Radiation therapy planning with ultrasound.

Diagnostic ultrasound is a relatively new diagnostic modality which is a practical method of acquiring anatomical information important in radiation treatment planning. Patient contour, port margins, location of tumors and normal structures, and tissue inhomogeneities can be recorded simply, safely, rapidly, and accurately. This information can then be utilized in developing radiation therapy plans that deliver irradiation more precisely to the malignant disease while avoiding normal structures. The proper application of ultrasound in radiation therapy planning has the potential of significantly improving cure rates and minimizing complication rates in the treatment of patients with malignant disease.     

Skeletal metastases from cancer of the uterine cervix: frequency, patterns, and radiotherapeutic significance

The records of eight hundred two patients who received primary radiotherapy for invasive cervical cancer between 1969 and 1985 were reviewed. The incidence of bone metastasis was 1.9% (15/802). Lumbar spine involvement was the most common site, followed by the pelvic bones. Lumbar spine involvement was characterized by unilateral destruction of one or several contiguous vertebrae. All 10 patients with lumbar spine involvement were associated with a para-spinal mass. In seven of ten patients, this bone destruction due to direct extension from metastatic para-aortic tumor was the only recurrent cancer. In contrast, involvement of a long bone, a rib or the skull indicates hematogenous bone metastasis. When a spine X ray or bone scan is positive in the lumbar area in a cervical cancer patient with back pain, a CT scan should be performed to determine the extent of the underlying tumor. This will allow more accurate establishment of a radiation treatment plan, and will improve the chances for successful palliation.     

Analysis of treatment modalities and their failures in stage IB cancer of the cervix

This is a retrospective analysis of 240 patients who had clinical Stage IB cancer of the cervix treated with radiation between 1969 and 1980. Of these, 186 patients were treated with a combination of external and intracavitary radiation therapy, and 54 patients received adjuvant postoperative radiation therapy. The minimum follow-up was 5 years. In the group who received only radiation therapy, the overall recurrence in 170 patients (excluding 16 patients found at laparotomy to have unresectable disease) was 17% (29 of 170); pelvic recurrence was 9% and distant metastases alone was 6%. In the group who received the adjuvant postoperative radiation therapy, 16 patients had a simple hysterectomy followed by vaginal ovoid and/or external pelvic irradiation for an unexpected Stage IB cancer of the cervix. Their overall recurrence was 37.5% (6 of 16). Pelvic recurrence was the most common treatment failure with a recurrence of 31%. Significant prognostic factors were depth of stromal invasion and status of surgical margins. Thirty-eight patients had a radical hysterectomy followed by postoperative radiation therapy because of positive pelvic lymph nodes and/or close surgical margins. In patients with positive pelvic lymph nodes, the overall recurrence was 39% (9 of 23); pelvic recurrence was 13%. Distant metastases, the most common treatment failure, was 26%. In seven patients with close surgical margins, five recurred in the pelvis. There was no distant metastases without pelvic failure. Five of eight patients with close paracervical margins recurred in the pelvis. All five of these patients were treated with vaginal ovoid irradiation alone. Whole pelvic irradiation plus vaginal ovoid irradiation is necessary in those with close paracervical margins. The vaginal ovoid irradiation alone should be limited to very selected patients with positive vaginal margins only.     

Use of ultrasound scan in prostatic I-125 implantation robert

The average dimension of prostate was measured by transabdominal ultrasonography preoperatively to compare with direct intmoperative measurements in 28 patients undergoing suprapubic I-125 seed implantation for the treatment of prostatic cancer. A highly significant correlation (r = 0.932) was found between these two measurements. Transabdominal ultrasonography is a relatively simple and accurate non-invasive method of determining the number of I-125 seeds needed to implant the patient with prostatic malignancy.