Richard E. Ottoman

Total-Skin Electron-Beam Therapy of Lymphoma Cutis and Generalized Psoriasis: Clinical Experiences and Adverse Reactions'

TOTAL-SKIN irradiation with mega-voltage electrons of uniform dose and low x-ray contamination represents one of the newer and more effective therapeutic modalities available for the management of generalized cutaneous lymphomas. Linear and Van de Graaff accelerators are commonly employed as the electron sources for these radiation therapy units. Two problems attendant on total-body irradiation with superficial and conventional x rays in the treatment of lymphoma cutis are bone-marrow depression resulting from the more penetrating elements of the radiation and technical difficulties inherent in the use of multiple ports of treatment. Low-megavoltage electron therapy proves more advantageous than roentgen rays because (a) the penetration of the electrons can be restricted to the superficial pathologically involved skin, minimizing radiation effects to the underlying normal tissue, (b) the inherent x-ray background is low, and (c) total-body irradiation is technically easy. The biological effect of high-ene...

CHROMOSOME ABERRATIONS IN RADIATION WORKERS.

Recently published discussions of the possible role of chromosome aberrations in leukemogenesis (1) and aging (2) suggest that an increase in the frequency of such aberrations may carry with it an increased risk of illness. It is of more than academic interest, therefore, that some radiation workers do show a higher frequency of chromosome aberrations than is found in a comparable group taken from the population at large (3). In the present report we present data on chromosome aberrations in thirty-six radiation workers, thirty-three of whom have lifetime exposure doses in excess of 10 r. The frequency of chromosome aberrations in this group is significantly higher than in a control group despite the fact that the radiation was accumulated over many years at a median dose rate only about ten times the natural background radiation.

RADIATION-INDUCED CHROMOSOME ABERRATIONS IN MAN.

A study has been undertaken of the production and elimination of radiation-induced chromosome aberrations in luekocytes taken from the peripheral blood of persons exposed to chronic or acute doses of high-energy radiation (1). Among the chronically exposed groups are radiologists and scientists working in university or industrial laboratories for whom there are available complete records of the radiation dose received during their working lifetime. We have also included a group of “distinguished radiologists,” men who have been practicing radiology for over twenty-five years, who may have received substantial doses of radiation early in their careers. Figure 1 shows seven karyotypes—a karyotype is a systematized array of chromosomes of a single cell—observed in leukocytes obtained from a distinguished radiologist. The twenty-two pairs of autosomes are arranged in two rows in decreasing order of size. The X, Y chromosome pair is arranged at the extreme right of each set. As can be seen, six of the seven ce...

THE FREQUENCY OF DICENTRICS IN HUMAN LEUKOCYTES IRRADIATED IN VIVO AND IN VITRO.

The authors present a comparison of the frequency of dicentrics in human leukocytes irradiated in whole blood in vitro and in vivo. The results indicate that the frequency induced in vivo can be a factor of two higher or lower than the frequency in vitro for the same radiation dose. Whole blood was heparinized and irradiated in plastic bottles at 37° C. immediately after drawing. The oxygen tension in the blood during irradiation was essentially that of normal venous blood. Irradiations were carried out with the x-ray beam from a 6 Mev Linac (effective photon energy about 1.9 Mev) at dose rates of 200 rad/min. and 10 rad/min. The leukocytes were separated from the whole blood and incubated for seventy-two or ninety hours; chromosome preparations were then made in standard fashion. Every metaphase figure was scanned for chromosome aberrations, but tetraploid cells were excluded from the scoring. Data are presented herein for the class of aberrations known as dicentrics only, because these can be readily de...

EARLY RESULTS OF COMBINED RADIATION AND CHEMOTHERAPY IN TREATMENT OF MALIGNANT TUMORS.

The knowledge of the effectiveness of adequately administered radiation therapy in achieving palliation and regression of certain types of malignant tumors and recent reports suggesting at least some effectiveness with the systemic use of chemotherapeutic agents in similar cases (1, 10) have precipitated an interest in the possibility of increasing therapeutic effectiveness by the use of these two modalities in combination. Published reports of such combined therapy have suggested an increased tumor response as compared to either method alone (4, 5, 8). In this series of cases treated with combined radiation and chemotherapy the results will be on the basis of patient survival; or in those instances where the patient is still alive, on objective evidence of tumor response. Because of the inherent dangers of the two therapy modalities, we are aware that premature conclusions can prove harmful in the long run. Case Selection This report is based on 99 cases of solid tumors. No patients with a diagnosis of l...

X-RAY CONTAMINATION IN TOTAL-SKIN ELECTRON THERAPY OF LYMPHOMA CUTIS AND EXFOLIATIVE DERMATITIS.

Low-megavoltage electron beams have 4 been utilized during the past fifteen years as one of the major therapeutic modalities in the management of patients with lymphoma cutis (1, 13, 14). Treatment with total-skin electron irradiation has resulted in symptomatic relief of pruritus and burning and frequently has promoted involution of plaques, skin ulcers, and tumors. Low-megavoltage electron beams have been employed in psoriasis and atopic dermatitis but with more variable results (4, 13, 15). The use of conventional superficial x-ray therapy in lymphoma cutis results in a significant degree of cumulative total-body irradiation. An advantage of electron therapy has been that the penetration of electrons can be controlled, concentrating the ionizing radiation to the pathologically involved epidermis and dermis with relative sparing of the underlying hematopoietic and visceral organs. Cumulative experience with this therapeutic modality, however, suggests that a small fraction of radiation delivered to the ...

Radiation breakage of human chromosomes in vivo and in vitro.

Chromosomes in the leukocytes from the peripheral blood constitute an almost ideal biological dosimeter: they are readily available for study, they show damage immediately following irradiation, and they also may show radiation changes years after the exposure of the person concerned. The immediate effects are exhibited by cells which were irradiated while circulating in the blood. Since the lifetime of the leukocytes in the blood stream is probably only a few days, the immediate effect should disappear rapidly as they are replaced by new leukocytes. This phenomenon is seen clearly in the work of Tough et al. (1), which showed the disappearance of cells exhibiting radiation damage in a matter of days from the peripheral blood of a patient who received a single dose of partial body irradiation. On the other hand, radiation injury to the precursors of the monocytes and large lymphocytes—the two kinds of leukocyte which can divide—persist probably for the lifetime of the individual. Thus irradiation to the l...

Side-Effects of Combined Radiation and Chemotherapy in the Treatment of Malignant Tumors

In a review of 99 cases of advanced solid tumors treated by a combination of irradiation and chemotherapy, it became apparent that toxic reactions capable of altering proposed treatment plans, even to requiring hospitalization, were frequent. Such reactions assume great importance in evaluating the response of any treatment technic. A high incidence of severe side-reactions, dangerous and debilitating to the patient, could well discourage therapy programs which produce only slightly better statistical improvement in the treatment of disease. In using therapeutic modalities in combination, the side-effects of each may become intensified. Great care must be taken not just in the treatment of these side-effects, but also in their anticipation. The patient must be questioned daily concerning minor symptoms in an effort to intercept and prevent the onset of major toxic reactions. In our series we have used predominantly 5-FU in combination with radiation. In a few cases, Actinomycin D, Mitomycin C, and chloram...

Use of Megavoltage Therapy in Cancer: End-Results

Although megavoltage radiotherapy has been available for many years, it has come into relatively widespread use only during the past decade. The increasing popularity of cobalt 60 has stimulated interest in this type of therapy. Megavoltage equipment in this country consists largely of telecobalt-60 sources, one- and two-million-electron volt resonant type generators (G. E.), the two-millionvolt Van de Graaff, the betatron, and the linear accelerator. There is also one 70-Mev synchrotron in medical use. In England and Scotland, where there has been a great deal of interest in linear accelerators, the trend is toward the use of 4-to 6-Mev linear accelerators. Cesium-137 teletherapy units are not considered in this discussion, since they are equivalent to only 660 kv of energy. Because of their low output and the large penumbra, it is not believed that they will ever become very popular in this country in spite of the long half-life of the cesium source. It is frequently stated that we have progressed about...