Virendra S. Saxena

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.

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.

Results of radiotherapeutic management of primary carcinoma of the vagina

Forty-five previously untreated patients with primary carcinoma of the vagina were treated with curative radiotherapy from 1965 through 1985. All patients were staged according to the FIGO system. One patient was classified as Stage 0, 15 as Stage I, 22 as Stage II, 6 as Stage III, and 1 as Stage IV. Treatment consisted of intracavitary irradiation alone in Stage 0 patients. Stage I patients received intracavitary/interstitial irradiation alone or in combination with external irradiation and an implant when feasible. When treated with an implant only, the total tumor dose delivered was between 65-70 Gy. External irradiation consisted of delivering a dose of 45-50 Gy over a period of 4 1/2-5 weeks to the whole pelvis to treat the regional lymph nodes. An additional dose of 20-25 Gy was delivered to the site of original involvement using an implant when feasible. If not technically feasible, as in advanced stages, the patient was treated with additional external irradiation to a total dose of 65-70 Gy by a shrinking field technique. All patients except one were followed either until death or for a minimum of 2 years. The actuarial 5-year survival rates were 100% for Stage 0, 78% for Stage I, and 71% for Stage II patients. None of the patients with Stage III or IV disease survived. Of the patients who recurred, all but two did so within 16 months after diagnosis. Pelvic recurrence as the first site of recurrence occurred in 86% of the patients who recurred. Distant recurrence as a component occurred in 20% of all failures. Complications as a consequence of therapy occurred in 18% of the patients. Vaginal necrosis that healed with conservative treatment was seen in four patients and the other four patients had rectal complications of varying severity. Thus, curative radiotherapy is an effective method of treatment, with acceptable morbidity, in patients with early stage primary carcinoma of the vagina.

Cancer of the tongue: Local control of the primary

The purpose of this study was to evaluate the effectiveness of radiotherapy in local control of primary cancer of the tongue. A determinate group of 440 patients with this cancer treated from 1945‐1959 at one institute were studied. It was found that radiotherapy controlled the local disease in 55.4, 50.0, 35.5, and 20.4 percent of the patients initially, but subsequent and further management by surgey and/or radiotherapy brought this local control rate up to 71.8, 82.0, 46.9, and 25.0 percent in T1, T2, T3, and T4 cancers of the tongue. The fate of all the patients whether alive, alive with recurrence, dead, or dead with or without disease at the end of 1, 3, 5, and 10 years is given in detail. No attempt is made to present authors opinions based upon this study.

Cancer of the tongue: A study of the regional lymph node spread

The purpose of this study was to collect and report data on different ways of management of the regional neck lymph node metastasis from cancer of the tongue and to evaluate their effectiveness in controlling disease in this region locally. The incidence of lymph node metastasis, its staging, and its relationship with the primary tumor are also discussed briefly. A determinate group of 440 patients with cancer of the tongue treated from 1945–1959 at one institute was studied. A total of 287 patients were found to have regional cervical lymph node metastasis either on first admission or during subsequent follow‐up of these patients. The incidence of clinically positive cervical lymph nodes rose from 8.2% in T1 lesions in the primary site to 29.0% in T3 and 58.0% in T4 lesions. Block dissection of the neck was done mostly in patients who developed neck lymph nodes at subsequent follow‐up or in patients with N1 disease. This method of management of lymph nodes resulted in local control rate of 20.5 and 24.0% in N0 stage and 28.5 and 26.0% in N1 stage at the end of 5‐ and 10‐year periods, respectively. Radiation only was used mostly in patients who had more advanced disease, i.e., N2 and N3 stages, or in earlier stage if the patient could not be operated on due to a variety of reasons. Results of radiation in this group are poor, but a handful of patients survived with no evidence of disease up to 5 and 10 years. It should be realized, however, that a significant number of these patients receiving irradiation were treated during an era of orthovoltage radiotherapy; most of these patients were poor risks, which might account for poor results of irradiation to regional lymph node metastasis from cancer of the tongue.

Influence of pre-treatment staging procedures on the results of treatment in stage I and II non-Hodgkin's lymphoma

More recently, patients with non-Hodgkins lymphoma have been more extensively staged with a lymphangiogram and bone marrow examination. This was not done on all the patients treated in earlier years. Of 116 patients with Stages I and II non-Hodgkins lymphoma treated for cure with radiation during the years 1964-1977, there were 54 patients who had both a lymphangiogram and a bone marrow examination performed. Twenty-seven patients had neither test performed. The remaining patients had only one of the two tests performed.