Benjamin Sischy

Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group.

Squamous carcinoma of the thoracic esophagus has an extremely poor prognosis. This study, EST-1282, was undertaken by the Eastern Cooperative Oncology Group (ECOG) to determine whether the combined use of 5-fluorouracil (5-FU), mitomycin C, and radiation therapy improved the disease-free survival and overall survival of patients with carcinoma of the esophagus, compared to those who received radiation therapy alone. Two- and 5-year survivals were 12% and 7% in the radiation alone arm and 27% and 9% in the chemoradiation arm. Patients treated with chemoradiation had a longer median survival (14.8 months), compared to patients receiving radiation therapy alone (9.2 months). This difference was statistically significant. The same pattern of survival was noted in almost all subgroups independent of whether surgical resection was performed.

Treatment of rectal carcinomas by means of endocavitary irradiation: a progress report

Treatment of rectal carcinomas with endocavitary irradiation is now an established method in the United States and is an important advance in the curative management of patients with selected cancers of the rectum that should be available to all such patients. Excellent palliation can also be achieved in many cases with advanced local disease. The total experience at Highland Hospital, Rochester, New York, is over 70 cases. Now that there are more centers using this method of treatment, an awareness of some of the problems and pitfalls encountered at Highland Hospital becomes relevant.

Treatment of breast cancer with segmental mastectomy alone or segmental mastectomy plus radiation

A retrospective review of the outcome of treatment for primary, Stage I and II breast cancer with segmental mastectomy (SGM) alone or segmental mastectomy plus postoperative irradiation (SGM + RT) at four Rochester, New York, city hospitals is reported. Between January 1971 and March 1984, 99 women were treated with SGM and 146 with SGM + RT. Groups were similar regarding significant clinical and histologic prognostic factors; they differed, however, in that the SGM group was considerably older (means = 72) than the SGM + RT group (means = 56). Among SGM patients, local and total locoregional failure was 26.44 and 35.2%, respectively. Local and total locoregional failure (7.6 and 12.4%, respectively) was significantly reduced among patients treated with SGM + RT (p less than 0.0001). Among SGM patients, there was scant advantage in enlarging the extent of resection from local excision (29.5% local failure) to wide local excision (27.3%) to quadrantectomy (22.2%). Among women receiving SGM + RT, similar rates of local failure occurred among patients receiving local excision (15.5%) and wide local excision (12.5%). By contrast, only 2.8% of those receiving quadrantectomy failed. Results are viewed as supportive of findings of NSABP-B06. Findings suggest that SGM constitutes inadequate treatment of Stage I and II breast cancer. Locoregional failure rates of 30-40% may be reduced to around 10% with postoperative irradiation.

Treatment of rectal carcinomas by means of endocavity irradiation.

Direct contact irradiation may be used in the curative treatment of patients with carefully selected early rectal lesions. With earlier diagnosis, a large number of patients may present with suitable lesions. The treatments last three minutes and are administered every two weeks to a total dose of 9,000 rad to 12,500 rad. The patients require no general anesthesia or hospitalization and may continue working during this treatment. There appears to be no risk of morbidity or mortality. The rectum is preserved. Most beneficial of all to the patient, a colostomy is avoided, although later surgery is not precluded for local failures. It has been found that recurrence, should it occur, appears within the 18 months immediately following treatment. Good palliation can be achieved in some cases for patients with metastatic disease, for their local symptoms. We believe that the endocavity method of irradiation contributes an important advance in the management of patients with cancer of the rectum and feel it should be available universally.

Treatment of rectal carcinomas by means of endocavitary irradiation

Treatment of rectal carcinomas with endocavitary irradiation is now an established method in the United States and is an important advance in the curative management of patients with selected cancers of the rectum that should be available to all such patients. Excellent palliation can also be achieved in many cases with advanced local disease. The total experience at Highland Hospital, Rochester, New York, is over 70 cases. Now that there are more centers using this method of treatment, an awareness of some of the problems and pitfalls encountered at Highland Hospital becomes relevant.