Of 55 patients with pituitary adenomas or craniopharyngiomas treated with irradiation, a retrospective study revealed that 5 sustained a visual loss compatible with radiation damage to the optic nerve. No patient who received less than 250 rads/day fractions showed such visual loss. Within the range of total dosages used in this series, total dose was not an important determinant of this complication. The time to occurrence of visual disturbance ranged from 5 to 34 months following therapy.
This report describes 150 patients with clinical stage I and II carcinoma of the breast treated at four institutions--Yale University School of Medicine, Harvard Medical School-Joint Center for Radiation Therapy, Hahnemann Medical College, Jefferson Medical College--with radiotherapy only following excisional biopsy. Closely similar treatment policies were followed at all four centers, 4500-5000 rads minimum tumor dose being delivered to the entire breast and axillary, supraclavicular and internal mammary nodes. Forty-six of 49 stage I patients treated are alive without disease, the actuarial relapse-free survival being 91% at 5 years. Of the 101 stage II patients, 75 are alive without disease with a relapse-free actuarial survival of 60% at 5 years. Local failure has occurred in 10 patients (9 stage II and 1 stage I, 6.6%) 5 of whom are disease-free following mastectomy. The results obtained in this study are comparable to those of conventional surgery. It is our conclusion that mastectomy is not a necessary part of the treatment of small breast cancers, that radiation without mastectomy is an acceptable alternative with far superior cosmetic and functional results. Adjuvant chemotherapy should be considered particularly in stage II patients in view of their 40% relapse rate.
The case histories of 40 patients with gliomas of the thalamus and midbrain (Group I) or caudal brain stem (Group II) were reviewed to determine the effect of radiation therapy on neurologic functional status and survival. Nine of 14 (64%) patients in Group I demonstrated an improvement in functional status following radiotherapy, as did 19 of 26 (73%) patients in Group II. Eight (57%) patients in Group I and 10 (38%) patients in Group II are alive with no evidence of disease after periods of 12 to 65 months following completion of treatment. Acturial survival data indicate a better survival rate in Group I patients. Based on our findings, an aggressive and potentially curative attempt with use of radiation therapy for gliomas of the thalamus, midbrain, and brain stem is justified.
One hundred sixteen patients with stage 111 carcinoma of the breast were treated by primary radiation therapy. The 5-year actuarial survival and relapsefree survival were 25% and 2296, respectively. The 5-year actuarial probability of local tumor control for the entire group was 64%. In patients undergoing an excisional biopsy and an interstitial implant of the primary tumor area, local control was 100%. In patients who had either an excisional biopsy or an implant, the 5-year actuarial probability of local control was 77% and 76%, respectively. In contrast, in patients having neither an excisional biopsy nor an implant, local control was only 41 %. In patients receiving a total dose of greater than 6000 rad, from external beam treatment or from external beam plus an interstitial implant, the local control was 78% compared to 39% in patients receiving a total dose of less than 6000 rad. Forty-one patients received some form of adjuvant therapy. Both local control and relapse-free survival were improved in patients receiving chemotherapy as the sole adjuvant and in patients receiving chemotherapy combined with an endocrine ablative procedure. However, patients treated with only an endocrine ablative procedure had no improvement in survival nor in local control. These results indicate that primary radiation therapy can provide local control in a high proportion of patients with stage I11 carcinoma of the breast and suggest that chemotherapy is effective in improving both local control and survival in these patients.Cancer 43:985-993, 1979.ATIENTS WITH stage I11 carcinoma of the P breast often present with advanced local disease that is difficult to control. Even if local control is obtained, the majority of patients develop distant metastases. Therefore, successful treatment for this stage of breast cancer must contain both local and systemic therapies. Attempts at employing radical surgery in this setting have not been successful. In 1943, Haagensen and Stout21 established operability guidelines based on their observations that certain grave signs heralded poor results when patients were treated by radical surgery. In 120 cases, retrospectively classified as inoperable by their criteria, the local recurrence rate was 49.2%; and only one pa-
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