William L. Caldwell

The relationship of time-dose fractionation factors to complications in the treatment of pituitary tumors by irradiation☆

Abstract The records of the Radiotherapy Division of the Radiology Department of Vanderbilt University Hospital were reviewed for the years 1952-71. During that period of time, 122 patients with diagnosis of pituitary adenomas were treated by external irradiation. A variety of techniques (2 or 3 stationary fields, 180° rotational fields), equipment ( 60 Co, 6 MeV Linac) and fractionation schedules (treating 4, 5 or 6 days per week, doses ranging between 150 and 280 rad per fraction), were used. Five patients developed severe complications: 1 with brain necrosis and 4 with blindness related radiation damage to optic pathways. From analysis of time-dose factors (TDF), it is evident that the risk of complications increases from 0% to 25% as the dose exceeds a TDF of 80. Although a significant increase in success rate has resulted from doses in excess of 3500 rad, there is little support for believing that doses in excess of 5000 rad (TDF 80) achieve improved results.

Adenocarcinoma of the esophagus

The relevant literature is reviewed in an attempt to clarify the true frequency of intraesophageal adenocarcinoma and to evaluate the different treatment modalities and survival of this uncommon type of tumor. The incidence of intraesophageal adenocarcinoma in reported clinical series is about 1%, and data from cancer registries show the incidence to be about 2% for upper and the middle thirds, a more reliable figure than that for the lower third in which lesions of cardia, or stomach infiltrating the lower esophagus have been included. The benefits of any particular treatment modality are difficult to evaluate in view of the rarity of this type of tumor, and the treatment results are as poor as those obtained in the treatment of squamous cell carcinoma.

Autopsy Findings in Carcinoma of the Esophagus

At autopsy of 82 cases of carcinoma of the esophagus over a period of 25 years metastatic tumor was found in 42 cases (51%) and residual tumor in the esophagus in 56 cases (86%). The most frequent site of metastases was in the lymph nodes, followed by liver, lung, and adrenal gland. Direct extension of the tumor to adjacent structures was established in 30 cases (36%), and the most frequent structure involved was the trachea. Five cases had a second primary and two cases a second separate lesion at another level of the esophagus.

RELATIONSHIP OF TIME DOSE FACTORS TO TUMOR CONTROL AND COMPLICATIONS IN THE TREATMENT OF CUSHING'S DISEASE BY IRRADIATION?

Abstract The records of the Radiotherapy Division of the Radiology Department of Vanderbilt University Hospital were reviewed for the period 1952–1970. During those 19 years 45 patients with a well-documented diagnosis of Cushings disease were treated initially by external irradiation of the pituitary. All of the patients were treated with megavoltage equipment using photons. When the results of irradiation are compared against total doses of radiation, it is evident that the control rate is unsatisfactory at doses less than 4000 rad and the maximum benefits of irradiation are evident in the 4500–5000 rad dose range. It is also clear that the complication rate increases as the dose exceeds 4800 rad. If the various treatment regimens of irradiation are converted to “equivalent” doses by the Nominal Standard Dose (NSD) or Time-Dose-Fractionation (TDF) methods, the relationship between “dose” and efficacy of therapy and complications is demonstrated. In order to reduce the possibility of treatment-related morbidity, the use of three or more small (4 × 4 cm) treatment portals or rotational techniques is recommended to a pituitary dose of 4600–5000 rad treating 5 days a week for 5–6 weeks.

Metastasis to Neck from Unknown Primary Tumor

The records of 54 consecutive patients who were irradiated for metastatic disease in the neck from an unknown primary tumor were reviewed. The overall survival results are comparable to those of other reported series. Patients with high or posterior cervical lymph node involvement were irradiated with fields including the nasopharynx and oropharynx. Patients with high neck nodes had a better survival rate than those with low neck nodes. The size of the neck tumors and the local control after treatment also have prognostic significance.

Low-dose radiation pneumonitis

A case demonstrating fulminant radiation pneumonitis following a course of prophylactic whole lung irradiation at doses below 2000 rads, resulting in death, is presented. The importance of predisposing factors and the suspected “sensitizing” factor in this case are discussed.

Age as a prognostic indicator in carcinoma of the lung.

Selected elderly patients with squamous cell carcinoma localized to the lung should be considered for radical irradiation. Age should not be used as a negative prognostic indicator. This group of patients has a lower incidence of distant metastasis and local control may produce long-term survival. Radical irradiation is well tolerated, particularly as a split course, and serious complications are few.

Testicular Seminoma: A Case Report of 2 Brothers with Seminoma and a Review of the Literature of Testicular Malignancies Occurring in Closely Related Family Members

AbstractTesticular malignancies in closely related family members rarely occur. This report describes 2 young adult brothers who had left testicular seminoma. Only 15 instances of testicular malignancies in closely related family members have been described previously.

The Effect of Prednisolone on Fatal Postirradiation Nephritis in Rabbits

Abstract Small doses of prednisolone were given to rabbits during and after a three-week course of bilateral renal irradiation. Survival at six weeks and nine months postirradiation was adversely affected by prednisolone. The clinical significance of these data is uncertain, but similar investigations in primates would appear to be indicated.

Time-dose-volume relationships in the treatment of glioblastoma multiforme.

Seventy-four patients with glioblastoma multiforme were treated with radiotherapy; all but 5 also underwent prior craniotomy. The authors found that split-course treatments produced less favorable results than conventional fractionation, particularly when high doses were employed. Short-term survival was not improved by this approach. Total doses of 1,400-1,700 rets yielded the best survival rate.