Hamed H. Tewfik

Para-aortic lymph node irradiation in carcinoma of the cervix after exploratory laparotomy and biopsy-proven positive aortic nodes.

From July 1970 to January 1977, 23 patients with previously untreated cancer of the cervix (CA CX), mostly Stage IIIB, were included in this study. The para-aortic lymph nodes (PALN) were histologically documented to have metastatic disease in all 23 patients. External radiation treatment (RT) was delivered using a Cobalt--60 machine to a spade-shaped field to treat the pelvic cavity and para-aortic area. The majority of the patients received 4000-6000 rad to the pelvic cavity and from 5000-5500 rad to the PALNs by external RT. In addition, intracavitary radium was used in 21 patients. Five patients are alive and free of disease at 115, 110, 90, 73 and 45 months after completion of RT. One survivor had clinical Stage IB, one had Stage IIB, and three had Stage IIIB cervical carcinoma. Two of 15 patients with clinically enlarged and suspicious para-aortic nodes are alive, while 3 of 8 patients with clinically normal appearing nodes survived. Three (60%) of the survivors developed late bowel radiation damage. Eighteen patients died--10 during the first year, 3 during the second year, 2 during the third year, 1 during the fourth year and 2 during the eighth year of the follow-up. Five (27.8%) of the patients who died had developed late bowel radiation damage. Fifteen of the 18 died with disease at an average of 21 months. Three patients died of intercurrent disease. Their average survival was 40 months, double that of patients dying of disease. This report suggests that in cancer of the cervix, radiation therapy can control some PALN metastatic disease, but the risk of complications is rather high. In the absence of better methods of management, this risk of complications is justifiable because the alternative is to leave known disease untreated.

Cervical lymph node metastases from an unknown primary

Abstract In this retrospective study covering the period from 1%0 to 1973, a series of 51 patients were treated at the University of Iowa Hospitals for cervical lymph node metastases from an occult primary. Of this group of 51 patients, 27 (53%) survived 2 years and 15 (29%) survived 5 years. The best control and prognosis occurred in those patients who had a radical neck dissection combined with radiation therapy consisting of at least 5000 rad to the entire neck and to the sites of a potential ENT primary. The dose of radiation therapy given to the contralateral neck prevented later appearance of nodes and was effective in eliminating the appearance of the primary cancer in the naso-oro-laryngopharyngeal region. Follow-up of our patients eventually yielded only 1 ENT primary, and 6 patients eventually demonstrated a lung primary as the cause of their cervical lymph node metastases.

Chordoma. Evaluation of clinical behavior and treatment modalities

Abstract Chordoma is a malignant tumor derived from the primitive notochord involving the axial skeleton. It usually is a slow growing invasive tumor, silently expanding over a period of years to considerable size before causing symptoms. It is characterized by a long clinical course and local recurrence after surgical resection. In our series there was 1.8:1 male preponderance and an average age of 54.1 years. The most common site was the sacrococcygeal region. We recommend surgical resection of the tumor and postoperative radiation therapy to a total tumor dose of 6000–6500 rad in 6–6.5 weeks. If the tumor is unresectable, we recommend a definitive course of radiation therapy to a total tumor dose of 7000 rad in 7 weeks.

A clinicopathologic study of orbital and adnexal non‐Hodgkin's lymphoma

An analysis of non‐Hodgkins lymphoma involving the orbital structures was performed at the University of Iowa between 1937 and 1975. Sixteen cases of primary orbital lymphoma were diagnosed. Histopathologic reclassification according to the Rappaport scheme and the clinical course of each histologic sub‐category was described. There were 5 patients with reactive hyperplasia, 2 patients with well‐differentiated lymphoid proliferation with Dutcher bodies which were also felt to be reactive, 3 patients with diffuse poorly differentiated lymphocytic lymphoma, 4 patients with nodular poorly differentiated lymphocytic lymphoma, and 2 patients with diffuse histiocytic lymphoma. It was concluded that the Rappaport classification is applicable to orbital lymphoid tumors and that those lymphomas which do present as primary tumors should be staged as one would stage the same histologic category of lymphoma presenting in other sites. Radiation therapy appears to be an effective treatment for local control; however, patients with primary orbital lymphoma should undergo observation for systemic disease similar to patients with lymphoma presenting in other sites. Excisional biopsy is recommended to facilitate precise classification.

Plasma prostaglandin levels in radiation-induced enteritis☆

Increased prostaglandin synthesis has been implicated as a causative factor in the production of radiation induced enteritis. Seventeen patients selected to begin pelvic irradiation for treatment of gynecological cancer had plasma Prostaglandin E, Prostaglandin F, and 13, 14 dihydro 15 keto PGF2 alpha metabolite determined by radioimmunoassay, prior to initiation of radiotherapy, at weekly intervals during treatment and at six weeks following completion of radiotherapy. A total of 362 prostaglandin determinations were performed. Thirteen patients (76%) developed significant diarrhea consisting of three or more watery bowel movements per day. Nine patients (53%) had intermittent colicky pain and six patients (35%) had nausea and vomiting during treatment. Statistical evaluation revealed no significant elevation of plasma prostaglandins during radiotherapy.

A clinical review of seventeen patients with ovarian dysgerminoma

This is a retrospective evaluation of 17 patients with the diagnosis of ovarian dysgerminoma who were treated at the University of Iowa Hospitals from January 1938, to December 1976. Not a single patient was lost to follow-up. The majority of patients were between 11 to 30 years old. Seven patients died with disease, 3 during the 1st year, 3 during the 2nd year and 1 during the 4th year after diagnosis. In this series we have 10 patients with no evidence of disease (NED). The duration of follow-up of that group is from 51 months to 444 months with a median of 102 months. Postoperative radiation therapy is a valuable adjuvant to surgical treatment for dysgerminoma.

Giant lymph node hyperplasia: A review of literature and report of two cases of plasma cell variant responding to radiation therapy

Abstract Giant lymph node hyperplasia is a benign lesion of unknown etiology, usually involving a single node or an aggregate of nodes. Treatment of choice has been surgical resection. Two patients with the plasma cell type of giant lymph node hyperplasia have received radiation therapy for unresectable lesions with resolutions of symptoms.

Thymoma: therapy and prognosis as related to operative staging.

Fifty-three patients were seen and treated for thymoma at the University of Iowa Hospitals. Staging of patients was based upon invasion. Stage I and Stage II patients had a 100% survival when surgery was the only method of treatment. With Stage III disease, 50% survival was noted at five years; combined surgery and radiation therapy was the treatment of choice.

Intraperitoneal distribution of 32p-chromic phosphate suspension in the dog

Abstract Intraperitoneal administration of radioactive chromic phosphate suspension is receiving renewed attention as a therapeutic treatment to limit metastatic dissemination of ovarian carcinoma. Our study utilized mongrel dogs to approximate the uptake and distribution of 3.0 millicuries 32P-chromic phosphate suspension administered intraperitoneally (IP). Lymph nodes, omentum, retroperitoneum, peritoneum, diaphragm, abdominal wall muscle, pleura, spleen, liver, kidneys, lung, small intestine and blood were sampled for liquid scintillation counting and autoradiography. Whole blood showed the least activity (1800 cpm/100 λ at day one, declining to 280 cpm/100 λ by day 16). Omentum and diaphragm maintained the greatest concentrations (183 x 106 dpm/g and 4 x 106 dpm/g respectively.) These initial high values were 100 times greater than the highest values found for the small intestine, abdominal wall muscle, mediastinal and retroperitoneal lymph nodes and pleura. The peritoneum increased in specific activity until day three (5.9 x 106 dpm/g) and then rapidly declined. Our results show that following IP administration to the dog, 32P suspension is associated with the serous membranes of the peritoneal cavity (most notably omentum, diaphragm, peritoneum and retroperitoneum). This distribution could be valuable in adjuvant tumor therapy since serosal surfaces of the peritoneum (both visceral and parietal) and the omentum are the most common sites of tumor metastases associated with ovarian carcinoma.