Abraham Marck

Stage III adenocarcinoma of the endometrium: two prognostic groups.

Abstract Between July 1968 and December 1976, 26 patients with surgical-pathologic Stage III adenocarcinoma of the endometrium were treated at the Joint Center for Radiation Therapy. In 15 patients, extrauterine disease was confined to the ovary and/or fallopian tube (Group A). In 11 patients, disease extended beyond these organs to the vagina or other pelvic structures (Group B). Treatment included a combination of radiation therapy and surgery in all but one patient, who was treated by radiation therapy alone. The median follow-up was 65 months and the median time to relapse 9 months. The actuarial relapse-free 5-year survival for all Stage III patients was 54%; it was significantly different ( P = 0.01) for Group A (80%) and Group B (15%). The nature of extrauterine involvement in surgical-pathologic Stage III adenocarcinoma of the endometrium is of major prognostic significance.

The role of postoperative irradiation in carcinoma of the breast.

Chest wall and regional nodal recurrences, and survival following postmastectomy radiation therapy, were analyzed in 352 patients. Patients with T1 and T2 central and medial breast lesions, negative axillary nodal findings, and no evidence of skin or chest wall extension received irradiation to the peripheral lymphatics alone. There were no chest wall recurrences among these patients. The remainder of the patients, including those with axilary nodal involvement, regardless of the site of the primary breast lesion received irradiation by a three‐field technique directed to both chest wall and regional nodes. The chest wall recurrence rate was 1.9% when axillary nodes were negative for metastatic disease, 1.3% when the axillary nodes showed less than 50% positivity, and 14.2% when axillary nodes showed greater than 50% involvement. The overall chest wall recurrence rate was 5.1%. A possible mechanism of chest wall recurrence is discussed. Cumulative 5‐year survival for stage I is 76%, for stage II, 79%, and for stage III, 57%. If chemotherapy proves to be effective in controlling distant microscopic disease local control may become an equally critical issue in long‐term survival of patients with breast carcinoma.

Combined irradiation and surgery in the treatment of stage II carcinoma of the endometrium

Between January 1969, and August 1975, 40 patients with pathologic Stage II carcinoma of the endometrium were treated at the Joint Center for Radiation Therapy. The treatment policy included external and intracavitary irradiation combined with surgery. The majority of patients received 4000 mg/hours of radium exposure using a Fletcher‐Suit applicator and 4000 rad whole pelvis external irradiation, followed by hysterectomy and bilateral salpingooophorectomy. Median age of the patients was 61 years (39–88) and the median followup of the patients still alive was 69 months (29–102). Relapse‐free 5‐year survival corrected for intercurrent disease was 83% and uncorrected, 78%. Overall survival was 80%. Five patients had relapsing disease, three patients failed at distant sites only, one patient died of treatment related complications, and two failed locally and distantly. There were no failures in the pelvis alone. Although the relationship between histologic grade and failure is not statistically significant, there were four failures among the 12 Grade III patients compared to two failures in 27 with Grades I and II. Similarly, 4 of 12 patients with gross cervical involvement developed relapsing disease, but only 2 of 28 failed with microscopic cervical involvement. This treatment policy yields excellent survival and continues to be our treatment recommendation.

Parasternal lymphoscintigraphy: Implications for the treatment planning of internal mammary lymph nodes in breast cancer☆

Abstract Parasternal lymphoscintigraphy is an easily performed technique for visualizing and accurately determining thethree dimensional location of internal mammary lymph nodes. Sixty-eight women with primary or locally recurrent breast cancer underwent parasternal lymphoscintigraphy before treatment planning. The mean depth and lateral position of the internal mammary nodes were 1.8. ± 0.9 cm and 2.4 ± 0.9 cm respectively. Thirteen per cent of the nodes would have been undertreated by the standard tangential technique used at our institution. Six of 15 patients whose treatment plans were examined retrospectively had at least 1 lymph node undertreated by the standard tangential tec hnique. Thus, although standard tangential portals provide adequate coverage for the internal mammary lymph nodes in a majority of patients, parasternal lymphoscintigraphy can insure complete coverage of this lymph node group.

Radiation therapy in stage II ovarian carcinoma. The influence of histologic grade

Between September 1968, and December 1975, 40 patients with Stage II epithelial tumors of the ovary were treated at the Joint Center for Radiation Therapy. Thirty‐six patients had undergone a total abdominal hysterectomy and bilateral salpingo‐oophorectomy (BSOH) with attempted total removal of disease, and all patients received postoperative pelvic irradiation. The five‐year actuarial relapse‐free survival rate is 66% and the overall survival rate 70% for the entire group of patients. The histology was reviewed in all cases and graded for the percentage of solid vs. papillary or glandular tumor in the specimen. Of the 36 patients treated with a BSOH, 18 had well‐differentiated tumors defined as containing less than a 10% solid architectural pattern. There have been no relapses in this group of patients. In contrast, 9 of 18 patients with moderately or poorly differentiated tumors containing a 10% or more solid pattern have relapsed; five diffusely in the abdomen, two in the pelvis, and two in the lungs or pleura. It appears that a BSOH followed by pelvic irradiation is sufficient treatment for Stage II patients with well‐differentiated tumors showing less than a 10% solid pattern. In contrast, patients with less well‐differentiated tumors have a high risk of relapse outside of the pelvis and need additional treatment. Alternative treatment options are discussed.

Pathogenesis of pleural effusion in carcinoma of the breast

Abstract Three hundred and fifty-two patients with carcinoma of the breast treated postoperatively with radiotherapy were analyzed for laterality and incidence of pleural effusion. A statistically significant increase in ipsilateral pleural effusions was noted in the entire group ( p p

Modification of gastrointestinal symptoms following irradiation by low dose rate technique

Tolerance of patients receiving 1000 rad total body irradiation at the low dose rate of 5 rad/min prior to bone marrow transplantation is presented. The striking gastrointestinal tolerance is stressed and, as a result of this experience, results in five patients with ovarian carcinoma receiving total abdominal irradiation with similar low dose rate irradiation are presented. Possible explanations for these results are presented and other potential applications of this technique are suggested.

Twice-A-Day Fractionation Preoperative Radiotherapy in Patients with Carcinoma of the Bladder: Preliminary Report

There were 13 patients with carcinoma of the bladder who received preoperative radiotherapy by a modified regimen before cystectomy. Doses of 135 rad were delivered twice daily for 10 days (2,700 rad) to a 15 times 15 cm. portal and followed by immediate cystectomy. Patient tolerance has been excellent, morbidity has been minimal and no increase in operative time, blood loss of major intraoperative or postoperative complications has ensued. The theoretical and practical advantages of this regimen may outweight either the standard regimen of 4,500 rad with a 4-week hiatus before operation or the high dose, short course regimen of 2,000 rad in 5 days and immediate cystectomy.

Combined Irradiation and Surgery in the Treatment of Stage II Carcinoma of the Endometrium

Between January 1969, and August 1975, 40 patients with pathologic Stage II carcinoma of the endometrium were treated at the Joint Center for Radiation Therapy. The treatment policy included external and intracavitary irradiation combined with surgery. The majority of patients received 4000 mg/hours of radium exposure using a Fletcher-Suit applicator and 4000 rad whole pelvis external irradiation, followed by hysterectomy and bilateral salpingooophorectomy. Median age of the patients was 61 years (39--88) and the median follow-up of the patients still alive was 69 months (29--102). Relapse-free 5-year survival corrected for intercurrent disease was 83% and uncorrected, 78%. Overall survival was 80%. Five patients had relapsing disease, three patients failed at distant sites only, one patient died of treatment related complications, and two failed locally and distantly. There were no failures in the pelvis alone. Although the relationshop between histologic grade and failure is not statistically significant, there were four failures among the 12 Grade III patients compared to two failures in 27 with Grades I and II. Similarly, 4 of 12 patients with gross cervical involvement developed relapsing disease, but only 2 of 28 failed with microscopic cervical involvement. This treatment policy yields excellent survival and continues to be our treatment recommendation.

Radiation Therapy in Stage II Ovarian Carcinoma. The Influence of Histologic Grade

Between September 1968, and December 1975, 40 patients with Stage II epithelial tumors of the ovary were treated at the Joint Center for Radiation Therapy. Thirty-six patients had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSOH) with attempted total removal of disease, and all patients received postoperative pelvic irradiation. The five-year actuarial relapse-free survival rate is 66% and the overall survival rate 70% for the entire group of patients. The histology was reviewed in all cases and graded for the percentage of solid vs. papillary or glandular in the specimen. Of the 36 patients treated with a BSOH, 18 had well-differentiated tumors defined as containing less than a 10% solid architectural pattern. There have been no relapses in this group of patients. In contrast, 9 of 18 patients with moderately or poorly differentiated tumors containing a 10% or more solid pattern have relapsed; five diffusely in the abdomen, two in the pelvis, and two in the lungs or pleura. It appears that a BSOH followed by pelvic irradiation is sufficient treatment for Stage II patients with well-differentiated tumors showing less than a 10% solid pattern. In contrast, patients with less well-differentiated tumors have a high risk of relapse outside of the pelvis and need additional treatment. Alternative treatment options are discussed.