Chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma: a radiation therapy oncology group study.

The results of radiotherapy alone for patients with locally advanced (stage III or IV) nasopharyngeal cancer (NPC) are poor in spite of the initial complete clearance. Twenty-seven patients (26 stage IV) were treated with concurrent standard radiotherapy and cisplatin 100 mg/m2 intravenously on day 1 and every 3 weeks for three courses. In 24 (89%) patients, complete response (CR) was achieved. The CR rate was higher for poorly undifferentiated cancer (100%). The major side effects were leukopenia (97%), anemia (54%), nausea and vomiting (81%), stomatitis (92%), and renal impairment (52%). Most of these side effects were either mild or moderate and reversible. All patients finished the radiotherapy dose (greater than 6,450 cGy), 19 (70%) had three courses of cisplatin, and eight had only two courses, six due to drug toxicity. Twenty-six patients with stage IV disease were compared with 78 patients treated with radiotherapy alone by the Radiation Therapy Oncology Group (RTOG). The disease-free survival (DFS), overall survival, and the incidence of distant organ metastasis appear to be better in the combined group. It was concluded that the combination of chemo-radiotherapy in patients with locally advanced NPC needs to be evaluated in a phase III randomized trial.

Delivering surface irradiation to persistent unresectable squamous cell carcinomas: a prosthodontic solution.

A simple afterloading maxillofacial radiotherapy prosthesis is used to provide surface irradiation to a persistent superficial carcinoma. Fabrication, loading, and application of the device, as well as indications for and advantages of its use, have been presented.

Myelographic evidence for nerve root enlargement in a case of Charcot-Marie-Tooth disease.

The myelographic findings of enlarged nerve roots in a patient with Charcot-Marie-Tooth disease is found to be identical to those of Hypertrophic Interstitial Neuritis and Neurofibromatosis. The hypertrophy of the roots may represent a single response to different noxious stimuli. Clinical and laboratory differentiation are given for the diseases.

Local control of breast cancer with tumorectomy plus radiotherapy or radiotherapy alone.

58 cases of breast cancer treated primarily by radiotherapy were evaluated to determine the optimum dose for local control. Of 36 patients with T1 + T2 lesions who had tumorectomy prior to radiotherapy, incomplete excision of tumor was demonstrated on microscopic examination in 18. The minimum tumor dose to the breast was 4,500 rads in 5 weeks. Treatment failed to control local tumor in only 2 (5%) and metastases in 1.26 (72%) remained disease-free for 2 to 9 years. Of the 22 patients with T3 + T4 lesions, treatment failed to control both local tumor and metastases in 12 (54%); in those who received 6,000 rads or less in 6 weeks, treatment failed to control any of these lesions. 4,500-5,500 rads controlled the tumor in 95% of those with NO + N1 disease, compared to only half of those with N2 + N3 tumors.

The treatment of locally advanced carcinoma of the colon and rectum by a surgical procedure and radiotherapy postoperatively.

Following resection of locally advanced carcinomas of the rectum and colon, 95 patients received moderate dose elective radiotherapy either to an inverted T field or the entire abdomen. In 27 instances, carcinomas invaded adjacent structures and were incompletely resected. Fifty-seven patients had tumors of the rectosigmoid and had either an abdominoperineal or an anterior resection. Thirty-five patients had a mean follow-up period of 26 months. Three of 35 carcinomas recurred locally, 26 of 35 patients are alive without disease. Thirty-eight patients had carcinomas of the colon and had either a partial or hemicolectomy. Thirty-one had a mean follow-up period of 24 months. Five of 31 carcinomas recurred locally. Seventeen of 31 patients are alive, without disease. Sixty-six of 95 patients have survived two years free of disease. One death occurred from radiation enteritis. Radiotherapy postoperatively for patients at a high risk of failure resulted in a low incidence of local recurrence.

Elective postoperative radiotherapy for locally advanced colorectal cancer. A preliminary report.

Preoperative radiotherapy in colorectal carcinoma invalidates surgical staging and delays performing the surgical resection. Postoperative radiotherapy does neither. From October 1972, to December 1975, 40 patients at high risk for local recurrence (B2 and C) received postoperative radiotherapy. Lesions that were located in the rectum, rectosigmoid and low sigmoid colon were given 4600 rads in four and a half weeks through an inverted T-shaped field which encompassed the pelvic and paraortic nodes. Patients with tumors located above mid-sigmoid were treated to the entire abdominal cavity by the moving strip technique. Of 19 patients with rectal and rectosigmoid lesions, 14 (74%) are alive without evidence of disease. Two had local recurrence in the treated area. Of 21 patients with lesions above the mid-sigmoid, four have failed locally, while 11 (52%) are alive without evidence of disease. One of these 40 patients died to radiation enteritis. Although the follow up period is short, the results suggest that a moderate dose of radiation may prevent local recurrence in patients with locally advanced colorectal cancer.