Seventy-three documented cases of uterine sarcoma were treated at the University of Rochester Strong Memorial Hospital from 1955 to 1975. Thirtythree patients (45%) were treated with surgery only [S], 31 (43%) with surgery and radiation [S + R], and 9 (12%) with radiation alone [R]. A review of the literature with over 900 cases was also performed. Several important issues regarding these rare tumors are addressed, such as the prognosis of the several histologic variants, the role of radiation therapy in their management and what perhaps may constitute a comprehensive therapeutic approach. These tumors are characterized by local aggressiveness and early widespread dissemination. There are three main histologic varieties: mixed mesodermal sarcoma (MMS), leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS).Of the three, MMS was the most common, seen in 60% of the cases; LMS occurred in younger patients and tended to be localized to the uterine corpus (Stage I) in 80% of the instances. Tumor extent at diagnosis was the main prognosticator for survival in uterine sarcomas; patients with Stage I tumors had a significantly lower incidence of recurrences, as well as a better survival than patients with more advanced tumors. Stage-by-stage, there were no significant differences in survival among the pathologic variants. To ensure adequate staging, a surgical procedure is recommended first whenever possible. Adjuvant radiation therapy significantly improved disease controlability in the pelvis, although it may not have dramatically affected the final outcome. In addition to pelvic irradiation, some form of systemic therapy should be administered to decrease distant metastases.

A publication from the University of Rochester Cancer Center in 1975 suggested an improvement in the survival time of patients with intracranial ependymomas in whom an aggressive postoperative radiation therapy approach had been adopted. The regimen was tailored to the aggressiveness and spread patterns of these tumors and therefore considered the patient's age, tumor histopathology and location, and status of the subarachnoid space and cerebrospinal fluid (CSF). The authors proposed using whole brain (WB) fields for all patients with low-grade supratentorial tumors, and WB with cervical cord field extensions for low-grade infratentorial tumors if either group had no CSF or subarachnoid evidence of spinal metastases. They also proposed using craniospinal irradiation for all patients with high-grade ependymomas (regardless of location) or with low-grade infratentorial tumors with positive CSF or subarachnoid findings of spinal metastases. Recommended doses were as follows: 4500 rads to the whole brain, 5500 rads to the primary tumor volume, and 3000 to 4000 rads to the spine, depending on its subarachnoid status. Children aged 3 years or under were to receive 80% of these doses and more protracted daily treatments. Analysis of the updated experience indicates that in 51 patients treated with this approach these criteria have yielded a beneficial and consistent increase in the survival time. A 69% 10-year survival rate has been observed (75% for low-grade and 67% for high-grade ependymomas). A multifactorial analysis of survival by prognostic factors and by grouping of prognostic factors, analysis of failures, autopsy findings, and quality of survival is presented and discussed.

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This is the final analysis of Protocol #78-10 which explored increasing singledoses of half-body irradiation (HBI) in patients with multiple (symptomatic) osseous metastases. When given as palliation, HBI was found to relieve pain in 73% of the patients. In 20% of the patients the pain relief was complete; over two thirds of all patients achieved better than 50% pain relief. The HBI pain relief was dramatic with nearly 50% of all responding patients doing so within 48 hours and 80% within one week from HBI treatment. Furthermore, the pain relief was long-lasting and continued without need of retreatment for at least 50% of the remaining patient's life. These results compare favorably with those obtained by the Radiation Therapy Oncology Group (RTOG) using several conventional daily fractionated schemes on similar patients in a prior study (RTOG #74-02). HBI achieves pain relief sooner and with less evidence of pain recurrence in the irradiated area than conventionally treated patients. The most effective and safest of the HBI doses tested were 600 rad for the upper HBI and 800 rad for the lower or mid-HBI. Increasing doses beyond these levels did not increase pain relief, duration of relief, or achieved a faster response; however, the increase in dose was associated with a definite increase in toxicity. Single-dose HBI was well tolerated with no fatalities seen among 168 treated patients. A comprehensive premedication program has proven to decrease the acute radiation syndrome to very acceptable levels. There were excellent responses found in practically all tumors treated, but especially breast and prostate among which over 80% of all patients experienced pain relief, 30% in a complete fashion. Single-dose HBI emerges as one of the safest, fastest, and more effective palliative tools for intractable cancer pain in modem radiation oncology. Cancer 58:29-36, 1986.

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