Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial II.

In a prospective randomized trial, 361 male patients with histologically proven adenocarcinoma of the rectum, judged preoperatively to require abdominoperineal resection (APR), were treated by surgery alone or were given 3,150 rads of preoperative radiotherapy. Surgical resection was done on 320 patients, 262 having "curative" APR. Only moderate symptoms from radiotherapy were noted and postoperative complications and 30-day mortality were similar in both groups.

Bronchioalveolar carcinoma arising in areas previously irradiated for Hodgkin's disease.

A man who received therapeutic irradiation to limited areas of each lung for intrapulmonary Hodgkin's disease developed bronchioalveolar carcinoma in the same areas more than 20 years later. This is the first report of a malignant process developing in areas of the lung that had been previously irradiated for treatment of a primary lung condition.

Advanced carcinoma of the nasopharynx. A clinical study of 274 patients.

A total of 274 patients with a diagnosis of nasopharyngeal carcinoma was treated in eight Veterans Administration Hospitals over a period of 22 years. Of the 274 patients, 256 (93%) had squamous-cell carcinoma, while 18 (7%) had other tumors. Most of the squamous-cell carcinoma patients (82%) had Stage IV disease; cervical lymph node metastases were found in 193 (75%), and distant metastases were present in 22 (9%).

Primary malignant lymphoma of the paranasal sinuses.

A case of primary malignant lymphoma of the paranasal sinuses is presented. The patient, a 56-year-old white man, had a good response to Cobalt 60 therapy. A review of the literature reveals that this rare tumor occurs predominantly in older individuals, and that the chance for survival is good when radiation has been administered.

Severe radiation injuries of the lung.

The lung is a radiosensitive organ whose limited tolerance must be treated with great respect in the radiation management of malignant tumors in the thorax. Severe radiation pneumonopathy can cripple and kill as the outcome of faulty judgment, error, accident, or calculated risk in an effort to control a locally advanced cancer. The clinical and radiologic profile of this unique and challenging syndrome is described and the histopathology and pathogenesis are reviewed.

Melanomas of the lower extremity among native Puerto Ricans.

The clinical features of 57 melanomas of the lower extremity occurring in native Puerto Ricans were studied. Whereas most melanomas of the lower extremity among Caucasians occur above the ankle, the group studied showed a predilection for the foot, particularly in the minimally pigmented zones (sole, heel, and nail bed), a distribution similar to that reported in black patients. The possibility that pigment-deficient areas may represent the target organ for sunligh-induced melanomas in Negroes and dark-skinned subjects is discussed.

The presentation of malignant lymphoma in the oral cavity and pharynx.

The oral and oropharyngeal presentation of malignant lymphoma is an uncommon occurrence. We are reporting ten cases from our radiation center because this cancer is most likely to be first seen and recognized by the dental practitioner at the earliest stage when it is radiocurable. More advanced lesions, as in our series, become associated with systemic lymphomatous disease and patients have a poor survival rate.

A special treatment couch for irradiation of a large body volume.

A special treatment couch has been designed for deployment of a greatly extended treatment distance for irradiation of a large body volume, particularly an irregular one which requires shielding. The basic unit is a commercial hydraulic lift table to which an appropriate plywood top and small wheels were added. Its advantage is its capacity to transfer very ill and disabled patients quickly and safely from a wheelchair, portable hospital litter, or bed.

Radiotherapy in malignant teratomas.

Twenty-seven patients with malignant teratoma, 19 of which received radiation, are presented and the radiation response analyzed. Radiotherapy seems most effective in the palliation of undifferentiated (embryonal) teratoma of the gonads and sacrococcygeal region in early childhood. It is less effective, yet useful, in undifferentiated gonadal and sacrococcygeal teratomas of older children and adults, but seems of little value in carcinomatous ovarian dermoids and in malignant mediastinal teratomas.

Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: reportof a National Veterans Administration randomized study.

In 1964 the Veterans Administration Surgical Adjuvant Group (VASAG) initiated a large-scale, controlled, randomized protocol to study the role of low-dose preoperative irradiation (2000-2500 rads/10fractions/12 days) in patients with operable adenocarcinoma of the sigmoid colon and rectum. This report analyzes the data in 700 patients, all at 5-year risk. There appears to be a definate benefit to irradiated patients who undergo abdominoperineal resections, when compared with the controls.

Preoperative radiotherapy for colorectal cancer.

In a prospective randomized trial, 700 patients with a confirmed histological diagnosis of adenocarcinoma of the rectum or rectosigmoid were randomized to receive radiotherapy prior to operation (2000 to 2500 rads in two weeks) or surgery alone. Five year observed survival in the 453 patients on whom "curative" resection was possible was 48.5% in the X-ray treated group compared with 38.