Post-operative radiotherapy in the management of advanced intra-oral cancers.

Advanced tumours of the tongue and floor of the mouth have a poor prognosis when treated by surgery or radiotherapy alone. The results reported here suggest that combined surgery and radical post-operative radiotherapy greatly improve the outlook for such patients. When the oral cavity is irradiated, both parotids usually receive a radical dose resulting in xerostomia. In this study, shaped fields are used to spare the contralateral parotid, thus minimising the reduction in saliva production. Previously, radical surgery of oral tumours left the patient deformed. Plastic surgery techniques of reconstruction using radial free flaps give excellent cosmetic results. Radial free flaps have their own blood supply and tolerate a radical dose of radiotherapy.

The role of radical surgery and post-operative radiotherapy in the management of intra-oral carcinoma.

The incidence rate for carcinoma of the tongue and floor of mouth has fallen in Scotland over the past 20 years (Fig. 1). Despite the fall in incidence rate and mortality rate many such tumours present late when the prognosis is poor (Pointon and Gleave, 1982; Decroix and Ghossein, 1981a; Shaw 1982). Until relatively recently most centres treated such lesions either by surgery or by radiotherapy alone. Over the past decade a number of centres have adopted a dual treatment policy involving both surgery and radiotherapy. The head and neck oncologists at the Royal Marsden advocate pre-operative radiotherapy (Shaw, 1982) while Glasgow and the Memorial in New York (Vikram et al., 1980) have adopted the practice of post-operative radiotherapy. A combined plastic surgery/radiotherapy clinic has been run in Glasgow for the past ten years and over that time a treatment protocol has evolved. The results of treatment of all advanced tumours of the tongue and floor of mouth referred to the Glasgow Institute of Radiotherapeutics and Oncology are presented here. The results of planned combined therapy-radical surgery followed by radical radiotherapy--are compared with the results of treating similar lesions by minimal surgery plus radical radiotherapy and the advantages of combined radical treatment are discussed.

Skeletal effects of orthovoltage and megavoltage therapy following treatment of nephroblastoma.

A review of 19 patients treated for nephroblastoma between 1945 and 1978 by nephrectomy and radiotherapy with chemotherapy showed a marked improvement in cure rate in recent years. In the decade from 1950 to 1960 there are four survivors. From 1960 to 1970, there are nine survivors from 25 cases and since 1970 there are 19 survivors from 27 cases. Skeletal effects of radiation therapy have been reviewed in 22 patients--seven of whom had orthovoltage and 15 megavoltage therapy. Similar skeletal changes followed both orthovoltage and megavoltage therapy, being more severe after the adolescent growth spurt and when the follow-up was longer. The radiation dose was normally 3000 cGy and skeletal changes followed the lowest dose of 2200 cGY. Scoliosis of the lumbar spine, concave to the side of the tumour, with angulation ranging from less than 5 degrees to 54 degrees developed in 12 patients; all but one showed asymmetry of the body LV2. Kyphosis was present in three patients; anterior beaking of the vertebral body in 10; and 16 patients showed asymmetry of more than one vertebral body. Iliac hypoplasia was present in 19 patients, being unilateral when only the renal bed was irradiated. Analysis of the radiological changes expressed as a total score against the age at follow-up shows that severe changes follow orthovoltage therapy. It is too early to assess the full extent of megavoltage therapy simply because patients have not been followed up for a comparable length of time.

Cancer of larynx in west of Scotland. A review of results and a consideration of new therapeutic approaches.

A recent epidemiological study carried out by the Cancer Intelligence Unit in Glasgow has shown: 1) there has been an increase in consumption of tobacco products and alcohol in Scotland over the past 25 years; and 2) the mortality rate from cancer of the larynx has been unchanged over that time (Fig. 1). Ayrshire, a county in the west of Scotland, has a population of 360,000 which is remarkably similar in age structure, sex and urban/rural mix to Scotland as a whole. The incidence of carcinoma of the larynx in this region has been unchanged over the 20-year period 1959-1978. The results of treatment for the period 1958-1968 were reported recently by Quayum. In this report the results of treatment of carcinoma of the larynx by radiotherapy in Ayrshire and district over the decade 1968-1978 are presented and compared with those of the previous decade. The overall survival is unchanged over the two decades 1958-68 and 1968-78. This confirms the findings of the Cancer Registry. The survival of certain stages has improved, though this may be due to changes in criteria for staging introduced in 1974. All cases in this report were staged retrospectively. Recent innovations in treatment which may improve overall survival are considered.

Seventh interim progress report of the british institute of radiology fractionation study of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx.

A fresh analysis of the data entered into the multicentre BIR fractionation trial of 3F/week versus 5F/week in radiotherapy of the laryngopharynx has been undertaken. Completed records of the 732 patients initially entered into the trial have now risen from 687 at the last report to 706. The data have been analysed in a manner similar to that adopted previously so as to measure the effects of the two regimes on both tumour and normal tissues, and some additional analyses have now also been made. There have been some modifications in the results in the various sub-groups which may be due to an inadequate number of patients having been followed up for long enough at the time of the previous analyses. More data for late radiation damage to normal tissues and new radiobiological findings have suggested possible explanations for the differences which have emerged between the two groups. The apparent differences between the sub-groups containing patients with highly localized tumours, which were reported in our previous report, are now less marked and not statistically significant.

Glomerulosclerosis following irradiation and cytotoxic therapy for nephroblastoma.

A 6-year-old child had a nephrectomy for nephroblastoma followed by radiotherapy and chemotherapy with actinomycin D and vincristine. He died of metastatic disease 13 months after the operation. Autopsy showed a diffuse glomerulosclerosis in the remaining kidney which is attributed to the postoperative therapy.