Antonio R. Antunez

The advantages of subtotal thyroidectomy and suppression of TSH in the primary treatment of papillary carcinoma of the thyroid

Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (131I). Moreover, distant metastases can be treated by either 131I or suppression as effectively after they are apparent on x‐ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients older than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, 131I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by 131I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.

Half and Total Body Radiation for Carcinoma of the Prostate

Despite recent advances in the treatment of stage D carcinoma of the prostate many patients become refractory to all therapeutic modalities. Progressive and incapacitating pain is one of the most difficult symptoms to manage. Ten patients with severely symptomatic metastatic adenocarcinoma of the prostate have been treated with either single or sequential doses of half body radiation using 800 rad delivered by a Linac 10 mV linear accelerator. There were 15 courses of half body radiation delivered and a good to excellent response was noted in 11 instances. Results often were immediate and the duration of the response was variable. Treatment was well tolerated with no fatal complications. Half and total body radiation appears to offer significant palliation and its use with other forms of therapy warrants further investigation.

Update on Intracavitary Radiation in the Treatment of Bladder Tumors

A 15-year experience with intracavitary radiation for the treatment of selected bladder tumors is presented. The age range of these patients was 39 to 91 years, with an average of 65 years. There were 38 men and 17 women with multiple stage A bladder tumors and carcinoma in situ. Some patients were poor risks for treatment by total extirpative surgery. A simplified technique using a 25 mg. radium capsule as a central source is described for administration of 4,000 to 5,000 rad to the surface of the bladder. Most patients tolerate the presence of the radium catheter with little difficulty. No morbidity and no mortality were reported. In this series more than 60 per cent of the patients benefited from the therapy, with no recurrence noted in some cases after up to 8 1/2 years of followup. Intracavitary radiation is used in few clinics. Use of this modality does not preclude or complicate the subsequent use of other conservative measures or radical therapy if required. It is an effective procedure for treatment of multiple superficial and noninvasive tumors, including primary or recurrent carcinoma in situ, that are uncontrolled by other conservative measures.

The combined modality therapy of diffuse histology non-Hodgkin's lymphoma with cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) and total body irradiation☆

The combination of cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) alternating with total body irradiation (TBI) has been shown earlier to be effective therapy in patients with malignant lymphoma who have received prior chemotherapy and/or radiation therapy. A limited institutional pilot study was therefore done by the Southwest Oncology Group between October 1977, and November 1978 to test the benefit of this program in previously untreated persons with Stages 3 and 4 diffuse histology non-Hodgkins lymphoma. Eleven evaluable patients with the following histologies were treated: 7 poorly differentiated, 2 with histiocytic, 1 with mixed lymphoma and 1 with well-differentiated morphology. CHOP was given in the following manner: cyclophosphamide 400 mg/M2 IV day 1, adriamycin 40 mg/M2 IV day 1, vincristine 2 mg IV day 1, and Prednisone 100 mg po daily X 5. Forty-five rad total body irradiation was delivered in three fractions on days 21, 23 and 25. Chemotherapy was repeated on day 42, etc., until four cycles of CHOP and three cycles TBI (135R) were delivered. Responses were seen in 8/11 patients (6 CR and 2 PR); 5 persons are currently alive and 6 are dead. Two of the living patients are alive with disease and the remainder are in unmaintained remission. Two persons died with no response and one died in complete remission of an unrelated illness. The median duration of remission is 15 months and the median survival for all patients is 48 months. The therapy was well tolerated with a mean nadir leukocyte count of 3,020 X 10(9)/microliters (range 1.2-5.5) and a mean nadir platelet count of 188 X 10(9)/microliters (range 016-270). As delivered, this program is capable of producing durable remissions and needs to be verified in a larger series of patients.

The combined modality therapy of diffuse histology non-hodgkin lymphoma with combination chemotherapy and total body irradiation

The combination of cyclophosphamide, adriamycin, vincristine, and orednisone (CHOP) alternatina with total bodv irradiation (TBIl is effective therapy in patients with malignant lymphoma who have received prior chemotherapy and/or radiation therapy. 1 A limited institutional pilot study was done by the SWOG between January, 1977 and July, 1978 to test the benefit of this program in untreated persons with stages 3 & 4 non-Hodgkin lymphoma of diffuse histology. Thirteen patients were treated and are evaluable. Histologies included: seven with poorly differentiated, four with histiocytic and two with mixed lymphana. CHOP was given in the following manner: cyclophosphamide 40Omg/m* I.V. Dl, adriamycin 4Omg/m* I.V. Dl, vincristine 2mg I.V. Dl, and prednisone 1OCmg p.o. daily x 5. 45 Rads total body irradiation were delivered in 3 fractions on days 21, 23 and 25. Chemotherapy was repeated on 042, etc., until 4 cycles CHOP and 3 cycles TBI (135R) were delivered. Responses were seen in 9/13 patients and 8 remain alive. Four persons died with no response and one died in complete remission of an unrelated illness. The median duration of remission is in excess of 3 years and the median survival has not been reached. Therapy was well-tolerated with a mean nadir leukocyte count of 36OO/cu.mn. (Range 1200-7700) and a mean nadir platelet count of 109 (Range 032-270). The activity of this program may be superior to that reported for chemotherapy alone and warrants confirmation in a larger series of patients. The techniques employed and a detailed analysis will be presented.