Biomedical subjects
Publications and source records attributed to C M Mansfield.
Intraoperative interstitial implantation of iridium 192 during a lumpectomy for carcinoma of the breast has been well tolerated by the patient. This procedure has decreased the need for anesthesia and repeat hospitalization.
Serum levels of angiotensin-I-converting enzyme (ACE) were assayed before, during, and after radiation therapy in 209 patients receiving treatment for neoplastic disease. Daily fluctuations in the measured ACE levels were minimized by comparing all patient values to that of a simultaneously run sample from a standard source of serum obtained by pooling sera from young, healthy volunteers. Most of the patients tested presented with a normal to low ACE level, with the mean value for all patients being 70% of the standard value. More patients with primary lung cancer displayed values that were low (107 of 120) than did patients with disease outside the lung (44 of 78), this difference being statistically significant at p less than 0.001. In addition, more patients with lung cancer had values less than 70% of the standard than did patients with disease outside the lungs. These initial results suggest that monitoring of serum ACE levels may be useful in the management of patients with malignant disease in the lung.
From July 1975 to December 1980, 156 patients with localized carcinoma of the prostate received external radiation therapy at the University of Kansas Medical Center. Sixteen patients were lost to follow-up. The follow-up period for the remaining 140 patients ranged from 2 years to 7 years. Median follow-up period was 4.2 years. The overall survival according to stage was as follows: stage A2, 100 percent; stage B, 83 percent; and stage C, 53 percent. Corresponding disease-free survival was 91 percent, 70 percent, and 40 percent, respectively. Both stage and grade have great influence on survival. In stage B, about 44 percent of grade 3 tumors developed distant metastases compared with only 19 percent with grades 1 and 2 tumors. In stage C, 71 percent of grade 3 tumors showed progression of disease. A majority of patients with positive nodes showed progression of disease when compared with patients with negative nodes (75 percent vs 15 percent).
There is growing evidence in the world literature that radiation therapy plus lumpectomy produces survival rates equal to those of mastectomy for stage I and stage II breast cancer. The technique of using an interstitial implant at the time of lumpectomy could improve local control by increasing the accuracy of the interstitial implantation. It will certainly decrease hospital stay, anesthesia, and cost to the patient.
Bilateral pelvic lymphadenectomy was performed in 100 patients as a staging procedure. Sixty-one patients received iodine 125 radioisotope implant and 39 patients received external radiation therapy. The overall incidence of lymph node metastases was 27 percent. The incidence of lymph node involvement was 14 percent with clinical stage A2 disease, 3 percent with stage B1, 44 percent with stage B2, and 40 percent with stage C disease. The grade of the tumor influenced the incidence of lymph node metastases. Only 6 percent of grade I tumors had lymph node metastases, whereas 26 percent of grade II tumors and 71 percent of grade III tumors showed lymph node metastases.
A retrospective review of 17 patients with a diagnosis of chemodectomas of glomus jugulare is presented. The patients' age ranged from 32 to 63 years, with a female to make ratio of 4:1, with 14 females and 3 males. In the majority of the patients (15/17), the primary treatment was surgery, with 10/15 (70%) incidents of recurrence. Radiation therapy was used in 11 patients, in 7 for recurrence, in 2 as postoperative and in 2 as a primary therapy. The radiation dose ranged from 2200 to 5600 rad. The follow-up period ranged from 2 to 22 years. Sixteen patients were living with disease controlled at the last follow-up.
A new instrument has been added to the Fletcher-Suit-Delclos group of gynecologic applicators. The colpostats can be used as mini-ovoids, but by adding a shielded cap, the instrument has the configuration of the original preload Fletcher colpostat. Dosimetric studies show that this applicator produced transmission ratios (the fraction of radiation transmitted through the tungsten shield) and isodose curves similar to the bladder trigone and anterior rectal wall of 10-25%. With the shield-containing cap removed, the mini-ovoid provides little reduction in dose to those areas and should be used with caution.
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The value of radiotherapy to the chest (RC) in disseminated small cell lung carcinoma (SCLC) has been questioned. Two protocols for disseminated SCLC from the Southwest Oncology Group (SWOG) have been compared. They were developed four years apart. The first one included radiotherapy (RT), 3000 rad in two weeks, to the primary tumor, mediastinum and supraclavicular areas, while the second one deleted any RC. Multidrug chemotherapy (CT) and brain RT were used in both protocols. Nonresponders to CT were removed from the study. Our main findings are as follows: (1) Initial chest relapses (patients with no initial extrathoracic relapse) have increased from 24-55% when RC is not given (P = 0.0001). Overall chest relapse (adding those patients that relapsed simultaneously in the chest plus other sites) in the second protocol was 73%. (2) Amount of response to CT does not influence the chances for relapse. Even complete responders to CT have a high chance for chest relapse. (3) Sites of relapse without RC are mainly in the primary tumor, ipsilateral hilus and mediastinum. (4) With RC, relapses shift to the chest periphery, mostly to the lung outside the radiotherapy field and to the pleura. (5) The two very different CT regimens have produced similar percentages and duration of response. (6) CT schema with periodic reinductions prolongs duration of response and survival over schema with continuous maintenance. Hence, interruption of CT to allow RC does not seem to adversely influence CT efficacy. From our results and the review of the literature we conclude that: (1) patients with disseminated SCLC that respond to CT should be given RC to decrease chest relapses. (2) A dose of 3000 rad in two weeks seems to be enough to produce a low percentage of chest relapse in disseminated SCLC, as survival of these patients is short and many will die prior to developing chest relapse. However, according to the literature, 4000-4800 rad is probably a more effective dose. (3) More studies and guidelines are needed to outline proper boundaries of radiotherapy fields, to decrease chances of peripheral chest relapses. (4) Median survival might not be a good parameter to evaluate the impact of RC in disseminated SCLC. The study of long-term survivors seems to be more important.
One hundred-twelve females with stage I-III breast carcinoma were treated primarily with radical megavoltage irradiation. The loco-regional area received 50 Gy/5 weeks with a boost to the primary site of 10 Gy/1 week to 20 Gy/2 weeks. Local control rates were as follows: 94 per cent in stage I, 86 per cent in stage II and 69 per cent in stage III. Survival rates were comparable to those reported by other authors. Complications correlated with disease stage and extent of radiation fields.
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Dihydroxyanthraquinone (DHAQ; NSC 279836) is a recently synthesized compound that is structurally similar to Adriamycin and produces greater antitumor effects in murine model systems. We compared DHAQ to Adriamycin in rats, with and without irradiation of the chest at various intervals after drug treatment. A single injection of Adriamycin (1 mg/kg i.p.) had little effect on animal survival, even if combined with radiation (12 Gy 25 MV X-rays), greater than 90% being alive at 1 year. A single injection of DHAQ (3 mg/kg i.p.) was equally uneffective up to 200 days after treatment (survival, greater than 90%). However, between 200 and 370 days after treatment, all animals died, producing a median survival time of 280 days. Further, when DHAQ was combined with radiation, there was an increase in animal deaths between Days 300 and 200. For animals irradiated on Days 0, 43, and 93 after DHAQ treatment, only 50, 75, and 80%, respectively, survived to Day 200. All animals that survived past Day 200 subsequently died by 1 year, displaying the same kinetics of lethality as those animals that had received DHAQ only. A repeat experiment using DHAQ at 1 mg/kg produced similar results. Based on these findings, we conclude that DHAQ produces a long-term (greater than 200 days) toxicity in rats that is not detectable by short-duration toxicity screening. In addition, radiation enhances short-term (less than 200 days) lethality, with the degree of enhancement decreasing as the interval between drug and radiation is increased.
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A total of 211 patients with a diagnosis of carcinoma of uterine cervix, managed by radiotherapy at the University of Kansas Medical Center between 1969-1975 was reviewed. There were 90 patients in Stage I, 65 in Stage II, 43 in Stage III, and 13 with Stage IV disease. Squamous cell carcinoma was found to be the most common histologic type. Twenty-three patients had shown uterine extension of the disease; of these, eight had adenocarcinoma. The majority of the patients received external whole-pelvic telecobalt therapy followed by a variety of intracavitary radium applications. The combined dose to point A ranged from 5000-13,000 rad. There were 166 patients followed for five or more years. Overall five-year survival was 74% (124/166). Survival by stage: IA--92% (12/13); IB--88% (55/62); IIA2--74% (23/31); IIB--58% (14/24); IIIA&B--64% (18/28); and IV--25% (2/8). The overall three-year survival was 73% (155/211). Thirty-three patients (33/211 = 16%) developed local recurrence, and five of these patients were salvaged by surgery. Surgery for complications was required in nine patients. Rectovaginal and vesicovaginal fistulae occurred in three patients (1.5%). Local recurrence and complications vs. dose and system used were analyzed.
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