John R. Glassburn

Hyperbaric oxygen therapy for carcinoma of the cervix—Stages IIB, IIIA, IIIB and IVA: Results of a randomized study by the radiation therapy oncology group

Abstract A total of 65 patients with Stage IIB, IIIA, III3 or IVA carcinoma of the cervix were randomized to receive conventional radiation therapy in air or hyperbaric oxygen therapy with radiation at optimal schedules. Seven patients could not be evaluated. Of the 19 patients treated in oxygen, 14 (73%) were living or had died without evidence of disease. Of the 29 patients treated with radiation alone 15 (52%) were alive or had died without evidence of tumor. Two of 29 patients treated in air and 5 of 19 patients treated in oxygen were dead of complications or intercurrent disease. No significant difference in survival could be demonstrated.

Hyperbaric oxygen in radiation therapy.

The importance of oxygen with low LET radiations has been established beyond any doubt in many different systems, both plant and animal. While some studies, especially head and neck tumors, are impressive, it has not been demonstrated unequivocally that radiation under hyperbaric conditions is superior to well fractionated, well conceived, conventional radiotherapy. Any resulting gain in survival from the addition of hyperbaric oxygen will be limited, especially with more advanced stages of disease. Well controlled studies, especially with earlier stage disease, are still necessary. It would be worthwhile to undertake such trials, especially with tumors of the head and neck constituting the most promising site of study, as others have noted,6 since even a 5% to 10% improvement in survival would mean many lives saved. Continued trials with hyperbaric oxygen, oxygen in other forms, neutrons and other particles, and radiation sensitizing drugs are all justified in an attempt to overcame the oxygen effect on human tumors.

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.

Treatment of recurrent carcinoma of the cervix.

Abstract From 1960 to 1970, 68 patients were referred to the Radiation Therapy Department of Hahnemann Medical College and Hospital with the diagnosis of recurrent or persistent carcinoma of the cervix. In 51 patients, tumor was limited to the pelvis. An aggressive retreatment program was pursued in all patients using either radiation or surgery. Among those patients with recurrent tumor limited to the pelvis, 5196 survived one year and 17.6% survived 5 years. The complication rate was acceptable. The choice of modality for retreatment depended on the original form of therapy employed, the site of recurrence, and the patients general condition.

Carcinoma of the endometrium

Controversy continues as to how and when radiation therapy can best be combined with surgery in order to improve treatment results in patients, with endometrial cancer. Various prognostic factors—tumor grade, depth of myometrial invasion, size of the uterine cavity, and the presence of nodal or parametrial spread—must all be considered when planning therapy. Well‐differentiated Stage IA endometrial cancers have an excellent prognosis when treated by surgery alone. Evidence suggests, however, that all other Stage I tumors benefit from combined radiation and surgical treatment. Patients with advanced stages of disease are candidates for combined surgery and radiation or radiation alone, owing to the high frequency of pelvic node involvement. Areas of active investigation include the addition of systemic therapy in patients with Stage III disease and the evaluation of extended field radiation in patients with histologically confirmed high pelvic or paraaortic nodal involvement.

Radiation therapy for metastatic disease involving the orbit

A SERIES OF 47 PATIENTS WITH CLINICALLY demonstrated metastatic disease to the eye were evaluated for treatment with radiation therapy. Of the 37 patients who completed treatment, 88.9% responded with demonstrated tumor regression and improvement of symptoms. The breast and lung remain the two most common sites of origin for metastatic disease involving the orbit although the reason for this remains undetermined. The most common site of orbital involvement is the posterior choroid and no predilection for involvement of either the right or left eye could be determined. Radiation doses in the range of 3000–4000 rad delivered over a 3− to 4-week period of time, with care being taken to spare the lens, is recommended. Aggressive radiation therapy is indicated when the eye metastasis occurs without systemic disease or with stable systemic disease. The median survival in this group of patients was 8.5 months in those patients in whom adequate follow-up information was available.

Radiation therapy of glottic carcinoma.

Abstract A total of 89 patients with glottic carcinoma were treated at Hahnemann Medical College and Hospital, and affiliate institutions from 1959 to 1971 inclusive. Patients were grouped into tumor, node, metastasis (TNM) categories and placed into appropriate stages; there were 38 (43%) Stage I, 21 (24%) Stage II, 19 (21%) Stage III, and 11 (12%) Stage IV. All patients were treated primarily by radiation therapy with surgery utilized only for recurrences. The 5 year tumor free survivals were: 89% for Stage I, 76% for Stage II, 53% for Stage III, and 9% for Stage IV. There were no significant complications from the radiation therapy course.

Correlation of 198Au Abdominal Lymph Scans with Lymphangiograms and Lymph Node Biopsies

Abstract A retrospective study was undertaken to determine the correlation between lymph node scan findings and biopsy or lymphangiographic findings. There was good agreement between the lymph scan, lymphangiogram, and biopsy in cases of lymphomatous disease. Correlation between studies in cases of testicular neoplasm was significant, however, the number of cases was small. Poor correlation between studies was seen in cases of carcinoma of the cervix and a group designated as miscellaneous. Except in cases of lymphomatous disease, the use of lymph scanning is not recommended except where there is contraindication to 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.

The radiotherapeutic management of carcinoma of the cervical stump

Abstract Twenty-seven patients with carcinoma of the cervical stump were seen from 1960 to 1970 in the Department of Radiation Therapy at the Hahnemann Medical College and Hospital. This represented 5.4% (27496) of carcinomas of the cervix seen during this time interval. A standard treatment regimen combining supervoltage external radiation and intracavitary radium was utilized. Work-up included chest radiograph, IVP, barium enema, cystoscopy and sigmoidoscopy, as well as a complete physical examination and blood studies. Five-year actuarial survivals according to stage were: 80% for Stage I, 78% for Stage II, 57% for Stage III, and 0% for Stage IV. The complication rate was minimal.