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Sophisticated conformal radiotherapy techniques with high dose 3-D conformal and intensity modulated radiation therapy improve the biochemical outcome in patients with favorable, intermediate and unfavorable risk prostate cancer. Intensity modulated radiation therapy is associated with minimal rectal and bladder toxicity, and, hence, represents the treatment delivery approach with the most favorable risk-to-benefit ratio.

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Background There are several management options for patients with squamous cell cancer of the base of tongue. We have had an interest in using primary radiotherapy with or without neck dissection, in an effort to provide optimal oncologic as well as functional outcomes. Methods From 1981 to 1995, 68 patients with primary squamous cell cancer of the base of tongue were managed with primary radiotherapy, with neck dissection added for those who were initially seen with palpable lymph node metastases. Ages ranged from 35 to 77 years (median age, 55 years). There were 59 men and 9 women. T Stage distribution was: T1, 17; T2, 32; T3, 17; T4, 2. Fifty‐eight patients (85%) were initially seen with nodal metastases. Initial treatment generally involved external‐beam radiotherapy (EBRT) to the primary site and upper neck (54 Gy) and to the low neck (50 Gy). A 192‐Ir brachytherapy boost (20–30 Gy) to the base of tongue was done about 3 weeks later, at the same anesthesia used for the neck dissection. All patients had temporary tracheostomy. Follow‐up ranged from 1 month to 151 months (median, 36 months). Nine patients received neoadjuvant chemotherapy as part of a larynx‐preservation protocol. Results Actuarial 5‐ and 10‐year local control is 89% and 89%, distant metastasis free survival is 91% and 76%, diseasefree survival is 80% and 67%, and overall survival is 86% and 52%, respectively. Complications occurred in 16%. Conclusions Our long term data clearly demonstrate that primary radiotherapy produces excellent oncologic outcomes. © 1998 John Wiley & Sons, Inc. Head Neck 20: 668–673, 1998.

Novel steroidal antiinflammatory antedrugs, 11 beta,20-dihydroxy-3,20-dioxo-3'-(ethoxycarbonyl)-isoxazolino[16,17 - d]pregna-1,4-diene (2a) and 9-fluoro-11 beta,20-dihydroxy-3,20-dioxo-3'-ethoxy- carbonylisoxazolino[16,17-d]pregna-1,4-diene (2b) were prepared in 97% yield via 1,3-dipolar cycloaddition of carbethoxyformonitrile (CEFNO) to 11 beta,21-dihydroxy-3,20-dioxopregna-1,4,-16-triene (1a) and 11 beta,21-dihydroxy-3,20-dioxo-9-fluoropregna-1,4,16-triene (1b), respectively, which were prepared via five steps from prednisolone and 9-fluoroprednisolone, respectively. The treatment of steroids 2a and 2b with acetic anhydride in pyridine led to the corresponding 21-acetates 3a and 3b, respectively, in 95% yield. Dose-response profiles of the croton oil-induced ear edema bioassay in rats were used to calculate the following ID50 values (nmol/ear resulting in a 50% reduction of edema): prednisolone (P), 540 nmol; 2b, 135 nmol; and 3b, 101 nmol. Inhibition of edema did not exceed 50% following application of either 2a or 3a. Relative potency calculations indicated that 2b was 4-fold and 3b 5.3-fold more potent than the parent compound P when applied topically. No significant adverse systemic effects were seen following treatments with 3b. These results suggest that C-9-fluorination, side-chain hydroxy group esterification, and [16 alpha,17 alpha-d]-3'-carbethoxyisoxazoline additions to the conventional steroid P improve topical antiinflammatory activity without concomitant increases in adverse systemic activity.