No abstract

Between December 1983 and December 1987, there were 44 patients with bulky, nonresectable squamous cell carcinomas of the gynecologic tract (cervix, 36; vagina, eight) who were treated with concomitant chemotherapy and radiotherapy. Chemotherapy consisted of 5-fluorouracil (5-FU) 1g/m2 given by continuous intravenous infusion on days 1 through 4 and mitomycin C 10 mg/m2 given intravenously on day 1. External-beam irradiation was started on day 1 with a total calculated dose of 5000 cGy in 25 fractions employed. This was followed by brachytherapy. With a mean follow-up of 30.3 months and a median of 28 months, local control has been achieved in 32 of 44 patients (73%). The overall response rate was 88% (3-month partial response, 43%; 3-month complete response, 45%; 8-month partial response, 15%; 8-month complete response, 73%). Analysis of complications by Radiation Therapy Oncology Group (RTOG) criteria did not demonstrate an increase in acute or late complications.

All patients with cancer of the glottis treated by radiotherapy with curative intent at the University of Virginia from 1956 through 1971 have been reviewed. Follow-up is complete through December, 1973. Results are presented by both stage and treatment policy and indicate that with our present methods of management a high degree of local control is achieved. The complications of treatment are examined, particularly those arising as a result of combined radiotherapy and surgery. A small number of cases have been salvaged following local recurrence and these are described in detail. Particularly striking has been the effectiveness of radiotherapy in the treatment of advanced (Stage III and IV) lesions. In this group 58 percent of the patients survive with their larynges intact. Considering the poor general condition and advanced nature of the lesions in these cases this result is important and may indicate the nature of future trends in treatment, namely radiotherapy, with surgery held in abeyance until there is overt recurrence.

At the University of Virginia Hospital, patients undergoing preoperative irradiation for carcinoma in the head and neck region are usually scheduled for surgery four to six weeks after completion of therapy. Since preoperative irradiation produces no significant difference in the operative difficulty or postoperative morbidity, it is assumed that the vascularity of the area has returned to the pre-treatemtn level. Thermography is being used to quantitatively gauge the amount of vascularity and thus, help predict the optimum time for surgery. Thermography is obtained at two-week intervals after a pre-treatment baseline and is carried out for eight weeks after completion of therapy. During therapy the vascularity as determined by thermography is noted to increase to a maximum at approximately three to four weeks or 3 to 4,000 rads. Following completion of treatment, the vascularity subsides gradually and returns to the pre-treatment level at four to six weeks after completion of therapy.

Gallium (67Ga) citrate is a scanning agent that has been shown to have a differential uptake in a variety of malignancies. Investigation of the usefulness of 67Ga scanning patients with proven squamous cell carcinoma of the head and neck region is now in progress. These patients have a 67Ga total body scan as part of the pre-treatment evaluation. The accuracy of the procedure is then judged by correlation with clinical and surgical findings. The results in 25 patients show that a clearly positive uptake occurs in 60 percent in the region of the primary. Uptake in metastatic disease in lymph nodes is much less, occurring in 6 of 18 sides of the neck. In one case, where clinical examination was considered to be negative, the gallium scan was positive and subsequently proven to be correct by histological examination of the surgical specimen. The various difficulties encountered in interpreting gallium scans in the head and neck region are described. It is felt that by improved patient selection and special techniques the yield of positive cases can be improved and unsuspected extension of malignancy demonstrated.