These results suggest that treatment of Stage IIIA or IIIB nonsmall cell lung carcinoma with AHTRT with or without chemotherapy may improve freedom from local progression and survival as compared with SFTRT, especially for patients with nonsquamous cell carcinoma. The statistical powers to detect the observed differences in median time to local progression and survival were approximately 55% and 35%, respectively. Therefore, further investigation comparing SFTRT with AHTRT is warranted.

One hundred ten patients with epidermoid carcinoma of the esophagus were treated at the Memorial Sloan-Kettering Cancer Center (MSKCC) with combined modality techniques involving preoperative irradiation (RT) and surgery, and with preoperative chemotherapy (CT), surgery, and irradiation. For the 76 patients receiving preoperative RT during the period 1965-1976, the overall resectability rate was 54% with an operative mortality of 12%; long-term survivors (greater than 3 years) were few (7%). For 34 patients receiving preoperative CT with cisplatin and bleomycin, major objective tumor regression (greater than 50%) was seen by day 18 in 20%, with an additional 44% having smaller but definite improvement in the barium esophagram and in swallowing function. Of those receiving preoperative CT, 76% had resectable lesions, with an operative mortality of 11%. The median follow-up for this group is 24 months; of the 30 patients followed for at least 12 months, 20% are alive without evidence of disease. Although the resection rate following preoperative chemotherapy seems to be higher, thus allowing better palliation, neither preoperative radiation nor chemotherapy with cisplatin and bleomycin have had a major impact on long-term survival.

Twelve patients with adenocarcinoma of the pancreas and two patients with carcinoma of the extrahepatic biliary tree received combined therapy with 125I implant, precision high-dose (PHD) photon external beam therapy, and systemic 5-fluorouracil (5-FU). The 125I implant delivered 120 to 210 Gy (median 140 Gy). PHD external beam therapy was given with high-energy photons (10, 15 or 45 meVp) and was initiated 4 to 6 weeks postimplant. A dose of 48.6 to 63 Gy was delivered over 5.5 to 7 weeks in 1.8 Gy increments. Six patients received 5-FU, 500 mg/m2 via weekly intravenous bolus injection. No patient was lost to follow-up (range, 3.5-57 months). Acute postoperative morbidity included pancreatic fistula in two patients and gastrointestinal tract bleeding, pulmonary embolism, and cholangitis in one patient each. No patient died of radiation complications. Median survival of the patients with pancrease cancer was 15 months. One patient is alive at 41 months with hepatic metastasis. Satisfactory palliation was observed in patients with pancreas cancer treated with 125I interstitial implant followed by PHD external beam photon therapy and 5-FU. Patient survival did not seem superior to that of patients treated with PHD external beam therapy +/- chemotherapy, a less morbid procedure. Two cases of bile duct cancer treated in similar fashion are presented.

Fifty‐two patients with medulloblastoma were seen at Memorial Sloan‐Kettering Cancer Center (MSKCC) between 1959 and 1979. All patients had their primary surgery at other institutions; 27 were referred postoperatively for the initial course of radiation therapy; 24 were referred for treatment of recurrence and 1 patient for adjuvant chemotherapy only. The patients were classified as: (1) Group I: small, localized tumor which was completely excised (14 patients), (2) Group II: large, localized, incompletely excised tumor (10 patients), (3) Group III: tumor spread within the central nervous system (8 patients), (4) Group IV: hematogenous metastases at initial presentation (2 patients). Eighteen patients could not be classified due to insufficient data. Of the 27 patients who received initial radiation treatments at MSKCC, six were of the Groups III and IV and all of these have died. Of the remaining 21 patients with localized disease ten are alive and disease‐free with follow‐up from 20 to 81 months. One patient died free of disease, at 11 months, due to chemotherapy toxicity. Fourteen patients received adjuvant chemotherapy: three received a single drug while 11 received multiple drugs in various combinations of vincristine, cyclophosphamide, methotrexate, lomustin, (CCNU), and prednisone. The extent of disease at the initial treatment was the most important prognostic factor. There were no survivors in the Groups III and IV. The most common site of recurrence was the posterior fossa, 21 of 40 patients, (53%), six patients (15%) had recurrence at the cribriform plate and the adjoining medial frontal lobes, and five (12%) had their first recurrence outside the CNS. None of the patients who received less than 3400 rad to the craniospinal axis or less than 5000 rad to the posterior fossa is alive. The duration of treatment seems to be of less importance for the outcome than the total dose of radiation delivered.