Woon Sang Yu

Bladder carcinoma. Experience with radical and preoperative radiotherapy in 421 patients.

Four hundred twenty‐one patients with bladder carcinoma were treated with radical intent between 1968 and 1981: 356 were treated with irradiation alone with megavoltage tumor doses of 60‐66 Gy delivered over a period of 6 to 7 weeks. Actuarial 5‐ and 10‐year survival was 66% and 58% for Stage A (58 patients), 42% and 35% for Stage B1 (62 patients), 35% and 28% for Stage B2 (120 patients), and 23% and 19% for Stage C (75 patients), respectively. Five‐year survival after salvage cystectomy (47 patients) was 51% from the time of surgery, with 4 operative mortalities and a major complication rate of 30%. Sixty‐five patients were entered into an integrated preradical cystectomy irradiation program. Fifty‐three patients in stages B2–C–D1 received high‐dose preoperative radiotherapy (40‐50 Gy) before a planned, delayed radical cystectomy. The actuarial 5‐year survival was 66% for 65 patients, and 64% for the 53 patients in the high‐dose precystectomy program; major complications were encountered in 34% and there were 2 mortalities. Five‐year actuarial survival for Stage B2–C was 30% but fell to 24% when patients with salvage cystectomy were excluded. Distant metastasis was found in 30% of patients in Stage B2–C–D1, and also in the high‐dose precystectomy program patients. Two‐thirds of patients with distant metastasis in the radiation alone group were never considered for salvage cystectomy as they had distant metastasis alone, persistent disease with metastasis within 6 months after initiation of irradiation, or local recurrence and distant metastasis simultaneously. Early local recurrence may be salvaged in 50% to 60% of patients without a significant increase in mortality or major complications. Accordingly, a program of radical irradiation with salvage cystectomy may avoid loss of the bladder in 45% of patients in Stage B2–C–D1 without compromising overall survival.

Complications of High Dose Preoperative Irradiation for Advanced Laryngeal-Hypopharyngeal Cancer

The authors studied 162 patients with advanced cancer of the laryngopharynx who were treated over the same period of time by standard techniques. High dose preoperative supervoltage irradiation to 5000 rads/5 weeks through large opposed lateral fields and a lower anterior neck field is not accompanied by a prohibitive increase in mortality or morbidity for patients with stage III-IV largynogopharyngeal cancer. Rescue surgery for recurrence after definitive irradiation can be accomplished.

Irradiation of Primary Brain-Stem Tumors

Of 40 patients treated for brain-stem tumors, 20 had lesions of the thalamus and midbrain (group A) and 20 had lesions of the pons and medulla (group B). Performance status measured 1 month after irradiation improved in 16 of 20 group A and 11 of 20 group B patients and was a valuable prognostic factor. The survival rate at 5 years was 40% (8/20) in group A and 30% (6/20) in group B. All recurrences appeared within 3 years and were predominantly locoregional. Treatment factors, including dose and field size, are analyzed.

High Dose Preoperative Irradiation for Advanced Laryngeal-Hypopharyngeal Cancer

Combined therapy, consisting of 5000 rads delivered in five weeks followed by total laryngectomy ± radical neck dissection, was compared with treatment by irradiation (6000–7000 rads) with surgical salvage when clinically possible for radiation failure. Patients were categorized according to site of primary cancer (glottic, supraglottic and pyriform sinus) and staged (T, N, M). Survival was equally good in the two programs for glottic and supraglottic lesions, N0 or N1. The combined treatment program was judged superior for supraglottic and pyriform sinus lesions, N2 or N3.

High dose preoperative irradiation for advanced laryngeal—hypopharyngeal cancer

Combined therapy, consisting of 5000 rads delivered in five weeks by total laryngectomy +/- radical neck dissection, was compared with treatment by irradiation (6000-7000 rads) with surgical salvage when clinically possible for radiation failure. Patients were categorized according to site of primary cancer (glottic, supraglottic and pyriform sinus) and staged (T, N, M). Survival was equally good in the two programs for glottic and supraglottic lesions, N0 or N1. The combined treatment program was judged superior for supraglottic and pyriform sinus lesions, N2 or N3.