Histiocytosis X: does radiotherapy still have a role?

Seventeen cases of histiocytosis X are presented (11 children and 6 young adults, with the usual male predominance), having a minimum follow-up of 1 year and a maximum of 20 years. In these age groups, even small doses of radiation should not be given without careful consideration, but fairly low doses carry only a small risk and may be very useful in management. Unlike chemotherapy, radiotherapy can be confined to the affected area, or to the area causing symptoms. All but two of our patients had radiotherapy for bone deposits; only one failed to show a complete response. In addition, the diabetes insipidus of two children responded immediately to radiation of the pituitary. One patient, however, after responding well to radiation for bone deposits, suffered increasing symptoms due to lung involvement and the latter showed no response. This striking contrast in radiosensitivity is hard to explain, given the identical histology obtained by biopsy from each site, but it has been noted many times by others.

Soft tissue sarcoma: two cases of solitary lung metastasis more than 15 years after diagnosis.

Soft tissue sarcomas may behave unpredictably. We present two adult cases in which solitary pulmonary metastases have occurred, 18 and 16 years after diagnosis. In both cases the primary disease was successfully controlled by conservative surgery combined with radiotherapy.

Prognostic factors in thyroid tumours.

Using Cox's Proportional Hazard Model, we have demonstrated the influence of age, sex, microscopic tumour type, extent of primary tumour, nodal status and the presence of metastases on prognosis, in our population of 441 patients with thyroid carcinoma. The TNM classification contributes significantly to survival, but does not include other contributory prognostic variables, whereas the prognostic index developed by the EORTC thyroid study group, which takes account of age and histology, proved a reliable predictor of survival for our patient group.