brachytherapy; Chromium; Chromium Compounds; Cystadenocarcinoma; Endometriosis; Female; Humans; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes

From 1977 through 1984, 23 patients with persistent epithelial carcinomas of the ovary received intraperitoneal instillation with chromic phosphate P 32 suspension as salvage therapy after second- or third-look laparotomy. Patients received a median 10 cycles of chemotherapy before chromic phosphate P 32. Disease consisted of microscopic residual only in 10 patients (43%), macroscopic residual that was completely resected in eight (35%), and macroscopic residual disease in which the largest diameter was less than 0.5 cm in five patients (22%). Ten patients are free of disease at 13 to 94 months after chromic phosphate P 32 salvage therapy. Life table survival is 75% at 2 years and 57% at 4 years, with a disease-free survival rate of 54% at 2 years and 27% at 4 years. Patients with no gross residual disease had median disease-free survival of 27 months versus 9 months for patients with macroscopic residual disease (p greater than 0.1). Only three patients (13%) developed surgical bowel complications related to chromic phosphate P 32. Compared with previous studies, intraperitoneal chromic phosphate P 32 as salvage therapy for patients with minimal residual ovarian carcinoma defined at secondary surgical evaluation results in comparable survival and fewer complications than does salvage abdominopelvic irradiation and should be considered as an option to further chemotherapy in selected patients.

Topics: Actuarial Analysis; Antineoplastic Combined Chemotherapy Protocols; Brachytherapy; Carcinoma, Papillary; Chromium; Chromium Compounds; Combined Modality Therapy; Female; Humans; Neoplasm Staging; Ovarian Neoplasms; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Reoperation

Twenty-eight patients with ovarian carcinoma received 555 MBq of labeled chromic phosphate (P-32) intraperitoneally. Indications for treatment included a high-grade tumor, extracapsular involvement, positive cytologic findings, or residual tumor. Fifteen patients (group 1) had stage I, II, or III completely resected tumor; 13 patients (group 2) had microscopic or less than 3-mm lesions at second-look laparotomy following combination chemotherapy. A major complication occurred in one patient; two patients had minor complications. Overall, 24 of 28 patients (85.7%) were alive at 11-77 months; 23 (82.1%) had no evidence of tumor. Fifteen of 15 (100%) group 1 patients and eight of 13 (61.5%) group 2 patients did not have tumor relapse after 30 months and 28 1/2 months, respectively. P-32 was found to be an effective adjuvant treatment in a select group of patients with ovarian carcinoma who were at high risk for intraabdominal recurrence.

Topics: Brachytherapy; Carcinoma; Chromium; Chromium Compounds; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Posture; Radiotherapy Dosage

Single photon emission computed tomography (SPECT) has been shown to be of value in estimating the radiation dose to the peritoneum from 32P therapy. Simple dosimetry calculations, assuming uniform irradiation of tissue, indicate that radiation doses of approximately 40 Gy to the peritoneal surface are achieved. However, the images show that the radionuclide distribution is non-uniform, giving rise to radiation dose variations of at least a factor of 10.

Topics: Chromium; Chromium Compounds; Female; Humans; Ovarian Neoplasms; Peritoneal Neoplasms; Peritoneum; Phosphates; Phosphorus Radioisotopes; Radiation Dosage; Tomography, Emission-Computed

Ten patients with intracranial cystic tumors underwent stereotactic intracavitary irradiation using 32P colloidal chromic phosphate. Accurate dosimetry (25,000-30,000 rad to the cast wall) was achieved by volume estimation using computed tomography. Between 1 and 15 months after surgery both craniopharyngioma and astrocytoma cysts regressed. Neurological, visual, and endocrinological deficits either stabilized or improved. Intracavitary irradiation should be the primary method of treating solitary cystic tumors of the brain.

Topics: Adolescent; Adult; Aged; Astrocytoma; Brain Neoplasms; Cerebral Ventricle Neoplasms; Child; Child, Preschool; Chromium; Chromium Compounds; Colloids; Craniopharyngioma; Cysts; Female; Humans; Male; Middle Aged; Phosphates; Phosphorus Radioisotopes; Pituitary Neoplasms; Stereotaxic Techniques

Malignant peritoneal cytology in patients with endometrial carcinoma is a poor prognostic feature, identifying patients at high risk for early intra-abdominal recurrence. Between 1977 and January, 1983, 65 women with endometrial carcinoma who had malignant peritoneal cytology were treated with adjuvant intraperitoneal radioactive chromic phosphate P 32 suspension. Fifty-three patients (80%) were clinical Stage I, nine (14%) were Stage II, and three (7%) were clinical Stage III. Life-table estimates of disease-free survival were 89% for clinical Stage I patients and 94% for surgical Stage I patients beyond 24 months. One patient developed an intraperitoneal recurrence, four had simultaneous intraperitoneal and extraperitoneal recurrences, and six developed recurrences outside of the peritoneal cavity. Few significant acute complications occurred after therapy with radioactive chromic phosphate P 32 suspension. Chronic intestinal morbidity that required surgical correction was encountered in five of 17 patients (29%) who received adjuvant pelvic radiation, compared to none of the 48 patients (0%) who received only radioactive chromic phosphate P 32 suspension (p less than 0.001). Intraperitoneal instillation of radioactive chromic phosphate P 32 suspension is effective therapy for patients with malignant peritoneal cytology from endometrial carcinoma. Caution should be exercised when radioactive chromic phosphate P 32 suspension and external radiation therapy are combined.

Topics: Adenocarcinoma; Brachytherapy; Catheters, Indwelling; Chromium; Chromium Compounds; Female; Follow-Up Studies; Humans; Hysterectomy; Injections, Intraperitoneal; Neoplasm Recurrence, Local; Neoplasm Staging; Peritoneal Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis; Uterine Neoplasms

Thirty-one synoviortheses were performed in 22 joints of 14 hemophilic patients (aged 12 to 28 years) with chronic synovitis and for whom "conventional treatments" were considered ineffective. Except for patients with inhibitors, conventional treatments included three to six months of adequate prophylactic therapy with the missing coagulation factors, intensive physiotherapy and, when indicated, antiinflammatory agents and orthosis. Colloidal 32P chromic phosphate was injected intraarticularly in doses of 1.0 mCi for knees and of 0.5 mCi for the other joints. Time of follow-up ranged from two to five years. Frequency and importance of bleeding decreased in all patients. Effect on range of motion was best in knees; six of the seven treated improved and one was unchanged. In elbows, flexion-extension was improved in four cases, unchanged in five and decreased in one; pronation-supination was decreased in four cases. Range of motion was not affected in shoulders and ankles except for internal-external rotation which was improved in two of three shoulders treated. The results of 13 synoviortheses in four hemophilic patients with high titer factor VIII inhibitors were comparable to those in hemophiliacs with no inhibitors. However, in three of the four patients synoviorthesis had to be repeated after two to four years for recurrence of synovitis. Extraarticular escape of radioactivity was monitored 62 times for 17 synoviortheses in 12 patients; extraarticular counts never exceeded 4% of the intraarticular counts. Chromosome aberrations were found not to be increased after treatment in the seven patients in whom adequate analysis could be done.

Topics: Adolescent; Adult; Child; Chromium; Chromium Compounds; Colloids; Elbow Joint; Follow-Up Studies; Hemarthrosis; Hemophilia A; Humans; Injections, Intra-Articular; Knee Joint; Phosphates; Phosphorus Radioisotopes; Radiation Monitoring; Synovitis

Radionuclide peritoneoscintigraphy has been used prior to chromic phosphate P-32 (P-32CP) intraperitoneal therapy to assure proper placement of the catheter in the peritoneal cavity, to exclude loculation, and to predict inadequate distribution of P-32CP. This is a case report of the detection of a peritoneal catheter improperly placed into the bowel lumen by pretherapy radionuclide peritoneoscintigraphy, and this case demonstrates the distinguishing characteristics of the radiocolloid distribution secondary to an intraluminal injection relative to an intraperitoneal injection.

Topics: Adenocarcinoma; Brachytherapy; Catheterization; Chromium; Chromium Compounds; Colonic Neoplasms; Female; Humans; Middle Aged; Peritoneal Cavity; Peritoneal Neoplasms; Phosphates; Phosphorus Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Systemic distribution of radioactive colloidal chromic phosphate P 32 after intraperitoneal instillation was studied in 10 patients with ovarian or endometrial malignancies. Seven patients without ascites received chromic phosphate P 32 for positive peritoneal washings, rupture of the capsule of the cyst during operation, or minimal Stage III disease. Three patients received chromic phosphate P 32 for recurrent ascites after multiple abdominal paracenteses. Blood and urine radioactivity measurements were performed at selected intervals. There was a clear statistically significant difference (p less than 0.01) between chromic phosphate P 32 activity levels in whole blood, red blood cells, and plasma in patients with and without ascites.

Topics: Adult; Aged; Ascites; Brachytherapy; Chromium; Chromium Compounds; Female; Humans; Kinetics; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Uterine Neoplasms

Topics: Breast Feeding; Chromium; Chromium Compounds; Cystadenocarcinoma; Female; Humans; Infant, Newborn; Milk, Human; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Radiation Dosage

Topics: Adult; Aged; Antineoplastic Agents; Chromium; Chromium Compounds; Combined Modality Therapy; Female; Humans; Injections, Intraperitoneal; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis

Topics: Adult; Breast Feeding; Chromium; Chromium Compounds; Cystadenocarcinoma; Female; Humans; Infant, Newborn; Injections, Intraperitoneal; Milk, Human; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Pregnancy; Pregnancy Complications, Neoplastic

Topics: Bronchial Fistula; Chromium; Chromium Compounds; Fistula; Humans; Male; Middle Aged; Phosphates; Phosphorus Radioisotopes; Pleural Diseases; Pleural Effusion; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The authors report the results of internal irradiation with labeled chromic phosphate (32P) and gold-198 (198Au) colloid in eight cases of cystic craniopharyngiomas. They used a newly developed dosimetric formula, by which the radiation dose at the cyst wall and at any point far from the radioactive source can be calculated. Ten courses of irradiation in eight patients were carried out by injection of either 32P or 198Au colloid into the cyst through an Ommaya drainage system that had been placed at craniotomy. Follow-up studies ranging from 13 to 156 months revealed that all cysts were effectively treated, with elimination of fluid or collapse of the cyst. This was confirmed by Conray cystography and/or computerized tomography. Not only the dose delivered to the wall but also the thickness of the cyst wall and the location of the cyst are important factors in planning internal irradiation. A safe and adequate dose to the cyst wall could range between 9000 to 30,000 rads for craniopharyngioma. This treatment is suitable for large cysts that are thought to be difficult to remove radically, recurrent cysts resistant to previous treatment, or multiple cysts. Internal irradiation may also be applicable in other cystic intracranial tumors if dosimetry is calculated accurately.

Topics: Adolescent; Adult; Child, Preschool; Chromium; Chromium Compounds; Craniopharyngioma; Female; Follow-Up Studies; Gold Colloid, Radioactive; Humans; Male; Methods; Middle Aged; Phosphates; Phosphorus Radioisotopes; Pituitary Neoplasms; Radiotherapy Dosage; Tomography, X-Ray Computed

An investigation of the efficacy of astatine-211--tellurium colloid for the treatment of experimental malignant ascites in mice reveals that this alpha-emitting radiocolloid can be curative without causing undue toxicity to normal tissue. By comparison, negatron-emitting phosphorus-32 as colloidal chromic phosphate had no antineoplastic activity. The most compelling explanation for this striking difference is the dense ionization and short range of action associated with alpha-emission. These results have important implications for the development and use of alpha-emitters as radiocolloid therapy for the treatment of human tumors.

Topics: Alpha Particles; Animals; Ascites; Astatine; Cell Survival; Chromium; Chromium Compounds; Colloids; Female; Mice; Neoplasm Transplantation; Neoplasms, Experimental; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Radioisotopes; Tellurium; Transplantation, Homologous

Increasing the injection volume had no significant long-term effect on the distribution or tissue dose of intraperitoneal 32P in New Zealand white rabbits. Further, the range of doses and dose rates observed in the rabbit had little effect in vitro against either a human ovarian cancer line or an established Chinese hamster cell line. Demonstrable kill of human ovarian cancer cells was achieved, however, for initial 32P dose rates of 11 and 22 rad/h (0.11 and 0.22 Gy/h). From these results, it is estimated that administered 32P activities ranging from about 75-150 mCi (2.8-5.6 GBq) would be required for significant tumoricidal effects in ovarian cancer patients.

Topics: Animals; Autoradiography; Carcinoma; Cell Line; Chromium; Chromium Compounds; Cricetinae; Diaphragm; Dose-Response Relationship, Radiation; Female; Injections, Intraperitoneal; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Radiotherapy Dosage; Rats

Topics: Absorption; Animals; Autoradiography; Chromium; Chromium Compounds; Dogs; Female; Humans; Infusions, Parenteral; Kinetics; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Radiometry; Suspensions; Thermoluminescent Dosimetry; Tissue Distribution

Two-hundred-eighty-nine patients received treatment with chronic phosphate (32P) colloidal suspension (CPCS) 346 times since 1963. One-hundred-seventy-eight patients received 200 intraperitoneal treatments. One-hundred-fifteen patients received 144 intrapleural treatments. Six patients received both intraperitoneal and intrapleural treatments. Two patients received two intrapericardial treatments. Results of therapy were evaluated three months later and then at yearly intervals. In those patients who survived three months, the referring physician observed improvement in 85% of intraperitoneal treatment and in 75% of intrapleural treatments.

Topics: Brachytherapy; Chromium; Chromium Compounds; Follow-Up Studies; Humans; Male; Neoplasms; Peritoneal Diseases; Peritoneum; Phosphates; Phosphorus Radioisotopes; Pleura; Pleural Effusion

One hundred sixty-seven patients with clinical State I carcinoma of the endometrium were treated primarily by operation consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and para-aortic lymphadenectomy, and cytologic testing of peritoneal washings. Twenty-six (15.5%) of the 167 patients had malignant cells identified on cytologic examinations of peritoneal washings. Recurrence developed in 10 of these 26 (34.0%) compared to 14/141 (9.9%) patients with negative cytologic testing. Of the 26 patients, 13 (50%) had disease outside of the uterus at operation and seven have died of disease (54%). Thirteen patients had malignant cells in the peritoneal washings but no disease outside of the uterus and six (46%) of these have died of disseminated intra-abdominal carcinomatosis. On the basis of the poor outcome of those patients who had malignant cells in the peritoneal washings in the 167 patients studied, a plan of treating such patients with intraperitoneal radioactive chromic phosphate suspension (P-32) was instituted. Twenty-three subsequent patients with clinical Stage I carcinoma of the endometrium were found to have malignant cells in the peritoneal fluid. All 23 received intra-abdominal P-32 suspension instillation after operation. There have been three recurrences with two patients dying of disease. All of the three recurrences appeared at sites distant from the abdominal cavity. Peritoneal cytologic examination appears to be an important factor in the prognosis of endometrial cancer and, when the washings are positive for malignant cells, intraperitoneal chronic phosphate therapy appears to be efficacious.

Topics: Adenocarcinoma; Ascitic Fluid; Chromium; Chromium Compounds; Female; Humans; Lymphatic Metastasis; Neoplasm Metastasis; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis; Uterine Cervical Neoplasms; Uterine Neoplasms

32P-CrPO4 in colloid form has been used for radiosynoviorthesis. There were no acute or subacute side reactions observed. The therapy results were equal to those following 90Y colloid application: 60% very good to good results after 6 months. The substance can be kept on stock since it has a relatively long shelf-life. The cost reduction and the simplification of treatment planning have proved to be the most important advantages of 32P-CrPO4.

Topics: Chromium; Chromium Compounds; Colloids; Humans; Middle Aged; Phosphates; Phosphorus Radioisotopes; Synovitis

Topics: Chromium Compounds; Liver; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity

Topics: Chromium; Chromium Compounds; Chromium Radioisotopes; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes; Pleural Effusion, Malignant

Topics: Ascites; Chromium Compounds; Exudates and Transudates; Humans; Phosphates; Phosphorus; Phosphorus Radioisotopes; Pleural Effusion; Pleurisy

Topics: Amputation, Surgical; Chromium Compounds; Humans; Neuroma; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary

Topics: Chromium Compounds; Humans; Male; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes; Pituitary Gland; Prostatic Neoplasms

Topics: Chromium Compounds; Guinea Pigs; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Pleura; Radioactivity

Topics: Chromium Compounds; Gold; Gold Radioisotopes; Guinea Pigs; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Pleura; Radioactivity

Topics: Carcinoma; Chromium Compounds; Gold Radioisotopes; Humans; Male; Phosphates; Phosphorus; Phosphorus Radioisotopes; Prostatic Neoplasms; Yttrium

Topics: Chromium; Chromium Compounds; Humans; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Urinary Bladder Neoplasms

Topics: Chromium; Chromium Compounds; Humans; Phosphates; Phosphorus; Phosphorus Radioisotopes; Urinary Bladder Neoplasms; Urologic Neoplasms

Topics: Chromium Compounds; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Pleural Effusion, Malignant

Topics: Autoradiography; Chromium Compounds; Humans; Injections, Intravenous; Liver; Mononuclear Phagocyte System; Phosphates; Phosphorus; Phosphorus Radioisotopes; Radiography

Topics: Chromium; Chromium Compounds; Humans; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Urinary Bladder Neoplasms

Topics: Chromium; Chromium Compounds; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes; Urinary Bladder Neoplasms

Topics: Chromium Compounds; Humans; Leukemia; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary

Topics: Chromium Compounds; Humans; Male; Phosphates; Phosphorus; Phosphorus Radioisotopes; Prostatic Neoplasms

Topics: Chromium Compounds; Humans; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes; Tongue; Tongue Neoplasms

Topics: Chromium Compounds; Humans; Male; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Prostatic Neoplasms

Topics: Chromium Compounds; Neoplasms; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary

Topics: Chromium Compounds; Humans; Phosphates; Phosphorus; Phosphorus Radioisotopes; Radiopharmaceuticals; Tooth

Topics: Anesthesia; Anesthesiology; Chromium Compounds; Humans; Injections, Intravenous; Phosphates; Phosphorus Radioisotopes