Bernard H. Feder

Treatment of extensive carcinoma of the cervix with the “transperineal parametrial butterfly”

In advanced carcinoma of the cervix the associated obliteration of the fornices or contracture of the vagina may interfere with accurate placement of conventional intracavitary applicators. Poorly placed applicators fail to irradiate the pelvis homogeneously. Waterman (and others)10solved this dilemma by transvaginal radium implants many years ago; however, despite good survival figures, this technique has not gained popularity, presumably because of excessive exposure to personnel. In this paper, we describe a technique which largely eliminates the exposure problem and at the same time improves the homogeneity of pelvic endoradiotherapy. We locate what is in essence a pair of “paravaginal intterstitial colpostats” in both parametria in combination with the usual intrauterine randem. This helps to distribute the dose laterally, with relative sparing of bladder and rectum. The technique employs a template to guide the insertion into the parametria of a group of 18 gauge hollow steel needles transperineally. Afterloading with 192Ir is accomplished when the patient has returned to her room (after orthogonal radiography and computer dosimetry). Doses to point B compare very favorably to those at point A.

Iridium-192 afterloaded implant in the retreatment of head and neck cancers

Abstract Retreatment of persistent (or “recurrent”) carcinoma of the head and neck by means of after-loading 192Ir techniques may prove quite satisfactory. A total of 64 patients were retreated by these techniques from February, 1974 to October, 1975 at the Los Angeles County—University of Southern California Medical Center and the Southern California Cancer Center. Follow-up periods, averaging only 24 months (18 to 36 months), are too short for statistically significant evaluation of survival, but the “response rate” has been gratifying. Only 11 of our 64 patients (17%) have shown no satisfactory response to re-irradiation by interstitial implant. Thirty-one of the 64 patients (49%) have had local control with “good palliation”. Twenty-two of the 64 (34%) had at least 50% regression of tumour with “fair” palliation. Thus 83% have had satisfactory response to retreatment. A considerable number of these have survived to the date of this report. Whereas 36 of the 64 (56%) are now dead, 28 of the 64 otherwis...

Persistent carcinoma of the oropharynx and oral cavity re-treated by after-loading interstitial 192Ir implant

After‐loading implantation techniques apparently offer an effective alternative in the management of persistent (or recurrent) oropharynx and oral cavity carcinoma postirradiation. A total of 29 patients with such lesions was treated from February 1974, to July 1975, in the LAC/USC Radiation Medicine Section, using after‐loading 192Ir implantation techniques. These patients all had extensive persistent cancer after “full tolerance” irradiation (with or without previous surgery) and were referred for palliation or for possible salvage. Additional doses administered ranged from 5000 to 7000 rads in three to five days. Eighteen of the 29 patients (63%) have had complete local control for 18 to 36 months. These patients have maintained a relatively satisfactory palliative status. Ten of the 29 are dead. Follow‐up periods are short, but early indications are that problem patients with persistent cancer after “full tolerance irradiation” can be salvaged, or at least satisfactorily palliated, with after‐loading interstitial implant techniques. Clinical details, sites of involvement, implantation techniques, dosimetry methodology, reactions and complications will be described.

Afterloading Interstitial Implant in the Treatment of Oral Cavity and Oropharyngeal Cancers1

(1) In all, 70 patients with carcinoma of the oral cavity and oropharynx have been treated utilizing one or more of several interstitial iridium-192 afterloading techniques. (2) After an 18-month minimum follow-up period, local control is still maintained in 9 of 10 patients with T1 and T2 lesions (UICC), in 17 of 22 patients with T3 lesions, and in 21 of 38 patients reirradiated for recurrent disease. The complication rate of 29% in the reirradiated patients, though high, is considered acceptable in these essentially hopeless cases. (3) This preliminary report is made to stimulate interest in the role of interstitial iridium-192 afterloading techniques. We feel they deserve evaluation in a controlled study of other head and neck cancer management techniques (including external irradiation, surgical resection and adjunctive chemotherapy).

Biological doses with template distribution patterns

Consideration of radiation dose rate effects emphasizes advantages of the template method for lateral distribution of multiple sources in treatment of laterally infiltrating gynecologic cancer, when compared to a conventional technique with colpostats. Biological doses in time dose fractionation (TDF), ret and reu units are calculated for the two treatment methods. With the template method the lateral dose (point B) is raised without significantly increasing the doses to the rectum and bladder, that is, relatively, the calculated biological doses at point A and B are more nearly equivalent and the doses to the rectum and bladder are significantly lower than the dose to point B.