Justin J. Stein

Preoperative radiation therapy for carcinoma of the rectum and rectosigmoid

There is a sound radiobiologic basis for the combined use of preoperative radiation therapy and surgery in the treatment of operable carcinoma of the rectum and rectosigmoid. It is recommended that a planned joint effort be made by surgeons and radiation therapists to evaluate the place of radiation therapy for carcinoma of the rectum and rectosigmoid. There is evidence that preoperative radiation therapy will improve the survival of patients who have metastases to the regional lymphatics and that pelvic recurrence can be eliminated or reduced.

Surgical or irradiation castration for patients with advanced breast cancer

Radiation and surgical castration should be equally effective, when indicated in the treatment of breast cancer, provided that when radiation castration is done an adequate tumor dose is given and both ovaries are irradiated. Surgical castration produces an immediate effect, whereas approximately 6 weeks is required following radiation therapy to achieve the maximum ovarian effect. Exploration of the abdomen permits evaluation of this region for evidence of metastases. There is a period of hospitalization, an anesthetic and some mortality‐associated with the procedure.

Intra-arterial epinephrine protection against radiation nephritis. A progress report.

The therapist sees that the kidneys are shielded to prevent radiation nephritis when cancerocidal doses of irradiation are given for widespread abdominal malignant tumors (2, 4, 6, 7). Unavoidably, he may spare areas of tumor infiltrating or surrounding the kidney. It has recently been shown that, by causing temporary renal hypoxia, it is feasible to protect the normal canine kidney from large single doses of radiation. Before and during kidney irradiation vasoconstrictive doses of epinephrine were delivered selectively into the canine renal artery through a percutaneously placed catheter. Modifications of the infusion technic for clinical application were also described in this report (8). Preliminary results of the clinical application of this method of renal radioprotection to six patients were subsequently reported, along with a review of the experimental data (5). Materials and Methods Since November 1967, five courses of intensive abdominal irradiation and concomitant renal artery epinephrine infusi...

THE CARCINOGENIC HAZARDS OF IONIZING RADIATION IN DIAGNOSTIC AND THERAPEUTIC RADIOLOGY.

being made in medicine, both in diag nosis and therapy, the enactment of medicare and cancer, heart and stroke legislation plus the continuing educa tion of both the lay public and the medi cal profession, it can be readily pre dicted that the use of radiological pro cedures will increase both in quantity and quality. It can be anticipated that more than half of the U.S. population will be exposed to ionizing radiation either through the use of X rays or from the administration of radioactive material during the diagnosis and treatment of disease. In a remarkably short period of time since the discovery of X rays (1895), of radioactivity (1896), and of radium (1898), the entire field of the radio logical sciences has progressed with lightning rapidity. What has been ac complished represents only the begin ning of greater things to come. The specialty of radiology has only been in existence 72 years. During recent years the demand for diagnostic X ray examination has in creased at an annual compounded rate in excess of 7%, and nuclear medicine services at 15%. The necessity for radi ation therapy will continue to increase

Use of Megavoltage Therapy in Cancer: End-Results

Although megavoltage radiotherapy has been available for many years, it has come into relatively widespread use only during the past decade. The increasing popularity of cobalt 60 has stimulated interest in this type of therapy. Megavoltage equipment in this country consists largely of telecobalt-60 sources, one- and two-million-electron volt resonant type generators (G. E.), the two-millionvolt Van de Graaff, the betatron, and the linear accelerator. There is also one 70-Mev synchrotron in medical use. In England and Scotland, where there has been a great deal of interest in linear accelerators, the trend is toward the use of 4-to 6-Mev linear accelerators. Cesium-137 teletherapy units are not considered in this discussion, since they are equivalent to only 660 kv of energy. Because of their low output and the large penumbra, it is not believed that they will ever become very popular in this country in spite of the long half-life of the cesium source. It is frequently stated that we have progressed about...

Pericardial effusion secondary to mucoepidermoid carcinoma of the parotid gland. A report of an unusual case

This paper reports a unique case of malignant pericardial effusion secondary to metastatic mucoepidermoid carcinoma in a patient who previously had mucoepidermoid carcinoma of the parotid gland and subsequently was found to have a hypernephroma of the kidney. Its distinctive features warranted the diagnosis of mucoepidermoid carcinoma as the cause of the effusion, and excluded the more aggressive hypernephroma. Although pericardectomy was ultimately necessary, there was no evidence of viable malignancy in fluid specimens obtained after an initial course of radiation therapy or in the resected pericardium. This suggests that conservative treatment with local radiation therapy might be successful in future cases of pericardial effusion in this malignancy.

Management of disseminated breast cancer

Approximately two-thirds of all breast cancer patients will develop disseminated disease. Of the premenopausal patients suffering this development 30-47.5% can benefit from radiation or surgical castration and about 50% can further benefit from adrenalectomy or hypophysectomy if castration has produced a good clinical response. Estrogen and short-term steroid administration can be of value to the postmenopausal patient. Useful chemotherapeutic agents include cyclophosphamide 5-fluorouracil prednisone vincristine sulfate and triethylenephosphoramide but the decision to use them singly or in combination must depend on whether the patient has a hormone-sensitive disease and her response to castration. 64% of patients receiving 7beta 17alpha dimethyltestosterone showed regressions averaging 7 months with greater tolerance for the drug than for most other chemotherapeutic agents. In trying these drugs care should be taken not to let a patients condition progress too far before making the decision to use secondary ablative procedures.

Abridgement: Cancer of the tonsillar area and palatine arch

2. Transitional cell carcinoma 3. Lymphoepithelioma 4. Lymphosarcoma Approximately two thirds of all malignant tumors of the tonsil are of the carcinoma type; less than 20 per cent are lymphosarcomas. The anterior and posterior tonsillar pillars are usu ally involved when carcinoma of the tonsil is present. The soft palate, base of the tongue, and the adjacent buccal mucosa will also be involved in a sub stantial number of cases. The tumors are often of a high grade of malig nancy and of the exophytic type. In from 40 to 80 percent of the cases the cervical lymph nodes will be involved. An analysis of involvement by sex, made by Scanlon et al., of published series of cases revealed male predom inance varying from 77.5 percent to 98.6 percent.2 The five-year results in several major series were also reviewed and it was found that the percentage of five-year survivals varied from 7.2 percent to 32 percent. Fletcher has reported the incidence of metastatic cervical lymph nodes for primary malignant tumors of the oro pharynx on admission as follows: 80 percent for base of tongue, 70 percent for the tonsillar fossa, and 50 percent for the remaining anatomical sites.3 Jesse has commented that the sur vival figures from published reports for squamous cell carcinomas of the oropharynx were very low prior to the past decade.4 He states that since treat Abridgement of a paper titled Cancer of the Tonsillar Area and Palatine Arch*, by Justin J. Stein, M.D.

THE ROLE OF MODERN RADIOTHERAPY IN THE TREATMENT OF BREAST CANCER.

Radiotherapy alone is vastly inferior to surgery as a means of treatment for primary operable breast cancer. Standard radical mastectomy is recommended, followed in all instances by irradiation therapy; simple mastectomy plus irradiation may be indicated if a highly qualified radiotherapist is available, but the majority of the patients should have the radical operation. Castration either by surgical means or by irradiation is also recommended for young patients and even for those up to three years past the menopause.