Rafael C. Chan

Management and results of localized Ewing's sarcoma.

Seventy‐six patients with localized Ewings sarcoma who received primary treatment at M. D. Anderson Hospital from 1948 through December 1975 were reviewed. Patients have been divided into four groups according to the different treatment regimens they received: Group I, moderate dose radiotherapy alone; Group II, high dose radiotherapy alone; Group III, radiotherapy plus vincristine and cytoxan; and Group IV, radiotherapy plus vincristine, Adriamycin, cytoxan and actinomycin. The problem of local recurrence appears to be solved with combined chemotherapy and radiation therapy with only one of 36 patients having a recurrence at the primary site in Groups III and IV. Multimodal therapy is the preferred treatment to obtain control of the primary lesion by radiation therapy while preserving good function. However, the major cause of failure remains distant metastases, 19 of 36 (53%) in Groups III and IV. In addition, 4 of 10 patients who have survived over 5 years have developed osteogenic sarcoma. Cancer 43:1001–1006, 1979.

Radiotherapy of choroidal metastases. Breast cancer as primary site

Forty‐two cases of metastatic breast cancer to the choroid treated by radiation therapy were reviewed. Fifteen patients (36%) had bilateral and 27 patients (64%) had unilateral choroidal involvement. In 12 patients (29%) the choroid was the first site of dissemination. The median survival period after choroidal metastases was 10 months. Most patients were treated with Co60 in doses of 2500 rads tumor dose (TD) in ten fractions, 2500 rads (TD) in five fractions and 3000 rads (TD) in ten fractions. An early group of patients had orthovoltage therapy. Good visual responses were obtained with each of the above treatment programs. Radiation treatment in the range of 2500‐3000 rads TD in a short course is recommended for palliation of metastatic breast cancer to the choroid.

Bladder carcinoma: results with preoperative radiation therapy and radical cystectomy.

The records of 159 patients treated with preoperative radiotherapy and radical cystectomy were reviewed to ascertain the influence on survival rates and disease-free intervals of tumor stage, tumor grade, tumor appearance, lymphatic permeation, history of previous bladder tumors, and downstaging (pathologic stage < clinical stage). Knowledge of grade, tumor appearance, lymphatic invasion, and history of previous bladder tumors did not make possible an accurate prediction of response to integrated therapy. However, both downstaging and the absence of muscle invasion were associated with significantly improved survival rates and disease-free intervals.

Single Dose Whole Pelvis Megavoltage Irradiation for Palliative Control of Hematuria or Ureteral Obstruction

Of 7 patients with bladder carcinoma whose medical condition or disease status prevented an operation 5 had intractable vesical hemorrhage and 2 had progressive azotemia caused by ureteral obstruction. These patients were treated with pelvic irradiation of 1,000 rad single doses. Four patients received 3 doses 3 to 4 weeks apart and 1 patient received 2 doses at a 4-week interval. Prompt cessation of bleeding occurred in all patients and renal function improved in the 2 patients with ureteral obstruction.

Integrated therapy for invasive bladder carcinoma experience with 108 patients

One hundred eight patients with invasive bladder carcinoma, clinically staged T3, who underwent preoperative irradiation followed by radical cystectomy and ileal conduit urinary diversion without pelvic lymphadenectomy at this Center between January 1, 1969, and December 30, 1975, were reviewed. Sixty-two patients are alive and free of disease twelve to ninety-six months after treatment. The incidence of recurrent pelvic disease is 8%. With protracted radiotherapy (5,000 rads TD/five weeks), pelvic lymphadenectomy is not necessary and has the benefit of distinguishing high-risk population who may benefit from adjuvant therapy.

Combination nephroureterectomy and postoperative radiotherapy for infiltrative ureteral carcinoma

Nephroureterectomy combined with postoperative irradiation was used in the treatment of eight patients with invasive carcinoma of the ureter. Radiotherapy was tolerated well; there were no long-term complications. Recurrent local disease was documented in only one instance. The disease-free survival of three patients at 13, 18, and 34 months suggests that combination therapy deserves greater clinical application.

Carcinoma of the prostate. Its treatment by a combination of radioactive gold‐grain implant and external irradiation

Out of 67 patients treated with radiotherapy from 1967 to August 1972, a small group of 17 patients were treated by a combination of radioactive gold grain implant plus external Cobalt‐60 teletherapy. The average dose from the implant was 4000 rads, which was supplemented with external irradiation to a total dose of 8000 rads TD. Because of the small number of patients and the short follow‐up, no definite conclusions can be drawn at this time. The technique used permits the delivery of a higher total tumor dose of about 8000 rads with relatively low complication rate.

Selection of high-risk bladder cancer patients for adjuvant chemotherapy by response to preoperative radiotherapy

With the availability of new chemotherapeutic agents for patients with bladder carcinoma, there is an attempt to select high-risk patient populations who may benefit from a clinical trial of adjuvant chemotherapy by response to preoperative irradiation. We have reviewed our experience in treating 160 patients with preoperative irradiation followed by a radical cystectomy and ileal conduit urinary diversion without pelvic lymphadenectomy at the M.D. Anderson Hospital and Tumor Institute from January 1, 1969 and December 5, 1977. Radiotherapy consisted of external megavoltage irradiation (25 MeV x-rays) to a dose of 5000 rads in 5 weeks. Persistent or recurrent local disease was documented in 10 patients (6%). 31 patients (19.4%) developed distant metastases. 114 patients (71.3%) are alive with no evidence of disease with a minimum follow-up of one year. There was no remaining malignant disease in 55 patients (34%) after each surgical specimen was carefully examined for the presence or absence of residual tumor. There was a significant difference in survival in the disease-free interval between those patients in whom malignant disease remained. It is apparent that careful pathologic examination of the cyctectomy specimen removed from patients receiving more protracted preoperative radiotherapy provides a method for selecting high-risk patients which might justify a trial of combination chemotherapy. Under current investigation is the use of combination chemotherapy utilizing cis-platinum, cyclophosphamide and adriamycin.

Management and results of localized Ewing's sarcoma

Seventy-six patients with localized Ewings sarcoma who received primary treatment at M.D. Anderson Hospital from 1948 through December 1975 were reviewed. Patients have been divided into four groups according to the different treatment regimens they received: Group I, moderate dose radiotherapy alone; Group II, high dose radiotherapy alone; Group III, radiotherapy plus vincristine and cytoxan; and Group IV, radiotherapy plus vincristine, Adriamycin, cytoxan and actinomycin. The problem of local recurrence appears to be solved with combined chemotherapy and radiation therapy with only one of 36 patients having a recurrence at the primary site in Groups III and IV. Multimodal therapy is the preferred treatment to obtain control of the primary lesion by radiation therapy while preserving good function. However, the major cause of failure remains distant metastases, 19 of 36 (53%) in Groups III and IV. In addition, 4 of 10 patients who have survived over 5 years have developed osteogenic sarcoma.