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A 48-year-old men died of liver metastases from a left testicular tumor and was autopsied. It is thought to be rare for a pure seminoma of the testis to metastasize to the liver in the form of a large solitary nodule and for no obvious difference to be seen on plain and enhanced CT in the low-density area. These findings are unreasonable in view of the characteristic proliferative patterns of the tumor. Thus, the correlation between CT and the autopsied specimen was studied histopathologically with the purpose of understanding the focal conditions. The following results were obtained. A large low-density area in the right lobe of the liver on CT coincided with the autopsied specimen, and small nodular lesions scattered in the necrotic tissues were seen. The lesion was diagnosed to be metastasis from the testicular tumor and it was almost the coagulative necroses of the tumor cells in the histologic examination. Moreover, severe tumor thrimbi were observed in the blood vessels with special reference to metastatic foci. Above findings indicating the articular ischemic condition in the region of metastatic foci made it possible for the CT findings to be reasonably understood.

Between 1972 and 1985, 210 patients with nodular poorly differentiated lymphocytic (NPDL), nodular mixed lymphocytic and histiocytic (NM), nodular histiocytic (NH), or diffuse well differentiated lymphocytic (DWDL) lymphoma according to Rappaport classification were treated among the 7 hospitals belonging to JLRTG (Japanese Lymphoma Radiation Therapy Study Group). Age greater than 50 years adversely affected overall survival. But no obvious survival differences were seen by sex and the primary site. Patients with NH had a significantly poorer survival (P less than 0.01), while there were no differences among the other histologic groups. Aggressive combination chemotherapy is advisable for patients with stages II, II and IV NH. But radiotherapy along may be treatment choice for patients with stage I NH. Because among stage I, over all survival and relapse-free survival of patients with NH were similar to those with the other histologic types. Five-year and 10-year relapse-free survival of stage I patients with the other 3 histologic types by radiotherapy alone were 85% and 67%, respectively. Those of stage II patients were both 58%. These data suggest cure of more than 50% of stages I and II patients with favorable lymphoma by radiotherapy alone.

A retrospective analysis of 245 patients with stage II non-Hodgkin's lymphoma of the Waldeyer's ring treated between 1972 and 1985 was performed. Treatment consisted of radiation therapy alone in 96 patients and 149 patients were treated with chemotherapy combined. Five-year survival and relapse-free survival rates were 57% and 50%, respectively. For cases with DH, they were 64% and 55% respectively, and for DLPD 31% and 27%, respectively. Of the cases with relapse, 21% were seen in stomach or intestine. There were no difference on survival rates between radiation therapy alone and chemotherapy combined with radiation therapy.

The combined effects of X-ray and UFT, which is a mixture of tegafur (FT) and uracil, were studied using C3H mouse mammary carcinoma. Tumors were irradiated with a single dose of 1,000 R, 2,000 R one week after intramuscular transplantation. UFT (FT 15mg/kg+Uracil 33.6mg/kg) was intragastrically administered 2 hours before irradiation. In the group treated by combination of UFT and 1,000 R, the dose modifying factor (DMF) of UFT was 1.28 on the tumor growth delay and 1.64 on the survival time. A decrease in pulmonary metastases was found in the group treated by combination of UFT and radiation. It is suggested that UFT is a useful oral drug for combined treatment with radiation.

In order to determine the value of CT in detecting lymphomatous involvement of the liver, 57 autopsied cases (48 cases of non-Hodgkin lymphoma and 9 of Hodgkin's disease) were analyzed in detail. Additionally, 90 recent cases of abdominal CT with liver study in the initial staging were reviewed and 6 cases in which the liver had been examined within 2 weeks before autopsy were compared for macroscopic and pathologic findings. The following results were obtained. Autopsy findings in 57 cases of malignant lymphoma. (1) Hepatic involvement was demonstrated in 56% of the patients with non-Hodgkin lymphoma and in 67% of those with Hodgkin's disease. Of these patients with hepatic involvement, intrahepatic nodular lesions over 1.0 cm in diameter were macroscopically identified in 22% of the cases of non-Hodgkin lymphoma and 33% of those with Hodgkin's disease. Lymphomatous involvements were seen in many organs in the cases of hepatic involvement. CT examinations of 90 cases for the initial staging showed no significant abnormality in the liver or spleen. Of the 6 cases in which the liver was examined by CT within about 2 weeks before autopsy, lymphomatous involvement was pathologically diagnosed in 5. Of these, only one having multiple nodules larger than the tip of a thumb was correctly diagnosed by CT. Hepatic involvement of lymphoma was thought to be the end stage, and minimal or early disease was detected in the region of Glisson's capsule. The above findings indicate that early hepatic involvement is not likely to be detected by CT at the present time.

Diagnostic accuracy about the relation between staging laparotomy and each diagnostic modality was reviewed. Modern diagnostic imaging revealed high diagnostic accuracy (80-90%) in detection of abdominal lymphoma except for diffuse hepatic and splenic lesions. Staging of malignant lymphoma before and after computed tomography was evaluated: in 15 cases out of 47 patients with malignant lymphoma, stage of disease was changed into the higher stage. Computed tomography can provide complementary information about extension of the disease, which are not detected by gallium scintigraphy and lymphography. Lymphography, gallium scintigraphy and computed tomography are the major diagnostic modalities for staging of malignant lymphoma.

The relation between the CT findings and the histopathology of metastatic liver tumors was investigated in nine autopsy cases of liver metastases. In hypervascular and necrotic tumors, large necrotic lesions demonstrated by CT were almost consistent with the pathological findings, but small metastatic nodules were better identified on plain CT than those on contrast-enhanced CT. Postmortem CT examination of the liver obscured metastatic nodules as compared with diagnostic CT. Diffuse liver involvement of lymphoma cannot be identified on CT examination. Plain CT is considered to be useful for screening liver metastases.

The effects of radiation on tumors should be divided into radiosensitivity and radioresponsiveness. The local effects of radiation are not always consistent with curability. Though local control is one requirement to attain cure, the primary factor that affects long-term survival is the natural history of the tumor. The effects of irradiation can not be predicted only by determining the histological type of tumor. However, the natural history of the tumor can be understood by careful observation of the stroma in the tumor and condition of the host. As the result, radiocurability can be predicted to some extent.

A 79-year-old man was admitted to our hospital for radiation therapy for lung cancer on July 24, 1984. In the course of radiation therapy, many bullas were recognized on his trunk. The lesion was diagnosed as bullous pemphigoid. To date, about 27 cases of malignant tumor with bullous pemphigoid have been reported in Japan. At present, the causal relation between malignant tumor and bullous pemphigoid has not been establishes. In our case, the bullous lesions disappeared during the course of radiation therapy, and the patient has been in good general condition for nine months without recurrence of metastasis of lung cancer.

The record of 73 patients with 153 sites of bone metastases from a lung cancer treated by radiation have been reviewed to evaluate the effectiveness of pain relief. Radiation therapy for bone metastases was found to be very effective. Sufficient symptomatic improvement was achieved in 94% of all patients, while 63% obtained almost complete pain relief that was sustained until death. Onset of a symptomatic response to radiotherapy was within less than 20 Gy in total dose in more than 80% of all patients. There were no significant differences in the frequency of pain relief among the various histological types of primary lung tumors.

To determine if IMACIS-1 might have the capability of specifically pinpointing an adenocarcinoma in the human lung, xenografts of adenocarcinomatous nude mice that were injected with IMACIS-1 have been evaluated by scintigraphy, and the IMACIS-1 biodistribution in the tissue measured after sacrifice. Results have revealed that scintigraphic images obtained twenty-four hours after the IMACIS-1 injection showed some activity in the area of the tumor. At seventy-two hours after the IMACIS-1 injection, tumoral radioactivity was only seen in mice with a large tumor. At ninety-two hours after injection, the animals were sacrificed and a biodistribution study was performed. The IMACIS-1 uptake was expressed in counts per minute per gram of tissue. The tissue-to-blood uptake ratio in mice with a large tumor was 8.4 in the viable part of the tumor, 27.2 in the necrotic part of the tumor, 3.0 in the liver, and 1.5 in the spleen, respectively. In contrast, the ratio in mice with a small tumor was 3.4 in the viable part and 18.3 in the necrotic part. Immunoperoxidase staining with either the anti CEA or the anti CA 19-9 antibody was strongly visible in the necrotic part of the tumor.

Effects of twice daily fractionations (B.I.D.) at smaller doses per fraction than 2 Gy on mammary carcinoma of C3H/He mouse (alpha/beta ratio = 15-20 Gy) were studied. Sixty percent doses of conventional fractionations (Q.D.) were irradiated twice daily with 4 hours interval. Though B.I.D. at 120 R, 150 R were less effective than Q.D. at 200 R, 250 R, B.I.D. at 180 R were more effective than Q.D. at 300 R, equivalent to the increments of the total doses. B.I.D. at smaller doses than "flexure dose" (not equal to 0.1 x alpha/beta) seemed to be less effective for tumors. Human tumors transplanted to nude mice might be useful to study therapeutic gain ratio.

The patients of malignant glioma mostly consisting of anaplastic astrocytoma (AA) and glioblastoma (GM) were surveyed at the Committee for Compiling the Manual of Radiotherapy in the Treatment of Brain Tumors, organized by Japanese Association for Radiotherapy Research. Total 286 patients were treated at ten institutes during the period from January 1985 through December 1987. Numbers of cases with AA and GM were 130 and 156, respectively. Concerning the treatment volume, the medium field (50-100 cm2) was applied to 127 patients (37.4%) and the whole brain to 25 one (7.4%). The total dose was given by the range from 56 Gy to 65 Gy in 158 patients (47.6%). One-year survival ratio of AA and GM were 60-75% and 40-65%, respectively. For obtaining the improvement of local control rate, it is considered that the beam focusing onto the target lesion and the sufficient removal of the tumor are necessary and essential.

The present status of clinical application and future prospect of immunotherapy using BRMs, especially PS-K, for cancer patients treated by irradiation were described here. Prolonged survivals were revealed in the radiation therapy of patients with carcinoma of lung and uterine cervix concomitant use of PS-K. And the condition necessary for long-term survival with BRMs were thought to be that the tumor was almost disappeared by irradiation. But, there is not an evaluation criteria for BRMs without any direct effects on tumor. Then judgment of clinical usefulness of immunopotentiators are difficult and needs to make new evaluation criteria.

Though radiotherapy combined with chemotherapy is used increasingly more frequently in the recent treatment of malignant tumors, very little is known about what dose of an antitumor agent equals what radiation dose in effect. We tried to determine those radiation doses which are required to produce the same effect as certain specific doses of antitumor agents (isoeffective dose) by studying the early effects of radiation and drugs chiefly on the intestine of dd strain mice. Parameters used were food consumption, body weight change, 3H-TdR radioactivity in the intestine and the labelling index of intestinal crypt cells. The results were as follows: 1) To determine that radiation dose which is equal to a drug dose (1/2 its LD50) in systemic effect, body weight change and food consumption were suggested to be useful parameters. 2) To determine that radiation dose which is equal to a drug dose in the effect on a specific organ, parameters suitable for the target cells must be selected. For evaluating the effect on the intestine, the labelling index of intestinal epithelium was a useful parameter. 3) The results of treatment with combined radiation and slight amounts of drugs suggested that the degree of aggravation of radiation injury due to drugs might vary with the time of drug administration. 4) Graphic representation of the severity of injury as indicated by parameters enabled us to grasp visually the characteristics of drugs.

During the years 1972-81, 168 patients with extranodal Non-Hodgkin's lymphoma localized in the head and neck were treated with radiation. Five-year survival rates were 62% in stage I, 56% in stage II, and 91% in diffuse well-differentiated lymphocytic, 77% in diffuse mixed, 52% in diffuse poorly-differentiated lymphocytic and diffuse histiocytic each. Marginal relapse was rare after radiation therapy, but relapses were not infrequently noticed in distant extranodal sites. Bone and/or soft tissue relapses were frequently noticed in patients with lesions initially located in the nasal cavity, paranasal sinus and oral cavity.

Single and combined treatment of interstitial microwave hyperthermia (HT) and radiation therapy (RT) were delivered to rat glioma models. The animal model tumors were induced by intracerebral inoculation of a small piece of G-XII glioma tissue to 6-8 week-old rats. Heating to about 44 degrees C at the surface of the inserting antenna using a 2450 MHz microwave was carried on for 30 minutes. A single dose of 800 r to the whole head was delivered by deep X-ray apparatus. In combined treatment, heating immediately preceded irradiation. Following treatment, animals were sacrificed at 1, 3, 6, 12, 24, 48, 72 and 96 hours. BUdR was administered intraperitoneally 1 hour before sacrifice. Microscopically, in HT, tumor cells became eosinophilic and separated from each other. Some of them were necrotic. Macrophage infiltration in tumor tissue was recognized after 72 hours. BUdR labelling indices were less than 1% till 24 hours had passed, then became 25% at 48 hours, nearly equal to that of the control animals. In RT, ballooning of the tumor cells was prominent, and some of the tumors became necrotic. Lymphocyte infiltration of the tumor tissue was occasionally seen. BUdR labeling indices decreased slowly; less than 10% in 24 hours, but continued until 96 hours had passed. Combined treatment of HT and RT showed addictive effect of histological changes and suppression of tumor cell growth.

Treatment for delayed brain injury after pituitary irradiation is discussed. Six cases with delayed brain injury were treated with a combination of dexamethasone or betamethasone, with heparin, glycerol, dextran 40 and some vasodilators. Two cases with temporal lobe syndrome were treated in the early stages of brain injury for a period of over 12 months were almost completely cured, another two cases with chiasma syndrome were treated in the relatively late stages, showed a partial improvement. One case which was irradiated 120 GY during 13 years did not improve. The final case treated with steroids for a short period also resulted in failure and the patient underwent an operation for the removal of the necrotic mass three years after the radiotherapy. Steroid therapy started in the early stages of brain injury after irradiation for over the 12 months is thought to be effective. Heparin therapy was also effective in one out of three cases, but in one of the cases subarachnoid hemorrhage from a traumatic aneurysm occurred during the therapy. In an acute phase, showing edematous change of the injured brain, the administration of glycerol is also thought to be useful. But the effectiveness of the other medicines containing some vasodilators was obscure or doubtful. We propose the following: (1) A meticulous observation is essential for the patients who received high doses of irradiation to diagnose brain injury in the early reversible stage. (2) Steroids should be given immediately in this reversible stage of brain injury before the irreversible "necrosis" occurs. (3) Steroids should be maintained for a long period over 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

A 57-year-old woman underwent left lower lobectomy for primary lung cancer (papillary adenocarcinoma, T2NOMO). Despite postoperative adjuvant immunochemotherapy with 5-Fu, Carboquone and PS-K, bone metastases were recognized at 9 months after the surgery. She received radiation therapy and was administered PS-K alone, 3.0 g daily. As a result, long-term good condition was maintained with a positive PPD skin test. The bone metastases developed slowly, and the patient survived 5 years and 8 months after the operation. At autopsy, no obvious metastatic lesions were identified except for the bone metastases. The cause of her death was thought to be acute renal failure due to severe hemorrhage from an esophageal ulcer. Moreover, she was doomed because of advanced polycystic disease.

The effects of radiotherapy were evaluated according to the aim of treatment in 526 patients with malignant tumors. All of them underwent medical examination and were treated by irradiation for the first time in the Department of Radiology, Gunma University Hospital, in 1977 and 1978. They were divided into five groups according to the aim of treatment, which was established before the start of radiotherapy and based on curability. Groups A, B, and C (radical radiotherapy) were composed of patients with localized tumors, and Group D (palliative radiotherapy) of those with advanced or recurrent tumors. The relative five-year survival rate was 107% in Group A (110 patients), 67% in Group B (85 patients),a nd 34% in Group C (151 patients), or 66% in all patients treated radically. The cumulative 24-month survival rate was 16% in Group D (159 patients). In 21 patients treated symptomatically (Group E), the rate of effectiveness of radiotherapy was 71%. In the 526 patients as a whole, the relative five-year survival rate was 46%. We were relatively satisfied with these results, but believe that much more favorable results will be obtained in the near future if a more suitable method of individual treatment for each patient with malignant tumor can be devised.

Extranodal non-Hodgkin's lymphoma (NHL) in the head and neck except Waldeyer's ring treated with radiation were analyzed. No definite difference was observed both in actuarial and relapse-free five-year survival rate between stage I and II. There was a high survival rate with orbital NHL in which most of the patients occupied with favorable histology. Prognosis of the disease was highly influenced by the histologic subtype; five-year survival was 91.4% in DWDL, 77.2% in the DM, 52.0% in DPDL and 51.7% in DH. Application of histologic classification with the Working Formulation was also recommended. There was a high incidence of extranodal relapses to bone and/or soft tissue from the lesions with nasal cavity, paranasal sinus and oral cavity.

Retrospective analysis of patients with malignant lymphoma of the brain was carried out. All cases were mainly treated with radiation therapy. Overall survival was 44% and 37% at two and five year. Survival was statistically better for patients with diffuse medium-sized cell or diffuse mixed type compared with diffuse large cell type by the LSG classification, for the age group less than 50 years compared with greater than or equal to 50 years, and for the group with Karnofsky Index greater than or equal to 50% compared with less than or equal to 40%. In 11 of 15 patients the first recurrent site was the central nervous system.

From 1972 to 1982, 563 patients with Stage I and II non-Hodgkin's lymphoma received radiation therapy in the department of radiology which belongs to the JLRTS group. Local control failures were seen in only 5 cases (0.9%). The regional recurrences were found in 30 cases (5%). 17 of recurrences occurred during the first 5 years. 17 cases had remissions again, and 5 cases had 5 year survivals.

A retrospective analysis of 1514 patients with non-Hodgkin's lymphoma treated between 1972 and 1985 was performed. Of these cases, 114 with histology of low-grade malignancy and 750 with intermediate malignancy were localized in the head and neck. All patients received definitive course of radiation therapy, including 390 cases with adjuvant chemotherapy. For cases with low-grade malignancy, all cases were locally controlled and five-year relapse free survival rates were 85% in stage I, and 75% in stage II. For cases with intermediate malignancy, local control rates were 97% in stage I, and 87% in stage II. Five-year survival rates were 67% in stage I and 50% in stage II. There were no benefit on survival rates from adjuvant use of chemotherapy with radiation therapy as compared to radiation therapy alone.

Six autopsy cases of glioblastoma multiforme in cerebral hemisphere were examined by large histological preparations. They were treated by surgery and high-dose fractionated radiation therapy (5 Gy twice weekly). Their morphological changes were compared to the last CT and radiation field and total doses. Four out of six cases showed small residual tumor. One case showed extensive necrosis of the tumor and brain. The other case exhibited no tumor tissue at all. Spongy degeneration of the white matter associated with astrocytosis and macrophage infiltration extended sometimes beyond the local irradiation field. These white matter changes were easily occurred in the previous peritumoral edema where tumor cell infiltration was frequently observed. Residual tumor cells consisted of small anaplastic cells, which might be radioresistant and recur. Enhancement effect of CT scan showed tumor tissue and radiation necrosis with vascular proliferation.