- Email: [email protected]
Update of the results of total skin electron irradiation for mycosis fungoides
Proceedings
of the 28th Annual ASTRO Meeting
171
required an unplanned break in radiation therapy due to bowel or skin lo/32 (31%) of patients reaction. No patient reaction was severe enough to warrant hospitalization. Four patients developed significant long-term complications felt to be radiation induced. Two of these were cases of painful benign anal ulcer necessitating colostomy and 2 were cases of hip fracture felt to be related to the use of APPA fields and 25 MeV photons. Six additional patients had minor complaints of mild anal bleeding (31, mild anal pain (21, and symptoms attributable to mild anal stenosis (1). We conclude that limited stage squamous cell cancer of the anal canal can be effectively managed with external beam radiation therapy alone with surgery reserved for salvage. Our data indicate chemotherapy may not be necessary in the primary management of limited squamous cell carcinoma of the anus.
154 HETEROTOPIC BONE FORMATION: CONTROL OF PROGRESSION BY RADIOTHERAPY C. Ronald Kersh, M.D.(l), Donald R. Eisert, M.D.(l), and Douglas E. Cook, M.D.(Z) (1)Department of Radiology/Divisionof Virginia Commonwealth University/The Medical College of Virginia Radiation Therapy & Oncology and (2)Department of Radiology/Divisionof Diagnostic Radiology Richmond, Virginia 23298 Heterotopic bone formation is a relatively common complication in patients who are chronically immobilized. Post-operative radiotherapy has been advocated to decrease this complication, and the most common area irradiated was the hip in our experience. We have retrospectively reviewed all patients referred with the diagnosis of heterotopic bone formation to the Division of Radiation Oncology at the Medical College of Virginia Hospitals for the time period of 1980 to 1985. A total of 15 hips in 14 patients were irradiated. During a comparable time period, 236 patients underwent total hip replacement, and severe heterotopic bone formation (Stage III or Stage IV) developed in 33 patients (14%) who did not receive radiotherapy. For the purpose of this study, each site irradiated is considered a separate patient. The patients ranged in age from 23 to 78 with a median of 54 years. There were 14 male patients and one female patient. Radiotherapy was given with supervoltage equipment with a dose range of 1000 cGy (7 patients) to 2000 cGy (8 patients). The films on all patients were reviewed by one of us (DEC) and grouped employing the Brooker staging system. Only one patient demonstrated progression, 6 patients had stable disease and 8 patients had downstaging of disease. The one patient in whom progression was observed had been treated to 2000 cGy. Based on his limited review, it would appear that 1000 cGy is as effective as the currently published recommendation for 2000 cGy.
155 UPDATE OF THE RESULTS OF TOTAL SKIN ELECTRON IRRADIATION FOR MYCOSIS FUNGOIDES D.ROSENTHAL,M.D.,F.R.C.P.C., A.A.M.TADROS,M.B.,D.M.R.T.,F.F.R.,F.R.C.P.C., D.MELNYCHUK,M.D. J.T.ROBERTS,M.B.,CH.B.,M.R.C.PATH., The Ontario Cancer Foundation and the Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada. we presented failure analysis and prognostic In the October 1982 ASTR meeting, factors on 106 patients with Mycosis Fungoides treated with whole skin Between 1970 and 1984 a total of 176 patients electron beam irradiation. received between 30 and 35 Gy of 3 to 3.5 MEV electrons in 12 treatments over three weeks. 117 patients had cutaneous plaques only (Tl, 2NO) and 59 the actuarial survival is At ten years, patients had more advanced disease. Initial response to electron beam was no response in six patients - 3X, 55%. response in 130 patients partial response in forty patients - 22% and complete There were 73 patients (41%) with persistent disease and 103 patients 73%. were free of disease (58) following second line treatment by topical nitrogen The disease free survival at 5 and 10 years mustard and/or retinoic acid. Of the 31 patients known to be free of disease in 1980, 8 have was 20%. 12 are still disease free at 14 years and 11 were not followed uo relapsed, in the last year.
of the 28th Annual ASTRO Meeting
171
required an unplanned break in radiation therapy due to bowel or skin lo/32 (31%) of patients reaction. No patient reaction was severe enough to warrant hospitalization. Four patients developed significant long-term complications felt to be radiation induced. Two of these were cases of painful benign anal ulcer necessitating colostomy and 2 were cases of hip fracture felt to be related to the use of APPA fields and 25 MeV photons. Six additional patients had minor complaints of mild anal bleeding (31, mild anal pain (21, and symptoms attributable to mild anal stenosis (1). We conclude that limited stage squamous cell cancer of the anal canal can be effectively managed with external beam radiation therapy alone with surgery reserved for salvage. Our data indicate chemotherapy may not be necessary in the primary management of limited squamous cell carcinoma of the anus.
154 HETEROTOPIC BONE FORMATION: CONTROL OF PROGRESSION BY RADIOTHERAPY C. Ronald Kersh, M.D.(l), Donald R. Eisert, M.D.(l), and Douglas E. Cook, M.D.(Z) (1)Department of Radiology/Divisionof Virginia Commonwealth University/The Medical College of Virginia Radiation Therapy & Oncology and (2)Department of Radiology/Divisionof Diagnostic Radiology Richmond, Virginia 23298 Heterotopic bone formation is a relatively common complication in patients who are chronically immobilized. Post-operative radiotherapy has been advocated to decrease this complication, and the most common area irradiated was the hip in our experience. We have retrospectively reviewed all patients referred with the diagnosis of heterotopic bone formation to the Division of Radiation Oncology at the Medical College of Virginia Hospitals for the time period of 1980 to 1985. A total of 15 hips in 14 patients were irradiated. During a comparable time period, 236 patients underwent total hip replacement, and severe heterotopic bone formation (Stage III or Stage IV) developed in 33 patients (14%) who did not receive radiotherapy. For the purpose of this study, each site irradiated is considered a separate patient. The patients ranged in age from 23 to 78 with a median of 54 years. There were 14 male patients and one female patient. Radiotherapy was given with supervoltage equipment with a dose range of 1000 cGy (7 patients) to 2000 cGy (8 patients). The films on all patients were reviewed by one of us (DEC) and grouped employing the Brooker staging system. Only one patient demonstrated progression, 6 patients had stable disease and 8 patients had downstaging of disease. The one patient in whom progression was observed had been treated to 2000 cGy. Based on his limited review, it would appear that 1000 cGy is as effective as the currently published recommendation for 2000 cGy.
155 UPDATE OF THE RESULTS OF TOTAL SKIN ELECTRON IRRADIATION FOR MYCOSIS FUNGOIDES D.ROSENTHAL,M.D.,F.R.C.P.C., A.A.M.TADROS,M.B.,D.M.R.T.,F.F.R.,F.R.C.P.C., D.MELNYCHUK,M.D. J.T.ROBERTS,M.B.,CH.B.,M.R.C.PATH., The Ontario Cancer Foundation and the Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada. we presented failure analysis and prognostic In the October 1982 ASTR meeting, factors on 106 patients with Mycosis Fungoides treated with whole skin Between 1970 and 1984 a total of 176 patients electron beam irradiation. received between 30 and 35 Gy of 3 to 3.5 MEV electrons in 12 treatments over three weeks. 117 patients had cutaneous plaques only (Tl, 2NO) and 59 the actuarial survival is At ten years, patients had more advanced disease. Initial response to electron beam was no response in six patients - 3X, 55%. response in 130 patients partial response in forty patients - 22% and complete There were 73 patients (41%) with persistent disease and 103 patients 73%. were free of disease (58) following second line treatment by topical nitrogen The disease free survival at 5 and 10 years mustard and/or retinoic acid. Of the 31 patients known to be free of disease in 1980, 8 have was 20%. 12 are still disease free at 14 years and 11 were not followed uo relapsed, in the last year.