Prior Definitive Therapy Research Articles

Regional Hyperthermia in Patients with Recurrent Genitourinary Cancer

During a 6-year period, 53 patients with advanced tumors of the genitourinary tract were treated in Phase I protocols with deep regional hyperthermia in combination with irradiation (83%) or in combination with chemotherapy (11%). Primary tumors included those of bladder in 22 patients (41%), prostate in 20 patients (37%), kidney in 9 patients (17%), and ureter testicle or adrenal in 3 patients (5%). The majority (77%) had prior definitive therapy and had experienced treatment failure, and 11% had clinically important distant metastases. Treatment consisted of deep regional hyperthermia (mean of 4 sessions). In addition, 44 patients (83%) received irradiation (mean dose 39.2 Gy). The 1- and 3-year actuarial survival was 60% and 56%, respectively. Patients with carcinoma of the prostate had a 1- and 3-year survival of 82%. Complete response was observed in 7 patients (13%), partial response in 8 (15%), and nominal response in 13 (25%). Complete and partial response correlated well with histology of the tumor (adenocarcinoma), radiation dose (greater than 50 Gy), primary site (prostate, kidney), and treatment (hyperthermia-radiotherapy combination), (p = 0.02). There was no such correlation between response and thermal dose (p = 0.13). The treatment tolerance was good in 79% of patients. Treatment toxicity was limited to acute side effects, including pain during hyperthermia (47%), tachycardia greater than 140/min (7%), and blister formation in the treated area (4%). Phase II studies in previously untreated patients with locally advanced tumors of bladder, prostate, and kidney are needed for evaluation of the role of deep regional hyperthermia in the management of these cancers.

Treatment results and patterns of failure in 646 patients with carcinoma of the eyelids, pinna, and nose

From 1956 to 1978, 646 patients were treated with radiotherapy for carcinoma of the nose (350 patients, 54 percent), eyelids (159 patients, 25 percent), pinna (93 patients, 14 percent), and skin adjacent to the lip (44 patients, 7 percent). The histologic distribution was 72 percent basal cell carcinoma, 18 percent squamous cell carcinoma, and 10 percent mixed basal and squamous cell features. Tumors less than 2 cm in diameter were found in 602 patients (93 percent), whereas 44 patients (7 percent) had larger tumors. Tumor involvement of cartilage and bone was seen in 23 patients at the time of diagnosis. The 5, 10, and 20 year control rates were 99 percent, 98 percent, and 98 percent, respectively, for 502 tumors less than 2 cm in diameter. This compared favorably with control rates of 92 percent at 5 years and 79 percent at 10 years for tumors from 2 to 5 cm in diameter and 60 percent at 5 years and 53 percent at 8 years for 12 patients with massive tumors (p < 0.0001). The histologic characteristics of the lesion had a strong influence on tumor control (p < 0.02). Of the patients with cartilage or bone invasion, tumor was controlled in 19 (83 percent). Of these 19 patients, 11 had no evidence of disease for 3 years or more. Of all 646 patients treated, failure was seen in 60 (9 percent). It correlated well with the size of the lesion, being 7 percent for tumors of less than 2 cm and 50 percent for tumors of greater than 5 cm. Of the 60 patients in whom treatment failed, 48 (80 percent) had prior definitive therapy. Radiotherapy was an efficient modality to control operative failures; however, it was not as efficient at control in patients in whom previous radiotherapy failed. Operation was the treatment of choice to salvage patients in whom radiotherapy failed. Of the patients in whom retreatment failed, 10 were known to have died from skin cancer, and an additional 6 patients were presumed to have died from the cancer. This study has demonstrated a good control rate and good cosmetic results for small tumors of the eyelids, pinna, and nose. In addition, a good control rate was obtained in patients with cartilage and bone involvement. Treatment of massive tumors should involve planned operative resection with adjuvant radiotherapy.