Radiation management of carcinoma of the tonsillar region.

This is a retrospective analysis of 185 patients with squamous cell carcinoma of the tonsillar region treated at the Department of Radiation Oncology, University of Maryland Hospital from 1956 to 1977. All patients were treated by one of the following: (1) external beam therapy alone; or (2) combined external beam and interstitial brachytherapy. Five-year disease-free survivals, for early Stages (I and II), are 100% and 73%, comparable to the other series published in the literature. However, in advanced Stages III and IV, survival data showed 52% and 21%, respectively, 5-year disease-free survival better than any other reports. It is thought that the special interest of the authors in interstitial brachytherapy and a well-integrated plan of external beam and brachytherapy is responsible for this success. The local control rate for T1, T2, T3, and T4 was 94%, 88%, 62%, and 19%, respectively, with the overall regional control rate of 83%. The prognostic factors appear to be related to the T-factor, N-factor, radiation dose, and method of treatment given, and the degree of tongue involvement. The detailed analysis of survivals and failures in the light of dosimetric study is presented along with some example cases of interstitial brachytherapy.

Adenocarcinoma arising in female urethral diverticulum.

Cancer arising from a female urethral diverticulum is rare, and because of its rarity, a review of the medical literature reveals significant nonuniformity in its management. We report an additional 2 cases of this disease, one of which has an even rarer feature of being mucin-producing. The management of our 2 cases is presented in detail and in line with the management of female urethral cancer. From our extensive literature search, diverticulectomy alone showed poor results with the highest rate of recurrence (67%). Extensive surgery, either in the form of cystourethrectomy or anterior exenteration, offered results comparable with those of combined therapy (diverticulectomy and full course of irradiation for early cases; preoperative irradiation followed by cystourethrectomy for late cases). Individualization of radiation treatment and cooperative effort between urologist and radiation oncologist are essential if best results are to be achieved.

Radiation management of advanced nasopharyngeal cancer.

During the period from 1957-1976, 70 patients with advanced malignant tumors of nasopharynx were treated by irradiation in the Department of Radiation Therapy, University of Maryland Hospital. Forty-nine patients were treated with curative intent and 21 patients with palliative purpose. Of 49 patients treated for cure, 22 (45%) survived disease-free for at least 5 years. Local control was achieved best (92%) by combined treatment, external beam and brachytherapy. Factors responsible for local control and disease-free survival, appear to be related to clinical staging (primary and nodal disease), cell types and treatment used. In spite of aggressive radiation treatment for advanced cases (Stages III and IV), distant disease is still a major problem and will necessitate further trial by combined chemotherapeutic treatment with irradiation. This article highlights the results and failures of the technique of the irradiation, both external and brachytherapy. It is suggested that aggressive radiation treatment using a combined approach (external beam and brachytherapy, whenever possible) be done in all cases for cure. Palliative treatment can only offer a short-term symptom-free status in 72% of all cases treated.