W.D. Rider

Radiation pneumonitis: experience following a large single dose of radiation.

Abstract The acute radiation pneumonitis syndrome of increasing cough with dyspnes and characteristic radiographic changes developed in 44 of 245 patients (17.5%) who were treated with a single large dose of radiation. The median onset was 100 days and proved fatal within 2 weeks in 84% of patients. Because these patients with advanced cancer had a median survival of 126 days, the incidence was calculated by the actuarial method. This was 83.5% and 29% for single uncorrected doses of 1000 and 800 rad: the two standard deviations were 20% and 14%. The risk increased with previous irradiation or intrathoracic tumor. Steroids had no obvious protective effect, but in three patients withdrawal of the drag apparently precipitated the syndrome. Vigorous supportive treatment with antibiotics and prednisone reversed the proem in three cases. Radiotolerance of the lung is the limiting factor in using radiation as a systematic treatment for cancer.

Whole abdominal radiation in the management of metastatic gastrointestinal carcinoid tumor

Abstract Twenty-eight patients with metastatic gastrointestinal carcinoid tumor were treated with whole abdominal radiation. Twenty-one of these patients had the carcinoid syndrome. The prescribed mid-line tumor dose was 2000 to 2500 rad. in 20 to 25 fractions in 4 to 5 weeks. The overall 5 year survival was 35% (median survival 2.5 years). A marked survival difference was noted in those patients with carcinoid syndrome compared to the non-functioning group. None of the syndrome patients survived five years (median survival 1.7 years) whereas six of the seven non-syndrome patients are five year survivors.

Postoperative local abdominal irradiation for cancer of the colon above the peritoneal reflection

A retrospective analysis of 82 patients with cancer of the colon above the peritoneal reflection who received postoperative local abdominal irradiation was undertaken to assess the survival, patterns of failure, and toxicity of treatment. Forty-eight patients (adjuvant group) had a complete resection, but were felt to be at high risk for local relapse and received postoperative local abdominal irradiation. Thirty-four patients had gross residual disease following surgery. The 5-year actuarial survival and local relapse free survival were 67 and 67%, respectively, in the adjuvant group. In this group, local relapse was observed in 9 of 28 patients with Stage C disease in contrast to 3 of 20 patients with Stage B2 disease; 1 of 14 patients with lesions in the right colon failed locally compared to 11 of 35 patients with lesions in the left. Only 2 of the 34 patients with gross residual disease remained relapse free from 93% of patients having a component of local failure. The majority of the treatment morbidity was seen in patients with gross residual disease. Prospective randomized studies should be done to determine the efficacy of postoperative irradiation in patients with colon carcinoma who are at high risk for local recurrence following surgical resection.

Ewing's Sarcoma Adjuvant total body irradiation, cyclophosphamide and vincristine

Abstract For patients with Ewings Sarcoma treated from 1960 to 1973, the 5-year survival and relapse free rates were: primary site irradiation without systemic treatment (16 patients) 25% and 12%: primary site irradiation with total body irradiation (13 patients) 38% and 23%. The 4-year survival and relapse free rates for 12 patients treated from 1970 to 1973 by primary site irradiation, total body irradiation and one year of elective Cyclophosphamide and Vincristine were 40% and 30%. These data provide further evidence that systemic therapy may be effective in eradicating occult metastases in a moderate proportion of patients with Ewings Sarcoma.

Ewing's sarcoma: a trial of adjuvant chemotherapy and sequential half-body irradiation

The results of a pilot study using adjuvant chemotherapy and sequential half-body irradiation (HBI) for nonmetastatic Ewings sarcoma are presented. Seventeen patients received Cyclophosphamide, Vincristine, and Adriamycin (8 cycles), followed by sequential radiation treatment of the upper (500 cGy) and lower (600 cGy) half body. Survival at 3 years was 49%. These results are contrasted with those for 18 concurrently treated patients who received standard adjuvant therapy. Overall 5-year survival and relapse-free survival for these 35 consecutive patients was 61 and 53%. The pilot protocol was given on an out-patient basis with limited and acceptable acute toxicology. Further study is necessary to determine the value of the pilot protocol.