Combined treatment modalities of rhabdomyosarcoma in children

Thirty-nine previously untreated children with rhabdomyosarcoma were managed by a coordinated program of surgery, radiation therapy, and chemotherapy during the years 1960 to 1973. The primary tumor was located in the head and neck (24), chest wall (1), abdomen (1), pelvis (10), and lower extremity (3). Radiation therapy consisted of tumor doses of 5000 to 6000 rads delivered in five to six weeks. Combination chemotherapy with actinomyctin-D, vincristine and cyclophosphamide was used after 1968. Seventeen of 25 cases (68%) treated after 1968 are alive two to five years following treatment. Only four of 14 cases (29%) who received less radical therapy before 1968 are alive. A relatively high incidence of local failure (23%) was noted in spite of adequate doses of radiotherapy. None of the four cases with metastatic disease at the time of diagnosis survived. Major complications were mainly noted in patients with orbital rhabdomyosarcoma. Correlation of absolute survival with dose of irradiation, primary site, extent of disease and histologic subtypes of the tumor are discussed.

Radiation therapy in the management of carcinoma of the lung

Carcinoma of the lung is the most common cancer in men in the United States and a major cause of death. This is due to the inadequate techniques for screening of high-risk patients and for detection of the tumor in early stages, before distant dissemination occurs. Although some progress has been made in the past, particularly in improving the knowledge of natural history and pathological characteristics of the disease, and there are better indications for surgical treatment and irradiation and the effective use of cytotoxic agents in selected groups of patients, particularly those with small cell undifferentiated carcinoma, the mortality rate is still very high. A great deal of investigation remains to be done in carcinoma of the lung concerning the basic cell kinetics of the tumor and the optimal conditions for the use of surgery, irradiation, chemotherapy or combinations of these agents in the treatment of these patients before survival rates can be substantially improved. Since the most important factor in patient mortality is distant tumor dissemination, it must be stressed that parameters other than survival should be used to evaluate the effectiveness of irradiation, surgery or combinations in the control of local and regional bronchogenic carcinoma. These efforts should be intensified through properly designed clinical trials.

Non-randomized comparison of preoperative irradiation and surgery versus irradiation alone in the management of carcinoma of the tonsil

This is a non-randomized comparison of 98 patients with epidermoid carcinoma of the tonsil treated by preoperative irradiation and surgery and 97 patients receiving irradiation alone. Patients treated with preoperative irradiation received, in most instances, 3,000 rads tumor dose in three weeks through ipsilateral portals, followed within two to six weeks after completion of therapy by an en bloc tumor resection and radical neck dissection. The group treated with irradiation alone received tumor doses in the range of 5,500-6,500 rads in six weeks. No significant difference was noted in the survival yielded by either treatment modality. Both treatment modalities were equally effective in controlling the tumor in the metastatic ipsilateral lymph nodes. In selected cases, a combination of both modalitites may offer better results, but this remains to be proved.

Effect of irradiation on immune responses

The radioresistance of antibody-mediated immune response is lowest when radiation is given before antigen, and rises steadily with time after antigen stimulation to reach a maximum when serum antibody is at a maximum, suggesting that antibody-producing cells are highly resistant. Irradiation affects the antibody-mediated response by 1) lengthening the period between stimulation and production of detectabel levels of serum antibody, 2) decreasing the rate of increase in serum antibody levls, and 3) decreasing the maximum concentration of serum antibody. Irradiation affects the cell-mediated response by inhibiting immunization and delayed hypersensitivity reactions when administered before antigen. Because the cell-mediated response involves nonlymphoid cells whose precursors are also radiosensitive, irradiation following stimulation may also produce temporary suppression.

Radiation therapy in the management of carcinoma of the ovary

The results in 212 patients treated with radiation therapy for various stages of carcinoma of the ovary are reported. The role of radiation therapy in the management of these patients is analyzed in the light of available data. Radiation therapy may improve the survival of patients with stage I ovarian cancer (with poorly differentiated lesions or extension through the capsule) and the survival of patients with stage II ovarian tumors. The patients with stage III ovarian lesions may benefit by a combination of irradiation and chemotherapy. A multidisciplinary approach to ovarian carcinoma must be promptly established, with participation of gynecologic surgeons, radiation therapists, pathologists, and chemotherapists. More thorough staging procedures and well-defined pathologic classifications are necessary. The biologic and pathologic behavior of these tumors must be further elucidated. The limitations of each treatment method must be exactly defined. Based on this information, rational treatment schemes may be formulated. Controlled clinical trials are necessary to evaluate the effectiveness of optimal surgery, irradiation, and chemotherapy, or their combinations.

Prognostic significance of endometrial extension from primary carcinoma of the uterinecervix

This is a retrospective analysis of 302 patients with histologically confirmed primary carcinoma of the cervix on whom a dilatation and curettage was performed during the initial workup. The prognostic significance of endometrial extension of the tumor was investigated. Four different types of specimen were identified: 1) endometrial extension of cervical carcinoma; 2) cervical carcinoma in the currettings only; 3) a mixture of normal endometrium and and epidermoid carcinoma in the curettings; 4) no cervical carcinoma noted (negative D&C). The patients were staged according to the FIGO classification. Patients with Stage I carcinoma and positive D&Cs showed significantly lower 3-5 year survival rates (50-60 percent), as opposed to those with D&C.

Glomus jugulare tumors: effects of radiotherapy

Twenty glomus jugulare tumors which received x-ray therapy are analyzed. Postirradiation angiography showed persistent tumor vessels and abnormal channels in eight patients. Histologic study of five postirradiation specimens showed that tumor cells persisted after treatment in a significant proportion of the patients. Vascular response was nonuniform and consisted of endothelial hyperplasia and subendothelial hyalinization. Radiotherapy is not always effective in the permanent eradication of the tumor when used as the only modality of treatment in patients with large glomus jugulare tumors. Because of the frequent recurrence after irradiation or surgical resection, a combination of both modalities offers the patient the best probability of cure.