Keene M. Wallace

Preoperative radiation therapy for carcinoma of the esophagus

From 1960 through 1973, 415 patients with carcinoma of the esophagus were treated with radiation therapy. Three hundred and thirty‐two patients had planned preoperative irradiation to a dose of 4500 rads in 18 fractions, and 101 of these had subsequent resections with either colon or stomach replacement. The operative mortality in this group was 18% and the 2‐ and 5‐year survivals were 22.8 and 13.6%, respectively. The dose of 4500 rads in 18 fractions produced tumor sterilization in 3% and reduction to in situ carcinoma in 10% of these 101 patients. The survival was considerably improved in this small group of patients. Those patients not amenable to exploration had a 3% 5‐year and a 5.6% 2‐year survival. Thirty‐three patients were given high‐dose curative radiation therapy and the 2‐year survival was 12.1%. The overall survival was 9% at 2 years and 6% at 5 years. The results in this series are compared with the most recent reports in the literature.

The Impact of Current Staging Procedures in Assessing Disease Extent of Prostatic Adenocarcinoma

We studied 454 patients with prostatic adenocarcinoma who were assigned a preliminary clinical stage on the basis of serum acid phosphatase, routine bone survey and physical examination. Subsequently, they were assigned a final clinical stage after radioisotopic bone scanning, lymphangiography and staging pelvic lymph node dissection. Only 53, 54, 57 and 26 per cent, respectively, of patients initially assigned the preliminary clinical stage of IB, II, III or IVA remained at that stage after the additional studies.

Extended Field Radiation Therapy Versus Delayed Hormonal Therapy in Node Positive Prostatic Adenocarcinoma

This study was undertaken to determine the disease control and survival advantage of either extended field megavoltage irradiation or delayed androgen ablation in a randomized clinical trial. Comparison of the 2 treatments, using either time-to-first evidence of treatment failure or survival, demonstrates an advantage to extended field radiation.

Radiation therapy control of nine patients with malignant thymoma

Malignant thymoma is a relatively rare condition and a review of the literature reveals approximately 100 reported cases. Only a small percentage of these have been treated with megavoltage radiation therapy; therefore, it is difficult to find the necessary information to establish a proper time‐dose relationship for treatment. This report deals with the radiation therapy and survival data concerning nine patients treated for malignant thymoma during a ten year period at the Medical University of South Carolina. Megavoltage irradiation in the dose range of 3500–4800 rads was employed in all patients. All gross tumor was completely resected in only three patients, two had a biopsy only, and the remaining four had subtotal resections. Local tumor control has been 100% with the average follow‐up being 5.5 years and a minimum of 30 months. Three patients are dead; one from intercurrent disease, one from myasthenia gravis, and one from radiation injury to the spinal cord. One patient is alive with metastatic disease controlled by chemotherapy. The technique of radiation therapy is outlined, as well as suggested treatment policy.

Radiation Therapy Versus Delayed Androgen Deprivation for Stage C Carcinoma of the Prostate

Seventy-three patients with prostatic adenocarcinoma who were believed to have disease limited to the pelvis without evidence of node or bone extension were assigned randomly to either full-field pelvic radiation (40) or delayed hormonal therapy (33). The interval to first evidence of treatment failure was used as the end point of the study. Failures occurred in 13 patients who received radiation therapy and 11 who received delayed hormonal therapy. No difference in disease response could be identified between the 2 treatment groups.

Megavoltage therapy in patients with aneurysmal bone cysts.

Three adolescent patients with similar destructive lesions involving the pelvis were found to have unresectable aneurysmal bone cysts. All 3 patients appear to have permanent control and good function from 2 to 7 years after megavoltage irradiation with 4,000 rads. No complications or late sequelae have occurred, and follow-up radiographs demonstrate reconstitution and calcification of the affected bone. A slightly lower dose may be just as effective in controlling such lesions.

Adenocarcinoma of the endometrium: Role of preoperative radiation in stage I disease

Abstract A prospective study was reported evaluating the effectiveness of preoperative radiation focused on the vaginal apex followed immediately by abdominal hysterectomy and bilateral salpingo-oophorectomy as a means of therapy for Stage I adenocarcinoma of the endometrium. Eighty-three consecutive patients over a 53/4-yr span of time were studied. This technique resulted in a predicted 5-yr survival of 91.8%. Complications were low and patient acceptance excellent. The precise dosages and schedules were discussed in detail.

Dysgerminoma-100% control with combined therapy in six consecutive patients with advanced disease

Abstract Six patients with either Stage II or III disease are all alive with no evidence of disease 2–8 years following treatment. All but 1 patient had total hysterectomy and bilateral salpingo-oophorectomy. All patients had pelvic, abdominal and mediastinal radiation therapy. This is the treatment policy that is recommended for patients with disease beyond the unilateral encapsulated stage.

Technical aid in moving strip abdominal irradiation

Abstract A technical aid is described for use in the daily setup of patients undergoing abdominal strip irradiation. The purpose of the aid is to accurately reproduce the treatment field and make it unnecessary for the patient to keep the strip marking on for seven to eight weeks. The technical aid (strip gradient) is inexpensive, easy to construct, and has been used in the treatment of 12 patients with no problems encountered.

Eight year radiation therapy experience in the treatment of 1129 patients with carcinoma of the lung

1129 patients with a diagnosis of lung carcinoma were seen in the Radiation Therapy Department at the Medical University of South Carolina during the period between January 1, 1969 and June 30, 1977. During this period three distinct methods of treatment can be recognized and the patients are subdivided into three groups designated A, B, and C. (See Table I) The patient acceptance policy has been essentially the same during each treatment period and there has been virtually no rejection or selection of patients. The results in terms of survival have been dismal; however, there is correlation between technique of administering radiation therapy and late complications. These results would support recent data from other institutions and the RTOG studies which suggest that higher doses are needed to obtain local control of primary disease and that large dose fractions are associated with an increased complication rate. Within each treatment group there was a distinct number of patients who received post-operative irradiation because of residual disease, marginal disease, or positive lymph nodes, In Group C, these patients were treated with more aggressive post-operative radiation therapy and the higher dose administered appears to account for an improved survival rate.