Roger R. Good

Radiation‐induced neoplasms of the brain

The histopathology of two patients with radiation‐induced neoplasms of the brain following therapeutic irradiation for intracranial malignancies is described. The second neoplasms were an atypical meningioma and a polymorphous cell sarcoma, respectively. They occurred 12 and 23 years after irradiation (4000 rad), within the original field of irradiation. In both cases, the radiation‐induced tumors were histologically distinct from the initial medulloblastomas. Both patients were retreated with local irradiation using permanent implantation of radioactive iodine‐125 seeds.

High activity iodine 125 endocurietherapy for recurrent skull base tumors

Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation‐induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high‐activity 125iodine (I‐125) permanent implantation.

Local Control of Recurrent Clival and Sacral Chordoma after Interstitial Irradiation with Iodine-125: New Techniques for Treatment of Recurrent or Unresectable Chordomas

Using new 125I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity 125I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity 125I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases.

Outcome of locally advanced stage III and IV head and neck cancer treated by surgery and postoperative external beam radiotherapy

An uncontrolled retrospective analysis of 76 patients with locally advanced Stage III and Stage IV squamous cell carcinoma of the oral cavity, oropharynx, pyriform sinus, suproglottic larynx, glottic larynx, and hypopharynx, who were treated in a uniform manner by surgical resection and 6,600 rad postoperative external beam radiotherapy, revealed relatively high 2‐year and 4‐year adjusted survival rates of 76% and 68%, respectively. Complication rates were acceptable (8%). The advantages of this treatment approach for locally advanced head and neck cancers compared to treatment by surgery alone are discussed.

Contrast‐enhancing computed tomography ring in glioblastoma multiforme after intraoperative endocurietherapy

The significance of the contrast‐enhancing ring seen on serial follow‐up postirradiation computed tomograms (CT) of the brain was evaluated in a group of 41 patients with glioblastoma multiforme (GM) who were treated in a phase I/II study by means of intraoperative remote afterloading endocurietherapy (ECT) with a high activity cobalt 60 probe (20.00 Gy) in one high‐dose rate fraction), and conventional fractionated external‐beam (EXRT) radiotherapy (60.00 Gy in 30 fractions in 7.5 weeks). All received minimum total tumor doses of 80.00 Gy. After completion of treatment, all patients were followed with serial CT scans of the brain. Two to 6 months after treatment, 27 of 41 patients developed the similar thin‐walled, regular, contrast‐enhancing CT rings with low‐density attenuation inside and outside the ring. Postmortem study in two of these patients revealed that the thin‐walled, regular, contrast‐enhancing ring represented a continuous capsule of dilated cerebral vessels with inner low‐density attenuation corresponding to necrosis, and outer low‐density attenuation corresponding to edema. The CT appearance of the thin‐walled, regular, contrast‐enhancing ring produced after high‐dose rate intraoperative ECT and EXRT is distinctly different from the CT ring characteristic of untreated or recurrent GM. After high‐dose rate intracranial ECT and EXRT, the appearance of a post‐ECT contrast‐enhancing CT ring should not be automatically interpreted as recurrent disease as previously reported after conventional fractionated EXRT.

Relationship of dose to local control in advanced stage III and IV head and neck cancer treated by surgery and postoperative radiotherapy

Retrospective analysis of 76 patients with locally advanced squamous cell carcinoma of multiple head and neck sites, who were treated by surgical resection and either 4,000–5,000, 6,000, or 6,600 rad postoperative external beam radiotherapy, revealed reduced local recurrence rates with increasing postoperative radiation dose.

Complete response of granulosa cell tumor metastatic to liver after hepatic irradiation: a case report.

A case of granulosa cell tumor of the ovary with extensive metastases to the liver was treated by a course of fractionated hepatic irradiation consisting of 30.00 Gray delivered to the whole liver, followed by boost to gross disease for a total dose of 50.00 Gray given in six weeks. This was followed by complete tumor response with normal liver function tests, and computed tomography demonstrated a normal liver two years after radiotherapy. Liver metastases from granulosa cell tumor of the ovary are unusual, and little information has been published regarding management of this problem.

Permanent high-activity iodine-125 in the management of petroclival meningiomas: case reports.

Two cases of petroclival meningiomas are reported wherein the tumors were completely destroyed without surgical resection or external-beam irradiation by means of permanent stereotactic implantation of one or two high-activity iodine-125 seeds.

High-activity iodine-125 endocurietherapy for head and neck tumors†

Inoperable solid tumor recurrence within a surgical bed or within a previously irradiated field usually responds poorly to re‐treatment with conventional external beam irradiation (EXRT) and/or chemotherapy. We present a new, alternative method of re‐treatment used in two patients with recurrent head and neck cancer involving the parotid (adenocarcinoma) and neck nodes (squamous cell carcinoma). These patients were successfully re‐treated with high‐activity 125iodine (I‐125) permanent implantation.

Spinal metastases from pituitary hemangiopericytic meningioma.

A rare, previously irradiated, recurrent malignant angioblastic meningioma of the pituitary, hemangiopericytic type, was locally controlled by a new endocurietherapy technique that allows delivery of very high (10,000 cGy), sharply localized irradiation. Rather than succumbing to the local tumor recurrence, as would otherwise be expected, the patient developed distant spinal metastases several years later.