Neutron therapy for head and neck cancer: II. Further follow-up on the M. D. Anderson TAMVEC randomized clinical trial

Between January 1977 and February 1980, 95 patients with inoperable squamous carcinomas of the head and neck were treated in a two-armed randomized clinical trial comparing 1) mixed schedule irradiation using two neutron and three photon fractions per week and 2) standard photon irradiation. Complete tumor regression was achieved in 80% of patients treated with mixed-schedule irradiation, and in 68% of patients treated with photons. The local control rate was 44% in patients treated with mixed-schedule irradiation and 41% in patients treated with photons. There were four complications of treatment in each treatment arm. Absolute survival was 20% with mixed-schedule treatment and 17% in photons. Actuarial analysis shows superior local control and survival rates with mixed-schedule irradiation over photons only in the first two years.     

The use of low-energy lasers for preventing and treating postoperative and radiation-induced complications in patients with head and neck tumors]

The efficacy of low-energy helium-neon and copper vapor lasers for prevention and treatment of postoperative and irradiation complications was assessed in 195 patients with locally advanced tumors of the head and neck. The control group included 118 patients. Intravenous laser irradiation of the blood was associated with a higher percentage of wound healing by first intention and better course of the postoperative period. Laser treatment of skin irradiation fields was shown to improve skin tolerance to the neutron beam. The study failed to establish tumor growth stimulation by the laser irradiation in terms of recurrence and metastasis development. The data obtained showed low-energy laser irradiation to offer promise for prevention and treatment of postoperative and irradiation complications.     

186Re内放射治疗颅咽管瘤的临床疗效

目的 评价应用立体定向肿瘤囊腔内注射186Re治疗颅咽管瘤的临床效果.方法 应用立体定向穿刺置管注射186Re方法治疗囊性或囊实性颅咽管瘤19例,其中男性12例,女性7例.年龄5～58岁,平均37.2岁.肿瘤呈囊性者12例,囊实性者7例.注射核素186Re前,颅咽管瘤囊性部分的平均体积为8390 mm3.结果 随访6个月至3年,有7例患者囊腔完全消失,囊腔体积缩小>50%以上者5例,囊腔体积缩小≤50%者7例.治疗前视力减退的8例患者中,5例患者治疗后视力显著改善.治疗前垂体功能正常者无一例出现垂体功能低下;而治疗前垂体功能低下的4例患者中,1例治疗后垂体功能改善.治疗前表现为尿崩症的5例患者中,3例治疗后尿崩症状改善.结论 立体定向肿瘤囊腔内注射186Re是治疗囊性或囊实性颅咽管瘤简单、安全、有效的方法.     

Acute cardiac effects of mediastinal irradiation: assessment by radionuclide angiography.

Mediastinal irradiation is considered as a long term cardiac risk factor, although no myocardial dysfunction can usually be documented during long term follow-up of the patients having undergone this treatment. We prospectively studied on 124 patients the early effects of irradiation on the myocardium using radionuclide angiography Left ventricular ejection fraction was measured at three different times: before starting the irradiation, 15 days after and more than 2 months after the end of treatment. The patients were divided into four groups according to the type of irradiation received: M group of 53 patients (mediasteinal irradiation), L group of 33 patients (left mammary chain irradiation), R group of 25 patients (right mammary chain irradiation), C group for 13 control patients (irradiation field did not include the heart). Sixty-nine of these patients were treated by chemotherapy, including adriamycin in 48 of them. For all patients for whom the myocardium was included into the field of irradiation (M, L, and R) there is a significant fall of the Left ventricular ejection fraction 15 days after the end of treatment, with recovery after 2 months. This fall is not seen in controls. Patients who received adriamycin follow the same evolution, and there is no significant difference in the basal LVEF value nor in the magnitude of the fall.     

The feasibility study on continuous 7-day-a-week external beam irradiation in locally advanced cervical cancer: a report on acute toxicity.

PURPOSE: To evaluate the feasibility and toxicity of continuous 7-day-a-week pelvic irradiation with no breaks between external beam irradiation and intracavitary applications. MATERIAL AND METHODS: Between November 1998 and December 1999, 30 patients with FIGO Stage IIB or IIIB cervical cancer were treated with continuous 7-day-a-week pelvic irradiation, to the total Manchester point B dose of 40.0-57.6 Gy. The first 13 patients (group A) were applied a daily tumor dose of 1.6 Gy and the remaining 17 patients (group B)-10.8 Gy. One or two immediate brachytherapy applications (point A dose 10-20 Gy, each) were performed in 28 cases. RESULTS: Two patients did not complete the irradiation due to apparent early progression of disease during the irradiation. Of the remaining 28 evaluable patients 11 (39%) completed treatment within the prescribed overall treatment time and 17 had unplanned treatment breaks. For the latter group overall treatment time ranged from 103 to 122% (mean 114%) and from 103 to 197% (mean 138%) of the planned treatment time for group A and B, respectively. The majority of patients experienced acute toxicity. Severe toxicity (EORTC/RTOG grade 3 and 4), predominantly gastrointestinal, occurred in 5 of the 13 patients in group A, and in 7 of 17 patients in group B. CONCLUSION: The studied regimen was accompanied by considerable toxicity, hindering delivery of irradiation within planned treatment time.     

Stage IB or IIA-B carcinoma of the intact uterine cervix greater than or equal to 6 cm in diameter: is adjuvant extrafascial hysterectomy beneficial?

This is an analysis of 150 patients with Stage IB or IIA-B carcinoma of the intact uterine cervix greater than or equal to 6 cm in diameter treated with irradiation alone (75 patients) or irradiation followed by surgery (75 patients) at the University of Florida between October 1964 and June 1983. Minimum follow-up in this series was 5 years. There was no significant difference in the distribution of prognostic factors between the two treatment groups. The 5-year local control rate was 74% with irradiation alone and 76% with irradiation and surgery. The 5-year survival rates for irradiation alone versus irradiation plus surgery were as follows: cause specific, 62% and 55%, and absolute, 54% and 52%. The proportion of patients who developed treatment complications necessitating hospitalization or a second operation was 4/75 (5%) after irradiation alone and 12/75 (16%) after irradiation and surgery. The authors conclude that the routine use of adjuvant extrafascial hysterectomy is not warranted in this patient population.     

The impact of pelvic recurrence and elective pelvic irradiation on survival and treatment morbidity in early-stage Hodgkin's disease

A retrospective analysis of patients with supradiaphragmatic Stage I-II Hodgkin's disease was performed to assess the impact of pelvic recurrence and elective pelvic irradiation on survival and treatment morbidity. One hundred twenty patients were treated with radiotherapy (RT) alone; 38 received total nodal (including pelvic) irradiation (TNI), 63 received modified total nodal (excluding pelvic) irradiation (MTNI), and 19 received involved-field or mantle irradiation only (less than MTNI). Thirty-three patients received combined-modality therapy. In laparotomy-staged (PS) patients treated with RT alone, the overall treatment failure rate was 13% after TNI, 24% after MTNI, and 43% after less than MTNI. The pelvic failure rate in PS patients was 0% after TNI, 9% after MTNI, and 29% after less than MTNI. Cause-specific deaths in patients treated with RT alone occurred in 10% following less than MTNI, 13% following MTNI, and 10% following TNI. Cause-specific deaths due to pelvic failure in patients treated with RT alone occurred in 5% following IF and 6% following MTNI, and also occurred in 7% of patients receiving combined-modality therapy. The potential disadvantages of elective pelvic irradiation in early-stage Hodgkin's disease include compromise of future tolerance of chemotherapy in the event of treatment failure, and infertility. Gonadal function was assessed in 67 patients less than 35 years old at the time of treatment. Compromise of gonadal function was correlated with the lack of special testicular shielding during pelvic irradiation and chemotherapy in the male, and with no oophoropexy before pelvic irradiation in the female. Twelve of 26 patients with recurrence after either less than MTNI or MTNI, with or without chemotherapy, were alive and without evidence of disease at greater than 2 years after completing salvage therapy, compared with 7 of 11 patients with recurrence after TNI.     

Inflammatory breast cancer: integration of irradiation, surgery, and chemotherapy.

Between January 1983 and April 1987, 36 consecutive patients with nonmetastatic clinical (30 patients) or occult (6 patients) inflammatory breast cancer were treated with irradiation, mastectomy, and chemotherapy. In 29 patients, treatment consisted of preoperative once daily (16 patients) or twice daily (13 patients) irradiation with concurrent chemotherapy. In 27 (93%) of these 29 patients, this treatment was followed by mastectomy and additional chemotherapy. In 25 (86%) of these patients, major clinical response was attained, but an examination of the pathology of the operative specimen revealed complete tumor absence in only two patients (7%). The remaining seven patients underwent immediate mastectomy followed by once daily irradiation and chemotherapy. With a median follow-up of 30.4 months in all patients (59.2 months in surviving patients), the 5-year probability of relapse-free survival was 24% and of overall survival, 34%. Overall, the probability at 5 years of initial isolated local-regional tumor recurrence was 19%; in patients treated with once daily irradiation, the 5-year probability was 28%, whereas the probability was 8% with twice daily (accelerated) fractionated irradiation. Chemotherapy dose intensity did not appear to be adversely affected by the use of irradiation. The treatment approach described herein provides results comparable with those in other contemporary American series.     

The therapeutic utility of lung irradiation for Hodgkin's disease patients with large mediastinal masses

Since Hodgkin's disease patients with large mediastinal masses frequently relapse in the intrathoracic area after regular mantle field irradiation, the feasibility and utility of low dose lung irradiation as an initial part of the supradiaphragmatic field was examined. Fifteen newly diagnosed patients with Hodgkin's disease and large mediastinal masses were treated with 1000–2000 rad to the lung as a part of extended field radiotherapy. All patients received radiotherapy aloe. Results of treatment were compared with those in 20 similar patients who were treated only with extended field irradiation. With a minimum follow-up of 24 months, only 2 patients (13%) who received lung irradiation have recurred and only one of these recurred in the Lung. In contrast 15 (79%) of the 19 complete responders who were treated without lung irradiation had relapsed by 24 months, 9 in the intrathoracic region. Recurrence-free survival was significantly longer in patients who received Lung irradiation. No increased frequency in serious complications has been experienced to date with low dose whole lung irradiation, compared with regular mantle field treatment. This study suggests that lung irradiation may be a feasible alternative to adjuvant combination chemotherapy when treating patients with Hodgkin's disease and large mediastinal masses.     

Stage II carcinoma of the cervix: analysis of the value of pretreatment extraperitoneal lymph node sampling and adjunctive surgery following irradiation

This is a retrospective analysis of the results of treatment of 24 patients with bulky stage II carcinoma of the cervix treated with full course irradiation followed by adjunctive surgery between 1975 and 1980. A review of the surgical specimens following irradiation showed that 12 patients had no residual cancer, five had only microscopic foci of cancer, and five had extensive residual cancer. Two patients had unresectable persistent cancer. Six patients had histological evidence of lymph node metastases prior to irradiation. The surgical-pathological findings following irradiation had important prognostic implications. All five patients with extensive residual cancer in the surgical specimen recurred, 2 of 5 patients with only microscopic foci of residual cancer and, none of the 12 patients with no residual cancer in the resected specimens developed a recurrence. Lymph node involvement was not associated with an increased incidence of recurrence. Most patients with residual cancer following full course irradiation recurred locally. Thus the addition of adjunctive surgery following full course irradiation did not significantly improve the treatment results of patients with bulky stage II carcinoma of the cervix.     

Results of chemotherapy as an adjunct to surgery in patients with localized ovarian cancer.

One hundred and forty-nine patients with early cancer of the ovary who were suitable for postoperative radiotherapy were treated in a random study in which whole abdominal irradiation with additional treatment to the pelvis was compared to chemotherapy with Melphalan. The number of patients without evidence of disease at 2 yr seems to show that the results of treatment are similar. When the Berkson-Gage method of projection is used, however, the survival rate in stage I is apparently improved with irradiation; there is only a minor difference in the results of the two methods in stage II, and survival rates are improved for patients with stage III disease who were treated with chemotherapy. The complications of treatment in this study were quite different. Melphalan was well tolerated, and only one patient had serious bone marrow depression as a result of this treatment. All had prompt recovery of blood counts to normal after completing the prescribed chemotherapy. Seven patients treated by radiotherapy developed a small bowel injury which required surgery. Six of these were treated with irradiation to the pelvis followed by strip irradiation to the entire abdomen. This treatment plan probably gives excessive doses of irradiation to the pelvis and has been discontinued. This type of complication is much less frequent with the other sequence of treatment--strip irradiation to the whole abdomen and subsequent treatment to the pelvis. The cost to the patient of the two treatment programs varied considerably. Patients who received irradiation had the added expense of living in Houston for the duration of treatment. Patients treated with chemotherapy were often seen a 2- or 3-mo intervals and had their chemotherapy supervised by their personal physician.     

Regrowth pattern of glioblastoma multiforme after radiotherapy

We investigated the correlation between the technique of radiation therapy used and the regrowth pattern of recurrent glioblastoma multiformes of 48 patients who received initial radiation therapy in our clinic from April, 1974 to March, 1988. Three different techniques have been applied to patients with brain tumors: whole brain irradiation, generous local irradiation (the parallel opposing technique or three field technique, in which the treatment field fully covers the peritumoral low density area on CT images), and restricted local irradiation (the rotation technique, in which the treatment field is restricted to within about 2 cm of the tumor margin on CT images). Radiation dose of the treatment field was over 45 Gy in every case. The regrowth pattern was defined as being one of the followings: inside of the treatment field, outside of the treatment field (this includes the boundary zone between the treatment and the non-treatment field), and remote from the treatment field-which mostly due to the tumor spreading through ventricular systems. In all 7 cases that received whole brain irradiation, tumor recurred inside of the treatment field. Two of these 7 cases showed remote recurrence at the same time. Mean duration time to recurrence was 36.3 weeks. In 27 (90%) of 30 cases that received the generous local irradiation, tumor recurred within the treatment field. Only one showed outside recurrence, and two other cases showed remote recurrence. The mean duration time to recurrence in this group was 32.2 weeks. Of 11 cases that received restricted local irradiation, 3 cases (27%) showed recurrence outside of the treatment field, one showed recurrence in a remote area. The mean duration time to recurrence in this group was 38.3 weeks, but was not significantly longer than that of other two groups. These results indicate that restricted local irradiation sometimes fails to cover the tumor invaded area, and that the results of treatment using generous local irradiation are almost the same as those using whole brain irradiation. This suggests that generous local irradiation is advantageous to patients with brain tumors since the incidence of subacute side effects such as mental deterioration is much lower in local irradiation as compared with whole brain irradiation.     

Radiothérapie du cancer bronchique non à petites cellules de stade III, inopérable, asymptomatique. Résultats définitifs d''un essai prospectif randomisé (240 patients)

PURPOSE: To report the results of a prospective randomized study concerning the role of radiotherapy in the treatment of stage III, unresectable, asymptomatic non-small cell lung cancer. MATERIAL AND METHODS: Between 1992 and 1996, 240 patients with stage III, unresectable, asymptomatic non-small cell lung cancer were enrolled in this study, and sequentially randomized to one of the three treatment arms: conventional irradiation, hypofractionated irradiation and control group. In the conventional irradiation arm (79 patients), a dose of 50 Gy in 25 fractions in five weeks was delivered to the primary tumor and the mediastinum. In the hypofractionated irradiation arm (81 patients), there were two courses of irradiation separated by an interval of four weeks. In each series, patients received 20 Gy in five fractions in five days, in the same treatment volume as the conventional irradiation group. In the control group arm, 80 patients initially did not receive radiotherapy and were only observed. Delayed palliative hypofractionated irradiation (20-25 Gy in four to five fractions in four to five days) was given to the primary tumor when major symptoms developed. RESULTS: The two-year actuarial survival rates for patients in the conventional irradiation, hypofractionated irradiation and control group arms were 18%, 6% and 0%, with a median survival time of 12 months, nine months and six months respectively. The differences between survival rates were statistically significant at the 0.05 level. CONCLUSION: Although irradiation provides good palliation, the results are disappointing. The comparison of conventional and hypofractionated irradiation shows an advantage for conventional schedules.     

Carcinoma of the uterine cervix treated with external irradiation alone

One hundred and four out of 2701 patients with carcinoma of the uterine cervix were treated with a curative intent by external irradiation alone at the National Cancer Center Hospital from 1962 to 1979. All patients were judged inappropriate for the combined treatment of intracavitary and external irradiation, which was the treatment of choice for patients with advanced carcinoma of the uterine cervix in the hospital. The 5-year survival rate was 17% overall and 36, 17, and 5% for patients with Stage II, III, and IV disease, respectively. The local control rate was 20%, at 2 years, for all patients. Major complications were observed in five patients. There were no major complications in patients given a total dose of less than 115 in the Time Dose Fractionation factor (TDF). External irradiation combined with interstitial irradiation and/or hyperthermia is being considered to improve the results.     

Irradiation, chemotherapy and surgery in esophageal cancer: a randomized clinical study. The first Scandinavian trial in esophageal cancer

In a randomized trial, irradiation alone (35 Gy) or irradiation (30 Gy) and bleomycin was given as preoperative treatment of esophageal cancer. In inoperable patients, a split course of irradiation alone (63 Gy) or irradiation (55 Gy) and bleomycin was given. Bleomycin doses were 5 mg i.m. 1/2-1 h before each irradiation dose. No benefit was obtained by addition of bleomycin to irradiation concerning survival or palliation of dysphagia. No benefit of bleomycin was seen either in any subgroup of patients according to different primary tumour classifications, histopathological gradings or localizations of tumour. In patients with advanced/metastatic disease, bleomycin and adriamycin treatment gave a significantly longer survival than bleomycin alone. It was shown that the presence of T1 tumours was a significant prognostic factor for long-term survival and that performing a radical operation was a significant advantage for a longer survival. Female patients treated with irradiation with or without bleomycin survived significantly longer than males, but in operable patients there was no significant difference between the two sexes with regard to survival.     

Value of prophylactic irradiation to supraclavicular areas in small cell lung carcinoma--analysis of 104 patients

A series of 104 patients with limited small cell lung carcinoma was treated by combination of chemotherapy and radiotherapy from August 1975 to July 1981. 104 patients were divided into three groups: prophylactic irradiation to supraclavicular areas (14 patients), non-prophylactic group (72 patients), non-prophylactic irradiation with positive supraclavicular lymph node metastasis after the treatment (18 patients). The 5 year survival rates of the three groups were 14%, 6% and 0%. Distant metastasis rates after the treatment were 36%, 52% and 61%, respectively. The supraclavicular lymph node metastasis rate after the treatment was higher in patients with intra-thoracic lymph node metastasis before the treatment (25%) than in those without this metastasis (0%). It is suggested that, for small cell lung cancer patients, especially with intra-thoracic lymph node metastasis before the treatment, prophylactic irradiation to the supraclavicular areas be valuable.     

The avoidance of small intestine injury in gynecologic cancer

The evolution of systematized operative staging and radical surgical procedures in the management of gynecologic cancer has increased the complexities of integrating radiation therapy. High dose irradiation to large treatment volumes has been associated with an increased incidence of small intestine injury. This complication is morbid and often fatal. Although predisposing factors have been extensively studied, there has been a paucity of reports evaluating preventative measures. Between 1975 and 1980, 140 patients with gynecologic cancer were treated at the Valley Presbyterian Hospital in the Division of Radiation Therapy. Twenty-six patients with cervix cancer received definitive irradiation and seven received adjunct irradiation. Seventy-two with corpus cancer received adjunct irradiation, seven received definitive irradiation and three palliative irradiation. Eleven patients with ovarian cancer received adjunct irradiation and 15 palliative irradiation. Eight-five patients were at potential risk for small intestine injury and had treatment planning small intestine X rays. Fixation was observed in 7/39 (18%) without prior pelvic surgery and 30/46 (65%) with prior pelvic surgery. Information from the small intestine X rays were used in 41 patients to make 60 treatment modifications. Twenty-five of 140 (17%) had a reduction of total dose, 26/140 (18%) had exclusion of the small intestine by shrinking fields, or patient positioning and 13/140 (9%) had displacement of the small intestine by distention of the bladder. No patient developed small intestine injury. The disease free survival for cervix cancer was 27/33 (82%), corpus cancer 68/79 (86%) and ovarian cancer 5/11 (45%). Pelvic failure was observed in 19/123 patients who received definitive or adjunct irradiation. One patient with corpus cancer and three patients with ovarian cancer might have benefited from the use of a larger treatment volume or a higher total dose.     

Pineal tumors

From 1972–1985, 30 patients with pineal area tumor have been treated with combinations of surgery and irradiation, no patient receiving chemotherapy as a primary recommendation. Patients ranged between 3 and 69 years of age, 18 were male and 12 female. In 18 patients a tissue diagnosis was made initially, 14 patients required shunts before definitive management and in 8 of the 14 tissue diagnosis was made at the same time. Eight patients had no surgical intervention at any time. Patients who have received irradiation have had whole brain irradiation, local field irradiation, or craniospinal irradiation. Two elderly patients died rapidly of their malignant processes before definitive treatment could be given. Only one patient with a non neoplastic lesion was seen. This was a bleed from an AVM with no underlying tumor. One patient with a pineocytoma was not irradiated. Overall, two-thirds of our patients are alive 5 to 15 years after treatment. There has been no surgical mortality and minimal morbidity from biopsy. Late effects of treatment include one patient with mild hearing loss and three patients with endocrinopathies amenable to medical treatment. We believe that tissue diagnosis allows optimal field design and dose recommendations to be made by the radiotherapist in addition to defining prognosis. In our experience, endodermal sinus tumor and pineoblastoma are highly malignant, and in view of their poor prognosis with conventional management consideration of more radical treatment with a possible role for chemotherapy is suggested.     

Carcinoma of the tonsillar fossa: prognostic factors and long-term therapy outcome

Purpose: To identify prognostic parameters and evaluate the therapeutic outcomes for patients with carcinoma of the tonsillar fossa treated with three treatment modalities.

Methods and Materials: The results of therapy are reported in 384 patients with histologically proven epidermoid carcinoma of the tonsillar fossa; 154 were treated with irradiation alone (55–70 Gy), 144 with preoperative radiation therapy (20–40 Gy), and 86 with postoperative irradiation (50–60 Gy). The operation in all but four patients in the last two groups consisted of an en bloc radical tonsillectomy with ipsilateral lymph node dissection.

Results: Treatment modality and total irradiation doses had no impact on survival. Actuarial 10-year disease-free survival rates were 65% for patients with T1 tumors, 60% for T2, 60% for T3, and 30% for T4 disease. Patients with no cervical lymphadenopathy or with a small metastatic lymph node (N1) had better disease-free survival (60% and 70%, respectively) at 5 years than those with large or fixed lymph nodes (30%). Primary tumor recurrence (local, marginal) rates in the T1, T2, and T3 groups were 20–25% in patients treated with irradiation and surgery and 31% for those treated with irradiation alone (difference not statistically significant). In patients with T4 disease treated with surgery and postoperative irradiation, the local failure rate was 32% compared with 86% with low-dose preoperative irradiation and 47% with irradiation alone (p = 0.03). The overall recurrence rates in the neck were 10% for N0 patients, 25% for N1 and N2, and 35–40% for patients with N3 cervical lymph nodes, without significant differences among the various treatment groups. The incidence of contralateral neck recurrences was 8% with the various treatment modalities. On multivariate analysis the only significant factors for local tumor control and disease-free survival were T and N stage (p = 0.04–0.001). Fatal complications were noted in 7 of 144 (5%) patients treated with preoperative irradiation and surgery, 2 of 86 (2%) of those receiving postoperative irradiation, and 2 of 154 (1.3%) patients treated with radiation therapy alone. Other moderate or severe nonfatal sequelae were noted in 30% of the patients treated with preoperative irradiation and surgery, in 53% treated with postoperative irradiation, and in 19% receiving radiation therapy alone.

Conclusion: Primary tumor and neck node stage are the only significant prognostic factors influencing locoregional tumor control and disease-free survival. Treatment modality had no significant impact on outcome. Radiation therapy remains the treatment of choice for patients with stage T1–T2 carcinoma of the tonsillar fossa. In patients with T3–T4 tumors and good general condition, combination surgery and postoperative irradiation offers better tumor control than single-modality and preoperative irradiation procedures, but with greater morbidity.     

Prophylactic brain irradiation and radiotherapy of brain metastases of small cell lung cancer

The report presents the results of cranial irradiation of 44 small cell lung cancer patients with clinically-identified intracranial metastases and 40 patients for metastatic spread prevention. Whole brain irradiation was carried out with single doses of 2-4 Gy (total dose--30-40 Gy) in both groups 5 times weekly. Patients irradiated for metastasis prevention revealed a 3.3-fold decrease in intracranial metastasis frequency and a good post-treatment tolerance. In the other group, radiation failed to reach tumor lesions in 20%; treatment produced a poor effect in 30%. There was a correlation between survival time, initial expansion of process and tumor response to primary treatment. No relationship was observed between survival time and procedure and duration of cranial irradiation. Prophylactic irradiation may be beneficial in responders to therapy. However, randomized research into the effectiveness of preventive irradiation and possible radiation injury to cranial and brain tissues is required, particularly, in patients responding to primary treatment by complete regression of localized tumor.