Supervoltage Radiation Research Articles

TREATMENT OF OAT-CELL CARCINOMA OF BRONCHUS BY PREOPERATIVE RADIOTHERAPY AND SURGERY

A series of twenty-nine patients with bronchoscopically and clinically operable oat-cell carcinoma of the bronchus have been treated by preoperative super-voltage radiotherapy followed by resection when technically possible. Pneumonectomy was performed in twenty-four of the twenty-nine patients. The results have been compared with those reported by the Medical Research Council (M.R.C.) in a comparative trial of surgery and radiotherapy for the primary treatment of smallcell or oat-cell carcinoma of the bronchus. The four-year survival in the M.R.C. series was 3% and 7% for surgery and radiotherapy respectively. The four-year survival in the present series was 24%.

An instrument for the rapid check of output, energy and field flatness of supervoltage therapy equipment

Describes an instrument which consists of two silicon diodes embedded in a wooden block of approximate unit density. A cabinet containing amplifiers, power supplies and digital display is attached to the wooden block. The instrument is used at the beginning and end of a treatment day to ensure proper operation of supervoltage radiotherapy equipment.

Proceedings: Time dose factors in radiation induced osteitis.

Sixty-eight patients with varying degrees of radiation induced bone damage were studied in detail with respect to the absorbed doses in soft tissue of bone and the time-dose-fractionation treatment schemes employed.The cases were divided into 2 large categories of bone damage. The first category included 52 cases of predominantly irreparable injuries; the second included 16 cases of reparable damage.Average values of the NSD (Nominal Standard Dose) required for irreparable osseous injury ranged from 2,120 rets to 3,200 rets (roentgen equivalent therapeutic) depending on site. The average NSD value for reparable osteopathy was in the range of 1,310 nets.Analysis of iso-effect dose curves indicated varying degrees of dependency on the number of fractions on over-all treatment time for the production of radiation osteitis.Preventive measures such as careful treatment planning, utilization of supervoltage irradiation, and avoidance of trauma and infection are stressed.

Cancer of the Gastrointestinal Tract

Advances in surgical and radiotherapeutic techniques have not altered the survival figures of esophageal cancers. The ability of surgeons to resect the entire esophagus and to reconstruct an alimentary channel has increased the operability and resectability rates, but not the survival rate. The introduction of supervoltage irradiation has led to aggressive treatment of this cancer with high-energy beams and high doses, but again, gains in survival have been small. A survey of the world literature for five-year survivors can best be described as pitiful. Only 135 survivors were noted by Smithers in 1957¹at the time of the survey. In their offering in this series, Nakayama and Kinoshita reported only 301 five-year survivors in all the surgical literature. The concepts of operability and resectability in esophageal cancer have undergone considerable change; now surgery is performed for palliation even if the patient's prognosis is bleak. The lack of a generally

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.

Carcinoma of prostate: Local extension following perineal needle biopsy

The sixth case of perineal extension of adenocarcinoma of the prostate apparently following needle biopsy is reported, with a brief review of the literature. The treatment of choice is total surgical excision of the tumor followed with supervoltage irradiation, if the excision appears incomplete. The incidence of this complication is extremely low considering the thousands of biopsies which have been performed.

Correlation of histopathology with clinical results following radiation therapy for carcinoma of the cervix.

CORRELATION OF HISTOPATHOLOGY WITH CLINICAL RESULTS FOLLOWING RADIATION THERAPY FOR CARCINOMA OF THE CERVIXLEONARD L. GUNDERSON, M.D., WILLIAM S. WEEMS, M.D., RICHARD M. HEBERTSON, M.D. and HENRY P. PLENK, M.D.Audio Available | Share

Questions and Answers on Cancer

CA: A Cancer Journal for CliniciansVolume 23, Issue 5 p. 284-285 Questions and Answers on CancerFree Access Questions and answers on cancer First published: September/October 1973 https://doi.org/10.3322/canjclin.23.5.284AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Wang, C. C. and Schulz, M. D.: The role of radiation therapy in the management of carcinoma of the sigmoid, rectosigmoid, and rectum. Radiology 79: 1– 5, 1962. 2 Whiteley, H. W., Jr., et al.: Palliative radiation therapy in patients with cancer of the colon and rectum. Cancer. 25: 343– 346, 1970. 3 Moertel, C. G., et al.: Combined 5-Fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 297: 865– 867, 1969. Volume23, Issue5September/October 1973Pages 284-285 ReferencesRelatedInformation

Treatment of Acromegaly

Therapeutic efficacy was studied in nine acromegalic patients. Eight were initially treated with supervoltage radiation therapy. Of these, four subsequently underwent surgery. Indices of activity correlated poorly with levels of somatotropin (STH). The other four had a satisfactory result manifested by a reduction in basal somatotropin level to normal, retention of anterior pituitary function, and absence of extrasellar extension. It is suggested that these patients have a small, or slow-growing adenoma, characterized by lower somatotropin levels and no extrasellar extension of hypopituitarism. Supervoltage radiation appeared to be best for this group. Reduction in somatotropin levels increased with time after radiation. Patients who would have been better managed with surgery had a large, or rapidly growing tumor and had clinical characteristics of hypopituitarism, hypothalamic extension, and visual field encroachment.

Rare complication resulting from radiotherapy of spinal cord malignancy

Abstract A rare complication of irradiation is reported of a ten-year-old boy who had been treated by supervoltage irradiation following decompressive-laminectomy for his primary spinal cord neoplasm. He probably received average dose of (4500) rads to a limited segment of his duodenum, within the six weeks. He developed this complication nine months after the completion of treatment. The dose-time-volume factors are considcred sufficient enough to produce such complications, however, there were apparent contributory factors such as unusual duodenal fixation and duodeno-jejunal ligament foreshortening.

Improved palliation of pancreatic carcinoma.

A retrospective study has been made of the diagnosis and treatment of 250 patients with carcinoma of the pancreas (confirmed by celiotomy, biopsy, and autopsy in 242) from a private surgical group at one hospital (Series A), a 12-year medical-surgical experience at a second private hospital (Series B), and a 10-year experience at the University of Nebraska Hospital, which included a high percentage of low-income referrals (Series C). Diagnosis was usually delayed until obstructive jaundice or radiologic evidence of upper gastrointestinal tract deformity existed, and was usually achieved by celiotomy. Follow-up studies using second look operations and autopsies suggest that supervoltage radiation therapy to at least 3,000 rads tissue dose initial course combined with initial 5-fluorouracil (FU), followed by weekly FU maintenance therapy, has at times favorably modified the course of the primary as well as locally metastatic carcinoma. Eight of nine patients whose erythrocytes were tagged with Cr51 for quantitative specific blood loss measurement excreted one or more stools significantly exceeding the normal 0.6 ± 0.4 ml lost per 24 hours; the ninth patient had complete biliary obstruction at the time of testing. In two patients, the blood loss was as high as 83-239 ml daily due to extrinsic gastric invasion. In a third patient, the blood loss decreased from 50 ml daily to 4 ml daily during irradiation and FU therapy. Survivorship studies indicate no significant difference between Series A and C cases in this study, with the proportion of survivors at 6 and 23 months palliated by major surgical resection attempts beginning to be equalled at 23 months, by those who received only bypass operations combined with pancreatic irradiation to 3,000–4,000 rads and FU therapy. Patients over 45 with nonspecific digestive disturbances and negative endoscopic and radiologic examination with persistent daily gut blood loss by the radiochromium technique of 1.8 ml or greater for 2–3 weeks duration should have the level of bleeding identified either by sequential gastrointestinal intubation and serial aspiration of digestive secretions for blood loss measurement, or by radiologic methods, which are usually negative early in the growth of extra-ampullary carcinomas.

Malignant tumors of the vagina.

A retrospective analysis of 118 patients with malignant tumors of the vagina shows that the prognosis, following adequate irradiation, is similar to cornparable stages of carcinoma of the cervix. The 5-year absolute cure rate was 75% for Stage I, 50% for Stage JIA, and about 25% for Stages IIB, 111, and IV. The patients were retrospectively staged according to the system adopted by the International Federation of Gynecology and Obstetrics. It is proposed that the Stage I1 lesions be subdivided into IIA (paravaginal submucosal extension only) and IIB (parametrial extension), since the prognosis is distinctly different in these patients. Otherwise, the prognosis correlates well with the various clinical stages. Tumor control was excellent in the in-situ and early invasive lesions treated by radium alone or combined with external beam in Stage I lesions. Local and pelvic failures were more frequently seen in tumors more extensive than Stage IIA. Well-planned irradiation, with the aid of computer calculations, will significantly increase tumor control. This is best achieved by combining interstitial and intracavitary vaginal radium and external beam supervoltage irradiation to the pelvic and parametrial tissues. The importance of careful follow-up after irradiation and the early treatment of recurrent lesions is emphasized since a number of these patients can be salvaged by a subsequent surgical procedure. The most significant factor affecting the prognosis was the stage of the disease, which was related to the depth of infiltration of the tumor in the vaginal wall or adjacent tissues. Age of the patient, location, or extent of mucosal involvement did not significantly influence the prognosis.

Management of Malignant Solid Tumors in Children

Multidisciplinary approaches are vital in the treatment of these malignant tumors. Accurate diagnosis and staging must precede any attempt at therapy. Improved pediatric surgical techniques, supervoltage radiotherapy, and the availability of effective chemotherapeutic agents have all contributed to better results.

Radiation Therapy in Cancer Management

Although radiation therapy has been used for more than half a century in the management of cancer, it did not assume a prominent role in the United States until the late 1950s when supervoltage radiation therapy became available in many centers. With the successes achieved in those centers, there developed an increased interest leading to a better understanding of the biological and physical bases of radiation oncology. Wider applications and rapid improvement in results came about through more precise and scientific use of radiation techniques. The radiation oncologist, therefore, is involved in the care of a majority of patients with cancer. Medical students and many physicians, however, have had little, if any, useful introduction to the utilization of radiation techniques in treating patients with cancer. The authors point out that recent improvements in medical school curricula have provided the students a somewhat cursory introduction to the subject. The major purpose

Carcinoma of the cervix presenting with rectal symptomatology: report of three cases.

Summary Three patients with progressive stenotic rectal symptoms as the initial clinical manifestation of carcinoma of the cervix are reported. The tumors infiltrated the rectum circumferentially at different levels from the anal canal up to 10 cm above the anus. Rectal and cervical biopsies showed well-differentiated squamous-cell carcinoma identical histologically at the two sites in each of the three patients. Two patients were treated with supervoltage radiation and are well after 39 and 30 months. This apparently very rare clinical form of cervical carcinoma may result from the slow growth of the tumor combined with self-neglect; it may have to be considered and ruled out as the possible primary site in cases of older women who have similar presenting symptoms.

Ten Thousand or More Rads Supervoltage Irradiation to the Bladder: Efficacy, Sequelae and Management

Ten Thousand or More Rads Supervoltage Irradiation to the Bladder: Efficacy, Sequelae and Management

Thio-TEPA and supervoltage radiotherapy for carcinoma of the ovary.

One hundred and twenty-one cases of carcinoma of the ovary treated post-operatively with irradiation are evaluated. Eighty-seven also received at least one course of TSPA, approximately 0.8 mg/kg IV or 1.2 mg/kg IP over 3 days, which was usually given prior to radiotherapy. Thirty-four additional patients are considered who were referred for radiotherapy only after recurrent or persistent disease. TSPA did not appear to provide additional benefit when given before postoperative radiotherapy in Stage I and Stage II cases. The value of TSPA in more advanced stages is uncertain. Radiotherapy, with or without TSPA, given after the appearance of recurrent disease had very little effect in the majority of patients. Rupture of a cyst with spillage at operation had no detectable effect on prognosis. Suggestions are made for possible improvements in the management of ovarian carcinoma.

Changes in intestinal and renal function after pelvic irradiation: Correlation of clinical and experimental observations

A group of tests for intestinal and renal function were carried out in female patients with carcinoma of the uterine cervix before and after treatment with a combination of intracavitary radium and orthovoltage or supervoltage radiotherapy. The results were statistically evaluated and correlated with the effects of radiation known from previous clinical reports and experimental studies in animal models. No change in the concentration of urea and creatinine in serum took place, and the urea clearance (which was uncorrected for body surface area and therefore low in a number of patients prior to therapy) was likewise unaltered by therapy. A small (15 per cent) but statistically significant reduction in creatinine clearance was observed after therapy. Serum xylose levels 2 hours after a loading dose were significantly reduced, but since the 5-hour urinary excretion of xylose was not significantly altered by therapy, it is likely that delay in stomach emptying contributed to the change in serum xylose concentration. Mean daily faecal excretion of nitrogen and fat were unaltered, but the percentage of fat relative to dry weight of the stool increased, possibly as a consequence of an increase in the rate of intestinal cell desquamation. A highly significant fall in the value for the Schilling test took place after radiotherapy. While reduced glomerular filtration rate and increased utilisation of Vitamin B₁₂ may have contributed, the main reason for the reduction was thought to be impaired Vitamin B₁₂ absorption from the ileum. It is suggested that reduction in ileal function should be kept in mind in planning the nutritional requirements of anaemic subjects during pelvic irradiation, while the fall in glomerular filtration rate may lead to the prolonged action of drugs normally cleared by this mechanism.

Selecting variations in extent of surgical procedure for breast cancer.

Most breast cancers arise in multicentric areas of the breast parenc hyma and exist as silent innocuous in-situ entities for many years before the infiltrating stage develops. Most of the lymphatic drainage extends to the axillary lymphatic nodes but some to the internal mammary lymph node chain. Risk of spread to the internal mammary nodes increases as the primary tumor approaches the sternal margin as the size of the primary tumor increases and when axillary nodes are also involved. The primary operation should remove all disease present. Aggressive primary surgery and radiation therapy will salvage those without generalized disease. Systemic therapy should be reserved for those with systemic disease. Uninvolved regional lymph nodes do not add to the immune protective mechanism. Modified radical mastectomy in which axillary nodes are removed is adequate for early cases. Histological study at time of operation is essential. Only patients with negative axillary nodes do well with this less complete operation. More complete axillary dissection is preferable when disease is present in the axilla. Radical mastectomy is best for most infiltrating breast cancers. When metastases are found in the axillary nodes supervoltage radiation therapy is also given because of the risk of spread to the internal mammary lymph chain. Extended radical mastectomy which includes en bloc excision of the internal mammary nodes has been used for patients with a high risk of spread to these nodes. Almost 800 patients have been so treated with an operative mortality of less than .5%. Of these 33% had metastases to these nodes and 47% also had axillary node involvement. Of those with negative axillary involvement 15% had positive internal mammary nodes; this was found highest when the primary tumor was on the inner side of the breast. 5 years after surgery 500 patients 47% with axillary involvement and 30% with internal mammary involvement were evaluated. 72.4% were alive 65.8% were disease-free and 7% had local recurrence. 41% with involvement of both nodal areas were clinically disease free. Of 315 evaluated at 10 years 52% were clinically disease-free. Of 98 patients with internal mammary node metastases 27 were clinically disease-free and 28 survived at 10 years. Palliative mastectomies were done on 37 considered inoperable. With added radiation therapy local control was obtained in 29. In only 5 of 14 treated with radiation alone was local control obtained. Of the total 51 inoperable patients 21% were alive at 5 years and 14% were free of disease. None survived 10 years.

Total laryngectomy and cancer of the larynx. A historical review.

This review focuses on the history of therapy of cancer of the larynx. The perfection of indirect laryngoscopy and biopsy by Morell MacKenzie, the first laryngectomies by Theodor Billroth, the tragedy of Crown Prince Frederick of Germany, perfection of laryngectomy and neck dissection, the development of orthovoltage and supervoltage radiotherapy, and the recent combination of radiation and surgery are the exciting highlights of this history which covers 140 years.