4-n-butylresorcinol enhances proteolytic degradation of tyrosinase in B16F10 melanoma cells

OBJECTIVE

4-n-butylresorcinol is a competitive inhibitor of tyrosinase and has been used as an antimelanogenic agent. However, its inhibition mechanism in intact cells is not fully understood. To elucidate the cellular mechanism, we compared in vitro and in vivo inhibitory effects of 4-n-butylresorcinol on tyrosinase activity.

METHODS

B16F10 melanoma cells were cultured in media containing α-MSH in the presence or absence of 4-n-butylresorcinol. Tyrosinase mRNA levels, protein levels and activity in B16F10 cells were compared by real-time PCR, immunostaining combined with western blot and colorimetric analysis, respectively. Melanin concentration was measured by colorimetry both in the cells and in the media. Tyrosinase glycosylation and proteolytic degradation were analysed by immunoblotting after cells were treated with Endo H/PNGase F and E64/proteasome inhibitors, respectively.

RESULTS

4-n-butylresorcinol inhibited tyrosinase activity and melanin synthesis more effectively in intact cells than in cell lysates. Western blotting and real-time RT-PCR showed that 4-n-butylresorcinol reduced protein levels, but not mRNA levels, of tyrosinase in B16F10 cells. 4-n-butylresorcinol showed no effect on the processing of tyrosinase glycosylation or on trafficking to melanosomes. However, treatment of B16F10 cells with E64 or proteasome inhibitor abrogated the 4-n-butylresorcinol-induced decrease of tyrosinase. Moreover, 4-n-butylresorcinol activated p38 MAPK, resulting in increased ubiquitination of tyrosinase.

CONCLUSION

4-n-butylresorcinol inhibits melanogenesis by enhancing proteolytic degradation of tyrosinase as well as competitive binding to tyrosinase. These findings will help to develop new, effective and safe chemicals for the treatment of hyperpigmentation disorders.

Navigation programs, are they helpful for perioperative care with thyroid cancer patients?

The purpose of this study was to develop and evaluate a navigation program for patients with thyroid cancer. The navigation program was developed following an analysis of the unmet needs of patients who underwent surgery for thyroid cancer. Ninety-nine patients in the control group received usual care, and 95 in the navigation group were managed with a navigation program during the perioperative period. The effectiveness of the navigation program was assessed by administering a questionnaire to both groups. Overall satisfaction scores were significantly higher in the navigation than in the control group (p = .025), as were satisfaction scores on the continuity of information (p < .001), the continuity of management (p = .002), the continuity of relationships with healthcare providers (p<.001), and patient empowerment (p < .001). The newly developed navigation program for patients with thyroid cancer was effective in raising satisfaction levels and in actively managing the disease during the perioperative period.

Cisplatin, fluorouracil, and leucovorin induction chemotherapy followed by concurrent cisplatin chemoradiotherapy for organ preservation and cure in patients with advanced head and neck cancer: long-term follow-up

PURPOSE

The poor functional outcome in patients with advanced head and neck squamous cell carcinoma (HNSCC) with surgery and radiation has led to alternative approaches to advanced disease. We conducted a phase II study of induction chemotherapy followed by concurrent chemoradiotherapy for organ preservation in patients with advanced resectable and unresectable (nasopharyngeal) tumors.

PATIENTS AND METHODS

Forty-two patients with stage III to IV resectable HNSCC and nasopharyngeal tumors received induction chemotherapy with two courses of cisplatin (20 mg/m2/d continuous infusion [CI]), fluorouracil (800 mg/m2/d CI), and leucovorin (500 mg/m2/d CI; PFL) for 4 days followed by concurrent therapy with cisplatin (100 mg/m2/d on days 1 and 22) and approximately 70 Gy of external-beam radiotherapy.

RESULTS

Response to induction chemotherapy included partial response rate of 52% and complete response rate of 24%. The most common grade 3 or 4 toxicity was neutropenia (59%). After cisplatin chemoradiotherapy the complete response rate was 67%. Toxicities of cisplatin chemoradiotherapy consisted of grade 3 or 4 mucositis (79%) and neutropenia (51%). At a median follow-up of 71.5 months, 43% of the patients are still alive and disease-free. The 5-year progression-free survival (PFS) rate was 60%, and the 2- and 5-year overall survival (OS) rates were 67% and 52%, respectively. Three patients died of second primaries. Late complications of treatment included xerostomia and hoarseness. One patient had persistent dysphagia and required laser epiglotectomy 108 months after treatment.

CONCLUSION

Induction chemotherapy with PFL followed by concurrent cisplatin chemoradiotherapy is well tolerated and results in a good likelihood of organ preservation and excellent PFS and OS.

Adenoid cystic carcinoma: a retrospective clinical review

Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were identified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer's criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recurrence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was significantly associated with increasing stage. No other variables were predictive for recurrence. Additionally, we found that nasosinal tumors were more likely to display higher stage at presentation, and were more often associated with perineural invasion. Also of interest was the association of perineural invasion with margin status, with 15 of 20 patients with positive margins displaying perineural invasion, while only 5 of 17 with negative margins showed nerve invasion (P = 0.02). On immunohistochemistry, 2 cases of the 29 (7%) tumor specimens found displayed HER-2/neu positivity. No correlation between clinical behavior and positive staining could be demonstrated. Our data concur with previous reports on ACC in terms of survival and recurrence statistics. Stage and site of primary were important determinants of outcome. Grade may still serve a role in decision making. We could not demonstrate any differences attributable to primary modality of therapy, perhaps due to the nonrandomization of patients into the various treatment tracks and the inclusion of palliative cases. Similarly, perineural invasion, radiation dose and field size, and HER-2/neu positivity did not prove to be important factors in our experience.

Expression of the Xenopus homologue of the receptor for activated C-kinase 1 (RACK1) in the Xenopus embryo

We have isolated the Xenopus homologue of the receptor for activated C-kinase 1 (RACK1), whose amino acid sequence shows significant similarity with other vertebrate RACK1s. XRACK1 is a maternally expressed gene and its zygotic expression is detected in the antero-dorsal region and dorsal midline in the late neurula. At tailbud stage, rather diffuse staining is seen in the somite and head. Later, XRACK1 mRNA is expressed highly in ventrally migrating abdominal muscle anlagen, where it remains expressed during subsequent stages.

Prognostic significance of cyclin D1 protein levels in early-stage larynx cancer treated with primary radiation

Recent laboratory experiments have demonstrated that cyclin D1 levels (cycD1) can influence radiosensitivity. The purpose of the current study is to evaluate the prognostic significance of cycD1 for local recurrence in early-stage larynx cancer treated with primary radiation therapy. The study was conducted using a matched case-control design in 60 early-stage (T1-T2/N0) larynx cancer patients. All patients had squamous cell carcinoma of the larynx and were treated with primary radiation to a total median dose of 66 Gy in daily fractions of 2 Gy, without surgery or chemotherapy. Thirty patients who suffered a local relapse in the larynx after treatment served as the index case population. These 30 cases were matched by age, sex, site (glottic vs. supraglottic), radiation therapy technique/dose, and follow-up, to 30 control patients who did not experience a local relapse. Immunohistochemical staining from cycD1 was performed on the paraffin-embedded specimens. The pathologist, blinded to the clinical information, scored each of the specimens on a four-point intensity scale (0 = no stain, 1 = faint, 2 = moderate, 3 = strong) and percent distribution. Patients were considered to be positive for cyclin D1 if the staining was 2+ or greater with a percent distribution of at least 5%. By design of the study, the two groups were evenly balanced with respect to age, sex, stage, radiation dose, and follow-up. CycD1 levels correlated with proliferating cell nuclear antigen levels. Low levels of cycD1 significantly correlated with local relapse; 19/30 (63%) of the index cases stained negative, while only 10/30 (33%) of the control cases stained negative (P = 0.03). These data suggest that low levels of cycD1 correlate with relatively radioresistant early-stage larynx carcinoma. With larger more confirmatory clinical and laboratory data, this data may have significant clinical implications. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 22-28 (2000).

Combined use of transverse and scout computed tomography scans to localize radioactive seeds in an interstitial brachytherapy implant

Various techniques have been developed to localize radioactive sources in brachytherapy implants. The most common methods include the orthogonal film method, the stereo-shift film method, and recently, direct localization from a series of contiguous CT transverse images. The major advantage of the CT method is that it provides the seed locations relative to anatomic structures. However, it is often the case that accurate identification and localization of the sources become difficult because of partial source artifacts in more than one transverse cut and other artifacts on CT images. A new algorithm has been developed to combine the advantages of using a pair of orthogonal scout views with the advantages of using a stack of transverse cuts. In the new algorithm, a common reference point is used to correlate CT transverse images and two orthogonal scout CT scans (AP and lateral). The radioactive sources are localized on CT transverse images. At the same time, the sources are displayed automatically on the two CT scout scans. In this way, the individual sources can be clearly distinguished and ambiguities arising from partial source artifacts are resolved immediately. Because of the finite slice thickness of transverse cuts, the longitudinal coordinates are more accurately obtained from the scout views. Therefore, the longitudinal coordinates of seeds localized on the transverse cuts are adjusted so that they match the position of the seeds on scout views. The algorithm has been tested on clinical cases and has proved to be a time saving and accurate method.

Intraoperative brachytherapy, laryngopharyngoesophagectomy, and gastric transposition for patients with recurrent hypopharyngeal and cervical esophageal carcinoma

OBJECTIVE

To evaluate the role of laryngopharyngoesophagectomy (LPE), intraoperative 125I brachytherapy (IOBT), and gastric transposition (GT) in patients with recurrent carcinoma involving the hypopharynx, or cervical esophagus.

METHODS

Between 1988 and 1994 a total of 21 patients were managed with LPE/IOBT/GT. All patients had documentation of recurrent disease at the hypopharynx or cervical esophagus and had previously been treated with external-beam radiation (EBRT) to a total median dose of 60 Gy. Median age was 67 years, with 17 male patients and four female. IOBT was performed in all cases with permanent 125I implantation. Medical records were retrospectively reviewed. Overall survival, local control, and complications were evaluated. Median follow-up was 6 months.

RESULTS

The median activity of 125I was 36 mCi, with a median dose of 80 Gy to the region at risk. Fifteen patients had lymph node dissections performed in conjunction with LPE, and 10 patients had nodal involvement on pathologic examination. Margins were microscopically positive in nine patients, and lymphvascular space invasion noted in 13. Actuarial survival at 1 and 3 years was 32% and 14%, respectively, with patients alive and with local control at 6, 24, 36, and 48 months (negative margins). Actuarial local control at 1 and 3 years was 63%. Complications included fistula in five patients, facial edema in four, protracted facial pain in two, cervical abscess in one, and mucosal hemorrhage in one.

CONCLUSION

Patients with recurrent carcinoma of the hypopharynx or cervical esophagus after EBRT have an extremely poor prognosis. LPE, IOBT, and GT may provide very good local control for all candidates and prolonged survival for a small percentage of patients with an acceptable risk profile.

Bioreductive alkylating agent porfiromycin in combination with radiation therapy for the management of squamous cell carcinoma of the head and neck

Porfiromycin (methyl mitomycin C) has been shown in laboratory studies to have increased preferential cytotoxicity to hypoxic cells and therefore may provide enhanced therapeutic efficacy over mitomycin C when used in combination with radiation therapy (RT). The purpose of the two clinical studies reported here is to evaluate the concomitant use of porfiromycin with RT in the management of squamous cell carcinoma of the head and neck. Between October 1989 and July 1992, 21 patients presenting with locally advanced stage III/IV squamous cell carcinoma of the head and neck were entered into a phase I toxicity trial evaluating porfiromycin as an adjunct to RT. Patients were eligible if they had biopsy documented squamous cell carcinoma of the head and neck with a low probability of cure by conventional means. Patients were treated with standard fractionated daily RT to a total median dose of 63 Gy, with porfiromycin administered on days 5 and 47 of the course of RT. Upon completion of this phase I trial, a phase III trial was initiated in November 1992 randomizing patients with squamous cell carcinoma of the head and neck to RT with mitomycin C vs. RT with porfiromycin. There is no radiation only arm in this current trial. To date, 75 patients have been entered on this trial and acute toxicity data are available on 67 patients (34 porfiromycin, 31 mitomycin C) who have completed their entire course of treatment. Median follow-up of the 21 patients enrolled in the phase I porfiromycin trial is 58.5 months. Of the 21 patients, 5 were treated at a dose of 50 mg/M2, 4 at 45 mg/M2, and the final 12 at 40 mg/M2, which appeared to result in acceptable acute hematological and nonhematological toxicities. As of December 1995, 14 of the 21 patients have died with disease and 7 remain alive and free of disease, resulting in a 5-year actuarial survival of 32%. Of the patients enrolled to date in the phase III randomized trial of mitomycin C vs. porfiromycin, there have been no statistically significant differences between the two arms with respect to white blood cell count (WBC), platelet, or hemoglobin nadirs. Acute nonhematological toxicities including mucositis, epidermitis, odynophagia, and nausea have also been comparable. Two patients in this current randomized trial died during treatment, apparently of nondrug-related causes. We conclude that the bioreductive alkylating agent porfiromycin has demonstrated an acceptable toxicity profile to date. Final analysis of the phase I trial, which revealed a 5-year no evidence of disease survival rate of 32% in patients with locally advanced disease and a low probability of cure, appears encouraging. We anticipate completion of the current ongoing trial comparing mitomycin C to porfiromycin in the next 2 years. Further investigations, including large-scale multiinstitutional trials employing bioreductive alkylating agents or other hypoxic cell cytotoxins as adjuncts to RT, are warranted.

Chemotherapy as an adjunct to radiation in the treatment of squamous cell carcinoma of the head and neck: results of the Yale Mitomycin Randomized Trials

PURPOSE

Two consecutive randomized trials were run at our institution using the bioreductive alkylating agent mitomycin as an adjunct to radiation therapy in an effort to improve outcome in patients with squamous cell carcinoma of the head and neck.

METHODS

Between 1980 and 1992, two consecutive randomized trials using mitomycin (trial 1) and mitomycin with dicumarol (trial 2) as an adjunct to radiation therapy in patients with squamous cell carcinoma of the head and neck were conducted at our institution. The patients were stratified by intent of therapy, extent of disease, and primary tumor site. Within each strata, patients were randomized to receive radiation therapy with or without mitomycin (trial 1) or mitomycin/dicumarol (trial 2).

RESULTS

A total of 203 patients were enrolled onto both trials, 195 of whom were eligible for analysis. Patients were equally balanced with respect to sex, age, extent of disease, primary site, radiation dose, and total duration of radiation treatment. Hematologic toxicities were more frequently noted in the drug-treated arms, but were acceptable with no drug-related treatment deaths. Nonhematologic toxicities were acceptable and not significantly different between the two arms. As of September 1995, with a median follow-up of 138 months, a statistically significant benefit occurred in the mitomycin arms with respect to cause-specific survival (0.74 +/- 0.05 v 0.51 +/- 0.05; P = .005), local recurrence-free survival (0.85 +/- 0.04 v 0.66 +/- 0.05; P = .002), and local regional recurrence-free survival (0.76 +/- 0.05 v 0.54 +/- 0.05; P = .003). No statistically significant difference in overall survival was obtained (0.48 +/- 0.05 mitomycin arms v 0.42 +/- 0.05 radiation alone).

CONCLUSION

The bioreductive alkylating agent mitomycin is a safe and effective adjunct to radiation therapy in the treatment of squamous cell carcinoma of the head and neck. The statistically and clinically significant improvement in local regional relapse and cause-specific survival obtained support the use of mitomycin as an adjunct to radiation therapy in the management of squamous cell carcinoma of the head and neck.

Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988-1994)

The reported mortality (40%) and neurologic morbidity (25%) rates for carotid rupture remain unacceptably high. This study was conducted to assess the impact of endovascular detachable balloon occlusion and the changing characteristics of carotid rupture in head and neck surgery. Between January 1, 1988, and June 30, 1994, 18 carotid ruptures were identified in 15 patients. Etiologic factors included radical surgery, radiation therapy, wound complications, and recurrent or persistent carcinoma. In 15 of 18 instances of carotid rupture, patients survived without major neurologic sequelae. After the introduction of endovascular techniques in 1991, the 12 patients whose hemorrhage was definitively managed through permanent balloon occlusion survived without significant neurologic sequelae. Endovascular occlusion techniques in the monitored patient may significantly improve the outcome after carotid rupture.

Nonsurgical alternative therapy for bulky advanced head and neck tumors

OBJECTIVE

To rapidly induce symptomatic relief and local tumor control in bulky advanced head and neck tumors without surgery.

DESIGN

A retrospective analysis of the results with palladium 103-labeled or iodine 125-labeled brachytherapy (BT) and adjunctive external beam radiation therapy (EBRT); a survival analysis by the Kaplan-Meier method; and a comparison of results between the BT/EBRT and EBRT/BT (or BT alone) groups by the log-rank test. A nonsurgical alternative therapy was given to a total of 51 patients who presented with tumors of more than 100 cm3 in volume.

RESULTS

Moderate to complete symptomatic relief was observed in 31 (61%) of 51 patients. Seven (33%) of 21 patients in the BT/EBRT group and two (7%) of 30 in the EBRT/BT group were recurrence-free at 36 months. The difference was significant by the log-rank test. Cause-specific and overall 36-month survivals were 23% and 5%, respectively.

CONCLUSION

Cure rate by conventional therapy in bulky advanced head and neck tumors is dismal. The palladium 103- or iodine 125-BT/EBRT offers good symptomatic relief and an acceptable probability of recurrence-free survival.

CT-guided percutaneous insertion of interstitial radiotherapy catheters in head and neck tumors

We describe a new method of placing interstitial radiation therapy catheters in patients with head and neck tumors. In three patients with recurrent inoperable head and neck tumors CT guidance was utilized to insert interstitial radiation therapy catheters percutaneously. This method enabled palliative radiation therapy to be administered without the need for surgical placement of seeds or catheters. The detailed anatomical localization of tumor and vascular structures provided by CT enabled precise percutaneous placement of afterloading catheters while ensuring safety. Pain was reduced and tumor size was decreased in all three patients. The CT-guided percutaneous insertion of afterloading catheters is a simple yet effective method of providing interstitial radiation therapy for head and neck tumors.

Mitomycin C as an adjunct to postoperative radiation therapy in squamous cell carcinoma of the head and neck: results from two randomized clinical trials

PURPOSE

This study was undertaken to assess the benefit of mitomycin C as an adjunct to postoperative radiation therapy in patients with operable squamous cell carcinoma of the head and neck.

METHODS AND MATERIALS

Between May 1980 and May 1991, 182 patients have been enrolled in two consecutive randomized clinical trials testing mitomycin C as an adjunct to radiation therapy in squamous cell carcinoma of the head and neck. In both trials, patients were stratified by stage, disease site and intent of therapy. This subset analysis includes 113 patients entered into these two randomized trials treated with surgery and postoperative radiation therapy. In the first trial, patients were randomized to receive standard postoperative radiation therapy alone compared with postoperative radiation therapy with concomitant mitomycin C. In the second trial, patients were randomized to postoperative radiation therapy or postoperative radiation therapy with concomitant mitomycin C plus dicoumarol.

RESULTS

As of November 1991, the 113 patients treated with surgery and postoperative radiation therapy in both trials had a median follow-up of 93 months. There have been a total of 12 local recurrences in the radiation therapy alone arm compared to 0 local recurrences in the radiation therapy/mitomycin C arm. There were eight regional recurrences in the radiation therapy alone arm compared with five regional recurrences in the mitomycin C arm. Patients in the mitomycin C arm experienced a superior 5-year actuarial local regional control rate (87% vs. 67%, p < .015) and a statistically significant disease-free survival benefit (67% vs. 44%, p < .03). Overall survival difference between the two arms (56% vs. 41%) has not reached statistical significance.

CONCLUSIONS

We conclude from these prospectively designed randomized clinical trials that in patients with operable head and neck cancer treated with surgery and postoperative radiation therapy, concomitant administration of mitomycin C with radiation therapy will result in a statistically significant disease-free survival and local regional control benefit. We are currently investigating the value of other bioreductive alkylating agents as adjuncts to radiation therapy in patients with squamous cell carcinoma of the head and neck.

Randomized clinical trial of mitomycin C as an adjunct to radiotherapy in head and neck cancer

A randomized prospective clinical trial was carried out to assess the usefulness of the addition of mitomycin C to radiation therapy used alone or in combination with surgery for the treatment of squamous cell carcinoma of the head and neck region. One hundred and twenty patients with biopsy proven tumor of the oral cavity, oropharynx, larynx, hypopharynx, and nasopharynx were randomly assigned to receive or not receive mitomycin C; all other aspects were similar in the two treatment groups. One hundred and seventeen patients were evaluable with a median follow-up time of greater than 5 years. Acute and chronic normal tissue radiation reactions were equivalent in the two treatment groups. Hematologic and pulmonary toxicity were observed in the drug treated patients. Actuarial disease-free survival at 5 years was 49% in the radiation therapy group and 75% in the radiation therapy plus mitomycin C group, p less than 0.07. Local recurrence-free survival was 66% in the radiation therapy group and 87% in the radiation therapy plus mitomycin C group, p less than 0.02. The findings demonstrate that mitomycin C can be administered safely as an adjunct to radiation therapy in the treatment of head and neck cancer. The drug improves local tumor control without enhancing normal tissue radiation reactions.

Therapeutic concepts of brachytherapy/megavoltage in sequence for pharyngeal wall cancers. Results of integrated dose therapy

This is a follow-up report on lateral, posterior oro-, hypopharyngeal wall cancer treatment based on a new therapeutic concept. Ir-192 or I-125 brachytherapy and craniocervical megavoltage irradiation are effective with improved local control and NED (no evidence of disease) survival rates. Local failure rate is 14% and actuarial survival (NED) is 82% at 5 years in 14 patients treated thus far.

Intraoperative adjuvant radiotherapy for advanced cancers of the head and neck. Preliminary report

We have reported the early local control and survival results of treatment of recurrent or metastatic head and neck tumors with intraoperative brachytherapy. All six patients were locally free of disease after curative surgery and intraoperative brachytherapy for 4 months to 1 year, whereas two of eight patients were alive at last follow-up at 7 and 8 months with some complications after palliative surgery and intraoperative brachytherapy. We advocate such a technique not only in hopelessly advanced tumors but also in less advanced tumors, as well as a definitively integrated plan of management. Doses of iodine-125 of up to 15,000 rads are safe and well tolerated, even in the presence of a past history of radiotherapy.

Subsequent upper aerodigestive malignancies following treatment of esophageal cancer

One hundred ninety-eight patients received radiation therapy for carcinoma of the esophagus. Eight patients subsequently developed at least one other epidermoid carcinoma within the upper aerodigestive tract. Analysis by life-table method suggests a steadily increasing risk for second malignancies as survival lengthens. Implications with regard to the treatment and management of patients with squamous cell carcinoma of the esophagus are discussed and the relevant literature is reviewed.

Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale

Oral cavity and oropharyngeal cancer in younger adults is a rare entity with an incidence of 2.7% among 1014 patients seen or treated at the Department of Therapeutic Radiology, Yale - New Haven Medical Center between 1958 and 1980. Although there are reports of contrastingly divergent therapeutic experiences, the authors contend that even early stage cancers frequently fail definitive therapy with a rampant course, causing a rapidly fatal outcome. The three-year actuarial survival was a mere 17% at Yale. The authors speculate that younger adult oral cavity and oropharyngeal cancers are possibly related to a genetic disorder or immunodeficiency, and recommend aggressive surgical and radiotherapeutic approaches combined with possible adjuvant immunotherapy.

Small cell carcinoma of bronchus: 1970-1980. A retrospective analysis

Seventy patients who had been referred to an oncology service during the past decade for management of small cell carcinoma of the bronchus were studied to determine survival in relation to different types of therapy as well as patterns of disease. Median survival for the entire group was 221 days. Treatments included radiotherapy, single agent chemotherapy, and combined modality treatment. Sites of metastatic disease did not influence outcome except as a sole extrathoracic site of disease. The biologic implications of these results are discussed.

Crossing and looping methods in radical interstitial therapy for lateral and posterior oro-, hypopharyngeal tumors

192Ir looping and crossing methods as a means of megavoltage tumor dose boosting have been applied for Stage II and III lateral and posterior oro-, hypopharyngeal tumors. A megavoltage and interstitial combined dose in excess of 9000 rad resulted in a soft tissue injury in two patients. Nevertheless, all five patients are alive without residual tumor at 8-38 months. We believe that a megavoltage dose of 5200 rad plus interstitial doses of 3000-3500 rad with a four week rest period intervening may improve cure rate at an acceptable injury rate.

High fractional dose irradiation of advanced head and neck cancer. Implications for combined radiotherapy and surgery

Short-course, high fractional dose radiation therapy was compared with the conventional protracted radiation schedule in the treatment of advanced (stages III and IV) head and neck cancer. Sixty-four patients with surgically unresectable squamous cell carcinoma were randomized to receive either 6,000 to 7,000 rad in six to seven weeks or 4,000 to 4,800 rad in two to three weeks. The palliative benefits of irradiation were comparable in the two treatment arms, and complete tumor regression was observed in the majority of patients in both groups. There was no difference between the groups with regard to either short-term normal tissue radiation reaction or long-term complications. High fractional dose irradiation appears to yield results equivalent to those of conventionally fractionated radiation therapy in advanced head and neck cancer and deserves further study both as primary treatment and in combination with surgery.

Randomized trial of conventional versus high fractional dose radiation therapy in the treatment of advanced head and neck cancer

A prospectively randomized clinical trial was undertaken to compare conventionally fractionated radiation therapy and high fractional dose irradiation in the treatment of advanced, surgically unresectable head and neck squamous cell carcinoma. Sixty-four patients were entered into the study between 1973 and 1979 and were randomized to receive either 200 rad daily to total tumor doses of 6000-7000 rad in 6-7 weeks, or 400 rad daily to a total of approximately 4400 rad in 2-3 weeks. The distribution of patients between the two fractionation schedules was comparable regarding site of the primary tumor, extent of disease, degree of histologic differentiation and performance status. Twenty-nine of 31 (94%) patients in the 200 rad group and 29 of 33 (88%) in the 400 rad group has Stage IV disease. Twenty-six in the former group and 30 in the latter completed radiation therapy as planned. Acute skin and mucosal reactions occurred earlier in patients treated with 400 rad daily, but were of equivalent intensity and well within acceptable levels in both groups. No increase in late adverse effects was seen with high daily doses. Palliation of tumor-related symptoms and extent of tumor control were comparable in the two groups. Actuarial five year disease-free survival rates were approximately 10% in both treatment groups with a mean follow-up period of 5 1/2 years. We conclude that high fractional dose irradiation is equivalent to conventionally fractionated radiation therapy in the treatment of advanced head and neck cancer.

Primary mucosal malignant melanoma. Appraisal of role of radiation therapy

Primary malignant melanoma of the vagina and esophagus are reported and the literature on the subject is extensively reviewed. The role of large fraction irradiation is appraised. In both cases, no exenterative surgery was imposed but instead, intermittent large fraction irradiation with protracted high doses was elected for local control.

Prognostic factors in pyriform sinus carcinoma

In the 48-month survival analysis of 76 evaluable pyriform sinus carcinoma cases, nodal stage and size played the most significant prognosis-affecting roles. N3 stage and node greater than 3 cm decreased the survival fourfold and threefold, respectively, at statistically significant levels. The difference between the 35 per cent preoperative radiation therapy and 3 per cent radical radiation therapy cumulative 48-mouth survivals was significant at p less than 0.01. Complication rates were 6 per cent with radical radiation, 35 per cent with preoperative radiation and 43 per cent with curative surgery.

Radiation therapy for testicular tumors metastasizing to the lungs

Records of 63 cases of testicular tumors treated at the Hunter Radiation Therapy Center, Yale-New Haven Hospital from 1962 through 1971 were reviewed. One hundred percent cure rate was obtained in the 36 Stage I and II pure seminoma (Group I) patients. For Stage I, the para-aortic and homolateral iliac lymph nodes were irradiated to a dose of 3,000 to 3,500 rads in three to four weeks. Elective irradiation of the mediastinum and supraclavicular areas was omitted. For Stage II, such extended field irradiation was employed to a dose of 2,000 to 3,000 rads in two to three weeks. Six (or 43 percent) of the 14 embryonal carcinoma (Group II) patients are alive for a minimum of three to a maximum of eleven years. Both teratoma (Group III) patients are alive at five and seven years as well. All eight Stage I teratocarconoma (Group IV) patients are alive with no evident disease at three to ten years. Our data indicate the difference in prognosis between patients who subsequently developed localized lung metastases and those who initially presented with pulmonary disease. We conclude that intensive combined efforts of both radiation and medical oncologists can salvage a considerable number of patients with metachronous onset of pulmonary metastases.

Radiation carcinogenesis

Accidental or therapeutic exposure to radiation may induce tumors of various histologic types in human beings as well as in animals. Two tumors in this report arose in the organs which had been included in the field of radiation 32 and 8 years before, respectively. The author briefly reviews the literature, which abounds with references to radiation carcinogenesis.