Henry Keys

Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes

Ninety-eight of 621 evaluable patients (16%) with cervical cancer enrolled into Gynecologic Oncology Group protocols were found to have periaortic lymph node metastases at staging laparotomy or at exploration for definitive operative management. As expected there was a progressive increase in the prevalence of periaortic metastases including 5% of 150 patients with Stage IB, 16% of 222 patients with Stage II, and 25% of 135 patients with Stage III. Periaortic lymph node metastases in the absence of pelvic lymph node metastases was an infrequent occurrence in patients so evaluated. The median survival of patients with periaortic metastases was 15.2 months with a survival probability of 25% at 3 years. The median duration of survival following recurrence was only 5 months. Recurrences were divided approximately equally between the pelvis and distant sites.

Ocular and orbital complications following radiation therapy of paranasal sinus malignancies and review of literature.

During the period from March 1963 through March 1978, 30 patients with malignant neoplasms of the paranasal sinuses were treated with supervoltage technique at the University of Rochester Medical Center. Twenty‐one patients had at least the medial portion of the orbit within the effective treatment volume and the rest of the patients had whole eye irradiation. In paranasal sinus malignancies, orbital involvement with ocular symptoms and signs is quite common; in many patients it can be the presenting problem. Enucleation is necessary in patients with gross orbital tumor. Eye preservation is worthwhile in patients with minimal orbital tumor. Anterior complications are a minimal risk if the technique is good. Posterior complications occur in almost all patients, but are rarely clinically significant until doses of 6000 rad or above are reached. In patients without gross orbital involvement, preservation of the eye can be considered optional treatment. It includes shielding of the anterior structures, but it is usually not possible to protect medial and posterior portions of the eye and orbit. In advanced cases, it is worthwhile to preserve the eye as cure rate is low and posterior eye complications are often late. Because the aim of treatment is cure, dose should not be compromised to prevent complications. Radiation injury to the optic nerve and retina is the major factor in visual loss, but it can be prevented by limiting the retinal and optic nerve dose to less than 6000 rad.

Carbogen breathing during radiation therapy-the Radiation Therapy Oncology Group Study.

Abstract The Radiation Therapy Oncology Group (RTOG) Study, in which 254 patients were analyzed, adjunctive carbogen breathing in irradiation of carcinomas of the oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx failed to bring about a gain in survival at any of these sites. In only two of the five regional subgroups did results show any improvement with respect to patients in the Carbogen group as compared to those in the Air group, i.e., the larynx and hypopharynx subgroups. Since both of these subgroups contained relatively small numbers of patients (42 larynx, 39 hypopharynx), it was not possible to declare these improvements as definitely due to carbogen breathing. In the case of the larynx subgroup, improvement might have been due to the slightly unequal distribution with respect to T-stage; in either subgroup, the possibility that apparent improvement was due to nothing more than random variation could not be ruled out. In the subgroups with larger numbers of patients, i.e., the oral cavity and oropharynx groups, there was no demonstrated improvement accompanying carbogen breathing.

Systemic hemibody irradiation for overt and occult metastases

Hemibody irradiation was initially employed as a palliative technique to treat diffuse metastatic disease in one session as opposed to multiple fields over an extended period. It provides a radiation treatment for disseminated cancer and therefore has been termed “systemic” therapy. Since it is possible to treat both halves of the body sequentially, it allows radiation treatment to the whole body in larger doses than could be accomplished with total‐body irradiation. Because of the success in terms of dramatic rapid pain relief and the objective response on metastatic disease, it has been explored in the treatment of occult disease and as consolidation therapy in patients with tumors that have responded to chemotherapy. When hemibody irradiation is combined with chemotherapy, responses have been shown in metastases for several primaries, particularly small cell carcinoma, which is perhaps the most encouraging, and supports further research in the treatment of micrometastatic disease for this tumor type. As the technique moves from its current research phase into more general clinical use, radiation oncologists should become more familiar with the treatment, and the hospitalization originally required may be able to be avoided. An intensive premedication program has been developed to facilitate this. Innovative approaches using radiosensitizers, radioprotectors, hyperthermia, and hyperfractionation are ideas that are starting to be tested and will be further explored in the near future.

Porcine sensitized lymph node cells (immunotherapy) and attenuated irradiation for infiltrative transitional cell carcinoma of bladder

Thirty-four patients wih infiltrative bladder carcinoma, Stage B2C or higher were treated with immunotherapy and irradiation. Seventeen patients are alive, and 17 have succumbed to their disease. Eight patients underwent cystectomy after immunotherapy and irradiation; 6 of 8 are alive and well at the present time. The technique of immunotherapy is outlined. New methodology for sequential CT scans and scheduled bladder biopsies is mentioned. The 17 patients have survived twelve to sixty-nine months after immunotherapy and irradiation. Downstaging is demonstrated based on sequential CT scans of the bony pelvis and histologic biopsy. The biopsies reveal eosinophilia and multinucleated giant cells, a specific response to immunotherapy. A prospective randomized study will be initiated.

Updating computed tomography of bladder carcinoma in assessing response to immunotherapy and attenuated irradiation.

Abstract Computed tomography (CT) was utilized as part of the surgical-pathologicradiologic evaluation of 21 patients who were treated for bladder carcinoma with attenuated irradiation and immunotherapy. Fifteen patients had moderately infiltrative (Stage B 2 -C or less) disease, and it was found that a routine high resolution CT technique using a modern fast scanner delineated the tumor in most cases. More accurate assessment of tumor response to therapy and evaluation of tumor progression were facilitated using a gas insufflation technique combined with intravenous contrast infusion. This was followed in selected cases by quantitative measurements of CT attenuation values using a recently introduced CT software program. Using this program, individual pixel values were obtained in selected areas and evaluation of the resulting numerical data and pixel histograms aided in the differentiation of tumor tissue from adjacent bladder wall and mapped out areas of tumor necrosis. Our preliminary observations suggest that quantitative CT studies incorporating assessment of printouts of attenuation values of adjacent pixels within a region of interest will improve the delineation of smaller (B1/B2) lesions and will aid objective characterization of tumor tissue during and following therapy.

Artificial salivary gland replacement for radiation-induced xerostomia.

Irradiation of salivary gland tissue during radiotherapy of head and neck cancer can cause severe xerostomia. The authors provide an artificial salivary flow using a continuous infusion pump and a subcutaneoustube.