Willis J. Taylor

Adjuvant Radiotherapy Following Radical Prostatectomy: Results and Complications

Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year followup. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not. The groups were comparable with regard to significant prognostic variables. Patient selection was by surgeon preference. Local recurrences were seen in 1 of 22 patients (5 per cent) receiving adjuvant radiotherapy and 7 of 23 (30 per cent) undergoing an operation alone (p less than 0.05). Of 8 patients with local recurrence 7 died of the disease. Delayed radiotherapy of a local recurrence generally was not effective in controlling the disease. Of the 11 patients who died of prostatic cancer with a mean followup of 9.2 years 3 received adjuvant radiotherapy and 8 did not. Severe but nonfatal long-term complications were seen in 14 per cent of the irradiated patients and 6 per cent of those treated with an operation alone. Most of the complications occurred in the earlier years of the study in patients who received 60cobalt radiotherapy. When clinical stage B cancer of the prostate is found to be pathological stage C following radical perineal prostatectomy, adjuvant radiotherapy can decrease the incidence of subsequent local recurrence. The potential risk of adjuvant radiation therapy should be weighed and its use considered, particularly in patients whose tumor extends to the surgical margins or who have seminal vesicle invasion.

Carcinoma of the prostate: local control with external beam radiation therapy.

Local clinical control of the primary disease was evaluated in 209 patients with stage C adenocarcinoma of the prostate treated with definitive external beam radiation therapy and followed for a minimum of 2 years. Of these patients 92 per cent required no further prostatic operations for obstruction. Prostatectomy before therapy did not necessarily prevent later prostatic obstruction from occurring. Of 129 patients who had only a needle biopsy before irradiation 90 per cent had improvement of the obstructive and/or irritative symptoms as tumor regression occurred with therapy and these patients did not require a later prostatic operation for obstruction. Stricture formation occurred in 8 per cent of the patients and was not influenced by the type of preirradiation prostatic operation done. If transurethral resection was reuqired after irradiation it was technically more difficult but the morbidity was acceptable. The incidence of hematuria and incontinence was far less than that reported in non-irradiated patients with this disease. Most tumors exhibited a down-grading effect after irradiation. There were no deaths attributable to the treatment. Over-all, 83 per cent of the 209 patients had no urinary complaints after completion of therapy. From a urological viewpoint, good clinical local control is achieved in the patient with stage C adenocarcinoma of the prostate treated with external beam radiation therapy.

Radiation therapy for localized prostate cancer

Since 1965, 401 patients with prostate cancer have received intensive local pelvic radiation therapy at the Virginia Mason Medical Center. Two hundred seventy‐seven of these patients were treated from 1965 through 1975, comprising the study group. Two hundred twenty‐one of this series were in the Stage C category. The 36 Stage B cancers were either medically nonoperable, or advanced extent, or had high‐grade histopathology. Ten patients each were in diffuse Stage A or Stage D groups, the latter receiving local palliative intensive treatment to the prostate area. The mean age of the patients was 67.6 years. The five year survival of the Stage C group was 57.7%. There was no apparent influence on the survival of irradiated Stage C patients who received estrogen therapy. Current treatment techniques employ 10 megavolt photon beam with whole pelvic nodal fields and bilateral arc rotational boost fields. The incidence of reactions and complications is presented. Cancer 43:1123–1127, 1979.

The role of radiation therapy in the treatment of glomus jugulare tumors.

The records of 14 patients who received irradiation for incompletely excised, inoperable or recurrent glomus jugulare tumors were retrospectively reviewed. Ages ranged from 12 to 66 years, and the male to female ratio was 1:3. With a follow‐up time of 1.3 to 17.2 years (mean of 7.7 years), 11/14 remain clinically disease‐free. Doses of at least 4000 rad are shown to be effective in controlling glomus jugulare tumors.

Are pelvic irradiation and routine staging laparotomy necessary in clinically staged IA and IIA Hodgkin's disease?

Thirty‐nine patients with clinically staged IA and IIA Hodgkins disease were treated with mantle plus paraaortic/splenic irradiation between 1968 and 1975. All patients had supradiaphragmatic presentations, and none had staging laparotomies. With a follow‐up time of 1 to 9 years, mean 4.3 years, the overall relapse‐free survival is 92% (100% for stage IA and 89% for stage IIA). The absolute relapse‐free 5‐year survival is 91% There were no pelvic recurrences. These data show that routine staging laparotomy and pelvic irradiation are not indicated for clinically staged IA and IIA Hodgkins disease with supradiaphragmatic presentations. The criteria for staging laparotomy in early‐stage Hodgkins disease are discussed. Cancer 40:2914‐2916, 1977.

Carcinoma of the tonsillar region. Results of external irradiation

A retrospective analysis is made of 104 patients treated with photon megavoltage radiotherapy for squamous cell carcinoma of the tonsillar region during the period 1965–1975. Moderately differentiated squamous cell carcinoma was the most common histological grade. Fifty‐three per cent of the cases presented with cervical lymphadenopathy with three cases of bilateral involvement. The three year local control rate was 100% for Stage I, 74% Stage II, 49% Stage III, and 33% Stage IV. Two Stage III cases and one Stage IV case developed subsequent contralateral neck disease. No patient with either T1N0 or T2N0 tumor failed in the ipsilateral or contralateral neck despite the fact that 42% of the T1N0 cases and 37% of the T2N0 cases were treated with unilateral portals. The prognostic significance of the T and N stages, treatment techniques, as well as dose response relationships are analyzed and the literature is reviewed.

Observations On Definitive Cobalt 60 Radiation for Cure in Bladder Carcinoma: 15-year Followup

Radiation therapy will result in tumor disappearance in a select number of patients. However, it does not prevent local recurrence and, therefore, the patient continues at risk. Tumor recurrence was noted in more than half the patients in our series and more than 50 per cent of these patients experienced multiple recurrences. A functional bladder was maintained in nearly 60 per cent of the patients. Survival in 11 patients in category 1 with radiation therapy and subsequent non-ablative extirpative surgical procedures in 8 patients was equivalent to series treated by preoperative irradiation and cystectomy. In contrast the 14 patients in category 2 had a survival rate that was appreciably lower than that obtained with preoperative irradiation followed by cystectomy. There was a significantly increased morbidity associated with an open operation in the treatment of recurrence in the irradiated patient. We would advocate preoperative irradiation followed by cystectomy in the patients with high grade and high stage disease. The value of single versus adjuvant forms of therapy for patients with diffuse, rapidly recurring low grade and low stage disease would be determined best by a randomized prospective study. Evidence from this series suggests that irradiation improved over-all survival in this category.

Radiotherapy treatment planning using lymphoscintigraphy

A method for the three dimensional location of lymph nodes with respect to the skin surface is described. The technique is based on the reconstruction of surface shape using isocentric radiographs taken with metal chains draped on the patient. Registration of the radiographic study to the lymphoscintigraphic study is accomplished automatically by matching the location of four radiopaque and radioisotope markers. This method allows nodes to be located in a beams eye view with any set up of an isocentric radiotherapy machine. An accurate determination of the depth of lymph nodes is obtained, which is of value in electron beam therapy.

Practical 3-D radiotherapy planning of brain tumors

In postoperative radiotherapy of brain tumors it is usually the case that preoperative imaging studies, either CT or MRI, were performed outside of the purview of the radiation therapy department. Thus the target volume is defined in an imaging study that does not lend itself readily for entry to a 3-D treatment planning system. A method is described that adjusts the patient structure defined by scan data to an appropriate position for radiotherapy. Software tools that are simple to use have been incorporated in a 3-D treatment planning program that allows oblique treatment planes to be defined. The program provides beams-eye-view plots of the fields that are used to overlay simulation films and will automatically describe a field blocking outline that provides a prescribed margin on the target volume or other structures that have been defined. Finally, dose calculations in arbitrary planes through the head are made and isodose plots produced.

The role of radiation therapy in the treatment of glomus jugulare tumors

The records of 14 patients who received irradiation for incompletely excised, inoperable or recurrent glomus jugulare tumors were retrospectively reviewed. Ages ranged from 12 to 66 years, and the male to female ratio was 1:3. With a follow-up time of 1.3 to 17.2 years (mean of 7.7 years), 11/14 remain clinically disease-free. Doses of at least 4000 rad are shown to be effective in controlling glomus jugular tumors.