External beam radiotherapy for palliation of pain from metastatic carcinoma of the prostate.

Radiotherapy often is used for palliation of bone pain from metastatic cancer of the prostate but an objective evaluation of its efficacy in a large series of patients is unavailable. We report the results of external beam irradiation in 62 patients who had bone pain secondary to stage D carcinoma of the prostate. The variables used to judge pain before and after radiotherapy included subjective evaluation of pain, status of activity and quantitation of analgesic use. Complete relief of pain was achieved in 26 patients (42 per cent), partial relief in 22 (35 per cent) and no relief in 14 (23 per cent). On the basis of our experience external beam irradiation is useful palliative therapy for pain from metastatic cancer of the prostate.

Systemic treatment of advanced prostatic cancer: development of a new system for defining response.

The low incidence of measurable or evaluable metastases in patients with prostatic cancer makes evaluation of response difficult. This is particularly true in patients with bone metastases only. With a digital model it is possible to measure quantitatively from the radioisotope bone scan the total area of skeletal involvement by metastatic tumor. Definitions of response in bone have been derived from this model. These response criteria have been compared to response in acid phosphatase determinations and clinical status in a study of 44 patients with advanced prostatic cancer treated with estramustine phosphate. Based on serial quantitative bone scans, serial measurements of acid phosphatase levels and repeat clinical evaluations a system is proposed for defining response to systemic therapy that is applicable to the majority of patients with metastatic prostatic cancer.

The use of serial bone scans in assessing response of bone metastases to systemic treatment.

The accuracy levels of serial radioisotope bone scans and conventional bone radiographs in assessing the response of bone metastases to systemic therapy were compared in 34 women with metastatic breast cancer. Each patient had measurable or evaluable nonosseous metastases, which were assessed independently of skeletal disease. The bone scan was found to be more accurate and sensitive indicator of the status of bone metastases than the radiograph. The bone scan correlated well with response of soft tissue or visceral disease, while the results of repeated bone radiographs were frequently misleading. With use of a digital model, it was possible to accurately measure the area of skeletal involvement of the bone scan, and from this derive quantitative criteria for response in bone metastases analogous to response criteria currently in use for soft tissue and visceral disease. It is suggested that serial quantitative bone scans be done, in preference to radiographs, to assess the response of bone metastases to systemic therapy.

Issues involved in the treatment of an adolescent group.

At first we had a lot of information about what to expect from an adolescent group. But we quickly found an enormous gap between our information and the actual experience and gut feelings. It is important to anticipate many overwhelming feelings! It is also crucial for therapists to be open and honest with themselves and each other about their counter-transferences. Second, we discovered that it is not hopeless! However, it is essential to provide structure via firm, consistent limits and goals. Adolescents need to feel protected by therapists who can manage the group's turbulence. Third, creative techniques frequently provide ways of dealing with feelings. Four, a treatment group cannot survive with too many acters-out; one or two may add spice and give permission to others to recognize and express feelings. Also, despite the often chaotic atmosphere, serious treatment takes place. It has been helpful to have Mrs. Friedman as our supervisor. At critical points, when we were overwhelmed, she helped with her objectivity and support, offering a clearer vision of actual treatment issues when feelings were high. At times when we felt depleted, Mrs. Friedman's support replenished us and we were able to return to the group with enthusiasm. In conclusion, it has been fun working as co-therapists. We have found that the sharing and mutual confrontation contributed significantly to our professional growth.