Long-term results from the first UKCCSG Ewing's Tumour Study (ET-1). United Kingdom Children's Cancer Study Group (UKCCSG) and the Medical Research Council Bone Sarcoma Working Party.

The aim of this study was to evaluate multimodal chemotherapy and radiotherapy in patients with Ewing's sarcoma. 142 (74 male, 68 female) patients were entered into the ET-1 study between 1978 and 1986. They were treated with vincristine, doxorubicin, actinomycin D, and cyclophosphamide with radiotherapy plus or minus surgery to the primary tumour. Of the 120 who had no metastases at diagnosis, 45 remain alive with a median follow-up of 11.2 years. Only 2 of those with metastases at diagnosis remain alive. The major prognostic factor was site of disease, but age and serum lactic dehydrogenase at diagnosis also had an influence on outcome. 45 of the 61 patients who survived 4 years or more had late effects documented. The type and extent were dependent on tumour site, type of local therapy, volume and dose of radiotherapy. 4 patients had second malignancies. Prospects for long-term survival have improved in patients treated for Ewing's sarcoma. However, late sequelae are present in the majority of patients.

Carcinomatous meningitis: antibody-guided therapy with I-131 HMFG1.

Seven patients with carcinomatous meningitis were administered intrathecal I-131 labelled monoclonal antibody HMFG1. Clinical responses were seen in two patients, with a long term survivor at 32 months. Aseptic meningitis occurred in 4/7 patients, but more serious toxicity was observed in the form of seizures (2/7 patients) and myelosuppression (3/7 patients). Partial obliteration of the subarachnoid space was identified as a potential problem in patients with advanced disease.

A new technique of brachytherapy for malignant gliomas with caesium-137: a new method utilizing a remote afterloading system.

Failure of conventional treatment to cure malignant gliomas has stimulated interest in various forms of brachytherapy. We describe a new method of using intracranial radiation utilizing a remotely-controlled afterloading system with a modified endotracheal tube as the applicator. The system used is the Selectron LDM/MDR (Nucleotron) which is a sophisticated machine widely available at radiotherapy centres and primarily used to treat gynaecological malignancies. It uses Caesium-137 in the form of spherical pellets in a linear source train within a sealed system. The applicator is implanted at the time of surgical resection. The inflated balloon stabilises the applicator and allows a suitable dose distribution at a distance from the source train to be achieved. Details of the implantation and radiation procedures as well as the dosimetry calculation are presented. The advantages are simplicity of use, the elimination of radiation risk to personnel and the combination of cytoreduction and applicator implantation in one surgical procedure.

Pulmonary changes in breast cancer patients treated by three different radiotherapy techniques.

Twenty eight patients with breast cancer were studied by CT, perfusion scans and pulmonary function tests to assess the extent of post-irradiation changes. The patients had been treated by three treatment techniques using either two, three or four fields with different amounts of lung included in the target volume. The most extensive changes were seen in those patients who received treatment to the mediastinum.

Radiation-induced chondrocalcinosis of the knee articular cartilage.

A case of a middle-aged man with symptomatic, localised chondrocalcinosis of the knee following irradiation is described. Cartilage damage induced by radiotherapy should be added to the list of local factors which can predispose to chondrocalcinosis.

A pilot study of 131I monoclonal antibodies in the therapy of leptomeningeal tumors.

A pilot study was performed to investigate the toxicity and therapeutic effect of radiolabeled antibody administered intrathecally in patients with leptomeningeal tumors. Five patients who failed conventional therapy received between 11 mCi and 40 mCi of radiolabeled antibody. The choice of antibody varied depending on the immunophenotype of the tumor. Therapy was well tolerated generally, with minimal acute toxicity. Four of five patients achieved an objective response to treatment that has been sustained for a period varying from 7 months to 2 years. No clinical signs of chronic toxicity have been observed in patients 1 and 2 years after therapy.

Growth and endocrine function after treatment for medulloblastoma.

Children with medulloblastoma in Bristol are treated surgically and with craniospinal irradiation, and in some cases chemotherapy. Thirteen medium or long term survivors were investigated to determine their growth and endocrine function. Their rate of growth was considerably reduced through the first year of their illness and after spinal irradiation spinal growth was poor. Nine children developed growth hormone deficiency. They were clinically euthyroid but 7 had raised basal thyroid stimulating hormone values. Gonadal function was abnormal in all but the youngest child. The rate of survival is increasing in children with medulloblastoma but this is associated with appreciable endocrine abnormalities. Some of these problems are present shortly after treatment ends but others may develop later and long term surveillance is therefore essential.

Half-body irradiation in the treatment of metastatic prostatic carcinoma.

High dose radiation therapy given as a single fraction to the upper and lower halves of the body gives effective palliation for metastatic solid tumours. This treatment modality appears to be particularly effective in tumours which may have a slow doubling time such as carcinoma of the prostate. Fifty-two patients with metastatic carcinoma of the prostate involving the skeletal system have received half-body irradiation. All had prior treatment with additive hormones or orchiectomy and the majority had received localised irradiation and/or chemotherapy. Significant immediate pain relief was achieved in 42 out of 52 patients (80%). This pain relief was maintained until death in 29 out of 43 patients (67%). Pain relief in responders appears to occur within 24 to 48 h of treatment.

U.K. and European trials of chemotherapy in osteosarcoma.

Three current studies of treatment of osteosarcoma are reviewed and the results of a small completed study of adjuvant chemotherapy are given. The Medical Research Council has 152 patients in a continuing trial comparing two differing adjuvant chemotherapy schedules. The European Organisation of Research on the Treatment of Cancer, together with the International Society of Paediatric Oncology, are undertaking a three-arm trial of chemotherapy, lung irradiation, and chemotherapy plus lung irradiation, as adjuvant treatments in osteosarcoma, in which 85 patients have been entered as of September 1979. The Bristol Bone Tumour Registry treated 11 patients with a regimen consisting of intermediate-dose methotrexate and doxorubicin given for 1 year postoperatively, and have 64% of patients alive and disease free at a followup period of 42 to 62 months. A further study, based in Bristol, of chemotherapy and surgical excision of lung metastases has 8 of 14 patients free of disease, 3 to 25 months from thoracotomy.

Total body irradiation as a secondary therapy in non-Hodgkin's lymphoma.

Twenty-six patients with non-Hodgkin's lymphoma have received total body irradiation (TBI) as a secondary therapy. A response was achieved with 17 patients, in six of whom it was complete. The actuarial survival rates were 50% at one year and 42% at 30 months. Best results were achieved in those with low grade histology and in those under 60 years of age. Transient marrow toxicity was the only detected significant side-effect of treatment and although it was usually severe there were no serious sequelae. TBI should be considered as a secondary therapy in non-Hodgkin's lymphoma, regardless of previous treatment.