Changing face and different countenances of prostate cancer: racial and geographic differences in prostate-specific antigen (PSA), stage, and grade trends in the PSA era.

The purpose of this investigation was to examine changes in pretreatment prostate-specific antigen (PSA), stage, and grade over the past decade as a function of race and geographic region. A multiinstitutional database representing 6,790 patients (1,417 African-American, 5,373 white) diagnosed with nonmetastatic prostate cancer between 1988 and 1997 was constructed. PSA, stage, and grade data were tabulated by calendar year and region, and time trend analyses based on race and region were performed. There was an overall decline of PSA of 0.8%/year, which was significant (P = 0.0001), with a faster rate of decline in African-Americans (1.9%/year) than for whites (0.6%/year). The odds ratio (OR) for a stage shift was 1.09, which was significant (P < 0.0001), and this shift was greater in whites. The OR for an overall grade shift was 1.15, which was significant (P < 0.0001). Although grade and PSA trends were similar for the different regions, there were significant regional differences in stage trends. The implications are that the face of prostate cancer has changed over the past decade; i.e., the distributions of stage, grade, and PSA (the most important prognosticators) have changed. In addition, the countenances of that face are different for whites and African-Americans. For African-Americans, this is good news: the stage, grade, and PSA distributions are more favorable now than before. For whites, the trends are more complex and more dependent on region. These findings should be used for future clinical and health-policy decisions in the screening and treatment of prostate cancer.

Method for reducing scatter radiation dose to the contralateral breast during tangential breast irradiation therapy.

PURPOSE: To reduce scatter dose to the contralateral breast during tangential breast irradiation therapy. MATERIALS AND METHODS: The authors used a 4-mm-thick commercially available vinyl-coated flexible lead shield that contains a compound of vinyl resin and lead powder of 1-mm-equivalent lead density. Contralateral scatter dose was measured at 5 cm outside the geometric field edge and along the field axis, with and without use of block trays and different wedges. RESULTS: On the skin, contralateral scatter dose from the medial tangential beam was reduced from about 15% to about 5% of the therapeutic dose delivered to the treated breast. The bulk of scatter dose was absorbed within the first 2 cm of breast tissue. CONCLUSION: Reduction in unwanted scatter dose to the contralateral breast is in accord with the philosophy of keeping radiation exposure as low as reasonably achievable and might be of most benefit for young patients.

Monitoring the radiation dose to a multiprogrammable pacemaker during radical radiation therapy: a case report.

Multiprogrammable pacemakers, using complimentary metaloxide semiconductor (CMOS) circuitry, may fail during radiation therapy. We report about a patient who received 6,400 cGy for unresectable carcinoma of the left lung. In supine treatment position, arms raised above the head, the pacemaker was outside the treated area by a margin of at least 1 cm, shielded by cerrobend blocking mounted on a tray. From thermoluminescent dosimeter (TLD) measurements, we estimate that the pacemaker received 620 cGy in scatter doses. Its function was monitored before, during, and after completion of radiation therapy. The pacemaker was functioning normally until the patient's death 5 months after completion of treatment. The relevant electrocardiograms (ECGs) are presented.

Scatter dose from tangential breast irradiation to the uninvolved breast.

Thermoluminescent dosimeters (TLDs) were used to measure scatter radiation to the uninvolved breast in 30 patients who received tangential breast or chest-wall radiation with a technique in which the deep edges of the tangential fields were aligned. In most patients, measurements were made during the 1st week of radiation therapy, after port radiographs were obtained to ensure proper field position and accurate alignment of the posterior tangential field edges. Phantom measurements were made simultaneously with TLD measurements to systematically assess the scatter dose as a function of the wedging, number of fields, type of accelerator, beam energy, and bolus used in each treatment. For most patients, the scatter dose to the contralateral breast at a point on the skin 5 cm outside the edge of the medial beam was 8%-13% of the prescribed dose. However, higher doses (up to 36% of the therapeutic dose) were recorded in some patients.

Impact of CT information on the treatment planning for lung tumors.

With CT information available today, the prevailing, though strong, argument for not applying lung corrections is that all clinical experience gathered so far applies to doses that were prescribed for uniform density throughout the treated volume. To ease the transition from not correcting, to the state of accounting for increased lung transmission, we have planned 10 patients: (a) in the conventional way with a wire contour obtained at simulation; target volume and critical structures were drawn in by the physician utilizing information gathered from diagnostic CT scans and X-ray films; no lung correction was applied for treatment planning. (b) For the same patients, a CT scan was obtained in treatment position and the target volume was outlined on the CT film utilizing the same information as in (a); a relative lung density of 0.3 was assigned for treatment planning. The geometric accuracy of patient outline and target volume obtained in both planning modalities is analyzed, and the intended and actually delivered tumor doses are compared when optimized treatment plans from either planning modality are selected for treatment.

Extended mantle radiation therapy for pathologic stage I and II Hodgkin's disease.

Between 1968 and 1983, 135 patients with pathologic stage (PS) I and II Hodgkin's disease were treated with extended mantle radiation technique (EMRT) at Michael Reese Hospital and the University of Chicago Center for Radiation Therapy. EMRT combines both standard mantle and para-aorta fields (M-PA) in one port. Actuarial disease-free survival at 5 and 10 years was 82.5%. Actuarial overall survival was 96% and 83% at 5 and 10 years, respectively. Acute complications were evaluated in 112 patients available for analysis. Severe nausea and vomiting occurred in 13%, weight loss of greater than 10% of body weight in 19%, and acute hematologic toxicity in 4% of patients. Bone marrow suppression was transient and did not interfere with subsequent delivery of salvage treatment with either chemotherapy or radiation therapy in 22 patients who relapsed. The cost of EMRT is 40% lower than the cost of treatment with M-PA. The median treatment time was 38 days, 33% less than the 56 days for M-PA field assuming no interruptions. These results suggest that the EMT is a safe and effective treatment tolerated by most patients. The advantages of this method are eliminating the possibility of technical error of matching between mantle and para-aortic field, decreasing overall treatment time, and reducing the cost.

Staging and therapy of orbital lymphomas.

Ten patients with non-Hodgkin's lymphoma primarily affecting the orbital region were evaluated at Michael Reese Hospital and Medical Center, Chicago, between 1976 and 1983. Diagnoses were based on the histopathologic classification systems of the Working Formulation of the Non-Hodgkin's Lymphomas and Rappoport. Sequential staging procedures performed at the time of diagnosis included liver-spleen scans, Technecium-99 bone scans, gallium 67 scans, computerized axial tomograms of the orbit and abdomen, bone marrow examination and cerebral spinal fluid analyses. Adverse prognostic factors included the following: orbital bone erosions, Stage IV disease, and large cell or mixed cell, diffuse histologic features. The type of histopathologic findings combined with the results of sequential staging procedures is useful in identifying those patients who would benefit most from systemic chemotherapy.