Anam Sudarsanam

Influence of exploratory celiotomy on the management of carcinoma of the cervix. A preliminary report.

The policy of treating patients with Stages IB and IIA carcinoma of the cervix by radical hysterectomy and pelvic lymphadenectomy led to the initiation of laparotomy staging of carcinoma of the cervix in 1970. Two‐hundred twenty patients were subjected to surgical staging at which time bilateral aortic lymphadenectomies and biopsies of perirectal and perivesical spaces were done. If these were negative, radical hysterectomy and pelvic lymphadenectomy were performed in patients with surgical Stage IB and IIA. Para‐aortic node involvement was seen in 7%, 14%, 18%, and 19% in patients with Stages IB, IIA, IIB, and IIIB, respectively, in the context of the surgical material being heavily weighed in favor of early stage disease. The methods of management in these patients were designed according to the findings at exploratory celiotomy. Twenty‐one patients were found to have positive para‐aortic nodes and received en bloc pelvis and para‐aortic irradiation. Four patients are alive and well at 63,23,20, and 19 months, respectively. One patient is alive with disease at 18 months. Two died from other causes at 34 and three months. There was no difference in the survival of the two groups of patients among 75 with negative para‐aortic nodes, who received either pelvic irradiation alone or pelvic and para‐aortic irradiation on the basis of possible presence of subclinical disease not dissected at the time of surgery.

Radiation Therapy for Exophthalmos: Report of Seven Cases

Five of 7 cases of exophthalmos showed improvement within three months with 2,000 rads of 6 MeV radiation. A new technique of X-ray beam localization employing a direct measurement 12 mm posterior to the anterior extent of the cornea was used and found more accurate than using a fixed point (external canthus). All cases should be treated bilaterally. Retreatment after radiation failure is not recommended. There were no complications. Improvement is usually rapid as orbital irradiation, not including the pituitary, causes rapid destruction of the massive collection of lymphocytes and a reduction in the bulky mass and edema of the orbit.

Preoperative extended field radiation with I-125 seed implant in prostatic cancer: a preliminary report of a randomized study

Abstract This study began in 1972, when randomly allocated patients received preoperative x-ray therapy to the pelvis and para-aortic areas to a dose of 3000 rad in 14 fractions; following this treatment retropubic extraperitoneal exposure of the prostate and node dissection were performed. Iodine-125 seeds were implanted in the prostate. Patients with positive nodes received postoperative radiation therapy to tolerance doses while those with negative nodes were only observed with no further therapy. In the alternate arm, the patients underwent straight retropubic extraperitoneal exposure of the prostate, node dissection, and Iodine-125 seed implant. If the nodes were positive, the patients received en bloc pelvic and para-aortic radiation to tolerance. Patients in this arm with negative nodes again received no further therapy. The aggregate dose was 5400 rad to the pelvis and was about 4400 rad to para-aortic nodes in both arms where the nodes were found to be metastatic. Thirty-two patients were evaluable for minimum of follow-up of two years with equal numbers in each group. Eight of 17 patients who had positive nodes in both the arms and who received extended field x-ray therapy, were disease-free with median survival of 312 years. Two patients in the preoperative radiation group and six in the alternate group had local failures. The pattern of survival and dissemination, otherwise were similar as of this writing.

Selective therapy for early cancer of the cervix: II. Surgically nonexplored cases

Abstract Of 337 patients with cervical cancer stages IB and IIA treated during 1967–1976, 46 or 13.6% were selectively excluded from surgical therapy in favor of radiation therapy. Major contraindications to surgery were age over 70 years, obesity, cardiovascular disease, diabetes, and lung disease. The corrected 3-year survival among those patients treated prior to March 1975 was 53% and the 5-year survival among patients treated prior to March 1973 was 48%. It is suggested that impaired oxygenation secondary to systemic complications of the mentioned medical conditions is primarily responsible for the relatively low cure rate. Other possible high risk factors are age and a large relative number of Stage IIA patients in the material.

The Role of Transverse Axial Tomography in Three-Dimensional Treatment Planning

The authors discuss the use of transverse axial tomography in target localization, treatment simulation, and computation of dose distribution, including three-dimensional display. This technique facilitates accurate and rapid treatment planning for the individual patient. Limitations encountered during the application of this method over a period of two years are described.

Electron and x-ray beam characteristics of the linac LMR-13.

Electron beams of nominal energies 4, 8, 10 and 12 MeV were investigated. The effect of Ni and Pb scattering foils on beam penetration and field flatness is discussed and optimal combinations of beam energies and scattering foils are suggested. Depth doses are expressed as percentiles. A study of the 10 MV x-ray beam shows a need for two flattening filters for clinical ranges of field sizes. Flatness and depth dose data variations for two lead flattening filters of the same maximum thickness and central axis percentage depth doses are given.