Marvin Rotman

A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Preliminary report by the radiation therapy oncology group

Preliminary analysis is presented of a prospective randomized study involving 365 patients with histologically proven unresectable non‐oat‐cell carcinoma of the lung treated with definitive radiotherapy. The patients were randomized to one of four treatment regimens: 4000 rad split course (2000 rad in five fractions one week, two weeks rest, and an additional 2000 rad in five fractions in one week) or 4000, 5000, or 6000‐rad continuous courses in five fractions per week. Ninety to 100 patients were accessioned to each group. The one‐year survival rate is 50% and the two‐year survival rate, 25%. The patients treated with the split course have the lowest survival rate (10% at two years) in comparison with the other groups (range = 20–25%). The complete and partial local regression of tumor was 49% in patients treated with 4000 rad and 55% in the groups treated with 5000 and 6000 rad. For patients who achieved complete regression of the tumor following irradiation, the two‐year survival rate is 40%, in contrast to 20% for those with partial regression, and no survivors among the patients with stable or progressive disease. The incidence of intrathoracic recurrence was 33% for patients treated with 6000 rad, 39% for those receiving 5000 rad, and 44–49% for those treated with a 4000‐rad split or continuous course. At present, the data strongly suggest that patients treated with 5000 or 6000 rad have a better response, tumor control, and survival rate than those receiving lower doses. However, additional followup of patients at risk in each group will be necessary before a final conclusion is drawn. Patients with high performance status (Kornofsky index higher than 70), or with tumors in earlier stages (T1N2 or T3N0) have a two‐year survival rate of approximately 40%, in comparison with 20% for other patients. The various irradiation regimens have been well tolerated, with complications being slightly higher in the 4000‐rad split course group (10 severe and 2 life‐threatening) and in the 6000‐rad continuous course group (9 severe and 4 life‐threatening). The most frequent complications have been pneumonitis, pulmonary fibrosis, and dysphagia due to transient esophagitis. Further investigation will be necessary before the optimal management of patients with bronchogenic carcinoma by irradiation is established.

Concurrent hyperfractionated irradiation and chemotherapy for unresectable nonsmall cell lung cancer. Results of radiation therapy oncology group 90-15

Background. Clinical trials of hyperfractionated radiation therapy and induction chemotherapy followed by standard radiation therapy have shown improved survival in patients with unresectable nonsmall cell lung cancer (NSCLC). Radiosensitization may improve local tumor control when chemotherapy is given concurrently with hyperfractionated radiation therapy, but also may increase toxicity. A Phase I/II trial, Radiation Therapy Oncology Group 90‐15, was designed to evaluate whethei this strategy could improve survival with acceptable toxicity and be part of a Phase III trial of chemoradiation sequencing.

Limitations of adjunctive surgery in carcinoma of the cervix

Abstract This study analyzed 41 patients with bulky/barrel-shaped Stage IIB cervical carcinoma. Twenty patients were treated with radical radiation alone. Twenty one patients had post-radiation surgery; ten underwent total abdominal hysterectomy and lymphadenectomy and eleven underwent extrafascial hysterectomy. Histologic review of the submitted specimens showed complete tumor sterilization in all but two. One of these had a microscopic focus of residual tumor with changes suggesting radiation damage; the other had wide-spread disease. All but one of the submitted nodal specimens were negative. Among patients receiving radiation and surgery, there was a 15% incidence of fistulization. In addition these patients had an unusually high incidence (60%) of prolonged (more than 18 months) unilateral and bilateral obstructive uropathy. Patients managed by radiation alone showed a 5% incidence of fistulization and 30% incidence of obstructive uropathy. This high incidence of ureteral obstruction following radiation alone without concurrent disease has not been reported previously. This study questions the routine use of abdominal hysterectomy with or without lymphadenectomy following radical radiation therapy in the treatment of Stage IIB disease and outlines the criteria for the combination of the modalities.

Supportive therapy in radiation oncology

Measures for supportive care of the radiation therapy patient are presented. These include emotional support prior to and during the course of therapy facilitated by a written interview that allows the radiation oncologist to be a supportive communicator of realistic information. A discussion is made of the support of body tissues affected by combination radiation and chemotherapy. These tissues usually include skin, oral, esophageal and intestinal mucosa, and teeth. Means of maintaining nutritional support following weight loss of patients during therapy are described.

Monocytosis: a new observation during radiotherapy.

Abstract Absolute cell counts were performed on patients prior to, during, and after irradiation. A total of 29 patients were evaluated prior to any irradiation; approximately equal numbers had malignant disease of the pelvis and thorax. In addition 44 patients were studied randomly during irradiation only. Absolute cell counts on a 10,000 cell sample demonstrated the usual neutropenia, lymphopenia and eosinophilia. A marked consistant monocytosis also was noted. Parallel 100-cell counts done manually were statistically inconclusive. This has not been reported previously.

Biomedical Applications of Polycations

Biomedical applications of polycation follow from their electrostatic attraction to negatively charged surfaces in silicosis therapy, immunochemistry, and as immune adjuvant. Polycation treated mouse tumor cells show a reduction in negative charge, increased cell aggregation, and increased cell lysis. Injecting polycations into tumor-bearing mice at dosages non-lethal to the host inhibits the growth of several types of tumor. Injecting polycations before challenging mice with tumor cells also increases their survival.

Radioisotope scanning of Kaposi's sarcoma--a modality for treatment planning.

The radionuclide Technetium 99m was used to detect occult infiltrations of Kaposis sarcoma in the subcutaneous and muscular tissues as well as draining lymph nodes. This allowed for large field Co‐60 teletherapy to encompass both the clinically evident as well as occult regional deposits of tumor. Seven patients were studied with an initial histologic diagnosis of Kaposis sarcoma. One patient who had a negative isotope study was later proven to have dermal metastasis from renal carcinoma. There were no false positive or false negative results.

Combined treatment of rodent fibrosarcoma by radiotherapy and immune adjuvanti

Abstract The effect of fractionated local tumor X-irradiation combined with intraperitoneal administration of several non-specific immune adjuvants has been compared with X-irradiation alone and immune adjuvant alone. The tumors employed are a transplanted syngeneic rat fibrosarcoma and a transplanted syngeneic mouse fibrosarcoma. The non-specific immune adjuvants studied were C. parvum, BCG, endotoxin, piromen and zymosan. The most effective protocol in rats and mice resulting in complete remission was obtained with C. parvum given intraperitoneally (i.p.) 1 day prior to each m three doses of 1500 R. Animals receiving the same dose schedule without adjuvant had only partial regression of their tumor. BCG as adjuvant was useful in treating mouse, but not rat tumors. Stimulation of the host immune response by non-specific adjuvant appears to improve the tumor response to radiotherapy.

Comparison of RPA-derived staging and AJCC staging in head and neck cancers based on RTOG data

We sought to evaluate the value of a new staging system for head and neck (HN4:140–144.

Some dosimetric observations in irradiation of non-oat cell unresectable carcinoma of the lung a randomized study by the radiation therapy oncology group

;Washington University School of Medicine, St. Louis, MO., 2RTOG Statistical Center, Boston, Mass., %niversity of Rochester Strong Memorial Hospital, Rochester, N.Y., Thomas Jefferson University Hospital, Philadelphia, Pa., Hahnemann Medical College and Hosoital. Philadelphia, Pa., Loyola University Medical Center, Maywood, Ill., Radiation Oncology Medical Group of Southern California, Inc., Fountain Valley. Calif., Allegheny General Hospital, Pittsburgh, Pa., qNew York Medical College, N.Y.. N.Y., lRadiological Physics Center, Houston, TX.