Morton M. Kligerman

Preoperative radiation therapy in rectal cancer

This paper outlines progress being made in the use of preoperative irradiation as an adjunct to surgery in the management of cancer of the rectum and rectosigmoid. Studies have shown that the normal rectal mucosa has a marked capacity for repair during fractionated radiation treatments. There is evidence that the use of preoperative irradiation reduces the number of involved lymph nodes found at operation. No marked interference with the ability of the surgeon to perform an abdominal perineal resection has been observed. In patients who subsequently undergo such a procedure, there are some data indicating that longevity may be increased when surgery is supplemented with preoperative irradiation, although further comparative studies are needed. Two studies are now under way by national clinical investigative groups.

Dependence of RBE on fraction size for negative pi-meson induced renal injury

Abstract A method is described for quantitation of murine late renal radiation response using histopathologic grading. Effective dose-50 percent (ED 50 ) is defined as the radiation dose at which 50% of animals showed renal tubular alterations of a specific histologic grade. The designated histologic grade was selected on the basis of its correlation with renal failure manifested by elevated blood urea nitrogen levels, weight loss and mortality of the experimental animals. Using this system, the ED 50 was determined for single, two, five, and fifteen (daily) fraction exposures with 300 kVp X rays and negative pi-meson (pion) beams generated at the Los Alamos Meson Physics Facility. The correlation between total radiation dose and the number of fractions was linear for both x ray and pion exposures when plotted on logarith mic coordinates, i.e. this relationship followed a power function. The relative biological effectiveness (RBE) for pions increased from 1.12 for a single dose of 1130 red, to 2.18 for 15 daily fractions of 145 rad. This latter fraction size approaches that being used in clinical trials, and provides an estimate of the RBE to be expected for kidney injury under conventional treatment protocols.

Radiotherapy and rectal cancer

Studies utilizing preoperative radiotherapy as an adjunct to surgery are reviewed, with results indicating marked increase in survival. Results of postoperative irradiation also appear beneficial, although less extensive data are available. Irradiation for inoperable and recurrent rectal cancer has demonstrated symptomatic relief, particularly avoidance of colostomy, and can render some patients operable and resectable. Adjuvant immunotherapy after irradiation and operation is suggested for further research.

Experience with pion radiotherapy

Forty‐one patients with a total of 86 tumors were treated with negative pi mesons (pions) at the Los Alamos Meson Physics Facility (LAMPF) through December 31, 1977. An additional 30 tumors in the total patient population were treated with 100 kVp x‐rays to assess comparative effects on skin nodules and 8 patients received additive photon or electron radiation to pion‐treated portals. Of 52 evaluable tumors in 20 patients treated with pions only and followed for 3 to 22 months, 81% (42 tumors) completely regressed; 6% (3 tumors) partially regressed; and 13% (7 tumors) did not respond, although 5 of the 7 have shown no growth for 10 months. Of eight tumors in seven patients treated with a combination of pions and conventional radiation, three tumors showed complete response and five tumors showed partial response, though the resected specimens in two (one with complete and one with partial response) revealed no tumor microscopically. Reactions in normal tissues have been mild, with some patients exhibiting no normal tissue reaction, as compared with relatively marked tumor response. Cancer 43:1043–1051, 1979.

Static pion beam treatment planning of deep seated tumors using computerized tomographic scans

Abstract Static negative pion beam treatment of deep seated tumors is in progress at LAMPF. The influence of the physical principles of pions on treatment planning, e.g., an enhanced peak dose, multiple scattering, variations of beam quality, pin beam emittance, and a fixed vertical beam, are discussed. Computerized tomographic (CT) scan data have proven invaluable in providing quantitative information on inhomogeneities within the anatomy. The methods of designing collimation and compensating bolus for tailoring the pion beam to individual patient ports are described. An interim method, using dosimetry measurements in a water phantom and CT scan data to construct patient isodose distribution is outlined. Typical treatment plans for patients with abdominal and head and neck cancers are presented. The method of X-ray simulation in verifying localization of CT-defined tumor volumes is demonstrated for the head and neck.

Initial Comparative Response of Experimental Tumors to Peak Pions and X Rays

The response of a mammary adenocarcinoma to peak pions and x rays was compared in C3H mice prior to conducting radiobiology experiments in human subjects. A relative biologically effective value (RBE) of 1.7 ± 0.2 for peak pions was established and applied in human studies.

Use of ACTH and Cortisone in the Treatment of Post-Irradiation Pulmonary Reaction

With the present trend toward higher radiation dosages in an attempt to control pulmonary, esophageal, and other thoracic lesions, the danger of producing post-irradiation pulmonary fibrosis has increased. Adrenocorticotropic hormone (ACTH) has been reported by Kennedy et al. (1) as producing beneficial effects in a patient with beryllium pulmonary granulomatosis. West and his associates (2) have observed clinical improvement in two patients with pulmonary fibrosis who were treated with ACTH and cortisone. Because of these results, ACTH and cortisone have been recently employed in a patient in whom an unusually severe post-irradiation reaction in the lung occurred after roentgen therapy for a pulmonary metastasis. Inasmuch as the hormone appeared not only to halt but partially to reverse the acute phase of the reaction, it has seemed worth while to record this case. G. K., a 68-year-old female, was referred in May 1950, for consideration of radiotherapy of a solitary metastatic nodule in the right middle ...

Present Status of the Proposed Use of Negative Pi Mesons in Radiotherapy

Publisher Summary This chapter presents the relationship of radiobiologic effects with the pion proposal. The clinical application of negative pi mesons requires expansion of the peak volume, and this expansion results in three alterations in the beam characteristics that might, at least theoretically, reduce the therapeutic effectiveness of the beams: (1) reduction of the peak to plateau dose ratio, (2) decrease in the peak dose rate, and (3) reduction of the non-low linear energy transfer (LET) components of the peak with increasing peak volume. Although a reduction of the peak-to-plateau dose ratio does accompany peak expansion, the ratio that remains is far in excess of that achievable with conventional radiations such as 60 Co γ rays. This ratio remains in excess of 1 for the largest peaks that were tested, compared to being far less than 1 for the conventional radiations. Therefore, this factor remains one of the most promising in terms of potential therapeutic gains. The three theoretical problems that attend expansion of the pion peak do not appear to invalidate clinical applicability of the beams, and they remain a useful tool in clinical radiotherapy.

Localization of structures for pion radiotherapy by computerized tomography and orthodiagraphic projection

Clinical trials of pion radiotherapy are being conducted at the Clinton P. Anderson Meson Physics Facility (LAMPF) in Los Alamos. For pion treatment planning, computerized tomography (CT) is used for three-dimensional localization of tumor and critical normal structures and for corrections for tissue inhomogeneities. Techniques that make anatomical information on CT scans directly transferable to therapy planning are described, as well as a technique for taking simulation and verification portal films using orthodiagraphic projection. Several requirements for direct use of CT scans in pion treatment planning are discussed. Finally, the effects of patient positioning on organ and tumor mobility and tissue inhomogeneity as shown by CT images are demonstrated.

Treatment planning for negative pi-meson radiation therapy: UNM-LASL experience

Abstract Human radiobiological studies using negative pi-mesons have recently been conducted at the Los Alamos Meson Physics Facility; metastatic tumor nodules in the skin and superficial tumors have been treated. Large tumors of the head and neck, cervix and rectum will be treated later this year to evaluate mucosal reactions. The dosimetry and treatment planning for these clinical studies is presented. Comparisons of measurements and calculations of the effect of inhomogeneities on pion dose distributions are shown. The pion treatment code, PIPLAN, and the Oak Ridge National Laboratory Monte Carlo code have been compared and an example of their respective dose distribution calculations is given.