John Antoniades

Lymphangiographic demonstration of the abscopal effect in patients with malignant lymphomas.

Abstract Lymphangiography with follow-up films was found to be an excellent method for demonstrating abscopal effect in patients with malignant lymphomas. In this manuscript two patients with clinical Stage III non-Hodgkins lymphoma are presented who exhibited marked reduction in the size of the abdominal lymph nodes following irradiation to the mantle. This was accompanied by a marked depression of the absolute number of peripheral lymphocytes, while the neutrophils remained unchanged or little affected. Excluding, on the basis of dosimetric studies, the possibility of scatter irradiation as the cause of this phenomenon, data based on the recirculation of lymphocytes are discussed, as a plausible explanation.

Clinical Evaluation of Lymph Node Scanning Utilizing Colloidal Gold 198

Radioactive colloidal gold 198, when injected intravenously, is localized within the reticuloendothelial system in the liver, spleen, and bone marrow. When injected in the intradermal and subcutaneous tissues, on the other hand, it flows through the lymphatic channels to the regional lymph nodes. The localization of the colloidal particles of gold 198 in the lymph nodes depends on the lymph node integrity and the patency of the lymphatic channels. The flow of the radioactive colloid through the lymphatics may be blocked by lymph nodes that are invaded or replaced by tumor. The diagnostic potential of colloidal gold 198 for the investigation of the lymphatic system has been explored by Hultborn et al. (3), Seaman et al. (8), Hahn and Carothers (2), and Sherman et al. (9, 10). The initial reports dealt not only with the distribution of the colloid in the regional lymph nodes when injected in the breast or in the calf region but also with its potential therapeutic efficacy in the treatment of lymph nodes inv...

The management of stage III carcinoma of the endometrium.

Ten percent of all patients with endometrial carcinoma have Stage III disease at the time of presentation. The management, the features of their disease, and their prognosis are quite different than those of patients with Stage I disease. This report is based on 37 patients with Stage III carcinomas. For their treatment, a program of definitive radiation therapy was applied. Eleven patients had a prior total abdominal hysterectomy (TAH) and bilateral salpingo‐oopho‐rectomy (BSO). On the basis of the tumor extension, three main patterns were identified: 1) downward into the vagina or the vagina and the cervix; 2) lateral into the parametrium and the pelvic wall; and 3) to the ovaries. This classification carries therapeutic and prognostic significance. Ovarian extension has the best prognosis when treated by TAH and BSO followed by postoperative radiotherapy. Extension to the vagina or to the vagina and the cervix can be treated successfully by a combination of external beam and local radium placements. Patients with pelvic wall extension have the poorest prognosis. They comprise more than 50% of all cases with Stage III tumors and have exhibited persistent or recurrent disease even when treated at high dose levels. The cumulative survival rates for the entire stage were 50% at the end of the first year, 32% at the end of the second year, and 25% at the end of the fifth year.

Evolution of radiotherapeutic techniques

Abstract Adenocarcinoma is the most common kind of tumor involving the uterine corpus, occurring in a frequency of 90% or better and found predominantly in postmenopausal women. Because of vaginal bleeding, diagnosis is made early and control rates are good. Regional lymph node metastases are found to occur in about 20% of all operable patients and more frequently in those with advanced lesions near the cervix. Surgery alone fails not only because of metastases but also because of persistence in the vaginal vault and in the periurethral region. From a theoretical and practical viewpoint, preoperative irradiation is a valuable and important role in the treatment of carcinoma of the endometrium. Treatment calls for a technique that will effectively irradiate the uterine tissue, the vaginal vault, and the immediate extrauterine tissues in which postsurgical persistence is known to appear. From the standpoint of survival, both preoperative external therapy and preoperative radium therapy are effective with equivalent survival figures. The incidence in our experience of vaginal recurrence in those patients who were irradiated preoperatively with external beam therapy techniques would indicate the need for supplemental radium within the vaginal vault.

Radiation therapy in carcinoma of the female urethra

In the interval from 1934 to 1966, 41 patients with the diagnosis of carcinoma of the female urethra were seen in the Ontario Cancer Institute. The data on 31 patients are sufficiently complete to report, with 25 patients being treated definitively and 6 palliatively. Carcinomas of the meatus are best treated by interstitial gamma ray therapy in dosages between 5500 to 6000 rads. Surgical excisions or figuration of meatal lesions should be followed by definitive local interstitial radiotherapy when there is a question of residual disease. Involvement of the distal half of die urethra without extraurethral spread can be handled in a similar fashion. Tumors of the proximal urethra or entire urethra carry a serious prognosis and should be treated by both external radiation as well as interstitial radium techniques. Treatment (surgical or radiation) to the regional lymph nodes should be reserved for demonstrated disease either on clinical examination or by lymphangiography.

Preoperative radiation therapy(a plan for combined therapy by the radiation therapy oncology group and the central oncology group)

Cancer of the rectum and sigmoid colon ranks second to lung cancer as the major cause of death in man. Radical surgical treatment has shown no significant improvement in the last 20 years. Radiation therapy was first utilized in the treatment as early as 1914 and has been explored by numerous investigators, either as an adjuvant to surgical resection or for palliation. There is a sound radiobiologic basis for the combined use of preoperative radiation therapy and surgery in the treatment of resectable carcinoma of the rectum. This program of management must be of the highest quality in planning and delivery, with proper attention to the limits of tolerance of the gastrointestinal viscera. The Veterans Administration Surgical Adjuvant Cancer Study Group reported a significant reduction in the finding of positive lymph nodes in patients pre‐operatively irradiated (27%) compared with the control treated by surgery alone (40%). The 5‐year survival for the preoperatively irradiated group was 40% vs. 27.5% for the surgical group. These data have been confirmed by other investigators. The Radiation Therapy Oncology Group and the Central Oncology Group have initiated a national joint program to evaluate preoperative radiation therapy in patients with carcinoma of the rectum and rectosigmoid. The objectives are to determine the efficacy of preoperative adjuvant radiation therapy, the rate of recurrence, the time of recurrence, and survival in patients treated surgically for this disease.

Bone scanning in carcinomas of the colon and rectum

SummaryBone scanning has been shown to have a higher rate of accuracy in diagnosing osseous metastatic lesions from carcinomas of the lung and breast. In the present report, we have demonstrated this to be true for osseous metastases from carcinomas of the colon and rectum. We found that a high percentage (75 per cent) of patients who have pelvic or back pain have positive99mTc bone scans for metastases in spite of the negative radiographs. The previously reported incidence of 5–6 per cent of osseous involvement from these tumors is probably lower than the actual incidence, as these studies were reported without the benefit of bone scanning.

Comparison brain scanning with mercury 203 and technetium 99m.

The localization by radioisotope scanning of intracranial lesions, both neo-plastic and non-neoplastic, has undergone profound change in the past seventeen years. The radiopharmaceutical originally employed was 131I-Iabeled diiodofluorescein and, subsequently, 131J-labeled human serum albumin. In 1960, Blau and Bender (1) introduced 203Hg-labeled chlormerodrin as an agent in localizing brain tumors. This material, along with improved equipment, revolutionized brain scanning. With the subsequent development of 197Hg-labelled chlormerodrin these compounds almost completely replaced radioiodinated albumin. In 1964 Harper (5) reported the development of technetium 99m and its use, as the pertechnetate ion, for brain scanning. Although 99mTc has excellent physical properties (a six-hour half-life, a nearly ideal scanning energy of 140 keV, and no associated beta emission), it came into use relatively slowly. The pertechnetate is obtained by the elution of a Molybdenum-99-Technetium-99m generator. The availabil...

THE MANAGEMENT OF STAGE III CARCINOMA OF THE ENDOMETRIUM

Ten percent of all patients with endometrial carcinoma have Stage III disease at the time of presentation. The management, the features of their disease, and their prognosis are quite different than those of patients with Stage I disease. This report is based on 37 patients with Stage III carcinomas. For their treatment, a program of definitive radiation therapy was applied. Eleven patients had a prior total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). On the basis of the tumor extension, three main patterns were identified: 1) downward into the vagina or the vagina and the cervix; 2) lateral into the parametrium and the pelvic wall; and 3) to the ovaries. This classification carries therapeutic and prognostic significance. Ovarian extension has the best prognosis when treated by TAH and BSO followed by postoperative radiotherapy. Extension to the vagina or to the vagina and the cervix can be treated successfully by a combination of external beam and local radium placements. Patients with pelvic wall extension have the poorest prognosis. They comprise maore than 50% of all cases with Stage III tumors and have exhibited persistent or recurrent disease even when treated at high dose levels. The cumulative survival rates for the entire stage were 50% at the end of the first year, 32% at the end of the second year, and 25% at the end of the fifth year.