192 Correspondence

until we arrive at a better understanding of radiobiology. Especially in the case of nico- tinamide, the evaluation of this drug in combination with radiotherapy and/or cis- platin will most likely show it to be harm- less. In the event of a positive result, it should be remembered that even this simple drug has a direct effect on D N A repair [2] by inhibiting adenosine-ribose transferase.

N. H. M U L D E R University Hospital Groningen

Division of Medical Oncology Department of Internal Medicine

Oostersinga159 9713 EZ Groningen

The Netherlands

References

1. Offerman JJG, Meijer S, Sleijfer DTh, et al. Acute effects of cis-diamminedichloro- platinum (CDDP) on renal function. Cancer Chemother Pharmacol 1984;12:36-8.

2. Mandel P, Okazaki H, Niedergang C. Poly (adenosine diphosphate ribose). In: W. E. Cohn, editor. Progress in nucleic acid research and molecular biology. New York: Academic Press, 1982:1-51.

Strive to Keep Alive?

SIR - I realize that there are probably as many opinions on the constitution of 'meddlesome medicine' as there are clini- cians, but the management of recurrent carcinoma of the cervix following radio- therapy is a common problem about which I feel there is increasing cause for concern. I refer to the re-establishment of renal function by invasive techniques carried out on patients whose ureters have been com- pressed by recurrent, untreatable, pelvic cancer.

I accept that the occasional patient referred for radiotherapy of previously untreated advanced cervix cancer will arrive in the clinic with bilateral nephros-

tomy tubes in situ; for them there is at least a chance that t reatment will prolong life, perhaps even cure. Some patients, how- ever, have ureteric stents inserted when they should, I honestly believe, be allowed to die.

Recently a failed radiotherapy patient of mine with re-growing treated para-aortic nodes and liver metastases was admitted as an emergency to another hospital with total anuria, extremely high serum potassium and urea, and pain. She underwent percuta- neous stenting of the ureters in the radio- logy department before being discharged home in misery.

Is there not a place for publishing guide- lines to prevent this? Even if our words fail to impress those in other specialties, let us at least try to persuade our cousins in diagnostic radiology that, in some cases, it is kinder to let Nature take its course.

I. J. KERBY Velindre Hospital Cardiff

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