A prospective randomized study concerning to the point A dose in high-dose rate intracavitary radiation therapy for carcinoma of the uterine cervix

From January 1983 through December 1987, a total of 138 patients with previously untreated carcinoma of the uterine cervix were entered into the prospective randomized study concerning the two different schedules of point A dose of remote afterloading high-dose rate intracavitary therapy (RALS) and external irradiation dose at the Center for Adult Diseases, Osaka. Group A consisted of 71 patients who were treated with fraction size of point A dose of 7.5 Gy and group B included 67 patients treated with fraction size of 6 Gy. According to the staging system of UICC (1978), 33 patients were classified into stage I, 50 patients stage II, 45 patients stage III, and ten patients stage IV. Three-year survival rates by stage and RALS schedule were in group A 80% and in group B 100% in stage I, 57% and 68% in stage II, 62% and 60% in stage III and 2/8 and 0/2 in stage IV. Survival curves showed no statistically significant difference in each stage. Late rectal and bladder complications requiring treatment (Kottmeier's grade 2 or more) after RALS developed 1.5% (2/138, group A none, group B two) and 1.5% (2/138, group A one, group B one), respectively. This result suggests that this trial is acceptable on survival as well as complication rates.

The nucleotide sequence and genome structure of the geminivirus miscanthus streak virus

A tandem dimer of miscanthus streak virus (MiSV) DNA was inserted into the T-DNA of the binary plasmid vector pBIN19 and agroinoculated into several monocotyledonous plants (monocots) using Agrobacterium tumefaciens or A. rhizogenes. Disease symptoms and geminate particles were produced in maize and Panicum milaceum plants, and MiSV-specific double-stranded and single-stranded DNAs were found in these plants. The nucleotide sequence of the infectious MiSV clone, consisting of 2672 nucleotides, was determined. Four open reading frames (ORFs) for proteins of Mr greater than 10K were identified, two (V0 and V2) in the virus (+) sense and two (C1 and C2) in the complementary (-) sense, although C2 did not have an ATG start codon. Unlike other geminiviruses infecting monocots, complementary-sense ORFs did not overlap. Potential splicing donor and acceptor sites were identified in the sequence of the border region between the C terminus of ORF C1 and the N terminus of ORF C2. Amino acid sequences predicted from three (V2, C1 and C2) of these ORFs showed significant homology with the corresponding ORFs of other geminiviruses infecting monocots. A fifth ORF (V1), which showed some homology with ORF V1 of other monocot-infecting geminiviruses despite having a coding capacity for a product of Mr 8.8K, was found just upstream of ORF V2 as observed in those geminiviruses. ORF V0 showed no significant homology with ORFs present in any other geminiviruses. A mutation of V0 indicated that the C-terminal 30% of this ORF was not necessary for infection in maize, but that sequences around the mutated LspI site might have some regulatory role.

Molecular cloning, sequencing and expression in Escherichia coli of the odontoglossum ringspot virus coat protein gene

The sequence of the 3'-terminal 1865 nucleotides of the genome of the tobamovirus odontoglossum ringspot virus (ORSV) was determined. This sequence contained two open reading frames (ORFs), 912 and 477 nucleotides long. The 912 nucleotide ORF has been identified as the cell-to-cell transport protein gene. The 477 nucleotide ORF was expressed in Escherichia coli, and the product was detected by antibodies specific for the coat protein of ORSV. The amino acid sequence of protein encoded by this ORF shares 84% similarity with the tobacco mosaic virus (TMV) (vulgare) coat protein. The 3'-terminal untranslated region of ORSV comprises 414 nucleotides, 210 nucleotides more than that of TMV (vulgare) RNA.

Antibody response against the Epstein-Barr virus-coded nuclear antigen2 (EBNA2) in nasopharyngeal carcinoma

Specific antibody responses against the Epstein-Barr virus-coded nuclear antigen2 (EBNA2) were evaluated. Thirty-five sera from pretreatment patients of nasopharyngeal carcinoma (NPC) and 12 from healthy adults were tested. Although the anti-EBNA2 response did not show any correlation with T stage, overall stage, or histopathology, it showed a correlation with the N stage of the disease. In a serological follow-up study, 17 (85%) of 20 patients showed a correlation on the change of antibody levels to EBNA2 and clinical progression. This suggests that EBNA2 serology might represent a useful marker relative to tumor status.

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck

From October 1977 through September 1986, a total of 77 patients (Stage I, 26; II, 35; and III-IV, 16) with primary non-Hodgkin's lymphoma (NHL) of the head and neck were treated with radiation therapy and chemotherapy (CVP or CHOP regimen) or radiation therapy alone. Actuarial 5-year survival rates by stage were 79% in Stage I, 35% in II, and 8% in III-IV. Significant prognostic factors were clinical stage (p = 0.0001), histological grade by the Working Formulation (p = 0.0089), and surface marker (T and B cell analysis) (p = 0.0001). In Stage II patients, the serum lactate dehydrogenase (LDH) level (p = 0.0286), the number of cervical lymph nodes involved (p less than 0.03), and maintenance chemotherapy after initial treatment (p = 0.0077) were significant prognostic factors. In conclusion, more intensive chemoradiotherapy is necessary as the first-line treatment in those with poor prognosis, especially those with T-cell type and high grade histology. In addition, maintenance chemotherapy after initial chemoradiotherapy is very important for Stage II NHL patients, especially those with a high LDH value or multiple cervical lymph node involvement.

Prognostic factors in patients with brain metastases from lung carcinoma: preliminary result of the second trial

Between September 1980 to December 1984, 85 patients with brain metastases from lung carcinoma were consecutively evaluated and were entered into the first prospective randomized trial. Since January 1985, the second prospective randomized trial was started based on the result of the first trial, i.e., lactate dehydrogenase (LDH) as the most important prognostic factor. We analyzed neurological improvement and survival of 79 patients, who were entered into the second trial until November 1988, compared with the first trial. This preliminary result suggests that LDH may also be an important prognostic factor in the second trial and neurological improvement may depend upon the irradiation dose, therefore we need further investigation in this second trial.

[Radiation therapy for prostatic cancer]

From February 1979 through May 1988, a total of 26 patients with adenocarcinoma of the prostate were treated with radiation therapy for the primary site. The actuarial 5-year survival rate was 59% for 14 patients with Stage C or less disease (A; 1 case, B; 2 cases, and C; 11 cases), and 10% for 12 patients with Stage D. The logrank test showed significant difference between these two groups (p less than 0.007). Rectal radiation injuries occurred in 2 cases (8%) at 7 months (grade I) and 6 months (grade II), respectively. From the analysis of local control and complication, optimum radiation dose ranged from 64.8 Gy to 68.4 Gy (TDF 100-106). In addition, optimum boost radiation field size with rotation technique (after whole pelvic irradiation of 40-45 Gy with anteroposterior opposing fields) ranged from 30 to 48 cm2.

Prognostic factors for patients with osseous metastasis: a multi-institutional prospective study

A multi-institutional prospective study for the analysis of prognostic factors for patients with osseous metastasis was performed. From February 1986 through June 1988, a total of 216 patients were included in this study. Cox's regression model made it clear that the most significant overall prognostic factor was primary site (p = 0.0002). In the lung cancer group, performance status (p = 0.0036) and metastasis of organs than bone (p = 0.0105) were also significant prognostic factors. In the breast cancer group, no significant factors were obtained. In the hepatoma group, the values for alkaline phosphatase (ALP) (p = 0.0021), lactate dehydrogenase (LDH) (p = 0.0195), and sex (p = 0.0264) proved significant. In the group of other cases, the most significant prognostic factor was the value for urinary hydroxyproline/creatinine ratio (p = 0.0001), followed by the pain score of RTOG (p = 0.0018). These factors and actual survival periods obtained in this study will be useful for the future stratification of patients for individualized optimal radiation schedules.

Radiation therapy of the para-aortic lymph nodes in carcinoma of the uterine cervix: the concurrent use of cimetidine to reduce acute and subacute side effects from radiation

A prospective study of the effects of radiation therapy (RT) on para-aortic lymph nodes in uterine cervical cancer was conducted. As part of the study, cimetidine (800 mg daily) was administered during RT to relieve and prevent adverse reactions of the gastrointestinal tract caused by RT. In half of the patients, cimetidine (400 mg daily) was continued after RT was finished. The RT field was 7 to 8 cm wide and covered the area from the 4th lumbar to 11th thoracic vertebrae. The total dose administered was 45 Gy in 25 fractions over a five-week period. From September 1986 through October 1987, 89 patients were entered in this study. During RT, only slight gastrointestinal symptoms, such as nausea, vomiting, appetite loss, fatigue, and epigastralgia, were observed. These symptoms increased when cimetidine was withdrawn, but not in the patients who continued to receive cimetidine. It is concluded that cimetidine during and after RT can reduce the acute and subacute side effects of RT.

Radiation therapy for early glottic cancer (T1N0M0): II. Prospective randomized study concerning radiation field

A prospective randomized study to determine the effect of radiation field on the local control of early glottic cancer was performed. From May 1982 through December 1985, a total of 87 patients with early glottic cancer (T1N0M0) were treated at our department with an individualized wedge filter technique using a shell to improve the dose distribution and immobilization during radiotherapy with 4 MV X ray. Patients were randomly allocated to either treatment group A (radiation field size: 5 x 5 cm2) or B (6 x 6 cm2) using bilateral parallel opposed portals. Total radiation dose administered was 60 Gy in 30 fractions over a 6-week period. The 3-year recurrence-free survival rates were 93% in group A and 96% in group B (no significant difference). Comparison with historical control showed that both arms achieved better results. These results were mainly due to the improved local control of whole-length lesions of single vocal cords. Acute mucosal reaction (p less than 0.05) and persistent arytenoid edema lasting more than 6 months (p less than 0.02) were more frequently observed in group B than in group A. It is concluded that the critical factor in getting optimal results in the treatment of early glottic cancer is careful attention to the technique of treatment.

[Radiation therapy with or without cisplatin in esophageal carcinoma]

Of 74 patients with an esophageal carcinoma, 26 were treated with a combined modality of radiotherapy and cisplatin (CDDP group), and 48 were treated with radiotherapy alone (RT group). Sixteen patients were salvaged by surgery after radiotherapy. Fifty-two patients were found to have a loco-regional disease (RT group: 34 patients; CDDP group: 18 patients) and 22 patients had a distant metastasis at the time of the initial treatment (RT group: 14 patients; CDDP group; 8 patients). For those with a loco-regional disease, the response rate was for those in the CDDP group and 34% for those in the RT group. For non-surgically salvaged cases, the median survival was 12 months and there was no statistically significant difference between the CDDP and the RT groups. For the surgically salvaged cases, 2 out of 7 patients in the RT group and 5 out of 9 patients an in the CDDP group are still alive. Additionally, four T3 cases were salvaged by surgery in the CDDP group.

Radiation therapy for early glottic cancer (T1N0M0): I. Results of conventional open field technique

From November 1977 through April 1982, a total of 91 patients with glottic cancer (T1N0M0) were treated with the open field technique of 4 MV X ray using bilateral parallel-opposed fields. Total radiation dose administered was 60 Gy in 30 fractions over a 6-week period. Actuarial 5-year disease-free survival rate was 89%. Significant prognostic factors of local control were tumor length (p = 0.021), tumor width (p = 0.001), tumor type (p = 0.004), tumor response to irradiation at 40 Gy (p = 0.000) and 60 Gy (p = 0.000) by chi-square test. Ultimate local control rate by radiation therapy and salvage surgery was 97% and voice preservation rate was 91%.

[Radiation therapy of early glottic cancer (T1N0M0); retrospective review of historical control]

From November 1977 through April 1982, a total of 91 patients with early glottic cancer (T1N0M0) were treated with the open field technique of 4 MV X-ray using parallel opposed fields in bandage. Radiation dose administered was 60 Gy in 30 fractions over 6-week periods. Actuarial 5-year disease-free survival rate was 88.7%. Significant prognostic factors of local control were tumor length, tumor width, tumor type, tumor response at 40 Gy and 60 Gy. Ultimate local control rate by salvage surgery was 97% and voice preservation rate was 91%.

[Prognostic factors in patients with brain metastases from lung carcinoma]

Between September 1980 to December 1984, 85 patients with brain metastases from lung carcinoma were consecutively evaluated and were entered into the first prospective randomized trial. Since January 1985, the second prospective randomized trial was started based on the result of the first trial, i.e., lactate dehydrogenase (LDH) as the most important prognostic factor. We analyzed neurological improvement and survival of 79 patients, who were entered into the second trial until November 1988, compared with the first trial. This preliminary result suggests that LDH may also be an important prognostic factor in the second trial.

Rearranged Epstein-Barr virus genomes and clonal origin in nasopharyngeal carcinoma

Epstein-Barr virus (EBV) is known to be associated with two malignant diseases, nasopharyngeal carcinoma (NPC) and endemic Burkitt's lymphoma. In this study, the genomes of EBV in biopsy specimens from 4 NPC patients in Japan were analyzed using Southern blot hybridization. The NPC tissues of all examined cases contained rearranged EBV genomes whose BamHI H fragments were larger than those of prototype EBV genomes. One of them had a BamHI fragment containing contiguous sequences of BamHI Y and H. A single-sized EBV DNA terminus was observed in these NPC tissues, implying the evolution of the carcinoma from a single EBV-infected cell.

[Cis-diamminedichloroplatinum (CDDP)-radiation therapy of an advanced nasopharyngeal carcinoma]

Between November 1983 and May 1985, 11 patients with locally advanced (stage IV) nasopharyngeal carcinoma were treated using a combination of Cis-diamminedichloroplatinum and radiation therapy (CDDP-RT group). In this group, 7 patients were given radical RT, sandwiched between 1 course of CDDP (70 mg/m2) before and 1 after. Four patients were given 1 course of CDDP prior to RT. Treatment results were compared with 32 patients (stage IV) who were treated with radiation therapy alone (RT group). These groups showed almost the same local control rate and distant relapses. There was no significant difference in the actuarial and relapse-free survival between the CDDP-RT group and the RT group. As a side effect, severe mucositis of the oral cavity was observed in 4 patients (36%) of the CDDP-RT group in contrast with 3 patients (9%) of the RT group (p less than 0.05).

[A multiinstitutional prospective randomized study of radiation therapy of bone metastasis. II. Prognostic factors]

A prospective randomized study for the analysis of optimal schedule for the patients with bone metastases was performed. From February 1986 through January 1987, a total of 131 patients entered on this trial. The data from 129 patients out of 131 were available for the analysis of prognostic factors by Cox's regression model. As a whole, it was clear that first significant prognostic factor was urinary hydroxyproline/creatinine ratio (p = 0.0001), second primary site (p = 0.0001), third pain score (p = 0.0005) and fourth other organ metastasis except bone (p = 0.0006). In the group of lung cancer, first significant prognostic factor was urinary hydroxyproline/creatinine ratio (p = 0.0007), second multiplicity of bone metastasis (p = 0.0113), and third pain score (p = 0.0270).

[Local control after radiation therapy for T1N0M0 glottic carcinoma]

From 1978 through 1984, we had 151 patients with T1N0M0 glottic carcinoma. They were treated by radiotherapy with 4MV x-ray in parallel opposing field of 5 X 5 cm2 or 6 X 6 cm2. The total dose was 60 Gy/30 fractions/6 weeks. The local control rate was 88.1%, the local recurrence being noted in 18 cases (11.9%). Of these 18 cases, 6 underwent partial laryngectomy, and 10 total laryngectomy. The remaining two cases died: one refused further treatment for recurrence and the other died in spite of total laryngectomy due to recurrence after partial laryngectomy. The salvage rate was 94.1%. The cumulative survival rate was 82.6% in Tla, 71.5% in Tlb and 81.1% in 151 T1N0. The tumor response was poor in the presence of lesion occupying the whole length of the vocal cord. Also, in the cases with ulcer formation or thickened vocal cord as seen on laryngogram, local control rate was not good. Better results will be achieved by improving treatment techniques, specially by improving dose-distribution by wedge-filtered technique and method for immobilization in plastic shell during radio-therapy.

Clinical and histopathological appraisal of preoperative irradiation for adenocarcinoma of the pancreatoduodenal region

A retrospective review to elucidate the rationale of preoperative irradiation was made on 18 carcinomas of the head of the pancreas area. After 50 Gy/25 fractions of 10 MV X-ray was given, all 18 tumors decreased from 3.3 +/- 0.8 cm to 2.0 +/- 0.7 cm. At the surgical operation, 16 patients (89%) received pancreatic resection, without operative death. Histologically, in 13 of these 16 cases, the population of severely degenerative cancer cells (SDCC) was more than 1/3 of all cancer cells, and SDCCs were likely to locate at the periphery (advancing point of carcinoma). These histological patterns were considered as favorable to improve the operative curability. However, in the remaining three cases, the SDCC population was less than 1/3. In addition, nonaffected (i.e., viable) cancer cells were detected at the periphery, and this is an extremely adverse condition for subsequent surgery. Chronic pancreatitis in the noncancerous area was present in these three cases, but not in the 13 cases. Therefore, the most significant factor that predicts the radioresistance especially at the periphery of the carcinoma was considered to be coexisting chronic pancreatitis.

Molecular cloning and physical mapping of the DNA of Miscanthus streak geminivirus

Molecular cloning and physical mapping of miscanthus streak virus (MiSV) circular double-stranded (ds) DNA was carried out. The circular dsDNA was isolated from leaves of Miscanthus saccariflorus (Gramineae) infected with MiSV. In addition to the monomeric circular dsDNA form in MiSV-infected leaves, there were minor circular dsDNA populations of twice (dimer) and approximately half genome length. The size of monomeric circular dsDNA was about 2.67 kilobase pairs. The evidence presented suggests that the genome of MiSV consists of one component.

Radiation therapy combined with or without chemotherapy for limited extent of non-small cell lung carcinoma

From July 1977 to December 1983, 130 patients with limited extent of non-small cell lung carcinoma received radiotherapy of more then 30 Gy combined with or without chemotherapy at the Center for Adult Diseases, Osaka, Japan. Four treatment arms were evaluated: RT alone, RT following chemotherapy, RT following low dose concurrent irradiation with chemotherapy (LDC-RT), and RT concurrently used with chemotherapy. Complete regression of local and regional tumor was produced in 5% and partial regression 58%. Among these four treatment arms LDC-RT showed the highest response rate (88%), while no difference in long-term survival was apparent. According to the RT dose, survival of cases who received RT doses above 50 Gy was better than that of cases under 50 Gy in spite of the combination with chemotherapy. These data suggest that adjuvant chemotherapy has no favorable impact against the survival. Concerning the prognostic factor, tumor response after treatment, general performance status and N stage were important.

Radiation therapy for carcinoma of the hypopharynx with special reference to nodal control

From October 1977 through December 1983, 61 patients with carcinoma of the hypopharynx were treated with radiation therapy (RT) and surgery or with RT alone. Five-year survival rates by N-stage, according to the TNM classification by UICC (1978), were 52% for N0 cases, 23% for N1, and 17% for N2-3 (N1 vs. N2-3, not significant). For N1-3 cases, corresponding figures by level of cervical nodal involvement by UICC (1978) were 29% for level 3 cases, 15% for level 2, and 8% for level 4 (level 3 vs. level 4, p less than 0.04). Therefore, the level of cervical nodal involvement was a more useful prognosticator for patients with nodal metastasis than the N-stage. Effective nodal control for patients with clinically positive nodes (N1-3) was obtained with a combination of neck node dissection and RT of 50 Gy or more. For N0 cases, elective RT of 50 Gy or more, encompassing an adequate field, was required.

High-dose rate intracavitary therapy for carcinoma of the uterine cervix: II. Risk factors for rectal complication

From August 1978 through December 1982, a total of 267 patients with carcinoma of the uterine cervix were treated using remote afterloading high-dose rate intracavitary therapy (RALS) with non-rigid applicator at our department. The data from 199 previously untreated patients with standard application out of 267 were available for this analysis of rectal complication. The incidence of moderate to severe rectal complication (Kottmeier's grade 2 and 3) was 7% (13/199). Cox's regression model was used for the analysis of risk factors for rectal complication in which even minor injuries (grade 1) were included. By using this method, it was clear that the first significant risk factor was z-coordinates of weighted geometric center (WGC-z) (p = 0.0007) and the second corresponding factor was rectal TDF (p = 0.0082), the sum of the rectal dose measured by semiconductor dosimeter (ICD-5) and the dose of external whole pelvic irradiation. From the analysis of application pattern of intracavitary sources, WGC-z indicated the approximation of intracavitary sources to the anterior wall of rectum quantitatively and three-dimensionally. The significance of rectal TDF also implied that the monitoring of rectal dose by ICD-5 had an important role for the prediction and prevention of rectal complication after RALS.

Quantitative evaluation of radiotherapy treatment planning using CT image

A method of computerized optimization system of radiotherapy treatment planning is presented. For the optimization of treatment planning, it is highly desirable to evaluate treatment planning quantitatively corresponding to a set of three-dimensional criteria. For this purpose, we introduce a set of criteria using some parameters defined as three-dimensional extension of those of ICRU report 29. The development of computer software has become feasible for clinical use of our criteria. This paper described some preliminary results of our criteria which was applied to some clinical cases. Our method was proved applicable to any type of treatment plannings, and the optimization of treatment plannings will surely be realized through our criteria.

Radical radiation therapy of the thoracic esophageal carcinoma supplemented with or without salvage surgery

From September 1977 to June 1985, 63 patients received radical radiotherapy for squamous cell carcinoma of the thoracic esophagus at the Center for Adult Diseases, Osaka. Fourty-six of them received radiation therapy alone (RT) and 17 received surgical treatment after irradiation (RT-OP) due to local recurrence or residual tumor. In these groups, 38 of 46 in RT only group and twelve of 17 in RT-OP group were selected for radiotherapy because of high risk for surgery or T3 lesion. For RT only group, tumor response after irradiation was the most important prognostic factor and a statistically significant difference of survival rates was detected between complete response (CR) group and non-CR group. Among RT-OP group, there were three five-year survivors in CR group (n = 8) after irradiation while no five-year survivor in non-CR group (n = 9). Tumor response after radical radiation therapy seems to show the indication for the salvage surgery in high risk or T3 patient.

High-dose rate intracavitary therapy for carcinoma of the uterine cervix: I. General figures of survival and complication

From August 1978 through December 1982, a total of 200 patients with previously untreated carcinoma of the uterine cervix were treated using remote afterloading high-dose rate intracavitary therapy (RALS) at our department. According to the staging of UICC (1978), 8 patients were classified into Stage Ia, 22 Ib, 22 IIa, 53 IIb, 85 III, and 10 IV. Actuarial 5-year survival rates by Stage were 100% in Stage Ia, 86% Ib, 67% IIa, 72% IIb, 41% III, and 20% IV (p = 0.0001). Significant prognostic factors in Stage II were the value of hemoglobin (p = 0.0115) and age (p = 0.0431) by logrank test. Corresponding factors in Stage III were the value of hemoglobin (p = 0.0005) and total protein (p = 0.0036). Late complications after RALS developed in 22 patients (11%), that is, rectum 14 (7%), bladder 6 (3%), small intestine 4 (2%) and sigmoid colon 1 (1%). Severe complications requiring surgery were noted in 7 patients (4%). There was no fatal case attributable to complication. It is concluded that RALS is one of the most effective and safe means for the treatment of carcinoma of the uterine cervix based on our results.

[Clinical studies of cancer of the mesopharynx]

From January, 1978 to December, 1984 fifty four cases of cancer of the mesopharynx were registered at our clinic. There were 47 males and 7 females. Age distribution was from 18 to 80 years old with a mean age of 59. Site distributions were 32 in the lateral wall, 11 in the superior wall, 3 in the anterior wall and 2 in the posterior wall. The Brinkman index for smoking habits and to alcohol index for drinking habits were 488.3 and 20.8 respectively, which were significantly higher than for the control group (p less than 0.05). Pathohistological diagnosis was squamous cell carcinoma in 46 cases, adenocarcinoma in 3 cases, anaplastic carcinoma in 3 cases, and 4 others. Secondary malignancies were highly developed in 15 cases (27.8%), including cancer of the larynx (5), esophagus (3), stomach (2) and others (5). Stage classification was stage I in 3 cases, stage II in 13 cases, stage III in 16 cases and stage IV in 22 cases. Of 47 cases, 39 cases were treated by radiation, 5 cases by operation and 2 cases by pre-radiation chemotherapy. The local control and absolute survival rates for T1-T2, N0-N1 lesions were quite good. Advanced local and nodal disease proved difficult to control with radiation alone. Three and five-year survival rates were both 37.0%. It is suggested that heavy drinking is one of the probable etiologic factors in cancer of the mesopharynx. Intensive follow-up is necessary to detect second primary cancers. For better results, multi-disciplinary treatment should be explored.

Serological follow-up study on the antibody levels to Epstein-Barr virus-determined nuclear antigen (EBNA) patients with nasopharyngeal carcinoma (NPC) after radiation therapy

Serological follow-up studies for up to 4 years on the levels of IgG antibody to EBV-determined nuclear antigen (EBNA) were carried out on 36 patients with nasopharyngeal carcinoma (NPC). The serum levels of IgA antibody specific to EBV capsid antigen (VCA) were also measured in some of the patients. The titers of EBNA antibody were measured by enzyme-linked immunosorbent assay (ELISA) and those of IgA antibody to VCA were measured by the indirect immunofluorescence method. The EBNA antibody titers in most sera from the patients before radiation therapy were found to be at least 4 times the mean values in the sera of healthy control adults. Within 2 to 8 months after completion of therapy by 4-MV liniac X-ray irradiation with total doses of 60 to 80 Gy, the titers of EBNA antibody in the sera of 6 patients had returned to normal levels, and low levels of EBNA antibody were maintained for a long time after therapy. These serological data were associated with a good clinical prognosis without recurrence or metastases. But in 6 patients, the patterns of change in the EBNA antibody levels were different: the levels remained high after therapy or first decreased to the normal level and then rose to at least 4 times this level. These 6 patients showed recurrence or metastases. The patterns of change in the EBNA antibody levels were well correlated with those of change in the levels of IgA antibody specific to VCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck in stage I-II

From September 1977 through January 1983, 34 previously untreated cases with primary non-Hodgkin's lymphoma of the head and neck in stage I-II were treated at our department. 16 cases were classified into stage I and 18 into stage II. Patients were treated with 4 MV X-ray (40 to 45 Gy) which encompassed Waldyer's ring and supraclavicular region with or without chemotherapy. The survival rates at three years were 93% and 50% in stage I and II, respectively. Stage, surface markers (T- and B-cell analysis) and initial primary site and the level of lymph node involvement were important prognostic factors. Chemotherapy in pre- or post-irradiation was essential, especially for cases in stage II. It was also indicated that the adequacy of radiation portal with special reference to anatomical consideration was necessary.

Radiation therapy for nasopharyngeal carcinoma. Retrospective review of 105 patients based on a survey of Kansai Cancer Therapist Group

One hundred five patients with nasopharyngeal carcinoma were treated with radiation therapy combined with or without chemotherapy at 16 of the participating institutes in Kansai Cancer Therapist Group, Japan, from January 1978 to December 1980. The study comprised 77 males and 28 females; their ages ranged from 15 to 80 years (mean, 53 years). Five-year survival rates according to stage were as follows: Stage I, 100%; Stage II, 67%; Stage III, 44%; and Stage IV, 34%. As far as Stage IV disease was concerned, the radiation therapy only group showed significantly poorer prognosis than the combined radiation and chemotherapy group (P less than 0.05). Concerning the N stage and treatment method, the radiation therapy only group showed a higher metastatic rate than the chemotherapy combined group (35% versus 14%, P less than 0.05).

[Cis-diamminedichloroplatinum (CDDP)-radiation therapy in nasopharyngeal carcinoma]

Between July 1977 and October 1983, 40 patients with nasopharyngeal carcinoma were treated by radiation therapy. From the investigation of this series, prophylactic treatment for distant metastases was recommended for good prognosis. Between November 1983 and May 1985, 10 patients with nasopharyngeal carcinoma were treated using a combination of cis-diamminedichloroplatinum (CDDP) and radiation therapy. Treatment results showed complete response in all 10 patients. One patient failed in the out field of boost therapy after whole-neck irradiation. This patient has shown no distant metastases. The remaining 9 patients have been controlled well. Major side effects were renal toxicity, and nausea and vomiting, which were mostly transient. However, severe mucositis of the oral cavity was observed in 4 patients (40%) of the CDDP-radiation group in contrast with 3 patients (8%) of the radiation-therapy-only group (p less than 0.01).

[The CADO-E I type endometrial applicator for RALS therapy]

A dual stainless steel applicator (CADO-E I type) was developed for intracavitary radiotherapy of endometrial carcinoma using remotely controlled afterloader (RALS). An inverted pear-shaped isodose curve was obtained by means of this metallic applicator and Co-60 source with a stepwise movement. Reference point X was defined as 2 cm below the fundus and 2 cm lateral to the center line of the uterus to specify the dose absorbed to the uterine corpus with our endometrial applicator. Since cancer residua resulting from cold spots in dose distribution were recognized at the uterine fundus by histopathological investigation of serial sections in the hysterectomy specimens, we intend to develop an applicator with three metallic tubes (CADO-E II type).

Prognostic factors in patients with brain metastases from lung carcinoma

Between September 1980 to December 1983, 70 consecutive patients were entered into two randomly allocated trials in order to investigate the effectiveness of different time-dose radiotherapy schemes (i.e., 30 Gy/ten fractions/two weeks versus 50 Gy/20 fractions/four weeks) and the prognostic factors on the palliation for patients with brain metastases from lung carcinoma. The most important factors for predicting poor prognosis in this series, which were shown by stepwise proportional hazard (Cox) model, were lactate dehydrogenase (LDH) and general performance status. In normal LDH group, the most important factors for predicting poor prognosis were multiplicity of brain metastases (p less than 0.001), treatment methods (p less than 0.0005) and age (p less than 0.0053). In high LDH group any items were not shown for meeting of the 0.05 significant level.

[Radiation therapy of T1N0M0 glottic carcinoma: clinical evaluations based on field size, plastic shell and wedge filter]

One hundred forty previously untreated cases of T1N0M0 glottic carcinoma underwent therapy at our department from November 1977 through May 1984. Ninety-six of them were treated with the open-field technique of 4 MVX-ray using parallel opposed fields in bandage up to April 1982 (group I). The remaining 44 cases were treated with the wedge-filtered technique in a plastic shell in order to improve the dose distribution and immobilization during radiotherapy starting in May 1982 (group II). The two-year disease-free survival rates were 85% and 91%, respectively. Thus, better results were achieved by improved treatment techniques.

Immobilization and reproducibility in radiotherapy for cancer of the larynx and pharynx using simplified shell and bite-block

In this paper we describe the comparative study concerning the immobilization during radiotherapy for cancer of the larynx and pharynx with or without shell and fixing device. Immobilization was continuously monitored by semi-conductor detector. Reproducibility was investigated by means of verification film. The result significantly indicated that better immobilization was obtained in the patients treated with use of the shell (p much less than 0.001). Reproducibility of the field arrangement was also sufficient throughout the course of radiotherapy.

[Assessment of response to therapy based on the application of the guideline of reporting treatment results of head and neck cancer]

It seems difficult to compare the treatment results to each other, without "common language" to describe cancer therapy and its results. In this paper, guideline of reporting treatment results of head and neck cancer was applied to carcinoma of the pharynx and larynx. There were some problems in reporting of response, such as the measurability and assessment of the response. However, there were small discrepancies between assessment of response to therapy and end-point evaluation, i.e., long-term control, survival and disease-free survival, according to the prospective department-based and retrospective hospital-based studies.