- Email: [email protected]
Role of ionizing irradiation — 393 keloids
187
Proceedings of the 29th Annual ASTRO Meeting
by tumor, consistent with clinically evident erythema. During photodynamic therapy, blood flow dramatically increased up to 3 fold further and subsequently declined over the next 1-24 hours to a level below that initially seen in the tumor and approximating that seen in normal tissue. We have seen residual pulsatile blood flow in all of the cases measured, even in tissues where subsequent necrosis has occurred. Preliminary work with blood flow changes in experimental murine tumors after photodynamic therapy will be discussed.
185 Palliative Radiotherapy for Yetastatic Malignant Melanoma William R. Rate, Ph.D, M.D., Lawrence J. Solin, M.D., and Andrew T. Turrisi, M.D. Department of Radiation Therapy, University of PennsylvaniaSchool of Medicine and the Fox Chase Cancer Center
The most effective method of palliation of metastatic malignant melanoma is often unclear. Fraction size and length of treatment need to be tailored to the anticipated survival. To examine this question, a retrospective review was performed of all patients with metastatic malignant melanoma to brain, bone and spinal cord between January, 1980 and August, 1986. Seventy-seven patients were identified with symptomaticbrain metastatses documented on CT scan (73) or nucleotide scan (4) who completed whole brain radiotherapy. All patients received high dose steroids. The median survival from the initiation of radiotherapywas 14 weeks. Sex or age did not influence survival at four months. Sixty-five of seventy-sevenpatients received large fraction radiotherapy (1 400 cGy). No change in survival was observed with low fraction (< 400 cGy) or mixed fraction treatment plans. The median interval from the diagnosis of melanoma to the appearance of brain metastases was 30 months. Thirty-two patients in whom the diagnosis of melanoma was present less than two years had a median survival of twelve weeks from the start of radiotherapy,and the median survival was eleven weeks in seventeen patients in whom the interval was greater than five years. Surgical resection significantly improved survival in patients with solitary brain metastasis. Twentytwo patients were assessed to have a single brain metastasis on CT scan (20) or nucleotide scan (2). Ten had sub&al to total resection and radiotheiapywith 9110 surviving 14 months-and with a median s&viva1 of 36 weeks. Five of these ten resected patients had evidence of skin, lung, or liver involvement. The remaining twelve patients with evidence of a solitary brain metastasis treated with radiotherapyalone had a median survival of 16 weeks with 4112 surviving 2 4 months. There were twenty-six patients with 39 symptomatic bony metastases, 20 involving extremities and 19 involving axial bones (pelvis, spine, and thorax). Eighteen of twenty patients treated with large fractions experienced complete to partial pain relief within one month of the start of radiotherapy,versus fifteen of nineteen treated with small fraction sizes. No trend could be established between fraction size and pain relief. The median survival for all patients with symptomaticbony metastases was 15 weeks. Partial or complete spinal cord compressionwas demonstratedon myelography in seventeen patients. Of these, eight treated with radiotherapy had significantor complete relief of pain and neurological deficits within one month of initiation of treatment. Three of these eight also had had a decompressivelaminectomy. The median survival of all patients with spinal cord compressionwas 13 weeks. We conclude that short course, high fraction radiotherapyprovides good short-term palliation in patients with symptomatic metastatic melanoma. A favorable subgroup who had solitary brain metastasis and was surgically resectible was found to have significantlyimproved survival. Significant palliation was also obtained in almost half of the patients with spinal cord compressiontreated with radiotherapy.
186 ROLE
OF IONIZING
IRRADIATION 1
T.L. Borok, M.D. ; MaBray, and C. Rollins, M.D. .
- 393 KELOIDS A.R.R.T.
2
; I. Sinclair,
1. Director-Metcalf Insti$ute,Radiation Oncology ?chool of Medicine; Dlvlslon of Radiation Chairman-Dept of Surgery; The Hospital Center
Ph.D.
2
; J. Plafker,
M.D.
3
; L. LaBirth2;
and Assistan Professor-New York Oncology; Chairman-Dept. of at Orange, Orange, N.J. 07051
University Pathology;
presented between 1928 to Three hundred ninety three keloid sites on 250 patients 1986 of which 375 sites received superficial quality therapeutic irradiation. Etiologies 166 surgical incision, 3 vaccination, (169 iatrogenic); 79 ear lobe pierce; 36 included: barbae; 3 Varicella 33 thermal trauma (burn); 4 pseudofolliculitis mechanical trauma; 1 ecthyma (7 infection); 2 chemical (acid burn); 2 Verruca scar; 2 mole scar, 3 abscess, (idiopathic). The majority (nevus); 1 rash; 1 shaving, 1 canine bite; and 56 spontaneous confirmation was obtained. In were excised prior to irradiation, and in these, histologic
Radiation
188
Oncology,
Biology,
Physics
October
1987, Volume
13, Supplement
1
later years, interstitial steroid infiltration was selectively permitted. Dose-success relationships, post-excision interval (velocity of initiating postoperative irradiation) data, and recurrence intervals will be presented. Recurrence rate after irradiation was low, 9/375 (2.4%). If 7 of 9 recurrences are eliminated for post-irradiation ear lobe 5/375 (1.3%) developed repiercing, true recurrence is only 2/375 (0.53%). An additional subcutaneous nodules < 5 mm. which were neither keloid nor visible. Two others formed flat wide hypertrophic scar without keloid at one pole of their scars. Cosmetic result was considered excellent without recurrence in 92%, favorably improved with hypertrophic scar or persistent hyperpigmentation in 5.6%, and marginally improved with smaller less symptomatic keloid in 2.4%. Complications were limited to transient hyperpigmentation in in a few, pre-irradiation hemorrhage in one (unrelatmany, persistent pigment disturbance and there were no cases of irradiated incision site failure to heal ed to radiotherapy), nor wound dehiscence. Complication statistics will be presented. Our null (0%) carcinogenicity rate to date and the one-half of one percent true recurrence rate supports continued use of postoperative irradiation to prevent keloid formation in this group of documented troublesome keloid formers. An unexpected finding was 22 of 250 subjects being Caucasian.
187 CONCOMMITTANT CHEMO RADIOTHERAPY IN LIMITED SMALLCELL CARCINOMA OF LUNG: SURVIVAL. A SOUTHWEST ONCOLOGY GROUP STUDY. Lalitha M. Janaki, J.D. McCracken, S. B. Taylor, P.G.S. J. Crowley Spohn Hospital, 334 Cape Cod, Corpus Christi, Texas
IMPROVED RESPONSE AND MEDIAN
Giri, G. B. Weiss,
W. Gordon,
Jr., R. B. Vance,
and
THE study is designed to use simultaneous Cisplatinum, Etoposide and chest radiation in limited small cell carcinoma of lung. Long term survival in evaluable patient population is imprqssive. SCHEMA: Radiation therapy to the primary tumor with concommittant chemotherapy to begin on day 1 of the Chemotherapy consisting of Cisplatinum, VP-16 and program. 180 rads/day to total tumor dose of 4500 rads. Vincristine to begin day 1. Prophylactic brain radatio to begin day 57. Consolidation chemotherapy to begin on day85 with Vincristine, Methotrexate, VP-16, Adriamycin, and cyclophomide. After 12 weeks of consolidation chemotherapy, patients with CR had all therapy discontinued and observed. The study was opened in Toxicity was acceptable and presented preDecember, 1982. Group wide participation began in April, 1985. The resA total of 164 patient put on the study. Complete response rate was greater than 55%. viously. Local recurrence rate was less than 10%. ponders have high performance status survival. The survival
curves with relapse
rate, response
rate to be presented.
The following
observations
were
made: 1. 2. 3. 4. 5.
The The The The The
high complete remission rate. excellent performance status in surviving patients. long tumor free interval off maintenance therapy. low recurrence rate. acceptable toxicity.
These points warrant CARCINOMA OF THE LUNG.
further
use of this program
in patients
with
the diagnosis
of LIMITED
SMALL CELL
188 LOCO-REGIONAL FAILURE RATE IN RELATION WITH RADIATION DOSE IN COMBINED MODALITY CHEMOTHERAPY AND RADIOTHERAPY FOR LIMITED STAGF SMALL-CELL LUNG CARCINOMA
APPROACH
Departments of Radiation Medicine+ and Robert C. Carey, M.D? Noah C. Choi, M.D! Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
OF MULTIAGENT
and Medicine?,
While the role of thoracic radiotherapy Erroneous conclusion can be drawn from inadequate studies. (RT) for limited stage small-cell lunq carcinoma (SCLC) has been a subject of the debate based on median survival time (MST) of lo-12 months (M) by either multiaqent chemotherapy (CT) alone or CT plus thoracic RT, radiation dose‘schedules employed in.m&y-studies remain-insufficient. A recent autopsy report, which states that the addition of RT to the orimarv tumor and mediastinum failed to modifv the distribution of residual tumors compared with that of patients treated with CT alone (J Clin Oncol 5:246-254, 1987), prompted us to evaluate the radiation dose-tumor response in modern CT era. As a few ongoing randomized studies are getting matured, it has become clear that thoracic RT continues to remain to play a vital role in achieving long-term survival beyond MST.
Proceedings of the 29th Annual ASTRO Meeting
by tumor, consistent with clinically evident erythema. During photodynamic therapy, blood flow dramatically increased up to 3 fold further and subsequently declined over the next 1-24 hours to a level below that initially seen in the tumor and approximating that seen in normal tissue. We have seen residual pulsatile blood flow in all of the cases measured, even in tissues where subsequent necrosis has occurred. Preliminary work with blood flow changes in experimental murine tumors after photodynamic therapy will be discussed.
185 Palliative Radiotherapy for Yetastatic Malignant Melanoma William R. Rate, Ph.D, M.D., Lawrence J. Solin, M.D., and Andrew T. Turrisi, M.D. Department of Radiation Therapy, University of PennsylvaniaSchool of Medicine and the Fox Chase Cancer Center
The most effective method of palliation of metastatic malignant melanoma is often unclear. Fraction size and length of treatment need to be tailored to the anticipated survival. To examine this question, a retrospective review was performed of all patients with metastatic malignant melanoma to brain, bone and spinal cord between January, 1980 and August, 1986. Seventy-seven patients were identified with symptomaticbrain metastatses documented on CT scan (73) or nucleotide scan (4) who completed whole brain radiotherapy. All patients received high dose steroids. The median survival from the initiation of radiotherapywas 14 weeks. Sex or age did not influence survival at four months. Sixty-five of seventy-sevenpatients received large fraction radiotherapy (1 400 cGy). No change in survival was observed with low fraction (< 400 cGy) or mixed fraction treatment plans. The median interval from the diagnosis of melanoma to the appearance of brain metastases was 30 months. Thirty-two patients in whom the diagnosis of melanoma was present less than two years had a median survival of twelve weeks from the start of radiotherapy,and the median survival was eleven weeks in seventeen patients in whom the interval was greater than five years. Surgical resection significantly improved survival in patients with solitary brain metastasis. Twentytwo patients were assessed to have a single brain metastasis on CT scan (20) or nucleotide scan (2). Ten had sub&al to total resection and radiotheiapywith 9110 surviving 14 months-and with a median s&viva1 of 36 weeks. Five of these ten resected patients had evidence of skin, lung, or liver involvement. The remaining twelve patients with evidence of a solitary brain metastasis treated with radiotherapyalone had a median survival of 16 weeks with 4112 surviving 2 4 months. There were twenty-six patients with 39 symptomatic bony metastases, 20 involving extremities and 19 involving axial bones (pelvis, spine, and thorax). Eighteen of twenty patients treated with large fractions experienced complete to partial pain relief within one month of the start of radiotherapy,versus fifteen of nineteen treated with small fraction sizes. No trend could be established between fraction size and pain relief. The median survival for all patients with symptomaticbony metastases was 15 weeks. Partial or complete spinal cord compressionwas demonstratedon myelography in seventeen patients. Of these, eight treated with radiotherapy had significantor complete relief of pain and neurological deficits within one month of initiation of treatment. Three of these eight also had had a decompressivelaminectomy. The median survival of all patients with spinal cord compressionwas 13 weeks. We conclude that short course, high fraction radiotherapyprovides good short-term palliation in patients with symptomatic metastatic melanoma. A favorable subgroup who had solitary brain metastasis and was surgically resectible was found to have significantlyimproved survival. Significant palliation was also obtained in almost half of the patients with spinal cord compressiontreated with radiotherapy.
186 ROLE
OF IONIZING
IRRADIATION 1
T.L. Borok, M.D. ; MaBray, and C. Rollins, M.D. .
- 393 KELOIDS A.R.R.T.
2
; I. Sinclair,
1. Director-Metcalf Insti$ute,Radiation Oncology ?chool of Medicine; Dlvlslon of Radiation Chairman-Dept of Surgery; The Hospital Center
Ph.D.
2
; J. Plafker,
M.D.
3
; L. LaBirth2;
and Assistan Professor-New York Oncology; Chairman-Dept. of at Orange, Orange, N.J. 07051
University Pathology;
presented between 1928 to Three hundred ninety three keloid sites on 250 patients 1986 of which 375 sites received superficial quality therapeutic irradiation. Etiologies 166 surgical incision, 3 vaccination, (169 iatrogenic); 79 ear lobe pierce; 36 included: barbae; 3 Varicella 33 thermal trauma (burn); 4 pseudofolliculitis mechanical trauma; 1 ecthyma (7 infection); 2 chemical (acid burn); 2 Verruca scar; 2 mole scar, 3 abscess, (idiopathic). The majority (nevus); 1 rash; 1 shaving, 1 canine bite; and 56 spontaneous confirmation was obtained. In were excised prior to irradiation, and in these, histologic
Radiation
188
Oncology,
Biology,
Physics
October
1987, Volume
13, Supplement
1
later years, interstitial steroid infiltration was selectively permitted. Dose-success relationships, post-excision interval (velocity of initiating postoperative irradiation) data, and recurrence intervals will be presented. Recurrence rate after irradiation was low, 9/375 (2.4%). If 7 of 9 recurrences are eliminated for post-irradiation ear lobe 5/375 (1.3%) developed repiercing, true recurrence is only 2/375 (0.53%). An additional subcutaneous nodules < 5 mm. which were neither keloid nor visible. Two others formed flat wide hypertrophic scar without keloid at one pole of their scars. Cosmetic result was considered excellent without recurrence in 92%, favorably improved with hypertrophic scar or persistent hyperpigmentation in 5.6%, and marginally improved with smaller less symptomatic keloid in 2.4%. Complications were limited to transient hyperpigmentation in in a few, pre-irradiation hemorrhage in one (unrelatmany, persistent pigment disturbance and there were no cases of irradiated incision site failure to heal ed to radiotherapy), nor wound dehiscence. Complication statistics will be presented. Our null (0%) carcinogenicity rate to date and the one-half of one percent true recurrence rate supports continued use of postoperative irradiation to prevent keloid formation in this group of documented troublesome keloid formers. An unexpected finding was 22 of 250 subjects being Caucasian.
187 CONCOMMITTANT CHEMO RADIOTHERAPY IN LIMITED SMALLCELL CARCINOMA OF LUNG: SURVIVAL. A SOUTHWEST ONCOLOGY GROUP STUDY. Lalitha M. Janaki, J.D. McCracken, S. B. Taylor, P.G.S. J. Crowley Spohn Hospital, 334 Cape Cod, Corpus Christi, Texas
IMPROVED RESPONSE AND MEDIAN
Giri, G. B. Weiss,
W. Gordon,
Jr., R. B. Vance,
and
THE study is designed to use simultaneous Cisplatinum, Etoposide and chest radiation in limited small cell carcinoma of lung. Long term survival in evaluable patient population is imprqssive. SCHEMA: Radiation therapy to the primary tumor with concommittant chemotherapy to begin on day 1 of the Chemotherapy consisting of Cisplatinum, VP-16 and program. 180 rads/day to total tumor dose of 4500 rads. Vincristine to begin day 1. Prophylactic brain radatio to begin day 57. Consolidation chemotherapy to begin on day85 with Vincristine, Methotrexate, VP-16, Adriamycin, and cyclophomide. After 12 weeks of consolidation chemotherapy, patients with CR had all therapy discontinued and observed. The study was opened in Toxicity was acceptable and presented preDecember, 1982. Group wide participation began in April, 1985. The resA total of 164 patient put on the study. Complete response rate was greater than 55%. viously. Local recurrence rate was less than 10%. ponders have high performance status survival. The survival
curves with relapse
rate, response
rate to be presented.
The following
observations
were
made: 1. 2. 3. 4. 5.
The The The The The
high complete remission rate. excellent performance status in surviving patients. long tumor free interval off maintenance therapy. low recurrence rate. acceptable toxicity.
These points warrant CARCINOMA OF THE LUNG.
further
use of this program
in patients
with
the diagnosis
of LIMITED
SMALL CELL
188 LOCO-REGIONAL FAILURE RATE IN RELATION WITH RADIATION DOSE IN COMBINED MODALITY CHEMOTHERAPY AND RADIOTHERAPY FOR LIMITED STAGF SMALL-CELL LUNG CARCINOMA
APPROACH
Departments of Radiation Medicine+ and Robert C. Carey, M.D? Noah C. Choi, M.D! Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
OF MULTIAGENT
and Medicine?,
While the role of thoracic radiotherapy Erroneous conclusion can be drawn from inadequate studies. (RT) for limited stage small-cell lunq carcinoma (SCLC) has been a subject of the debate based on median survival time (MST) of lo-12 months (M) by either multiaqent chemotherapy (CT) alone or CT plus thoracic RT, radiation dose‘schedules employed in.m&y-studies remain-insufficient. A recent autopsy report, which states that the addition of RT to the orimarv tumor and mediastinum failed to modifv the distribution of residual tumors compared with that of patients treated with CT alone (J Clin Oncol 5:246-254, 1987), prompted us to evaluate the radiation dose-tumor response in modern CT era. As a few ongoing randomized studies are getting matured, it has become clear that thoracic RT continues to remain to play a vital role in achieving long-term survival beyond MST.