Nelson Urdaneta

Pituitary adenomas and craniopharyngiomas: Analysis of 99 cases treated with radiation therapy

Abstract A total of 85 cases of pituitary adenomas and 14 of craniopharyngiomas were treated in the Department of Therapeutic Radiology at the Yale-New Haven Hospital from 1958 to 1973. The over-all control rate of the chromophobe adenomas were 86% at 5 years and 73% at 10 years. The results were similar in the groups treated with surgery followed by postoperative radiation and the group treated initially with radiation therapy alone , with surgery for the radiation failures. This report discusses 13 patients with eosinophilic adenomas; of these, half obtained control of the disease. In 4 of the 6 basophilic adenomas, endocrine abnormalities appear to be arrested. The results in the fourteen patients with craniopharyngioma were disappointing. The incidence of visual field loss after therapy was high. Complications were few and those attributed to the radiation therapy were present in patients who received unusually high fractions and often high total doses.

Cancer of the nasopharynx: review of 43 cases treated with supervoltage radiation therapy.

Forty‐three cases of cancer of the nasopharynx treated at the Yale‐New Haven Hospital in the last 15 years were analyzed. The clinical aspects of the disease, the technique of therapy and results of treatment are presented. The five‐year cumulative survival in all the cases treated was 27%. Patients with lymphoepitheliomas seem to do better than those with squamous cell carcinoma. Even in patients with advanced disease, a cure is still possible after radical radiation treatment. Retreatment of recurrent disease is frequently successful in these tumors. The complications after curative radiotherapy even with the use of supervoltage are still relatively frequent. The incidence of distant metastases was 29%.

Breast cancer in brothers Case reports and a review of 30 cases of male breast cancer

Two brothers with breast cancer are presented. One died 8 years after diagnosis and the other is presently living at 1 year with metastatic disease. The courses of 28 other previously unreported male patients with carcinoma of the breast are reviewed, and the possibility of male breast carcinoma being metastatic disease from the prostate is discussed. Useful etiologic information might be obtained from following the offspring of male breast cancer patients to see if they are at increased risk of developing the disease.

A dosimetric analysis of morris, fletcher, and henschke systems for treatment of uterine cervix carcinoma

The role of intracavitary irradiation in the treatment of uterine cervix carcinoma is well established, and over the years a number of different systems for intracavitary irradiation have been developed. To compare the clinical efficacy of different systems and to develop guidelines for the design of applicators with new sources such as americium-241, we present a dosimetric comparison of three systems: (a) the Morris system, a modified Stockholm technique; (b) the Henschke system; and (c) the Fletcher system. Using a computerized planning system, dose distributions with different configurations of each system were calculated. For each case, doses to point A, B, and a set of reference points representing bladder and rectum were also calculated. Also, the 60 Gy reference volumes, as defined by ICRU Report No. 38, 1985, were calculated for six different treatment regimens. These treatment regimens employ widely different combinations of whole pelvis external beam dose, split pelvis external beam dose, and intracavitary irradiation dose to achieve similar clinical outcomes for the treatment of various stages of cervix carcinoma. From this analysis we observe the following: (a) The Morris system produces a higher dose rate to point A (70 to 90 cGy/hr) compared to the Fletcher or Henschke system (50 to 70 cGy/hr); (b) the doses to point B relative to point A dose are about the same for all three systems at 28 to 32%; (c) the doses to reference rectum and bladder points relative to point A dose for clinically equivalent configurations are about the same for Fletcher and Henschke systems (58-65%) not including the effects of shields in the vaginal ovoids, and somewhat higher for the Morris system (72-79%); (d) the volume treated to a given dose rate by each intracavitary system alone is about the same; and (e) the 60 Gy volume depends critically upon the external beam whole pelvis dose, rising steeply as the external beam whole pelvis dose approaches 30 Gy. Since different groups have used widely different prescriptions of external beam whole pelvis dose, ranging from 0 to 50 Gy depending upon stage, the 60 Gy volumes for these various dose prescriptions are strikingly different. Because the Morris system uses lower values for the external beam whole pelvis dose than the others, its 60 Gy volume for the advanced Stage IIB and IIIB is 2 to 4 times lower than others. This choice makes the Morris system more conservative than others, probably resulting in slightly lower cure rates for the advanced stage disease.

Olfactory neuroblastoma. Observations on seven patients treated with radiation therapy and review of the literature

Seven patients with olfactory neuroblastoma were treated, using the staging classification proposed by Kadish (stage A two patients, stage B one, stage C three, and local recurrence one patient). Treatment was not uniform. Radiation therapy was employed initially as the only treatment modality in three patients who had stage A, B, and C, respectively. In one instance, it was used to treat a local recurrence after surgical treatment. Surgery and radiation therapy was employed in three patients: one with stage A and two with stage C. Chemotherapy was used as an adjuvant to radiation and surgery in one patient with stage C, and in three individuals, it was used for advanced disease. Four of the seven patients are alive without evidence of disease from 23 months to 16 years 8 months after treatment. A review of 11 series from the recent medical literature is presented. It is essential to follow these patients for long periods of time because of the slow growth and the propensity of local recurrence that some of these tumors have. The actual tendency in the management of this neoplasm seems to be combined therapy with surgery and radiation. The role of adjuvant chemotherapy is not well established, but has been recommended for locally advanced disease.