Salitha Reddy

Preoperative chemotherapy and irradiation for stage III non-small cell lung cancer

Surgical therapy for stage III non-small cell lung cancer (NSCLC) has not resulted in substantial long-term survival. Neoadjuvant treatment programs that could down-stage the tumor and achieve increased long-term survival would be of obvious benefit. We have used preoperative simultaneous chemotherapy and irradiation in 85 patients with clinical stage III non-small cell lung cancer considered candidates for surgical resection. One group of 56 patients was treated with cisplatin, 5-fluorouracil, and simultaneous irradiation for five days every other week for a total of four cycles. After treatment, 39 patients underwent resection, and the operative mortality was 2 (5%) of 39. A second trial was undertaken in which etoposide (VP-16) was added because of its synergism with cisplatin. In this group, 29 patients were considered to have potentially resectable disease, and 23 underwent thoracotomy with 1 operative death (4%). Of the total of 62 patients having thoracotomy, 60 underwent resection (97%). Complications were major, and there were four bronchopleural fistulas. For the 85 patients eligible for surgical intervention in these two groups of patients, the Kaplan-Meier median survival estimate is 40% at 3 years. The median survival of the 62 patients having thoracotomy is 36.6 months. Combination preoperative chemotherapy and irradiation is feasible with acceptable toxicity and operative mortality in patients with clinical stage III non-small cell lung cancer. Prospective randomized studies are suggested for further evaluation of this treatment program.

Simultaneous Cisplatin Fluorouracil Infusion and Radiation Followed by Surgical Resection in Regionally Localized Stage III, Non–Small Cell Lung Cancer

Sixty-four patients with stage III (M omicron) non-small cell lung cancer were treated with cisplatin fluorouracil infusion chemotherapy and simultaneous radiation therapy for 5 days every other week. A total of 4 cycles (40 Gy) was followed by attempted surgical resection. Clinical response to the preoperative treatment included 5 (8%) complete and 32 (48%) partial responses. Thirty-nine (61%) underwent the planned operation, and in 9 (23%) of these patients the resected specimens were histologically negative. Clinical assessment failed to predict histological response. With 17 months median follow-up (range, 2.4-29 months), estimated 1-year survival was 61% and median survival was 16 months for all patients.

Results of re‐irradiation for cerebral metastases

After an initial course of radiation, 56 patients with cerebral metastases had their brain retreated at least once for recurrent neurologic symptoms. The most common primary was from either the lung or breast. The frequent symptoms were headache, weakness, seizures, visual problems, and/or mental changes. Forty‐two (75%) of these patients responded to the second course of treatment. The median duration of response was 10 weeks and median survival was 14 weeks.

Extranodal non‐Hodgkin's lymphoma

From 1964 to 1977, 42 patients with Stages I and II non‐Hodgkins lymphoma involving the extranodal sites were seen and treated with curative intent by radiotherapy in the Department of Therapeutic Radiology at Rush‐Presbyterian‐St. Lukes Medical Center. The initial pathologic specimen was reclassified according to the criteria of Rappaport et al.16 Diffuse histology was the most common histologic type found in 80% of the patients. The five‐year actuarial survival and disease‐free survival rates were found to be almost identical at 74% for Stage I and 38% for Stage II patients.

Early nodal and extra‐nodal non‐Hodgkin's lymphomas

There were 54 Stage I and 38 Stage II patients with non‐Hodgkins lymphomas treated with curative radiotherapy between 1964 and 1975. The initial biopsy material was reclassified according to the criteria of Rappaport et al.10 The frequency of nodular vs diffuse histological pattern was 26% vs 74%. The survival and recurrence free survival were significantly superior for the nodular pattern as compared with diffuse in both Stages I and II. The sites of first recurrence were evaluated. Fourteen out of 20 Stage I and 18 out of 26 Stage II patients recurred in one of the nodal areas only as their first site of recurrence. In 50%, this was in contiguous lymph node areas only. Extra‐nodal non‐Hodgkinss lymphomas survival and recurrence‐free survival rates at five years were identical. Cancer 40:98–104,1977.

Carcinoma of the nasopharynx: Survival and patterns of recurrence

We have analyzed survival, disease-free (NED) survival, and patterns of recurrence for 76 patients with carcinoma of the nasopharynx treated from June 1964 through July 1979. Patients with Stages I through IV, who were treated for cure, comprise the study group. Megavoltage teletherapy treatment was delivered to the primary bilateral neck and supraclavicular areas. Dose to the nasopharynx ranged from less than 55 Gy to 70 Gy with several patients receiving higher doses. The observed 5 year NED survival rates were: Stage I, 75%; Stage II, 20%; Stage III, 42%; and Stage IV, 31%. During a 5-year minimum follow-up for all patients, 46 or 60.5% failed. Ninety-five percent of these failures occurred within 3 years; only two patients relapsed after more than 5 years.

Pre-treatment prognostic factors in stage III non-small cell lung cancer patients receiving combined modality treatment

Approximately one-third of non-small cell lung cancer (NSCLC) patients present with locally advanced disease. Increasing numbers of clinical trials are being conducted in this group of patients and recently a new international staging system has been introduced, resulting in the sub-division of Stage III into IIIa (potentially operable disease) and IIIb (inoperable disease). Kaplan-Meier survival analyses and Cox regression analyses were used to analyze data from 129 Stage III NSCLC patients who had been treated on two consecutive Phase II trials testing combined modality treatment. The pretreatment characteristics of these patients were: median age--59 years, males/females--87/42, caucasian/non-caucasian--111/18, squamous cell or adenocarcinoma/large cell carcinoma--57/72, previous weight loss less than or equal to 5%/greater than 5%-76/46, previous history of cardiorespiratory disease--no/yes--91/36, performance status (PS) 0-1/2-3--102/27, Stage III, 2 groups--IIIa/IIIb--83/46, Stage III, 3 groups--IIIa T3 N0/IIIa N2/IIIb--41/41/47, surgical eligibility--eligible/ineligible--83/46. Kaplan-Meier statistics revealed significantly longer survival for PS 0-1 versus 2-3 (p = .001), for eligible versus ineligible for surgery (p = .003), for Stage-IIIa versus IIIb (p = .004), and for Stage-IIIa T3N0 versus IIIa N2 versus IIIb (p = .004). The best model developed from Cox regression analyses included stage (IIIa T3 N0 vs IIIa N2 vs IIIb), PS, and sex. These observations appear to have implications for clinical research in Stage III NSCLC.

Stage I and II non-hodgkin's lymphomas: Long-term results of radiation therapy

One hundred and sixteen patients with Stages I and II non-Hodgkins lymphomas were treated with curative radiotherapy between 1964 and 1977. The initial biopsy material was classified according to the criteria of Rappaport et al. All the patients except six were followed for a minimum of 8 years or until death with ninety-two patients having been followed for 10 or more years. Histological pattern was found to be an important prognostic factor with better survival in patients with nodular histology. There were forty-three patients with an initial involvement of an extra-nodal site forming 37% of the total group. Stage I extra-nodal lymphomas had a survival and recurrence-free survival rates of 80% and 74% respectively, similar to those of nodal lymphomas. Stage II patients in both groups did worse than those with Stage I. Survival rates and disease-free survival rates for different histologic types and their pattern of recurrence are presented.

Malignant metastatic disease of the eye: management of an uncommon complication.

Twenty‐four patients with metastatic cancer of the choroid were seen in the Department of Therapeutic Radiology, Rush‐Presbyterian–St. Lukes Medical Center, Chicago, between 1964 and 1975. One fourth of the patients had involvement in both eyes, for a total of 30 eyes involved with metastatic cancer. The most common site of the primary carcinoma was the breast. Most of the patients had inadequate vision, proptosis, pain, heaviness, and double vision. Retinal detachment was a common finding. All the patients received a palliative course of radiotherapy to the posterior chamber of the eye; between 2100–3000 rad in 7/10 fractions were given. Of the patients, 33% had complete recovery of symptoms, and 37% had only partial recovery; 30% showed no response to therapy. Survival period from the time of radiotherapy to death varied from one to 21 months, with a median of four months and a mean of 6.6 months. All patients responding to therapy showed marked improvement in their quality of life until death.

Pattern of Recurrences in Endometrial Carcinoma and Their Management

During the period 1961-1971, 177 surgical candidates with clinical Stage I adenocarcinoma of the endometrium were treated. The pattern of recurrence according to the initial mode of treatment and the high risk factors predisposing to recurrence are presented. The incidence of vaginal vault recurrence was reduced from 7.4% with surgery to 1.2% by the use of adjunctive radiotherapy. Management of recurrence according to site is outlined. The local control rate for patients with local recurrence was 44% and the five-year survival rate after recurrence was 33%.