History Of Prior Irradiation Research Articles

Postirradiation sarcomas. A single-institution study and review of the literature.

With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop in the irradiated field after radiation therapy (RT). The authors undertook a study to estimate the risk, and compared the risk of postirradiation sarcoma (PIS) with other treatment modalities used against cancer. Since 1987 the authors have reviewed the records of 1089 patients with head and neck, gynecologic, gastrointestinal, and extremity sarcomas. Of these 1089 patients, 37 had a prior history of RT. Conditions for which these patients received RT included: Hodgkin's disease (2 patients), retinoblastoma (3), non-Hodgkin's lymphoma (2), acne (1), astrocytoma (1), multiple recurrent mixed parotid tumor (1), laryngeal cancer (1), papillary adenocarcinoma of the thyroid (1), bony fibrous dysplasia (1), lymphangioma (1), squamous cell carcinoma of the nasopharynx (1), Ewing's sarcoma (1), choriocarcinoma (1), menorrhagia (4), cervical cancer (6), ovarian cancer (2), breast cancer (7), and hypoplasia (1). RT doses ranged from 3000 to 12,440 cGy. Latency time from RT to the development of PIS averaged 12 years. More than 15,000 patients have received RT for various conditions at our institution since 1955. From our data and a review of the literature, we estimate the risk of PIS with long-term follow-up to be 0.03-0.8%. From a review of the literature that compared mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Thus, given the large number of patients who can be cured or receive palliative treatment with RT, concern regarding PIS should not be a major factor influencing treatment decisions in patients with cancer.

Association of hyperparathyroidism with nonmedullary thyroid carcinoma: review of 31 cases.

In a series of 948 patients operated on for primary hyperparathyroidism (HPT) by one surgeon (JNA) from 1952 to 1992, there were 242 (26%) instances of coincidental thyroid and parathyroid disease. Of these, 211 had benign thyroid lesions. In the remaining 31 cases HPT was associated with nonmedullary thyroid carcinoma; all were treated by resection of parathyroid adenomas and thyroidectomy. One patient died of unrelated cause (carcinoma of breast) 11 years following surgery. The remaining 30 patients are living and well 2 to 20 (mean 8.2 years) years after surgery; there was no recurrence or thyroid cancer-related mortality in the series. In contrast to prior reports, only six (20%) of our patients had a history of prior radiotherapy. We suggest that during neck exploration for HPT, the entire thyroid gland be evaluated and all palpable nodules resected and submitted to pathologic study.

Local hyperthermia, radiation therapy, and chemotherapy in patients with local-regional recurrence of breast carcinoma.

We retrospectively reviewed the response rate and the acute and long-term toxicity of combined treatment using radiation therapy, hyperthermia, and chemotherapy in 29 patients with locally or regionally recurrent or advanced adenocarcinoma of the breast who completed at least 4 of the 6 prescribed hyperthermia treatments as part of a Phase I-II trial. Thirty-nine separate hyperthermia treatment fields were evaluated. Cisplatin alone or cisplatin with etanidazole or bleomycin was delivered just prior to hyperthermia once weekly. Hyperthermia was delivered to a target minimum tumor temperature of 43 degrees C +/- 0.5 for 60 min. Following hyperthermia, a 400 cGy fraction of radiation was given. The radiation fraction size on other days was 200 cGy. Twenty-two fields had previously been irradiated and 17 fields had not. Prior chemotherapy had been given in 24 of 29 patients (83%) and hormonal therapy given in 21 (72%). The median follow-up time is 10 months; 16/29 patients (55%) have died of disease. The overall complete response rate for all fields was 53%. Response rate was not related to any clinical factor, radiation dose, microwave or ultrasound technique, type of chemotherapy, or tumor temperatures, but the number of patients in the study population was small. A statistically significant association between the likelihood of complications and the total radiation therapy dose (previous radiation and present radiation) was found. Persistent ulceration lasting greater than 1 month after completing treatment was seen in 67% of previously irradiated fields compared to 21% of fields that had not been previously treated (p = 0.015). Surgical wound repair was needed for 38% of fields with a history of prior irradiation versus 6% of those without prior treatment (p = 0.050). A statistically significant radiation therapy dose response was found for the likelihood of these complications. None of the hyperthermia temperature parameters studied correlated with an increased risk of complication. We conclude that the combination of radiation therapy, hyperthermia, and chemotherapy results in a high rate of complete response. However, in patients who have been treated with prior radiation therapy, this combination may be more locally toxic than treatment with hyperthermia and radiation therapy alone. The precise impact of chemotherapy on the therapeutic index of hyperthermia and radiation therapy remains to be determined in randomized clinical trials.

Head and neck irradiation in childhood: Increased risk of developing thyroid disease

A nodule of the thyroid in a patient with a history of prior irradiation to the head and neck area in childhood is more likely to be malignant than a nodule in the general population. Thirty-two of 144 such patients (22%) who came to surgery were found to have a carcinoma of the thyroid. A relative short-term (6 mo) trial with suppressive therapy with a thyroactive agent may be helpful in selecting out those nodules that may be malignant. Although considerable controversy continues to exist as to the proper surgical treatment, our current surgical management involves performing a total extracapsular thyroidectomy.

Survival discriminants for differentiated thyroid cancer

Since 1975, the American Cancer Society, Illinois Division, has published end results of major cancer sites drawn from patient data contributed voluntarily by hospital cancer registries throughout the state. The current study was undertaken, in part, to apprehend information regarding contested areas in the management of patients having differentiated (papillary/follicular) thyroid cancer. A total of 2,282 patients with either papillary or follicular carcinoma of the thyroid from 76 different Illinois hospitals and providing 10 years of follow-up information (life-table analysis) were retrospectively analyzed for demographic, disease, and treatment-related predictors of survival. Multivariate analysis using the Cox proportional hazards method was made for stage, age, race, sex, morphology, history of radiation exposure, presence of positive lymph nodes, initial surgical treatment, postoperative iodine 131 therapy, and replacement/suppressive thyroid hormone treatment. Statistically significant (p less than or equal to 0.05) predictors of favorable survival after thyroid cancer were low stage (I and II), young age (less than 50 years), white race, female sex, and the administration, postoperatively, of either thyroid hormone or radioactive iodine. Factors that had no influence on survival were lymph node status, choice of initial surgical treatment, and a history of prior irradiation. We suggest that where a prospective clinical trial is impracticable, a retrospective analysis of a large and detailed database, such as that available from cooperating hospital-based tumor registries, may yet provide useful insights to solutions of cancer management problems.

Lymph node metastasis from papillary-follicular thyroid carcinoma in young patients

A total of 117 patients under 20 years of age with papillary and/or follicular thyroid cancer presented to the M. D. Anderson Cancer Center between 1949 and 1987. The most common presenting symptom was a cervical mass. Twenty percent of the patients had a history of prior irradiation. Sixty percent initially had palpable lymph nodes, while 26% who had clinically negative examinations had pathologically positive lymph nodes. Recurrence was highest in regional lymph nodes at 24%, with only a 4% recurrence rate at the primary site and a 3% recurrence rate at distant sites. There were no deaths due to the thyroid cancer. To maintain a low rate of recurrence, near-total thyroidectomy with neck dissection followed by iodine 131 treatment should be considered in these young patients.

Characterisation of LiF:Cu,Mg,P (GR-200) for Personnel Thermoluminescence Dosimetry

Abstract We report the results of our dosimetric characterisation of hot-pressed GR-200 LiF:Cu,Mg,P chips for personnel radiation protection. The TL sensitivity was studied as a function of the maximum temperature of glow curve readout and heating rate. In order to achieve acceptable re-usability we recommend a maximum temperature of 240 ± 2 oC or alternatively 235 ± 5 oC, although the latter choice will lead to a significantly higher residual signal. The TL sensitivity is not a function of glow curve heating rate. We have also studied the dependence of the residual TL signal (TMAX = 240 ± 2 oC) on a large number of experimental and radiation field parameters. Our main conclusion is that the ratio of the second and subsequent readouts to first readout is, to a good approximation, independent of all parameters except for TMAX and its duration, LET and possibly the time between readouts. The dependence on LET arises from the preferential population of the high temperature peak at 270 oC in alpha particle and neutron irradiation. The use of 'unannealed' LiF:Cu,Mg,P individually calibrated dosemeters is thus possible in personnel dosimetry applications if the prior irradiation history of the dosemeters is permanently recorded and the proper corrections (of the order of 10%) are applied. This represents a serious shortcoming of the currently available dosemeters for personnel dosimetry applications.

Surgery for Radiation-Induced Symptomatic Carotid Atherosclerosis

Carotid atherosclerosis occurring secondary to cervical irradiation is known to produce stroke. Transient neurologic symptoms have necessitated surgical intervention to prevent stroke despite concern over technical problems, wound healing, operative risks, and uncertain therapeutic outcome. With this report, 26 surgical procedures in 20 patients are now documented in the literature (12 men--60%; eight women--40%). Mean age of these patients (56 years) was 10 years younger than carotid surgery patients with no prior radiation history. No relationship was noted between elevated serum cholesterol and the subsequent development of radiation-induced carotid atherosclerosis. Surgical procedures performed included carotid endarterectomy in 17 cases (65%) and arterial bypass in nine (35%). The combination of radiation therapy and previous neck surgery, including prior radical neck dissection, did not adversely influence operability. Surgical outcome was uniformly good with only one stroke (4%) documented in the perioperative period. Longer follow-up on our six cases (mean two years) disclosed neither new clinical symptoms nor the development of hemodynamically significant restenosis.

Comparison of megace, stilphostbol, megace plus des, or streptozotocin in metastatic prostatic cancer in patients with hormonal failure and prior radiotherapy

The National Prostatic Cancer Project from 1982 to 1985 evaluated several treatments for metastatic prostatic cancer patients who had a history of prior radiotherapy and were refractory to hormone manipulation. The treatments studied were megestrol acetate (Megace), Megace plus diethylstilbestrol (DES), diethylstilbestrol diphosphate (Stilphostrol), and streptozotocin. While the four treatment arms did not differ significantly with respect to survival, there was a small but significant difference in progression free survival among the treatment groups. These patients are difficult to treat and have many secondary problems, and perhaps future studies of current and new agents should focus more on subjective and other secondary benefits for them.

A Reticulated Eruption on the Chest

<h3>REPORT OF A CASE</h3> A 35-year-old man presented to the University of Michigan, Ann Arbor, dermatology outpatient clinic for evaluation of an asymptomatic rash on his left pectoral region. This condition began approximately one year prior to examination, and was felt by the patient to be secondary to trauma sustained from a tree that had fallen on his chest. Subsequently, the patient noticed a nodule on the anterior aspect of his chest. The nodule was eventually replaced by a slowly spreading red-brown reticulated eruption with the development of alopecia in the same location. No further papules or nodules were noted to develop. During the year prior to presentation, the eruption would decrease slightly in size, but it never disappeared. There was no prior history of radiation therapy, heat application, or photoexacerbation of the lesion. Pertinent medical history included the diagnosis of rheumatoid arthritis, which was made concomitantly with the presentation

Interstitial pneumonitis following autologous bone marrow transplantation.

The incidence of interstitial pneumonitis (IP) was reviewed in 70 consecutive patients who received autologous marrow transplants for hematologic malignancies. All patients were treated with total-body irradiation (TBI), with or without other chemotherapeutic agents. Seven patients (10%) developed IP, 3 were due to cytomegalovirus, 1 due to Pneumomcystis carinii, and 3 of unknown cause (idiopathic). Risk factors for developing IP were increasing age and a prior history of irradiation to the chest. The use of methotrexate posttransplant did not increase the incidence of IP.

Compression plates in the treatment of advanced anterior floor of mouth carcinoma.

Advanced anterior floor of mouth squamous cell carcinoma has been traditionally treated with wide excision in conjunction with mandibulectomy and radical neck dissection. This has resulted in significant mandibulofacial defects with functional and cosmetic significance. Efforts at primary reconstruction in the past using bone grafts, osteomyocutaneous flaps, and other methods have yielded unsatisfactory results. A history of prior irradiation has made this problem even more refractory. We present a series of 11 patients who underwent composite resection for advanced anterior floor of mouth carcinoma (T2-T4), with primary reconstruction using a dynamic compression plating system in conjunction with local and regional tissue flaps. The clinical courses, complications, and surgical techniques are discussed. The issues of reconstruction at primary treatment, irradiation with a metal plate in the field, and the early restoration of oral function are addressed. Experience in this series shows that compression plates can be an effective method of primary reconstruction for advanced anterior floor of mouth lesions.

ESR studies of damage processes in X-irradiated high purity a-SiO2:OH and characterization of the formyl radical defect

A range of high purity type III synthetic silicas (Suprasil 1, Spectrosil, Dynasil 1000) has been subjected to 100 keV X irradiation at 77 K and the induced ESR spectra have been recorded at 100 K before and after successive pulse anneals to higher temperatures. Absolute spin concentrations are determined as functions of radiation dose, anneal temperature and time, prior irradiation history, and sample supplier. Defects monitored comprise E′ centers, oxygen-associated hole centers (OHCs), atomic hydrogen, and a previously unidentified defect in a-SiO2 characterized by a 13.3 mT doublet centered on g=2.0. The 13.3. mT doublet is ascribed here to formyl radicals HCO produced by the reaction of radiolytic hydrogen atoms with minute amounts (≲0.1 ppm) of dissolved carbon monoxide present in Suprasil 1 and Dynasil 1000 but not Spectrosil. This identification is based on production kinetics and the similarity of the spin Hamiltonian parameters measured at 30 K to those previously reported for the formyl radical in solid carbon monoxide. Motional effects apparent in the HCO spectra at ≳100 K are interpreted with the aid of computer line shape simulations, and inferences are drawn concerning the interaction of the HCO molecule with the glass network. The isochronal anneal data are discussed in some detail and an influence of radiolytic molecular hydrogen on the color-center bleaching kinetics is postulated.

Malignant mesothelioma of the pleura: review of 123 patients.

One-hundred-twenty-three cases of malignant pleural mesothelioma were reviewed. Exposure to asbestos or to other industrial dusts or chemicals was an important etiologic factor with 24% of patients relating such a history. A history of prior irradiation or previous lung disease was also occasionally noted. Diagnosis was most often made by exploratory thoracotomy, with pleural biopsy or cytology rarely helpful. Except for nine patients, tumor was confined to the chest at the time of diagnosis, but in 33 of the remaining 114 patients, spread to the abdomen or distant metastasis was seen during the course of disease. Surgery and radiotherapy were ineffective in preventing local recurrence. There were only three major responses to chemotherapy in 111 trials. Median survival was 12 months, and only seven patients (5.6%) lived more than five years. Patients with epithelial mesothelioma and Stage I disease had the most favorable prognosis.

Radiation and risk for thyroid cancer: atypical findings of a community thyroid recall program.

Screening of 553 persons for thyroid disease by scan and physical exam was performed. Group I (245) had documented irradiation, with most (85%) receiving 300 R for lymphoid hyperplasia. Group II (308) had only a history of prior irradiation. Abnormal glands were found in 17 of 245 (7%) of Group I with 7 of 245 (3%) having nodular disease. No cancers were found in six of eight (75%) persons with nodular disease having surgery. Abnormal glands were found in 45/308 (14.6%) of Group II with 16/308 (5.2%) having nodular disease. Twelve of 16 (75%) with nodular disease from Group II had surgery and three thyroid cancers were found; in addition, one person from this group had a history of prior surgery for thyroid cancer. The incidence of thyroid cancer in Group I was 0%, Group II was 1.3%, and the combined incidence was 0.7%. The relatively low incidence of thyroid cancer observed is attributed to the relatively late average age at time of irradiation; 22 years for Group 1, 13 years for Group II.

Irradiation induced salivary gland neoplasia.

Twenty-six patients with a prior history of irradiation for benign conditions of the head and neck and salivary gland abnormalities are reported. All the patients had preoperative physical findings suggestive of tumor, not glandular infection. Forty-six per cent of the patients had one carcinoma and 11% had two carcinomas within the irradiated field. Eight of the 11 malignant tumors in these 26 patients were in the parotid gland. The nonmalignant salivery changes were similar to those previously reported in glands receiving therapeutic irradiation for carcinoma.

The Approach to the Irradiated Thyroid

Nodular thyroid disease and cancer are frequently associated with a history of prior irradiation. Mass screening and patient recall programs have identified those at risk. Treatment involves careful evaluation followed by total or near-total thyroidectomy for patients with cancer.

Irradiation-induced polyglandular neoplasia of the head and neck

Eighteen patients are presented with twenty-one tumors of the head and neck, which include ten salivary gland tumors and eight parathyroid adenomas. Eight of the patients also had thyroid neoplasms. All patients had a history of prior irradiation to the head and neck. Seventy per cent of the salivary gland tumors and 37 per cent of the thyroid tumors were malignant. Recommendations are made for detection and treatment.

Thyroid Neoplasms After Radiation Therapy for Adolescent Acne Vulgaris

There is a potential hazard of thyroid cancer after exposure to external irradiation for the treatment of adolescent acne vulgaris. We noted a 60% incidence of thyroid carcinoma among 20 patients with such a history, who were operated on for thyroid nodules during a five-year period. Eighty-three percent of the patients with carcinoma had either a follicular or a mixed papillary-follicular carcinoma; 17% had a papillary carcinoma; 33% had regional node metastases; none had evidence of distant metastases. The interval between radiation exposure and thyroidectomy ranged from nine to 41 years. This association of thyroid neoplasms and a prior history of radiation for acne vulgaris may be coincidental and therefore remains to be proved by retrospective surveys of large numbers of treated patients with appropriate controls.

Thyroid neoplasms after radiation therapy for adolescent acne vulgaris

• There is a potential hazard of thyroid cancer after exposure to external irradiation for the treatment of adolescent acne vulgaris. We noted a 60% incidence of thyroid carcinoma among 20 patients with such a history, who were operated on for thyroid nodules during a five-year period. Eighty-three percent of the patients with carcinoma had either a follicular or a mixed papillary-follicular carcinoma; 17% had a papillary carcinoma; 33% had regional node metastases; none had evidence of distant metastases. The interval between radiation exposure and thyroidectomy ranged from nine to 41 years. This association of thyroid neoplasms and a prior history of radiation for acne vulgaris may be coincidental and therefore remains to be proved by retrospective surveys of large numbers of treated patients with appropriate controls. (<i>Arch Dermatol</i>114:53-55, 1978)