Mixed beam radiation therapy for unresectable squamous cell carcinomas of the head and neck: the results of a randomized RTOG study.

Three hundred and twenty-two patients with inoperable squamous cell carcinomas of the head and neck were entered on a randomized study comparing "mixed beam" radiation therapy with photon radiation therapy. Patients with histologically proven tumors of T-stage T2, T3, or T4 and any N-stage originating in the oral cavity, oropharynx, supraglottic larynx, or hypopharynx were eligible. One hundred forty-five patients were randomized to photon treatment and 177 were randomized to mixed beam treatment. No significant differences could be demonstrated between the experimental and control groups for primary tumor control or overall survival, although there was an advantage for mixed beam treatment over photon treatment for patients with metastatic cervical adenopathy (69 vs. 55% complete response rate in the nodes, p = .024). It is concluded that mixed beam radiation therapy does not offer a significant advantage over photon radiation therapy for patients with advanced squamous cell carcinomas of the head and neck.

Fast neutron irradiation of metastatic cervical adenopathy: the results of a randomized RTOG study.

Between 1977 and 1982, 199 evaluable patients with measurable cervical adenopathy were entered on a prospective, randomized RTOG study evaluating the use of fast neutrons in treatment of advanced, inoperable squamous cell carcinomas of the head and neck region. One hundred-eleven patients were randomized to receive mixed beam radiation therapy, and 88 were randomized to the photon control treatment. The complete response rates were 86% for mixed beam vs 75% for photons for Stage N1 nodes, 62% for mixed beam vs 48% for photons for Stage N2 nodes, and 63% for mixed beam vs 53% for photons for N3 nodes. The percents of patients remaining free of their adenopathy for two years were 78% for mixed beam vs 55% for photons for Stage N1 nodes, 39% for both mixed beam and photons for N2 nodes and 24% for mixed beam vs 13% for photons for N3 nodes. The median disease-free status was 20.3 months for mixed beam treated patients and 6.4 months for photon-treated patients. Patients who had clearance of cervical adenopathy survived significantly longer than those who did not.

Fast neutron beam radiation therapy in the United States.

Following a 30-year hiatus after Dr. Stone's work in the 1930's and 1940's, clinical trials with fast neutrons were restarted in the United States in 1972. Approximately 2500 patients have been treated with neutrons since that time. Three hundred and seven patients with squamous cell carcinomas of the head and neck were entered on an RTOG-coordinated randomized study comparing standard photon irradiation with mixed beam radiation therapy. No significant differences were noted in the local control, survival or complication rates. One hundred and sixty patients were entered on a randomized glioblastoma study. Although there were no significant differences in median survival, autopsy results showed greater tumor effect on the neutron-treated tumors. Twenty-six patients were treated for transitional cell carcinomas of the bladder with either preoperative mixed beam irradiation or mixed beam irradiation alone. Both the local control rates and survival rates compare favorably with photon radiation therapy. The future of fast neutron beam radiation therapy in the United States is discussed.

New dimensions in computed tomography.

Total body CT scanning may be utilized as a means of treatment planning for radiation therapy. Computer reconstruction of coronal and sagittal views from CT cross-sectional slices was accomplished by taking each of the cross-sectional images and placing them together in the specific order in the sequence in which they were scanned to form a cube. Once the cube is built, retrieving in the sagittal and coronal views is readily achieved.

Further progress in CT scanning and computerized radiation therapy treatment planning.

Total body computed tomography has introduced a unique method of obtaining body contours as well as anatomical representations for radiation therapy treatment planning. CT scanning combined with computerized radiation therapy treatment planning has improved accuracy and contributed greatly to the solution of complex treatment problems. CT scans can also be used to evaluate the progress of patients undergoing radiation therapy.

Definitive treatment of carcinoma of the rectum by intracavitary radiation therapy.

A combination of external and contact irradiation treatment has been used successfully in treatment of selected patients with carcinoma of the rectum. The advantages include eliminating a permanent colostomy. If the treatment is unsuccessful in controlling the lesion, electrocoagulation and abdominoperineal resection are still available.

The use of computed tomography for radiation therapy treatment planning.

In this treatment planning method, information from total body scans is fed into a radiation therapy treatment computer, the Artronix PC-12 system with 16K core. By providing an accurate profile of the patients's anatomy, total body computed tomography may contribute greatly to the solution of complex treatment problems involving the head and neck, thorax and abdomen.

Scanning and angiography in the diagnosis of pulmonary embolism.

Lung scanning is a safe and simple procedure which, when correlated with chest roentgenograms and clinical picture, is a valuable tool in diagnosing pulmonary embolism. Pulmonary arteriography is a valuable diagnostic procedure and should be employed when serious doubt exists as to the presence or absence of pulmonary emboli. It should also be used whenever surgical treatment is under consideration.