Rads Tumor Dose Research Articles

Treatment and outcome of undifferentiated carcinoma of the nasopharynx in childhood: a 13-year experience.

Between 1970 and 1983, 22 pediatric patients diagnosed as having undifferentiated nasopharyngeal carcinoma (UNC) were treated at the National Children's Hospital of Costa Rica; primary tumor with local extension (T3-T4) was present in 45% of the patients, and metastasis of the cervical nodes (N1-N3) in 82%. Patients were divided into groups A and B according to the type of treatment received. A description of both groups is as follows. Ten patients were treated with 5,000 to 6,000 rads tumor dose to the primary and a 5,125-rad dose was administered to the lower neck between 1970 and 1977 (group A). Six patients received postradiation therapy with cyclophosphamide and vincristine and two patients also received 5-fluorouracil. The outcome in group A was as follows: four (40%) failed to respond, six (60%) achieved full remission initially with two subsequent relapses, and the remaining four are still alive and free of relapse after 90 to 160 months (average 130) (two were treated with Co60 alone and two with chemotherapy. Twelve patients were treated with chemotherapy pre- and postradiation with CPM and adriamycin for a total of 12 months (group B) between 1978 and 1984. All (100%) achieved complete initial remission; two patients relapsed and died. Ten patients have remained in relapse-free survival for 18-67 months (median 32). Though this is not a controlled study, our experience indicates that pre- and postradiation chemotherapy is effective in prolonging the disease-free survival in UNC and may allow a decrease of the radiation tumor dose.

Inflammatory breast carcinoma treated by radical radiotherapy.

Sixty-two patients with localized clinical inflammatory breast carcinoma were treated with curative, radical radiotherapy doses to the breast and draining lymphatics at Massachusetts General Hospital from January 1960 to December 1977. Fifty patients have died from disease, 7 are alive with disease, and 5 are free of disease at time of reporting, thus indicating the fulminant nature of this rare form of breast cancer. Median survival is approximately 18 months (mean 24 months). A five-year actuarial survival relapse-free survival of 14% and 6%, respectively, are obtained. Local and regional recurrence was noted in 43 of 62 patients (69%). Twelve patients (19%) failed in the locally irradiated area only, 31 patients (50%) failed in both local, regional, and distant sites, and 14 patients (23%) failed with distant metastases only. Due to the complex dosimetry required in the treatment of breast cancer, retrospective analysis was made of actual tumor doses delivered before 1972. The breast was oftentimes calculated to receive 20 to 35% less than the stated dose. This gave the unique opportunity of observing a dose response relationship in local control within the same institution. Doses in excess of 6000 rads tumor dose seem necessary since 14 of the 15 patients with persistent disease had received less than this dose. However, once tumor exceeded 10 cm, increasing dose within clinical therapeutic ranges failed to control disease, although the recurrence-free interval was somewhat prolonged. Since 1976, twice-a-day fractionation has been used in larger tumors, and this appears to have decreased the local recurrence rate to 33% (2/6) patients. Preliminary results of adjuvant multiple drug therapy, e.g., modified Cooper regimen (CMFVP) or the CMF regime appear encouraging.

The role of radiation therapy in the treatment of small cell undifferentiated bronchogenic cancer

The current enthusiasm for polychemotherapy in small cell undifferentiated bronchogenic carcinoma obscures the necessity for primary control by radiation therapy. One hundred and sixty-three patients with this diagnosis were treated in the periods 1965-67 (56) and 1974-76 (107). In the earlier period patients received radiation alone or radiation plus single-agent chemotherapy. In the latter period, all patients were treated with multiple-agent chemotherapy in addition to radiation therapy. Median survival time was extended approx. 4 weeks for the latter group of patients at the cost of much morbidity and occasional lethality. In the patients that were autopsied from both series, only 5/30 were free of disease within the treatment portals and all had received more than 4000 rad tumor dose regardless of adjuvant therapy. A total of 14 autopsies were performed on patients treated by chemo-immunotherapy alone during the 1974-76 period. All of these revealed disease in the primary site and mediastinum although some had no evidence of distant metastasis. Tumor volume is sufficiently large within the primary site and regional lymphatics that presently available chemoimmunotherapy without high dose irradiation is unlikely to sterilize loco-regional disease. Elective radiation to the whole brain was administered to 25 patients and only 3 developed cerebral metastases. Of the remaining 82 patients who were treated concurrently, 25 developed cerebral metastasis and then received radiation therapy to the whole brain, 10 of these patients subsequently died.

The role of radiation therapy in treatment of small cell undifferentiated bronchogenic carcinoma

The current enthusiasm for polychemotherapy in small cell undifferentiated bronchogenic carcinoma obscures the necessity for primary control by radiation therapy. One hundred sixty-three patients with this diagnosis were treated in the periods 1965-1967 (56) and 1974-1976 (107). In the earlier period patients received radiation alone or radiation plus single agent chemotherapy. In the latter period, all patients were treated with multiple agent chemotherapy in addition to radiation therapy. Median Survival Time was extended approximately 4 weeks for the latter group of patients at the cost of much morbidity and occasional lethality. In the patients autopsied from both series, only 5/30 were free of disease within the treatment portals and all had received more than 4,000 rad tumor dose regardless of adjuvant therapy. A total of 14 autopsies were performed on patients treated by chemo-immunotherapy alone during the 1973-1976 period. All of these revealed disease in the primary site and mediastinum although some had no evidence of distant metastasis. Tumor volume is sufficiently large within the primary site and regional lymphatics that presently available chemo-immunotherapy without high dose irradiation is unlikely to sterilize loco-regional disease. Elective radiation to the whole brain was administered to 25 patients and only 3 developed cerebral metastases. Of the concurrently treated remaining 82 patients, 25 developed cerebral metastases which were treated as they were manifest.

60Co Moving strip technique in the management of carcinoma of the ovary: Analysis of tumor control and morbidity

The anatomical sites of tumor recurrence and morbidity are reported in 52 patients who were treated with moving 60Co strip technique to the abdomen (3000 rad) and pelvic irradiation (2700 rad tumor dose (TD) in 3 weeks) using 23 MV photons. The survival at 2 and 5 years is approximately 60% for Stage I and II and 10% for Stage III. The pelvic recurrence rate was 27% for Stage I and II (3 of 11 patients in each group) and 52% in Stage III (13 of 25 patients). The failures in the abdomen were 18% for Stage I (2 of 11 patients), 27% for Stage II (3 of 11 patients) and 84% for Stage III (21 of 25 patients). Three patients with Stage IV (liver involvement) all had recurrences in the pelvis and abdomen. Major complications, mostly in the small bowel or colo-rectum were noted in seven patients (13.4%). All but one were related to the high dose of radiation delivered to the pelvis. The most frequent minor complications consisted of leukopenia (lymphopenia) which was documented in 40 patients. In 32 (61%) the white blood count was less than 50% of the initial value for over 6 months after therapy. Recovery began at 4–6 months and took as long as 18 months following completion of irradiation. The 60Co strip technique theoretically delivers a biologically higher dose of irradiation but has not improved survival or tumor control in comparison with other methods. When this technique is employed, careful dosimetric considerations should be made and appropriate shielding of sensitive organs undertaken during therapy to minimize morbidity.

Radiotherapy of choroidal metastases.Breast cancer as primary site

Forty-two cases of metastatic breast cancer to the choroid treated by radiation therapy were reviewed. Fifteen patients (36%) had bilateral and 27 patients (64%) had unilateral choroidal involvement. In 12 patients (29%) the choroid was the first site of dissemination. The median survival period after choroidal metastases was 10 months. Most patients were treated with Co60 in doses of 2500 rads tumor dose (TD) in ten fractions, 2500 rads, (TD) in five fractions and 3000 rads (TD) in ten fractions. An early group of patients had orthovoltage therapy. Good visual responses were obtained with each of the above treatment programs. Radiation treatment in the range of 2500-3000 rads TD in a short course is recommended for palliation of metastatic breast cancer to the choroid.

Radiotherapy of choroidal metastases: Breast cancer as primary site

Forty-two cases of metastatic breast cancer to the choroid treated by radiation therapy were reviewed. Fifteen patients (36%) had bilateral and 27 patients (64%) had unilateral choroidal involvement. In 12 patients (29%) the choroid was the first site of dissemination. The median survival period after choroidal metastases was 10 months. Most patients were treated with Co60 in doses of 2500 rads tumor dose (TD) in ten fractions, 2500 rads, (TD) in five fractions and 3000 rads (TD) in ten fractions. An early group of patients had orthovoltage therapy. Good visual responses were obtained with each of the above treatment programs. Radiation treatment in the range of 2500-3000 rads TD in a short course is recommended for palliation of metastatic breast cancer to the choroid.

Time, dose and tumor volume relationships in megavoltage irradiation of squamous cell carcinomas of the retromolar trigone and anterior tonsillar pillar

Between March 1954 and August 1973, 204 patients with 5quamous cell carcinomas of the retromolar trigone and anterior tonsillar pillar were treated with conventional definitive megavoltage radiotherapy with conventional time schedules. The data were analyzed with time-dose scattergrams to correlate the probability of control of the primary lesion with dose, total treatment time and tumor volume (stage). For early stage lesions ( T 1), 6000–6500 rad tumor dose given in 6–6.5 weeks is felt to be adequate for a control rate of approximately 90%. For more advance disease ( T 2− T 3), a control rate in excess of 90% should be obtained when 7000 rad tumor dose is delivered in 7 weeks. The slope of an isoeffect curve between 4 and 8 weeks is probably around 0.35. Complications correlate with the extent of cancer present, since 6 of the 9 complications which required surgery were in patients with stage T 3 disease. A certain percentage of complications must be accepted if a high percentage of control is to be achieved.

Postoperative pelvic irradiation of stage II ovarian carcinoma

Clinical Stage II carcinoma of the ovary (1964 FIGO classification) represents a small proportion of total patients and has not been studied extensively. Even though the disease apparently is localized, end-results have been poor. Between 1960 and 1970, 24 patients with clinical Stage II disease received postoperative megavoltage pelvic irradiation following surgical procedures of varying extent. All patients but one received between 5000 and 6000 rad tumor dose to the whole pelvis and all patients were evaluable at a minimum of 5 years. Of 4 Stage II-A patients one was alive without disease. No patients were alive with recurrent tumor. Recurrences in the pelvis occurred only in 2 patients; 4 patients had recurrent disease in the pelvis and upper abdomen. A total of 8 patients developed upper abdominal recurrences in the apparent absence of pelvic disease. These results and those of others which are discussed in this paper suggest that surgery and irradiation to the pelvis only will not eradicate disease completely in over 60% of patients with clinical Stage II ovarian carcinoma.

Radiation therapy of choroid metastasis from breast cancer

The results of radiation therapy of choroid metastases in 46 breast cancer patients, involving 57 eyes, have been analyzed. The choroid lesions were classified into three grades according to the severity and extent of involvement. Thirty-four eyes were treated with high energy electron beam therapy and 23 eyes with X-rays or telecobalt beams. Four representative electron beam techniques were shown. The tumor response to radiation therapy was described as either marked improvement, slight improvement or no improvement. The overall results of treatment showed marked improvement with total or near total restoration of vision in 35% of cases for mean and median durations of 12 and 11 months respectively. Another 28% showed slight improvement with partial return of vision. The overall response rate was 63%. The best results were seen in Grade I lesions, indicating the importance of early recognition of the disease and early treatment. The radiation dose recommended for choroid metastases is 4000 rad, delivered in 3 weeks (i.e. 280 rad tumor dose × 15, 5 times a week, or a TDF of 0.83).

Radical irradiation with the split-course technique in carcinoma of the lung.

The possible advantages of a split-course of irradiation in the treatment of patients with locally advanced and/or inoperable carcinoma of the lung were explored in over 200 cases. The patients were separated into two groups with different prognostic factors: Group A, patients with well-differentiated tumors confined to the lung and mediastinum; and Group B, cases with anaplastic tumors and/or supraclavicular metastases, bone erosion, or superior venal caval syndrome. The treatment consisted of 5500-6000 rads tumor dose in 20 to 24 fractions over a period of 7 to 8 weeks with a rest interval of 2 to 4 weeks in the middle. The 3- and 5-year survival figures, 19% and 16%, respectively, in Group A cases, along with the excellent tolerance, suggest that the split-course approach has definite advantages.

Non-randomized comparison of preoperative irradiation and surgery versus irradiation alone in the management of carcinoma of the tonsil

This is a non-randomized comparison of 98 patients with epidermoid carcinoma of the tonsil treated by preoperative irradiation and surgery and 97 patients receiving irradiation alone. Patients treated with preoperative irradiation received, in most instances, 3,000 rads tumor dose in three weeks through ipsilateral portals, followed within two to six weeks after completion of therapy by an en bloc tumor resection and radical neck dissection. The group treated with irradiation alone received tumor doses in the range of 5,500-6,500 rads in six weeks. No significant difference was noted in the survival yielded by either treatment modality. Both treatment modalities were equally effective in controlling the tumor in the metastatic ipsilateral lymph nodes. In selected cases, a combination of both modalitites may offer better results, but this remains to be proved.

Prostate carcinoma Measures to improve therapeutic response and prevent complications

Between 1965 and 1973, 80 patients with prostatic carcinoma were treated with definitive supervoltage irradiation; 35 patients received adjuvant estrogens. A favorable tumor response was uniformly observed in patients with less advanced tumors who received a minimum of 6,000 rads tumor dose and adjuvant estrogens. Radiation complications were frequent and severe in patients with locally advanced tumors who had antecedent lower urinary tract surgery and received a minimum of 7,000 rads tumor dose. Complications were less frequent in patients who received adjuvant estrogens, and complications were uncommon and mild in patients who received less than 7,000 rads.

Osteogenic sarcoma (osteosarcoma): results of therapy.

OSTEOGENIC SARCOMA (OSTEOSARCOMA): RESULTS OF THERAPYJUSTIN J. STEIN, M.D.Audio Available | Share

Cervical synovial sarcoma at the bifurcation of the carotid artery

Cervical synovial sarcoma has been reported in only 15 cases; in none of these was there any association with a vascular structure. A patient with cervical synovial sarcoma encompassing the bifurcation of the left carotid artery underwent a left radical neck dissection, including excision of the left external carotid artery and the hypoglossal nerve. The tumor was dissected away from the common carotid and internal carotid arteries. Although the fibrous pseudocapsule of the tumor had not involved the fibrous adventitia of the carotid arteries. Radiation therapy with 6000 rads tumor dose was administered to a wide local field. There is no evidence of recurrence 1 year postoperatively. Histologic and ultrastructural findings were similar to those reported previously in a case of synovial sarcoma of an extremity.

A method for postmastectomy chest wall dosimetry.

Postmastectomy chest walls are often irradiated by means of parallel opposed, tangential 60Co fields. The necessary given dose per field to achieve a prescribed tumor dose depends on field size, chest curvature, and field separation. Computer calculations on 50 patients indicate that the given dose is mainly determined by a single parameter, the separation between medial and lateral fields. Over a considerable range, the relationship between given dose and separation is linear. A nomogram was constructed indicating the given dose per field necessary to give 200 rads tumor dose. With this method treatment planning with good dose distribution is simplified.

Cerebrospinal axis radiation therapy for meningeal leukemia with tumor dose levels in the range of 2,000 rads.

In 14 children, the entire neuraxis was irradiated with 2000–2500 rads tumor dose in three weeks for meningeal spread of acute leukemia. Children in bone-marrow remission tolerated the dosage well; those in relapse required whole-blood components and antibiotic support to complete radiotherapy. The duration of CNS remission ranged from 48 to 427 days (median 181 days), with the longest remission in 2 patients given two doses of intrathecal methotrexate immediately prior to radiotherapy. Elective CNS irradiation and∕or intrathecal chemotherapy prior to development of CNS leukemia should be explored.

Short-term radiation therapy of localized lymphoma.

Abstract Fifty patients with lymphoma limited to one nodal or extranodal area were treated with high increment therapy, 2000 rad tumor dose in five days. Duration of local control was compared with results obtained with conventional extended time to dose relationships used in treatment of other areas in 37 of the 50 patients. Time to resolution in the high increment group was related to type and size of the tumor. Good local control was achieved in generalized reticulum-cell sarcoma. Relapse rate was low. In view of the advantages of saving patient time and resources and the satisfactory results avhieved, more extensive use of this method seems justified.

Successful treatment of inoperable embryonal rhabdomyosarcoma

Embryonal rhabdomyosarcoma, when inoperable or metastatic, has usually ben a rapidly fatal cancer. Intensive combination chemotherapy (VAC) with Vincristine (VCR), Actinomycin-D (AMD) and Cyclophosphamide (CYT) in conjunction with radiotherapy is effective in the treatement of this tumor. Twenty-one children with inoperable or metastatic embryonal rhabdomyosarcoma, or undifferentiated sarcoma suggestive of embryonal rhabdomyosarcoma, were treated in the 3-year period 1967–1969. Sixteen of them (76%) are alive without evidence of disease 1–4 years after initiation of therapy. Therapy consisted of biopsy, Co80 radiation 5000–6000 rads tumor dose, and VAC chemotherapy. Surgery was subsequent;ly utilized when feasible. The chemotherapy consisted of VCR 2 mg./M2 IV weekly x12, AMD 75 MG./kG. divided into 5–8 daily doses every 3 months for 5 or 6 courses, and CYT given either as 2.5 mg./Kg./day for 2 years or 10 mg./Kg./day for 7 days every 6 weeks. The type of CYT therapy was dependent on tumour location and extent.

Time-dose relationships in radiation therapy of lymphosarcoma and giant follicle lymphoma.

Abstract Radiation therapy as primary treatment for lymphosarcoma and giant follicle lymphoma in 62 patients was evaluated for the rate of recurrence in treated areas as the first manifestation of relapse. For lymphosarcoma, local recurrence was prevented by 3,500 rads tumor dose or more in four weeks. Giant follicle lymphoma did not recur after radiotherapy with more than 2,000 rads tumor dose in ten to twenty-one days. The five-year survival of lymphosarcoma patients was higher when treated with the higher dose of radiation.