Lourdes Z. Nisce

Rapid‐course radiation therapy of cerebral metastases: Results and complications

Eighty‐three patients (Group A) with parenchymal brain metastases were treated with “rapid‐course” whole brain irradiation (1500 rad in 2 treatments) and the results were compared retrospectively with a group of 79 patients (Group B) treated conventionally (approximately 3000 rad in 15 treatments). Neurologic improvement occurred in 57% of patients in Group A and 62.3% of Group B. Median duration of remission was shorter in Group A: 2.0 vs. 3.5 months (p = 0.059); median duration of survival was significantly shorter in Group A: 59 vs. 116 days (p < 0.02) (means: 103 vs. 147 days). Complications were significantly more frequent in Group A: 49.4% vs. 15.2% (p < 0.01). These included acute cerbral herniation (6 cases in Group A, 3 cases in Group B), headache, nausea and vomiting, and fever. The major advantage of the rapid course is the reduction of the period of treatment. Since lethal complications occurred primarily in patients with evidence for markedly elevated intracranial pressure, the “rapid course” should probably be withheld in such patients.

Recent results of multimodal therapy of gastric lymphoma.

The efficacy of multimodality treatment of gastric lymphoma was examined in a retrospective study of 46 patients treated at the Memorial Sloan‐Kettering Cancer Center from 1971 to 1982. The principal treatment plan consisted of (1) surgical resection of the gastric lymphoma (n = 36) where feasible, followed by (2) radiation therapy of the whole abdomen (n = 23) with a boosting dose to the stomach‐bed to 3700 cGy, and/or (3) chemotherapy using mainly the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen as an adjuvant (n = 7), or CHOP plus other drugs for advanced disease. The median follow‐up time of patients was 61 months (range, 30 months to 14 years). There was no operative mortality. No patient developed known relapse in the abdomen after resection and total abdominal irradiation, and none suffered relapses after adjuvant chemotherapy, for Stages I‐E and II‐E. At 5 years, the estimated survival rate after treatment was 95%, 78%, and 25%, respectively for Stages I‐E (n = 20), II‐E (n = 9) and IV (n = 17). The results for Stage I‐E and II‐E resectable tumors were significantly improved (P < 0.05 and < 0.1 respectively) over those of similar tumors treated in 1949 to 1970.

Local tumor hyperthermia in combination with radiation therapy. 1. Malignant cutaneous lesions.

There is increasing evidence that the use of hyperthermia alone or in conjunction with other modalities may improve the therapeutic effectiveness of treatment of cancer. The present clinical studies were carried out to evaluate the response of normal and tumor tissues in patients with various cutaneous malignant lesions to repeated courses of hyperthermia alone or in conjunction with radiation therapy. Thirty‐six patients with malignant cutaneous lesions (mycosis fungoides, Kaposi sarcoma, malignant melanoma, lymphoma cutis, and other metastatic skin lesions) have been studied. The heating methods used were: 1) temperature regulated water bath immersion; and 2) radiofrequency inductive heating. The normal tissue effects of the combined treatments of radiation and hyperthermia do not appear to be greater than those treated with radiation alone. The initial tumor regression rates were faster in patients treated with radiation plus hyperthermia than in radiation alone, particularly in patients with Kaposi sarcoma and lymphoma cutis. Among ten locally recurrent patients, seven showed significant prolonged benefits achieved by the combined treatments as compared with the radiation therapy alone. Fractionated hyperthermia alone caused significant tumor regression in four out of five patients. Possible mechanisms leading to the improved results from the combined treatments are discussed. Cancer 40:161–169, 1977.

Management of coexisting Hodgkin's disease and pregnancy

The management of pregnant women with active Hodgkins disease (H.D.) should be individualized depending on the stage, the presence of infradiaphragmatic involvement, and age of gestation. Seventeen women aged 16–31 years with coexisting H.D: and pregnancy were followed between 1969 and 1982. H.D. was diagnosed during pregnancy in 15 patients and two became pregnant while on treatment. Seven women whose pregnancies were allowed to proceed uninterrupted were irradiated to supradiaphragmatic sites to doses of 1,500–2,000 rad during the second or third trimester; all had full term spontaneous normal deliveries and normal infants. Fetal doses ranged from 2–50 rad. Two patients treated with Vinblastine throughout three pregnancies delivered normal full term infants. Pregnancy was interrupted in six patients at 6–20 weeks of gestation for various reasons. In spite of several months delay in initiation of definitive therapy, the outcome of H.D. was not adversely affected in the majority of uninterrupted pregnancies as evidenced by long term disease-free survivals of 6–11 years in four of seven patients who were irradiated; the children now aged 6–11 years are also alive and reported normal.

Management of primary gastric lymphoma.

A retrospective study of 51 patients treated for primary gastric lymphoma was made to evaluate the influence of clinicopathologic features and the method of treatment on survival. The lymphocytic type of tumor showed a higher survival rate than the histiocytic type. Tumors that involved only the gastric wall resulted in a five-year survival rate of 62%, as compared with 50% for tumors that involved also the adjacent gastric lymph nodes, and 25% for those involving the distant gastric lymph nodes. Treatment by subtotal, total, or extended forms of gastric resection without postoperative radiation gave a five-year survival rate of 33%. Resection followed by radiation yielded a higher survival rate of 67%. The best results were obtained in 13 patients who received higher doses of radiation: 11 (85%) survived five or more years. One-third of the patients developed manifestations of systemic malignant lymphoma after curative therapy. These observations suggest a planned multimodal therapeutic program for this disease.

Current therapy in the management of heterotopic ossification of the elbow : A review with case studies

Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.

Aspermia and Recovery of Spermatogenesis in Cancer Patients Following Incidental Gonadal Irradiation during Treatment: A Progress Report

The 11 patients in this study who received incidental gonadal irradiation from clinical therapy all became aspermic within 8-34 weeks following treatment. The estimated gonadal dose was 118-228 rads. Five of these patients have shown recovery of spermatogenesis; 3 of these have reached fertilizable concentrations. Recovery of semen sperm was noted at 44-77 weeks following treatment. The other 2 patients, after 110-176 weeks, have sub-fertile concentrations of semen sperm. Five patients have not been followed for a sufficient length of time to permit recovery to be noted.

The Role of Radiation Therapy in the Management of Hematopoietic Neurologic Complications in Thalassemia

Extramedullary hematopoiesis is encountered in some severe anemic conditions. Very rarely it may cause neurologic symptoms, leading to spinal cord or cauda equina compression. Two patients with thalassemia who developed neurologic complications are described. Diagnosis was based on clinical findings, CT scan and magnetic-resonance imaging (MRI). The two patients responded successfully to irradiation and blood transfusion. The prognosis is excellent, if recognized at an early stage. Our experience supports the role of radiation therapy as standard treatment for this complication.

Effectiveness of once weekly total skin electron beam therapy in mycosis fungoides and sezary syndrome

During the past eight years, 137 patients with mycosis fungoides were given total skin electron beam therapy (TSEB) using 2.5 to 4 MeV electrons. A single treatment delivers 400 rads to the entire skin surface, and patients are treated once a week for six to eight consecutive weeks. All have been followed for a median of 18 months (range 6–103 months). Although approximately 80 to 90% of the total population were in the advanced stages of the disease and had been previously treated elsewhere, cutaneous lesions and associated symptoms were effectively controlled. The remission lasted 6 to 103 months (median 19 months) after beginning the therapy for 109 mycosis fungoides patients, who were at risk for 12–103 months (median 24 months). Erythroderma and circulating Sezary cells adversely affected the duration of remission and indicate extracutaneous dissemination. Lymphocyte responsiveness to various mitogens and antigens correlated well with duration of the remission that was obtained from a course of TSEB.

Radiation therapy of choroid metastasis from breast cancer

Abstract The results of radiation therapy of choroid metastases in 46 breast cancer patients, involving 57 eyes, have been analyzed. The choroid lesions were classified into three grades according to the severity and extent of involvement. Thirty-four eyes were treated with high energy electron beam therapy and 23 eyes with X-rays or telecobalt beams. Four representative electron beam techniques were shown. The tumor response to radiation therapy was described as either marked improvement, slight improvement or no improvement. The overall results of treatment showed marked improvement with total or near total restoration of vision in 35% of cases for mean and median durations of 12 and 11 months respectively. Another 28% showed slight improvement with partial return of vision. The overall response rate was 63%. The best results were seen in Grade I lesions, indicating the importance of early recognition of the disease and early treatment. The radiation dose recommended for choroid metastases is 4000 rad, delivered in 3 weeks (i.e. 280 rad tumor dose × 15, 5 times a week, or a TDF of 0.83).