Paul Y. M. Chan

Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon.

Two‐hundred‐four patients with previously untreated adenocarcinoma of rectum, rectosigmoid, and sigmoid colon were retrospectively evaluated to determine patterns of recurrence following curative resection. Seventy‐eight (38%) subsequently developed recurrent disease. Of these, 40% (31/78) presented with local recurrence alone, 28% (22/78) with regional recurrence, 15% (12/78) with concomitant local recurrence and distant metastasis, and 17% (13/78) with distant metastasis alone. The degree of tumor anaplasia and depth of tumor penetration into the bowel wall influenced the rate of local recurrence. Through five years local recurrence without clinical evidence of distant metastasis was the most common cause of death. Need for adjuvant radiation therapy is discussed.

Recurrences from malignant parotid salivary gland tumors

The clinical course of 130 patients treated for malignant parotid tumors at the three institutions have been reviewed. Fifty‐six of these 130 patients developed recurrences following their primary treatment by a surgical procedure. There were a total of 109 recurrences among these 56 patients. The average number of recurrences was two per patient. The average survival from first recurrence was 3.7 years, with the median survival 2 years. The range of survival was 0.5 to 17 years. Once recurrence developed, treatment was by surgery, radiation therapy, chemotherapy, or a combination. Of 56 patients with recurrence, 33 are dead and 9 patients are alive with disease. Fourteen patients are alive and well with no evidence of disease. These NED patients had an average number of 1.6 recurrences and a median survival to date of only 3 years. Our study indicates that for the majority of patients who develop recurrence, survival is relatively short and treatment is usually ineffective in three of four patients. The authors conclude that after a surgical procedure for malignant salivary gland tumors, a trial of wide field postoperative radiation therapy to high dose should be considered as part of the initial treatment.

A clinical appraisal of post‐irradiation biopsy in prostatic cancer

Twenty patients with adenocarcinoma of the prostate were reviewed clinically and by serial biopsy to demonstrate the spectrum of difficulties encountered. Only three patients recurred locally during their lifetime. In spite of positive biopsies, 17/20 patients had negative clinical exams at 2–7 years. Deaths were mainly secondary to disseminated disease. There is yet no good correlation between clinical evaluation and the biopsy response pattern. The significance of no residual tumor or fibrosis with scattered tumor nests on post‐irradiation biopsies has yet to be defined.

Effectiveness of local radiotherapy in colorectal carcinoma

The records of 144 patients with colorectal carcinoma treated with radiotherapy were reviewed. Ninety‐two patients received treatment for palliative purposes only (bleeding, pain, mucus discharge, tenesmus, mass). Good palliation was achieved in the majority of patients with a dose in the range of 1200 to 1400 rets. Thirty‐seven patients received radical doses of radiation for recurrent or inoperable cancer. Five out of 37 (14%) are alive without evidence of disease, 24 to 84 months following radiotherapy. Fifteen patients received pre‐ or postoperative radiotherapy as an adjuvant to surgery. Six out of the 15 (40%) are alive without evidence of disease.

Unresectable squamous cell carcinoma of the lung and its management by combined bleomycin and radiotherapy. A clinical study of the enhanced results

The interaction between the antibiotic bleomycin and x‐radiation has been studied in vitro and in vivo. Tissue culture results appear to reflect in vivo sensitivities correctly. Simultaneous exposure to bleomycin and gamma radiation enhances killing of both sensitive and resistant lines. Data from a pilot study combining bleomycin with conventional radiation for unresectable squamous cell carcinoma of the lung suggest that the simultaneous administration of bleomycin (10 mg/m2 intravenously twice weekly) with short‐course radiation treatment is well tolerated and without dangerous pulmonary complications. Tumor response was greater in the combined‐therapy group (46%) than in radiation‐only controls (26%); median survivals were 13 and 6 months, respectively. Unlike previously published data, responders appeared to have a significant survival advantage over nonresponders, suggesting that bleomycin may be slightly effective in inhibiting the development of systemic metastasis, and that it positively enhanced local control of primary disease.

Adenocarcinoma of the uterine cervix

Abstract The accepted current practice in the treatment of adenocarcinoma of the uterine cervix is radiation therapy. Opinion is frequently expressed in the literature that adenocarcinomas are not as easily controlled by irradiation as squamous cell carcinomas of the cervix. For this reason it has been the practice of some physicians to follow radiation therapy by conservative hysterectomy. The problem to be presented is whether adenocarcinoma of the cervix is to be treated with radiation therapy alone, or in combination with conservative hysterectomy. This paper deals with 30 patients with adenocarcinomas of the cervix treated primarily with radiation therapy and gives the survival rates for these patients. Our results indicate a 50 per cent 5 year survival for these patients treated primarily with radiation therapy. In the literature are reported series of patients treated with irradiation plus surgery, with 80 to 84 per cent 5 year survivals. Seven of our 30 patients died of local pelvic disease. If conservative hysterectomy had been done, and these 7 patients had survived, we project a 5 year survival rate of 80 per cent, matching the results reported in the literature for combined therapy. We believe that irradiation alone is not adequate for adenocarcinoma of the cervix. We recommend the addition of conservative hysterectomy if the goal is improval in survival rate.

Single‐ and double‐plane iridium‐192 interstitial implants: Implantation guidelines and dosimetry

Computerized dosimetric studies of single- and double-plane iridium-192 (Ir-192) planar implants were performed. With respect to dose homogeneity, we found that the optimal source and ribbon separation for single-plane implants was 1.0 cm. For double-plane implants, the preferred ribbon and plane separation was 1.5 cm, maintaining a 1-cm separation for the sources. Using these separations, standard dose rate curves for single- and double-plane Ir-192 implants were generated by computer calculations. These standard curves are useful for quickly and fairly accurately estimating the dose from any size planar implant, without requiring more time-consuming individual computer dosimetry. We believe that the curves will prove to be of practical clinical value to physicists and radiotherapists.

Thyroid Carcinoma: Is Postoperative External Irradiation Indicated?

A review of 76 patients with thyroid carcinoma, in which residual disease was left behind, has been presented. Of the 76 patients, 29 received postoperative irradiation, and 47 received no postoperati