Real-Time Dynamics of the Formation of Hydrated Electrons upon Irradiation of Water Clusters with Extreme Ultraviolet Light.

Free electrons in a polar liquid can form a bound state via interaction with the molecular environment. This so-called hydrated electron state in water is of fundamental importance, e.g., in cellular biology or radiation chemistry. Hydrated electrons are highly reactive radicals that can either directly interact with DNA or enzymes, or form highly excited hydrogen (H^{*}) after being captured by protons. Here, we investigate the formation of the hydrated electron in real-time employing extreme ultraviolet femtosecond pulses from a free electron laser, in this way observing the initial steps of the hydration process. Using time-resolved photoelectron spectroscopy we find formation timescales in the low picosecond range and resolve the prominent dynamics of forming excited hydrogen states.

Late complications after radiotherapy for prostate cancer.

BACKGROUND: The aim of the present study was to analyze in detail the time course of the incidence of radiation-induced late effects. For this purpose, unpublished data of patients treated by radiation therapy in Hamburg in the late 1980s were analyzed. Relatively large volumes were exposed to comparatively high doses, thus leading to a high rate of treatment-related side effects. PATIENTS AND METHODS: A total of 180 consecutive patients received radiotherapy for prostate cancer. The median age was 66 years (range 41-88 years). The median of the maximum dose was 77.5 Gy (range 56.3-95 Gy) and overall treatment time was 51 days (range 28-128 days). Endpoints analyzed were late complications of grade 3 or higher, overall and disease-free survival, local tumor control, and distant metastases. Data analysis was actuarial and the log-rank test was used to compare the various subgroups. RESULTS: After 2 years, 80.5 ± 3.2% of the patients were without any complications of grade 3 or higher, and after 5 years a constant level of 70.3 ± 4.0% was approached. When multiple lesions occurred per patient, the later events were disregarded. A total of 66 complications occurred in 42 patients. The percentage of patients being free from late complications, plotted as a function of time after start of radiation therapy, was adequately described by an exponential function and a constant fraction. Complications approached a constant level of 70.3% at a rate of 5.3% per month. This means that patients who will develop a complication do so at exponential kinetics and at a relatively high rate, whereas about 70% of the patients will never experience a late effect even over long observation periods. After subdividing the maximum dose into three equal dose groups of 55 patients each (< 73.3 Gy, 73.3-80 Gy, > 80 Gy), the constant fraction decreased from 85.7 to 72.8% and 52.2%, whereas the incidence rate was 4.3%, 7.7%, and 5.6% per month and, thus, almost independent of radiation dose. CONCLUSION: For a given group of patients, the rate of the incidence of late complications appears to be independent of radiation dose and (from analyzing data in the literature) independent of the grade of lesions, whereas the fraction of patients without late effects depends on both parameters.

[PCCP--first choice of the treatment of trochanteric fractures in our orthopaedic department]. / PCCP--metoda volby v lécení trochanterických zlomenin na nasem pracovisti.

INTRODUCTION: The authors present their experiences with the treatment of trochanteric fractures (31A1.1-31A3.3) using the Gotfried's percutaneous compression plate (PCCP). The authors evaluate some parameters at other kinds of osteosynthesis in the same indication. MATERIAL: We made 230 osteosynthesis of trochanteric fractures in the period from August 2004 to December 2008. The PCCP was used 179x (72x type 31A1.1-3, 90x type 31A2.1-3, 17x type 31A3.1-3). The other kinds of osteosynthesis were used 51x (DHS 40x, PFN 9x and condylar plate 2x) in the same indication. The mean age, the hospitalization time, the interval admission - operation, wound complications and the lethality within 30 days, 90 days and 1 year were evaluated. Some patients were lost to follow up or died. The bone healing was evaluated at 119 PCCP and 43 other osteosynthesis, which remained in the study. METHOD: The stabilisation is done via two 2-3 cm long incisions. The plate, assembled on a introducer, is inserted through the proximal incision. The special hook for the plate fixation to the bone, two angular stable self-cutting neck screws and three diaphyseal screws are inserted from the distal incision. RESULTS: The first value concerns the PCCP, the value in brackets concerns the other osteosynthesis. Number 179 (51).The mean age 78.9 (76.2) years, the interval admission - operation 0.95 (1.12) days, the hospitalization time 15.3 (16.5) days, the wound hematoma and revision 3 (1), the wound infection and revision 1 (1). Died within 30 days 8.4% (5.9%), within 90 days 13 % (13.7%), within 1 year 33.9% (29.2%). All 119 patients with PCCP (including 15 type AO 31A3) were healed within 8 months. No pseudoarthrosis, collaps or cut-out were noted at the PCCP group. Four failures, caused by an unsuitable indication or by a surgeon error, were noted in the group of the other osteosynthesis. DISCUSSION: The advantage of the PCCP is minimally invasive technique and rotation stability. The authors proved that the PCCP reduces and fixes the fractured lateral wall at high subtrochanteric fractures (31 A3.1-3). The wall is healed and prevents collapse. The authors indicate AO type 31A3 fractures to the PCCP unlike the author of the method. CONCLUSION: The study confirmed that the PCCP is a minimally invasive osteosynthesis suitable for all types of trochanteric fractures. All 119 followed up patients including 15 with 31 A3.1-3 fractures were healed.

Early tolerance of different organs to fast fractionation in clinical practice.

PURPOSE: To assess the feasibility of accelerated hyperfractionated radiotherapy in the treatment of breast, abdominal cavity, and pelvic tumors. METHODS AND MATERIALS: Between August 1989 and March 1993, 39 patients were treated in Portsmouth by an accelerated, hyperfractionated regimen giving 45 to 54 Gy three times a day over 12 days. Twenty patients had abdominal cavity or pelvic tumors and 19 patients breast carcinoma, 9 of whom were treated prophylactically after local excision. RESULTS: No local recurrence has been observed in the 19 patients with breast carcinoma, and out of the 20 with abdominal or pelvic tumors, 6 showed complete regression and so far no severe late damage has been observed. In those patients who had pelvic or abdominal tumors treated, the acute toxicity varied widely from minimal to very intensive. No surgical intervention was necessary and most reactions settled within a 6-week period. CONCLUSION: Accelerated fractionation by small increments is well tolerated by the breast, pelvic, and abdominal organs.

High dose-rate microselectron molds in the treatment of skin tumors.

PURPOSE: The feasibility of high dose rate iridium afterloaded molds in the treatment of skin tumors. METHODS AND MATERIALS: Expanded silicone rubber and bronchial applicator tubes were used in the construction of various molds. The number of tubes used and the separation between them depends on the size and area to be treated. Source dwell position and time are set to follow Paterson-Parker rules. Single plane expanded silicone rubber molds between 15 X 15 mm and 60 X 70 mm were used in 120 different sites, and of the others, seven were perspex double molds, two were cylindrical applicators, and one was a partially shielded intranasal applicator. One hundred and thirty lesions of various site and histology were treated in all. After exclusion of treatments that were combined with either external beam or chemotherapy, 106 lesions (76 patients) were evaluated. RESULTS: Full response was obtained in all but four basal cell carcinomas. The acute reaction ranged from moist desquamation (27 sites) to erythema only. Follow-up at 5 or more months revealed no changes whatever in 47 sites; 53 showed an excellent cosmetic outcome, although slight changes in pigmentation or minimal atrophy was demonstrable and 6 sites became noticeably atrophic with patchy pigmentation. For 9.6 months of average follow-up time, no recurrences have been observed. CONCLUSION: The high-dose-rate iridium-loaded skin applicators offer the possibility of improved therapeutic ratio in the treatment of superficial skin tumors. With the availability of a high-dose-rate afterloader this technique is simple and straightforward.

Seventeen years experience with accelerated radiotherapy for carcinoma of the breast.

Between 1973 and 1989, one hundred and three women received accelerated radiotherapy to the breast. Fifteen of them had the treatment after local tumor removal; the rest had primary radiotherapy for inoperable cancer. Eleven patients were irradiated twice a day, 83 three times a day, and nine four times a day. The overall time was five days in 52 courses, 7-15 days in 49 courses, and two patients had a longer regime. Actuarial local tumor control was 34.6% at five, and 24.7% at ten years in the whole group, and 25.5% and 14.6%, respectively, in the patients with macroscopical disease. Crude local control in the latter patients was achieved in 24.4% after a five day course, 28.8% after 7 to 11 days course, and 50% after a time of 12 or more days. Crude local control after total dose of less than 40 Gy was 15.8%, after 40-45 Gy, 31.7%, after 45.1-50 Gy, 33.3%, and after more than 50 Gy, 100% (four patients). Sixty patients were evaluable for late damage at 18 months; twenty three of them developed moderate changes. Six suffered severe late damage such as skin leathering or necrosis: three of them were treated for recurrence after previous radiotherapy. The main factor influencing tumor control was not the overall treatment time, but the total dose.

The feasibility of high-dose multiple daily fractionation and its combination with anoxic cell sensitizers in the treatment of head and neck cancer. A pilot study of the Radiotherapy Group of the EORTC (European Organisation for Research on Treatment of Cancer).

From 1978 to the end of 1980, 179 patients with advanced head and neck tumors were accrued in a multicenter pilot study of the EORTC Radiotherapy Group, investigating the feasibility of high dose multiple daily fractionation (MDF) and its combination with misonidazole. The irradiation scheme consisted of three daily fractions of 1.6 Gy (four hour intervals) to a total dose of 48 Gy in two weeks, followed 3 to 4 weeks later by a boost to a total of about 70 Gy in 6 to 7 weeks. Misonidazole was given in daily doses of 1 g/m2 (total 13 or 14 g/m2) to 53 patients, thus sensitizing every radiation session. All patients had large head and neck tumors, with a poor prognosis. Acute reactions were well tolerated. Skin reactions were very moderate; mucosal reactions started at day 10 to 12. All patients had a confluent mucositis that lasted for one to two weeks. When the whole oral cavity was irradiated, reactions lasted somewhat longer. The boost caused no significant symptoms. The radiosensitizer did not modify the reaction pattern. Tumor regression was very impressive, so that palliation was obtained quickly. Nine patients died from treatment related causes. It is difficult to assess local control at this time, but at the time of analysis (August 1981), the actuarial control rate was 48% at 20 months, with misonidazole 57%. This difference, however, is not statistically significant. Survival of the total group is 31% at 20 months. In these patients with a heavy tumor burden the early results were considered a success by all participants. For patients with sufficient follow-up, late reactions can be evaluated. Some edema and fibrosis is seen, but did not exceed a degree which could be expected with single daily fractionation to the same dose. This study demonstrates the possibility of giving highly concentrated treatments to total doses equal to those used in conventional fractionation. For assessment of a possible benefit in local control and ultimate survival, a randomized study is necessary. Such a study is now underway in the EORTC Radiotherapy Group, comparing single daily radiotherapy with multiple daily fractionation with or without misonidazole.

Thy-1 epitopes are expressed on murine myeloid leukemia and reticulum sarcoma cells.

Expression of Thy-1.2 specificities in cells from 29 primary spontaneous leukemias of random-bred ICR Swiss mice was examined by cell membrane and cytoplasmic immunofluorescence with monoclonal HO-13-4 antibody [1]. The Thy-1.2 epitopes were detected in all thymic lymphomas and were absent in the lymphomas of non-thymic origin. Unexpectedly, the Thy-1.2 epitopes were also detected in 71% (5/7) of myeloid leukemias and 40% (4/10) of reticulum cell sarcomas examined.

Quantification of late complications after radiation therapy.

BACKGROUND: An increasing number of patients survive cancer after having received radiation therapy. Therefore, the occurrence of late normal tissue complications among long-term survivors is of particular concern. METHODS: Sixty-three patients treated by radical surgery and irradiation for rectal carcinoma were subjected to an unconventional sandwich therapy. Preoperative irradiation was given in four fractions of 5 Gy each applied within 2 or 3 days; postoperative irradiation consisted mostly of 15 x 2 Gy (range, 20-40 Gy). A considerable proportion of these patients developed severe late complications (Radiother Oncol 53 (1999) 177). The data allowed a detailed analysis of complication kinetics, leading to a new model which was tested using data from the literature. RESULTS: Data on late complications were obtained for eight different organs with a follow-up of up to 10 years. For the various organs, the percentage of patients being free from late complications, plotted as a function of time after start of radiation therapy, was adequately described by exponential regression. From the fit, the parameter p(a) was obtained, which is the percentage of patients at risk in a given year of developing a complication in a given organ during that year. The rate p(a) remained about constant with time. Following sandwich therapy, the annual incidence of complications in the bladder, ileum, lymphatic and soft tissue, and ureters was about the same (p(a)=10-14%/year), whereas complications in bone or dermis occurred at lower rates (4.7 or 7.5%/year, respectively). DISCUSSION: Numerous data sets collected from published reports were analyzed in the same way. Many of the data sets studied were from patients in a series where there was a high incidence of late effects. Three types of kinetics for the occurrence of late effects after radiotherapy were identified: Type 1, purely exponential kinetics; Type 2, exponential kinetics, the slope of which decreased exponentially with time; Type 3, curves composed of two components, a fast initial decline followed by an exponential decrease. For each kind of kinetics, provided that the dose distribution is not too heterogeneous, the incidence of late effects appears to occur at exponential or approximately exponential kinetics, even many years after treatment. This implies that a random process might be involved in the occurrence of late radiation sequelae. CONCLUSIONS: There might be a lifelong risk of developing late complications, of which patients and clinicians should be aware. It appears worthwhile to try to identify, in follow-up examinations of patients after radiation therapy, what kind of processes might be involved in triggering subclinical residual injury to develop into a clinically manifest late effect.

Late complications after a combined pre and postoperative (sandwich) radiotherapy for rectal cancer.

BACKGROUND AND PURPOSE: The purpose of this study was to analyse the treatment related side effects, the outcome and the prognostic significance of clinical parameters in two groups of patients with rectal cancer receiving either preoperative or pre and postoperative radiotherapy after radical resection. The authors of this study were not involved in the radiation treatments. PATIENTS AND METHODS: From 1986 to 1990, 63 patients received a combined pre and postoperative (sandwich) radiotherapy. Preoperative irradiation was given in four fractions of 5 Gy each applied within 2 or 3 days. Postoperative irradiation consisted mostly of 15 x 2 Gy (31 patients) but the range was 20-40 Gy. The results were compared with those on 73 patients who only received preoperative radiotherapy in the same time period. The distribution of prognostic factors was not very different between treatment groups. Out of 63 patients in the sandwich group, 22 received concurrent chemotherapy and 18 also received radiotherapy to the liver. Radical surgery usually followed on the day after the last preoperative radiotherapy session. Median follow-up of survivors was 6 years. RESULTS: Local tumour control was 88% after 5 years and 84% after 8 years in the sandwich group, and 90 and 85%, respectively, in the preoperative radiotherapy group. Thus, tumour control was similar for the two radiotherapy regimens applied. However, the percentage of patients suffering from one or more complications after 5 years was 84% in the sandwich and 17% in the preoperative radiotherapy group. The incidence of severe late complications (grade > or = 3) was recorded as a function of time after start of treatment. In the sandwich group the actuarial rates of late complications at 5 years (and the median time to diagnosis) were 53% (27 months) for anorectum, 43% (37 months) for bladder, 28% (51 months) for bone, 19% (36 months) for dermis, 47% (48 months) for ileum, 41% (32 months) for lymphatic and soft tissue, and 44% (53 months) for ureters. CONCLUSIONS: Severe late reactions did not occur within a certain period of time, but continued to appear for at least 10 years after radiotherapy. Sandwich therapy, as given in this series, did not appear to give a greater tumour control than preoperative radiotherapy alone, whereas the rate of complications was drastically enhanced. Thus, the rationale of a sandwich therapy with a long time interval between surgery and postoperative irradiation appears questionable.

Late results of multiple fractions per day (MFD) with misonidazole in advanced cancer of the head and neck. A pilot study of the EORTC radiotherapy group.

In the EORTC Radiotherapy Group, the feasibility of multiple fractions per day (MFD) was tested in a pilot study from 1978 to 1980. Three daily fractions of 1.6 Gy were given (4 h interval) during 2 weeks (total dose 48 Gy), with a boost to about 70 Gy after 3-4 weeks. In 53 of the 179 patients, misonidazole was given on every irradiation day (1 g/m2, total 13-14 g/m2). Data on tolerance and early treatment results were published previously; results with a minimum follow-up period of 3 years are now available. Survival (actuarial is 21% and locoregional tumor control was obtained in 34% of patients; no significant differences were seen between the subregions in the head and neck area. Survival is better in patients treated with misonidazole (probably due to selection), but locoregional control was identical as in patients treated without the sensitizer. In February 1984, 38 patients were alive, 35 without evidence of local tumor (5 after rescue surgery). Metastases were seen in 16% and a second tumor in 7% of patients. Seventeen patients (9%) died of causes, possibly related to treatment; necrosis was observed in 8 (4 with local tumor). Late effects in the long survivors were comparable to what is usually seen after high-dose radiotherapy.

The EORTC randomized trial on three fractions per day and misonidazole in advanced head and neck cancer: prognostic factors.

In trial no. 22811 on a randomized comparison of multiple fractions per day (MFD), with or without misonidazole, to conventional fractionation in advanced head and neck cancer, a large number (523) of patients was entered in a short period of time. No differences in treatment results were obtained, but the study created an important database, allowing for detailed evaluation of the most important factors influencing prognosis. In univariate analysis, factors significantly influencing survival and locoregional control were: performance status, histological differentiation, tumor site, tumor and nodal staging, and tumoral and nodal volume. In multivariate analysis, significant factors for survival were nodal involvement, tumor stage, performance status, and tumor site. Significant factors for locoregional control were nodal involvement and total tumor burden. This analysis suggests that total tumor burden (volume) should be included in the interpretation of treatment results in head and neck cancer.

The EORTC randomized trial on three fractions per day and misonidazole (trial no. 22811) in advanced head and neck cancer: long-term results and side effects.

From 1981 to 1984, a randomized study was done by the EORTC Radiotherapy Group comparing a fractionation schedule with three fractions per day (multiple fractions per day, MFD), with or without misonidazole, to conventional fractionation. The aim of the study was to obtain improved local and regional control and survival by shortening of the treatment time in the first 2 weeks of irradiation. Three fractions of 1.6 Gy/day (4-h interval) were given during 10 irradiation days to a total of 48 Gy. After 3-4-weeks interval, a boost was given to 67.2 or 72 Gy also in three fractions per day. This schedule was compared to an identical arm with misonidazole 1 g/m2/day and a third arm with conventional fractionation (70 Gy in 35 fractions, 7 weeks or 75 Gy in 44 fractions, 9 weeks). A total number of 523 patients was included in the study. Acute mucositis was much heavier in patients treated with three fractions per day (Van den Bogaert et al. Int. J. Radiat. Oncol. Biol. Phys. 8: 1649-1655, 1982). Early results, communicated in 1986 (Van den Bogaert et al. Int. J. Radiat. Oncol. Biol. Phys. 12: 587-591, 1986) showed no differences in treatment outcome between the three treatment arms. Long-term results and data on late effects are now available. Survival at 5 years was 18% (SE 1.9%) and locoregional control was 27% (SE 2.9%). No statistically significant differences could be observed between the three treatment arms.(ABSTRACT TRUNCATED AT 250 WORDS)

Periplasmic cuticular calcium oxalate crystal deposition in Dracaena sanderiana.

• The chemical nature and biological basis for crystal deposition in epidermal subcuticular areas are reported here for the angiosperm Dracaena sanderiana. • Position, development and identification of crystals in adult leaves of D. sanderiana was carried out using X-ray diffraction, crystal morphology and scanning and transmission electron microscopy techniques. • Numerous small (< 1-6 µm) calcium oxalate monohydrate crystals were found between the primary epidermal cell wall and the cuticle. Their formation was highly specific and predictable with respect to location and relative timing of development during leaf ontogeny. The crystals were perisplasmic as, at formation, the nascent epidermal cell wall was external to the crystals. Cuticular crystallization of calcium oxalate monohydrate in D. sanderiana occurred in crystal chambers situated between the plasma membrane and the primary cell wall. Crystal deposition did not occur in developing guard cells. • The spatial pattern of calcium oxalate monohydrate within the epidermal cells, orientation of the crystallographic axes and the existence of crystal chambers outside the plasma membrane suggest biologically controlled crystal deposition in D. sanderiana.

Myeloid leukemia 239Pu-treated mice.

Incidence of myeloid leukemia was studied in 79 mice injected i.v. with 180 kBq 239Pu/kg. Plutonium-treated mice were compared with 70 controls of the same origin and sex (random-bred ICR-SPF female mice). The animals were killed moribund and the disease was diagnosed on the basis of histological and cytologic examination of bone marrow, spleen, liver, peripheral blood, and other tissues. It has been found that 22 plutonium-treated mice (27.8%) and 17 controls (24.3%) were leukemic. The mean survival of diseased animals was 459 +/- 19 days in the tested group and 559 +/- 24 days in controls. It means that the occurrence of myeloid leukemia was not very different in irradiated and control mice, but under plutonium contamination the disease appeared significantly earlier and its incidence was shifted to the younger age.

Comparison of methods employing gas chromatography retention data to determine vapour pressures at 298 K.

Validity of five models suggested for expressing the relationship between vapour pressures and GC retention times measured on a non-polar capillary column were tested on a common set of compounds [five homologous series of the type H-(CH2)n-Y, where Y denotes Cl, Br, CHO, OCOCH3 and COOCH3, and n varies from 6 to 14]. Standard methods of statistical analysis, as well as vapour pressure values obtained independently from direct vapour pressure measurements were used as validity criteria. For the 40-compound data set examined, the methods provided vapour pressures agreeing within 9.2-24.7% (average absolute percent error) with direct experimental data.

Reduction of subacute lethal radiotoxicity of polonium-210 in rats by chelating agents.

The protective effect of N,N'-di(2-hydroxyethyl)ethylene-diamine-N,N'-biscarbodithioate (HOEtTTC) against the subacute lethal radiotoxicity of polonium-210 was investigated in a survival study and by histopathological and haematological examinations of some organs and tissues in Sprague-Dawley rats. This effect was compared with that of N,N'-diethylamine-N-carbodithioate (diethy dithiocarbamate, DDTC). In the survival study, rats injected in intravenously solely with a lethal amount of 210Po (1.45 MBq kg-1 body mass) died within 14-44 days while 90% of rats treated with HOEtTTC survived for 5 months until sacrificed. When treated with DDTC all rats died within 36-93 days. In the histopathological examination, relevant changes resulting from incorporation of 210Po were found in lymph nodes, thymus and humeral bone marrow. After the treatment with HOEtTTC no pathological changes were observed. In the haematological examination, severe reduction in blood and femoral bone marrow (BM) cell counts was revealed in rats injected with 210Po. This reduction was reversed by treatment with HOEtTTC. Treatment with DDTC led only to partial recovery of blood and BM cell count. In conclusion, under the conditions of the experiment only HOEtTTC was fully effective in reducing subacute lethal radiotoxicity of 210Po.

Radiotherapy by several sessions a day.

The early clinical experience with external beam radiotherapy using three treatment sessions a day is briefly reported. Thirty-seven patients suffering from advanced malignant disease, mostly of the breast or neck, were treated. The normal tissues tolerance was similar to the tolerance of daily fractions using the same doses.

Further experience with radiotherapy by multiple daily sessions.

Since 1972 over 100 patients have been treated by frequent daily sessions of radiotherapy with a short overall time. Cobalt 60 teletherapy and 250 kV X-ray beams have been used with radical or palliative dosage. The tolerance to these regimes of the skin, breast, chest wall, neck, lung and pelvis is discussed and the tumour responses described. Radiotherapy by multiple daily sessions is clinically possible and often an advantage. Its therapeutic ratio is not inferior to comparable regimes using longer intervals.

Management of soft tissue sarcomas in Portsmouth 1965-1985.

This paper describes the results of combined surgical and radiotherapy management of 118 patients with soft tissue sarcoma referred to the Department of Radiotherapy and Oncology at Portsmouth between 1965 and 1985. After exclusion of paediatric rhabdomysarcomas, tumours of the gastrointestinal tract and patients who were referred for follow-up only, 109 patients were left for retrospective analysis: 23 patients had surgery only, 11 received a course of preoperative radiotherapy, 52 were irradiated postoperatively and 14 had only radiotherapy. A range of doses and fractionations was used. The total 5-year actuarial survival was 39.7%, the disease-free survival was 35.6%. After excluding Kaposi sarcomas, retroperitoneal tumours, patients with distant metastases or those too ill for radical therapy, the respective figures were 55.5% and 49.7%. If we also excluded patients, treated by radiotherapy only, or irradiated with gross postoperative disease, the figures were 62.7% and 57.3% respectively. Five-year actuarial local control in 68 patients irradiated either without surgery, or postoperatively, was 57.2%. In tumours smaller than 5 cm in diameter, 5-year survival was 86.7%, and local control was 93.3%. For large tumours over 10 cm in diameter, the respective values were 22.2% and 50%. The dose of 60 Gy was satisfactory, if the surgical procedure removed all macroscopical disease, but higher doses are recommended when there is clinically apparent residual disease.