Gestational trophoblastic disease metastatic to the brain is curable with systemic chemotherapy and whole-brain irradiation. The authors suggest treatment with steroids, chemotherapy (etoposide, high-dose methotrexate [1 g/m2], dactinomycin, cyclophosphamide, and vincristine sulfate), and concurrent whole-brain irradiation (3,000 cGy in 200-cGy fractions).

A series of 22 infants and children with posterior fossa benign ependymomas treated surgically during the past 12 years is presented. All patients were operated on with posterior fossa craniotomy: visible total resection in 10, subtotal resection in 9, partial resection in 2 and biopsy only in 1. One patient (4.5%) died shortly after surgery. Only 5 patients had documented infiltration of the floor of the fourth ventricle. Postoperative radiotherapy was administered with variable radiation fields and doses. Two out of six patients who had total resection and postoperative radiation therapy did not show recurrence during at least 26 months follow-up period. However, patients with incomplete tumor resection almost invariably developed recurrence. An attempt should be made to remove posterior fossa ependymomas totally at the initial craniotomy. The risk periods for recurrence were between 1 and 2 years after subtotal resection and between 2 and 3 years after total resection. In our experience, gross recurrent tumors appear to be resistant to chemotherapy, and a combination of surgery and radiation therapy does not necessarily prevent recurrence. Newer agents or protocols of adjuvant chemotherapy are needed to explore.

A detailed retrospective analysis was performed with 103 patients who had T1 carcinoma of the glottic larynx and underwent radiation therapy between 1960 and 1987. Prognostic and radiation therapy variables were analyzed including sex; age; staging procedures; mucosal extent; histologic grading of tumor; field size; use of wedges; treatment of alternate fields versus both fields every day; nominal standard dose; time, dose, and fraction; dose per fraction; total radiation dose per fraction; total radiation doses; and the impact of cord stripping. Initial local control was 89%, and ultimate control after surgical salvage was 97%, with a 5- and 10-year adjusted survival of 98%. Univariate analysis indicated that larger field size (P = .04), histologic grade (P = .02), and treatment strategy (P = .08) were of some value in predicting recurrence. Multivariate analysis indicated that field size (P = .03) was the only significant variable in predicting local recurrence. These data confirm that radiation is highly effective in the treatment of early laryngeal cancer.

✓ A comparison is made between limited field and whole brain irradiation in the treatment of 60 patients with intracranial glioblastomas, 34 of whom were picked at random for either treatment and 26 who were selected for specific treatment. A significant increase in overall survival time and tumor-free period was found in the limited field treatment groups and this was especially significant in those patients selected for limited field treatment. The improved results are felt to be due to the higher dose permissible because of avoidance of more sensitive brain-stem structures. Tumor location in the frontal lobe also appears significant in the longer survival of those patients selected for limited field treatment. More exact localization of the lesion by brain scan, surgery, and angiography also contribute to more efficient treatment and consequently better survival.

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