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Radiotherapy for kaposi's sarcoma
drome. After the second dose, i.e. 800 rads, itching was markedly relieved and scaling was decreased. (The median duration of remission was 18 months for the 71 patients at risk for 12-90 months.) Treatments were well tolerated. 17 patients received a second course of TSEB 6-32 months later. The influence of erythroderma, circulating Sezary cells, palpable lymphadenopathy and other.prognostic factors will be presented. Responsiveness of peripheral lymphocytes to mitogens, antigens and allogenic cells was measur ed in 12 patients and a correlation was observed between the stage of the disease, response to TSEB, duration of remission and these laboratory results.
(40)
ANALYSIS OF PATIENTS TREATED IN A COMPREHENSIVE MYCOSIS FUNGOIDES PROGRAM
V. Petras, R. Tokars, M.L. Griem, J.M.
Baron, and D. Variakojis
University of Chicago Chicagu, Illinois 60637
From a total population of 60 patients seen since 1970 with the pathological diagnosis of mycosis fungoides, a subset of 46 patients were referred and treated with electron beam. Thirteen patients were treated with localized fields using electrons or whole body electron beam with a dose of less than 3000 rads. Thirty-three patients were treated with tissue doses of 3000 to 4000 rads using the Stanford technique. Six of these patients have had six cycles of MOPP or COPP following electron beam. The one-year survival for the 13 patients with local electron beam is 45%. The one-year survival for the 33 whole body electron beam patients is 84% (79% for those without chemotherapy) and 100% for those with whole body electrons followed by four-drug chemotherapy. Recurrence-free periods correlate with these observations.
(41)
RADIOTHERAPY
FOR KAPOSI!S SARCOMA
Theodore C.M..Lo, M.D.1, Ferdinand A. Salzman, M.D ', Magnus I. Smedal, M.D.l, Kenneth A. Wright, M.S.* 'Lahey Clinic Foundation, Boston, MA 'Massachusetts Institute of Technology, Cambridge, MA Between 1954 and 1976, sixty patients with Kaposi's sarcoma were - Lahey Clinic treated in the High Voltage Research Laboratory (M.I.T.) Radiotherapy facility. Only two patients were free of clinical disease in the lower extremities at the time of initial presentation and 40 patients (69%) had cutaneous lesions involving areas beyond the lower limbs. Eight patients (13%) also presented with mucous membrand involvement in addition to skin disease.
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Twenty-one patients were treated only with megavoltage electrons during the initial course of radiotherapy and twelve patients were treated with supervoltage photons alone. The remaining 27 patients were treated with a combination of electrons and photons; in the 17 the same tumor Eleven patients received whole sites were irradiated with both modalities. The choice of treatment modalities body surface electron irradiation. was based on the extent and distribution of cutaneous disease and depth of the lesions. The overall response rate was 93% after a single fractionated course of radiotherapy. Twenty-five patients achieved complete regression while eighteen of them were in remission for 2 to 13 years. Response rates were also analyzed with respect to the 3 subgroups in terms of treatment modalities. It was found that a single dose of 800 to 1200 rads or its equivalence was required to control the local cutaneous lesions. Widespread visceral metastasis was the most common cause of failure and death and the incidence of second malignancies was increased. Trial of systemic chemotherapy and immunotherapy would seem to be a reasonable therapeutic adjunct.
(42)
AN EFFECTIVE RADIATION THERAPY TREATMENT FOR SPINAL CORD COMPRESSION K.V. Reddy, M.D., 0. Salazar, M.D., H. Castro-Vita, M.D., and P. Rubin, M.D. University of Rochester Cancer Center Division of Radiation Oncology Rochester, New York 14642
Acute spinal cord compression (SCC) constitutes a medical emergency which involves radiation as a primary therapy. A retrospective analysis of cases at our Institution for the last 15 years yielded 80 patients with this condition. One fourth of all patients had primary spinal cord tumors and the remaining 75% were metastatic The most common metastatic tumors were carcinomas of the lung, breast, prostate and lymphomas accounting for 50% of all patients. There were decompressive laminectomies performed in 50% and diagnostic myelograms in 90% of all cases. Myelograms become an essential diagnostic technique; 50% of the patients had complete block, 20% showed a defect and less than 10% showed skipped lesions on contrast studies. Myelograms aid the radiation oncologist in targeting the treatment fields appropriately. Laminectomies constituted a good decompressive, but not therapeutic procedure; only 5% of the patients subjected to it had ~50% clinical improvement and less than 10% had some improvement after the procedure. The most common involved segment of the spinal cord was the thoracic accounting for almost 70% of all patients. The bi-association of superior vena caval obstruction (SVCO) and SCC occurred in less than 10% of the cases. Previous reports by Rubin et al in 1969 presented clinical and laboratory data suggesting better results when SCC was treated with initial high daily doses than when treated with conventional fractionation. The clinical material consisted of only 12 patients in 1969; this report constitutes an update from those previous publications. More than 50% of the cases in the present series (80 patients) were treated with initial high doses (2750 rad in the first 3
99
(40)
ANALYSIS OF PATIENTS TREATED IN A COMPREHENSIVE MYCOSIS FUNGOIDES PROGRAM
V. Petras, R. Tokars, M.L. Griem, J.M.
Baron, and D. Variakojis
University of Chicago Chicagu, Illinois 60637
From a total population of 60 patients seen since 1970 with the pathological diagnosis of mycosis fungoides, a subset of 46 patients were referred and treated with electron beam. Thirteen patients were treated with localized fields using electrons or whole body electron beam with a dose of less than 3000 rads. Thirty-three patients were treated with tissue doses of 3000 to 4000 rads using the Stanford technique. Six of these patients have had six cycles of MOPP or COPP following electron beam. The one-year survival for the 13 patients with local electron beam is 45%. The one-year survival for the 33 whole body electron beam patients is 84% (79% for those without chemotherapy) and 100% for those with whole body electrons followed by four-drug chemotherapy. Recurrence-free periods correlate with these observations.
(41)
RADIOTHERAPY
FOR KAPOSI!S SARCOMA
Theodore C.M..Lo, M.D.1, Ferdinand A. Salzman, M.D ', Magnus I. Smedal, M.D.l, Kenneth A. Wright, M.S.* 'Lahey Clinic Foundation, Boston, MA 'Massachusetts Institute of Technology, Cambridge, MA Between 1954 and 1976, sixty patients with Kaposi's sarcoma were - Lahey Clinic treated in the High Voltage Research Laboratory (M.I.T.) Radiotherapy facility. Only two patients were free of clinical disease in the lower extremities at the time of initial presentation and 40 patients (69%) had cutaneous lesions involving areas beyond the lower limbs. Eight patients (13%) also presented with mucous membrand involvement in addition to skin disease.
98
Twenty-one patients were treated only with megavoltage electrons during the initial course of radiotherapy and twelve patients were treated with supervoltage photons alone. The remaining 27 patients were treated with a combination of electrons and photons; in the 17 the same tumor Eleven patients received whole sites were irradiated with both modalities. The choice of treatment modalities body surface electron irradiation. was based on the extent and distribution of cutaneous disease and depth of the lesions. The overall response rate was 93% after a single fractionated course of radiotherapy. Twenty-five patients achieved complete regression while eighteen of them were in remission for 2 to 13 years. Response rates were also analyzed with respect to the 3 subgroups in terms of treatment modalities. It was found that a single dose of 800 to 1200 rads or its equivalence was required to control the local cutaneous lesions. Widespread visceral metastasis was the most common cause of failure and death and the incidence of second malignancies was increased. Trial of systemic chemotherapy and immunotherapy would seem to be a reasonable therapeutic adjunct.
(42)
AN EFFECTIVE RADIATION THERAPY TREATMENT FOR SPINAL CORD COMPRESSION K.V. Reddy, M.D., 0. Salazar, M.D., H. Castro-Vita, M.D., and P. Rubin, M.D. University of Rochester Cancer Center Division of Radiation Oncology Rochester, New York 14642
Acute spinal cord compression (SCC) constitutes a medical emergency which involves radiation as a primary therapy. A retrospective analysis of cases at our Institution for the last 15 years yielded 80 patients with this condition. One fourth of all patients had primary spinal cord tumors and the remaining 75% were metastatic The most common metastatic tumors were carcinomas of the lung, breast, prostate and lymphomas accounting for 50% of all patients. There were decompressive laminectomies performed in 50% and diagnostic myelograms in 90% of all cases. Myelograms become an essential diagnostic technique; 50% of the patients had complete block, 20% showed a defect and less than 10% showed skipped lesions on contrast studies. Myelograms aid the radiation oncologist in targeting the treatment fields appropriately. Laminectomies constituted a good decompressive, but not therapeutic procedure; only 5% of the patients subjected to it had ~50% clinical improvement and less than 10% had some improvement after the procedure. The most common involved segment of the spinal cord was the thoracic accounting for almost 70% of all patients. The bi-association of superior vena caval obstruction (SVCO) and SCC occurred in less than 10% of the cases. Previous reports by Rubin et al in 1969 presented clinical and laboratory data suggesting better results when SCC was treated with initial high daily doses than when treated with conventional fractionation. The clinical material consisted of only 12 patients in 1969; this report constitutes an update from those previous publications. More than 50% of the cases in the present series (80 patients) were treated with initial high doses (2750 rad in the first 3
99