Radiotherapy in the treatment of multiple myeloma.

Fifty-nine patients with multiple myeloma referred for treatment of painful bony lesions received irradiation to 95 local areas, and 16 of the 59 were irradiated using hemibody techniques. Pain relief was obtained in practically all of the irradiated regions. Most local areas were treated to doses of 3000 cGy in 10 to 15 fractions. Patients with generalized pain due to multiple site involvement were treated with single dose hemibody irradiation, to doses of 600 cGy to the upper hemibody, and of 800 cGy to the lower hemibody. This treatment was well tolerated and side effects minimal. Median survival from diagnosis was 30 months and the survival at 1, 3, and 5 years was 80%, 42%, and 12% respectively. Key articles on radiation therapy of multiple myeloma are reviewed and discussed. Since all patients eventually relapse after chemotherapy, the role of radiotherapy using present techniques should be fully evaluated and considered as an alternative in the primary treatment of multiple myeloma.

Nasopharyngeal carcinoma in the second decade of life.

The clinical findings and treatment results in 27 patients, 11 to 20 years of age, with nasopharyngeal carcinoma were retrospectively reviewed. The histological diagnosis was lymphoepithelioma in 18 patients and undifferentiated carcinoma in nine patients. Seven patients (26%) presented with T4 lesions, 24 patients (89%) with clinically positive cervical nodes, and two patients (7%) with distant metastases. All patients received radiation therapy to the primary site; chemotherapy was employed as an adjuvant in six patients. Overall survival was 64% at five years and 57% at 10 years. Local control of the primary tumor and regional lymph nodes was 85%. Distant metastases were more frequent in patients with advanced primary disease and were associated wtih extremely poor prognoses. A moderate dose of radiotherapy is the recommended treatment for primary tumors and neck nodes. More effective adjuvant chemotherapy is suggested as a possible way to improve therapeutic results.

Survey of human polyomavirus (JCV, BKV) infections in 139 patients with lung cancer, breast cancer, melanoma, or lymphoma.

In 139 patients with breast or lung carcinoma, malignant melanoma, and Hodgkin's or non-Hodgkin's lymphoma, JC and BK virus serology (hemagglutination inhibition) and urinary polyomavirus excretion (cytology and immunofluorescence microscopy) were studied. Overall, 18 of 70 patients with paired sera (26%) had titer increases against JC or BK virus, and 11 of 114 patients (10%) had evidence for urinary excretion. The infection rate was highest in patients with Hodgkin's or non-Hodgkin's lymphoma (approximately 40%). Serum HAI antibody titers against JC and BK viruses appeared similar to age-matched controls in each patient group--with the exception of decreased BK titers at diagnosis in patients with resected malignant melanoma and increased JC virus antibody titers at diagnosis in patients with poor-prognosis non-Hodgkin's lymphoma (IC-2). The biologic significance of these observations remains to be determined. Initial antibody titers against JC or BK virus were not of prognostic value for subsequent survival in any of the tested patient groups. Both nonspecific immunotherapy and aggressive, multidrug chemotherapy had surprisingly little effect on serum HAI titers to JC or BK virus. Patients with poor-prognosis non-Hodgkin's lymphoma appear especially suitable for further investigation of JC and BK virus infections. Study of nonbrain, nonurinary-tract tissues may disclose other parenchymal sites of polyomavirus replication in these patients.

Adenocarcinoma of the esophagus.

The relevant literature is reviewed in an attempt to clarify the true frequency of intraesophageal adenocarcinoma and to evaluate the different treatment modalities and survival of this uncommon type of tumor. The incidence of intraesophageal adenocarcinoma in reported clinical series is about 1%, and data from cancer registries show the incidence to be about 2% for upper and the middle thirds, a more reliable figure than that for the lower third in which lesions of cardia, or stomach infiltrating the lower esophagus have been included. The benefits of any particular treatment modality are difficult to evaluate in view of the rarity of this type of tumor, and the treatment results are as poor as those obtained in the treatment of squamous cell carcinoma.

Autopsy findings in carcinoma of the esophagus.

At autopsy of 82 cases of carcinoma of the esophagus over a period of 25 years metastatic tumor was found in 42 cases (51%) and residual tumor in the esophagus in 56 cases (86%). The most frequent site of metastases was in the lymph nodes, followed by liver, lung, and adrenal gland. Direct extension of the tumor to adjacent structures was established in 30 cases (36%), and the most frequent structure involved was the trachea. Five cases had a second primary and two cases a second separate lesion at another level of the esophagus.

Metastasis to neck from unknown primary tumor.

The records of 54 consecutive patients who were irradiated for metastatic disease in the neck from an unknown primary tumor were reviewed. The overall survival results are comparable to those of other reported series. Patients with high or posterior cervical lymph node involvement were irradiated with fields including the nasopharynx and oropharynx. Patients with high neck nodes had a better survival rate than those with low neck nodes. The size of the neck tumors and the local control after treatment also have prognostic significance.

Failures after irradiation in early vocal cord cancer.

Radiation therapy for early laryngeal cancer offers an excellent probability of cure as well as preservation of vocal function. Reported failure rates range from 9 to 21% in patients with T1 lesions, and from 28 to 44% in those with T2 lesions, the majority of whom are subsequently salvaged by surgery. Results obtained at the Radiotherapy Center of the University of Wisconsin Hospitals in 44 patients during the period from 1960 to 1972 yielded failure rates of 21% in patients with T1 tumors and 38% in patients with T2 tumors at 5 years. Five of the eight recurrences were salvaged with surgery yielding an overall tumor control rate of 93%. The larynx was preserved in 82% of the cases. Determinate 5-year survival was 91% in T1 cases and 86% in T2 cases. Failure rates at 3 years were 18% for T1 tumors and 30% for T2 lesions. These results are in conflict with those reported by Brandenburg and Rutter as being 46% and 60% respectively. Ultimate success in the treatment of laryngeal cancer rests in the full cooperation between surgeons and radiotherapists.

Carcinoma of the pinna.

Ninety-seven consecutive cases of carcinoma of the pinna are reviewed in this report. Fifty-six of the tumors were basal cell and thirty-nine squamous cell carcinoma. Fifty patients were surgically treated and forty-five irradiated. Small and/or peripheral lesions were excised and the large and/or centrally located lesions referred for irradiation. Analysis of the results shows no difference in tumor control rate, and the complication rate was also comparable with both modalities. Although chondritis was seen in three cases after irradiation, it also occurred in one case after excision. Our results indicate that neither modality should be used with total exclusion of the other. Initial resection would seem preferable in small lesions where primary closure is possible and in extensive lesions where a good cosmetic result is precluded by the destruction of normal tissue. Radiotherapy seems of value in those lesions in which resection would result in objectionable cosmetic defect.

Complications after radiation therapy for cervical carcinoma.

A series of 1 139 patients with invasive carcinoma of the cervix uteri who received a complete course of treatment by means of external irradiation followed by intracavitary curietherapy was evaluated in order to assess the results of treatment and, in particular, the radiation complications induced. Complications developed in 145 instances (12.7%). Severe complications occurred in only 3 per cent. Twenty-four cases had more than one complication. Rectosigmoidal injuries accounted for 72 per cent of all complications, and appeared earlier than did bladder complications and within the first two years after treatment. No apparent correlation between age and the occurrence of complications was found. The rate was higher in early stages. The radiation complications did not adversely affect the survival results.

Cancer of the nasal cavity.

The experience with 40 consecutive cases of cancer of the nasal cavity seen over a period of 15 years is presented. Males outnumbered females in a ratio or 5 to 3. Age ranged from 35 to 88 years, and the median age was 67 years. Epidermoid carcinoma accounted for 78% of the cases. Smoking from early age was a noticeable habit among these patients. The median length of smoking history was 51 years. Most lesions were diagnosed in an advanced stage of the disease, 58% of the cases being T3 lesions. Regional lymph nodes metastases were infrequent; only 12% of the patients presented nodes on admission; another 5% developed metastatic nodes during the follow-up period. An overall 5-year survival of 56% was obtained. The survival of cases with T1N0 lesions was 91%. Radiation therapy was the treatment of choice employed in 85% of the cases. A 5-year survival of 50% was obtained in these patients. Irradiation offers an additional means of salvaging recurrences after surgery. The special characteristics of tumors of the nasal cavity merit the evaluation of such lesions separately from tumors of the paranasal sinuses.

Cancer incidence in the United States and Puerto Rico.

This study compares cancer incidence in the United States National Survey areas and Puerto Rico for the period of 1969 to 1974. There are several differences between the 2 areas. Puerto Rico has a higher incidence of cancer of the mouth, pharynx, esophagus, stomach, cervix uteri, vulva, and penis. The Survey areas have higher incidences of cancer of the colon, rectum, lung, corpus uteri, female breast, and ovary. The differences between sexes are more or less the same as in other countries.

[Sensitivity of the thyroideal cell to external irradiation]. / Sensibilidad de la célula tiroidea a irradiación externa

Evaluation of the variation in thyroid function utilizing 131I uptake in patients exposed to external radiation to the thyroid gland for reasons not related to this gland. The study was initiated with 54 patients who were examined prior to irradiation. They received an average dose of 5.650 r to the gland in a period of 5-6 weeks. Upon completion of the radiation therapy an abrupt drop in the uptake values occurred reaching the hypofunction range and one month later there is a recovery to 80% of the initial level and the value remains stable up to one year. Followed, year after year, a progressive reduction occurs in the uptake value up to a period of 6 years when the 2 surviving patients have returned to the hypothyroid level. The number of patients during the latter years of the study is too low to be statistically significant. The usefulness of this observation is discussed and a comparison is made of the external irradiation effects and the effects of 131I therapy.