Treatment of hepatocellular carcinoma by transarterial injection of anticancer agents in iodized oil suspension or of radioactive iodized oil solution

Transarterial injection of modified iodized oil was performed in 48 patients with hepatoma. In 41 cases an adriamycin and/or mitomycin C-iodized oil suspension was administered into the proper hepatic artery or peripheral hepatic branches. A reduction in tumor size of over 50 per cent was obtained in 14 of the 33 patients in whom CT examination was performed before and after treatment. Serum alpha-fetoprotein levels decreased in 20 of 21 cases within the first month after injection. The one-year survival rate was estimated at 55 per cent in advanced hepatoma. In 7 patients, transarterial internal irradiation using radioactive iodized oil was carried out. A decrease in tumor size was observed in all cases and in alpha-fetoprotein levels in 6 cases. One patient with severe liver cirrhosis died in hepatorenal failure. No severe complications or other adverse reactions were encountered with either of the methods.     

Efficiency of postoperative radiation in carcinoma of the breast. A comparison between two methods.

The results of simple mastectomy and postoperative irradiation of the chest wall and the regional lymph nodes in a series of 256 patients with primary carcinoma of the breast (between 1970 and 1972) were compared with those in a series of 155 patients (from 1963 to 1965) treated with radical mastectomy and postoperative irradiation of the regional lymph nodes. A statistically significant difference (p less than 0.01) was found between the chest wall recurrences in the group of patients with irradiation of the chest wall and the group without. No evidence indicates that routine postoperative irradiation should be harmful. Distant metastases in the 1970--1972 group were less frequent (13%) than in the 1963--1965 group (29%)9 The age-corrected 4-year survival rates for stages I and II were 83 per cent for the 1970--1972 group and 78 for the 1963--1965 group. The age-corrected 10-year survival rates for states I and II were 60 per cent.     

Report on treatment of cancer of the ovary.

A malignant ovarian tumour has been diagnosed in 373 patients referred to the R.R.T.I. from January 1966 to Jun 1972. Serious ovarian carcinoma was the commonest type and occurred in 254 patients. The results in these patients are studied in detail after staging according to F.I.G.O. recommendations. Following surgery and postoperative radiotherapy, chemotherapy was started immediately in all patients with progressive disease and after randomization also in 50 per cent of the others. The three-year survival rate in Stage II patients tended to be more favourable following irridation ofthe pelvis and lumboaortic nodes (55 per cent ) than following radiotherapy restricted to the pelvic area (40 per cent). The dose should be 5-6 krad. The five-year survival was 68 per cent for Stage I, 26 per cent for Stage II and nearly zero for Stages III and IV, as well as for patients referred for treatment of a recurrence. In spite of whole-abdomen irradiation 50 per cent of the patients in the latter three groups were deceased within eight months; therefore chemotherapy should be preferred. The main problem in ovarian cancer is late diagnosis. Evaluation of results is difficult because numerous variable factors concerning pathology and treatment make it necessary to sub-divide the patients into groups too small for statistically reliable conclusions. Each treatment factor should be studied by a group of hospitals.     

Prognostic factors in pyriform sinus carcinoma

In the 48-month survival analysis of 76 evaluable pyriform sinus carcinoma cases, nodal stage and size played the most significant prognosis-affecting roles. N3 stage and node greater than 3 cm decreased the survival fourfold and threefold, respectively, at statistically significant levels. The difference between the 35 per cent preoperative radiation therapy and 3 per cent radical radiation therapy cumulative 48-mouth survivals was significant at p less than 0.01. Complication rates were 6 per cent with radical radiation, 35 per cent with preoperative radiation and 43 per cent with curative surgery.     

Malignant tumours of the nasopharynx.

A series of 115 patients with malignant tumours of the nasopharynx were primarily irradiated. All the cases of carcinoma were TNM classified in retrospect. 60Co irradiation appeared to afford a somewhat better prognosis than conventional irradiation previously used. The 5-year crude survival rate for the patients with lymphoma and with carcinoma was 40.0 per cent and 23.8 per cent respectively. A distinctly better prognosis was found for women than for men and the prognosis was independent of whether or not lymph node metastases were present. There seems to be no indication for maintaining lympho-epithelial carcinoma as a special group of tumour. Surgical procedures are rarely indicated in the treatment of malignant nasopharyngeal tumours.     

The management of soft tissue sarcomas in adults: surgery and postoperative radiotherapy.

Traditionally soft tissue sarcomas have been managed by surgery, because they were considered radioresistant. Experience has shown that the local recurrence rate after a simple excision is 90 per cent and 30 per cent after radical surgical procedures. The treatment of soft tissue sarcomas by radical ratiation therapy alone is also unrewarding-the local recurrence rate being 66 per cent. In order to preserve a functional limb, a selected group of patients was treated using a conservative surgical excision of the gross tumor (usually a simple "shelling out"), and immediate postoperative radiation therapy. The rationale for removing all gross tumor by conservative surgical excision is that the remaining subclinical disease can be destroyed with moderate doses of postoperative irradiation. In 70 patients with soft tissue sarcomas of the extremities, all local failures occurred in tumors of the fleshy parts with a recurrence rate of 17.2 per cent, independent of the histological type. In spite of generous radiation fields, 4 of the 12 local recurrences were outside of the irradiated volume, some more than 5 cm from the margin of the field. This documents the tendency of soft tissue sarcomas to spread along the fascial planes for a great distance. To avoid complications only part of the entire circumference of an extremity must be irradiated since a severe constricting fibrosis may result with varying degrees of edema distal to the irradiated volume when all of most of the circumference is irradiated. This retrospective review of patients treated for extremity lesions by conservative excision and postoperative radiotherapy shows that a functionnal limb can be preserved in 80 per cent of the patients.     

Results of radiation therapy of early carcinoma of the vocal cords.

A material of 91 early carcinomas of the vocal cord treated by radiation therapy were reviewed. The 5-year crude and determinate survival rates were 86 and 95 per cent, respectively. Primary irradiation only, resulted in a 5-year cure rate of 77 per cent. Of the 21 patients who developed local recurrences, 11 were cured by total, and one by partial laryngectomy. Eight patients developed other primary carcinomas.     

Medulloblastoma. Treatment results.

A series of 44 patients with medulloblastoma is presented. The treatment was primary operation followed by irradiation of the entire CNS. The 3-year and 5-year survival rates for children and adults together were 36 and 33 per cent, respectively, and for children alone 37 amd 33 per cent, respectively. No certain difference in the prognosis for boys and girls was found.     

Postoperative radiotherapy of supratentorial anaplastic glioma

Between 1970 and 1983, 149 patients with high grade anaplastic supratentorial gliomas received a postoperative irradiation during primary treatment. 118 out of these patients had an anaplastic astrocytoma, 18 an anaplastic oligodendroglioma, and 13 an anaplastic ependymoma. Most of these patients were treated by irradiation of a great volume with 50 Gy within five weeks, the others by irradiation of the total brain with 50 Gy within five weeks and saturation with 10 Gy within one week. The one-year survival of the total group was 35.5% and the two-year survival 10.6%. Patients at an age of less than 40 years show a significantly longer survival than older patients (one-year survival rates 40% and 30.7%, respectively). Patients suffering from anaplastic tumors with astrocytic and oligodendrocytic differentiation have a comparable prognosis. Patients suffering from anaplastic tumors with ependymal differentiation, however, have prolonged survival times. The therapy results of different treatment methods are discussed using the communications of literature.     

Needle puncture followed by pneumocystography of palpable breast cysts. A controlled clinical trial

In a prospective analysis of 123 consecutive patients the current clinical and mammographic criteria of a cyst of the breast proved well-suited as a basis of selection for pneumocystography. Only about 12 per cent of the punctured lumps were solid, 9.8 per cent of them benign and 2.4 per cent malignant. The therapeutic effect was satisfactory, 94 per cent of the cysts not showing any recurrence after pneumocystography during a 6-month follow-up period with repeated palpation and mammography one and 6 months after the aspiration. The 6 per cent recurrences appeared within one month. The appearance of the aerogram was reliable in differentiating between a simple cyst and an intracystic lesion, whereas neither the tendency to recurrence nor the cytologic examination afforded a reliable basis of evaluation.     

Effect of local irradiation on the acute rejection process in transplanted kidneys.

The graft in 178 renal transplant patients was irradiated in an effort to halt acute rejection phenomena. Of the patients, 61 per cent received their transplant from either a sibling, parent or child and 38 per cent received cadaveric kidneys. Of the irradiated kidneys 61 per cent were functioning at 6 months, 58 per cent at 12 months and 49 per cent at 18 months. The rational for irradiation of transplanted kidneys with acute rejection is discussed.     

Lymphography in carcinoma of the uterine cervix.

Lymphography was carried out in a series of 158 patients with carcinoma of the uterine cervix. The diagnostic accuracy rate of 85 per cent compares favourably with the results of a similar investigation made ten years ago. Positive lymphography does not alter the survival rate in clinical stages I and II, probably due to the more accurate and selective therapeutic approach induced by lymphography. In stage III the 2-year survival rate of patients with negative findings is 58 per cent compared to only 17 per cent in case of positive lymphographic findings.     

Bleomycin and radiotherapy in nonresectable thoracic oesophageal carcinoma

The survival rates of nonresectable thoracic oesophageal carcinoma patients were studied in 50 patients treated by radiotherapy and by a combination of radiotherapy and bleomycin. The patients of two series were very similar. The one-year survival rates were 21 and 10 per cent, in radiotherapy and in radiotherapy with bleomycin group, respectively. In the literature, there were only few reports from survival figures of patients with oesophageal carcinoma treated with bleomycin in combination with radiotherapy. The authors concluded that the combination of bleomycin and radiotherapy has very limited effect on advanced oesophageal carcinoma. The survival rate after this combination therapy is not better with radiotherapy alone, if bleomycin and radiotherapy are used with reduced doses and without severe complications.     

Radiation therapy of secondary nodal metastases in the neck and mediastinum after resection of esophageal carcinoma.

Eighty-two patients underwent curative resection for squamous cell carcinoma of the esophagus. The 5-year actuarial survival rate was 33 per cent. Sixteen of 34 patients who developed secondary nodal metastases of the neck and mediastinum were irradiated with a dose of 40 to 60 Gy over 4 to 6 weeks (81 in average TDF), which probably prolonged the survival.     

Carcinoma of the uterine cervix. Results of treatment in 2 248 cases

Data on the survival of 2 248 patients with cervical carcinoma, treated between1966 and 1972 at 3 oncologic centers in Cuba, are presented. Intracavitary radium application combined with external 60Co irradiation was the main treatment method. The most frequent complication was radiation proctitis, but fistulas occurred only in 1.6 per cent.     

Combined surgery and radiation therapy versus surgery alone in primary mammary carcinoma. I. The effect of orthovoltage radiation.

The effect of routine postoperative irradiation in the treatment of carcinoma of the breast has been evaluated. Postoperative irradiation had no effect on the proportion of patients free of disease nor on the survival rate, but the incidence of local recurrence and homolateral supraclavicular lymph node metastasis was reduced. In stage II patients homolateral axillary lymph node metastases were also encountered less frequently in the irradiated group. Distant metastases occurred either in stage II patients with postoperative irradiation as compared with controls.     

The Effect of 238Pu α-particles on the Mouse Fibroblast Cell Line C3H 10T1/2: Characterization of Source and RBE for Cell Survival

Summary

Considerable interest has been aroused in recent years by reports that the transforming and carcinogenic effectiveness of low doses of high LET radiations can be increased by reducing the dose rate, especially for transformation of 10T1/2 cells in vitro by fission-spectrum neutrons. We report on conditions which have been established for irradiation of 10T1/2 cells with high LET monoenergetic α-particles (energy of 3·2 MeV, LET of 124 keV μm^?1) from ²³⁸Pu. The α-particle irradiator allows convenient irradiation of multiple dishes of cells at selectable high or low dose rates and temperatures. The survival curves of irradiated cells showed that the mean lethal dose of α-particles was 0·6 Gy and corresponded to an RBE, at high dose rates, of 7·9 at 80 per cent survival and 4·6 at 5 per cent survival, relative to ⁶⁰Co γ-rays. The mean areas of the 10T1/2 nuclei, perpendicular to the incident α-particles, was measured as 201 μm², from which it follows that, on average, only one in six of the α-particle traversals through a cell nucleus is lethal. Under the well-characterized conditions of these experiments the event frequency of α-particle traversals through cell nuclei is 9·8 Gy^?1.     

The early evaluation of ultrasound-guided iodine-125 interstitial implants for high-risk hepatocellular carcinoma

IntroductionTo evaluate the feasibility and safety of ultrasound-guided iodine-125 interstitial implants for high-risk hepatocellular carcinoma.MethodsFrom October, 2016, to August, 2018, 49 patients suffering from a total of 66 hepatocellular carcinoma lesions were treated with ultrasound-guided iodine-125 interstitial implantation. Treatment planning system was applied to make preoperative plan. The response evaluation criteria in solid tumors were used to evaluate the curative effect. The evaluated outcomes included postoperative complications and complete disease control rate, 6-month disease-free survival, and 6-month overall survival.ResultsAll 49 patients underwent iodine-125 seed implantation successfully. Patients were followed up for 5 to 27.5 months. No patients developed serious complications and only 2 (4.1%) patients had slight pain. The complete response was seen in 21 lesions (31.8%), partial response in 26 lesions (39.4%), stable disease in eight lesions (12.1%), and progressive disease in 11 lesions (16.7%). The overall disease control rate was reached to 83.3%. The 6-month disease-free survival rate was 46.4% with a median disease-free survival time of 5.0 months. The 6-month overall survival rate was 83.6% with a median overall survival time of 15.0 months.ConclusionsIodine-125 interstitial implantation is a kind of safe and feasible treatment for high-risk hepatocellular carcinoma.     

Results of primary and combined radiotherapy of mouth carcinomas (tongue, tonsil, maxilla, mandible, palate, floor of the mouth cheek mucosa)]

Responses to highvoltage radiotherapy of 320 patients with carcinomas of the oral cavity are discussed. Five year survival rate according to the stage of the, disease were the following ones: in carcinoma of the anterior 2/3 of the tongue and floor of the mouth 20-60%, buccal mucosa, upper and lower jaw 30-50%, base of the tongue 26% and tonsil 30-100%. After simultaneous irradiation of the efferent lymphatics in parimary N0 patients, whose primary tumor subsequently was under control, a significantly lower frequency of metastases to the lymph nodes was found than without coirradiation of the lymph flow. Clinically verifiable metastases of the lymph nodes are also controllable to a high percentage by radiotherapy alone: Only in a little more than five per cent of the primary N1-3 patients with the parimary tumor being under control, additional metastases of the lymph nodes developed later on. The complication rate was 6.8 per cent. Most frequently, osteonecrosis was involved, indeed occurring chiefly in cases, where a primary skeletal manifestation of the tumor already was existing.     

Current status of radiotherapy following ablative and breast-sparing treatment of breast cancer

After a total mastectomy in cases of a high risk of loco-regional recurrence the postoperative irradiation of the chest wall is indicated in the following situations: Inflammatory type of carcinoma, tumor stage T3-T4, extended multifocal and multicentric primary tumor. After radical axillary surgery even in patients with positive nodes irradiation is not necessary except in cases where all axillary nodes are involved or with invasion of the axillary tissue. The supra- and infraclavicular lymph drainage regions caudal to the operated area (clip) should be irradiated with 50 Gy providing both an enlarged or subtotal involvement can be diagnosed. The irradiation of the retrosternal lymph-drainage system with 45-50 Gy is indicated as follows: Medial or central tumor site, extensive involvement of the axillary nodes and advanced stages of the primary tumor (T2-T4). Axillary irradiation alone cannot serve as a substitute for surgery. After segmental mastectomy without postoperative radiotherapy a local failure rate of 30% is to be expected during a 5 year period. After surgery with adjuvant postoperative irradiation the local failure rate can be reduced to about 5%: 50-60 Gy should be applied. In case of an unfavourable histology an additional boost dose is recommended. The objective of breast cancer irradiation is to achieve freedom of loco-regional recurrence. The survival can be improved occasionally after local irradiation, theoretically improvement of survival can be achieved in 7-10% at the most.