Bernard S. Aron

Radiation-associated gliomas: a report of four cases and analysis of postradiation tumors of the central nervous system.

Four cases of radiation-associated gliomas are described. All patients were white men, irradiated in childhood for craniopharyngioma, anaplastic ependymoma, retinoblastoma of the orbit, and Burkitts lymphoma, respectively. The dose ranged from 1800 to 5900 rads, and the latency period was 5 to 25 years. All primary and secondary tumors were verified histologically, and no evidence of persistence of the primary tumors was found. All secondary tumors arose in the fields of irradiation. Ninety-six cases of radiation-induced tumors of the central nervous system have been reported in the literature to date. Twenty-four were gliomas and occurred mainly in young men.

Radiation-Induced Bladder Tumors

A recent 25-year experience with patients treated for carcinoma of the uterine cervix who subsequently had bladder tumors is presented. Of the 3,091 patients treated 2,674 had received radiotherapy and 8 suffered vesical malignancies of varied histopathological type 6 months to 20 years after irradiation. This incidence rate is 299.9 per 100,000, which is 57.6 times that of the general female population. Benign radiation reactions of the bladder and the possible etiology of radiation-induced bladder cancers are discussed.

RADIATION THERAPY IN PROSTATE CANCER: WHOLE PELVIS WITH PROSTATE BOOST OR SMALL FIELD TO PROSTATE?

The purpose of this retrospective study is to identify prostate cancer patients who would benefit from pelvic nodes irradiation (whole pelvis) as opposed to the small-field irradiation to the prostate only. Between 1975 and 1983, 126 patients were treated by whole pelvis (4,600-5,000 cGY) with prostate boost (2,000 cGY) radiation (WP + P). Median follow-up was six years and six months. Comparison was made with historic control of 116 patients irradiated at the same institutions between 1971 and 1977 by small field to the prostate (P) to a dose of 7,000-7,500 cGY. There was a significant five-year survival improvement in the current WP + P radiation in Stage C (72% vs 40%, p = 0.0004) and Stage B (92% vs 70%, p = 0.025) but not in Stage A2 patients. However, WP + P radiation significantly improved disease-free survival (DFS) in only well and moderately but not in poorly differentiated carcinoma with a combined well and moderately differentiated five-year DFS of 63 percent compared with the 45 percent in P radiation (p = 0.0228). Local tumor control was significantly improved in WP + P radiation in only Stage C cancers with their local recurrence rate 16 percent as compared with the 34 percent in P radiation (p = 0.0172). Although acute radiation reactions were more frequent in WP + P than P radiation (61% vs 41%, p = 0.0022), chronic radiation morbidity in both series were similar. Thus, whole pelvis with prostate boost radiation should be utilized in Stage B and Stage C cancers as this has shown to increase the survival of the patient without increasing chronic radiation morbidity.

Para-Aortic Lymph Node Irradiation in Cervical Carcinoma

Cervical carcinoma metastatic to the para-aortic lymph nodes is generally considered incurable. Three of 6 patients with proved metastases are alive and well three to eleven years following irradiation. Para-aortic regions can be adequately treated with 6,000 rads in six weeks via a 360° rotational 60CO treatment plan. Extensive surgery immediately prior to radiotherapy contributed to complications in 1 patient. Of 5 who lived at least one year following irradiation, more distant metastases developed in 2. Over 85 per cent of patients with more distant metastases die within a year. Para-aortic metastases secondary to endometrial carcinoma may be treated similarly.

The reirradiation of recurrent bronchogenic carcinoma with external beam irradiation

Symptomatic local failure following thoracic irradiation for bronchogenic carcinoma presents a clinical challenge to the Radiation Oncologist. We retrospectively evaluated the efficiency of reirradiation with external beam radiation of 30 patients. The median dose of initial irradiation was 6,000 cGy in 6 weeks. The median time following initial irradiation to recurrence was 12 months. The median dose of retreatment was 3,030 cGy in 3 weeks. Of the symptomatic patients, 88% and 70% subjectively responded to initial irradiation and to reirradiation, respectively. Retreatment toxicity included radiation esophagitis (6 patients), dry desquamation (4 patients), and symptomatic radiation pneumonitis (1 patient). Based on this study, doses of external beam radiation in the range of 2,000–3,000 cGy in 2 to 3 weeks appear safe and effective in reirradiating recurrent bronchogenic carcinoma.

Carcinoma of the tonsil: Results of combined therapy†‡

Carcinoma of the tonsil is second in frequency to carcinoma of the larynx among malignant tumors of the upper air passages. Thirty‐six patients with squamous cell carcinoma of the tonsil were treated with 4,000–4,500 rads of preoperative radiation followed in four to six weeks by surgical excision of the primary tumor and in‐continuity neck dissection. The male to female ratio was five to one, and the majority of the patients was between 50 and 69 years of age. The most common symptom was a sore throat, and the duration was usually less than four months prior to the initial examination. The two‐year absolute survival rate is 56 percent and the determinate survival rate is 67 percent. All recurrences were evident by the second year. Factors associated with an unfavorable prognosis were the presence of a fixed node in the neck, a pathologic specimen containing two or more positive neck nodes, and involvement of the tongue.

Transient radiation myelopathy (Lhermitte's sign) in patients with Hodgkin's disease treated by mantle irradiation.

Abstract Transient radiation myelopathy diagnosed by Lhermittes sign was noted in four of 44 patients with Hodgkins disease who were treated with 4000 rad/four wks. mantle irradiation from 1969 to 1977. Symptoms appeared four, six, six and twenty weeks after treatment and lasted for four, eight and twenty-four weeks respectively; one patient developed late minor neurological disability two years later. There was no correlation within this group of patients between incidence and time dose fractionation (TDF) or equivalent single dose (ED ret) but a dose response-incidence relationship was noted when this study was compared to others in the literature.

The distribution of power and heat produced by interstitial microwave antenna arrays: II. The role of antenna spacing and insertion depth☆

The distribution of power and temperature generated by 915 MHz interstitial microwave antenna arrays was studied in static muscle-equivalent phantoms and both perfused and non-perfused canine thigh muscle. These arrays, which would form the geometric basis of larger volume implants, consisted of four parallel antennas oriented such that transverse to their long axes they formed the corners of a square. Arrays with 2 and 3 cm sides were compared at various depths of insertion where the nodes for all four antennas were coincident at the same depth. The position relative to the antenna nodes of the maximum power and highest temperature within the array volume varied with the depth of insertion of the antennas. Though power dropped rapidly distal to the nodes at all depths, a shift in the location of the maximum power proximal to the nodes resulted in an increase in the effective heating volume at certain insertion depths. For 2 cm array spacing the highest power and temperature were measured along the central axis of the array at all insertion depths. However, arrays using 3 cm spacing generated their maximum power adjacent to the antennas with only 50% of this level occurring along the central axis. When the temperature produced by 3 cm arrays was measured in phantoms midway through simulated 30-minute hyperthermia treatments, the effect of thermal conduction on the temperature distribution was evident. Though power was only 50% centrally, the highest temperatures occurred there. This same pattern of central heating occurred in perfused canine muscle demonstrating the importance of conductive and convective heat redistribution in reducing thermal gradients within the array volume.

Prevention of stomal recurrence in patients requiring emergency tracheostomy for advanced laryngeal and pharyngeal tumors.

Since 1976, patients requiring emergency tracheostomy for advanced laryngeal and hypopharyngeal cancer at the University of Cincinnati have been treated with a short course of prelaryngectomy radiation in an attempt to decrease the incidence of stomal recurrence. Twenty‐one patients were treated after emergency tracheostomy with a course of radiation that usually consisted of 20 Gy in five fractions followed by laryngectomy 1 or 2 days later. Most patients also received postoperative radiotherapy of some type. The follow‐up of 18 evaluable patients revealed only two (11%) stomal recurrences–a quite acceptable rate for this high‐risk population. Overall, however, local recurrences were seen in ten patients (56%), which is higher than reported in most series of similar tumors. The most likely explanation for this seems to be that the short course preoperative radiation prevented the administration of adequate postoperative radiation for residual disease, which was usually present. An alternative treatment policy would be a planned course of moderate‐ to high‐dose postoperative radiation, which could sterilize tumor in the entire locoregional area including the stoma.

Successful treatment of placental choriocarcinoma metastatic to brain followed by primary brain glioblastoma

Abstract A 17-year-old patient was found to have metastatic choriocarcinoma to the brain and lungs while pregnant. A primary lesion was found in the placenta. Complete remission was obtained with combination chemotherapy and whole brain radiation therapy. Subsequently, the patient delivered two normal infants. Six years after therapy she developed two foci of glioblastoma in the contralateral cerebral and cerebellar hemispheres.