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Diagnostic ultrasound is a relatively new diagnostic modality which is a practical method of acquiring anatomical information important in radiation treatment planning. Patient contour, port margins, location of tumors and normal structures, and tissue inhomogeneities can be recorded simply, safely, rapidly, and accurately. This information can then be utilized in developing radiation therapy plans that deliver irradiation more precisely to the malignant disease while avoiding normal structures. The proper application of ultrasound in radiation therapy planning has the potential of significantly improving cure rates and minimizing complication rates in the treatment of patients with malignant disease.

The records of eight hundred two patients who received primary radiotherapy for invasive cervical cancer between 1969 and 1985 were reviewed. The incidence of bone metastasis was 1.9% (15/802). Lumbar spine involvement was the most common site, followed by the pelvic bones. Lumbar spine involvement was characterized by unilateral destruction of one or several contiguous vertebrae. All 10 patients with lumbar spine involvement were associated with a para-spinal mass. In seven of ten patients, this bone destruction due to direct extension from metastatic para-aortic tumor was the only recurrent cancer. In contrast, involvement of a long bone, a rib or the skull indicates hematogenous bone metastasis. When a spine X ray or bone scan is positive in the lumbar area in a cervical cancer patient with back pain, a CT scan should be performed to determine the extent of the underlying tumor. This will allow more accurate establishment of a radiation treatment plan, and will improve the chances for successful palliation.

A diagnostic ultrasound examination is a simple and reliable method of obtaining anatomical information for intracavitary irradiation of endometrial carcinoma of the uterus. Scanning before treatment to determine uterine size and shape assists in choosing the most appropriate applicator. Scanning after insertion of an afterloading applicator facilitates calculation of radiation doses at critical points within and on the surface of the uterus. Poor applicator position can also be detected. Diagnostic ultrasound examinations should be adopted as a routine procedure in establishing intracavitary irradiation programs for adenocarcinoma of the uterine fundus.

Medical teachers and practising doctors were surveyed by questionnaire and given pre- and post-tests to determine the efficiency and effectiveness of Practical Reviews in Cancer Management, a cassette tape programme of continuing medical education (CME). Doctors indicated a high degree of satisfaction with this approach; in particular the idea of keeping abreast of the current literature while commuting in their cars was appealing. The programme's effectiveness was measured by pre- and post-tests, and the data were analysed by the non-directional t-test for dependent groups. These tests indicated a significant (P less than 0.001) increase in knowledge from the pre- to post-tests.

The successful management of cancer with high energy radiation requires precise knowledge of the tumor position relative to the body surface and normal organs. Diagnostic ultrasound assists in determining the size and location of tumors and vital normal structures in patients undergoing radiation therapy. Radiation fields can be established dynamically under direct ultrasound imaging, and anatomical information about the tumor, normal organs, and body contour utilized in dosimetry calculations. Diagnostic ultrasound is a safe, noninvasive technique of acquiring anatomical information that cannot be obtained by other routine diagnostic methods. Its application in clinical radiation therapy planning has the potential of improving cure rates and decreasing complication rates.

This is a retrospective analysis of 240 patients who had clinical Stage IB cancer of the cervix treated with radiation between 1969 and 1980. Of these, 186 patients were treated with a combination of external and intracavitary radiation therapy, and 54 patients received adjuvant postoperative radiation therapy. The minimum follow-up was 5 years. In the group who received only radiation therapy, the overall recurrence in 170 patients (excluding 16 patients found at laparotomy to have unresectable disease) was 17% (29 of 170); pelvic recurrence was 9% and distant metastases alone was 6%. In the group who received the adjuvant postoperative radiation therapy, 16 patients had a simple hysterectomy followed by vaginal ovoid and/or external pelvic irradiation for an unexpected Stage IB cancer of the cervix. Their overall recurrence was 37.5% (6 of 16). Pelvic recurrence was the most common treatment failure with a recurrence of 31%. Significant prognostic factors were depth of stromal invasion and status of surgical margins. Thirty-eight patients had a radical hysterectomy followed by postoperative radiation therapy because of positive pelvic lymph nodes and/or close surgical margins. In patients with positive pelvic lymph nodes, the overall recurrence was 39% (9 of 23); pelvic recurrence was 13%. Distant metastases, the most common treatment failure, was 26%. In seven patients with close surgical margins, five recurred in the pelvis. There was no distant metastases without pelvic failure. Five of eight patients with close paracervical margins recurred in the pelvis. All five of these patients were treated with vaginal ovoid irradiation alone. Whole pelvic irradiation plus vaginal ovoid irradiation is necessary in those with close paracervical margins. The vaginal ovoid irradiation alone should be limited to very selected patients with positive vaginal margins only.

We present a retrospective analysis of seven patients with chondrosarcoma of the bone treated by high-energy irradiation between 1961 and 1976. Its major role in this series was prevention of local recurrence in cases with inadequate resection. In three of the five cases in which radiation therapy was adjuvant rather than primary treatment, long-term local control was obtained in a dose of 5,000 to 6,500 rads in five to six weeks. Although primary treatment of chondrosarcoma is surgical, high-dose radiation therapy is indicated when surgical resection is not possible. Chondrosarcoma can respond to high doses of irradiation even though the response is slow.

All cases of uterine perforation occurring during intracavitary application for carcinoma of the cervix over a 13-year period (1968-1981) were reviewed. There were 14 perforations out of 799 applications in 622 patients, for an incidence of 2.25% of patients and 1.75% of applications. In most cases, it is sufficient to halt the application and carefully monitor the patient, as supported by the uneventful post-perforation course in 12 cases. Nine patients (64%) underwent subsequent intracavitary application without further complications; of these, 8 are still living or died without evidence of tumor. In the other 5, it was impossible to locate the cervical canal on subsequent applications. Alternative treatments, results of therapy, and analysis of failures are presented. The authors conclude that there is no direct evidence that uterine perforation alters the prognosis following radiation therapy for carcinoma of the cervix.

Three hundred and thirty-six B-mode ultrasound examinations of the retroperitoneal region were performed on 179 patients with Hodgkin's disease or non-Hodgkin's lymphoma; histological confirmation was available in 56 patients. Ultrasonography was correct in predicting retroperitoneal periaortic lymph node involvement in 87.5% of cases. Node size was correctly predicted 98.2% of the time, and nodes 2 cm or larger in diameter were detectable. Ultrasound was more accurate than physical examination, and as accurate as gallium-67 imaging and lymphography in disease detection. The combination of ultrasound and gallium imaging gave the best accuracy of detection (97%).

The average dimension of prostate was measured by transabdominal ultrasonography preoperatively to compare with direct intraoperative measurements in 28 patients undergoing suprapubic I-125 seed implantation for the treatment of prostatic cancer. A highly significant correlation (r = 0.932) was found between these two measurements. Transabdominal ultrasonography is a relatively simple and accurate non-invasive method of determining the number of I-125 seeds needed to implant the patient with prostatic malignancy.