Bernard Roswit

The Survival of Patients with Inoperable Lung Cancer: A Large-Scale Randomized Study of Radiation Therapy Versus Placebo

The death toll from lung cancer, particularly for the American male in the prime of life, is beginning to approach the dimensions of a national calamity. This year we may expect 55,000 new cases and 50,000 deaths, of which 42,000 will be in males and 8,000 in females (1). Lung cancer is already responsible for 1 out of 4 deaths from cancer in men. It is imperative, therefore, that a dependable assessment be made of the patients outlook for survival according to the stage of the disease and the therapeutic modality employed. Guide lines for such an assessment may be drawn from retrospective long-range survival studies in a single institution or center. More dependable answers can be derived from planned, prospective large-scale studies involving many patients, strict randomization with concurrent controls, and strong biostatistical support. In the hospital system of the Veterans Administration (VA), which supports 170,000 beds, nearly all the patients are males, and a large percentage are cigarette smoker...

Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: Report of a national veterans administration randomized study

In 1964 the Veterans Administration Surgical Adjuvant Group (VASAG) initiated a large‐scale, controlled, randomized protocol to study the role of low‐dose preoperative irradiation (2000–2500 rads/10 fractions/12 days) in patients with operable adenocarcinoma of the sigmoid colon and rectum. This report analyzes the data in 700 patients, all at 5‐year risk. There appears to be a definite benefit to irradiated patients who undergo abdominoperineal resections, when compared with the controls. This advantage is reflected in improvement of 5‐year survival, and reductions in lymph node invasion, local recurrence, and distant metastases. A second protocol has been initiated in 30 VA hospitals employing a higher dose (3150 rads) to extended portals (to L2) to male patients who require abdominoperineal resections.

Preoperative radiation and surgery for cancer of the rectum: veterans administration surgical oncology group trial II

In a prospective randomized trial, 361 male patients with histologically proven adenocarcinoma of the rectum, judged preoperatively to require abdominoperineal resection (APR), were treated by surgery alone or were given 3,150 rads of preoperative radiotherapy. Surgical resection was done on 320 patients, 262 having “curative” APR. Only moderate symptoms from radiotherapy were noted and postoperative complications and 30‐day mortality were similar in both groups. Five‐year survival for curative APR was the same in both groups (50% for both treated and control patients). The incidence of positive lymph nodes in the resected specimens was 35% in treated and 41% in controls. In the first preoperative radiotherapy trial conducted by the group, 5‐year survival in patients undergoing “curative” APR was 47% in treated versus 34% in control groups. Additionally, the difference in positive lymph nodes in the resected specimens was substantially greater in the first trial (26% in treated versus 44% in controls). Cancer 58:352–359, 1986.

The Impact of Current Staging Procedures in Assessing Disease Extent of Prostatic Adenocarcinoma

We studied 454 patients with prostatic adenocarcinoma who were assigned a preliminary clinical stage on the basis of serum acid phosphatase, routine bone survey and physical examination. Subsequently, they were assigned a final clinical stage after radioisotopic bone scanning, lymphangiography and staging pelvic lymph node dissection. Only 53, 54, 57 and 26 per cent, respectively, of patients initially assigned the preliminary clinical stage of IB, II, III or IVA remained at that stage after the additional studies.

Extended Field Radiation Therapy Versus Delayed Hormonal Therapy in Node Positive Prostatic Adenocarcinoma

This study was undertaken to determine the disease control and survival advantage of either extended field megavoltage irradiation or delayed androgen ablation in a randomized clinical trial. Comparison of the 2 treatments, using either time-to-first evidence of treatment failure or survival, demonstrates an advantage to extended field radiation.

Preoperative Irradiation of Operable Adenocarinoma of the Rectum and Rectosigmoid Colon

Preoperative irradiation in a moderate dose schedule (2,000–3,000 rads∕two weeks) followed promptly by surgery has had a favorable effect, when matched with controls, on the survival of male patients with operable and resectable adenocarcinoma of the rectum, particularly when the lesion is low-lying and requires an abdominoperineal resection. There is a significant reduction in the finding of positive lymph nodes in the treated group (27%) compared with the controls (40%). With 700 men already in the study, life table survivals at five years are documented at 40.4% for irradiated patients who undergo abdominoperineal resection vs. 27.5% for the control group. This favorable effect appears dose-related.

Radiation Therapy Versus Delayed Androgen Deprivation for Stage C Carcinoma of the Prostate

Seventy-three patients with prostatic adenocarcinoma who were believed to have disease limited to the pelvis without evidence of node or bone extension were assigned randomly to either full-field pelvic radiation (40) or delayed hormonal therapy (33). The interval to first evidence of treatment failure was used as the end point of the study. Failures occurred in 13 patients who received radiation therapy and 11 who received delayed hormonal therapy. No difference in disease response could be identified between the 2 treatment groups.

Melanomas of the lower extremity among native Puerto Ricans.

The clinical features of 57 melanomas of the lower extremity occurring in native Puerto Ricans were studied. Whereas most melanomas of the lower extremity among Caucasians occur above the ankle, the group studied showed a predilection for the foot, particularly in the minimally pigmented zones (sole, heel, and nail bed), a distribution similar to that reported in black patients. The possibility that pigment‐deficient areas may represent the target organ for sunlight‐induced melanomas in Negroes and dark‐skinned subjects is discussed.

RADIATION EXPOSURE TO PERSONNEL DURING CARDIAC CATHETERIZATION. A PRELIMINARY STUDY.

The authors studied the radiation exposure to personnel in the examining room during a complete cardiac catheterization procedure. Commercial film badges and thermoluminescent LiF wafers were worn at several anatomical sites. Data on the examining physician alone indicate an exposure of 50 mrems to the trunk area during a complete cardiac procedure. Exposure levels for 2 attending physicians, a nurse, and a technician are also given.

Hemorrhage into pituitary adenoma with spontaneous recovery and reossification of the sella turcica.

ACUTE HEMORRHAGE into pituitary tumors is attended by fulminant symptoms and a high mortality rate. Of 36 patients who showed this syndrome in the acute form,l.2 22 died either in minutes or within a few hours to a month. Of those who survived, some recovery of vision or ocular movements or both was noted in at least 9. Some authors have related these lesions to the development of Simmonds’ disease3 or severe hypopituitarism4 that contributed to mortality and morbidity. Operative intervention has resulted in a favorable outcome in several instances. However, spontaneous recovery from bleeding into a presumably eosinophilic adenoma observed by Cairns5 and in another instance by Jefferson6 is a rare event. The case to be reported is another striking example of spontaneous recovery from hemorrhage into a pituitary adenoma, which, in addition, was accompanied by reossification and marked reduction in size of the previously greatly enlarged sella turcica. Reconstruction of the sella turcica after surgical and/or radiation therapy has been previously ~ b s e r v e d , ~ . ~ but we were unable to h d another report of spontaneous sellar reconstruction in the literature. We, therefore, consider the unique clinical and roentgenologic features of this case worthy of report.