Rushdy Abadir

Spinal cord glioma following irradiation for Hodgkin's disease

A 21‐year‐old patient, after radiation therapy to the mediastinum for Hodgkins disease, died six years later of a spinal cord glioma, believed to be caused by irradiation therapy. That the x‐ray therapy provoked neoplastic changes seems likely, although it could be coincidental.

Preliminary Observations on the Results of Combined 125Iodine Seed Implantation and External Irradiation for Carcinoma of the Prostate

Fifty-seven patients with localized carcinoma of the prostate were treated with pelvic lymphadenectomy and a reduced 125iodine implant dosage, supplemented by a moderate dose of external beam radiotherapy to the whole pelvis delivered 4 to 6 weeks later. The incidence of pelvic nodal metastases was 28 per cent and the operative morbidity was 15 per cent. Late radiation sequelae developed in 18 patients, including 15 patients with radiation proctitis (29 per cent), among whom 2 (4.6 per cent) suffered rectal ulceration and required diverting colostomy. Followup has been 2 years or longer (median 33 months) in 26 patients, of whom 22 (85 per cent) are free of disease. Three patients are living with osseous metastases or local disease and there has been 1 death of prostatic carcinoma, for an absolute 2-year survival rate of 95 per cent. Of the 7 patients with poorly differentiated tumor and of the 8 patients with positive pelvic lymph nodes 5 and 6, respectively, remain free of disease after a minimum 2-year followup. Potency has been lost in 20 per cent and reduced significantly in 30 per cent of the patients followed 18 months or longer. Prostatic biopsies on 28 asymptomatic patients 12 to 30 months after completion of therapy showed no tumor in 21 (75 per cent).

Carcinoma of the Prostate Treated by Pelvic Node Dissection, Iodine-125 Seed Implant and External Irradiation" A Study of Rectal Complications

The University of Missouri-Columbia protocol for localised cancer of the prostate calls for pelvic node dissection, 10000 cGy at the periphery of the prostate from 125I and 4000 cGy in 20 fractions to the whole pelvis using supervoltage X-ray therapy. Rectal complications were studied in 104 patients; acute and chronic reactions were defined. During external irradiation 54% did not develop diarrhoea, 43% had mild diarrhoea and 3% had severe diarrhoea. In the chronic stage 77% did not have diarrhoea, 12% had delayed, non-distressing rectal bleeding which did not need specific treatment or needed only simple treatment, 7% had prolonged distressing proctitis and 4% had rectal ulceration or recto-urethral fistula necessitating colostomy. Each of the four patients who had colostomy had an additional aetiological factor (arterial disease, pelvic inflammation, additional radiation, pelvic malignancy or second operation). None of the patients entered in the combined brachytherapy and teletherapy programme, and in whom 0.5 cm space was maintained between the closest seed and the rectal mucosa, developed prolonged proctitis.

Carcinoma of the prostate irradiated by combined I125 and external, irradiation. Analysis of failure and significance of positive biopsy one year or more after therapy

Sixty-three patients with cancer of the prostate T2 or T3 were evaluated. The protocol of treatment called for pelvic lymphadenectomy, 10,000 rad from I125 implant and 4000 rad in 20 fractions using a Cobalt60 machine. They were followed for 1 to 5 years with a plan to rebiopsy the prostate 1 to 2 years after therapy. Six of 59 evaluable patients (10%) showed progressive disease. Distinctive prognostic features in the failure group were younger age, larger prostate, more advanced stage, poorer differentiation, more possibility of positive pelvic lymph nodes, and if the nodes were positive, the involvement of more than two pelvic lymph nodes. On the other hand, the patients with controlled disease with or without positive prostatic biopsy on follow-up showed identical features regarding age, size of prostate, stage, differentiation, involvement of pelvic lymph nodes, and if the nodes were positive, only one or two nodes involved. Positive biopsy 1 to 2 years after radical irradiation in otherwise controlled disease is considered of no prognostic value.

Breast carcinoma treated by conservative surgery: results of postoperative external radiotherapy with photons only and a nonsplit supraclavicular field.

Eighty-nine breasts in 85 patients were treated by lumpectomy and then radiotherapy from a Co-60 source only. The supraclavicular field was nonsplit. Eighty percent were in their 40s, 60s, or 70s with almost equal distribution. The majority of cases (80%) was T1 followed by T2 (18%). Axillary dissection was not done in 26% of patients. The majority (84%) had infiltrating ductal carcinoma; 6% had carcinoma in situ only. The dose to the breast including the boost was in the range of 6,000 cGy to 7,000 cGy in 96%, whereas in 4% it was in the range of 5,000 cGy. Forty-four patients (49%) with N0 did not have nodal irradiation. The dose to the nodes in the remaining patients ranged from 5,040 to 6,840 cGy. The cosmetic result was good to excellent in 99% of evaluated patients. There was telangiectasia in 1, arm edema in 2, no fibrosis in supraclavicular–tangential fields junction and no other soft-tissue or bone complications. Fifteen percent died; 6% had no evidence of cancer, and 9% had metastatic disease. Two had local recurrence, but with salvage mastectomy and systemic therapy were alive and well. The use of external photons only for breast irradiation and a nonsplit supraclavicular field yielded good results compared with alternative methods.

A feasibility study of computerized tomography radiation therapy treatment planning in transverse, coronal and saggital sections☆

Abstract The feasibility of simultaneous corona) or saggital reconstruction of computerized axial tomography (CT) images and isodose distributions from multi-planar data has been examined as an approach to three-dimensional treatment planning. With the aid of a computer (PDP 11/50), serial sections of a CT were used to reconstruct saggital and corona) sections. Central and off-center isodose distributions on the corresponding cross section were produced on a radiation therapy treatment planning (Artronix PC-12) computer. Isodose curves thus produced were used for reconstruction of saggital and corona) isodose distributions. The limitations of that system are discussed as well as further developments.

I-125 implant and supervoltage irradiation for treatment of T0−2 or T3 carcinoma of the prostate: the impact of invasion beyond the prostatic capsule and minimal nodal involvement

Sixty-three consecutive patients with cancer of the prostate treated by pelvic lymphadenectomy, 1–125 implantation ± Co60 therapy were studied regarding the impact of extension of cancer beyond the capsule and minimal nodal involvement. Extension of cancer beyond the prostatic capsule, Stage T3, constituted 34%, while Stages TO-2 comprised 66% of the cases. The features of T3 compared with T2 or less were: higher incidence of younger age (50s), 29% vs. 19%; less well-differentiated cancer, 29% vs. 64%; higher incidence of pelvic node involvement, 52% vs. 18%; and higher incidence of recurrence, 24% vs. 4.7%. The involvement of only one or two pelvic nodes by microscopic cancer did not adversely affect the prognosis in T2 group over a relatively short period of follow-up. No local recurrence occurred in T2. In the T3 group, two of 21 (9.5%) developed local recurrence.