A. Robert Kagan

Osteoradionecrosis of the mandible: Scientific basis for clinical staging

Osteoradionecrosis of the mandible can be a serious complication of radiotherapy for head and neck cancer. The disorder generally presents in one of several distinct clinical variations. This is probably because of a complex interaction of etiologic factors. A clinical staging system for the disordeOsteoradionecrosis of the mandible can be a serious complication of radiotherapy for head and neck cancer. The disorder generally presents in one of several distinct clinical variations. This is probably because of a complex interaction of etiologic factors. A clinical staging system for the disorder is described. Such a system is necessary for the conduct of clinical research, and for the development and assessment of treatment regimens.

Epidural spinal cord compression from metastatic tumor

Abstract The occurrence of spinal epidural metastases is one of the several oncological emergencies which require prompt medical attention.

Prognostic indicators in Hodgkin's disease.

A series of 270 patients with Hodgkins disease, diagnosed between July 1953 and July 1968, and classified according to the Lukes‐Butler histologic classification scheme, is used to illustrate two statistical procedures for evaluating the simultaneous effect of various prognostic factors. The results are presented as equations in which median years of survival depend jointly on histologic type, sex, stage of disease, and symptoms at diagnosis. The data included in this report are sufficient for illustrating the statistical methods, although a much larger series of Hodgkins disease patients would be required for carrying out an analysis of this type that would provide valid results for survival prediction.

Fatal Foam Cell Arteritis of the Brain After Irradiation for Hodgkin's Disease: Angiography and Pathology

A case of foam cell arteritis of the brain following irradiation of the neighboring structures for Hodgkins disease is described. A differential diagnosis of the unique angiographical findings is presented. The etiology of foam cell arteritis restricted to the brain is considered. It is hoped that the experience of this case encourages a careful neuroradiological and neuropathological examination of the brain in all patients with Hodgkins disease who present with the stroke syndrome.

Lymphomas of the testicle

Although lymphomas of the testicle anecdotally may be confined to that organ, in general they represent a part of the disease which is distributed widely in other parts of the body. A review of the literature and of our nine cases indicates that of those presenting initially in the testicle, the first recurrence is often in a visceral organ or in a noncontiguous lymph node region. Frequent involvement of Waldeyers ring, the paranasal sinuses, and contralateral testicle makes this disease worthy of further study.

Radiation Damage to the Nervous System: a delayed therapeutic hazard

This volume represents a good overview of an important issue - late effects of radiation on the nervous system, a topic of interest to everybody who deals with neurooncologic problems. The book is well edited and includes almost all relevant subjects ranging from diagnostic and dosimetric considerations to treatment of radiation brain necrosis.

A comparison of single-dose and fractionted total-body irradiation on the development of pneumonitis following bone marrow transplantation

PURPOSE A review of 132 consecutive patients who received bone marrow transplant for various malignancies was conducted to determine factors associated with increased risk in developing interstitial pneumonitis (IP) as the result of total body irradiation (TBI). Twenty-four patients were excluded because 22 did not receive TBI and two had insufficient records. METHODS AND MATERIALS Patients were conditioned with TBI and various drug regimens. Eighteen patients received a single 6.0 Gy dose of x-rays. The remaining 90 were treated with three doses of 3.33 Gy separated by 24 h. All patients were followed for at least 18 months for the purposes of determining the IP incidence. RESULTS Twenty-seven of these 108 (25%) patients developed IP; 19 (17.6%) died. The 2-year estimated incidence of IP was 24 and 18.6% for fatal IP. The etiology was determined to be idiopathic in 12 patients, the result of cytomegalovirus in 6 patients, and caused by a variety of other infectious organisms in 9 patients. We were unable to demonstrate a statistically significant increase in IP with age (adults vs. children), dose regimen, use of methotrexate for graft-vs.-host disease prophylaxis, the presence of acute graft-vs.-host disease, time from diagnosis to transplant, or transplant type (allogeneic vs. autologous). CONCLUSIONS The incidence of fatal IP reported here is similar to that reported by other institutions utilizing hyperfractionated TBI protocols. Our data do not support the need for hyperfractionation to reduce the risk of IP.

On the role of intensity-modulated radiation therapy in radiation oncology.

Physicists are critical members of the radiation therapy team, and rightfully so. Therefore, it is not unreasonable that they be acquainted with the broader aspects of the management of patients who receive radiation treatments, as well as the roles played by surgeons, medical oncologists and other members of the treatment team. The spate of recent technical developments openly embraced by medical physicists, many of whom appear unconcerned by questionable benefits and very high costs, leads the authors to believe that this acquaintance is not as widespread as it should be. The present paper provides a brief review of clinical considerations in radiation oncology, statistics for the most prevalent cancers, and how those cancers that account for over 90% of mortality are currently treated. With these data as background, it then considers the extent to which one of the more widely promoted new technologies is likely to impact upon survival. By providing this modicum of perspective, physicists will be in a better position to evaluate these new technologies in more fundamental clinical terms, and thereby enhance their contributions to the overall care of the cancer patient.

Primary malignant mixed tumor of the mandible

Tumors of aberrant salivary gland origin can involve the jaws and present as primary bone tumors of the mandible. Examples of such tumors are cylin‐dromas, mucoepidermoid carcinomas and adenocarcinomas. The most common tumor of the salivary gland, the mixed tumor, has not been previously reported in the jaw. The case reported here is that of a primary bone tumor showing light, histochemical, and ultrastructural features of a malignant mixed tumor.

Proton-beam therapy for prostate cancer.

The treatment options for prostate cancer include prostatectomy, external-beam irradiation, brachytherapy, cryosurgery, focused ultrasound, hormonal therapy, watchful waiting, and various combinations of these modalities. Because the prostate abuts the bladder and rectum, the dose distributions of external-beam irradiations and the accuracy of their placement play crucial roles in the probability of tumor cure and the incidence of posttreatment complications. Principal among the newer radiation technologies is proton-beam therapy (PBT), whose dose distributions make it possible to deliver higher tumor doses and smaller doses to surrounding normal tissues than from x-ray systems. However, as the 10-year cause-specific survival for early-stage disease treated by radiation therapy now exceeds 90%, and with severe late toxicities in the range of 2% to 3%, randomized clinical trials provide the only means to demonstrate improved outcomes from PBT. Short of the data provided by such trials, the efficacy of PBT can be gleaned only from reports in the clinical literature, and, to date, these reports are equivocal. In view of the current health care crisis and the higher costs of PBT for prostate cancer, it is reasonable to assess the viability of this in-vogue but not-so-new technology.The treatment options for prostate cancer include prostatectomy, external-beam irradiation, brachytherapy, cryosurgery, focused ultrasound, hormonal therapy, watchful waiting, and various combinations of these modalities. Because the prostate abuts the bladder and rectum, the dose distributions of external-beam irradiations and the accuracy of their placement play crucial roles in the probability of tumor cure and the incidence of posttreatment complications. Principal among the newer radiation technologies is proton-beam therapy (PBT), whose dose distributions make it possible to deliver higher tumor doses and smaller doses to surrounding normal tissues than from x-ray systems. However, as the 10-year cause-specific survival for early-stage disease treated by radiation therapy now exceeds 90%, and with severe late toxicities in the range of 2% to 3%, randomized clinical trials provide the only means to demonstrate improved outcomes from PBT. Short of the data provided by such trials, the efficacy of PBT can be gleaned only from reports in the clinical literature, and, to date, these reports are equivocal. In view of the current health care crisis and the higher costs of PBT for prostate cancer, it is reasonable to assess the viability of this in-vogue but not-so-new technology.