Combined treatment methods for carcinoma of the esophagus.

From 1950 to 1973, 129 patients received irradiation for esophageal squamous-cell carcinoma at the University of California, San Francisco. From this group, 26 received surgical and irradiation treatment. Twelve did not receive irradiation until recurrence became evident and among them were no 5-year survivors. Among the other 14 were six 5-year survivors (43%). The authors believe that planned sequential irradiation and surgery offer the best chance for cure in squamous-cell carcinoma of the esophagus. Selection factors, treatment details, and therapeutic regimens are presented and a management plan proposed for this group of operable patients.

The role of radiation therapy in myasthenia gravis.

Myasthenia gravis is a serious and debilitating disease associated with conduction defects occurring at the myoneural junction. About 15 per cent of the patients have associated tumors of the thymus and 80 per cent of the remaining patients show abnormalities of the thymus. Although a definite relationship between cause and effect has not been proved, thymectomy or radiotherapy of the thymus does seem to influence the disease. Seven cases of myasthenia gravis in which radiation therapy was used at the University of California Medical Center are reported and compared with those described in the literature. It is concluded that patients whose disease is progressing and not well managed medically, and who have no evidence of thymoma, should be treated by irradiation-whether pre-operatively or as definitive treatment, depending on the result of irradiation. Those patients with evidence of thymoma should be irradiated before surgical procedure. Small tumors, or patients in whom surgical risk is increased, may be managed by radiation therapy alone.

The role of external irradiation in the treatment of transitional cell carcinoma of the bladder-a review of fifty cases.

Of 100 patients with carcinoma of the bladder seen in the Section of Therapeutic Radiology, University of California, San Francisco, between 1957 and 1962, 59 were accepted for radiation treatment. Fifty had transitional cell carcinoma and were treated with supervolt therapy (1 mev or cobalt-60).TWO TYPES OF TUMORS WERE AGAIN FOUND SUITABLE FOR EXTERNAL IRRADIATION: Papillary carcinomas Grades II and III, as long as they have not, or at least have not massively, invaded muscle; and undifferentiated carcinomas, Grade IV, regardless of degree of extension through the pelvis. The former type, if single, is treated by irradiation for the first recurrence after one attempt with radical transurethral resection. In the presence of multiple lesions at the first examination, radiation therapy is given immediately. The latter type is treated by radiation therapy without any attempt at surgical removal.Of 37 patients, Stages A to C, treated more than three years ago, 14 (38 per cent) lived more than three years and eight (22 per cent) had no cystoscopic or clinical signs of active disease and had normal bladder function. Of 23 patients treated more than five years ago, eight were alive after five years (35 per cent) and four (17 per cent) remained controlled by radiation therapy alone, with normal bladder function.No major complications were observed. In particular, no fibrosis of the bladder occurred. Doses ranged from 5,000 r in five and a half weeks to 6,000 r in seven weeks.A close cooperation between urologic surgeons and radiotherapists during recent years permits long-range treatment planning from the time of diagnosis, which is essential in the effective therapy of carcinoma of the bladder.