Failure of open radioactive 125iodine implantation to control localized prostate cancer: a study of 41 patients.

We studied 41 patients with localized prostate cancer who underwent bilateral pelvic lymphadenectomy with open insertion of radioactive 125iodine. Followup was a minimum of 5 years. Of the patients 13 died: 10 of recurrent prostatic adenocarcinoma (including 4 of 5 with pathological stage D1 cancer) and 3 of unrelated causes within 2 years of implantation without clinical evidence of prostate cancer. Of the 28 remaining patients 16 have known recurrence of cancer (positive bone scan and increasing prostate specific antigen (PSA) level or positive tissue biopsy]. Six patients have strong suspicion of local recurrence with elevated PSA levels (greater than 4.0 in 5) and increasing induration on digital rectal examination. Only 6 of the 41 patients (14.6%) are without evidence of disease. Openly implanted radioactive 125iodine does not appear to control effectively adenocarcinoma of the prostate.

Chemotherapy is superior to sequential hemibody irradiation for remission consolidation in multiple myeloma: a Southwest Oncology Group study.

Six hundred fourteen previously untreated patients with multiple myeloma were evaluated on this phase III Southwest Oncology Group (SWOG) trial. For remission induction, two noncross-resistant drug combinations (vincristine, melphalan, cyclophosphamide, and prednisone [VMCP] and vincristine, carmustine [BCNU], Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH], and prednisone [VBAP]) were administered with either a direct alternating or a syncopated schedule. Pretreatment serum beta-2 microglobulin (beta 2M) was the single most important prognostic factor for survival (P less than .0001). There was no difference in toxicity, response, or survival by induction chemotherapy schedule (P greater than .7). For consolidation, 180 eligible and responsive patients were randomized to receive either an additional year of VMCP or sequential hemibody radiation (HBI) with vincristine and prednisone (VP) administered between the two HBI courses. Relapse-free survival (26 months) and overall survival (median, 36 months) were better with VMCP than with HBI (median, 20 months and 28 months; P = .04 and .018, respectively). HBI was also evaluated on a nonrandomized basis in 66 patients who achieved either a partial response (PR) or who were nonresponders to induction therapy. While HBI converted 24% of the PR patients to remission status, this effect was only seen in 5% of nonresponding patients. The survival of responsive and nonresponding patients receiving HBI was similar. All HBI groups had an inferior outcome to those receiving VMCP consolidation. Myelosuppression was also significantly worse after HBI. Survival from the time of relapse did not differ between patients randomized to receive VMCP or HBI. Thus HBI induced less durable remissions, but did not render patients less amenable to postrelapse chemotherapy. Our findings do not support the use of HBI in either chemotherapy responsive or nonresponding patients with multiple myeloma.

Cisplatin and adriamycin combination chemotherapy for uterine stromal sarcomas and mixed mesodermal tumors.

Twenty-eight patients with a uterine stromal sarcoma or mixed mesodermal tumor were treated with cisplatin 100 mg/m2 and Adriamycin 45-60 mg/m2, given with intravenous hydration every 3 to 4 weeks. Group I consists of 11 patients with measurable disease following initial surgery or with a recurrence. Eight of the eleven evaluable patients with measurable disease had a response (73%), and three of these patients have had a negative second-look procedure, and two are alive and disease free more than 24 months after initiation of treatment. Group II consists of 17 patients treated with adjuvant chemotherapy after primary surgery. The patients were selected for adjuvant therapy based on previous established poor prognostic features. Of the 17 patients in group II, 14 had invasion of the outer one-third of the myometrium and the other three had invasion to the middle one-third. Seven had documented positive pelvic and/or periaortic lymph nodes and five had positive peritoneal washings. With a median follow-up of 34 months, there have been only four recurrences in group II. Two of the recurrences occurred in patients who discontinued therapy after only two cycles of chemotherapy. There is a projected 5-year survival of 75% in these high-risk patients. Of the seven patients with documented nodal involvement, one patient died with a recurrence at 23 months, one patient died from a perforated diverticulum, and the other five are alive and disease free with a median follow-up of 36 months (34-90 months). Two patients with multiple positive nodes are disease free at more than 5 years. Combination chemotherapy with cisplatin and Adriamycin has a high response rate with advanced measurable disease and improves survival in high-risk patients who receive it as adjuvant therapy.

Phase I pilot study on fast neutron teletherapy for advanced carcinomas of the head and neck region. Final report on local control rate and survival.

A final report is presented on the local control rate and length of survival for 100 patients with advanced squamous cell carcinomas of the head and neck region who received fast neutron teletherapy at the University of Washington during the period 1973 through 1977. Sixty-two patients were treated with neutrons alone and 38 were treated with a combination of neutrons and photons as part of a mixed beam fractionation scheme. The overall initial complete remission rate was 68% for the mixed beam group and 44% for the group treated with neutrons alone. Initial complete remission rates for the two groups of patients are given as a function of T-stage and N-stage and acturarial curves are presented which show the time course of local control and survival for the two treatment groups. For T3 and T4 lesions the initial complete remission rate appears to be greater using the mixed beam form of treatment than using neutrons alone. Treatment to high-dose levels using neutrons alone gave rise to significantly greater morbidity--both acute and late effects--than resulted from the mixed beam form of treatment. Local control rates and survival rates are compared with similar groups of patients treated with neutrons at other institutions.

Carcinoma of the tonsillar region: results of external irradiation.

A retrospective analysis is made of 104 patients treated with photon megavoltage radiotherapy for squamous cell carcinoma of the tonsillar region during the period 1965--1975. Moderately differentiated squamous cell carcinoma was the most common histological grade. Fifty-three per cent of the cases presented with cervical lymphadenopathy with three cases of bilateral involvement. The three year local control rate was 100% for Stage I, 74% Stage II, 49% Stage III, and 33% Stage IV. Two Stage III cases and one Stage IV case developed subsequent contralateral neck disease. No patient with either T1N0 or T2N0 tumor failed in the ipsilateral or contralateral neck despite the fact that 42% of the T1N0 cases and 37% of the T2N0 cases were treated with unilateral portals. The prognostic significance of the T and N stages, treatment techniques, as well as dose response relationships are analyzed and the literature is reviewed.

Solitary plasmacytoma of bone and soft tissues.

Between 1956 and 1978, nine patients with solitary plasmacytoma of bone (SPB) and seven with extramedullary plasmacytoma (EMP) were treated at the University of Washington Hospital and Swedish Tumor Institute. All but one patient had local radiotherapy. In the SPB group, six of nine patients progressed to multiple myeloma (MM) and five died of disease within three years after dissemination. Three of the nine patients are alive at 5, 8, and 16 years, respectively. In the EMP group, none of the seven patients progressed to MM. Five are alive 16 months to 23 years after radiotherapy. Since there are no reliable criteria for prospectively distinguishing true solitary plasmacytoma from occult MM, all patients with apparently isolated plasmacytoma should receive local radiotherapy with curative intent.

The role of radiation therapy in the treatment of glomus jugulare tumors.

The records of 14 patients who received irradiation for incompletely excised, inoperable or recurrent glomus jugulare tumors were retrospectively reviewed. Ages ranged from 12 to 66 years, and the male to female ratio was 1:3. With a follow-up time of 1.3 to 17.2 years (mean of 7.7 years), 11/14 remain clinically disease-free. Doses of at least 4000 rad are shown to be effective in controlling glomus jugular tumors.

The effectiveness of prophylactic brain irradiation in small cell carcinoma of the lung: a Southwest Oncology Group study.

Brain involvement in small cell carcinoma of the lung is a common phenomenon occurring in from 29 to 45% of patients. Because of this, it was suggested that prophylactic brain irradiation be made a part of treatment plans for small cell carcinoma. In December 1974, the Southwest Oncology Group (SWOG) began treating patients with combination chemotherapy and irradiation of both the primary lesion and whole brain. In two years, there were 390 patients entered into the study. In patients with extensive disease only 6 of 152 prophylactically irradiated patients developed CNS signs or symptoms of CNS recurrence. In limited disease, 6 of 88 prophylactically treated patients had CNS recurrence and in only 4 was this the site of initial failure. We feel prophylactic brain irradiation in small cell carcinoma of the lung is of benefit.

Are pelvic irradiation and routine staging laparotomy necessary in clinically staged IA and IIA Hodgkin's disease?

Thirty-nine patients with clinically staged IA and IIA Hodgkin's disease were treated with mantle plus paraaortic/splenic irradiation between 1968 and 1975. All patients had supradiaphragmatic presentations, and none had staging laparotomies. With a follow-up time of 1 to 9 years, mean 4.3 years, the overall relapse-free survival is 92% (100% for stage IA and 89% for stage IIA). The absolute relapse-free 5-year survival is 91% There were no pelvic recurrences. These data show that routine staging laparotomy and pelvic irradiation are not indicated for clinically staged IA and IIA Hodgkin's disease with supradiaphragmatic presentation. The criteria for staging laparotomy in early-stage Hodgkin's disease are discussed.

Ultrasonic evaluation of radiation therapy ports.

Radiation therapy is useful in the palliative treatment of large, unresectable abdominal and pelvic malignancies. The purpose of this study is to evaluate the effectiveness of B mode ultrasound scanning as an adjunct in radiation treatment planning of these patients. Fifty-one patients with large abdominal or pelvic masses had radiation therapy ports established using findings from surgery, radiographs, and physical examination. All the patients then had B mode ultrasound examinations. The position of the therapy ports was marked on the echogram. Thirty-one of the 51 patients studied (61%) had evidence of extension of tumor beyond the therapy ports. This was often due to "iceberging", i.e. when the deep portion of the tumor was considerably larger than the palpable margins of the superficial portion. B mode ultrasound scanning is a valuable adjunct in planning palliative radiation therapy of patients with large, unresectable, abdominal and pelvic malignancies.

A therapeutic audit at autopsy.

A survey of one hundred patients submitted to autopsy has been carried out to assess the contribution of investigational procedures, surgery and drug therapy to death. In nineteen patients drug therapy, usually appropriate and necessary therapy, was thought to have contributed to death. In five patients failure to continue therapy properly contributed to death. The survey was not representative either of patients dying in hospital or in the community, but it suggests that a larger and more comprehensive survey should be undertaken.

Errors of drug prescribing.

Seven thousand five hundred and twenty-six prescriptions written for eight hundred and forty patients in three hospital wards have been analysed for errors of drug use and errors of prescription writing. 2. According to the criteria adopted for this survey, more than 3% of prescriptions contained an error of drug use and more than 30% an error of prescription writing. 3. The incidence of adverse drug reactions, overdosage and undertreatment might be reduced by more careful prescribing.