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Sixty-one patients with midline pineal tumors and 16 patients with suprasellar germinomas were treated with surgical decompression and relatively high-dose radiotherapy of the primary site. Results were excellent, and there were no long-term complications. Ten per cent of midline pineal tumors and 37% of suprasellar germinomas metastasized to the cerebral or spinal subarachnoid space within 6 months to 5 years. Irradiation of the entire neural axis is recommended for locally extensive tumors, simultaneous pineal and hypothalamic lesions, and all biopsy-proved germinomas. The five-year survival rate was 79% for midline pineal tumors and 77% for suprasellar germinomas.

Treatment results on 109 patients with craniopharyngioma treated surgically or by combined surgery and radiation therapy are reported. The five-and ten-year survival rates were 62.9% and 48%, respectively, for 74 patients treated primarily with surgery. For 32 patients treated with combined surgery and radiation therapy, the survival rates were 82.2% and 71%. The 74 patients treated with surgery but no radiotherapy had five-and ten-year relapse-free survival rates of 31.5% and 17.4%, respectively, and for the 32 patients treated with combined surgery and radiation therapy, these relapse-free survival rates were 76.3% and 43.8%, respectively. The survival and relapse-free survival rates were better for children. Morbidity and mortality were higher in patients who were reoperated on for recurrent tumors. Our data indicate that radiation therapy should play a major role in the initial combined management of craniopharyngiomas especially when the lesion cannot be totally resected and when postoperative CT scan shows residual tumors.Cancer 47:847-852, 1981. R A N I O P H A R Y N G I O M A S FORMabout 3% of all intra-C cranial tumors, and more than half of these are observed in childhood and adole~cence.'~ Since the first description by Erdheim (1904), it is widely accepted that the development of these cystic tumors arise from remnants of the original Rathke's pouch. They vary greatly in size, extent, and cystic component but in general compress the optic chiasm, the pituitary gland, the cavity of the third ventricle, and hypothalamic region. This mass effect may produce critical physiologic disturbances. Treatment of craniopharyngiomas has been controversial. After 1950, with the synthetic glucocorticoid available and the aid of the operating microscope, the attempt of radical tumor excision has been vindicated by the long-term r e s~I t s .~* '~ However. Kramer er al.7 believe that radical removal is unnecessary in patients with craniopharyngiomas because they found that radiation therapy administered after initial biopsy and cyst decompression was curative in most of their patients. Those reports make pertinent a review of our own experience in the treatment of this tumor at Columbia-Presbyterian Medical Center. Materials and MethodsOne-hundred-nine patients were seen in the Neurological Institute and Presbyterian

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Radiation of skin results in slower healing of open wounds, and provides an in vivo system for evaluation of topical dressings and growth factors in radiation-impaired wounds.

Wound bursting strength analysis, combined with techniques aimed at elucidating changes at the molecular level, provides a useful tool for the study of factors that impair healing and potential treatments for resulting healing deficits.

From 1965 to 1980,35 patients were treated by radiation for palliation of symptoms related to metastatic renal cell carcinoma. The male:female ratio was 1.9:1. Eighty‐six percent (30/35) of the patients were over 40 years of age at initial presentation. Sixty‐three percent (22/35) of the patients showed symptoms of metastatic disease within three years of diagnosis of the primary malignancy. Sixty sites were irradiated in the 35 patients: 36 sites of metastatic bone pain, 14 obstructing and/or palpable masses, and ten sites treated for symptoms due to central nervous system (CNS) metastases. Efficacy of treatment was assessed at serial follow‐up visits beginning one month after completion of radiotherapy. Bone pain responded at 77% of the treated sites. Mass effect responded in 64%. Disappointing results were obtained with CNS metastases. There was only a 30% response of brain and spinal cord lesions within the dose range that these patients were treated. No correlation between TDF equivalent dose of radiation administered and frequency of palliative response was found. In those sites where a response of bone pain to radiation was observed, 86% of the responses lasted the remainder of the patient's life. No correlation was found between TDF equivalent dose of radiation administered and duration of response. Radiation may be a useful palliative tool for bone pain and mass effect from metastatic renal cell carcinoma. Inordinately high doses need not be used to achieve the desired effect.