Carl F. von Essen

Improvement in Quality of Survival Following Whole-Brain Irradiation for Brain Metastasis

The benefits of palliative therapy for patients with brain metastases have often been questioned (1–4) since these patients usually have widely disseminated disease and a limited survival. Assessment of therapeutic gain or successful palliation has proved to be the most difficult task. Prolongation of life (2, 5), or “increased survival for at least six months without further disability” (3), has been the surgical criterion for success, and amelioration of signs was reported as the criterion in the largest radiotherapeutic series (6). Yet, ultimately, it is the improvement of the functional capacity of the patient, his regained intellectual awareness and physical abilities, that determines whether a palliative result has been achieved. It is the purpose of this study to review the clinical findings, results, and implications of the treatment of brain metastases in 108 patients treated with whole-brain radiation. A patient classification based on functional status, which defines improvement and reports suc...

High-dose-rate afterloading brachytherapy in carcinoma of the uterine cervix

The Brachytron has been used in the University of California at San Diego Medical Center since 1970 as one method of treating gynecological malignancies. This machine contains a high intensity cobalt 60 remote afterloading cycling source used for intracavitary brachytherapy. One hundred twenty-seven patients with epithelial carcinoma of the cervix are available for analysis of 5-year survival, and 176 are analyzed for treatment complications two years following therapy. Five year survival figures for FIGO-staged patients treated with external beam pelvic irradiation and intracavitary Brachytron treatments are as follows: Stage I, 89%; Stage II, 58%; Stage III, 33%, and two of five patients Stage IVa. Rectal complications graded moderate or severe (M, S) were dose-related and gradually decreased over the years as techniques improved. Complications from early results in 1970-1972 (24% M, 10% S) were reduced to lower levels in 1976-1979 (14% M, 4% S). The Brachytron offers the advantage of rapid dose delivery. Thus, patients can be treated in an outpatient setting, avoiding the cost of hospitalization and the risks of anesthesia. The Brachytron also offers virtually complete radiation safety to all attending medical personnel. With survival and complication figures similar to those reported for patients treated with conventional low-dose-rate brachytherapy, the Brachytron represents an effective alternate mode of therapy for uterine carcinoma.

Sequelae of Radical Radiotherapy of Carcinoma of the Lung

Although radiotherapy offers adequate palliation of symptoms in inoperable carcinoma of the lung, the overall cure rates have been disappointing (1–4). A recent study reported a high incidence of severe complications in long-term survivors of treatment (5). We were interested in the frequency of complications, both acute and late, in our patients following radical radiotherapy. This is of major importance because of the reports of Bleodorn et al. (6–8) and other workers (9, 10) concerning the possible advantage of combined radiotherapy and surgery in the management of carcinoma of the lung. If this combination therapy increases the survival rate of patients with carcinoma of the lung, more who receive radical radiotherapy will be exposed to long-term complications. Included also in this report are survival data of all patients and our preliminary observations on patients given radiation followed by surgery. Methods All 132 persons treated in our institution (Grace-New Haven Community Hospital) for primary...

RADIATION AND 5-FLUOROURACIL: A CONTROLLED CLINICAL STUDY.

Clinical and experimental studies have demonstrated that the pyrimidine analog, 5-fluorouracil (FU), may exert considerable antitumor effect (4). Further therapeutic advantages might be gained by combining this drug with another agent such as ionizing radiation. An important consideration in assessing the possible advantages of combination therapy, however, is the comparison of the efficacy of the individual agents with their effects when combined. The purpose of this investigation was to compare the effects of x-irradiation and FU when administered separately and in combination in the treatment of patients with advanced neoplastic disease. Methods Because the variability of tumors in different patients is great, the most suitable study was considered to be the measurement of changes in multiple metastases within individual patients. Experimentally controlled observations of comparable lesions treated with different modalities could thereby be achieved. The parameters were the regression rates of multiple...

Sequential chemotherapy and radiotherapy. Preliminary results of clinical trial with methotrexate in head and neck cancer.

The number of drugs which have been proved to sensitize cells to ionizing radiation is limited. Clinically, differential sensitization must be obtained in which the drug, when combined with irradiation, results in a greater effect on the tumor than on the normal tissues. No such therapeutic effect has been observed with available sensitizers. The halogenated pyrimidines, 5-bromodeoxyuridine (BUDR) (3) and 5-iododeoxyuridine (IUDR) (5), have been shown to sensitize cells grown in tissue culture to ionizing radiation. IUDR was found to markedly increase the effectiveness of ionizing radiation in patients (2, 10). In those subjects in whom relatively low-energy x rays were used, however, a marked effect was also observed on the skin. A suitable measure of the relative reaction of the skin as compared to tumor response was not available, so proof is still lacking that IUDR represents a suitable clinical radiation-sensitizer. Other drugs such as 5-fluorouracil (5-FU) are thought by some (8) to sensitize human ...

A SPATIAL MODEL OF TIME-DOSE-AREA RELATIONSHIPS IN RADIATION THERAPY

Parameters affected by more than two simultaneously changing variables are not easily expressed in nonmathematical terms. This problem was noted in teaching some of the fundamentals of clinical radiation therapy to medical students and resident physicians. In particular, it was difficult to explain the relationships of the cumulative radiation dose, the time of administration of this dose, and the volume or area of exposed normal and malignant tissue to the subsequent biological reactions. In order to give a visual appreciation of these relationships, a three-dimensional model was constructed which has proved to be of benefit in teaching and investigation. Materials and Methods A graph depicting isoeffect curves for skin damage and skin cancer curability has been previously published (1). This graph was modified for demonstration in a three-dimensional form (Fig. 1). From this modification a model was constructed (Fig. 2) with two planes indicating normal tissue and malignant tumor responses respectively....

The piotron: II. Methods and initial results of dynamic pion therapy in phase II studies☆

Negative pi-meson (pion) therapy employing dynamic scanning with a focused spot of convergent beams has been in use since 1981 at SIN. Three-dimensional conformation of the treatment volume to the target volume can thus be achieved. Following previously reported Phase I and Ib clinical trials, a Phase II trial was initiated with the goal of treating primary deep-seated tumors in a dose optimization schedule which included stepwise increase of total pion dose and of target volume. Patients with multicentric superficial bladder tumors who were cystectomy candidates were initially selected. Since then, more invasive cases have been treated. A graded scoring of acute tissue reactions was employed. Follow-up periods were from 10 to 20 months. The pion dose escalation ranged from 3000 rad (minimum) to 3600 rad (minimum) in 20 fractions over 5 weeks. The treatment volumes encompassed 190 cc for local to 1,820 cc for extended volume therapy. Treatment reactions ranged from a faint erythema and increase of bladder frequency to dry desquamation, mild nausea, moderate dysuria, and moderate proctitis or diarrhea with mucus. These reactions were closely related to treatment volume and site. One severe late cystitis has occurred in a patient treated with 2 courses of pions (4475 rad). Mild to moderate late proctitis has been seen in 4 patients. Ten of 13 bladder cancer patients had local control of disease while all 3 pancreas or biliary tract cancer patients had microscopic residual disease locally at time of death from metastasis. A total of 11 of 17 patients are thus clinically or pathologically free of local tumor to time of last observation.

Carcinoma of the tongue and floor of the mouth results of radical radiotherapy

A review was made of 104 cases of carcinoma of the tongue and floor of the mouth treated at the Hunter Radiation Center of the Yale New Haven Hospital from October 1958 through December 1966. This study was undertaken to determine the cure rates and complications of irradiation therapy in the management of this disease. The cure rates varied according to the location and stage of the tumor. The overall, corrected, cumulative 3‐year survival was 45%. Serious complications developed in 5% of the patients. Twenty‐six patients considered to be radiation failures underwent resectional surgery. The results of this study justify continuation of the approach thus far employed. To improve the cure rates, emphasis ought to be put on earlier detection of cases.

Static pion beam treatment planning of deep seated tumors using computerized tomographic scans

Abstract Static negative pion beam treatment of deep seated tumors is in progress at LAMPF. The influence of the physical principles of pions on treatment planning, e.g., an enhanced peak dose, multiple scattering, variations of beam quality, pin beam emittance, and a fixed vertical beam, are discussed. Computerized tomographic (CT) scan data have proven invaluable in providing quantitative information on inhomogeneities within the anatomy. The methods of designing collimation and compensating bolus for tailoring the pion beam to individual patient ports are described. An interim method, using dosimetry measurements in a water phantom and CT scan data to construct patient isodose distribution is outlined. Typical treatment plans for patients with abdominal and head and neck cancers are presented. The method of X-ray simulation in verifying localization of CT-defined tumor volumes is demonstrated for the head and neck.

Ten year survey of oral cancer in a general hospital

Abstract Patients with oral cancer seen at the Yale-New Haven Hospital from 1951 through 1960 have been studied. The status of patients was known for a minimum of five years. Of the total 226 patients, eighty-four had lesions of the tongue, forty-five floor of mouth, twenty-seven tonsil, and seventy had lesions of alveoli, buccal mucosa, or palate. Male patients comprised 78.8 per cent of the group. Each of the categories was evaluated separately. Lesions localized to the structure of origin made up 50.9 per cent of the group, and in these, 55.6 per cent five year survival was achieved. Lesions having regional involvement of adjacent structures or nodes made up 34.5 per cent, and in this group the five year survival was 18.2 per cent. Irradiation was the method of treatment of the majority of the primary lesions, but there was a greater utilization of surgical measures than in earlier reports from this institution. There is emerging a concept of the respective role of irradiation and surgery in the treatment of oral cancer.