James J. Nickson

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.

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...

Pneumonitis Following Radiation Therapy of Cancer of the Breast by Tangential Technic1

Pulmonary changes following radiation therapy of carcinoma of the breast have been reported frequently with the use of direct portals. In an attempt to deliver adequate radiation to tumor-bearing tissue and at the same time to avoid excessive damage to the lungs, tangential therapy has been used in many countries since 1926 (13). With the establishment of the Radiation Therapy Department at Memorial Center (New York) six years ago, this technic was adopted for irradiation of all inoperable, postoperative, and some recurrent breast carcinomas. It is the purpose of this paper to demonstrate that a tangential technic decreases the incidence and severity of post-irradiation pneumonitis. Review of Literature Pulmonary changes following roentgen treatment of breast carcinoma were first described by Groover, Christie, and Merritt in 1923 (10). From 1923 to 1942 many reports appeared in the literature regarding the pathology, incidence, radiographic appearance, and clinical signs of pulmonary damage following irr...

Local Recurrences after Radical Neck Dissection with and Without Preoperative X-Ray Therapy

Radical neck dissection is today considered the treatment of choice for resectable neck metastases and has become one of the most frequent cancer operations. In 1961, 402 such operations were carried out at our Center (Memorial Hospital for Cancer and Allied Diseases), a number which was surpassed only by 445 radical mastectomies. The main drawback of the radical neck dissection is the high rate of local recurrence in the dissected neck. The lowest reported rate, to our knowledge, is that of the Mayo Clinic with 26 per cent recurrences within one year (1). Preoperative irradiation has been used in the treatment of many cancers, and retrospective analysis has indicated the potential value of this combined therapy. In our Center, we have been particularly impressed by the higher five-year survival rate in a group of patients with rectal carcinomas in Dukes Stage C, who received preoperative irradiation (2, 3). In 1960, the Head and Neck Service and the Department of Radiation Therapy of the Memorial Center...

LATE CONSEQUENCES OF EARLY SKIN REACTIONS.

Abstract Re-evaluation of 29 of 85 patients originally categorized quantitatively as to the extent of skin reaction following a standardized 250-kVp irradiation treatment regimen was carried out approximately ten years later, using essentially the same objective criteria. No apparent relationship between the severity of the initial skin reaction and the late changes was noted. Early and late adverse skin reactions appear to be independently variable. This was true for all skin colors and complexions. Thus, the degree of early reactions to irradiation does not predict later consequences.

Value of Preoperative X-Ray Therapy as an Adjunct to Radical Neck Dissection

In 1960, the Head and Neck Service and the Department of Radiation Therapy of the Memorial Hospital Center, New York, N. Y., instituted a controlled clinical study to determine the value of preoperative irradiation in the prevention of recurrence after radical neck dissection. To avoid a significant delay in surgery as well as complications, a tissue dose of 2,000 rads to the subcutaneous tissues of the neck was chosen. This was given by 5 treatments, each of 400 R in air, on five successive treatment days immediately preceding the operation. All therapy was administered through one large lateral field which covered the whole neck and included the primary except when it was in the maxilla, the palate, or the nasopharynx. The Allis-Chambers betatron was employed, with an electron beam of 18 Mev maximum energy. Patients born on an odd day received preoperative radiation, while those born on an even day did not, thus constituting a control group. It was agreed at the outset of the study that the patients in ...

Preoperative X-Ray Therapy in a Simulated Colon Carcinoma in the Rat

X-ray treatment may be of some value in slowing, at least temporarily, the cancerous invasion of a fast-growing tumor so that its total removal by surgery is greatly facilitated. The experiment to be described was designed to determine the effect of preoperative x-ray therapy on a simulated colon carcinoma in the rat (1). Methods and Materials For this experiment 2-mm. bits of Walker 256 carcinosarcoma were implanted in the cecal appendix in 200 female Wistar rats (Charles River Farms) having an average weight of 200 gm., by a method previously reported (1). The tumors of 100 of the rats were irradiated with an exposure dose of 200 r for four successive days, starting two weeks after implantation. The remaining 100 rats were kept as controls. The radiation source was a General Electric Maxitron operated at 250 kevp and 30 ma, emitting a beam having a half-value layer of 1 mm. Cu (0.38 mm. Cu filtration added). The target-source distance was 100 cm. During irradiation the rats were restrained in dorsal rec...

Quantitative and qualitative evaluation of skin erythema I. Technic of measurement and description of the reaction.

THE RADIOSENSITIVITY of the skin can be altered as a result of physiological status or external manipulation before, during, or after exposure to radiation. Alteration of skin temperature, concurrent with irradiation, is the most frequently reported method of modifying the sensitivity of the skin by objective measures (1–3). There is not, however, complete agreement among investigators in respect to the effect of altering the temperature of the skin (4–6). In 1960 our group reported a quantitative measure of skin change of both erythema and melanin formation, utilizing the reflectance spectrophotometer (7, 8). In view of the variation of observations of modification of radiation injury to human skin, the present study was undertaken in the hope that by employing this standardized quantitative technic the problem might be clarified. Materials And Methods Volunteer patients undergoing treatment for malignant disease were selected for this investigation. To explore the possibility that the pattern of events ...

Mediastinoscopy for assessing mediastinal spread in clinical staging of carcinoma of the lung

A clinical staging for carcinoma of the lung utilizing conventional diagnostic procedures and mediastinoscopy for careful assessment of the upper mediastinum has been developed. In an analysis of 144 patients, one of 83 right‐sided tumors had contralateral spread compared to 7 of 61 for the left side. Bilateral spread was equal. Forty‐three of 52 patients with squamous cell carcinoma had negative upper mediastinal nodes, 6 had ipsilateral, and 3 contralateral node involvement. Forty of 64 poorly differentiated tumors had involved nodes, and 28 had either contralateral or bilateral spread. Twelve of the 16 oat‐cell cancers had involved nodes; 8 were bilateral. Eight of the 12 adenocarcinomas had involved nodes; 3 were bilateral. Seventy‐three percent of the well‐differentiated tumors fell into Stages 1 and 2; 83 percent of the anaplastic tumors in Stages 3 or 4.

RADIATION EFFECTS ON SKIN AND SUBCUTANEOUS TISSUE. A QUANTITATIVE STUDY OF COLLAGEN CONTENT: MODIFICATION WITH L-TRIIODOTHYRONINE

The results of direct measurement indicate that hydroxyproline increases in irradiated skin and subcutaneous tissue. Under the influence of the thyroid analog L-triiodothyronine, this accumulation is reversed. The nonirradiated tissues which normally increased in hydroxyproline content with age have also been found to have a decrease in this constituent. (auth)