[Remote afterloading high dose rate intracavitary radiotherapy for head and neck cancer (author's transl)].
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Biomedical subjects
Publications and source records attributed to H Fuchihata.
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Seventy-three patients with carcinoma of the tongue were treated with 192Ir implantation. The total dose for control of the primary lesion without late radiation injury could be fixed to about 70 Gy with a variation of the dose rate between 0.25 and 1 Gy per hour. Additional external irradiation, without reduction of the dose from the interstitial irradiation, involves a high risk of local necrosis.
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Ten cases of so-called development defect were detected on panoramic radiograms. One of them was bilocular, two were round, three were ovoid, and four were half-ovoid. Eight were in men and two were in women. These cystlike lesions are sometimes misdiagnosed as epithelium-lined cysts or benign tumors, such as ameloblastoma. For the detection of this kind of defect, panoramic radiography is available, and the lesion is differentiated from many cysts and tumors in the jaws by posteroanterior projection and occlusal films. From the published literature, some tendencies of age distribution and sex incidence were reviewed.
Of 36 patients with early carcinoma of the tongue treated with interstitial irradiation, 25 were controlled, 10 recurred and one developed local necrosis. Of 57 advanced cases treated with telecobalt therapy followed by interstitial irradiation, 15 were controlled, 20 recurred and 22 developed local necrosis. The frequency of necrosis following the combined irradiation was unacceptably high. Interstitial therapy alone may be a more adequate method for the primary tumour.
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Some 908 cases of malignant tumors of the nose and paranasal sinuses treated from 1957 through 1974 were statistically analysed. The most common tumor site was the maxillary sinus (91.4%) and the most common histological figure was carcinoma (92.4%). The crude and relative survival rates for each treatment mode were calculated in January 1975. The number of cases and the 5 year relative survival rates of the main groups were as follows: I. Primary cases of malignant tumors (761 cases) 29.2% A. Carcinoma (709 cases) 29.3% B. Sarcoma (45 cases) 27.4% II. Primary cases of maxillary sinus carcinoma (561 cases) 26.1% A. Period 1957-66 (282 cases) 22.8% 1. Combination of irradiation and surgery (114 cases) 36.9% 2. Irradiation alone (168 cases) 12.7% B. Period 1967-69 (130 cases) 34.5% 1. Irradiation with 5-FU intra-arterial infusion (25 cases) 36.1% 2. Irradiation with intra-arterial infusion of other radiosensitizers (35 cases) 35.7% 3. Irradiation only without infusion (45 cases) 35.2% C. Period 1970-71, Linac X-ray irradiation (61 cases) 15.9% D. Period 1972-73, Irradiation with 5-FU infusion (80 cases), 3 year relative survival rate 39.3% The stage-grouping of maxillary sinus carcinoma based on the classification of tumor spread in the TNM system was recommended for the comparison of survival rates. The best mode of treatment in our experience is the combination of Co-60 gamma-ray irradiation and continuous intrarterial infusion of 5-FU. A curettage during irradiation is recommended. A maxillectomy should be performed only for irradiation failure cases.
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