Breast carcinoma treated by conservative surgery: results of postoperative external radiotherapy with photons only and a nonsplit supraclavicular field.

Eighty-nine breasts in 85 patients were treated by lumpectomy and then radiotherapy from a Co-60 source only. The supraclavicular field was nonsplit. Eighty percent were in their 40s, 60s, or 70s with almost equal distribution. The majority of cases (80%) was T1 followed by T2 (18%). Axillary dissection was not done in 26% of patients. The majority (84%) had infiltrating ductal carcinoma; 6% had carcinoma in situ only. The dose to the breast including the boost was in the range of 6,000 cGy to 7,000 cGy in 96%, whereas in 4% it was in the range of 5,000 cGy. Forty-four patients (49%) with N0 did not have nodal irradiation. The dose to the nodes in the remaining patients ranged from 5,040 to 6,840 cGy. The cosmetic result was good to excellent in 99% of evaluated patients. There was telangiectasia in 1, arm edema in 2, no fibrosis in supraclavicular-tangential fields junction and no other soft-tissue or bone complications. Fifteen percent died; 6% had no evidence of cancer, and 9% had metastatic disease. Two had local recurrence, but with salvage mastectomy and systemic therapy were alive and well. The use of external photons only for breast irradiation and a nonsplit supraclavicular field yielded good results compared with alternative methods.

Lung carcinoma-M0. Patterns and results of radiotherapy of all patients referred to one department.

All patients with M0 carcinoma of the lung regardless of the histology, exclusive of Pancoast tumors referred to the same radiation oncology team from 1988 to 1992 were identified. They were 101 patients; 16 of whom were postoperative. To determine the patterns of radiation therapy and results, these cases were analyzed according to the radiation dose and volume irradiated. Fifteen patients had no or futile dose of radiation because of poor general condition. No prophylactic radiotherapy was intentionally given to the supraclavicular area. Relief of symptoms occurred in 87% of symptomatic, evaluable patients. Distant metastases developed in 20% of patients. There were no local recurrences in the nonirradiated supraclavicular or prophylactically irradiated mediastinal areas. Increasing the dose to the primary tumor from 6,000-6,500 to 6,600-7,000 cGy (180-200 cGy/fraction) was tried in a small number of patients with encouraging results.

Radiation reaction recall following simvastatin therapy: a new observation.

A 60-year-old woman was treated postoperatively for carcinoma of the gall bladder with a split course of radiotherapy. The tumour dose (TD) was 61.2 Gy in 34 fractions delivered by an anterior and two lateral wedge fields with 60Co; the Dmax was 70% of TD for the anterior field and 150% of the TD at the thin edge of the wedges. She also underwent 5-FU and leucovorin chemotherapy. No skin reaction was seen during radiotherapy or in 1 year of follow-up. A year after radiotherapy she was treated for hypercholesterolaemia by simvastatin. Within 2-3 days a severe skin and subcutaneous reaction developed in the lateral radiation fields but not in the anterior field. To our knowledge, recall of skin radiation reaction after simvastatin therapy has not been previously reported.

Case report: squamous cell carcinoma of the skin in both palms, axillary node, donor skin graft site and both soles--associated hyperkeratosis and porokeratosis.

A 74-year-old woman presented with skin squamous cell carcinomas on both palms, ankles and soles. The patient also had biopsy-proven porokeratosis. There was hyperkeratosis of the palms and soles. The left palm cancer was excised and skin grafted, but recurred. A nodule in the scar of the donor site of the skin graft in the left upper arm was biopsy-proven squamous cell carcinoma. A metastatic left axillary lymph node was excised. There were no palpable metastatic lymph nodes in either the groin or right axilla. All cancers were irradiated and disappeared, as did the incidentally irradiated hyperkeratosis. Porokeratosis may be associated with skin squamous cell carcinoma, yet in this case porokeratosis could not be identified in the heavily hyperkeratotic palms and soles. Despite poor prognostic signs, i.e. the location in the palm, and metastasis, the patient has done well so far.

Late results of combined iodine-125 and external beam radiotherapy in carcinoma of prostate.

A total of 96 patients were treated for localized carcinoma of the prostate using combined Iodine-125 (125I) implantation and external beam radiotherapy. The implant was tailored to deliver 10,000 rad to the periphery of the prostate. A significant incidence of serious late rectal complications was observed. Positive pelvic nodes were found in 28 percent of the patients. Disease-free survival at seven years was 76 percent for those with negative nodes and 46 percent for patients with positive nodes.

Results of radiotherapy in carcinoma of cervix stages I and II: the impact of involvement of endocervix.

The results of radiotherapy in carcinoma of the cervix stages I and II at the University of Missouri-Columbia (UMC) in the period between 1975 and 1980 were analyzed. The failure rate was 13/58 (22.4%). While the failure was 8% (3/36) in ectocervical cancer it was 45% (10/22) in endocervical cancer. The difference was statistically significant to a p value of 0.001. Ten of 13 failure cases (77%) had involvement of the endocervix. In endocervical carcinoma 7 of 10 (70%) of the failure cases had recurrence in para-aortic or supraclavicular nodes. The impact of age, differentiation and hemoglobin level was examined.

I-125 implant and supervoltage irradiation for treatment of T0-2 or T3 carcinoma of the prostate. The impact of invasion beyond the prostatic capsule and minimal nodal involvement.

Sixty-three consecutive patients with cancer of the prostate treated by pelvic lymphadenectomy, I-125 implantation +/- Co60 therapy were studied regarding the impact of extension of cancer beyond the capsule and minimal nodal involvement. Extension of cancer beyond the prostatic capsule, Stage T3, constituted 34%, while Stages T0-2 comprised 66% of the cases. The features of T3 compared with T2 or less were: higher incidence of younger age (50s), 29% vs. 19%; less well-differentiated cancer, 29% vs. 64%; higher incidence of pelvic node involvement, 52% vs. 18%; and higher incidence of recurrence, 24% vs. 4.7%. The involvement of only one or two pelvic nodes by microscopic cancer did not adversely affect the prognosis in T2 group over a relatively short period of follow-up. No local recurrence occurred in T2. In the T3 group, two of 21 (9.5%) developed local recurrence.

Clinical problems associated with dosimetry of 125-iodine for cancer of the prostate.

Dosimetry and clinical data for iodine-125 prostatic seed implants in 63 patients were retrospectively studied to evaluate the methods of calculating the effective implant activity. Our protocol called for 10 000 cGy to the periphery of the prostate from 125I and 4 000 cGy to the whole pelvis in 20 fractions from supervoltage. Most procedures used seed strengths of 20.35 to 21.09 MBq (0.55-0.57 mCi). The average number of seeds lost per patient was 2.1 without prior transurethral prostatic resection (TURP), and 5.6 with prior TURP. Specific precautions are recommended to minimize seed loss. In a 3 cm diameter gland with uniform seed distribution, the periphery received 10 000 cGy, while the central 2 cm diameter core received 20 000 cGy. Near the periphery there was a rapid decrease in dose averaging 1 390 cGy per millimeter radially. Because of this rapid fall-off, it may be misleading to specify the dose in cGy only. It is recommended that the total 125I activity per implant also be specified in the same way as mghr-of-radium-equivalent for cancer of the cervix. Recommended total activities needed for implantation in various prostate gland sizes are given.

Carcinoma of the prostate treated by pelvic node dissection, iodine-125 seed implant and external irradiation: a study of rectal complications.

The University of Missouri-Columbia protocol for localised cancer of the prostate calls for pelvic node dissection, 10000 cGy at the periphery of the prostate from 125I and 4000 cGy in 20 fractions to the whole pelvis using supervoltage X-ray therapy. Rectal complications were studied in 104 patients; acute and chronic reactions were defined. During external irradiation 54% did not develop diarrhoea, 43% had mild diarrhoea and 3% had severe diarrhoea. In the chronic stage 77% did not have diarrhoea, 12% had delayed, non-distressing rectal bleeding which did not need specific treatment or needed only simple treatment, 7% had prolonged distressing proctitis and 4% had rectal ulceration or recto-urethral fistula necessitating colostomy. Each of the four patients who had colostomy had an additional aetiological factor (arterial disease, pelvic inflammation, additional radiation, pelvic malignancy or second operation). None of the patients entered in the combined brachytherapy and teletherapy programme, and in whom 0.5 cm space was maintained between the closest seed and the rectal mucosa, developed prolonged proctitis.

Carcinoma of the prostate irradiated by combined I125 and external irradiation. Analysis of failure and significance of positive biopsy one year or more after therapy.

Sixty-three patients with cancer of the prostate T2 or T3 were evaluated. The protocol of treatment called for pelvic lymphadenectomy, 10,000 rad from I125 implant and 4000 rad in 20 fractions using a Cobalt60 machine. They were followed for 1 to 5 years with a plan to rebiopsy the prostate 1 to 2 years after therapy. Six of 59 evaluable patients (10%) showed progressive disease. Distinctive prognostic features in the failure group were younger age, larger prostate, more advanced stage, poorer differentiation, more possibility of positive pelvic lymph nodes, and if the nodes were positive, the involvement of more than two pelvic lymph nodes. On the other hand, the patients with controlled disease with or without positive prostatic biopsy on follow-up showed identical features regarding age, size of prostate, stage, differentiation, involvement of pelvic lymph nodes, and if the nodes were positive, only one or two nodes involved. Positive biopsy 1 to 2 years after radical irradiation in otherwise controlled disease is considered of no prognostic value.

Preliminary observations on the results of combined 125iodine seed implantation and external irradiation for carcinoma of the prostate.

Fifty-seven patients with localized carcinoma of the prostate were treated with pelvic lymphadenectomy and a reduced 125iodine implant dosage, supplemented by a moderate dose of external beam radiotherapy to the whole pelvis delivered 4 to 6 weeks later. The incidence of pelvic nodal metastases was 28 per cent and the operative morbidity was 15 per cent. Late radiation sequelae developed in 18 patients, including 15 patients with radiation proctitis (29 per cent), among whom 2 (4.6 per cent) suffered rectal ulceration and required diverting colostomy. Followup has been 2 years or longer (median 33 months) in 26 patients, of whom 22 (85 per cent) are free of disease. Three patients are living with osseous metastases or local disease and there has been 1 death of prostatic carcinoma, for an absolute 2-year survival rate of 95 per cent. Of the 7 patients with poorly differentiated tumor and of the 8 patients with positive pelvic lymph nodes 5 and 6, respectively, remain free of disease after a minimum 2-year followup. Potency has been lost in 20 per cent and reduced significantly in 30 per cent of the patients followed 18 months or longer. Prostatic biopsies on 28 asymptomatic patients 12 to 30 months after completion of therapy showed no tumor in 21 (75 per cent).

Wilms tumors in adults.

A 63-year-old man had an unresectable metastatic Wilms tumor in the right kidney. Radiotherapy to the abdomen and chest wall as well as chemotherapy in the form of actinomycin D, vincristine, and cyclophosphamide was given. The tumor was radioresponsive but failed to respond to chemotherapy. The literature was reviewed. Other reported cases of Wilms tumor in adults treated with chemotherapy that is usually given to children are few, but the results are mostly disappointing.

Combined I125 seed implant and external irradiation for carcinoma of prostate.

Localized carcinoma of the prostate was treated in 20 patients by pelvic lymph node dissection, radioactive iodine implant and external radiotherapy. Treatment was well tolerated. Pelvic lymph node involvement was present in 35% of the patients. Well-differentiated cancers were essentially in small prostates (3 cm), stages T1 or T2. They had a lower possibility (10%) of metastasis to only one pelvic lymph node. None had more than one lymph node involved. Moderately or poorly-differentiated cancers occurred in larger prostates (4 cm or more), stage T3. They had a high likelihood (60%) of pelvic node involvement.

Comparative effect of x-ray and ultrasound (inducing hyperthermia) on the testes of rats--a rationale for male castration by ultrasound.

The testes of rats were treated by x rays, or ultrasound. 2000 rads single dose of x ray led to tubular atrophy, which was defined as destruction of all spermatogenic cells but Sertoli cells. Ultrasound of 1 W/cm2 for 15 min led to tubular necrosis, which was designated as complete disorganization of the seminiferous tubules with disappearance of spermatogenic as well as sertoli cells. The possibility of male castration by ultrasound is raised.