Isadore Lampe

Treatment of Bronchogenic Carcinoma with Mediastinal Metastases

Abstract Mediastinal lymph node dissection in conjunction with pulmonary resection was performed on 231 patients with bronchogenic carcinoma. Mediastinal metastases were found in 48 patients. Thirty-six of these 48 patients underwent mediastinal irradiation in the immediate postoperative period. Seven of the 36 patients receiving postoperative irradiation lived five years (an absolute five-year survival rate of 19.5%). Of 17 patients with squamous cell carcinoma and mediastinal metastases, 5 lived five years (a five-year survival rate of 29.5%); only 1 of the 17 patients with adenocarcinoma and mediastinal metastases lived five years (an absolute survival rate of 5.9%). No patient who did not receive mediastinal irradiation postoperatively survived five years. The presence of mediastinal lymph node involvement in patients with squamous cell carcinoma of the lung is not a contraindication to resection because long-term survival can be achieved in a significant percentage of these patients.

Treatment of squamous cell carcinoma of the oral cavity

Abstract Three hundred thirty-six patients with squamous cell carcinoma of the oral cavity (oral tongue, floor of the mouth, and lower alveolus) received a complete course of radiotherapy at the University of Michigan from 1955 through 1969. The dominant policy was to administer radiation to high doses aiming at eradication of the primary tumor and its metastasis, if present. In case of failure to control the primary lesion or the cervical adenopathy, surgery was instituted whenever possible. Surgery to the neck was also indicated when cervical node metastasis developed while the primary lesion was controlled by irradiation. Survival was studied in two separate periods, 1955 through 1969 and 1955 through 1964. For the first period, a 53 per cent five year actuarial survival rate was obtained; at ten years the survival rate was 50 per cent considering patients dying an intercurrent death as withdrawn alive in the year of their death. Seventy-seven of 205 patients were alive without disease at five years in the period from 1955 through 1964. Of these, eleven were cured by postirradiation surgery for recurrence. No undue complications followed the surgical procedure. We divided the cases into three stages, with marked difference in survival between stages. At five years the actuarial survival was 63 per cent, 43 per cent, 15 per cent, and 48 per cent in stages I, II, III, and all cases respectively. In our opinion the main advantage of irradiation as the primary treatment of carcinoma of the oral cavity lies in its ability not only to control as many tumors as with surgery, but also to preserve essentially normal anatomy and function of the organs of the oral cavity. In case of recurrence, surgery has proved to be effective in curing a certain number of cases. In our opinion, the present policy of high dose radiation followed by surgery in case of failure has proved to be effective. This approach of course pre-supposes that a good rapport exists between the two departments concerned and that there are equally good personnel and resources.

The Value of Chest Wall Resection in the Treatment of Superior Sulcus Tumors of the Lung

Abstract The diagnosis of superior sulcus tumor was established in 35 patients at the University of Michigan Medical Center over the sixteen-year period from 1955 through 1970. Twelve patients underwent preoperative irradiation with cobalt 60 followed by radical en bloc excision of the chest wall. None of these patients survived five years. Twenty-three patients received radiation therapy with cobalt 60 only. Three of these patients survived five years free of disease. The absolute five-year survival in the entire group of patients was 8.6%. This study raises the question of the role of radical chest wall excision in the treatment of superior sulcus tumor.

RADIOTHERAPY OF CARCINOMA OF THE FLOOR OF THE MOUTH.

Among 130 irradiated patients with carcinoma of the floor of the mouth, the actuarial five-year survival rate was 62%. Of these patients, 79% were free of metastatic adenopathy, and their survival rate was 75%. The curability of carcinoma of the floor of the mouth is almost independent of the size of the primary lesion if metastases are absent. Prophylactic neck dissection was not found to be necessary. The three-year survival of patients in whom cervical metastases developed after irradiation was 77%.

PERORAL IRRADIATION OF CARCINOMA OF THE ORAL TONGUE.

THE TREATMENT of squamous–cell carcinoma of the oral part of the tongue has developed in the hands of many workers along surgical lines; others emphasizing radiation therapy have evolved a variety of technics. At the University of Michigan orthovoltage radiation (200–220 kV) was the only agent available for ex–ternal irradiation until 1955. Since it was not possible to deliver a high dose to a tumor of the tongue using opposing or multiple fields without producing undesirable radiation damage of the jaw, a peroral technic with malleable thin–walled lead cones was developed for the treatment of certain lingual lesions and frequently was used as the sole method of radiotherapy. It avoided radiation exposure of the mandible, the soft tissues of the face, and the major salivary glands. This method produced encouraging results which persuaded us to favor it over radium needle implants as the preferred mode of treatment in selected carcinomas of the tongue. This technic is certainly not original with us, having...

Cardiac Apical Mass in Hodqkin's Disease1

Hodgkins disease can manifest itself as a mass near the apex of the heart, simulating the roentgenographic appearance of a pericardial apical fat pad. Three cases which demonstrated this abnormality are presented. Irradiation and chemotherapy are effective in controlling this lesion.

The lymphomas: response to irradiation.

Four hundred eighty‐four patients with lymphoma received initial irradiation at the University of Michigan from the years 1960 through 1971. No patient with staging celiotomy was included. The distribution was as follows: Hodgkins disease, 46.9%; lymphosarcoma, 26.7%; reticulum cell sarcoma, 23.5%; and unclassified lymphoma, 2.9%. In most instances, only involved regions were irradiated in the non‐Hodgkins lymphomas. Hodgkins disease was treated regionally, but in supradiaphragmatic disease, adjacent areas received prophylactic irradiation, in recent years with the use of a mantle. Present doses vary between 3500–4500 rad given in 4 to 5 weeks. Complications were minimal. The reactivation‐free interval at 6 years for Stages I and II nodal was 41%, 32%, and 31% for Hodgkins, lymphosarcoma, and reticulum cell sarcoma. A non‐nodal component on first reactivation was found in 24% of Hodgkins, 33% of lymphosarcoma, and 41% of reticulum cell sarcoma. In these two groups, systematic total nodal irradiation probably would have had no potential benefit. The authors conclude that limited irradiation in early stages (after staging celiotomy) has merits.

Radio Iodine Uptake in Humans. V. Absolute Determination of Radio-iodine in the Thyroid

Summary A method of counting at a distance over the thyroid was used in animal and human subjects. This method involves the shielding of the Geiger counter tube from all radiation except the thyroid gland, by enclosing the counter in a long lead tube opening over the thyroid. The statistical error inherent in long distance counting is thereby effectively reduced. Independent beta assays were done on the thyroids of 5 dogs and 1 human adult who were subjected to total thyroidectomy immediately after counting with the above technic. Comparison of radioactivity of these glands, as determined by beta assays and by long distance gamma counting, showed a maximal deviation of the order of 20%, with the majority agreeing within about 5%. Suggestions are made regarding improvement of in vivo measurements such as employed in this technic.