Preliminary results using twice-a-day fractionation in the radiotherapeutic management of advanced cancers of the head and neck.

Twenty-four cases of advanced T4 cancers of the head and neck were treated using a twice-a-day treatment fractionation delivering a 1,200 rad weekly tumor dose and 7,000 rad total tumor dose in 5 1/2-6 weeks. Acute normal mucosal reactions and skin reactions were plotted weekly and corresponded to reactions observed when delivering 1,000 rad per week in five treatment sessions. Chronic problems have been limited to severe neck fibrosis appearing in three of five patients who underwent a planned neck dissection 6 weeks after the completion of radiotherapy. Local control was observed in 14 of 23 patients (61%) and regional control in 22 of 23 patinets (96%).     

Treatment tolerance and early complications with extended field irradiation in gynaecological cancer.

Treatment tolerance and early complications have been analysed in patients treated with extended field irradiation and pelvic irradiation alone. At the Centre Georges-Fran?ois Leclerc, 126 patients were treated for carcinoma of the uterine cervix and endometrium from May, 1972 to November, 1974. All patients received external irradiation using a 25 MV X-ray beam. Follow-up has been nearly complete in all patients with the minimum follow-up being 15 months and the average 24 months. Treatment tolerance was approximately the same for all field sizes except when the field was extended to the top of D12. In this situation the patients occasionally required a short rest during their irradiation. The age of the patient was found to contribute significantly to the tolerance, with 70% of the patients who experienced poor tolerance being older than 60 years. Complications were evenly distributed in all all catagories of field size and appeared to be affected only by age and previous surgery. Of the patients who experienced complications 68% were older than 60 years, and of the 37 patients who had previous surgery, 32% had a complication. With certain treatment modifications the treatment tolerance and early complications appear acceptable when using extended field irradiation for gynaecological cancer.     

Prevention of caries and osteonecrosis through daily local fluoridation in radiotherapy patients]

The healthy dentition of 432 patients treated by radiotherapy for ENT and salivary gland lesions was preserved and subjected to a programme of strict hygiene and daily local fluoride application using a gel containing 1% of sodium fluoride. Effectiveness in terms of the prevention of caries was satisfactory. Caries developed in only 7% of the patients. None of the patients in whom there was a clear indication and who followed treatment carefully to an extent greater than 70% suffered decay. Thorough initial assessment, and very careful selection of cases should make it possible in the future to avoid the majority of sources of failure observed. The prevalence of osteo-necrosis secondary to dental preservation was 1.2%, identical to the prevalence of trophic complications seen in patients who underwent total extraction before radiotherapy. The technique of fluoride application is simple, with no risk of toxicity, but must be continued indefinitely. Preservation of the dentition must be undertaken only with the close cooperation of the responsible medical and odontological teams, the latter being responsible for the initial assessment, care and surveillance. Preservation of a healthy dentition together with the possibility of early fitting of a prosthesis if necessary contribute to the rapid functional rehabilitation of patients irradiated for malignant disease in the ENT area.