Search

A new cell line producing alpha-fetoprotein, designated NMT-1, was established from rat yolk sac tumor with the potential for lymphatic metastasis in inbred Wistar rats. In this paper, we investigated the characteristics of NMT-1 cells. The cell line grew in a monolayer and had a polygonal epithelioid appearance in phase-contrast microscopy. The doubling time of NMT-1 cells during exponential growth was approximately 16 h in RPMI-1640 with 10% fetal calf serum. The D0 value for radiation sensitivity was 97 +/- 3 cGy. The extrapolation number, n, for NMT-1 was 1.08 +/- 0.15. In the log phase, the G0/G1, S and G2/M fractions were 23.2%, 62.1% and 14.3%, respectively. Tumor take was observed in all of the rats inoculated with NMT-1 cells. In the case of flank tumor, the mean survival time was 104 days after inoculation with 10(6) tumor cells. Inguinal, axillary, paraaortic, mesenteric and mediastinal lymphnode metastases were observed in all rats inoculated with NMT-1 cells. Rats which survived for a long time developed metastases in a lymphatic vessels of the liver, lung and/or kidney microscopically. The biological behavior and the histopathological features of the tumor induced by inoculation with NMT-1 cells were the same as those of the original tumor induced by fetectomy.

We report a patient with limited small cell lung cancer treated with radiation therapy alone, who survived more than two years. At autopsy no residual tumor or metastasis was found. This case can be of help in estimating the value of thoracic irradiation for local control of tumor, which is still a subject of controversy.

From 1976 to 1985, 185 patients with non-small cell lung cancer at stages I-III were treated with definitive radiotherapy in Gunma University Hospital. As a result of analyzing the long-term survivors treated with radiotherapy, suitable conditions of the patients for radical radiotherapy were as follows; 1) stage I or II, and some stage III, 2) as regards the histologic type epidermoid carcinoma or well-differentiated adenocarcinoma, 3) as regards the primary sites, the upper lobe and the superior segment of the lower lobe, 4) the optimum dose was 60-70Gy, 5) the size of the radiation fields given > 40Gy was 100 cm2 or less, and 6) the host condition was satisfactory (BRM combined use). In particular, as a result of administering PSK as adjuvant treatment to patients with epidermoid carcinoma of the lung showing satisfactory tumour shrinkage after radiotherapy, the five year survival rate of the patients with stages I or II disease, as well as stage III was 39% and 22% respectively, compared with the non-administered group's 16% and 5%. These differences are statistically significant. Although an improvement in the results of treatment with the combined use of appropriate BRMs is anticipated in the future, when clinical trials for combined BRM and radiotherapy are planned, the subjects should be patients with satisfactory tumour regression after radiotherapy.

The histopathological and immunohistological features of non-Hodgkin's lymphoma limited to the Waldeyer's ring were studied in 22 Japanese patients using a panel of T- and B-cell markers on paraffin-embedded sections. All cases showed a diffuse growth pattern. Twenty cases were B-cell lymphomas and two were T-cell lymphomas. In contrast to the primary malignant lymphomas of the nasal cavity and paranasal sinuses, in which T-cell neoplasms are more frequently seen, the majority of the primary Waldeyer's ring lymphomas were B-cell neoplasms. Sixteen of the 20 cases of B-cell lymphoma were centroblastic lymphomas, and the monomorphic variant comprised the majority of these; the other three B-cell lymphomas were immunocytomas. Two of the T-cell lymphomas showed morphological features of angiocentric lymphomas.

Purpose: A retrospective analysis was performed to investigate the radioprotective effects of amifostine on the long-term outcome of radiation therapy for the patients with carcinoma of the uterine cervix., Methods and Materials: Eighty-three patients with histologically proven epidermoid carcinoma (Stage II-IVA disease) of the uterine cervix were treated with definitive radiation therapy between January 1978 and December 1984. Forty-six patients treated with radiation alone, whereas 37 patients treated with radiation plus amifostine. Amifostine was given intravenously 30 min prior to every radiation. Most patients received 75 mg/m2 of amifostine daily from the initiation of the course of radiation therapy. The median total dose of amifostine given was 1300 mg/m2, with a range of 280 mg/m2 to 3700 mg/m2., Results: The 5-year overall actuarial survival for the patients treated with radiation alone and with radiation plus amifostine were: 72% and 88% in Stage II disease (p = 0.45); 52% and 50% in Stage III disease (p = 0.68); and 40% and 43% in Stage IVA disease (p = 0.51), respectively. The 5-year intra-pelvic recurrence rates in the patients treated with amifostine were almost the same as those observed in the patients treated without amifostine (0% vs. 6% in Stage II disease; 15% vs. 10% in Stage III disease; 25% vs. 40% in Stage IVA disease). There was also no statistically significant difference of the chronic rectal or bladder complication rate between the groups treated by each regimen., Conclusion: We concluded that any radioprotective effects of amifostine on tumor tissue and any beneficial effects of amifostine against chronic radiation injury were not observed in the patients with cervical cancer followed up for more than 5 years after radiation therapy.

Of five patients with epidermoid carcinoma of the lung who were treated with small fields of 80 Gy in 40 fractions/8-11 weeks (TDF123-129) to the hilar region, four patients developed marked stenosis of the proximal bronchi without tumour progression and died of pulmonary insufficiency 1-3 years after radiotherapy. These results should serve as a warning against escalation of the radiation dose, and the upper optimal dose might prove to be less than 80 Gy for the treatment of pulmonary hilar lesions.

IMACIS-1 is a radiopharmaceutical containing a mixture of Iodine-131 labeled monoclonal antibodies to CEA and CA19-9. IMACIS-1 immunoscintigraphy was evaluated for tumor detection in 7 primary lung cancer and 2 metastatic lung cancer patients who received radiotherapy. No adverse side effects due to IMACIS-1 were observed in this study. Positive detection was achieved in 5 of 9 patients (55.6%). It was less, but nearly the same as the detection rate obtained with Gallium-67 citrate (67Ga-citrate) in these patients. There was no clear correlation between IMACIS-1 accumulation and the CEA or CA19-9 serum levels. The IMACIS-1 positive detection rate decreased in many of the irradiated lesions. We considered that the decreased number of tumor cells and changes in blood perfusion are some of the factors controlling accumulation in tumors.

From 1970 to 1985, 117 patients with stage I and stage II carcinoma of the larynx (98 with glottic, 15 with supraglottic, and 4 with subglottic cancer) received radiation therapy. The patients were treated with (1) a 60Co machine equipped with 45-degree wedge filters, at a total dose of 6,000-7,000 cGy, 300 cGy per fraction, 3 days a week in the period from 1970-1974; (2) 10 MeV linear accelerator X-rays from 1975-1980, and (3) 10 MeV linear accelerator X-rays and/or the 60Co machine in the period from 1981-1985, at a total dose of 6,000-7,000 cGy, 5 days a week by parallel opposing portals without wedge filters. The 5-year local control rates by radiotherapy alone were 66%, 78%, and 83%, respectively, in the three periods, and the 5-year survival rates were 77%, 97%, and 96% following salvage surgery for recurrent disease. In the 1970-1974 period, four patients developed severe laryngeal edema, and two patients had total laryngectomy without local residual tumor. In the 1975-1985 period, 16 patients had local recurrence in five years, and in five of them the tumor exhibited verrucous-like histopathological findings. In the 1975-1980 period, local recurrence was considered to result from underdosing of lesions with 10 MV X-ray beams and split-course irradiation. In the last five years of the period, the 5-year local control rate for stage I and II carcinoma of the glottis, excluding verrucous-like carcinoma, reached 90% with 10 MV X-rays combined with 60Co gamma-rays.

Split-course radiation therapy (Sp-RT) is based on theoretical differences between the kinetics of normal and malignant cells. A rest interval halfway through the course of treatment permits the normal tissues to recover, while the tumor shows vary little repopulation. Indeed, it shows mostly regression, resulting in shrinkage of the radiation field. From 1976 through 1985, 185 patients with localized but inoperable or unresectable (stage I-III) non-small cell carcinoma of the lung completed high-dose definitive RT delivered by continuous-course or split-course irradiation. Forty-seven patients who had large tumors or atelectases of the lung showing slow radioresponsiveness received Sp-RT over 60 Gy at 2 Gy per fraction. Rest periods were two or three weeks long in the interrupted schedules. The 5-year survival rate was 16% in the Sp-RT group and 13% in the continuous RT group. In the 33 patients that had differentiated epidermoid carcinoma with slow responsiveness to irradiation, the radiation fields could be shrunk by Sp-RT to the same extent as in the continuous group. Sp-RT was considered to be useful in the treatment of well-differentiated epidermoid carcinoma of the lung.

The clinicopathologic and immunohistological features of 20 Japanese patients with non-Hodgkin's lymphomas (NHLs) limited to the sinonasal area were studied using a broad panel of T- and B-cell markers on paraffin-embedded and fresh frozen tissue. All cases showed a diffuse growth pattern. Nine cases were B-cell lymphomas (immunoblastic n = 4, centroblastic n = 3, immunocytoma n = 1, centrocytic n = 1), and nine were T-cell lymphomas (pleomorphic medium and large cell n = 8, angioimmunoblastic n = 1). In two cases, the cell lineage could not be determined. No morphologic features of angiocentric/angiodestructive lymphoproliferative lesions or lymphoepithelial lesions in ductal or glandular epithelium were seen in our series. Eight (89%) of the nine T-cell tumors and four (44%) of the nine B-cell neoplasms involved both the nasal cavity and paranasal sinuses. Six of the nine T-cell neoplasms showed a clinical presentation of rhinitis, whereas all of the B-cell neoplasms showed tumor masses in the nasal cavity and/or paranasal sinuses. The two-year survival rate for T-cell lymphomas was poorer than that for B-cell lymphomas. The five-year survival of patients with NHLs involving both the nasal cavity and paranasal sinuses was also poorer than that of patients in whom NHLs were limited to the nasal cavity.

We analyzed the effects of radiotherapy on 226 sites of metastatic bone tumors from 1981 to 1984, and on 157 sites of bone metastases of prostate cancer from 1970 to 1988. The radiation effect on pain relief was recognized in about 90% of cases within the dose of 20Gy to 30Gy, and there were not many differences in these effects according to the original tumors or histological types. In prostate cancer, the sites which needed re-irradiation were not recognized within 6 months after irradiation, and only 12 out of 80 sites (15%) that could be observed after more than 6 months needed re-irradiation due to recurring pain. As more than 60% of the patients with prostate cancer who needed irradiation to control bone metastases died within a year, to get pain relief by irradiation immediately and safely was thought to be very useful from the viewpoint of useful life. One patient was irradiated on 16 sites and 2 of these 16 sites received 4 treatments of irradiation and the shortest interval was 10 months and the longest one was 18 months.

We analyzed the patients treated with radiotherapy in Gunma University Hospital in 1990, to determine the characteristics of the practice of radiotherapy. During this period, 540 patients with various diseases received radiation therapy. Five hundred thirty-one (98.3%) of them had malignant tumors, and the remaining nine had benign diseases. Of the patients with malignant tumors, primary tumor of the head and neck (21.7%), and lung and mediastinum (13.0%) were most common. Four of nine patients with benign diseases had pterygium. Three hundred thirty-two patients (63%) had previously untreated malignant tumors. Curative radiotherapy was performed in 296 patients (56%), and palliative radiotherapy in 235 (44%). Of CRG patients, 43% were treated with radiation alone and 40% with surgery followed by radiotherapy. The proportion who received curative radiotherapy was the highest in patients with cervical cancer (80%). Twenty-four of 34 patients treated with intracavitary irradiation had cervical cancer. Interstitial irradiation was performed in nine patients. Four patients with pterygium were treated postoperatively with surface irradiation using an Sr-90 contact device. Radioactive iodine was administered to ten patients: eight thyroid cancer patients and two hyperthyroid patients.

The aim of this study is to evaluate the safety and clinical usefulness of lung scintigraphy using 99mTc-technegas produced by the evaporation of pertechnetate elution at 2500 degrees C. Lung images were recorded by the gamma camera-computer system after a few deep inspirations of 99mTc-technegas. One healthy volunteer and 32 patients including 10 with lung cancer, 8 with chronic obstructive lung disease, 5 with pulmonary embolism, 2 with interstitial pneumonia, 2 with bronchiectasis and 12 with other various disease were studied. Delayed images were taken at more than 1 hour later in one healthy and 13 patients to investigate the interval changes of the intrapulmonary distribution of 99mTc-technegas. Obvious differences of radioactive distribution between early and delayed image were observed in only 2/14 cases. Penetration index (P.I.) averaged 0.81 +/- 0.11 for early images and 0.85 +/- 0.12 for delayed image. There was no significant difference between P.I. for early and delayed images. More than 97 MBq of 99mTc-macroaggregated albumin (99mTc-MAA) were required to obtain the adequate perfusion images after the acquisition of lung images with about 37 MBq of 99mTc-technegas. Bronchial deposits of 99mTc-technegas were shown in 12/33 cases and pathological defects in 26/32 patients (81.3%). Twenty three of 33 cases also had a perfusion scintigraphy with 99mTc-MAA. Ventilation perfusion mismatches were presented in 5/5 patients with pulmonary embolism and 1/10 patients with lung cancer. The safety was confirmed in all cases and clinical usefulness in 30/32 patients (94%). In conclusion, the safety and clinical usefulness of lung scintigraphy with 99mTc-technegas were proven in this study.

The records of 49 patients with nodular histiocytic lymphomas (NH) who were treated from 1972 to 1985 in hospitals belonging to the JLRTG were retrospectively reviewed. The actuarial survival rate and relapse-free survival rate of all patients after 5 years were 55.0 and 51.3%, respectively. Twenty-one patients with stage I disease had a significantly better survival rate than did 12 patients with stage II disease (P less than 0.01). Without combination chemotherapy, all 15 patients with stage I NH treated by radiation therapy were in complete remission, and 14 of them remained alive and well. Among these 15 patients, no difference in relapse was observed between patients who received involved field irradiation (1 of 6) and those who received extended field irradiation (2 of 9). Patients with stage II or more NH should be treated with intensive chemotherapy and radiotherapy, as are patients with diffuse histiocytic lymphoma (DH). However, involved field radiotherapy with careful follow-up observation may be the treatment of choice for patients with stage I NH, provided their tumors are not bulky.

This article reports on attempt to characterize the interactions of radiation and BRMs in the treatment of malignant tumor on the basis of our some experimental results. BRMs have a high possibility to enhance radiation effects on tumor cells with in a radiation field and bring some benefits to host tumor immune system with minimizing deleterious effects of irradiation to the immune responses. But it is very difficult to determine the rational design of administration of BRMs to induce the most effective interactions on relevant immune system and other host responses in the combination with radiotherapy. We should make it clear how radiation can be useful to potentiate the tumor antigenecity or antitumor immune responses.

Tumors as malignant as lung cancer can be cured by radiation therapy. Local control is the primary requirement for complete cure of the tumor, but the continued presence of the mass demonstrated by imaging techniques does not necessary mean persistence of viable tumor cells. The mass shadow persisting in the region irradiated at a cure dose may simply represent delayed absorption of dead cells so that the patient should be observed for at least 3 months after the therapy. This requires patience on the part of clinitians, but erroneous additional irradiation must be avoided, because excess irradiation can do harm but no good. Radiosensitivity, radioresponsiveness, and radiocurability are all independent characteristics of the tumor. In general, the effects of radiation therapy must be evaluated comprehensively in consideration of these three characteristics of the tumor. Understanding of the natural history of the disease is essential for the treatment of malignant tumors. Therapeutic approach cannot be determined if the natural history of tumor is disregarded.

The combined effects of fractionated radiation and UFT, which is a mixture of tegafur (FT) and uracil, have been studied using C3H mouse mammary carcinoma. The tumor was implanted in the right hind legs of and irradiated with 300R daily for either 10 or 15 days. UFT (FT 15mg/kg + uracil 33.6mg/kg) was intra-gastrically administered 2 hr. before irradiation. Dose modifying factor (DMF) of UFT obtained from the tumor growth delay assay was 1.52 for 10 fractions (3,000R) and 1.27 for 15 fractions (4,500R). The continuous administrations of UFT for one month after combination treatment suppressed the tumor regrowth. It is suggested that UFT is a useful radiosensitizer for concurrent fractionated radiation and useful adjuvant agent after radiation therapy.

201Tl, 123I-IMP-SPECT were performed in 17 patients with brain tumors before and after radiation therapy, compared with X-CT. 15 of 17 patients showed enhanced areas on X-CT and higher accumulations on 201Tl-SPECT in the same lesions before radiation therapy. There was significant correlation between enhanced lesions on X-CT and lesions of higher accumulation on 201Tl-SPECT before and after radiation therapy. But, the patients with residual enhanced lesions on X-CT did not always show higher accumulation on 201Tl-SPECT after radiation therapy. And, 2 patients with radiation injury after radiation therapy for brain tumor did not show higher accumulation on 201Tl-SPECT, though one patient showed enhanced lesion on X-CT. 201Tl-SPECT was expected to evaluate viability of brain tumor. 123I-IMP-SPECT was useful to recognize the site of higher 201Tl accumulation and evaluate blood flow around brain tumor. It is concluded that 201Tl, 123I-IMP-SPECT is useful for the evaluation of treatment effect of brain tumor and for the differentiation of cerebral radiation injury from recurrent tumor.

The role of radiotherapy in the initial management of small-cell lung cancer (SCLC) is a matter of current debate. Unfortunately, compared to other cell types, radiotherapy for SCLC is limited in its use. The value of radiation therapy in palliation is unquestioned. SCLC is quite sensitive to both radiation therapy and chemotherapy. However, in extensive disease radiation therapy is secondary to combination chemotherapy. In limited disease, it is well documented that thoracic irradiation increases locoregional tumor control and improves the complete remission (CR) rate. However, the patients given high-dose thoracic irradiation concurrently with chemotherapy are the possibility of local toxicity, especially, drug induced pneumonitis. Recently, the optimal sequence of radiation therapy and chemotherapy has been discussed. We believe that it is better to start with chemotherapy. With prolongation of survival related to intensive combination chemotherapy, brain metastases become more frequent. Therefore current therapeutic regimens include prophylactic cranial irradiation (PCI) soon after the attainment of CR, but it has not prolonged survival. So there are conflicting reports about neurotoxicity after PCI. It is difficult to reach any firm conclusion in regard to the value of PCI.

Eight cases of primary malignant lymphoma of the brain were examined clinically and immunohistopathologically. According to the LSG classification the patients were subclassified into 5 with diffuse large cell type, 2 with diffuse medium-sized cell type and one with diffuse mixed cell type. Immunohistological stainings demonstrated that all of them were of B lymphocyte origin. Two cases had multiple lesions which were seen in the periventricular area. Tumor response for the treatment consisted of surgery followed by radiation therapy was excellent except for one. Only 2 patients were alive and well at 24 months and 27 months.

The clinical features of 102 patients with low grade non-Hodgkin's lymphomas treated from 1972 to 1981 among the hospitals belonging to the JLRTG were retrospectively reviewed. According to the Rappaport classification, there were 29 cases of NPDL, 26 of NM and 47 of DWDL. The survival rate and relapse-free survival rate for all patients at 10 years were 49% and 41%, respectively. No obvious difference in survival rate was seen by histologic type, but patients with DWDL had a better relapse-free survival rate than those with NM (P less than 0.01). This study also suggested that patients with stages I and II low grade lymphomas might be treated by irradiation alone, if they are staged properly.

Rat glioma model was used to evaluate the effect of hyperthermia with and without radiation therapy. The animal model was induced by left frontal burr hole opening and inoculation of a small piece of G-XII glioma tissue to 6- to 8-week-old rats. The therapeutical experiments were given 10-14 days after inoculation of the tumor. Interstitial heating at 44 and 45 degrees C at the surface of the inserting probe using 2450 MHz microwave was delivered for 30 minutes. Deep X-ray whole head irradiation of 800 R using Stabilipan 2 (Siemens) was given just after the hyperthermia therapy. The survival of treated animals of hyperthermia, radiation, and combination of hyperthermia and radiation was significantly superior to that of non-treated control group. There was no significant difference of survival among the treated groups, though median survival was longest in the group of combination therapy of hyperthermia and radiation. Large tumors developed at the time of death in all the control and the treated animals. Histological examination showed some tendencies of macrophage infiltration in tumor tissue of hyperthermia therapy.

A rare case of primary malignant melanoma of the esophagus is reported. Our case is of interest because an extraordinary effect was observed early during conventional radiation therapy. The primary lesion was irradiated with 60 Gy, it almost disappeared. Metastatic lesions were irradiated with 30 Gy, their volume decreased by more than 50%. At autopsy, these lesions were more or less unchanged. Histologically, cells from the main tumor were small and round. The growth of pleomorphic cells with large amounts of melanin granules was observed in the regions of irradiation. These findings suggest that the small round cells in malignant melanoma are radiosensitive and the pleomorphic cells with abundant melanin granules are radioresistant.

For the past twenty years, 85 adult patients with cerebral glioblastoma were treated with postoperative radiation therapy (RT). Hypofractionated RT (5 Gy twice a week) was performed in 31 patients. The survival rate of the hypofractionated RT was superior to the conventionally fractionated RT, especially in the patients involved mainly in the frontal lobe. In the hypofractionation group, misonidazole proved of benefit to the survival. In future, hyperfractionation of RT seems reasonable to be explored for improving CNS tolerance.

This is a clinical and pathological study of malignant germ tumors in the lung or mediastinum. Germ cell tumors may be considered to originate from primitive germ cells with totipotency. One of 3 cases showed clinical and pathological findings suggesting that a part of the tumor differentiated into many kinds of tissue, such as growing and metastasizing. Initial diagnosis was performed radiographically and pathologically with difficulty. But finally, the first patient was diagnosed as malignant teratoma, the second as yolk sac tumor and the third as choriocarcinoma, in consideration of the tumor markers and clinical process.

We have previously reported that Amifostine, a radioprotective agent, was effective in treating acute radiation mucositis in the head and neck region. We found that when a considerable amount of Amifostine accumulates in the salivary glands, it may be useful in preventing chronic disturbances of salivary secretion. We have observed an increase in the uptake of Ga-67-citrate to the salivary glands when they were irradiated. In this paper, the radioprotective effects of Amifostine, in treating chronic radiation injury of the salivary glands, were studied, using the cessation of an increase in uptake of Ga-67-citrate after radiotherapy as the criterion. The subjects were 105 patients, (280 salivary glands in Ga-scintigrams) with malignancy of the head and neck region treated by irradiation from 1978 to 1984. Ga-negative glands were recognized in 97%, that is, 36 out of 37 glands, before irradiation, and the figure decreased to 19%, seven out of 37, within 1 to 2 weeks (10Gy less than or equal to) after the start of radiotherapy. In patients who were irradiated with more than 30 Gy and in whom scintigraphy was performed at 6 months or more after radiotherapy, Ga-negative glands were recognized in 18 out of 41 glands, 44%, with Amifostine, compared with 13%, four out of 32 glands, without Amifostine. A difference was recognized between these two groups in the negative change in Ga-67 uptake after radiotherapy (p less than 0.05). These facts suggest that Amifostine may have a radioprotective effect on chronic radiation injury.

During the years 1972-81, 118 patients with stage I (78 cases) and II (40) nodal non-Hodgkin's lymphoma originated in the neck were treated with radiation. 5 year survival rates were 74% for stage I and 40% for stage II. Favorable histology group showed better prognosis than unfavorable one. Among stage I patients with unfavorable histology group, prognostic factors were studied and tumor size larger than 4 cm is found to be a sole prognostic factor.

The results of radiation therapy in 31 patients with intracranial germ cell tumors have been analyzed. The five-year survival rates were 70.1% for germinomas and 38.1% for teratomas. Three patients with germinoma have since died of spinal seeding. The prophylactic irradiation of the spinal canal has been found effective in protecting spinal seeding, since no relapse of germinoma has been observed in cases that received entire neuraxis irradiation, whereas teratomas and marker (AFP, HCG) positive tumors did not respond favorably to radiation therapy, and the cause of death in these patients has been local failure. Long-term survivors over 3 years after radiation therapy have been determined as having a good quality of life.

Clinical staging of malignant lymphoma, especially that of non-Hodgkin lymphoma, should be made according to the organ of its origin and the histologic type, taking the natural course of each tumor type into consideration. This is only possible if a universal system of histopathological classification is present, such a classification is unlikely to be established in the near future. Under these circumstances, the Ann Arbor classification for Hodgkin's disease must be applied for the time being to clinical evaluation of lymphoma. Remarkable improvements have been made in the diagnostic modalities, but conventional procedure such as biopsy, lymphography, plain chest X-ray, and gastro-intestinal fluoroscopy still remain important in the diagnosis of malignant lymphoma.

The patient was a 21-year-old man with SVC syndrome due to a large anterior mediastinal mass. Following radiotherapy which improved his condition, thoracotomy was performed, however, total resection failed. Despite postoperative re-irradiation, his condition worsened rapidly and he died five months after the onset of his symptoms. The neoplasm was composed of a yolk sac tumor producing alpha-fetoprotein. Yolk sac tumors of the mediastinum are rare and lethal. Recent reports indicate that cis-platinum may be highly effective in germ cell tumors. Therefore, radiotherapy combined with cis-platinum may be improved the survival of patients with yolk sac tumor.

Twenty-four adults with glioblastoma multiforme (astrocytoma, grade 4) underwent postoperative large dose fraction radiotherapy (LDFR; 5 Gy twice weekly) with Linac X-rays. The outcome in this group was compared with that of 26 patients who received conventional fractionated radiotherapy (CFR; 2 Gy 5 times weekly). The time, dose, and fractionation (TDF) factor was about 100 in both groups. The survival rates following LDFR and CFR were, respectively, 63% vs 65% at 1 year; 36% vs 8% at 2 years; 17% vs 4% at 3 years; and 4% vs 0% at 5 years. Although the survival curve for LDFR was superior to that for CFR, the difference was not statistically significant. Autopsies of nine LDFR and 13 CFR patients showed no residual tumor in one case and no cases, respectively; small residual tumor in three cases in each group; extensive coagulation necrosis of the tumor and surrounding brain tissue in one LDFR and four CFR patients; tumor proliferation in three LDFR and four CFR cases; and mixed glioblastoma and fibrosarcoma in one LDFR and two CFR patients. These results suggest that maximum tumor removal followed by LDFR may offer a better prognosis for patients with glioblastoma than that offered by surgery plus CFR.

A total of 234 patients of Hodgkin's disease treated at 7 institutions from 1972 through 1985 were analyzed. Male to female ratio was 157: 77, mean age was 39.8 years, and overall 5- and 10-year survival were 67% and 56%, respectively. Of 126 patients treated by radiotherapy with more than 36 Gy, alone or preceded to other treatments, 5- and 10-year survival rates were 84% and 80% for Stage I (43 patients), 79% and 69% for Stage II (71 pts.), and 52% and none for Stage III (12 pts.), respectively. Survival rate was better for LP, NS and MC histologies as compared to LD, better for patients without constitutional symptoms, as compared to patients with B, and better for patients with ages younger than 59 years as compared to those with ages over 60 years. Relapse was observed in 57 out of 126 patients. Relapse within the irradiation field was observed in only 4, and nodal areas outside the field, especially of abdomen (1/3), were the most common sites. Half of the relapses occurred within 20 months, and 80%, 40 months. Five-year survival of patients after relapse to lower torso lymph nodes (19 patients) was 37%, which was worse than patients after relapse to upper torso lymph nodes (15 patients: 63%) (z = 1.507, N.S.).

Fifty-three patients with intracranial metastases from pulmonary carcinoma were treated with cranial irradiation between 1976 and 1983. There was improvement in neurologic symptoms in 80%, and the one and two-year survival rates for the entire group of patients were 21% and 4%. Those or patients without metastasis tumor in other organs were 38% and 9%, respectively. It was suggested that the total dose should be in excess of 40 Gy. Histologically, adenocarcinoma and epidermoid carcinoma showed better prognosis than other types of cancer.

563 patients with Stage I and II non-Hodgkin's lymphoma were treated by radiotherapy. 34 recurrences that occurred after 3 years from initial treatment were seen in those patients. 15 (44%) of 34 recurrences occurred after 5 years. 20 patients (59%) had remission by re-treatment, and 13 (38%) survived more than 2 years. 20 (59%) of recurrences were seen on head and neck lesions and superficial lymph nodes.