Cellular immunity was assessed in 85 patients with head and neck cancer with monoclonal antibodies to lymphocyte surface antigens that identify total T cells, helper cells, and suppressor cells. The control group consisted of 22 healthy volunteers. Nine patients who had surgical procedures for benign diseases were also studied. Compared with the controls, the patients with cancer who received radiation therapy had a significant decrease in total lymphocytes, T cells, helper cells, suppressor cells, and decreased helper/suppressor cell ratio. Significant decreases in lymphocyte subpopulations were not detected in patients tested before treatment or in patients treated with surgery alone. The immune deficits observed were prolonged in duration, with some present in the patients studied up to 11 years after radiation therapy. This long-lasting immune depression may have relevance to tumor recurrences and second primaries in patients with head and neck cancer treated by radiation therapy and to attempts at increasing cure rates with adjuvant agents that improve immune reactivity.
One hundred and twenty patients with early glottic carcinoma received radiation therapy at the University of Maryland Hospital from 1959 to 1977. The radiation dose ranged from 55 Gy in 4 weeks for small Tla lesions to 65 Gy in 6 '/2 weeks for T2 lesions. The local control rates by irradiation alone for stages Tla, Tlb, and T2 were 92, 91 and 88 per cent, respectively, while 5-year determinate disease-free survival rates were 96 per cent for stage I disease and 88 per cent for stage I1 disease. Most of the local failures were salvaged by surgery, with a low complication rate. Regional metastases were uncommon, and occurred in 7 per cent in stage I and in 6 per cent in stage I1 disease. Factors increasing the risk of failures appeared to be bulky tumor, anterior commissure involvement and subglottic extension.
Recurrent vulvar cancer after surgical treatment carries a poor prognosis and poses a clinical therapeutic problem. Retrospective analysis of 21 recurrent vulvar cancer treated by radiation alone over 20 years (1958–1977) is presented. Highly individualized interstitial brachytherapy was used alone in some selected cases and combined with external beam therapy in most cases. The results showed that limited disease in the introitus and introitus involving the vagina have the best prognosis (6/6; 100%). Small groin node has a good chance for cure (2/4; 50%), while all extensive recurrences have the worse prognosis as expected. Factors responsible for the success of radiation treatment appear to include (1) size and depth of the recurrence (5 cm or less lesion has a high chance for cure); (2) groin node (≤2 cm has good prognosis); (3) perineal skin involvement (the lesser, the better); (4) degree of tumor tissue necrosis (the lesser, the better); and (5) radiation dose (5500–8500 rad). Integration of the external beam and brachytherapy and individualization with good planning are essential to achieve a better cure rate. Attempts were made to recommend a criteria for patient selection for cure and method of treatment as well as a technical aspect of the treatment.
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