William T. Moss

High-dose reirradiation of head and neck cancer with curative intent.

Abstract Purpose : This study evaluates the responses of new or recurrent head and neck cancers and the response of associated normal tissues to high dose reirradiation with curative intent. Methods and Materials : From 1964 to 1991, 15 patients with in-field new second head and neck cancers and 85 patients with recurrent head and neck cancers have high-dose reirradiation that overlapped with previously irradiated volumes. Reirradiation was given only to patients with no more than apparent minimal clinical radiation effects from the first radiation course. The reirradiation consisted of external beam only in 82 patients, external beam plus intracavitary or interstitial implant irradiation in 14 patients, and interstitial implant irradiation only in four patients. The combined overlapping dose from both the initial and subsequent irradiation (including brachytherapy) was 69–89 Gy in 14 patients, 90–99 Gy in 15 patients, 100–119 Gy in 27 patients, and 120 Gy or greater in 44 patients. Four patients had areas of overlap that received greater than 180 Gy. Results : The actuarial 5-year survival was 37% for patients with new second primary cancers and17% for patients with recurrent cancers. Loco-regional tumor control was achieved in 67% of the patients with new tumors and in 27% of the patients with recurrent tumors. Nine of the 100 patients developed severe adverse normal tissue effects from the reirradiation. Conclusion : High-dose reirradiation of head and neck cancers can be successful curative treatment in a significant proportion of patients. It is associated with substantial but acceptable risks in properly selected patients.

SOME FACTORS ALTERING THE SEVERITY OF ACUTE RADIATION PNEUMONITIS: VARIATION WITH CORTISONE, HEPARIN, AND ANTIBIOTICS

Most of Us justifiably regard the lungs as relatively radioresistant. It is only when large ports are irradiated to moderately high doses that we begin to see clinical symptoms of radiation pneumonitis. Among the many known factors which influence the severity of such symptoms are the type and extent of superimposed infection, status of pulmonary function prior to this additional damage, and the general condition of the patient. Time-dose-volume factors are also important, but their relationships to radiation pneumonitis remain poorly defined, particularly in patients with pre-existing lung disease. Symptom-producing reactions will be kept to a minimum if field sizes are small and if doses are fractionated and kept as low as possible. A certain number of reactions, however, are unavoidable. Therapy of radiation-induced lung reactions has been directed toward the decrease of fibrosis with steroids and the control of superimposed infections with antibiotics. The effects of these agents have been difficult t...

Elective Irradiation of the Lower Cervical Region in Patients at High Risk for Recurrent Cancer at the Tracheal Stoma

The results of treatment for recurrent cancer at the tracheal stoma have been poor. From 1971 to 1976, elective postoperative irradiation of the neck was given to 26 high-risk patients with carcinoma of the larynx and hypopharynx. None of the 22 patients whose stomas were irradiated developed stomal or peristomal recurrence, while 2 of the 4 patients whose stomas were shielded had stomal recurrence. Elective irradiation of the tracheal stoma was effective in preventing stomal recurrence; we recommend inclusion of the stomal area in preoperative or postoperative irradiation to the lower cervical region for high-risk patients.

The Relationship between Oxygen Tension of Inhaled Gas and the Severity of Acute Radiation Pneumonitis

The relationship between oxygen tension of inhaled gas and t he severity of radiation response has been studied for many tissues. Within limits, an increase in oxygen tension of the gas has been shown to increase radiosensitivity of tissues while a decrease diminishes their radiosensitivity (2, 3, 4, 7). In a comparison of various tissues, the change in sensitivity has been found not to be of the same magnitude, though it has always been in the same direction. Prior to this investigation we had no reason to believe that lung parenchyma differed from other tissues which have been studied. In our previous work (5, 8) , it was found that total thoracic compliance was a good index of the severity of radiation-induced lung damage. The test is simple to per form and it provided the data for this study. The anatomical and microscopi changes in the lungs and adrenals will be the subject of a future publication. Methods Female Sprague-Dawley rats weighing 150 to 175 gm. were anesthetized with 4 mg. of sodium pento...

The Effect of Acute Anemia on the Radiosensitivity of V2 Rabbit Sarcoma

IONIZING irradiation has an important role today in cancer therapy, both as an adjunct to surgery and as a primary treatment. Methods of increasing the effectiveness of irradiation have been sought, and numerous studies have been carried out in an attempt to elucidate the factors which alter the radiosensitivity of tumor cells (1). The amount of oxygen available to tissues at the time of irradiation is recognized as an important factor in their radiosensitivity. The radiosensitizing effect of oxygen on normal tissue is well documented (3-5) (Fig. 1). The premise that anemia decreases tissue radiosensitivity has long been accepted by radiotherapists, and correction of the anemia has been recommended as a means of increasing the effectiveness of irradiation (7). This concept is based upon an assumed correlation between anemia and reduced tissue oxygen tension. The present study was undertaken to assess the effect of anemia on the radiosensitivity of animal tumor tissue. Material and Methods New Zealand whit...

Effect of Irradiation on Tumor-Infused Lymph Nodes

The lateral aspect of the left hind limb of 70 New Zealand white rabbits was irradiated under general anesthesia. The rabbits were divided into three groups: (a) control, (b) 1,000 rads, and (c) 3,000 rads. V2 cancer was infused into the afferent lymphatic of the popliteal lymph node of the animals. In controls the node acted as a barrier to tumor spread for up to three weeks. Ionizing irradiation significantly increased distant tumor growth in the animals.

Usefulness of the Brain Scan in Therapeutic Radiology

The accurate localization of intracranial neoplasms as well as a simple assessment of tumor response are essential to modern therapeutic radiology. Until recently the radiotherapist had no satisfactory diagnostic aid for exact portal placement in the treatment of single or multiple intracranial neoplasms, or for the re-treatment of recurrent or persistent brain tumors. Conventional as well as special roentgenographic studies are frequently inconclusive and do not permit exact tumor localization before treatment. The extent of a neoplasm may be equally difficult to ascertain at the time of craniotomy. The advent of brain scanning has aided considerably not only in the diagnosis but also, and perhaps more importantly, in the localization of intracranial neoplasia (1). The purpose of this communication is to report our experience with the brain scan in the planning and follow-up of cranial radiotherapy. Clinical Material Seventy patients given radiotherapy for proved intracranial neoplasms had scans performe...

High dose reirradiation of head and neck cancer

PURPOSE This study evaluates the response of new or recurrent head and neck cancers and the response of associated normal tissues to high dose reirradiation with curative intent. METHODS AND MATERIALS From 1964 to 1991, 15 patients with in-field new second head and neck cancers and 85 patients with recurrent head and neck cancers have had high-dose reirradiation that overlapped with previously irradiated volumes. Reirradiation was given only to patients with no more than apparent minimal clinical radiation effects from the first radiation course. The reirradiation consisted of external beam only in 82 patients, external beam plus intracavitary or interstitial implant irradiation in 14 patients, and interstitial implant irradiation only in four patients. The combined overlapping dose from both the initial and subsequent irradiation (including brachytherapy) was 69-89 Gy in 14 patients, 90-99 Gy in 15 patients, 100-119 Gy in 27 patients, and 120 Gy or greater in 44 patients. Four patients had areas of overlap that received greater than 180 Gy. RESULTS The actuarial 5-year survival was 37% for patients with new second primary cancers and 17% for patients with recurrent cancers. Loco-regional tumor control was achieved in 60% of the patients with new tumors and in 27% of the patients with recurrent tumors. Nine of the 100 patients developed severe adverse normal tissue effects from the reirradiation. CONCLUSION High-dose reirradiation of head and neck cancers can be successful curative treatment in a significant proportion of patients. It is associated with substantial but acceptable risks in properly selected patients.

Cauda Equina Syndrome Secondary to Lymphoma

One year ago, this 59-year-old woman developed rapidly progressive leg weakness. An exploratory laparotomy and biopsy of a large retroperitoneal mass demonstrated a diffuse large cell lymphoma. A partial response with cyclophosphamide, Adriamycin (doxorubicin), Oncovin (vincristine)-bleomycin (CHOP-BLEO) and subsequent delivery of 3600 cGy to the whole abdomen still did not make the mass disappear on computed tomography (CT), so Cytoxan and prednisone were added. The mass began to grow and this was accompanied by nausea, vomiting, neutropenia, fever, and leg weakness.

A Plea for Increased Use of Clinical Staging in the Cancer Patient

The success of clinical staging for end-result reporting requires general acceptance of the criteria comprising each clinical stage and its widespread application. It is highly desirable that a common classification be included in all clinical reviews, and a plea is made that each radiation therapy department reassess its pretreatment clinical staging procedures and systematically record the data in order that future clinical studies will be of maximum value.