An outcome study of the RTOG Cancer Control program.

The Cancer Control program, funded by the National Cancer Institute, was initiated with the goal of involving community hospitals in multi-institutional clinical trials. The Radiation Therapy Oncology Group (RTOG) began participating in this program in 1976. This investigation compares the survival of patients treated by protocol in RTOG Full Member versus Cancer Control institutions between 1976 and 1985. The RTOG has 28 Full Members which are major treatment centers and enter at least 50 patients on RTOG protocols each year. The 11 Cancer Control members, which are mostly community hospitals, must enter at least 12 patients on RTOG protocols each year. A comparison of survival between Full Members and Cancer Control members was made for five RTOG studies. No difference in data quality or protocol compliance was observed for these studies between Cancer Control and Full Member institutions. Overall survival comparisons, as well as comparisons adjusted for prognostic factors, were made for each of the five studies. No differences in survival between Cancer Control and Full Members were observed in either analysis.

Radiation therapy alone or in combination with chemotherapy in the treatment of residual or inoperable carcinoma of the rectum and rectosigmoid or pelvic recurrence following colorectal surgery. Radiation Therapy Oncology Group study (76-16).

Between 1976 and 1981, 147 patients with residual, inoperable, or locally recurrent carcinoma of the rectum were randomized to receive either radiation (XRT) alone or XRT plus chemotherapy (concomitant 5-FU during XRT and maintenance 5-FU + MeCCNU). An initial field received 4,500-5,100 rad in 5-6 weeks, with a boost field dose to a maximum of 7000 rad/8 weeks (maximum 6,000 rad/7 weeks with chemotherapy), dependent on findings of special small bowel films. One hundred twenty-nine patients were evaluable (65 XRT, 64 XRT + chemo). There were no statistically significant differences between treatments with respect to overall survival, complete remission rate, time to disease progression, local failure rate, or radiation dose distribution. Median survival was 17 months for XRT, 18 months for XRT + chemo; the 2-year survival probability was 36% for XRT, 44% for XRT + chemo. Initial performance status was a significant prognostic factor for both survival and time to disease progression. A trend was observed favoring the combination treatment for patients with residual disease. Treatment complications were greater for the combined modality arm than for radiation alone. Twenty-seven patients (22%) were alive at last data analysis, with no evidence of disease (NED) from 2-51 months (30 months median). Patients with resection of gross disease before or after irradiation had a much better result than those with gross residual or without any resection, but the relative influence of patient selection versus impact of surgery remains unclear.

Radiation therapy technology manpower needs 1982.

A shortage of radiation therapy technologists has existed in the United States for many years. This report analyzes the data from the third manpower survey of ACR/ASTR carried out in 1981 to 1982, using the Patterns of Care master facility list. Of 1106 questionnaires mailed, 77% were returned. The survey identified 3757 technologists performing radiation therapy technology duties. Of these, 2537 of these were Registered Technologists (Therapy) American Registry of Radiologic Technologists RTT (ARRT), 1220 were not. There has been a good growth in the total number of RTT (ARRT) members as indicated by the 1982 ARRT Annual Report (1148 in May, 1977, 2878 in May, 1982). Using the "Blue Book" Criteria of 1981 of 2 RTT/megavoltage unit or 2 RTT/300 new patients, the technology need (2900) would appear filled. However, 860 of the RTT were performing supervisory or dosimetry duties and 42% of the 2897 staff technologists were non RTT personnel. At the time of the survey, 597 funded vacancies existed (241 in 1977). A trend toward a changing standard of 3 RTT/megavoltage unit, reflecting the increased complexity of modern radiation therapy techniques, especially in Patterns of Care Strata A1, A2, C1 institutions was identified. While great progress has been made, there is a continuing need for recruitment into the 113 existing educational programs to try to stabilize the supply of technologists. Attention should also be given to measures for upgrading the skills and knowledge of the non RTT personnel in the field and retention of the RTT personnel.

An evaluation of a cancer control outreach program in radiation therapy.

Using the methodology of retrospective chart review, this study in radiation therapy compared workup and treatment scores for two groups of community hospitals. The group that participated in clinical trials with a radiation therapy cooperative consortium was superior in several respects to a matched comparison set of hospitals. However, the superiority appears to have been in evidence before the program began. There are presumed to be selection mechanisms that operate to bring certain facilities into the clinical research effort, while excluding others.

Computed tomographic evaluation of laryngeal neoplasms.

Nineteen patients with laryngeal lesions each underwent diagnostic studies consisting of laryngoscopy and computed tomography (CT). Sixteen patients had linear tomography and coronal and sagittal reconstruction of their transaxial CT images. The results of each examination were compared with the surgical and pathological findings to assess their relative value. The results confirmed previous reports of the accuracy and value of transaxial CT and direct laryngoscopy, but indicated that coronal and sagittal reconstruction as well as linear tomography added no significant information.

Radiologic technology and education: the role of the radiologist.

Present methods of accreditation of education of all programs in radiologic technology and credentialling of radiologic technologists are based on the activities of the Joint Review Committee on Education in Radiologic Technology (JRC-ERT), and the American Registry of Radiologic Technologists (ARRT), but with increasing role of government in this process. Because it is so important to radiology and radiologists that this process continue, radiologists are urged to play a more active role.

The association of the IGA levels of serum and whole saliva with the progression of oral cancer.

Elevated IgA concentrations in the serum and whole saliva of patients with neoplastic disease have been reported. However, there does not seem to be any information available on the correlation of the secretory immunoglobulins of these patients with the progress of their disease. The whole saliva and sera of 102 cases of squamous carcinoma of the oral mucosa were studied. Patients were subclassified into age-matched groups of primary untreated cancer (21), recurrent cancer (18), and "cured" patients who had been free of disease for at least 9 months (16). A separate group of laryngeal (14) patients was included. Sixteen (16) patients treated by radiation therapy alone were also included to test the effects of radiation on whole saliva IgA. An age-matched group of patients (17) with moderate to severe periodontal disease served as controls. Unstimulated whole saliva was collected for 15 minutes and stored at 0 degrees C. IgA was quantitated by radial immunodiffusion on Hyland and Meloy Laboratory low level plates with 7S and 11S standards. Serum IgA was measured on Hyland plates with serum standards. Protein content of saliva was assayed by the Lowry method. Flow rate was quantitated for the 15-minute collection period. Primary oral and laryngeal cancer patients had a two-fold increase of serum and salivary IgA compared to controls. Recurrent cancer patients had even greater elevation of salivary IgA. Cured patients showed a persistent elevation of serum but a return to normal of salivary IgA. Radiation therapy did not markedly influence the level of salivary IgA. A followup study of 26 patients confirmed this pattern of a drop in whole salivary IgA with cure and a spike with recurrence. It would appear that IgA levels of whole saliva and serum are elevated in oral cancer patients, and that salivary IgA levels may prove useful in distinguishing patients with possible recurrent disease.