Bahman Emami

Effect of preoperative irradiation on resectability of colorectal carcinomas

From 1968 to January 1, 1977, 44 patients with initially unresectable colorectal carcinoma were treated with preoperative radiotherapy and surgery. On presentation, unresectability was determined either clinically (26 patients) or by preradiotherapy laparotomy (18 patients). Preoperative irradiation consisted of 4500-5000 rad. After radiotherapy, 33 of 44 lesions were considered resectable. Seven of 33 patients underwent incomplete resection with mean survival of 17 months. Resection was complete in 26 of the 33 patients. Of the latter group (26), 18 patients are alive with no evidence of disease with minimum follow-up of 36 months. Detailed results are discussed.

Histopathological study on the effects of hyperthermia on microvasculature

Abstract Recent experimental evidence suggests that hyperthermia has profound effects on tumor tissue microcirculation. Indeed, this is one of the suggested mechanisms involved in the anti-tumor effects of heat. Groups of WAG-Rij rat transplanted tumors (rbabdomyosarcoma-BA1112) were ireated with local hyperthermia (Radio-Frequency). Various temperatures (ranging from 38° to 43°C) were used. Animals were subsequently sacrificed at 1, 3, and 24 hours after beating and tumors were subjected to detailed pathological studies for evaluation of the effects of heat on microcireulation as well as on tumor cells. The results are indicative of no specific changes in microvasculature up to 40.5°C. At intermediate temperatures (42°C) vessels show marked dilatation and congestion (?stasis). At higher temperatures (44.5°C) there is massive hemorrhage and necrosis with rupture of vessel walls. The degree and intensity of this process also depends on the interval between heating and time of sacrifice of the animal. Detailed results are presented. The correlation of pathological findings and blood flow observations as well as their relevance to treatment of cancer patients are discussed.

Radical radiation therapy of advanced lung cancer: evaluation of prognostic factors and results of continuous and split course treatment.

One hundred patients with inoperable (80) or unresectable (20) bronchogenic carcinoma without evidence of spread beyond the thorax and supraclavicular nodes were planned for radical radiotherapy. Seventy‐six patients received continuous irradiation (6000 rads in 30 treatments in 6 weeks, TDF 99) and 24 received split course therapy (2 courses of 2500 rads in 10 treatments with a 3 week break between courses, TDF 88). Forty‐three patients had squamous cell carcinoma or adenocarcinoma and were considered to have favorable prognostic factors, while 57 patients had unfavorable prognostic factors: undifferentiated large cell or small cell carcinoma, supraclavicular metastases, SVC obstruction, superior sulcus tumors, or bone erosion in continuity with the tumor. Ninety‐two patients completed the planned course of treatment. In patients completing treatment, local control of cancer within the irradiated volume was achieved in 58.5% of continuously irradiated patients and 45.4% of patients receiving split course therapy. Median survival was 1.2 months in patients not completing treatment and 12 months for the patients who completed treatment; 19% of the total group survived 3 years. Median and 3 year survivals of 14 months and 20.4% and of 9 months and 11% were observed for patients treated continuously and by the split course techniques, respectively. Corresponding survival figures for patients with favorable and unfavorable prognostic signs were 21 months and 26%, and 4 months and 11%, respectively. Implications of these data for treatment planning and patient selection for radical radiotherapy in bronchogenic carcinoma are discussed. Cancer 44:446‐456, 1979.

Photon activation-15O decay studies of tumor blood flow.

A direct, noninvasive method for measuring absolute values of specific capillary blood flow in living tissue is described. The method is based on the photon activation, in situ, of tissue elements and the measurement of the subsequent decay of the positron activity induced, employing coincidence detection of the photon pairs produced in positron annihilation. Analysis of the time-dependent coincidence spectrum reveals the contribution to the total signal from the decay of 15O, from which the specific capillary blood flow in the imaged, activated volume is ultimately determined. By virtue of its introduction of the radioisotope of interest (15O) directly and uniformly into the tissue volume under investigation, the method described permits both the nonperfused and well perfused fractions of an activated volume to be estimated and hence, the average specific blood flow within imaged tumor volumes to be computed. The model employed to describe and analyze the data is discussed in detail. Results of application of the technique to measurement of specific blood flow in rhabdomyosarcoma tumors grown in WAG/Rij rats are presented and discussed. The method is shown to be reliable and well suited to studies designed to determined the effects of various agents, such as heat, radiation and drugs, on tumor blood flow.

The cost effectiveness of a radiation therapy simulator: a model for the determination of need.

Abstract The requirement for a certificate-of-need for capital expenditures of

The value of supraclavicular area treatment in radiotherapeutic management of lung cancer

100,000 or more has placed a major constraint on purchases of new medical equipment. Consideration of a “first principles” argument has not proven compelling to the planning agencies in justifying the purchase of a radiation therapy simulator. Thus a strategy based on cost-effectiveness and the consequences of survival in successfully treated patients is proposed for equipment justification. We have reviewed the records of 18-month survivors among patients with lung cancer that were treated by irradiation; we observed 3 spinal cord injuries in non-simulated patients, whereas none were observed in patients who had the benefit of simulation. Considering the societal costs of spinal cord injury, a cost-benefit analysis of a simulator justifies the expense of this equipment.

Radiation plus adjuvant CCNU (1-[2-chloroethyl]-3cyclohexyl-1-nitrosourea) vs CCNU, hydroxyurea and vincristine in the treatment of malignant glimoa

Records of 295 patients treated for carcinoma of the lung have been reviewed. 64 patients (21.7%) had a supraclavicular involvement at initial presentation, local control was achieved in that region in 26 out of 27 (96%) patients who received a minimum dose of 5,000 rads in 25 treatments. „Local control”︁ applies to complete disappearance of disease in that area with no subsequent recurrence at any time or until death of the patient. One patient had persistent disease despite a dose of 7,000 rads in 35 treatments. Elective supraclavicular irradiation was given to 79 patients, one of whom subsequently developed clinically detectable disease there. One hundred fifty‐three patients did not receive elective supraclavicular irradiation, and 21 (14%) subsequently developed supraclavicular disease, a statistically significant difference. Patients considered at higher risk for supraclavicular metastasis were selected for elective supraclavicular irradiation. Therefore, the markedly lower rate of involvement in the treated patients can be attributed to the irradiation given that group. Overall, supraclavicular nodes were present in 24.8%, 30.2%, 34.1%, and 31.5% of patients with squamous cell carcinoma, adenocarcinoma, and undifferentiated small and large cell carcinoma, respectively. Seventy‐six of 85 patients (89.4%) with supraclavicular involvement had hilar and/or mediastinal involvement at initial presentation. No significant difference in survival was observed between patients receiving supraclavicular, irradiation and those not receiving treatment to that area. Of 64 patients with initial supraclavicular involvement, there were 14, 9, and 5 survivors at 12, 18, and 24 months, respectively, with four patients surviving beyond 36 months.