Richard D. Marks

Megavoltage therapy in patients with aneurysmal bone cysts.

Three adolescent patients with similar destructive lesions involving the pelvis were found to have unresectable aneurysmal bone cysts. All 3 patients appear to have permanent control and good function from 2 to 7 years after megavoltage irradiation with 4,000 rads. No complications or late sequelae have occurred, and follow-up radiographs demonstrate reconstitution and calcification of the affected bone. A slightly lower dose may be just as effective in controlling such lesions.

High dose pre-operative radiotherapy and surgery for cancer of the larynx.†‡

High dose pre‐operative radiotherapy has played an increasing role in the treatment of advanced cancer of the larynx at the University of Virginia Hospital since 1966. The results of treatment of 72 cases treated in this fashion are compared with 151 cases treated by surgery alone. Employing the actuarial method for calculating survival, there would appear to be a distinct improvement in the group receiving pre‐operative radiotherapy. Local recurrence was reduced to 15 percent following radiotherapy from a level of 30 percent with surgery alone; however, this is a retrospective study, and the two groups are not strictly comparable by age, sex and race. Comparison by stage demonstrates that the more advanced cases received pre‐operative radiotherapy. Morbidity from the combined approach was not increased with a dose of 5,000 rads delivered in five weeks.

Fourteen years' experience with Cobalt‐60 radiation therapy in the treatment of early cancer of the true vocal cords

The results of treatment and reasons for failure are analyzed for a group of 110 patients with early (T1 and T2) squamous cell carcinoma of the true vocal cords, all treated with a Cobalt‐60 source. The report covers a period from 1956 through 1969, and presents 5‐year survival figures for over 50% of the patients in the series. For 55 Tl patients, the 5‐year absolute and relative survival rates were 80% and 94%, respectively. Similarly, for 12 T2 patients, the respective figures were 67% and 100%. Employing the actuarial method, the cure rates for radiotherapy alone were calculated utilizing the entire group of 85 Tl patients and 25 T2 patients. The cure rate for Tl lesions was 91%, for T2 lesions, 80%. Only eight radiotherapy failures were discovered in the combined group, and five of these have been salvaged by laryngectomy and now are alive and well. There were no significant complications attributed to the radiation therapy, and, in the five patients who came to surgery, the laryngectomy was carried out with no added morbidity. In six of the eight radiotherapy failures, technical reasons were discovered which may have contributed to the poor results in these patients. The results are compared with a large series of patients recently reported in a review article by Vermund.

Sequelae of Pelvic Irradiation in Infancy 25·Year Followup-

Late radiation changes are reported in a 25-year-old woman whose entire pelvis was irradiated at the age of 13 months. Changes were apparent in the skin, muscles, primary sexual organs, bone, and bone marrow. No clinically manifested late radiation effects were revealed in the bladder or rectum. In view of the dose delivered (2,200 rads), it would appear that the normal tissues of infants are highly sensitive to irradiation.

Twenty-five-year survival of sarcoma botryoides treated by irradiation.

The case of a 26‐year‐old woman with a history of sarcoma botryoides of the vagina treated by radiation therapy at the age of 13 months is presented. The patient is free from local tumor recurrence or distant metastases. As a result of pelvic irradiation during her infancy, she has hypoplastic external genitalia, hypofunction of the ovaries, and infantile vagina and uterus. She has, however, normal urinary and bowel function.

Eight year radiation therapy experience in the treatment of 1129 patients with carcinoma of the lung

1129 patients with a diagnosis of lung carcinoma were seen in the Radiation Therapy Department at the Medical University of South Carolina during the period between January 1, 1969 and June 30, 1977. During this period three distinct methods of treatment can be recognized and the patients are subdivided into three groups designated A, B, and C. (See Table I) The patient acceptance policy has been essentially the same during each treatment period and there has been virtually no rejection or selection of patients. The results in terms of survival have been dismal; however, there is correlation between technique of administering radiation therapy and late complications. These results would support recent data from other institutions and the RTOG studies which suggest that higher doses are needed to obtain local control of primary disease and that large dose fractions are associated with an increased complication rate. Within each treatment group there was a distinct number of patients who received post-operative irradiation because of residual disease, marginal disease, or positive lymph nodes, In Group C, these patients were treated with more aggressive post-operative radiation therapy and the higher dose administered appears to account for an improved survival rate.