James R. Eltringham

A comparison of deep regional hyperthermia from an annular array and a concentric coil in the same patients

Twenty-two patients with advanced pelvic or abdominal malignancy (or both) were treated on successive occasions with hyperthermia produced by an annular array (AA) (60-80 MHz, 500-1800 W forward power) and a concentric coil (CC) (13.56 MHz, 350-1000 W forward power). Both devices were compared with respect to acute toxicity and power limitations. There was no power limiting factor in pelvic heating in 7/14 patients treated with the AA, however 13/14 experienced power limiting sacrococcygeal pain with the CC. The 9 patients who underwent abdominal heating had a variety of power limitations with both devices. Thermal mapping was performed in 23 treatments with the AA and in 19 with the CC. Composite thermal maps of patients with similar thermometry sites show that heating patterns produced by the CC were predictable from theory and static phantom measurements. The AA achieved broader regional heating, particularly at depth, but heating patterns were less predictable. Spatial thermal dose (TD) analysis revealed higher minimum tumor TDs and more favorable mean tumor/normal tissue TD ratios with the AA than with the CC. We conclude that the AA is superior to the CC for pelvic treatment and that both devices have limitations in abdominal treatment.

Adriamycin Cardiomyopathy: Enhanced Cardiac Damage in Rabbits with Combined Drug and Cardiac Irradiation

Rabbits received either (a) no treatment; (b) a single radiation dose; (c) protracted low-dose Adriamycin; (d) combined cardiac irradiation and low-dose Adriamycin; or (e) protracted high-dose Adriamycin. More severe myocardial lesions (similar to those in high-dose Adriamycin groups) developed in rabbits receiving combined treatment. Pericardial effusions and fibrosis were more common in the combined treatment group.

The effectiveness of prophylactic brain irradiation in small cell carcinoma of the lung. A Southwest Oncology Group Study

Brain involvement in small cell carcinoma of the lung is a common phenomenon occurring in from 29 to 45% of patients. Because of this, it was suggested that prophylactic brain irradiation be made a part of treatment plans for small cell carcinoma. In December 1974, the Southwest Oncology Group (SWOG) began treating patients with combination chemotherapy and irradiation of both the primary lesion and whole brain. In two years, there were 390 patients entered into the study. In patients with extensive disease only 6 of 152 prophylactically irradiated patients developed CNS signs or symptoms of CNS recurrence. In limited disease, 6 of 88 prophylactically treated patients had CNS recurrence and in only 4 was this the site of initial failure. We feel prophylactic brain irradiation in small cell carcinoma of the lung is of benefit.

Results of Postoperative Megavoltage Radiotherapy of Malignant Surface Epithelial Tumors of the Ovary

The results of postoperative radiotherapy in 151 patients with malignant epithelial tumors of the ovary are presented. Actuarial survival at five years for patients in FIGO Stage I was 76%; in Stage II, 56%; Stage III, 16%; and Stage IV, 0%. Survival also varied with histopathological type, the best prognoses occuring in the serous (malignant) and endometrioid types (NED survival of 35% and 50%, totalling all stages, respectively). The presence of ascites or intraperitoneal surgical spillage did not adversely affect survival. The role of lymphangiography in staging is discussed. New approaches to diagnosis, staging and treatment are required for improving the prognosis of patients with ovarian carcinoma.

Combined therapy for endometrial carcinoma preoperative intracavitary irradiation followed promptly by hysterectomy.

A group of 99 patients with endometrial cancer clinically confined to the uterus has been treated with preoperative adjunctive intracavitary irradiation followed within 72 hours by total abdominal hysterectomy and bilateral salpingooophorectomy. Those patients with poorly differentiated tumors, deep myometrial invasion, cervical involvement, or pelvic metastases were then considered for external beam radiotherapy to the whole pelvis because of the increased risk of involvement of pelvic nodes or other pelvic structures. Only one of 16 patients so treated has failed in the pelvis. The overall Berkson‐Gage actuarial survival at 3 years, uncorrected for death from intercurrent disease, is 85.8%. No vaginal recurrences have been identified. Although this series has not been randomized, it appears that there has been a reduction in vaginal and pelvic recurrences when compared with patients reported by others who have received no adjuvant radiotherapy. The low recurrence rate and favorable survival in this group of patients was achieved with low morbidity from this treatment technique.

THE SOUTHWEST ONCOLOGY GROUP EXPERIENCE: ADJUVANT THERAPY FOR STAGE IB AND II NON-SEMINOMATOUS TESTICULAR CANCER

During a two year period, 65 patients with Stage II non-seminomatous testis cancer were randomized to receive adjuvant chemotherapy and radiation. Of the 52 evaluable patients, 23 received radiation followed by chemotherapy (sequential), and 29 received the same chemotherapy as initial treatment, but had drug treatment temporarily interrupted for radiation (sandwich). The combined treatment was well tolerated, but did not eliminate recurrence. With regard to duration of survival and disease-free survival, no statistically significant difference could be found between the sequential and sandwich approaches.