Barbara F. Danoff

The radiotherapeutic management of optic nerve gliomas in children

Abstract Optic nerve gliomas represent one to five percent of all intracranial tumors in children. The management of these tumors remains controversial. From 1956 to 1977, 18 children with optic nerve gliomas were treated at Thomas Jefferson University Hospital using external beam radiotherapy . All children presented with decreased visual acuity and five of eighteen were blind in one eye. No patient was found to have involvement of a single optic nerve. In eight patients, the chiasm was involved, in ten patients, tumor had extended to the frontal lobes and/or hypothalamus. Initial surgical management included biopsy only in seven patients, inspection of tumor in two patients and partial excision in seven patients. Two patients were treated with radiotherapy based on radiological findings. A tumor dose of 5000–6000 rad was given in 5.5–6.5 weeks. Stabilization of visual impairment or improvement in vision was noted in 78 percent of patients who were evaluable. The ten year survival was 73 percent. Radiological evidence of tumor regression will be presented. It is our impression that radiotherapy is indicated in the treatment of children with optic nerve gliomas who have poor prognostic signs (i.e. chissmal and/or hypothalamic involvement and progressive visual loss).

Childhood craniopharyngioma: Survival, local control, endocrine and neurologic function following radiotherapy

Between 1961 and 1978, 19 patients with a diagnosis of childhood or teenage craniopharyngioma received supervoltage radiotherapy. All patients had previously undergone either partial surgical resection (10 patients), total gross resection (3 patients), or aspiration and biopsy (6 patients). Fourteen patients were treated primarily and five were treated for recurrence. The five-year survival was 73% with a 10-year survival of 64%. Sixteen percent developed a recurrence following radiotherapy. Long term effects were assessed in terms of neurologic, intellectual, psychological and endocrine function. Seventy-nine percent had none or minimal neurologic disability. The mean full scale IQ for the group was 90. There were no additional endocrine deficiencies that could be directly attributed to radiation. Behavioral disorders occurred in 50%. These results are at least comparable, if not superior, to those of surgery.

Assessment of the quality of life in long-term survivors after definitive radiotherapy.

AN INTERVIEW QUESTIONNAIRE WAS DEVELOPED to assess quality of life both in objective and subjective terms in cancer patients. Standardized measures were employed and allowed for comparison with a national baseline. Three hundred thirty-nine patients who were alive without evidence of disease 3 or more years following initial treatment were interviewed. There was no difference in terms of educational level, marital status, or satisfaction with local government, family, job, friends, community, health, recreation, or activities when compared to the age-adjusted national baseline. The patients were more satisfied with region, self, and life as a whole. There was no evidence of a diminished quality of life in these patients.

Conservative Surgery and Irradiation in the Treatment of Early Breast Cancer

The treatment of early (stage I and II) breast cancer over the past 10 years has shown a trend towards conservative use of surgery. The role of mastectomy in achieving local-regional control has been challenged by procedures that preserve the breast, in which tumor excision and axillary node dissection are followed by breast irradiation. Data from retrospective studies as well as prospective randomized trials have shown that in selected patients conservative surgery and radiation achieve results comparable to those of mastectomy in terms of 10-year survival and local-regional recurrence. Studies have shown that conservative surgery, radiation, and adjuvant chemotherapy can be combined effectively in patients at high risk for systemic disease. Although the optimal treatment of early breast cancer remains controversial, the non-mastectomy approach represents major progress.

STAGE III ENDOMETRIAL CARCINOMA: ANALYSIS OF PATTERNS OF FAILURE AND THERAPEUTIC IMPLICATIONS

Abstract From 1967 to 1977 at Thomas Jefferson University Hospital 281 patients with endometrial carcinoma received radiotherapy. Thirty-two patients had Stage III disease. Nineteen patients had clinical Stage III disease and 13 patients had pathologic Stage III disease based on findings following total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Follow-up ranged from two to nine years. crude five-year survival rates of 11.7% for clinical Stage III carcinoma of the endometrium and 44% for pathologic Stage III were observed. Local control was achieved in 92% of the patients whose clinical Stage III disease was treated definitively and in all patients whose pathologic Stage III disease was treated postoperatively. Distant metastases occurred in 58% of the clinically staged patients and 23% of the pathologically staged patients. Adjuvant chemotherapy is recommended.

Quality of life after radiation therapy: A study of 309 cancer survivors

Abstract(1) Comparison of patients with a national sample reveals no difference in income (adjusted for inflation), marital status and education level but patients, who are typically older, are more often retired or disabled. (2) Overall, perceived quality of life is nearly the same for patients and national sample; apparent differences can be readily explained by factors other than cancer or its treatment. (3) While some minor differences among patients were found as a function of their site of cancer, treatment modality, or health status, no evidence was found of significant detrimental effects due to radiation therapy or perceived quality of life. (4) Contrary to expectations of deteriorated quality of life, compared to the national baselines the patients are actually more satisfied with their lives as a whole.

Carcinoid tumors of the uterine cervix: Response to combination chemotherapy and radiotherapy

Two cases of advanced (Stage III) carcinoid. tumors of the cervix are presented. Initial treatment in both cases consisted of combination chemotherapy (CCNU, cyclophosphamide and methotrexate) administered in the same regimen used in the treatment of small cell carcinoma of the lung. Initial response in the first case was remarkable, but toxic side effects delayed further treatment. Local tumor progression followed resulting in bilateral complete ureteric obstruction. Radiation therapy was discontinued before an effective dose could be delivered, and the patient expired in uremic coma. In the second case, initial response to chemotherapy was not as effective, but radiation therapy seemed to produce local control of the disease. Review of the English literature produced 21 additional cases of carcinoid tumors of the cervix: eight Stage I, seven Stage II, four Stage III, and one Stage IV. No firm conclusions with regard to therapy could be drawn from such small numbers.

The value of computerized tomography in delineating suprasellar extension of pituitary adenoma for radiotherapeutic management.

Radiotherapy plays a major role in the management of pituitary adenomas, either as a surgical adjunct or as the primary form of treatment. Small field precision techniques are utilized. The ability to employ limited field therapy and produce local control rates of 80–90% demands precise tumor localization. The extrasellar extension of pituitary adenomas has classically been demonstrated on angiographic and pneumoencephalographic examinations. Direct superior extension is accurately delineated by these examinations; lateral extension, however, is not and the total anterior‐posterior extent of the tumor may be underestimated. The addition of computerized tomography significantly increases the information available in the assessment of tumor extension and the subsequent accuracy of treatment planning for radiotherapeutic purposes.

Breast cancer in young women treated definitively with radiotherapy. An early report.

BETWEEN 1977 AND 1982, 34 BREAST CANCERS IN 33 women aged ≤35 years were treated with primary radiotherapy following excisional biopsy and axillary lymph node dissection. The records of these cases were reviewed and compared to 156 women > age 35 with 157 breast cancers treated similarly during the same time period. Analysis of these cases was limited to patients with invasive cancers who were AJC Stages I or II. In the women ≤ age 35, there were only six failures (two with locoregional failure only and four with distant metastases). The treated breast was preserved in all of the younger women except for the two patients with locoregional failure only who were treated for salvage with a mastectomy. The actuarial freedom from breast relapse alone at 3 years was 96% in women ≤ 35 years vs. 97% in women > 35 years. Freedom from locoregional relapse only was 88% vs. 95% at 3 years in the above groups, and the actuarial disease-free survival at 3 years was 76% vs. 87%, respectively. None of the above comparisons between younger and older women are statistically different. We conclude that definitive radiation therapy for Stages I and II carcinoma of the breast in women ≤ age 35 yields similar results to those for women > 35. Such treatment achieves excellent preservation of the breast and should continue to be considered as an alternative to mastectomy.

The value of computed tomography in delineating suprasellar extension of pituitary adenomas.

Pituitary tumors commonly produce suprasellar extension. We have found that in assessing lateral suprasellar extent, the pneumoencephalogram and arteriogram are least accurate. CT scanning significantly increases the accuracy, and it is recommended that all patients with pituitary tumors have an initial CT scan.