phosphorus-radioisotopes and Mesothelioma

Topics: Alkylating Agents; Antineoplastic Agents; Cyclophosphamide; Dactinomycin; Doxorubicin; Drug Therapy, Combination; Fluorouracil; Gold Colloid, Radioactive; Humans; Mesothelioma; Methotrexate; Nitrogen Mustard Compounds; Palliative Care; Peritoneal Neoplasms; Phosphorus Radioisotopes; Pleural Neoplasms; Radiotherapy Dosage; Thiotepa

The charts of all patients having received intraperitoneal 32P in the Indiana University Department of Radiation Oncology were retrospectively reviewed for complications and potentially related factors. Ninety-five patients had received this therapy, with a mean follow-up of 43.6 months. The majority of patients (81) had ovarian cancer. Complications were defined as mild if no intervention was required, moderate if medical intervention was required, and severe if the event was life-threatening or required surgical correction. Twenty patients (21%) had acute side effects recorded, with 15 of them (16%) being mild. The moderate complications (five patients) consisted of three cases of bowel obstruction, and two cases of abdominal pain requiring narcotics. There were no severe acute side effects. Chronic complications were found in 15 patients (20% actuarial 5-year incidence). Seven cases were mild (12% 5-year incidence), one was moderate (1%), and seven cases were classified as severe (7.4% 5-year incidence). All moderate and severe cases were bowel obstructions. Acute side effects were found to be related only to the volume of instillate (P = 0.049). Chronic complications were found to be related only to adjunctive pelvic/abdominal radiotherapy, with a 44% 5-year rate in patients receiving the combination having complications vs 17% (P = 0.04) (or 4.7% if mild complaints are excluded, P = 0.002) of those with 32P only. Comparison is made to other reports in the literature.

Topics: Acute Disease; Adult; Aged; Appendiceal Neoplasms; Carcinoma; Chronic Disease; Female; Genital Neoplasms, Female; Humans; Instillation, Drug; Mesothelioma; Middle Aged; Peritoneal Cavity; Phosphorus Radioisotopes; Radiation Injuries; Retrospective Studies

A patient underwent intracavitary P-32 chromic phosphate therapy for a chest tumor. Tc-99m sulfur colloid instilled before the P-32 demonstrated uniform distribution of activity throughout the right pleural space, and the P-32 was immediately administered. Ten days later, SPECT imaging using bremsstrahlung radiation of the P-32 showed an unexpected loculation of the P-32. A subsequent chest CT scan demonstrated pleural infolding and fluid localization in the same area as the P-32, indicating that the bremsstrahlung SPECT study had, in fact, documented the final localization of the P-32, which was unexpected and different from the initial localization. The procedure used in this case may be of value in documenting the ultimate distribution of intracavitary P-32.

Topics: Aged; Brachytherapy; Humans; Male; Mesothelioma; Phosphorus Radioisotopes; Thoracic Neoplasms; Tomography, Emission-Computed, Single-Photon

Malignant peritoneal mesothelioma remains a therapeutic problem. A review of the use of intraperitoneal 32P and a review of the status of therapy for this disease are presented. Six patients treated with 32P and combinations of external radiation therapy, surgery, and chemotherapy are reviewed with survival times from 5 months to 18 years. Overall survival in this disease is poor, about 44.2 months. This series suggests that with combined therapy with intraperitoneal 32P and chemotherapy, longer survivals can be achieved.

Topics: Adolescent; Adult; Colloids; Combined Modality Therapy; Female; Humans; Male; Mesothelioma; Middle Aged; Peritoneal Neoplasms; Phosphorus Radioisotopes

A case of diffused malignant mesothelioma of the peritoneum in a 64-year-old man is presented. This mesothelioma, of the papillary type, was complicated, after a year without significant clinical symptoms, by the development of ascites and obstructive upper bowel ileus. Physiological-anatomical and clinical aspects, as well as special radiologic findings and therapeutic regimens, are discussed in the light of the literature. It is recommended that all patients with malignant mesothelioma of the peritoneum be treated by total abdominal irradiation and intreperitoneal instillation of colloid P32.

Topics: Ascites; Humans; Intestinal Obstruction; Male; Mesothelioma; Middle Aged; Peritoneal Neoplasms; Phosphorus Radioisotopes