Timothy L. Thar

Hodgkin's disease, stages I and II. Relationship of recurrence to size of disease, radiation dose, and number of sites involved

A total of 57 patients with Hodgkins disease limited to above the diaphragm (Stages I and II, A and B) were treated with radiation therapy alone at the University of Florida between 1964 and 1974. Staging laparotomy was done on 24 patients (42%). A total of 16 patients have relapsed, 4 within the treatment fields, 3 marginally, and 9 as extensions. Analysis of dose vs. size showed no in‐field failure with disease less than 6 cm in size, with a range of doses. Massive disease continued to recur occasionally, even with higher doses. Most of the massive disease was mediastinal or hilar; the risk of lung or pleural involvement as determined by x‐ray and/or biopsy showed a dramatic increase with size of mediastinal/hilar disease. Only 2 (5%) of 43 patients with mediastinal disease less than 6 cm in size had lung or pleural involvement, compared with 10 (71%) of 14 patients with disease greater than 6 cm in size. Both in‐field recurrence and generalized relapse were closely related to the number of anatomical sites involved. Treatment programs need to consider tumor size, particularly in the mediastinum, and the number of sites involved. Cancer 43:1101–1105, 1979.

Primary lymphoma of the central nervous system. Computerized tomography scan characteristics and treatment results for 12 cases

A retrospective analysis of 12 patients with primary central nervous system non‐Hodgkins lymphoma seen from 1958 to 1980 was carried out with emphasis on diagnostic evaluation and treatment results. Computerized tomography (CT) scans were found to be the most valuable diagnostic tool both for initial evaluation as well as follow‐up. Characteristic CT scan features were identified and are discussed. Three patients had a history of previous immunosuppression; two had preceding and concurrent uveitis. Nine of the 12 patients were treated primarily with radiation therapy. Three patients were diagnosed at autopsy and had not received definitive therapy. Size of lesion proved to be the most important prognostic factor and appeared to be related to location. Gross total excision of tumor did not appear to improve survival. Two patients were alive with no evidence of disease at 38 and 48 months, respectively. Recurrences were noted from 1 to 33 months after diagnosis (median, 14 months), suggesting the advisability of long‐term follow‐up prior to presumption of cure. From these results and a review of the literature, possible treatment approaches are presented. Cancer 52:1993‐2000, 1983.

Prognostic and treatment factors affecting pelvic control of Stage IB and IIA-B carcinoma of the intact uterine cervix treated with radiation therapy alone.

This is a retrospective analysis of 264 patients with Stage IB and IIA‐B carcinoma of the cervix treated with curative intent at the University of Florida from October 1964 through April 1980. There is a minimum 2‐year follow‐up. Patients dead of distant metastases (13), dead from intercurrent disease (14), or lost to follow‐up (1) less than 24 months from treatment with pelvic disease controlled were excluded from analysis of pelvic control. All patients were included in analysis of complications and survival. Tumor size and hematocrit were noted to be significant prognostic factors with regard to control of disease in the pelvis in Stage IB and IIA cancers. Tumor size and hematocrit also influenced pelvic control in Stage IIB, but to a lesser extent than in Stages IB and IIA. Patient age was a weak prognostic factor for control of disease in the pelvis for Stages IB, IIA, and IIB, but more strongly influenced pelvic control when considered in conjunction with tumor size and hematocrit. Overall treatment time influenced pelvic control in all cases when the size of the lesion was ≧6 cm. in lesions ≧6 cm in diameter, the amount of tumor regression noted at the time of the radium application after 3500 to 4000 rad external beam irradiation was a predictor of pelvic control. Data on treatment complications and survival are included, and future treatment strategies discussed.

The prognostic significance of soft tissue extension in Ewing's sarcoma

From January 1969 through December 1977, 28 patients were treated at the University of Florida with the diagnosis of Ewings sarcoma. All patients received radiation therapy to the primary site and adjuvant chemotherapy according to several different regimens. A retrospective analysis was carried out to determine the prognostic significance of gross extraosseous extension by the primary lesion. Gross soft tissue extension at the primary site was found to be of prognostic importance. Patients with soft tissue extension more often presented with metastatic disease (39 versus 10%). The five‐year survival rate for patients presenting without distant metastasis and whose primary lesions were grossly confined to bone was 87% compared to 20% for those with extraosseous extension. The decrease in survival with soft tissue extension resulted from an increase in distant metastasis as well as local failure, and was independent of primary site location. The proportion of patients with extraosseous extension should be reported in subsequent analyses of local control and survival.

AN EVALUATION OF SPLIT-COURSE IRRADIATION FOR PELVIC MALIGNANCIES

Abstract Therapeutic results of split-course vs continuous-course whole pelvis irradiation were analyzed in 235 consecutive patients with carcinoma of the uterine cervix, prostate, or urinary bladder. Eighty-six patients with carcinoma of the cervix were assigned randomly to receive either split or continuous treatment; 65 patients with prostate cancer and 84 patients with bladder cancer were not randomized. Except for a planned 14–16 day interruption after 2800–3000 rad in the split-course group, the techniques of irradiation did not differ. For each tumor site, local control for the 2 techniques was similar when total doses were the same. No significant differences in survival were noted. Paradoxically, in both the randomized and non-randomized groups, the occurrence of radiation-induced chronic gastrointestinal injury was more frequent in patients who were treated by the split-course technique.

Pediatric neuroblastoma: postoperative radiation therapy using less than 2000 rad.

There is considerable controversy regarding the role of radiation therapy in the treatment of neuroblastoma. Postoperative irradiation in the range of 2500-4000 rad is commonly used in the treatment of Evans Stage II or III disease, but there are no data in the literature to suggest the optimum dose of radiation that is necessary. Because much lower doses have been used at the University of Florida, a retrospective study was undertaken in an attempt to determine the optimum dose necessary in conjunction with surgery. From March 1964 through July 1979, 21 children with Stage II or III neuroblastoma were seen at the University of Florida. One patient died postoperatively. The remainder received postoperative irradiation with doses ranging from 900 to 4500 rad. The lower dose of radiation used did not adversely influence survival, particularly for patients less than two years of age at diagnosis. In this group, no patient had a local recurrence or died of disease, even though nine of 15 available patients received doses of 900-1500 rad.

Total body irradiation in non-Hodgkin's lymphoma

Abstract Between October 1972 and August 1977, low-dose fractionated total body irradiation (TBI), 150–300 rad, was selected for 48 patients with previously untreated non-Hodgkins lymphoma staged II, III and IV. In 63% of the patients the disease had a nodular pattern; there were no patients with diffuse histiocytic lymphoma. All but 2 patients responded to TBI. The 4-year actuarial survival was 71% for the nodular group and 57% for the diffuse group. There were no acute symptoms during the course of treatment and no mortality associated with the treatment. Seventeen per cent of the patients developed transient platelet counts less than 30,000/mm 3 . Four required hospitalization for correction of thrombocytopenia and/or infection. The majority of patients who failed more than 3 months after initial complete remission were placed back in remission with either chemotherapy, TBI, or local irradiation. Patients with persistent disease after TBI showed a less favorable response with chemotherapy. A selected group of 15 patients in relapse after chemotherapy or localized radiotherapy were treated with TBI. Eleven responded to treatment, while 4 showed no useful response. The median survival for this group was slightly over 2 years. Twenty per cent developed transient platelet counts less than 30,000/mm 3 .