Satoru Matsumoto

Brachytherapy for stage I & II oral tongue cancer: An analysis of past cases focusing on control and complications

An analysis of the therapy used for 370 tongue cancer patients has been made, said patients having been treated by interstitial irradiation alone or by combined external irradiation and brachytherapy (Stage I:90 cases, IIa: 196 cases; and IIb: 84 cases). The neck was followed by close follow-up (304 cases), treated by elective neck irradiation (56 cases), or underwent operation at the time of local recurrence (10 cases). The results have shown that the 5-year survivals for Stages I, IIa, and IIb were 84%, 78%, and 72%, respectively. further, the 5-year primary control was 85% for tumors of the superficial type, 79% for tumors of the exophytic type, and 45% for tumors of the infiltrative type (p < 0.004). In non-electively irradiated patients, a neck metastasis occurred in 31% in Stage I, 41% in Stage IIa, and 51% in Stage IIb. Finally, 110 patients incurred radiation-induced complications (110/291 = 38%) and 11 patients (11/291 = 4%) required a surgical procedure. Brachytherapy for tongue cancer achieved results that are comparable with surgery. The analysis also revealed that the introduction of computer dosimetry and the use of a spacer (a dental guard) in brachytherapy have achieved superior results in the management of a tongue cancer.

The efficacy of radiation therapy for a malignant melanoma in the mucosa of the upper jaw: an analytic study

An analysis has been made of the effect of radiation therapy in 28 patients with a malignant melanoma (Stage I: 18 cases; Stage II: 10 cases) in the mucosa of the upper jaw. Treatment had been provided by one of the following methods: intraoral mold (10 cases), interstitial brachytherapy (two cases), intraoral electron therapy (nine cases), or external irradiation (seven cases). The results have shown that the survival rate for all 28 patients was 25%, and that the survival rate for stage I patients treated by intraoral electron or brachytherapy was 47%. The primary tumor control rate in percentages was 79% (22/28) in all 28 radiotherapy patients; 92% (11/12) for tumors treated by a mold or an interstitial implant; 67% (6/9) for tumors treated by an intraoral cone; and 71% (5/7) for tumors treated by external irradiation with or without surgery. A neck metastasis that was found in 19 patients was treated by surgery, radiotherapy, and/or immunochemotherapy, and the result was successful in nine patients. The major factor in the failure of treatment was a distant, metastatic dissemination. This analysis revealed that radiotherapy has achieved similar or better results than surgery and may be advocated for the management of a localized malignant melanoma in the mucosa of the upper jaw.

Usefulness of 198Au grain implants in the treatment of oral and oropharyngeal cancer

A series of 177 patients with squamous cell carcinoma of the oral cavity and oropharynx were treated with 198Au grain (gold grain) implants. Sites of the lesion included the tongue, mouth floor, buccal mucosa and oropharynx, especially the soft palate and faucial arch. Three-fourths of the patients were treated in combination with prior external beam irradiation. A permanent implant dose (total decay) of 80-90 Gy was given in the form of gold grains alone and in combination with an external dose of no more than 30 Gy, and 60-70 Gy, total decay, was given after an external dose greater than 30 Gy. The 2-year recurrence-free rate was 86.2% in the case of T1N0, 72.6% in T2N0 and 72.2% in T3N0. The difference in the results of implant therapy alone and combined therapy was not significant. Late complications were minimal after grain implantation alone, and when used in combination, less than 70 mCi of grain activity after a 40 Gy external dose did not seem to be a serious hazard with respect to bone damage except in the case of cancer of the mouth floor. Gold grain implants were useful and easily applied under local anesthesia to early or superficial lesions at sites where a rigid linear source could not be used. Exposure of the radiology staff was only 5-10 mrad in the case of the usual 10-15 (50-75 mCi) implant grains.

T1 and T2 squamous cell carcinomas of the floor of the mouth: Results of brachytherapy mainly using 198Au grains

PURPOSE To investigate the effectiveness of brachytherapy provided by this institution over a 25-year period, and to specifically verify the efficacy of 198Au grain therapy, this study evaluated the outcomes in patients given brachytherapy for T1 and T2 squamous cell carcinoma (SCCs) of the floor of the mouth. METHODS AND MATERIALS A retrospective analysis of data from 90 patients with T1 and T2 SCCs of the floor of the mouth who underwent brachytherapy between 1965 and 1989. Therapy mainly consisted of 198Au grain implants with or without external irradiation. As for the brachytherapeutic source, 15 patients were treated with radon seeds, 60 with 198Au grains, 10 with radium needles, 3 with cobalt needles, and 2 with iridium hairpins. Based on the 1987 International Union Against Cancer (UICC) classification, the SCC stagings and number of cases per staging follow: Stage I (T1N0), 21 cases; Stage II (T2N0), 55 cases; and Stage III-IV (T1-2N1-2), 14 cases. The minimum follow-up time was 3 years. RESULTS The local control rates of these SCCs, based on tumor size, were 89% for T1 lesions, 76% for T2a (< or = 3 cm) lesions, and 56% for T2b (> 3 cm) lesions, and 82% for T1-2 lesions without a gingival involvement, in contrast to 55% for lesions with a gingival involvement (p < 0.05). The 5-year, cause-specific survival rates by staging were 95% for T1N0, 79% for T2N0, and 54% for T1-2N1-2. For patients given 198Au grain brachytherapy, local control was achieved in 93% of the T1 lesions, 79% of the T2a lesions, and in 56% of the T2b lesions. Further, the incidence of severe complications requiring surgery was low (5%). CONCLUSIONS For T1N0 and T2aN0 SCCs of the floor of the mouth, excluding lesions with a gingival involvement, 198Au grain brachytherapy alone or in combination with external radiotherapy was found to be efficacious.

Comparison of CT Findings in Non-Hodgkin Lymphoma and Squamous Cell Carcinoma of the Maxillary Sinus

The findings at CT in 11 patients with primary non-Hodgkin lymphoma (NHL) of the maxillary sinus were compared with the CT findings in 21 patients with squamous cell carcinoma (SCC) of the maxillary sinus. In NHL, the segmental bone destruction was in alignment with the bony wall with a massive tumor infiltration into the neighboring structures. In contrast, all patients with SCC were characterized by a soft tissue mass with aggressive bone destruction. About half of the patients with NHL had cervical lymphadenopathy. Post-treatment recalcification of previous bone destruction was seen in 4 out of 5 NHL patients on follow-up CT. In the patients with SCC, only a few had metastatic lymphadenopathy, and no recalcification occurred after treatment. CT is therefore of importance in differentiating NHL from SCC of the maxillary sinus.

Brachytherapy for non-metastatic squamous cell carcinoma of the buccal mucosa : an analysis of forty-five cases treated with permanent implants

An analysis has been undertaken of 45 patients with non-metastatic squamous cell carcinoma of the buccal mucosa treated by permanent 198Au or 222Rn implants and in most cases supplementary external irradiation. Eight patients had T1, 30 had T2, and 7 T3 disease. Of the lesions 21 were located in the buccal mucosal surface, 14 in the retromolar region, and 10 in the bucco-alveolar sulci. Seven of the 45 (16%) died of the disease and the actuarial 5-year survival rate was 81%. No obvious differences were noted in survival rate between different stages of the disease or between different subsites of the primary lesion. There were 6 local recurrences occurring from 3 to 33 months after treatment, and only one of these was salvageable by further radiation therapy. Neck node metastasis occurred in 11 cases from 2 to 34 months after treatment, and 8 of these cases responded successfully to a radical neck dissection or radiotherapy.

Squamous Cell Carcinoma of the Maxillary Sinus and the Oral Part of the Upper Jaw: Comparison of treatment results

The treatment results were compared in 77 patients with maxillary sinus squamous cell carcinoma (MC) and 53 patients with squamous cell carcinoma arising from the oral part of the upper jaw (OC). Both sets of patients received radiotherapy alone, or radiotherapy combined with surgery and/or chemotherapy. Computerized tomography was useful for the definition of the treatment volume. Intraarterial chemotherapy was given in 89 of 130 patients and in these patients the total radiation dose was reduced by about 10 Gy. No difference was found in the 5-year survival rate between the MC (65%) and the OC (66%) groups. The cumulative incidence of local failure was higher in MC (36%) than in OC (26%), whereas the ultimate incidence of neck node metastasis was higher in OC (43%) than in MC patients (18%). Half of the inoperable patients (9/18) were older than 80 years and had contraindications to anaesthesia and major surgery. The local recurrence rate was high in the inoperable MC patients (6/8). Contralateral sinus cancers occurred in 4 patients in the MC group.

Scintigraphic Diagnosis of Rib Lesions in Patients with Lung Carcinoma

One hundred twenty-five patients with carcinoma of the lung received 171 pyrophosphate bone scans. Twentythree (18%) of these 125 patients had abnormal uptake only in the ribs. Of these 23 patients, 14 (61%) were diagnosed as having a benign lesion. Five showed direct invasion from the primary carcinoma and another four were diagnosed as having metastatic rib lesions. Benign rib lesions were also suspected in several patients with multiple metastases.