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A woman more than 5 years postmenopausal with right advanced breast cancer (T4, T3, M1, stage IV) was treated with a mild chemo-endocrine therapy. The regimen consisted of diethylstilbestrol diphosphate (Honvan) at 15 mg/day orally and cyclophosphamide at 100 mg/day orally. By the sixth month after administration, both the right breast cancer and multiple lymph node metastases completely disappeared. The change of hormonal therapy from Honvan, as estrogen, to tamoxifen, as antiestrogen, was done 2 years and 9 months after the beginning of initial treatment. The breast cancer recurred 9 months after the change of treatment. At that time, Honvan was again administered instead of tamoxifen. Complete remission was again obtained for 6 months beginning 2 months after the change of drugs, but then the tumor recurred. Although combination chemotherapy was undertaken, the patient died 5 years after initial treatment. These results suggest that chemoendocrine therapy using a low dose of Honvan and cyclophosphamide is effective for advanced breast carcinoma.

There has been some controversy concerning dose-time correction in continuous irradiation at low dose rates. We present the results of carcinoma of the tongue in a patient complicated by chronic renal failure, for which he was undergoing hemodialysis three times a week. This patient was treated with a single implant but with a doubling of 137Cs needles for double strength. The actual dose was given in a shorter treatment time than recommended, with the dose-time adjustment following the Paterson-Parker system. The patient has been alive and well for eight years.

Between 1966-1977, 250 patients with esophageal carcinoma were treated by radiotherapy alone. The 5-year survival rate was 10.4% (12 of 115) in the curative cases. 52 of 5-year survivors, including 40 cases from the literature, were analyzed according to age, sex and the extent, location and type of tumor. 37 patients (71.1%) were between 50 and 69 years of age. There were more female than male survivors. Patients whose esophagograms showed spiral-type tumor had a worse prognosis than other tumor types. 16 of the 52 (30.8%) patients had received intracavitary treatment. We posit that an additional boost dose by intracavitary techniques improves the local control of the primary lesion. Radiation-induced myelitis and carditis were noted in some patients.

Between 1974 and 1982, 78 primary esophageal squamous cell carcinomas were treated by external irradiation combined with additional intracavitary radium therapy. 50 to 60 Gy were given by external irradiation, and 5 to 20 Gy were delivered on the surface of the esophageal mucosa. The combined dose ranged from TDF 110 to 140 on the esophageal mucosa and TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa. The 5-year survival rate was 19.3% by this combined radiotherapy alone. We conclude that the optimal dose of the combined therapy for esophageal cancer ranges from TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa.

We developed and applied interstitial after-loading endocrine therapy as a cancer treatment modality. Between Sept. 1982 and May 1983, 5 patients with malignant brain tumors were treated using the removable after-loading Iridium-192 seed assembly implant technique. 4 of the 5 patients experienced recurrent gliomas after the operation alone or in combination with external post-operative radiotherapy. In 3 patients, local control was achieved and has been maintained for more than 11 months. Our preliminary brachytherapy procedures for the treatment of malignant brain tumors are described.

Late local recurrence of cervical cancer more than 10 years after successful initial treatment is very rare. We now present 17 patients with late local recurrence. Only one patient had undergone primary surgery alone; the other 16 patients had received various types of radiotherapy. All 17 patients received radiotherapy as the second treatment. Local control was achieved in 9 patients, 4 of these survived for more than 5 years after the second treatment. Longterm follow-up for more than 10 years is important for the early detection of late local recurrence.