Radiation therapy in the treatment of aggressive fibromatoses

Twelve patients with aggressive but histologically benign connective tissue tumors (nine desmoids and three neurofibromas) were treated with either radiation or radiation plus surgery. Long term local control was accomplished in eight of nine desmoid tumors and 2 of 3 neurofibromas. In the successfully treated patients, local control was obtained with minimal long term complications when compared with radical surgical procedures that would have been necessary for cure. Details of radiation treatment are discussed along with proposed indications for therapy.     

An analysis of the severe complications of irradiation of carcinoma of the uterine cervix: treatment with intracavitary radium and parametrial irradiation

Between January 1967 and December 1974, 254 patients with carcinoma of the uterine cervix were treated with either intracavitary radium and parametrial irradiation or 2000 rad whole pelvis irradiation followed by intracavitary radium and parametrial irradiation. In general, these patients had tumors of relatively limited volume and vaginal and uterine anatomy that was favorable for intracavitary radium. Not all patients had a lymphangiogram performed prior to irradiation. Of those who did, only patients with negative lymphangiograms are included in this analysis. All patient had a minimum follow-up of four years. The absolute four year survival rate for this group of patients was 86%. Only 6.3% of patients died of disease. The incidence of severe complications was 7.5%. Complications were associated with a high number of milligram hours of radium plus a high dose of external irradiation, in combination with either asymmetry of the radium system and/or history of previous pelvic inflammatory disease, pelvic surgery, or diverticulosis.     

125I vicryl suture implants as a surgical adjuvant in cancer of the head and neck

Sixty-four intraoperative 125I seed implants using absorbable suture (Vicryl) carriers were performed in 53 patients with head and neck cancers at Stanford between 1975 and 1980. In previously untreated patients, local control in the implanted volume or in all head and neck sites was obtained in 79 and 71%, respectively. Five of these patients (40%) remained NED. Of 34 patients with recurrent carcinomas, local control was obtained in the implant volume in 20 (59%), while 38% had no recurrence post-implantation in any head and neck site. The incidence of complications is correlated with 125I radiation doses, total millicuries inserted, seed strength used, and tissue volume implanted for both untreated patients and those with local recurrences. Guidelines for the optimal use of the above 4 parameters are also presented. We conclude that 125I seed Vicryl intraoperative suture implants are an effective surgical adjuvant in the treatment of advanced, previously untreated or recurrent head and neck cancers.     

The heterogeneity of the T2 glottic carcinoma and its local control probability after radiation therapy

The definition of T₂ glottic carcinoma permits heterogeneity, which is implied in the literature by the varying local control probability ranging from about 40% to 80% for these tumors. In a prospective series of 59 consecutive patients with T₂ glottic tumors, the local control probability has been evaluated for two hypothetical subdivisions, one with relatively small tumors and the other with tumors of larger volume. The local control probability at 2 years appears to be significantly different, 96% as opposed to 65 %, for the above subdivisions. Dose response analysis has been made. The T2 tumors with small volume have a flat response curve below 7000 rad, whereas tumors with larger volume appear to have responded better with doses above 7000 rad.     

Curative surgery for adenocarcinoma of the pancreas/ampulla of Vater: the role of adjuvant pre or postoperative radiation therapy

From 1972 to 1981, 7 patients received adjuvant external beam radiation therapy before (5 patients) or after (2 patients) a curative Whipple operation for adenocarcinoma of the pancreas (5 patients) or ampulla of Vater (2 patients). Via supervoltage, 4000-4520 rad/20-25 fractions/4-5 1/2 weeks were delivered to the tumor bed and draining lymphatics. Two patients (of 4 at risk) are 5-year survivors; 3 are alive-without-disease at 1-2 years follow-up. Distant metastases have developed to date in 3 patients. A marginal miss occurred at the edge of radiation portal in 1 patient, and no true in-field failures have occurred. Complications occurred in 2 patients. Because of the high incidence of local-regional failures after curative surgery alone for adenocarcinoma of the pancreas or ampulla of Vater, the above results suggest that adjuvant radiation therapy should be considered as a modality to potentially improve treatment results.