Analysis of factors contributing to treatment failures in stages IB and IIA carcinoma of the cervix

Between April, 1971, and September, 1977, 98 patients with Stages IB and IIA cervical cancer who underwent surgical exploration prior to treatment at Hershey Medical Center were studied. Those who had bulky primary tumor (greater than or equal to 4 cm) had a higher incidence of nodal metastases (80% vs. 16%), local recurrences (40% vs. 5%), and distant metastases (40% vs. 1%). Patients who had positive nodes had more local recurrences (24% vs. 6%) and distant metastases (28% vs. 0%). Those with grossly positive nodes had more distant metastases (60% vs. 7%) than those with microscopically positive nodes. Those who had positive nodes, vascular invasion, and/or deep invasion of the cervix (greater than or equal to 70% of thickness) in the radical hysterectomy specimen had more nodal metastases and local recurrences. Postoperative radiation seemed to prevent local recurrences (40% vs. 6%) and improve the 2-year tumor-free survival rate (94% vs. 55%). Patients who had bulky primary tumors and/or grossly positive nodes at laparatomy may require systemic therapy in view of the high incidence of distant failures.

Histologic grading in the clinical evaluation of laryngeal carcinoma

A histologic grading system based on tumor differentiation was applied in a study of 73 patients with epidermoid carcinoma of the larynx treated at the Milton S. Hershey Medical Center of the Pennsylvania State University from 1971 through September 1977. The supraglottic and subglottic primary tumors were more likely to be poorly differentiated than the glottic carcinomas. In general, the more poorly differentiated the primary tumor, the more advanced was the stage of disease, and the higher the incidence of cervical node metastasis. After treatment, grade 3 patients have a higher incidence of treatment failure and cancer death than grade 1 or 2 patients. The findings suggest that a histologic grading system is an important adjunct to the clinical evaluation.

Radiotherapy in the management of primary malignancies of the hard palate

Primary malignancies of the hard palate are rare. Only 66 cases have been seen at the University of Virginia Hospital in the 43 years from 1932 through March 1975. These have been reviewed with regard to age, sex, race, histology and clinical presentation. There was 32 squamous cell carcinomas, 25 salivary gland tumors and 9 nonepithelial malignancies. The nonepithelial malignancies were a diverse group and are not considered further. The results of treatment for the squamous cell carcinoma group and salivary gland tumors have been analyzed by stage and mode of therapy. Although no great improvement in the results of surgery or combined therapy have been observed over the years in the squamous cell carcinoma group, there has been a dramatic improvement in the results of treatment with radiation therapy from the orthovoltage era to the super-voltage era. Primary control with radiation therapy for the squamous cell carcinoma group was 2/5 (40%) in the orthovoltage era and 7/7 (100%) in the supervoltage era. Surgery would appear to be the appropriate treatment for salivary gland tumors with possibly a place for combined therapy. Radiation therapy proved useful in salvaging certain surgical failures. The time of appearance of local recurrence following initial therapy, the incidence of distant metastases and second primary tumors were analyzed and are presented.

Early corticosteroid administration in experimental radiation-induced heart disease

The ability of dexamethasone (DEX) to reduce the severity of the late stage of radiation-induced heart disease (RIHD) was assessed in 25 New Zealand white rabbits. Ten rabbits served as unirradiated controls (CONT). In Group A, seven rabbits received intravenous DEX prior to irradiation and every 24 hours for three consecutive days. DEX was not administered to the eight rabbits in Group B. At 100 days postirradiation, the severity of the late state was determined by microscopic examination (MICRO) for myocardial fibrosis and determination of myocardial hydroxyproline content (MHP). Myocardial fibrosis was evident in Groups A (40%) and B (80%) while none was present in CONT by MICRO. One rabbit in Group B with no fibrosis by MICRO had abnormally increased MHP. MHP was significantly increased in Groups A and B, as compared to CONT (p less than 0.01). In addition to less fibrosis by MICRO, Group A demonstrated a significant reduction of MHP when compared to Group B (p less than 0.05). Determination of MHP may be superior to MICRO in the detection of the late stage of RIHD. Also, early DEX administration appears to reduce myocardial collagen content (fibrosis) in this experimental model.

Tumor sterilization following high-dose pre-operative irradiation for advanced cancer of the larynx or pyriform sinus

Twenty-two patients with advanced laryngeal cancer and 5 with advanced pyriform sinus cancer were given 51 Gy (5,100 rad) followed by surgical resection. In 10 (45%) of patients with laryngeal cancer, no tumor was found at the primary site pathologically; 15 (68%) had negative neck specimens. All of those with pyriform sinus cancer had positive specimens. Eighteen patients with laryngeal cancer are free of disease. In contrast, only 1 with pyriform sinus cancer is free of disease; 1 has had a local recurrence and 3 have had metastases. The data suggest that 51 Gy (5,100 rad) are insufficient to sterilize pyriform sinus cancer; higher doses together with adjuvant chemotherapy are needed.

Postoperative beta irradiation in the treatment of pterygium

High recurrence rates are reported after surgical treatment of pterygia. With the use of beta irradiation, the recurrence rate drops dramatically. This paper describes technic and dosage used in a group of patients receiving postoperative beta irradiation. Two thirds of these patients, however, had at least two surgical procedures. A recurrence rate of 3.5% was observed, with no apparent morbidity.

Malignant salivary gland tumors of the palate

Twenty patients with malignant salivary gland tumors of the hard and soft palate were seen at the University of Virginia Hospital from 1956 through 1975. The characteristics of the tumors, including symptoms and histology are reviewed and the results of treatment are analyzed. In particular, the place of radiotherapy in their management has been examined. Primary control by initial surgery alone was achieved in 60% (9/15) of the cases, and, when those patients who received radiotherapy for residual disease or salvage are included, the primary control was 94% (16/17). Five- and ten-year determinate survival rates were 88% and 67%, respectively. From this retrospective analysis and a review of the literature, it appears that radiotherapy has made a very positive contribution to the management of these tumors.

Complications of laryngectomy and neck dissection following planned preoperative radiotherapy

One hundred sixty-nine patients with carcinoma involving the larynx treated with surgery, combined preoperative radiotherapy plus surgery, or failed curative radiotherapy with surgical salvage have been evaluated with respect to complications. Major complications occurred at approximately the same rate with all three modes of therapy. Major complications had generally a later onset and healed less rapidly in the preoperative radiotherapy group. Minor complications occurred more frequently in irradiated patients than in nonirradiated patients. When evaluating postoperative complications in irradiated patients the time interval must be extended beyond the immediate span because of delayed onset.