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Whole brain irradiation for intrcranial metastases
(108)
THE MANAGEMENT OF HEPATIC METASTASES:
THE ROLE OF RADIATION THERAPY
R.R. Weichselbaum, D.M. Sheraman, C. Trey, L. Cloud, and A.J. Piro The Joint Center for Radiation Therapy, The New England Deaconess Hospital, and the Departments of Radiation Therapy and Medicine, Harvard Medical School, Boston, Mass.
Carcinoma metastatic to the liver is a common finding in patients with malignant disease and is frequently the cause of.great pain in terminal patients. Although palliative irradiation of liver metastases has been described, the practice has not become widespread, and therefore, large numbers of patients are not available for analysis. We have reviewed 33 patients with liver metastases treated at the Harvard Joint Center for Radiation Therapy from 1971 to 1975. The majority of these patient had primary cancers of the gastrointestinal tract, and the remainder had primary lesions originating in the lung or breast. 17 patients failed prior chemotherapy, and 14 patients received concomitant chemotherapy. In general, patients were treated with a 4 MeV linear accelerator using a treatment portal which included the entire liver to a total dose of 2100 rad in 300 rad fractions, four days per week. Of 28 patients suffering severe pain, 25 had complete relief and 3 patients had no pain relief. The remaining 5 patients. were asymptomatic at the time of treatment. Eight patients had pre and early post radiation liver function tests and 7 of these patients had marked reduction of abnormal laboratory values. The median survival was five months in spite of the fact that many patients were preterminal with diffuse liver involvment and multiple distant metastases. The treatment protocol was well tolerated with only 5 of 33 patients experiencing severe nausea and vomiting. Four of these 5 patients had concomitant multiple agent chemotherapy. We recommend whole liver irradiation as an effective palliative modality. An analysis of survival as well as toxicity and treatment techniques will be discussed.
(109)
METASTASES WHOLE BRAIN IRRADIATIONFOR INTRCRANIAL J.H. West, M.D. and J.B.
Caderao, M.D.
The University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston, TX At MDAH, bsetween 1944 and 1975, a total of 563 patients have been treated with whole brain irradiation for intracranial metastases (other than cerebral melanoma) from primaries of the lung (248), breast (182), urogenital (52), soft tissues and bone (24), unknown sites (26), and miscellaneous 97
sites (31). Various conventional dose-time schedules (3000 rad/2 weeks, 2000 rad/l week, 3000 rad/3 weeks, 400 rad/4 weeks, etc.) have been given through the years. The patients will be grouped as to whether the primary was controlled or uncontrolled at the time of diagnosis of the intracranial metastases with or without other sites of spread. Analysis by the total dose-time regimes received will then be done according to the following: 1) neurological response and Karnofsky performance status, beofre and after, 2) survival from day 1 of irradiation, 3) evidence of regression or clearance of metastases, and 4) end results. An evaluation of palliative benefits derived, tolerance to the various radiation doses, possible late effects, and the appropriate dose-time schedule to use in a given clinical situation will be presented.
98
THE MANAGEMENT OF HEPATIC METASTASES:
THE ROLE OF RADIATION THERAPY
R.R. Weichselbaum, D.M. Sheraman, C. Trey, L. Cloud, and A.J. Piro The Joint Center for Radiation Therapy, The New England Deaconess Hospital, and the Departments of Radiation Therapy and Medicine, Harvard Medical School, Boston, Mass.
Carcinoma metastatic to the liver is a common finding in patients with malignant disease and is frequently the cause of.great pain in terminal patients. Although palliative irradiation of liver metastases has been described, the practice has not become widespread, and therefore, large numbers of patients are not available for analysis. We have reviewed 33 patients with liver metastases treated at the Harvard Joint Center for Radiation Therapy from 1971 to 1975. The majority of these patient had primary cancers of the gastrointestinal tract, and the remainder had primary lesions originating in the lung or breast. 17 patients failed prior chemotherapy, and 14 patients received concomitant chemotherapy. In general, patients were treated with a 4 MeV linear accelerator using a treatment portal which included the entire liver to a total dose of 2100 rad in 300 rad fractions, four days per week. Of 28 patients suffering severe pain, 25 had complete relief and 3 patients had no pain relief. The remaining 5 patients. were asymptomatic at the time of treatment. Eight patients had pre and early post radiation liver function tests and 7 of these patients had marked reduction of abnormal laboratory values. The median survival was five months in spite of the fact that many patients were preterminal with diffuse liver involvment and multiple distant metastases. The treatment protocol was well tolerated with only 5 of 33 patients experiencing severe nausea and vomiting. Four of these 5 patients had concomitant multiple agent chemotherapy. We recommend whole liver irradiation as an effective palliative modality. An analysis of survival as well as toxicity and treatment techniques will be discussed.
(109)
METASTASES WHOLE BRAIN IRRADIATIONFOR INTRCRANIAL J.H. West, M.D. and J.B.
Caderao, M.D.
The University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston, TX At MDAH, bsetween 1944 and 1975, a total of 563 patients have been treated with whole brain irradiation for intracranial metastases (other than cerebral melanoma) from primaries of the lung (248), breast (182), urogenital (52), soft tissues and bone (24), unknown sites (26), and miscellaneous 97
sites (31). Various conventional dose-time schedules (3000 rad/2 weeks, 2000 rad/l week, 3000 rad/3 weeks, 400 rad/4 weeks, etc.) have been given through the years. The patients will be grouped as to whether the primary was controlled or uncontrolled at the time of diagnosis of the intracranial metastases with or without other sites of spread. Analysis by the total dose-time regimes received will then be done according to the following: 1) neurological response and Karnofsky performance status, beofre and after, 2) survival from day 1 of irradiation, 3) evidence of regression or clearance of metastases, and 4) end results. An evaluation of palliative benefits derived, tolerance to the various radiation doses, possible late effects, and the appropriate dose-time schedule to use in a given clinical situation will be presented.
98