An analysis of the Hanford data adjusted for age and calendar year of death reduces the number of cancer sites for which a radiation dose relationship can be suggested to two, cancer of pancreas and multiple myeloma. There is no suggestion of a radiation relationship for lymphatic and haemopoietic cancers other than myeloma, or for solid tumors of sites other than the pancreas, with the possible, and very weak, exception of the kidney. The conclusion of Mancuso et al. with regard to variations in sensitivity to radiation by age at exposure appears to be untenable. Radiobiologic considerations, including the results of other studies, suggest that the excess proportional mortality at doses above 10rem for cancer of pancreas and multiple myeloma is likely to be explainable in terms of a correlate of dose rather than in terms of radiation. The analyses of Mancuso et al. and of the present reviewers are preliminary and do not take advantage of the available data on the total exposed population. A cohort analysis of the Hanford data will permit better understanding of the experience than the present proportional mortality analyses.
A collaborative trial with random assignment to involved field or extended field radiotherapy for localized Hodgkin's disease was begun in 1967. Case accession was completed in 1973, with 224 eligible patients assigned to involved field and 243 to extended field. With a median follow-up time of 27 months no significant survival difference is found between involved and extended field regimens for the total patient group or for most subgroups defined by age, sex, histology, stage, class, and use of laparotomy for staging. A single exception is an improved survival in the involved field group for female patients. Survival free of distant extension shows a similar lack of treatment effect, but survival free of any extension, local or distant, shows a significant benefit from extended field treatment. Complications of radiotherapy are significantly increased following extended field treatment. Survival following local extension is similar to survival following periods free of any extension.
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