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Radioactive eyeplaque therapy for choroidal malignant melanomas
Proceedings of the 1st Annual ASTRO Meeting .correlate
factors
of
potentlal
prognostlc
199
slgnlflcance
factors Include the cllnlcal stage, the method ( lymphanglogram, laparotomy, none), hlstologlcal transurethral resection. The end polnts of the rate, distant fal lure rate, disease-free survival
and the cllnlcal course. These assessment of reglonal lymphatlcs hormona I management grade, and analysis Include local-regional failure and survival.
of
Cllnlcal stage was found of Iimlted value In predlctlng elther local-reglonal control or dlsease-free survlval. Slmllarly the method of nodal evaluation and the nodal status dld not correlate slgnlflcantly with the cllnlcal outcome. Hlstologlcal grade was establ lshed as the best predlctor of both local-reglonal control and the lncldence of dlssemlnatlon. These flndlngs mlght prove valuable In the deslgn of future studies on carcinoma of the prostate.
RS27 INFLUENCE
OF LYMPH NODAL STATUS ON PRIMARY TUMOR CONTROL PROBABILITY IN HEAD AND NECK
CANCER T. J. Wall, M. D. and L. J. Peters, M.D. Diiision of Radiotherapy UT M. D. Anderson Hospital and Tumor Institute Houston, Texas 77030 A retrospective review of 249 patients with squamous cell carcinoma of the supraglottic larynx was undertaken to determine whether the probability of control of the primary lesion was influenced by the presence and/or extent of neck All patients were treated at the UT M. D. Anderson Hospital between 1960 and 1980, and had a minimum 3 nodal disease. year follow-up. From descriptions and diagrams made on initial presentation, the volume of neck disease was scored on a The primary tumor sites were scale of 0 (no palpable nodes) to 9 (bilateral neck nodes reater than 6 cm in diameter). infrahyoid epiglottis f 57 patients), aryepiglottic folds (56 patients), false cords (35 suprahyoid epiglottis (95 atients), patients), and arytenoids P6 patients). Of the 249 patients, 38 presented with Tl disease, 132 with T2, and 51 with T3, and All primary lesions were treated 28 with T4. Sixty percent (60%) were clinically node negative on initial presentation. Treatment to the neck varied according to the extent of lymph node involvement definitively with radiation therapy. There was no with a planned lymph node dissection being performed in 41 patients with more extensive disease. significant difference in the range of total radiation doses delivered to the primary lesions, stage for stage, in patients The most frequently prescribed doses for Tl and T2 lesions who presented with clinically negative or positive nodes. were 65 Cy and 70 Gy, and for T3 and T4 lesions 70 Gy and 75 Cy, given in daily fractions of approximately 2 Gy. Analysis of the probability of primary tumor control was made by life-table methods to avoid distortion of the results by For Tl and T2 primary lesions, any positive node decreased the the poorer survival expectation in node positive patients. probability of primary tumor control (p = 0.06). For T3 and T4 lesions, a single node less than 2 cm in diameter did not For Tl worsen the chance of primary tumor control, but any greater degree of lymph node involvement did so (p = 0.04). and T2 lesions the probability of primary tumor control at 5 years was 82% in node negative patients compared with 66% in node positive patients. For T3 and T4 lesions the probability of primary tumor control was 67% in NO and Nl patients In the T3 and T4 group, the greatest adverse influence of compared with 41% in those with more extensive nodal disease. nodal disease was in those patients who received less than 68 Gy tumor dose to the primary lesion. Possible biological explanations for these findings will be discussed.
RS28 RADIOACTIVE Luther
NEPLAQUE
W. Bradyl,
Hahnemann
THERAPY
Arnold
University
FOR CHOROIDAL
M. Markoel,
Hospital1
Jerry
and Wills
MALIGNANT Shields2,
MELANOMAS James Augsburger2,
Eye Hospita12,
Philadelphia,
and John Day" Pa.
We have reviewed our experience utilizing radioactive eyeplaque therapy for the treatment of choroidal malignant melanomas. We shall examine the initial 100 patients so treated and compare this group against a similar number of enucleated patients in terms of metastatic rate and survival. The minimum follow-up time for these plaqued patients is now approaching 3.5 years. We will present data dealing with the retention of visual acuity in the patients treated with eyeplaques. We will also discuss trends in similar analysis of over 500 patients (including the initial loo), although the median follow-up period is shorter. The data show that the prognosis for patients with choroidal malignant melanoma is directly related to the size of tumor at presentation. Patients with similar size tumors at presentation have similar survival rates and metastatic rates whether they are enucleated or are treated by radioactive eyeplaque therapy. However, the latter patients may retain useful vision over a significant period of time. We will also present preliminary information regarding the potential for replaquing patients with new and distinct second tumors in a previously treated eye or in patients who exhibit regrowth of the originally treated tumor. We will briefly discuss the potential utility of radioactive eyeplaques other than radioactive Cobalt eyeplaques and review our initial experience with radioactive Iodine and Iridium eyeplaques. From our date we can conclude that treatment of choroidal malignant melanomas by radioactive eyeplaque therapy would appear to be, over the follow-up period involved, at least as efficacious as enucleation and has the advantage of preserving useful vision in certain patients for prolonged periods.
factors
of
potentlal
prognostlc
199
slgnlflcance
factors Include the cllnlcal stage, the method ( lymphanglogram, laparotomy, none), hlstologlcal transurethral resection. The end polnts of the rate, distant fal lure rate, disease-free survival
and the cllnlcal course. These assessment of reglonal lymphatlcs hormona I management grade, and analysis Include local-regional failure and survival.
of
Cllnlcal stage was found of Iimlted value In predlctlng elther local-reglonal control or dlsease-free survlval. Slmllarly the method of nodal evaluation and the nodal status dld not correlate slgnlflcantly with the cllnlcal outcome. Hlstologlcal grade was establ lshed as the best predlctor of both local-reglonal control and the lncldence of dlssemlnatlon. These flndlngs mlght prove valuable In the deslgn of future studies on carcinoma of the prostate.
RS27 INFLUENCE
OF LYMPH NODAL STATUS ON PRIMARY TUMOR CONTROL PROBABILITY IN HEAD AND NECK
CANCER T. J. Wall, M. D. and L. J. Peters, M.D. Diiision of Radiotherapy UT M. D. Anderson Hospital and Tumor Institute Houston, Texas 77030 A retrospective review of 249 patients with squamous cell carcinoma of the supraglottic larynx was undertaken to determine whether the probability of control of the primary lesion was influenced by the presence and/or extent of neck All patients were treated at the UT M. D. Anderson Hospital between 1960 and 1980, and had a minimum 3 nodal disease. year follow-up. From descriptions and diagrams made on initial presentation, the volume of neck disease was scored on a The primary tumor sites were scale of 0 (no palpable nodes) to 9 (bilateral neck nodes reater than 6 cm in diameter). infrahyoid epiglottis f 57 patients), aryepiglottic folds (56 patients), false cords (35 suprahyoid epiglottis (95 atients), patients), and arytenoids P6 patients). Of the 249 patients, 38 presented with Tl disease, 132 with T2, and 51 with T3, and All primary lesions were treated 28 with T4. Sixty percent (60%) were clinically node negative on initial presentation. Treatment to the neck varied according to the extent of lymph node involvement definitively with radiation therapy. There was no with a planned lymph node dissection being performed in 41 patients with more extensive disease. significant difference in the range of total radiation doses delivered to the primary lesions, stage for stage, in patients The most frequently prescribed doses for Tl and T2 lesions who presented with clinically negative or positive nodes. were 65 Cy and 70 Gy, and for T3 and T4 lesions 70 Gy and 75 Cy, given in daily fractions of approximately 2 Gy. Analysis of the probability of primary tumor control was made by life-table methods to avoid distortion of the results by For Tl and T2 primary lesions, any positive node decreased the the poorer survival expectation in node positive patients. probability of primary tumor control (p = 0.06). For T3 and T4 lesions, a single node less than 2 cm in diameter did not For Tl worsen the chance of primary tumor control, but any greater degree of lymph node involvement did so (p = 0.04). and T2 lesions the probability of primary tumor control at 5 years was 82% in node negative patients compared with 66% in node positive patients. For T3 and T4 lesions the probability of primary tumor control was 67% in NO and Nl patients In the T3 and T4 group, the greatest adverse influence of compared with 41% in those with more extensive nodal disease. nodal disease was in those patients who received less than 68 Gy tumor dose to the primary lesion. Possible biological explanations for these findings will be discussed.
RS28 RADIOACTIVE Luther
NEPLAQUE
W. Bradyl,
Hahnemann
THERAPY
Arnold
University
FOR CHOROIDAL
M. Markoel,
Hospital1
Jerry
and Wills
MALIGNANT Shields2,
MELANOMAS James Augsburger2,
Eye Hospita12,
Philadelphia,
and John Day" Pa.
We have reviewed our experience utilizing radioactive eyeplaque therapy for the treatment of choroidal malignant melanomas. We shall examine the initial 100 patients so treated and compare this group against a similar number of enucleated patients in terms of metastatic rate and survival. The minimum follow-up time for these plaqued patients is now approaching 3.5 years. We will present data dealing with the retention of visual acuity in the patients treated with eyeplaques. We will also discuss trends in similar analysis of over 500 patients (including the initial loo), although the median follow-up period is shorter. The data show that the prognosis for patients with choroidal malignant melanoma is directly related to the size of tumor at presentation. Patients with similar size tumors at presentation have similar survival rates and metastatic rates whether they are enucleated or are treated by radioactive eyeplaque therapy. However, the latter patients may retain useful vision over a significant period of time. We will also present preliminary information regarding the potential for replaquing patients with new and distinct second tumors in a previously treated eye or in patients who exhibit regrowth of the originally treated tumor. We will briefly discuss the potential utility of radioactive eyeplaques other than radioactive Cobalt eyeplaques and review our initial experience with radioactive Iodine and Iridium eyeplaques. From our date we can conclude that treatment of choroidal malignant melanomas by radioactive eyeplaque therapy would appear to be, over the follow-up period involved, at least as efficacious as enucleation and has the advantage of preserving useful vision in certain patients for prolonged periods.