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Four cases of hepatocellular carcinoma (HCC) were surgically resected following combined radiotherapy (RT) and hyperthermia (HT). Complete necrosis of the tumor without viable tumor cell was found in one case and extensive tumor necrosis was observed in the other three cases; the percentage of necrosis in the specimens were 40%, 70%, and 80%, respectively. Histologic assessment showed mainly coagulative necrosis in the tumor with focal liquefactive necrosis. Cystic dilatation of sinusoids was observed in both tumor and nontumorous normal liver tissue. Other changes in normal liver tissue were unremarkable except for infiltration of inflammatory cells, fatty change, and proliferation of the bile ducts which can usually be seen beyond the area where any space occupying lesions are present. It is concluded that combined radiotherapy and hyperthermia can significantly induce coagulative necrosis of hepatocellular carcinoma with nonsignificant minimal histologic changes in adjacent nontumorous liver tissue.

Sixty patients, treated with postoperative radiation therapy following radical hysterectomy and pelvic lymphadenectomy for stage lb carcinoma of the uterine cervix between Jan. 1980 and Dec. 1984 at Department of Radiation Oncology, Yonsei University College of Medicine, were retrospectively analysed. The minimum follow-up period was 5 years. The indications for postoperative radiotherapy were positive pelvic lymph node (34 pts), a large tumor size more than 3 cm in longest diameter (18 pts), positive surgical margin (10 pts), deep stromal invasion (10 pts), and lymphatic permeation (9 pts). The overall 5-year survival rate was 81.8%. The univariate analysis of prognostic factors disclosed tumor size (less than 3cm, greater than or equal to 3cm) and the status of the surgical margin (positive, negative) as significant factors (tumor size; 88.1% vs 6.3%, surgical margin; 85.5% vs 60%, p less than 0.05). Age (less than or equal to 40, greater than 40 yrs) was marginally significant (90.2% vs 73.1%, p less than 0.1). Multivariate analysis clarified two independent prognostic factors; tumor size (p = 0.010) and surgical margin (p = 0.004). Analysis of the tumor factors with the radiation dose disclosed a better survival rate for patients with a positive surgical margin who were given over 50 Gy than for those who were given below 50 Gy in patients (4/4, 100% vs 2/6, 33.4%; p = 0.06). Significant complications requiring surgical correction were not observed. In conclusion, it is believed that the status of the surgical margin and tumor size both have important prognostic significance, and that a radiation dose over 50 Gy is advisable for patients with a positive surgical margin.

Sixteen cases of male breast cancer seen over a 20-year period were reviewed. The causes of cancer of the male breast are no better understood, but major alterations in hormonal environment could be a significant factor. Some clinical characteristics correspond well with the results of other series. The median age at presentation was 61.7 years. The most frequent initial symptom was a painless mass, and the incidences of nipple discharge, central tumor location, and axillary node involvement were high. Males also had a higher incidence of local advancement which was associated with a longer delay in seeking treatment and small breast tissue. The pathologic type was infiltrating ductal type in all cases except one, and all cases showed favorable nuclear grade. Estrogen receptor analysis was performed from the tumor of 2 patients. Both of them showed a high receptor level. There was no locoregional relapse in 5 patients who received adjuvant radiotherapy in contrast to the 2 relapses in 3 patients who underwent surgery alone. And three of the five patients who received radiotherapy suffered from systemic metastasis which suggested the important role of adjuvant chemotherapy as well as radiotherapy. In light of the encouraging results about adjuvant chemotherapy in the treatment for female breast cancer with axillary lymph node involvement, it would be desirable to extend this policy to male breast cancer.

Forty patients (median age 49.6 years) were treated for primary gastrointestinal lymphoma between 1979 and 1989. There were twenty-three cases of gastric lymphoma and seventeen cases of intestinal lymphoma. Following surgery, seventeen patients received postoperative chemoradiotherapy (ACOP) by the sandwich technique, seven patients received postoperative radiotherapy, and sixteen patients did not receive any other form of adjuvant treatment. Nineteen patients were stage IE and twenty-one were stage IIE. Stage IE disease was more prevalent in the gastric lymphoma group than the intestinal lymphoma group (p less than 0.01). At a median follow-up of 17 months (1-102 + months), 17 of 19 stage IE patients and 15 of 21 stage IIE patients remained alive. The survival rate was 90% in the postoperative chemoradiotherapy group and 83.3% in the postoperative radiotherapy group at five years, and 42.7% in the surgery alone group at four years, which showed statistical significance (p less than 0.01, p less than 0.05, each). Statistically improved survival rates were achieved with a postoperative chemoradiotherapy modality in intestinal lymphoma (p less than 0.01), stage IIE (p less than 0.01), intermediate grade by NCI criteria (p less than 0.01), poorly differentiated lymphocytic lymphoma (p less than 0.05), and diffuse histiocytic lymphoma (p less than 0.01) according to Rappaport classification, compared to those of the surgically treated only group. Three local relapses occurred in the operation alone group, and one in the adjuvant radiotherapy group which occurred simultaneously with distant lymph node recurrence. The pathologic stage of all of these relapsed patients was stage IIE-2. These results suggest that adjuvant chemoradiotherapy in completely resected localized gastrointestinal non-Hodgkin's lymphoma can decrease local and systemic relapse resulting in long-term disease free survival and overall survival compared to operation alone.

Yonsei Cancer Center developed an RF(Radiofrequency) capacitive type heating device, GHT-RF8(Greenytherm) in cooperation with Green Cross Medical Corp., Korea in 1986 for the first time in Korea. Cooperative clinical studies of hyperthermia for the treatment of cancer using GHT-RF8 were conducted by Yonsei Cancer Center in collaboration with the Presbyterian Medical Center, Chonju, Korea. A total of forty patients with various histologically proven malignant tumors, including superficial (N = 13) and deep-seated tumors (N = 27), were treated with this newly developed heating device in conjunction with radiotherapy (N = 38) or chemotherapy (N = 2) at two different institutes between October 1986 and September 1987. These patients were locally far advanced or recurrent cases and considered to be refractory to conventional cancer treatment modalities. Radiotherapy was given in 200cGy per day, five times a week fractionations with a total tumor dose of 50-60Gy in 5-6 weeks. Within an hour after radiotherapy, the RF capacitive type of hyperthermia was given two times a week for a total of 4-10 treatment sessions and an attempt was made to maintain the tumor temperature at 41-45 degrees C for 30-60 minutes. Of forty patients treated, 14 patients with deep-seated tumors showed complete response and 20 patients showed partial response. The overall response rate was 85% (34 out of 40 patients) and only 6 patients showed no response. Complications from this treatment were mainly burns, superficial first degree burn in 2 cases, second degree in 4 cases and subcutaneous fat necrosis was observed in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Twelve patients with primary lymphomas of the central nervous system were treated in the Department of Radiation Oncology, Yonsei University College of Medicine, between 1976 and 1987. There were seven males and five females ranging from 19 to 63 years of age. They had single (6 cases) or multiple (6 cases) discrete intracerebral nodules. All patients were treated with radiation therapy. Surgical resection was performed in five cases and intrathecal chemotherapy with methotrexate was performed in seven cases after radiotherapy. All patients except one had received whole brain irradiation with a median dose of 4000 cGy. The radiation dose for a primary tumor was 4800-6000 cGy (median 5560 cGy). Initial response to radiation was excellent with a 91.7% complete response rate, but late recurrences were noted and the median survival was 42.3 months. Intracranial recurrences were observed in two patients who received less than 4000 cGy to the whole brain without intrathecal chemotherapy. Although intracranial recurrence was not seen in the patients receiving intrathecal chemotherapy after radiation, a high incidence of necrotizing leukoencephalopathy was noted. High dose irradiation with a minimum of 4000 cGy to the whole brain and more than 5000 cGy to the primary tumor is recommended for the treatment of primary CNS lymphomas. Combined use of chemotherapy should be carefully attempted because of the increased toxicity.