Hyperthermia delivered by scanned focused ultrasound was combined with external beam radiation to treat 15 patients with primary malignant tumors of the brain. A preliminary craniectomy was performed to avoid attenuation of the ultrasound beam by the skull, and multiple thermal sensors were employed to ascertain intratumoral temperatures. The target temperature was 42.5 degrees C at the tumor boundary. This was attained at more than one point during every complete treatment, while a mean temperature in excess of 42 degrees C was achieved within the scanned tumor volume during at least 1 treatment in 11 patients. Technical problems and toxicities are described.

Malignant sweat gland neoplasms are rare tumors. Historically, the principal mode of treatment has been local surgical excision. Eight published studies show that greater than 50% of patients develop either local tumor recurrence after surgery or regional lymph node metastases. Most patients have evidence of locoregional failure before distant metastases are detected. Three patients were recently referred to the University of Arizona Cancer Center for consideration of irradiation after resection of such tumors. In two patients, the tumor was located on the scalp and, in one patient, on the alar surface of the nose. Their ages ranged from 19 to 60 years. All underwent surgical resection followed by high-dose irradiation of the surgical bed (approximately 70 Gy) and regional lymphatic chains (approximately 50 Gy). Two patients remain disease-free at 27 and 35 months, respectively, after completion of treatment; the third died of rapidly progressive systemic metastases. A review of the literature is provided focusing on treatment success and predominant patterns of recurrence. Finally, a rational approach for evaluation of patients that might benefit from local irradiation is presented.

Treatment of paragangliomas of the temporal bone (glomus jugulare and glomus tympanicum tumors) is controversial, with both surgery and radiation therapy having their advocates. This paper discusses the experience at the University of Arizona Health Sciences Center in treating 10 cases of this uncommon tumor between 1971 and 1988. Seven of 10 cases were initially treated using irradiation and achieved complete tumor control for a mean of 67 months (range = 23-107 months). Two patients, one treated surgically and the other by embolization, had recurrences and were salvaged by radiation, and neither has recurred. The final patient is disease-free 9 months after embolization and surgery. There have been no serious sequelae of treatment. We conclude that moderate-dose irradiation can safely control most temporal bone paragangliomas.

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Epithelioid sarcoma is an uncommon tumor characterized by its appearance in the distal extremities (especially the forearm, wrist, and ankle), the tendency to recur locally, and high probability of spread to regional lymph nodes. Most patients have been treated surgically, and the potential role of radiation therapy alone or combined with surgery is not well defined. The authors treated eight‐patients with epithelioid sarcoma. Four patients were male; patients ranged in age from 7 to 66 years (median, 54.5). Six patients had upper extremity lesions, and two had lower extremity lesions. Median maximum tumor dimension was 3.0 cm. Three patients had Grade 2 lesions, and the others had grade 3 lesions. Regional lymph nodes were involved initially or during the course of the disease in five of our eight patients (62%). Five patients were treated following surgery for primary or recurrent tumor, with a median dose of 68 Gy (TDF 109). Four were NED with follow‐up at 18, 24, 72, and 84 months, respectively, and the other patient failed locally and in regional nodes at 6 months (treated successfully by salvage amputation) and is now living at 96 months with distant metastases. One patient treated pre‐amputation with 50 Gy (TDF 81) is NED at 12 months. Two patients received radiation therapy alone, with a median dose of 65 Gy (TDF 104). One patient with a 22–cm primary died with persistent local disease as well as metastases, and the other died with distant metastases but with local control at 18 months. Four patients with local control did not undergo amputation, and all have unimpaired function of the affected extremity. Local control and survival for this group of patients is similar to that for other patients with upper extremity or high grade sarcomas. The authors concluded that radiation combined with surgery achieves a low rate of local recurrence, and a high likelihood of maintaining a functional extremity and good cosmesis.

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Forty‐nine patients with biopsy‐proven Waldeyer's ring lymphoma were treated with radiation therapy between 1968 and 1979; 45 to 50 Gy were given to Waldeyer's ring structures with a 5‐ to 10‐Gy boost to the primary site. Uninvolved low cervical nodes received 40 to 50 Gy. Chemotherapy was reserved for treatment failures. Actuarial 5‐year survival was 53%, disease‐free survival was 48%, and local control was 98%. Patients with Stage I disease fared better than patients with Stage II disease, and unilateral adenopathy conferred a better prognosis than bilateral adenopathy. When classified by the Rappaport system, nodular lymphomas had a better prognosis than diffuse lymphomas, and of the diffuse lymphomas, histiocytic lymphoma was a more lethal disease than lymphocytic lymphoma. Patients with diffuse undifferentiated lymphomas in the Rappaport system, or high‐grade lymphomas in the Working Formulation, fared poorly. Most relapses were systemic, and actuarial 5‐year survival after salvage was only 20%. A logical approach to the treatment of this disease can be based on these prognostic features.