Primary radiation therapy in the treatment of anal carcinoma.

From 1966 to 1981, 47 patients with a diagnosis of anal carcinoma were irradiated. This group was composed of 23 males and 24 females, with age ranging from 38-84 years (average 64.4 years). The average age of the males was eight years less than the females. Of the 47 patients, 39 had an intact anal canal following biopsy and were treated with curative intent. Thirty-one of these 39 had no evidence of nodal metastasis (N0) and eight had groin, pelvic and/or para-aortic nodal disease. Only three patients were treated with pre-irradiation chemotherapy; all had locally advanced disease. Five patients were treated preoperatively and 34 were treated definitively with cancericidal doses of irradiation. Acute radiation reactions requiring a rest-break were noted in 28% of patients, but all were managed as outpatients without untoward chronic sequelae. Chronic complications were noted in 13 patients, including two patients who required colostomy for severe anal stenosis and two who required A-P resection for large painful ulcers. Two of these four patients had received part of their treatment with an interstitial implant and one had an excessively high dose of perineal irradiation. Twenty-eight of 35 patients (80%) treated with irradiation alone have remained locally controlled without further treatment. An additional four have been salvaged by surgery. Only three patients had interstitial implants as part of their treatment course. Actuarial survival at five years for the N0 patients and the group as a whole are 95.6 and 79.3%, respectively. It is concluded that external beam irradiation alone, properly fractionated to cancericidal doses, can control anal carcinoma with acceptable morbidity rates and without the use of either chemotherapy or interstitial implants in most cases. There is also a strong correlation suggesting that anal intercourse and male homosexuality play a significant role in the etiology of this disease.

Radionuclide salivary imaging usefulness in a private otolaryngology practice.

Radionuclide salivary gland scans were performed on 44 patients using sodium pertechnetate Tc 99m. The accuracy of the scans and their usefulness in the clinical treatment of the patients were reviewed. The scan provided helpful information in 31 of 38 (82%) cases in which adequate follow-up data were available, although it proved diagnostic in only six patients. It was particularly useful in the evaluation of primary salivary gland neoplasms, acute and chronic sialadenitis, and sialolithiasis, as well as in the differential diagnosis of xerostomia. The value of this procedure in the elucidation of a variety of morphologic and functional diseases of these glands warrants its greater application in private otolaryngologic practices.

Xenon ventilation-perfusion lung scans. The early diagnosis of inhalation injury.

The use of xenon Xe 133 ventilation-perfusion lung scans for the early diagnosis of inhalation injury was evaluated in 67 patients with acute thermal burns. Study results were interpreted as normal if there was complete pulmonary clearance of the radioactive gas by 150 seconds. Thirty-two scans were normal, 32 abnormal, and three technically inadequate. There were three true false-positive study results and one false-negative study result. Good correlation was found between the scan results and various historical, physical, and laboratory values currently used to evaluate inhalation injury. The scans appeared to be the most sensitive method for the detection of early involvement, often being abnormal several days before the chest roentgenogram. Xenon lung scanning is a safe, easy, accurate, and sensitive method for the early diagnosis of inhalation injury and has important therapeutic and prognostic implications as well.

Brain scanning in oligodendrogliomas: a detailed neuropathology-scan correlation of 34 histologically verified cases.

Thirty-six brain scans and biopsies from 34 patients with histologically verified oligodendrogliomas were evaluated. Twenty-nine of the 36 scans were positive (80.6%) but the abnormal uptake produced by these neoplasms had no distinguishing features. The levels of endothelial proliferation-vascularity, necrosis, and mitoses were significantly different between the positive and negative scans. In the oligodendrogliomas, the relationship between histologic malignancy, detectability on scan, and prognosis remains unresolved.