Jerzy Einhorn

Incidence of oral carcinoma in patients with leukoplakia of the oral mucosa

A series of 782 patients with a clinical diagnosis of oral or lip leukoplakia was followed with regular checks for 1 to 44 years (mean 12 years). Oral carcinoma developed in 2.4% of the patients in 10 years and in 4% in 20 years. The prevalence in the various age groups was about 50 to 100 times greater than for the Swedish population according to the 1959 Cancer Registry. It was primarily the small group of cases of leukoplakia in persons not using tobacco that were responsible for the excess morbidity from oral carcinoma; among tobacco users with leukoplakia the figure was considerably lower. There is no evidence the the incidence of oral carcinoma can be diminished by surgical removal of the leukoplakia but this does not mean that the operation should be abandoned, mainly for histologic diagnosis. The prevalence of other malignant tumors than oral and lip carcinoma in cases of oral leukoplakia did not differ from that of malignant tumors in the Swedish population as a whole.

Radiotherapy, chemotherapy, and tamoxifen as adjuncts to surgery in early breast cancer: A summary of three randomized trials☆

The paper summarizes up-dated results of three randomized adjuvant trials from the Stockholm Breast Cancer Group. The objective of all studies included an evaluation of the role of megavoltage radiation in the primary management of patients with early breast cancer. The first trial was started in 1971 and included 960 pre- and postmenopausal patients with operable disease. The study compared adjuvant radiotherapy with surgery alone. All patients were treated with a modified radical mastectomy. There was a sustained improvement of the recurrence-free survival with radiotherapy (p less than 0.001). Among node positive cases radiation reduced the frequency of both loco-regional recurrence (p less than 0.001) and distant metastasis (p less than 0.01). This observation indicates that distant dissemination in subgroups of patients can originate from uncontrolled local deposits of tumor cells, for instance in the regional lymph nodes. No adverse effect from radiation on long-term survival was observed. The second study was started in 1976 and compared postmastectomy radiation with adjuvant chemotherapy in pre- and postmenopausal high-risk patients. At a mean follow-up of 6 1/2 years there was no significant difference in recurrence-free survival between the two treatments. However, postmenopausal patients fared better with radiotherapy (p less than 0.01). In this subgroup, radiation was more effective than adjuvant chemotherapy in reducing both distant metastases (p less than 0.01) and loco-regional recurrences (p less than 0.001). In the third trial--which only included postmenopausal patients--2 years of adjuvant tamoxifen was compared with no adjuvant endocrine treatment. The number of treatment failures was significantly reduced with tamoxifen (p less than 0.01) but there was no significant overall survival benefit. Subset analysis indicated that tamoxifen improved the recurrence-free survival among patients treated with adjuvant chemotherapy (p less than 0.01) but only to a level close to that achieved with radiotherapy alone. Addition of tamoxifen to radiotherapy failed to further increase the recurrence-free survival.

Radiation therapy in operable breast cancer: results from the Stockholm trial on adjuvant radiotherapy.

In a randomized trial, 960 women with Stage 1-3 operable breast cancer were treated by a modified radical mastectomy alone, or by the same procedure, preceded or followed by radiotherapy (4500 rad to the breast/chest wall, and internal mammary, axillary and supraclavicular lymph nodes). Up to ten years after treatment, there is an increasing gap between the recurrence-free survival of the irradiated patients and the surgical controls. Between the two types of radiotherapy, there was no difference. There were significantly fewer distant metastases and a tendency for improved survival in node positive patients treated with postoperative radiotherapy, compared to the surgical controls, this difference was, however, statistically not significant.

Multimodality treatment in anaplastic giant cell thyroid carcinoma

Anaplastic giant cell thyroid carcinoma is highly malignant. Surgery, chemotherapy, or radiotherapy used separately have not been effective. Combinations of the three modalities have been used at Radiumhemmet since the middle of the 1970s. Nine patients received three‐drug chemotherapy and radiotherapy. One patient was alive after 12 years; eight died. Twenty‐five patients were given a similar regimen (with two fractions of radiotherapy per day), aiming at surgery. Twelve patients could undergo surgery. Two were alive 11 and 3.5 years after diagnosis. One patient died free of tumor after 6.5 years. Of the remaining 22 patients, many died of metastatic disease. A combination of preoperative and postoperative radiotherapy, chemotherapy (bleomycin, cyclophosphamide, and 5‐fluorouracil) and surgery during the remission has given a 12% (four of 34) survival (>3 years). All survivors had undergone surgery. The patients who died had in many cases achieved local tumor control. Adriamycin (Adria Laboratories, Columbus, OH) once a week replaced BCF due to treatment complications in patients receiving BCF. Of five patients, only one was alive more than 10 months after treatment.

Incidence of Hypothyroidism and Recurrences Following I131 Treatment of Hyperthyroidism

The incidences of hypothyroidism and its recurrence were studied in 791 patients at varying intervals after I/sup 131/ treatment of hyperthyroidism. Radiotherapy with I/sup 131/ tends to lead to hypothyroidism, both early and, especially, late. After a long remission, however, there is small likelihood of recurrence of hyperthyroidism. The influence of sex, age, type of goiter, and number of I/sup 131/ therapy doses administered on the incidence of hypothyroidism was studied. (auth)

Hypothyroidism after External Irradiation to the Thyroid Region

Reports of a pronounced tendency toward development of hypothyroidism long after I131 therapy for hyperthyroidism (1, 3, 7, 17) prompted an examination of the thyroid function many years after heavy external irradiation of the normal thyroid gland. Felix et al. (6) reported a case of hypothyroidism appearing six years after irradiation for laryngeal carcinoma, and Mark-son and Flatman (16) reported 5 cases developing four to thirty-six months after irradiation of tumors of the neck not arising from the thyroid gland. In neither of these papers is the total number of patients given, so that no calculation can be made of the frequency of hypothyroidism or of the probability of a coincidence. Greig et al. (9) found no hypothyroidism among 20 patients with external irradiation of the thyroid region for laryngeal carcinoma. Nineteen of these were examined eighteen months to six years—one of them twelve years—after irradiation. Horst-Meyer and Vollmar (10) noted no decrease in the thyroid function in 15 patient...

Thyroid carcinoma in children and adolescents.

Forty patients aged 20 years or younger at the time of the diagnosis of thyroid carcinoma were followed between 10 and 35 years (mean, 22 years). All patients had had surgery, either a total thyroidectomy or a resection. Sixteen patients received additional radiotherapy. One patient died during surgery. Two patients died of metastatic tumor growth, 5 and 14 years after the primary diagnosis, respectively. Six further patients had recurrences (1–7.5 years after first treatment) and received further treatment. At the end of the study 37 patients were alive without signs of recurrence.

Thyroid Antibodies in Euthyroid Subjects after Iodine-131 Therapy

established that irradiation of an organ can elicit an increase in the antibodies against this organ. The conditions for the formation of antibodies to cytoplasmic antigen are particularly favorable in hyperthyroidism, for the thyroid gland is then rich in such antigen and circulating antibodies are often present even in the case of the untreated disease. A general immunological hyperactivity has, moreover, been observed in the thyroxine-fed guinea pig (4). The investigation reported below was performed to examine whether, in the absence of hyperthyroidism, there is any increase in the thyroid auto-antibodies after radioiodine therapy. In earlier studies on hyperthyroidism, an increase in the antibodies to thyroid epithelial cytoplasm was found 2 to 12 months after radioiodine therapy (3). We have now studied in euthyroid subjects also the situation during the first 2 months after treatment. To examine the possibility of nonspecific serological reactions at low titers, the same tests for thyroid antibodies were performed after intensive irradiation of other organs than the thyroid gland. MATERIAL

Organ Antibodies After Local Irradiation

Radioiodine treatment for hyperthyroidism is followed by an increase in the thyroid humoral antibodies (2). This increase is temporary (3, 11, 16), lasting about one year, after which there is a gradual drop to below the pretherapy values (3). The increase is due to the radiotherapy, since it is not found after other forms of treatment for hyperthyroidism, such as subtotal thyroidectomy (3, 7). The rise in humoral thyroid antibodies after radioiodine therapy has also been observed in euthyroid patients (4). The question is whether this increase in thyroid antibodies is a manifestation of a general nonspecific increase in the humoral antibodies or a sign of a specific immunologic reaction directed only against the irradiated tissue. It should be possible to decide which of these two explanations is the correct one if it were known whether radioiodine therapy produces an increase in antibodies also against other tissues than the thyroid and whether there is an increase in the thyroid antibodies also after i...

Radiotherapy for Carcinoma of the Lung

The aim of this investigation has been to analyse the results of high-voltage radiotherapy in cases of inoperable carcinoma of the lung. The material selected consisted of cases in which the lesion was undoubtedly a primary one and, if operation had been performed, those in which fragments of tumour obviously remained. Radiotherapy was preceded by careful planning, and all the cases were followed up. Material. Between 1957 and October 1962,457 patients had been referred to Radiumhemmet with a diagnosis of carcinoma of the lung; 158 were selected for highvoltage radiotherapy, and 20 of these were not included in the present material because there was no definite microscopic verification of the clinical diagnosis of malignancy, because the microscopic examination revealed that it was not a primary lung turnour, or because close scrutiny of the operation reports and histologic examination of the surgical specimens provided no conclusive evidence of any tumour tissue remaining after the operation. It had been found on the basis of the clinical and radiologic examinations, mediastinoscopy, explorative thoracotomy and lymph-node biopsy that 124