Radiation therapy for symptomatic vertebral haemangioma.

Vertebral haemangiomas are slowly growing benign tumours and are usually asymptomatic. They rarely cause symptoms and signs related to cord compression. Larger lesions create significant problems during surgery because of haemorrhage and vascular supply crucial to spinal cord function. In such severely symptomatic vertebral haemangiomas, radiation therapy has been tried and good results obtained, especially in terms of good functional recovery. We have treated 17 patients (including nine paraplegic patients) with radiotherapy (Co-60). Treatment was given by single posterior field, encompassing the involved area with a dose of 35-40 Gy in 3 to 4 weeks (five fractions per week). All patients with pain and tenderness were relieved completely (87.5%) or partially (12.5%). Similarly patients with numbness and paresis showed either complete (66.7%) or partial response (33.3%) from symptoms on follow-up. Out of nine paraplegic patients six (66.6%) had recovered completely, one (11.2%) partially and two (22.2%) had no response. The two patients who did not show any marked relief, had paraplegia of longer duration (more than 6 months). Our study indicates that severely symptomatic vertebral haemangioma can be successfully treated by radiation therapy and it can be chosen as first line of treatment with an optimum dose of 35-40 Gy in 3 to 4 weeks.

Giant cell tumor of the spenoid bone.

The clinical features of the giant cell tumor of the sphenoid bone have been discussed and a case report has been added to the fourteen cases reported in the literature. Such cases may first report to an ophthalmologist, an otolaryngologist, a neurologist, or an internist. They should consider this condition in a patient who complains of headache, ocular symptoms such as diplopia, and diminution of vision progressing to complete blindness. The presence of multiple cranial nerve palsies involving II, III, IV, V, and VI nerves in various combinations and the sellar erosion in the lateral x-ray of the skull are quite suggestive of this tumor which should be confirmed by biopsy. The telecobalt therapy appears to give the best results.

Male breast cancer.

This study comprises 27 cases of male breast cancer treated at the University Hospital from 1966 through 1978. Its incidence was 0.53% of all cancer in males and 3.2% of all mammary cancers. Mean age was 52 years old. Lump in the breast was the commonest presenting feature in all patients followed by skin ulceration in 44.4% of cases. The average duration of symptoms was 16 months. Twenty-five patients had infiltrating duct carcinoma and two had papillary carcinoma. Two cases were in stage I, 10 in stage II, 11 in stage III, and 4 in stage IV. Of the 12 patients in stages I and II who underwent radical mastectomy, the axillary lymph nodes were pathologically negative in stage I and positive in stage II. The nodes were clinically involved in stages III and IV. Simple mastectomy followed by radiotherapy were used in stage III cancer and all patients in stage IV cancer had only biopsy and palliative chemotherapy. Bilateral orchidectomy followed by estrogen gave only marginal benefit in terms of survival and objective regression. Only four patients, two each in stages I and II, are alive and well for more than five years. These include two cases of papillary carcinoma. Poor prognosis in this series was exclusively determined by axillary lymph node involvement, although other factors such as shorter span of symptoms, younger age group, higher incidence of skin involvement, and invasive nature of carcinoma also appear to be significant.