Radiation therapy: a long term cost benefit analysis in a North American region.

The annual cost for a concentrated, high volume radiation therapy (RT) department during 1977 was 3.79 million Canadian dollars (C$). From a population of 1.14 million, 955 patients were treated with RT during 1977 at an average cost of C$3969 per patient. It is estimated that 225 will survive 15 years at a cost of C$1123 per survivor-year. The area under the RT survival curve presented indicates that RT given in 1977 will contribute to 5730 person-years of life at a cost of C$661 per person-year or C$1.82 per person-day (little more than the cost of a city bus ride). The cost to the community is C$3.32 per head per year. A 6 MV workhorse linear accelerator and its vault will contribute to one person-year of life at a cost of C$35.04 (or C$0.68 per person-week). RT is cheaper than various listed medical and surgical procedures in terms of cost per procedure or cost per year of life gained. All costs are adjusted to the 1988 C$.

Ultrasonography and radiography in the diagnosis of Peyronie's disease.

In this study the authors compare ultrasonography and radiography with clinical examination in the diagnosis of Peyronie's disease. They also review its clinical presentation. In contrast to previous studies they found no correlation between plaques found on ultrasonography or radiography and those found on clinical examination. They conclude that ultrasonography and radiography are not reliable in diagnosing Peyronie's disease.

Effect of decicurie doses of radioactive iodine 131 on parathyroid function.

Although parathyroid deficiency has been reported after administration of relatively small doses of iodine 131, reports of such deficiency after the much larger doses given in the management of thyroid cancer are notable by their absence in the literature. We observed one such patient, then instituted a prospective study. We observed a 58 percent incidence of apparently diminished parathyroid reserve among 53 patients given high doses of I 131. Susceptibility does not appear to be related to age, sex, extent of thyroid operation, operative technique, the amount of thyroidal I 131 uptake, the use of external radiation to the neck, or to the presence of parathyroid glands or of Hashimoto's disease in the operative specimen; however, susceptibility may be related to the anatomic location of the parathyroid glands in relation to the thyroid gland. The administered dose of I 131 almost reached significant levels (p = 0.1) in the present study. The initial pretreatment serum calcium levels were consistently lower among affected patients (p = 0.01), suggesting the presence of a preexisting latent impairment of parathyroid reserve which was subsequently unmasked after the administration of I 131. Thyroid cancer is compatible with very long-term survival, and therefore, there is a considerable risk of delayed chronic hypocalcemia among patients who have received large doses of I 131, particularly female patients in the premenopausal age group. These patients deserve special management surveillance.

The cooling effect of tubular liquid flow during radiofrequency heating: the "rind" survival hypothesis.

The influence of flowing blood on temperatures reached in nearby tumor cells during localized radiofrequency (RF) hyperthermia may be critical for tumor cell survival. We have investigated the effect on the temperatures nearby of blood flowing in a vessel. Using 13.56 MHz capacitive RF, we heated gel phantoms containing a tube through which cooling solution could flow. Our results demonstrated a reduction in temperature of the order of 3 degrees C around the tube when coolant was flowing, and the cooling pattern correlated with theoretical mathematical predictions. Up to 564 joules per minute could be removed from the system. Our results suggest the improbability of uniform tumor cell killing by RF heating. A scheme for integrating the concepts of physical cell damage, biochemical cell damage and peripheral cell survival in a tumor nodule is presented.

Local radiofrequency (RF) hyperthermia in the treatment of cancer: Edmonton experience.

We have treated 16 patients suffering from recurrent malignancies who were unsuitable for any other form of treatment with local radiofrequency (RF) hyperthermia. Relief of pain as a major symptom occurred in six patients and reduction in size of tumor occurred in 13 instances.

Occupational nasal carcinogenesis among dentists?

671 dentists were registered in Alberta for 1973. In that year two dentists presented at the Cross Cancer Institute with extensive anaplastic squamous cell carcinoma involving the nasal cavity and accessory sinuses, an incidence rate of 298 per 100,000. Owing to the Provincial Cancer Service the registration of malignant disease is virtually complete and during 1973 the total Alberta registration of squamous carcinoma of the nasal cavity, accessory sinuses and nasopharynx was 28 cases. Assuming that all 28 cases arose in males over 24 years of age, and knowing that the 1973 Alberta population included 412,000 males over the age of 24 years a maximum expected incidence rate of 6.8 per 100,000 would apply to this population group. This paper describes the two dentists referred to above, contrasts the incidence rates previously quoted, discusses the frequency of malignancy among dentists in general and most especially draws attention to the role of inhaled oil droplets produced by high speed air rotor dental drills as a possible occupational carcinogenic hazard in the dental profession. On reviewing the world medical literature no previous report of this hazard has yet been traced. There is no significant risk for dental patients.

Urinoma diagnosed on a bone scan.

A case of urinoma diagnosed on a bone scan is described. The administration of radiotracers excreted by the kidney is a useful, non-invasive, uncomplicated diagnostic procedure when leakage from the urinary tract is suspected.

Radionuclide angiography in juvenile angiofibroma of the nasopharynx.

Radionuclide angiography was performed by intravenous injection of 99mTc-pertechnetate and recorded by serial gamma camera scintiphotographs. Its usefulness as a prebiopsy or preoperative procedure is demonstrated by two case reports of angiofibroma of the nasopharynx and it was also found to be useful for radiation therapy follow-up assessment. Radionuclide angiography offers a convenient and safe method to assess the vascularity of a mass and by this technique the surgeon may be alerted to the possibility of severe postbiopsy hemorrhage and also the occasional dramatic complications of radiological carotid angiography can be avoided.

Changing trends in cancer management.

Changing trends in cancer management are reviewed, with special reference to multidisciplinary consultation and combined treatment methods. Earlier diagnosis at the primary site and earlier detection of metastatic spread influence treatment policy. Considering the need for public education, the epidemiological search for causative agents and the concept of practical psychological support for cancer sufferers, it is apparent that the comprehensive management of the whole cancer problem in a community is equally as important as the narrower concept of treatment in an individual patient.

Kaposi's sarcoma in an Eskimo.

An Eskimo who had been treated for a nasopharyngeal carcinoma was subsequently found to have a rapidly progressive form of Kaposi's sarcoma confirmed at biopsy. No objective response was obtained by irradiation treatment of isolated nodules. However, vinblastine sulfate arrested the progression of the disease. Because this neoplasm is most prevalent in tropical climates its presentation in an Eskimo is believed sufficiently unusual to warrant this report.