Damon D. Blake

Response of superior vena cava syndrome to radiation therapy

The treatment of a superior vena caval obstruction associated with a mediastinal mass is a true radiotherapeutic emergency. The heralding signs and symptoms and the morbidity of the syndrome justify beginning therapy before a pathologic diagnosis is established. In a series of 19 patients with superior vena cava syndrome, there was an excellent response to an initial high‐dose course of irradiation, consisting of 400 rads midplane for 3 days, then reduced to conventional daily fractionation. It is concluded that rapid high‐dose irradiation in the treatment of a superior vena cava syndrome is safe and effective.

Radiation therapy in the treatment of superior vena caval obstruction.

The obstruction of the superior vena cava by tumor is recognized as an acute or subacute oncologic emergency. Rapid high‐dose irradiation to the mediastinum is shown to be effective therapy for a superior vena caval obstruction. In our series 35 patients have been treated with rapid high‐dose irradiation between January 1971 and July 1977. The present treatment consists of 400 rad given in a daily midplane dose for 3 days, and then slowing to 150 rad mid‐plane per day to a total dose of 3000 rad over 15 fractions. There have been no instances of exacerbations of symptoms or severe complications from this treatment. There have been 2 failures of the 35 patients treated with this regimen. Both were shown at autopsy to have massive thrombi obstructing the superior vena cava. Six years of experience using this regimen has proven to be a safe and effective means of treatment for superior vena caval obstruction. Cancer 42:2600–2603, 1978.

Thymic irradiation:An approach to chronic lymphocytic leukemia

Abstract Twenty-two patients with active chronic lymphocytic leukemia were treated with thymic irradiation; a full remission was achieved in 14 and a partial response in 7. In a similar group of 28 patients treated with chlorambucil, there were 7 full remissions, 5 partial responses, 6 with white cell control and 10 with no response. Thymic irradiation restored the leukocyte count to normal in 76 per cent of the cases (16 of 21) and the differential in 32 per cent (7 of 22), with complete resolution of lymphadenopathy in 81 per cent (17 of 21), hepatomegaly in 75 per cent (12 of 16), splenomegaly in 76 per cent (11 of 14) and symptoms in 100 per cent (20 of 20). Chlorambucil restored the leukocyte count to normal in 50 per cent (14 of 28) and the differential in 7 per cent (2 of 28), with complete resolution of lymphadenopathy in 43 per cent (9 of 21), hepatomegaly in 43 per cent (9 of 21), splenomegaly in 24 per cent (4 of 22) and symptoms in 64 per cent (16 of 25). Thymic irradiation produced a more rapid response even in patients resistant to chemotherapy and was more effective (11 of 12 or 92 per cent) than chlorambucil (7 of 22 or 33 per cent) in patients with hematocrit readings of less than 30 per cent and/or greater than 75 per cent infiltration of the bone marrow and a leukocyte count of more than 40,000 cells/mm 3 and in patients with splenomegaly. Anemia was corrected in all three patients and thrombocytopenia in two of six patients treated with thymic irradiation. Chlorambucil corrected anemia in 2 of 11 patients and thrombocytopenia in 2 of 5 patients. Anemia developed in 5 of 17 patients and thrombocytopenia in 4 of 23 patients treated with chlorambucil and in no patients treated with thymic irradiation.

The Calculation of Dose Distribution for Chest Wall Irradiation Using B-Mode Ultrasonography

B-mode ultrasonography has been used to determine chest wall dimensions for radiotherapy treatment planning. The ultrasonograms reveal the inner surface of the chest wall and the anterior surface of the sternum in relation to the skin. Using this information, dose distributions for 60Co tangential breast irradiation are calculated.

COMPLICATIONS OF INTENSIVE RADIATION THERAPY FOR CERVICAL CARCINOMA. WITH EMPHASIS ON SUPERVOLTAGE RADIATION AND SUPPLEMENTAL RADICAL PELVIC OPERATION

A comparison was made of the complications following conventional and telecobalt radiotherapy of 75 patients with cervical cancer. The most frequert complication of telecobalt therapy was subcutaneous lignification, which occurred in 24% of the patients. Other severe reactions were noted in bladder (5%), rectum (5%), and vagina (4%). Fracture of the femoral neck occurred in 5%, infection in 5%, and death (attributable to therapy) in 2%. No severe skin changes were noted below the 4000-r level, but 50% of patients receiving 4000 to 4999 r and 75% receiving 5000 r or more developed acute or severe chronic skin reactions. The changes are more likely to occur with high dosage increment, 500 to 800 r every fourth day, rather than with an increment of 300 r every second day. It is suggested that supervoltage radiation must be limited to the known tolerance of the exposed organs, including the subcutaneous tissue. At intensive dose levels the frequency and severity of complications precludes continuation of such therapeutic prograrns, such as additional radiation or radical operation for persistent cancer. A total lateral pelvic wall dosage of 5000 r, including intensive intracavitary radiation, is the suggested tentative limit above which complications increase markedly. (H.H.D.)