Florence C. H. Chu

Radiation-induced soft-tissue and bone sarcoma.

From the records of Memorial Hospital of the past 50 years, 47 cases with an established diagnosis of radiation-induced sarcoma were identified and divided into two groups: the first included 20 cases of soft-tissue sarcoma arising from irradiated tissues, and the second comprised 27 cases of bone sarcoma arising from normal bones in the irradiated field. Medians for the latent periods from irradiation to diagnosis of bone and soft-tissue sarcoma were 11 and 12, years, respectively. In bone sarcomas, the latent period was longer after larger radiation doses and children appeared to be more susceptible to cancer induction than adults. Criteria for establishing the diagnosis of radiation-induced sarcoma and the magnitude of the risk of bone sarcoma are discussed.

Effectiveness of radiation therapy in the management of sarcoma of the soft somatic tissues.

Response of sarcomas of the soft somatic tissues to irradiation therapy is not uncommon but it is unpredictable except for liposarcoma, which is radiosensitive. Nevertheless, definite radiocurability is exhibited by a smaller, though still unpredictable, group of sarcomas of the soft parts. Preoperative irradiation, followed by surgical excision, is recommended as the preferred method of treatment for sarcomas of the soft parts.

Testicular cancer in cryptorchids.

One‐hundred thirty‐seven patients with a history or clinical evidence of cryptorchidism and testicular germinal tumor were treated at our hospital from 1934 to 1976. Cryptorchidism was corrected ipsilaterally or contralaterally in 93 patients with intrascrotal testis cancer when they were from 2 to 42 years old, either spontaneously (24 patients), by orchiopexy (58 patients), or by hormonal therapy (11 patients). Forty‐four cryptorchid patients (uncorrected cases) had either ipsilateral inguinal (24 patients), or abdominal (14 patients), or contralateral intrascrotal tumors (six patients). Tumor histologic types on orchiectomy were pure seminoma in 56 patients, embryonal carcinoma in 41, teratocarcinoma in 37, and pure choriocarcinoma in 3.

Radiation Therapy of Cardiac and Pericardial Metastases

Cardiac metastasis should be strongly suspected in the cancer patient with sudden onset of unexplained tachycardia, arrhythmia, or congestive heart failure. Conduction defects and low voltage on electrocardiographic examination and an enlarged heart shadow on the chest film are virtually confirmatory. Thirty-eight such patients were treated through anterior and posterior opposing portals and received 2,500-3,500 rads in 3-4 weeks, except for 6 lymphoma and leukemia patients who were controlled with lower doses (1,500-2,000 rads in 11/2-2 weeks). Primary sites and duration of improvement were as follows: breast (11/16 patients): 2-36 months; lung (2/7 patients): 1-9 months; lymphoma and leukemia (6/7 patients): 2-4 months; others (4/8 patients): 1-4 months. Overall, the clinical improvement rate was 60%, with durations of 12 to 36 months.

Treatment of primary and recurrent retroperitoneal liposarcoma

Thirty‐four cases of retroperitoneal liposarcoma treated at Memorial Hospital, through 1965, were analyzed. During this same time, 249 patients with liposarcoma were seen here with the retroperitoneal origin occurring 13.6% of the time. Patients were divided into three groups: complete excision with or without radiation therapy (11 patients), partial excision followed by radiation therapy (15 patients), and biopsy followed by radiation therapy (8 patients). The overall 5‐year survival of these 34 patients including patients not free of disease was 41%; however, only 4, or 12%, were free of disease at this report, 6 to 30 years after treatment. Of these four survivors free of disease, three were treated by complete excision (two with and one without postoperative radiation therapy) and one was treated by irradiation alone. Complete excision produced the highest 5‐year survival rate, longest disease‐free interval, and fewest number of operations for repeated recurrence. Beneficial effects of radiation therapy included one 30‐year cure in Group III patients and prolongation of the disease‐free interval to 32 months following partial excision as compared to only 16 months if no radiation therapy was employed in Group II patients. For the management of retroperitoneal liposarcoma, complete excision of the tumor en bloc with adjacent involved organs whenever feasible should be carried out. For inoperable cases, or cases with residual disease or suspicious of residual disease following surgery, intensive radiation therapy should be given in an attempt to cure or at least to prolong the disease‐free interval.

The Clinical and Radiographic Aspects of Radiation Osteitis

Patients with radiation osteitis were studied in regard to the protean manifestations of this entity as it affects the skeleton, with emphasis on distinguishing radiation osteitis from radiation osteogenic sarcoma, metastatic bony involvement, or simple changes of disuse. Bone fragmentation, resorption, and soft tissue calcification may mimic the appearance of a radiation-induced osteogenic sarcoma. In the absence of infectious or traumatic complications, an area of known radiation osteitis which suddenly changes in appearance, becomes symptomatic, or is associated with a mass lesion should be considered neoplastic.

The effectiveness of radiation therapy in the treatment of bone metastases from breast cancer.

The authors studied 75 patients with 158 areas of bone metastases from breast cancer treated by radiation therapy. The treatment regimen used was usually 2000 to 2500 rads delivered over a period of 2 weeks. Both subjective and objective responses were evaluated. This dose schedule proved to be highly effective in symptomatic relief and in healing osteolytic lesions; various levels of pain relief for about one year were observed in 96% (151/158 treatment areas), and radiographic evidence of recalcification was observed in 78% (73/94 treatment areas examined by serial radiography). After cases from previous studies were incorporated, the subjective response rate of the overall group was 91% (191/212) for a mean duration of 12 months, and the objective response rate was 75% (151/202) for a mean duration of 9 months.

Treatment by radiotherapy of spinal cord compression due to extradural metastases.

The occurrence of spinal cord compression marks one of the few genuine emergencies in the practice of radiotherapy. It is a dramatic and not infrequent presentation of metastatic disease. Its appearance can have a devastating impact upon the patient and his family, and the resulting nursing problems can become an overwhelming burden. A general aura of pessimism pervades the undertaking of treatment of cord compression, yet with successful therapy the symptoms may be relieved, and on occasion the patient may resume his usual activities. How frequently is treatment successful? What is the relation of duration or extent of symptoms to the outcome of treatment? To get some answers to these questions the experience of the Department of Radiation Therapy at Memorial Hospital was reviewed. Between January 1958 and December 1964, 82 patients fulfilling the clinical, neurological, and radiological specifications of spinal cord compression syndrome were treated. The results obtained in these cases form the basis of...

THE EFFECTS OF VARYING DOSAGES OF IRRADIATION UPON STERNAL-MARROW REGENERATION.

In our earlier work concerning the effects of radiation therapy upon the sternal marrow (1, 2), it was found that an exposure dose of 3,000–4,700 R delivered in a period of three to four weeks to the sternal area resulted in severe depression of the sternal marrow in almost all cases. This present study attempts to define a critical irradiation dosage below which bone-marrow regeneration would consistently occur, and above which dosage marrow aplasia would persist. Materials and Methods This study includes 33 cases previously reported (2) and 28 new ones; a total of 61 patients. The 28 new patients include 20 with mammary cancer, irradiated after radical mastectomy; they received an exposure dose of 3,500 to 4,700 R to the sternum in twenty-one to thirty days with 250 kv equipment. The technic of irradiation was as previously recorded (1, 2). Four patients in whom sternal marrow was examined postmortem had received radiation for advanced cancer: 1 of the esophagus, 2 of the breast, and there was 1 case of...

Radiation Therapy for Metastases to the Base of the Skull

The clinical features and management of 46 patients with metastatic involvement of the base of the skull were retrospectively analyzed. Diagnosis could often be made on clinical grounds, with a limited number of investigations necessary. Local treatment with megavoltage radiotherapy relieved symptoms in 78% of patients, with improvement lasting until death in most. Field size and dosage are discussed. The likelihood of response dropped sharply the longer treatment was delayed. Therefore, if the clinical picture is suggestive, treatment should not be withheld even if radiographic investigations are negative.