Carl M. Mansfield

Radiation therapy as initial treatment for early stage cancer of the breast wiithout mastectomy

This report describes 150 patients with clinical stage I and II carcinoma of the breast treated at four institutions—Yale University School of Medicine, Harvard Medical School‐Joint Center for Radiation Therapy, Hahnemann Medical College, Jefferson Medical College—with radiotherapy only following excisional biopsy. Closely similar treatment policies were followed at all four centers, 4500–5000 rads minimum tumor dose being delivered to the entire breast and axillary, supraclavicular and internal mammary nodes. Forty‐six of 49 stage I patients treated are alive without disease, the actuarial relapse‐free survival being 91% at 5 years. Of the 101 stage II patients, 75 are alive without disease with a relapse‐free actuarial survival of 60% at 5 years. Local failure has occurred in 10 patients (9 stage II and 1 stage I, 6.6%), 5 of whom are disease‐free following mastectomy. The results obtained in this study are comparable to those of conventional surgery. It is our conclusion that mastectomy is not a necessary part of the treatment of small breast cancers, that radiation without mastectomy is an acceptable alternative with far superior cosmetic and functional results. Adjuvant chemotherapy should be considered particularly in stage II patients in view of their 40% relapse rate.

Dosimetric comparison of the fletcher family of gynecologic colpostats 1950–1980

The Fletcher gynecologic applicator was developed for irradiation of carcinoma of the uterine cervix in the early 1950s. Since that time, numerous modifications and changes have been made in the colpostat construction and in the location of the shields that provide a reduced dose to the bladder trigone anteriorly and to the rectal wall posteriorly. The original applicators include the preload radium double colpostat and the preload radium single colpostat. In the 1960s, afterloading colpostats were manufactured as the Fletcher-Suit and the Fletcher-Green devices. With the introduction of the Delclos mini-colpostat, a new generation of applicators followed in the 1970s. The Fletcher-Suit-Delclos colpostat recently manufactured by two companies can be used as a mini-colpostat. By adding a shield-containing cap, these applicators function as the original Fletcher colpostat. With the development of new applicators over the past 30 years, numerous changes in the position of the shields and, therefore, the dose transmitted to the surrounding tissues have been made. This paper describes dosimetric evaluation of all of these applicators and the various changes that have occurred through the generations of Fletcher colpostats in an attempt to provide information for radiation therapists and gynecologists who are using these instruments in their clinical practice.

Thermoradiation therapy for superficial malignant tumors

Background. Between 1980–1990, 126 patients were treated with radiation therapy (RT) and hyperthermia using 915‐MHz external microwave applicators. All but 11 patients had failed to respond to previous therapy.

Prognosis in Patients with Metastatic Liver Disease Diagnosed by Liver Scan

UNTIL RECENT years the diagnosis of liver metastases was greatly dependent upon laboratory results (1, 2), contrast studies (3), and clinical acumen. In 1953 Stirrett et al. (4) demonstrated that metastatic disease of the liver could be diagnosed with a 96 per cent accuracy, employing a wide-angle scintillation counter following the administration of 300 ,μCi of 131 I-Iabeled human serum albumin. Subsequent workers using rose bengal 131I and colloids such as 198Au, l31I-Iabeled albumin, and 99IDTc sulfide have supported these findings (5). As a result liver scanning has become a significant aid in the diagnosis of hepatic metastases (6–9). It is also possible to make an earlier diagnosis of metastatic disease in those cases in which it is suspected despite normal laboratory or clinical findings. Metastatic disease to the liver usually carries a grave prognosis and most patients die within one year after the diagnosis (14). The purposes of this study were to determine (a) the possibility of making an estim...

Use of heat-sensing devices in cancer therapy. A preliminary study.

Todays oncologist is often faced with a patient in whom several alternate modalities of treatment are available, of which possibly only one will give a therapeutic response. In recent years various investigators, such as Bulbrook (1) studying the urinary excretion of certain hormonal by-products, Gerbrandy et al. using the excretion of calcium (2), Bullen et al. (3) using radio-active phosphorus, and Ferguson et al. (4) using cesium 131, have tried to determine if it is possible to predict the clinical response of a patient with advanced cancer of the breast to a particular therapeutic modality. If one could monitor tumor cell metabolism, observation of the effects of different therapeutic maneuvers upon it would be possible, and thereby one might predict the tumors future response. In this respect phosphorus has been shown to play an important role in cell metabolism (5–8). Bullen and Hale (3) recorded the uptake of radioactive phosphorus in tumors and noted cycles or periods of increased and decreased...

Multiple field hyperthermia combined with radiotherapy in advanced carcinoma of the breast

Extensive recurrences on the chest wall of advanced carcinoma of the breast in 20 patients were treated with multiple field patchwork hyperthermia combined with radiation therapy between 1987-1991. The objective of the study was to evaluate the feasibility, tumour response and complications of treating extensive lesions with multiple, overlapping fields of hyperthermia. All lesions were diffuse encompassing up to 2900 cm2 in area with or without multiple nodules < or = 3 cm deep. All lesions had failed previous therapy with all but three failing previous radiotherapy. Hyperthermia consisted of 282 hyperthermia applicator fields and 357 hyperthermia treatments with external 915 MHz microwaves using commercially available applicators. Hyperthermia applicator fields were defined by the surface 50% SAR distribution of a particular applicator, and hyperthermia fields were abutted to cover the entire tumour bearing area. Radiation therapy consisted of 81 fields to a mean dose of 40 +/- 1 Gy (SE), 88% of fields received between 30 and 50 Gy. The equivalent dose was 42 +/- 1 Gy, based on the linear-quadratic model and alpha/beta = 25 (Fowler 1989). Overlapping hyperthermia fields were separated by an interval of at least three days. Up to four heat sessions per week were required to cover the entire tumour in a rotating fashion. The hyperthermia treatment time was 60 min. Hyperthermia treatments were continued for the duration of radiation therapy. Each hyperthermia applicator field was heated at least once. Patients were exposed to a mean of 14 +/- 3 hyperthermia applicator fields (range of 3-46 fields) and a mean of 18 +/- 3 hyperthermia treatments (range of 6-61) delivered over a mean of 7.5 +/- 0.9 weeks (range of 3-17 weeks). Each field was heated an average of 1.3 times. The tumour complete response rate was 95% with a recurrence rate of 5%. Nevertheless, the mean survival of patients with a complete response was only 10.8 +/- 1.7 months (range of 2-28 months) because of the systemic tumour burden existing outside of the treated fields in these patients. Neither complete response, local control nor survival after thermoradiotherapy correlated with the disease free interval between initial mastectomy and recurrence. There was no evidence of increased thermal damage to skin nor evidence of tumour recurrence at junctions of hyperthermia field overlap. It is concluded that recurrent advanced carcinoma of the breast presenting as extensive, diffuse lesions on the chest wall can be treated as effectively with multiple field patchwork thermoradiotherapy as can nodular lesions treated with single hyperthermia fields.

A Comparison of the Temperature Curves Recorded over Normal and Abnormal Breasts

Abstract Continuous monitoring of a patients breast temperature over an extended time may disclose fluctuations: in the normal breast a cyclic pattern approximately twenty-four hours in duration; in the abnormal breast a temperature higher than normal and less pronounced cyclic patterns; in benign lesions a temperature and pattern similar to those of the normal side. Mastitis causes elevation of the temperature but the cyclic pattern remains.

The Use of Thermography in the Detection of Metastatic Liver Disease

Abstract The authors evaluated the role of thermography in the diagnosis of liver metastases. Results in 68 cases were as follows: 41 positive, correct; 7 false-positive; 7 negative, correct; 6 false-negative; 7 equivocal. It is believed that the method is worthy of further study.

Clinical and Dosimetric Considerations in the Radiation Treatment of Breast Cancer

Preliminary results indicate that film dosimetry is a simple and precise method of determining volume dose distributions. Calculated dose distributions using computers or estimations of surface dose using TLD dosimeters are within 5% of the measured dose. Initial attempts to find suitable alternate techniques tailored to each clinical situation are encouraging.

‘Patchwork’ fields in thermoradiotherapy for extensive chest wall recurrences of breast carcinoma

SummaryChest wall lesions of advanced breast carcinoma in 23 patients were treated with thermoradiotherapy with clinical intent between January 1987 and March 1992. Treatment consisted of external 915 MHz microwave hyperthermia with commercially available applicators and radiation therapy to doses between 32–58 Gy. Twenty-three large, diffuse lesions were treated with multiple field patchwork hyperthermia. All lesions were diffuse with or without multiple nodules ≤ 3 cm depth. All lesions had failed previous therapy. The mean number of hyperthermia fields per patient was 3.2 ± 0.4 (range of 2–7). The complete response rate was 91% in this group of extensive, diffuse lesions treated by the patchwork technique. Mean total radiation dose administered concurrently with multiple field patchwork hyperthermia was 42 ± 1 Gy. The recurrence rate was 5%. The mean survival in patients who had a complete response was 9.0 ± 1.3 months. The reduced survival among patchwork treated patients was due to the extensive tumor burden existing outside of the treated fields in these patients. The skin reactions were minor, causing minimal discomfort. There was no evidence of increased thermal damage to skin, or of tumor recurrence at junctions of hyperthermia field overlap. It is concluded that extensive, diffuse lesions of chest wall recurrence of advanced carcinoma of the breast can be treated effectively with multiple field patchwork thermotherapy.