Course Of Radical Radiotherapy Research Articles

Concurrent chemoradiation in advanced cervical cancer

The pelvis is the predominant site of failure following radical radiotherapy (RT) for locally advanced cervical cancer. We report the results of phase I–II studies on 200 patients with bulky (⩾5 cm) carcinoma of the cervix. Patients were treated between 1981 and 1988 on sequential protocols of concurrent chemoradiation to establish an acceptable treatment regimen. RT with daily or partially hyperfractionated pelvic ( n = 154) or pelvic plus paraaortic ( n = 46) fields was given by continuous ( n = 154) or split course ( n = 46) regimens. Infusional fluorouracil (5-FU) in a dose of 1 g/m 2/day was given on the first and last 4 days of a 5-week course of continuous RT, or with both halves of split course RT. Seventy-eight patients received bolus mitomycin C (Mit-C), 6 mg/m 2, once or twice with the start of the 5-FU infusion. The median external RT dose was 46 Gy (range 40 to 65 Gy) followed in 90% ( n = 181) by a single intracavitary application of 40 Gy using a linear source of cesium-137. Median follow up is 2.5 years (range 0.6 to 6.9 years) and is sufficient to reliably estimate late toxicities. Acute toxicities were transient oral mucositis (13), RT interruption for enteritis (7), febrile neutropenia (3), and thrombocytopenic tumor bleed (1). Serious late toxicities resulted in death in 3 patients and occurred in bladder in 6 and in bowel in 25, including 8 patients with tumor recurrence. The incidence of late bowel toxicity correlated with the specific therapy given and decreased with each successive protocol. On logistic regression the only treatment variable showing a statistically significant effect on complications was the use of Mit-C ( P = 0.0053). Pelvic RT and 5-FU alone produced fewer complications, only 4 105 , than historically seen with standard pelvic RT alone. Three-year pelvic control and survival rates were 85 and 71% respectively in stage Ib/II ( n = 100) and 50 and 42% in stage III/IV (n = 100). Encouraged by these results and decreased toxicity, we have begun a phase III study to determine whether the addition of concurrent 5-FU to continuous partially hyperfractionated pelvic RT improves local control and survival.

Improved results in the treatment of nasopharyngeal carcinoma using combined radiotherapy and chemotherapy

A total of 77 patients with nasopharyngeal carcinoma were retrospectively reviewed for the effectiveness of combining chemotherapy (CT) with radical radiotherapy (RT). From 1972 to 1976, 26 patients were treated with a relatively short course of radical RT alone: 52-55 Gy/16 Fx/4 wk (study 1). From 1977 to 1982, 29 patients were also treated with radical RT alone, but with a more prolonged fractionation schedule: 65-70 Gy/26-28 Fx/6.5-7 wk (study 2). In 1983, the policy was to combine CT and RT. From 1983 to 1987, 22 patients received four to six courses of CMU regimen (consisting of cyclophosphamide, methotrexate, and UFT, a 5-fluorouracil analog) after completion of radical RT (study 3). The three studies were comparable with regard to patient characteristics: histologic type, stage, sex, and age distribution. There were no significant differences in survival and relapse figures between study 1 and study 2, but study 3 compared favorably with study 1 and study 2 in actuarial survival, relapse-free survival, relapse rate, and median relapse time. A mild nausea and transient granulocytopenia during CT was the only side effect encountered. In conclusion, the use of CT in combination with RT appeared to increase significantly the chance of long-term survival and probable cure.

Human chorionic gonadotrophin expression and histological findings as predictors of response to radiotherapy in carcinoma of the bladder

A retrospective analysis of the prognostic value of pretreatment histology and expression of human chorionic gonadotrophin (B-hCG) was carried out in 100 invasive (T2/T3) transitional cell carcinomas of the bladder treated in a uniform manner. After transurethral resection of the tumour, all patients received a course of radical radiotherapy, with salvage cystectomy for those who failed to respond. Forty-nine of 100 patients responded to radiation; thus 51 did not. Forty-seven of 60 (78%) patients whose tumours contained areas of squamous differentiation and 22 of 29 (76%) of tumours staining positively for HCG failed to respond to radiotherapy. Twenty-two of 23 (96%) patients with tumours that had both these features did not respond to radiotherapy. The other histological features studied (grade of tumour, necrosis, inflammation, vascular invasion, and growth pattern) appeared unrelated to each other or to clinical outcome.

Primary radical radiotherapy for T3 transitional cell cancer of the bladder: an analysis of survival and control

Patients who completed a course of radical radiotherapy for T3 bladder cancer are reviewed. A follow up cystoscopy where tumor response was assessed, was carried out in 272 of the 333 patients of whom 41.2% had complete local regression. Significant factors correlated with complete local tumor regression are described, the most significant being histological grade of the tumor. A higher proportion of patients with complete regression were found among those with Grade 3 cancer (55.7%). Patients who received a central tumor absorbed dose of 55.0 gray or 57.5 gray in 20 fractions over 4 weeks had a significantly higher probability of complete local regression and lasting local control than those who received lower doses. Patients with initial complete local regression had a significantly better probability of survival than those with incomplete regression ( p < 0.0001). There was a significant association between the hemoglobin level at the start of radiotherapy and both local regression and survival. Patients with T3 cancer are more critically selected for treatment by primary radical radiotherapy on the basis of primary tumor size, tumor grade and the patient's plasma urea level. Primary cystectomy may be the more appropriate treatment for a patient with a tumor of more than 7 cm in diameter, a Grade 1 cancer or a plasma urea level of more than 10 mmol/l.

Radiotherapy Alone for Patients with Operable Carcinoma of the Lung*

Between 1966 and 1980, 72 patients with operable carcinoma of the lung were treated primarily with radiotherapy because coexisting, nontumor related medical problem, or patient refusal prevented thoracotomy. We compared results obtained in this group with results obtained by thoracotomy in 123 consecutive patients over the age of 70, who were assessed in a similar fashion, but who underwent thoracotomy. All patients in both groups had proven, nonsmall cell carcinoma of the lung without clinical, laboratory, or radiologic evidence of tumor spread. All patients in both groups had a negative staging mediastinoscopy, and bronchoscopic findings consistent with operability. Many of the patients treated with radiotherapy had less than a curative dose as their general medical condition prevented a course of radical radiotherapy. It is apparent, however, that the results of radiotherapy for patients with operable carcinoma of the lung may be disappointing and that for patients who are marginal in terms of operative risk, the benefits of surgical resection may warrant the risks involved.

Adenoid cystic carcinoma of the salivary glands

Eighty-two patients with adenoid cystic carcinoma treated by a radical course of radiotherapy are reviewed. In 44 cases the tumour arose in the major salivary glands and, of these, 77% had an incomplete surgical excision and 23% had only a tumour biopsy before radiotherapy. Thirty-eight tumours arose in the minor salivary glands and, of these, 18% had an incomplete surgical excision and 82% a biopsy only before treatment. Primary tumour control was achieved in 67% of patients at 5 years. The local control was significantly better in patients who had an incomplete surgical excision: 86% compared with 37% at 5 years. The local control of tumours arising in the major salivary glands is significantly better than that of tumours arising in the minor glands, but this difference is explained by more patients with major gland tumours having had incomplete surgery. For patients treated after only a biopsy, local tumour control was achieved in 37%, demonstrating the radioresponsiveness of this type of carcinoma. No difference in survival was demonstrated in patients with major or minor gland tumours. Despite local tumour control, 43% of patients with major gland tumours died from metastatic disease. The commonest cause of death of patients with minor gland tumours was local failure.

Factors influencing salvage cystectomy results.

Analysis of 86 patients who underwent salvage cystectomy following a radical course of radiotherapy for bladder cancer and 37 patients who underwent primary cystectomy has shown a greater survival for women than men. The following factors were associated with a significant deterioration in survival: 1. Age at time of cystectomy: post-operative mortality and tumour recurrence are greater over the age of 70. 2. Non-function of one kidney on IVU. 3. Grade 3 tumour on cystectomy specimen. 4. pT3 or pT4 tumour on cystectomy specimen.

Osteoclastoma of the petrous temporal bone

This paper has described an unusual case of osteoclastoma of the petrous temporal bone which presented with multiple cranial neuropathies. A radical course of radiotherapy reversed the neuropathies but it is too early to comment on possible cure.

Cancer of the nasopharynx: Incidence, clinical course and results of therapy: a report from Greece

A series of 149 cases of cancer of the nasopharynx treated in Greece is reported. All patients were treated by supervoltage irradiation and 105 of them were eligible for 5 year, and 53 for 10 year survival analysis. The five year survival was 25.7% and that for 10 years was 16%. Treatment failures were due to distant spread, inadequate dosage and possibly an incorrectly defined tumour volume. Recurrence of the disease in the nasopharynx, lymph nodes of the neck, the upper mediastinum or hilum of the lung responds well to treatment, and a second course of radical radiotherapy is indicated. Tumour recurrence in the base of the skull and metastases in the lungs, bones or liver carry an extremely bad prognosis. The use of 67 Ga scanning is demonstrated.

The treatment of carcinoma of the lung by radiotherapy.

Summary Where the diagnosis of cancer of the lung is made by bronchoscopy the preferred treatment is surgery for squamous lesions and radiotherapy for anaplastic and oat-cell lesions. In inoperable tumours 8% of patients survive for more than 3 years after a radical course of radiotherapy; some clinical trials aimed at improving this survival rate are described. This lecture deals with the established disease, earlier diagnosis, before spread, would make radical treatment with a possibility of cure possible in more patients but this disease can be prevented to a large degree and this is the obvious method of attack.

The influence of tumour type, persistent precancerous lesions and lymph node involvement on the results of radiotherapy in oral cancers.

Abstract A series of 172 cases of oral cancer who had serial biopsies taken during a radical course of radiotherapy is reviewed. It was found that: (1) a prognosis based on early histological changes induced by radiation is in very good agreement with the clinical results of the initial treatment. (2) patients with differentiated tumours had a significantly higher five-year survival rate than those with anaplastic carcinomata; (3) lymph node involvement and persistence of precancerous lesions occurred less frequently in differentiated than in anaplastic cancers; (4) a higher percentage of patients with persistent precancer than of those without this lesion died ultimately of cancer but after a longer survival period than did patients with refractory tumours; (5) lymph node involvement did not affect the survival rate significantly in cases receiving equal radiation treatment at primary and secondary sites; (6) cancer persisted in the primary (with and without tumour in the nodes) in 85 per cent, but in th...