[Radiation ulcer after radiotherapy of esophageal carcinoma]

17 patients with esophageal ulceration (benign or non-cancerous ulcer) after irradiation for esophageal carcinoma are reported. Nearly half of these 17 patients had been misdiagnosed as cancer recurrence (malignant ulcer) and deprived of further effective treatment. In this series, the cause of misdiagnosis is analysed. The clinical symptoms of benign ulcer and its manifestations on the X-ray films are described. The etiology and differentiation between the benign and malignant ulcer are discussed.

Radiation therapy of giant cell tumor of bone: analysis of 35 patients

This paper reports 35 patients treated for giant cell tumor of bone. Ten patients were treated by surgery followed by postoperative irradiation. All 10 were cured; eight have survived for more than 5 years and four for more than 10 years without recurrence. Twenty-five patients were treated by radiation alone. All patients were followed for 2 to 17 years. For those who received more than 3500 rad, the local control rate was 82% (14/17); for those who received more than 4000 rad, the local control rate was 85% (11/13). Thirteen have lived for more than 5 years and nine have lived for more than 10. Our experience reveals that surgery and postoperative radiation produce the best results, and that these results are better than those reported in the literature. The results of radiation alone are comparable to that of surgery. For lesions not amenable to surgery, or those which would become crippling if surgery is attempted, radiation should be used either alone or in combination with conservative surgery. The dose for radiation alone should be 5000 to 6000 rad and for postoperative radiation, 3000 to 4000 rad. Supervoltage X rays (60Co or 8 Mv X ray), but not orthovoltage X rays, are indicated. A single radiation course with higher dose is preferred to multiple courses with lower doses. In 62% (15/24) of patients, pain relief begins before treatment is completed. In 74% (14/19) of patients, the tumor mass will not resolve until the sixth month after radiation.

Value of computed tomography in staging the primary lesion (T-staging) of nasopharyngeal carcinoma (NPC): an analysis of 54 patients with special reference to the parapharyngeal space

CT scans of the nasopharynx and the base of skull were performed in 54 patients with histologically proven NPC. The CT findings are compared to those obtained by routine clinical examination. In this series, involvement of the parapharyngeal spaces was found by CT scan in 61% (33/54) of patients, which is impossible to assess by clinical means. Intracranial invasion was demonstrated by CT scan with intravenous contrast enhancement in five patients. CT is more sensitive in showing the erosion of skull base than X ray film. CT scans demonstrated 17% (5/30) of bony invasion in X ray negative patients. Clinical examination showed one involved wall in nine patients; CT scan discovered involvement of two or more walls in five (55%) of these nine. Routine clinical examination discovered extra-nasopharyngeal extensions in 34 locations, whereas CT scans discovered 106, a ratio of 1:3.1. The common sites of extra-nasopharyngeal extension detected by CT scan are: parapharyngeal space, intracranial invasion, sphenoidal sinus, orbit, ethmoidal sinus, maxillary antrum, oropharynx and the nasal cavity. In T-staging of NPC, 55% (6/11) of clinical T2 lesions are up-staged by CT. Thirty-six percent (4/11) of clinical T3 lesions were also up-staged. However, 94% (17/18) of clinical T4 lesions remained unchanged. Only 6% (1/18) of clinical T4 lesions were down-staged.