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Unresectable carcinoma of the pancreas
1382
Radiation
Oncology
0
Biology
??Physics
October
1980, Volume
6. Uumber
IO
Two hundred and thirteen of the 335 patients were administered 4500 rad in 18 fractions, and 100 of these were subsequently explored. Sixty-eight patients from this group had an esophageal resection. Usually those patients not found a candidate for surgery were given an additional boost of 1500 rad to the primary tumor volume. The two year survival in the overall group was J"! and of the 68 patients resected, 26'; survived two years and 14% three years. The operative mortality was 18%. Twenty-six patients were planned for curative radiation therapy with no surgery, and a two and three year survival in this group was 11" and 8%, respectively. An assessment of the influence of the radiation therapy upon the tumor In the patients and nodes in the resected specimen revealed the following. who survived 24 months or longer, 6:; had tumor sterilization, 12" reduced to carcinoma in-situ, 24:; to microscopic residual only and 58"i had gross tumor remaining. Two patients had positive mediastinal nodes. In contrast, in the patients who survived less than two years, only lo"! had microscopic residual, 90% had gross residual, and 40% had positive lymph nodes. Obviously, patients do much better where there is a significant effect of the radiation upon the tumor and nodes; therefore, an aggressive approach More intensive radiation therapy augmented is planned for future patients. with combined chemotherapy will be employed and hopefull:/, an improved tumor clearance will lead to an improved survival, possibly without surgery.
(67)
UNRESECTABLE
CARCINOMA OF THE PANCREAS
R. Whittington, M.D. "R.R. Dobelbower, M.D. M. Mohiuddin, M.D. **F.E. Rosato, M.D. Department of Radiation Therapy **Department of Surgery Thomas Jefferson University Hospital Philadelphia, PA 19107 *Director of Radiation Oncology Medical College of Ohio at Toledo Toledo, Ohio 43699 From 1974 to 1980, 110 patients with unresectable carcinoma of the pancreas were seen in the Department of Radiation Therapv at Thomas Jefferson University Hospital. Seventy-one patients were accepted for definitive therapy. Of these, 48 patients received precision high dose radiotherapy to a dose of 6800 rads on the 45 MeV Betatron using either Photons alone or mixed photon and high enercly electron beams. Eighty-eight percent of the patients completed treatment as per the protocol. Relief of symptoms was obtained in 65 percent of patients. Median survival was ten months. In spite of the high doses employed, 40 percent of the patients had evidence of recut-~ -ent tumor in the treatment volume at the time of death. In view of the high incidence of local failure with precision high dose therapy alone, a protocol using Iodine-125 implantation to suPP 1ement the external beam therapy was developed in 1978. Since then 15 patients with disease confined to the region of the pancreas were treated with the combination of Iodine-125 implantation and prec sion high dose therapy. Ninety-one percent of the patients camp eted treatment. Follow-up ranges from 3 to 15 months. Seven patients are alive with a median survival of one year. Eight patients have died, six with hepatic metastases and two with wide spread
1383
Proceedings of the 22nd Annual ASTR Meeting None of the patients completing the intra-abdominal metastases treatment protocol have developed local recurrence of tumor. These results will be presented together with details of the treatment technique, normal tissue reactions and implications for future approaches to the treatment of localized, but unresectable. cancer of the pancreas.
WHOLE ABDOMINAL RADIATION IN THE MANAGEMENT OF METASTATIC GASTROINTESTINAL CARCINOID TUMOR
(68)
T.J. Keane, W.D. Rider, B.J. Cummings, A.R. Harwood,
G.M. Thomas
Princess Margaret Hospital Toronto, Canada Thirty-three patients with metastatic gastrointestinal carcinoid tumor Twenty-one patients were treated with whole abdominal megavoltage radiation. had carcinoid syndrome with liver metastases and elevated urinary 5-HydroxyThe remaining twelve patients had non Indole Acetic Acid (5 H.I.A.A.) levels. functioning metastatic disease and four of these had proven liver metastases. All P@ ients were treated with parallel opposed whole abdominal fields machine or a 35 MEV Linear Accelerator. using a Co The prescribed midline tumor dose was 2000 to 2500 rads in 20 to 25 fractions given over four to five weeks. The actuarial five year survival rate following radiation treatment for the total group was 41% (median survival 2.5 years). A marked survival difference was noted in those patients with carcinoid syndrome compared to the nap None of the syndrome patients survived 5 years (median SUP functioning group. viva1 1.7 years), whereas 834 of the non-syndrome patients were alive at 5 years. Gross residual disease and cardiac manifestations of the carcinoid syn drome were felt to be the major factors influencing survival. Tumor response as measured by reduction in tumor size and reduction in 5 H.I.A.A. excretion will be presented. (69) HYPERTHERMIA:
EXPERIMENTAL BACKGROUND CLINICAL TRIAL
AND RESULTS OF A COMPREHENSIVE
Haim I. Bicher, Fred W. Hetzel and Taljit S. Sandhu Henry Ford Hospital,
Division of Radiobiology
& Physics, Detroit, MI. 48202
Employing ultramicroelectrodes with dimensions of approximately 1 micron, tissue oxygen levels, pH and blood flow have been determined in a C3H mouse mammary tumor system. Determinations have been made under normal conditions as well as following microwave induced hyperthermia. Even under normal conditions each of the three parameters is found to fluctuate widely within a single tumor. The normal distributions obtained for each parameter, obtained from a series of animals, will be presented. Changes in tissue oxygenation, pH, and flow following both microwave hyperthermia and x-irradiation have been determined. Hyperthermia was induced employing microwaves at a frequency of 2450 MHz. In all cases tissue temperature was monitored using specially designed micro-thermocouples. A characteristic relationship was found between tissue ~02 and temperature. In all cases, tissue oxygen levels rose until a temperature of approximately 41.5OC was attained with a sharp fall in ~02 above that temperature dependent upon the type and location of the tissue.
Radiation
Oncology
0
Biology
??Physics
October
1980, Volume
6. Uumber
IO
Two hundred and thirteen of the 335 patients were administered 4500 rad in 18 fractions, and 100 of these were subsequently explored. Sixty-eight patients from this group had an esophageal resection. Usually those patients not found a candidate for surgery were given an additional boost of 1500 rad to the primary tumor volume. The two year survival in the overall group was J"! and of the 68 patients resected, 26'; survived two years and 14% three years. The operative mortality was 18%. Twenty-six patients were planned for curative radiation therapy with no surgery, and a two and three year survival in this group was 11" and 8%, respectively. An assessment of the influence of the radiation therapy upon the tumor In the patients and nodes in the resected specimen revealed the following. who survived 24 months or longer, 6:; had tumor sterilization, 12" reduced to carcinoma in-situ, 24:; to microscopic residual only and 58"i had gross tumor remaining. Two patients had positive mediastinal nodes. In contrast, in the patients who survived less than two years, only lo"! had microscopic residual, 90% had gross residual, and 40% had positive lymph nodes. Obviously, patients do much better where there is a significant effect of the radiation upon the tumor and nodes; therefore, an aggressive approach More intensive radiation therapy augmented is planned for future patients. with combined chemotherapy will be employed and hopefull:/, an improved tumor clearance will lead to an improved survival, possibly without surgery.
(67)
UNRESECTABLE
CARCINOMA OF THE PANCREAS
R. Whittington, M.D. "R.R. Dobelbower, M.D. M. Mohiuddin, M.D. **F.E. Rosato, M.D. Department of Radiation Therapy **Department of Surgery Thomas Jefferson University Hospital Philadelphia, PA 19107 *Director of Radiation Oncology Medical College of Ohio at Toledo Toledo, Ohio 43699 From 1974 to 1980, 110 patients with unresectable carcinoma of the pancreas were seen in the Department of Radiation Therapv at Thomas Jefferson University Hospital. Seventy-one patients were accepted for definitive therapy. Of these, 48 patients received precision high dose radiotherapy to a dose of 6800 rads on the 45 MeV Betatron using either Photons alone or mixed photon and high enercly electron beams. Eighty-eight percent of the patients completed treatment as per the protocol. Relief of symptoms was obtained in 65 percent of patients. Median survival was ten months. In spite of the high doses employed, 40 percent of the patients had evidence of recut-~ -ent tumor in the treatment volume at the time of death. In view of the high incidence of local failure with precision high dose therapy alone, a protocol using Iodine-125 implantation to suPP 1ement the external beam therapy was developed in 1978. Since then 15 patients with disease confined to the region of the pancreas were treated with the combination of Iodine-125 implantation and prec sion high dose therapy. Ninety-one percent of the patients camp eted treatment. Follow-up ranges from 3 to 15 months. Seven patients are alive with a median survival of one year. Eight patients have died, six with hepatic metastases and two with wide spread
1383
Proceedings of the 22nd Annual ASTR Meeting None of the patients completing the intra-abdominal metastases treatment protocol have developed local recurrence of tumor. These results will be presented together with details of the treatment technique, normal tissue reactions and implications for future approaches to the treatment of localized, but unresectable. cancer of the pancreas.
WHOLE ABDOMINAL RADIATION IN THE MANAGEMENT OF METASTATIC GASTROINTESTINAL CARCINOID TUMOR
(68)
T.J. Keane, W.D. Rider, B.J. Cummings, A.R. Harwood,
G.M. Thomas
Princess Margaret Hospital Toronto, Canada Thirty-three patients with metastatic gastrointestinal carcinoid tumor Twenty-one patients were treated with whole abdominal megavoltage radiation. had carcinoid syndrome with liver metastases and elevated urinary 5-HydroxyThe remaining twelve patients had non Indole Acetic Acid (5 H.I.A.A.) levels. functioning metastatic disease and four of these had proven liver metastases. All P@ ients were treated with parallel opposed whole abdominal fields machine or a 35 MEV Linear Accelerator. using a Co The prescribed midline tumor dose was 2000 to 2500 rads in 20 to 25 fractions given over four to five weeks. The actuarial five year survival rate following radiation treatment for the total group was 41% (median survival 2.5 years). A marked survival difference was noted in those patients with carcinoid syndrome compared to the nap None of the syndrome patients survived 5 years (median SUP functioning group. viva1 1.7 years), whereas 834 of the non-syndrome patients were alive at 5 years. Gross residual disease and cardiac manifestations of the carcinoid syn drome were felt to be the major factors influencing survival. Tumor response as measured by reduction in tumor size and reduction in 5 H.I.A.A. excretion will be presented. (69) HYPERTHERMIA:
EXPERIMENTAL BACKGROUND CLINICAL TRIAL
AND RESULTS OF A COMPREHENSIVE
Haim I. Bicher, Fred W. Hetzel and Taljit S. Sandhu Henry Ford Hospital,
Division of Radiobiology
& Physics, Detroit, MI. 48202
Employing ultramicroelectrodes with dimensions of approximately 1 micron, tissue oxygen levels, pH and blood flow have been determined in a C3H mouse mammary tumor system. Determinations have been made under normal conditions as well as following microwave induced hyperthermia. Even under normal conditions each of the three parameters is found to fluctuate widely within a single tumor. The normal distributions obtained for each parameter, obtained from a series of animals, will be presented. Changes in tissue oxygenation, pH, and flow following both microwave hyperthermia and x-irradiation have been determined. Hyperthermia was induced employing microwaves at a frequency of 2450 MHz. In all cases tissue temperature was monitored using specially designed micro-thermocouples. A characteristic relationship was found between tissue ~02 and temperature. In all cases, tissue oxygen levels rose until a temperature of approximately 41.5OC was attained with a sharp fall in ~02 above that temperature dependent upon the type and location of the tissue.