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Five whole-brain irradiation schedules ranging from 2000 rad in one week to 4000 rad in four weeks were evaluated in 1830 patients with cerebral metastases treated in two randomized studies by the Radiation Therapy Oncology Group. The duration of palliative effectiveness among those patients with favorable survival prognosis was investigated. Favorable subgroups were identified consisting of 123 ambulatory breast cancer patients with no soft tissue metastases, 373 ambulatory lung cancer patients with primary absent or no extracerebral metastases, and 65 ambulatory patients with other primaries and no extracerebral metastases. This group of 561 patients had a median survival of 28 weeks compared with 11 weeks for the remaining patients. Analyses of neurologic function control rates failed to show a significant benefit of higher doses. No advantage was demonstrated for treating brain metastases patients with favorable prognoses with more than one week of whole-brain irradiation.

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Eighteen patients with unresectable ductal adenocarcinoma of the pancreas received definitive, high-dose, small-volume radiation therapy. All patients had at least one laparotomy, at which time a biopsy was obtained, radio-opaque clips were placed to define the extent of the gross tumor, and usually some form of bypass procedure was performed. External-beam irradiation was delivered from a 45-MV betatron to an area encompassing the clipped tumor volume plus a 1 to 2 cm margin. A three-field technique, employing opposed lateral 45-MV photon beams and an anterior "mixed beam" (50% 45-MV photons and 50% 15- to 35-MeV electrons), was used to treat 13 of the patients. The choice of electron energy used for these patients was based on the depth of the posterior margin of the target volume. Five patients were treated by either four-field "box" or three-field, 45-MV photon techniques. Minimum tumor dose was 6300-6700 rads delivered in 180-rad fractions in 7-9 weeks. With the three-field technique, all fields were treated daily; with the four-field technique, two fields were treated daily. The projected survival rate 12 months post idagnosis is 59%, with the median length of survival, 11.8 months. Seven patients are alive 11.5 to 57 months after diagnosis, all clinically free of disease. Treatment has been generally well tolerated, and there have been no severe late radiation complications. This therapeutic modality appears capable of producing improved palliation, if not offering definitive radiotherapeutic management of localized unresectable carcinoma of the pancreas.

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Background: Data evaluating outcomes and patterns of recurrence following radiation therapy (RT) for cutaneous squamous cell carcinoma (cSCC) of the head and neck are limited. Methods: We performed a retrospective analysis of 111 head and neck cSCC patients treated with RT at 4 affiliated institutions. Results: With median follow-up of 7 months, there were 29 (26%) recurrences, 73% of which were nodal (n = 21). Immunosuppression (IS) was the only factor associated with recurrence (47% in IS, 22% in non-IS, P = .04), and also with time to recurrence in multivariate analysis (HR 5.5; P = .03). No factors were associated with recurrence among patients who received definitive RT. The majority of patients who recurred were salvaged with surgery (n = 20, 69%). Conclusion: In a cohort of cSCC treated with radiotherapy, there was an association between IS and increased failure risk. The majority of failures were salvaged surgically.