Heart and kidney transplantation using total lymphoid irradiation and donor bone marrow in mongrel dogs.

Heart and kideny allografts showed markedly prolonged survival in unrelated mongrel dogs following total lymphoid irradiation (TLI) and donor bone marrow without any other immunosuppression. In every animal the heart survived longer than the kidney; genetic disparity was ruled out, since the heart and kidney from the same donor were placed into one recipient. Placing the kidney allograft in the abdomen with the bone marrow given intraperitoneally doubled kidney survival over placement in the neck, but heart survival was equally prolonged in the abdomen or neck. Splenectomy before TLI or after TLI, but just before transplantation, almost completely eliminated the prolonged survival of both heart and kidney allografts. Thus there is suggestive evidence from the work of Slavin and his colleagues and from our study that TLI plus bone marrow from the donor may be valuable for transplantation in man, particularly heart transplantation.

Adenocarcinoma of the esophagus.

The relevant literature is reviewed in an attempt to clarify the true frequency of intraesophageal adenocarcinoma and to evaluate the different treatment modalities and survival of this uncommon type of tumor. The incidence of intraesophageal adenocarcinoma in reported clinical series is about 1%, and data from cancer registries show the incidence to be about 2% for upper and the middle thirds, a more reliable figure than that for the lower third in which lesions of cardia, or stomach infiltrating the lower esophagus have been included. The benefits of any particular treatment modality are difficult to evaluate in view of the rarity of this type of tumor, and the treatment results are as poor as those obtained in the treatment of squamous cell carcinoma.

Autopsy findings in carcinoma of the esophagus.

At autopsy of 82 cases of carcinoma of the esophagus over a period of 25 years metastatic tumor was found in 42 cases (51%) and residual tumor in the esophagus in 56 cases (86%). The most frequent site of metastases was in the lymph nodes, followed by liver, lung, and adrenal gland. Direct extension of the tumor to adjacent structures was established in 30 cases (36%), and the most frequent structure involved was the trachea. Five cases had a second primary and two cases a second separate lesion at another level of the esophagus.

Metastasis to neck from unknown primary tumor.

The records of 54 consecutive patients who were irradiated for metastatic disease in the neck from an unknown primary tumor were reviewed. The overall survival results are comparable to those of other reported series. Patients with high or posterior cervical lymph node involvement were irradiated with fields including the nasopharynx and oropharynx. Patients with high neck nodes had a better survival rate than those with low neck nodes. The size of the neck tumors and the local control after treatment also have prognostic significance.

Failures after irradiation in early vocal cord cancer.

Radiation therapy for early laryngeal cancer offers an excellent probability of cure as well as preservation of vocal function. Reported failure rates range from 9 to 21% in patients with T1 lesions, and from 28 to 44% in those with T2 lesions, the majority of whom are subsequently salvaged by surgery. Results obtained at the Radiotherapy Center of the University of Wisconsin Hospitals in 44 patients during the period from 1960 to 1972 yielded failure rates of 21% in patients with T1 tumors and 38% in patients with T2 tumors at 5 years. Five of the eight recurrences were salvaged with surgery yielding an overall tumor control rate of 93%. The larynx was preserved in 82% of the cases. Determinate 5-year survival was 91% in T1 cases and 86% in T2 cases. Failure rates at 3 years were 18% for T1 tumors and 30% for T2 lesions. These results are in conflict with those reported by Brandenburg and Rutter as being 46% and 60% respectively. Ultimate success in the treatment of laryngeal cancer rests in the full cooperation between surgeons and radiotherapists.

Why retroperitoneal lymphadenectomy for testicular tumors?

Most patients with seminoma can be managed successfully with irradiation after a high inguinal orchiectomy. Since anaplastic seminoma has a high predilection for dissemination adjuvant chemotherapy with an alkylating agent, such as L-phenylalanine mustard, is advised. There is much more controversy regarding the management of patients with non-seminomatous tumors. Because lymphangiography has an accuracy of about 90 per cent the justification of a retroperitoneal lymphadenectomy for staging purposes is no longer valid. Irradiation of the retroperitoneal and pelvic lymph nodes in a good survival rate for patients with clinical stages I and II diseases. It is anticipated that with limited resection in selected stage IIB patients and with the judicious use of elective or adjuvant chemotherapy the results in these patients may be improved further. The morbidity associated with retroperitoneal lymphadenectomy is no longer justified since equally effective alternative approaches with lower morbidity rate are available.

Anaplastic seminoma.

Eight patients with the diagnosis of anaplastic seminoma of the testicle were treated during the megavoltage era from January 1959 to January 1976. Two patients with Stage I disease and one patient with Stage IV disease have died from their malignancy. By contrast, 57 patients with typical seminoma were treated during the same interval and with the same treatment methods. However, only two patients with typical seminoma have died. One of these patients had Stage II disease and one had Stage IV disease. There were no deaths among patients with Stage I typical seminoma. These results suggest that anaplastic seminoma has a poorer prognosis than typical seminoma even when the diseases are compared stage for stage. Implications for therapy are discussed.

Age as a prognostic indicator in carcinoma of the lung.

Selected elderly patients with squamous cell carcinoma localized to the lung should be considered for radical irradiation. Age should not be used as a negative prognostic indicator. This group of patients has a lower incidence of distant metastasis and local control may produce long-term survival. Radical irradiation is well tolerated, particularly as a split course, and serious complications are few.