[en] An investigation of the reactions ⁴⁰Ca(α, γ)⁴⁴Ti and ⁴⁸Ca(α, γ)⁵²Ti in the region of the giant dipole resonance (GDR) has been completed. For the ⁴⁰Ca(α, γ) reaction, 90 degree excitation functions over the bombarding energy range 6.5 to 17.5 MeV were obtained for gamma transitions to the ground state and first excited state in ⁴⁴Ti and for a sum of the unresolved transitions to the third and fourth excited states in ⁴⁴Ti. Angular distributions were measured at the extrema of the excitation functions. The data reveal that the ⁴⁰Ca(α,γ) reaction proceeds predominantly via the isospin forbidden E1 transition and populates the T = 1, GDR states of ⁴⁴Ti via T = 0 isospin impurities. The results provide an estimate of the isospin mixing in the GDR as well as support for a possible giant quadrupole resonance (GQR) below the GDR in ⁴⁴Ti. The excitation functions exhibit a gross structure which reflects the isospin mixing in the GDR of ⁴⁴Ti, and a structure of intermediate width which may reflect T = 0 alpha cluster states in ⁴⁴Ti. The ⁴⁸Ca(α, γ) 90 degree differential cross section was investigated over the bombarding energy range 6.0 to 14.0 MeV. The isospin allowed ⁴⁸Ca(α,γ₀) reaction was found to be a factor of 20 smaller in cross section than the isospin forbidden ⁴⁰Ca(α, γ₀) reaction

[en] A historical review of conventional fractionation offers little confidence that such treatment is optimal for all tumors. Thus manipulation of time-dose schedules may provide a relatively inexpensive yet potentially useful technique for improving therapeutic results in radiation therapy. Consideration of basic radiobiological principles and animal model data illustrates the complex and heterogeneous nature of normal tissue and tumor response to time-dose effects and supports the hypothesis that better time-dose prescriptions can be found in clinical practice. The number of possible time-dose prescriptions is very large, and a review of the clinical trials using nonconventional fractionation demonstrates that the sampled portion of the total three-dimensional space of time, fraction number, and dose has been very small. Only carefully designed clinical trials can establish the therapeutic advantage of a new treatment schedule, and methods for selecting the most promising schedules are discussed. The use of simple data reduction formulas for time-dose effects should be discarded since they ignore the very complexity and heterogeneity of tissues and tumors which may form the basis of improved clinical results

[en] Although conventional fractionation schedules have been satisfactory for the treatment of some tumors, there is reason to believe that the results of radiation therapy could be improved in some cases by appropriate alterations in treatment schedules. The pharmacological characteristics of some of the electron affinic radiation sensitizers have provided added incentive to investigate newer fractionation schemes, particularly ones which deliver the majority of the radiation dose in short periods of time. This editorial discusses three papers describing preliminary clinical studies using multi-daily fractionated (MDF) radiation therapy. Two of these studies also make use of the radiation sensitizer misonidazole

[en] From 1963 through 1984, 74 patients with Stage I, II, or III epithelial ovarian cancer who completed a total hysterectomy and debulking procedure and had less than 2 cm residual disease were treated with whole abdominal and pelvic boost radiation therapy (WAP) at Yale-New Haven Hospital. WAP consisted of a whole abdominal dose of 1750 to 2500 cGy (at 100-160 cGy per fraction) and a total pelvic dose of 4000-4600 cGy. Based on stage, amount of residual disease, pathologic type, and grade of tumor, the 74 patients were classified into a favorable group (FG) and an unfavorable group (UG) using the classification scheme developed at the Princess Margaret Hospital (PMH). The actuarial survival at 10 years for the FG patients was 77% (+/- 10%, 95% confidence limits) and for the UG patients was only 7% (+/- 13%). Local control of disease in the abdomen and pelvis was 87% in the FG and only 36% in the UG. Severe long-term complications occurred in 7% of the patients and consisted of small bowel obstruction. Our results strongly indicate that the PMH classification of FG and UG is useful in our patient population in determining which subgroup of patients should be offered WAP

[en] Introduction: Uterine papillary serous carcinoma (UPSC) is a morphologically distinct variant of endometrial carcinoma that is associated with a poor prognosis, high recurrence rate, clinical understaging, and poor response to salvage treatment. We describe the presentation, local and distant control, survival, salvage rate, and complications for patients undergoing whole abdominal radiation therapy (WART), low dose rate (LDR) intracavitary brachytherapy, or high dose rate (HDR) vaginal brachytherapy in patients with stage I UPSC. Methods: Between 1976 and 1994 more than 1700 patients with endometrial carcinoma were treated with radiation therapy, 30 patients with stage I UPSC (1.8%) were treated with radiation before or following TAH/BSO. All patients underwent either preoperative Simon's packing or tandem and plaque which delivered 30-40 Gy to the serosa, WART, or HDR Ir-192 vaginal apex brachytherapy to a total dose of 21 Gy in 3 fractions at 0.5 cm from the vaginal mucosa. A total of 14 patients received HDR vaginal brachytherapy and (5(14)) patients received systemic chemotherapy. All patients presented with vaginal bleeding at a median age of 67 years (range 34-88). The group of 30 patients underwent TAH/BSO, 17 patients were completely staged pathologically (pelvic and para-aortic lymph nodes, omentectomy, and pelvic washings), and 2 patients underwent omental biopsy and pelvic washings only. All specimens revealed UPSC, nuclear grade 3, and lymphovascular invasion (23%). The pathologic stage was IA: 23% (7), IB: 67% (20), and IC: 10% (3). The median follow-up for all patients was 49 months (range 13-187 months). For the patients receiving postoperative HDR vaginal brachytherapy the median time from surgery to radiation was 42 days (range 29-91). Results: The 5-year actuarial disease free survival for Figo stage I UPSC patients treated with postoperative HDR vaginal brachytherapy and systemic chemotherapy was 100% compared to 74% for stage I UPSC patient treated with combinations of pre and postoperative LDR brachytherapy and WART. The Mantel and Haenszel analysis comparing the survival curves between the two groups of patients revealed X² = 3.25 (p=0.07). None of the patients treated with HDR vaginal brachytherapy failed (14 patients). All patients with stage IB, and 50% ((2(4))) of stage IA UPSC treated with HDR vaginal apex brachytherapy were pathologically staged. The overall failure rate for patients treated with combination WART and LDR vaginal brachytherapy was 25% (4 patients), combined local/distant failure 19% ((3(4))), distant failure only 6% ((1(4))), and no patients had local failure only. The median overall time to failure was 20.5 months (range 8-24 months). Three patients with pathologic stage IB and one patient with stage IC UPSC failed. None of the patients who failed, and only 45% of the group treated with combination LDR vaginal brachytherapy and WART had complete pathologic staging. The overall salvage rate for local and distant recurrence was 0%. Complications following HDR vaginal apex brachytherapy included dysuria in one patient. However, complications from patients treated with WART, and/or LDR brachytherapy included small bowel obstruction 13% (2 patients), with one patient dying of related complication, and vaginal stenosis 13% (2 patients). Conclusion: Patients with pathologic Figo stage I UPSC can be effectively and safely treated with HDR vaginal apex brachytherapy. All patients with clinical stage I UPSC must undergo complete pathologic staging prior to treatment. Control of local disease is essential because recurrence at the vaginal apex may be associated with distant disease, and the salvage rate for both local and distant disease is extremely poor. Complications from HDR vaginal apex brachytherapy were minimal

[en] From 1974 to 1984, 307 patients with local prostate cancer (Stage A2, B, or C) were referred to the Hunter Radiation Therapy Center, Yale-New Haven Hospital for definitive radiation therapy. One hundred forty-one patients underwent an interstitial Iodine-125 implant (IMP) and 166 patients received external beam irradiation (EB). For IMP patients with Stage A2, B, and C tumors, the actuarial 5-year disease-free survival (NED) rates were 88%, 84%, and 38% and the 9-year NED survival rates were 88%, 62%, and 30%, respectively. For EB patients with Stage A2, B, and C tumors, the 5-year NED survival rates were 88%, 77%, and 43% and the 9-year NED survival rates were 74%, 63%, and 37%, respectively. The NED survival rates by histologic grade were equivalent for the IMP and EB patients. The absolute local control rate (LCR) was 77% for all of the IMP patients but if one excludes patients who were inadequately treated, the LCR was 82%. LCR in the EB patients was 86%. The LCR for Stage A2, B, and C patients treated with EB was 100%, 94%, and 82%, respectively. The LCR for Stage A2, B, and C patients treated with an adequate IMP was 100%, 83%, and 71%, respectively. The complication rate was 8.5% in the IMP patients (with 0% severe complications) and 14% in the EB patients (with 3% severe complications). Our results indicate that a carefully selected group of IMP patients (Stage A2, B) will have an equivalent NED survival rate and an excellent LCR compared to EB patients but with fewer and less severe side effects

No abstract available

[en] The new insights and controversies concerning the radiobiological properties of malignant melanoma and how these relate to new clinical approaches are reviewed. The recent clinical experience with large individual fraction sizes is analyzed. The treatment of malignant melanoma in certain specialized sites is also described. An attempt is made to place in perspective the usefulness of radiation therapy in the treatment of this complex disease. Finally, certain new applications for radiation therapy both alone and in combustion with other treatment modalities are proposed that may ultimately prove appropriate for clinical trials

[en] Three children with Stage IV-S neuroblastoma and massive hepatomegaly were treated with low dose radiotherapy to the liver (1200 to 1400 rad at 125 to 150 rad per day). Radiotherapy was efficacious in reducing liver size in our small series; the three patients are alive without disease at 2, 33, and 4 years, respectively, following treatment. Although all three patients are doing well, our data suggest a low threshold for radiation kidney damage in children less than 6 months old. Since treatment strategy is designed to reverse liver enlargment and not to deliver a curative dose, radiation treatment should be designed to avoid the kidneys

[en] A new technique of intracavitary brachytherapy for malignant biliary obstruction is presented. The technique involves the use of a high-dose-rate remote afterloading device, which offers all the advantages of conventional brachytherapy with the added benefit that the dose can be delivered in a single treatment over a few minutes. The potential problems associated with conventional brachytherapy are thereby minimized