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Between October 1961, and November 1978, 31 patients with intraperitoneal metastatic adenocarcinoma of the endometrium were treated by whole-abdomen moving-strip technique and pelvic boost irradiation. In 27 patients, with residual disease less than or equal to 2 cm, the corrected 5-year survival rate was 80%. The absolute 5-year survival rate was 63%. Within this group of 27 patients, the favorable prognostic trends were Stage III, incidental findings, and age less than 50 years. Tumor-reductive surgery to 2 cm or less residual disease was beneficial. Only one patient required operative correction for a complication of radiotherapy. The four patients who had residual disease greater than 2-cm disease died from tumor.

From 1948 through June 1971, 173 patients with squamous-cell carcinoma of the supraglottic larynx were treated by primary irradiation. The results were analyzed by staging of the primary lesions and specific extensions of disease. Primary irradiation of exophytic lesions of the supraglottic larynx offers a high control rate and preservation of the voice. Laryngectomy salvages a high percentage of the failures. In lesions of the suprahyoid epiglottis, moderate infiltration of the valleculae, although a cause of failure, is not a contraindication for primary irradiation as infiltration of the pre-epiglottic space is in lesions of the infrahyoid epiglottis.

Between October 1961, and November 1978, 31 patients with intraperitoneal metastatic adenocarcinoma of the endometrium were treated by whole-abdomen moving-strip technique and pelvic boost irradiation. In 27 patients, with residual disease less than or equal to 2 cm, the corrected 5-year survival rate was 80%. The absolute 5-year survival rate was 63%. Within this group of 27 patients, the favorable prognostic trends were Stage III, incidental findings, and age less than 50 years. Tumor-reductive surgery to 2 cm or less residual disease was beneficial. Only one patient required operative correction for a complication of radiotherapy. The four patients who had residual disease greater than 2-cm disease died from tumor.

A total of 151 patients with Stage I carcinoma of the uterine cervix received treatment with intracavitary irradiation alone between 1948 and 1971. All patients had a minimum follow-up of five years. There were no local failures. No patient with microinvasive carcinoma (Stage IA) had a regional failure. A maximum of 4% (4/93) of patients with invasive cancer less than 1 cm in diameter (Stage IB-Small Volume) had regional failures. The five year determinate survival rates for patients with Stage IA and IB (Small Volume) lesions were 100% and 96% respectively. The incidence of severe complications was low, with a fistula developing in only one patient. Treatment with intracavitary radium alone is sufficient for patients with invasive cancer less than 1 cm in diameter who have adequate anatomy that allows effective irradiation of the primary lesion and paracervical lymphatics.

One hundred and sixteen patients with advanced squamous cell carcinoma of the oral cavity and oropharynx were treated with irradiation and surgery. Failures were correlated with respect to tumor factors and treatment. Associated with failures are: (a) cut-through of disease at the primary site, (b) connective tissue involvement in the neck, (c) insufficient dose or use of a wedge pair, and (d) failure to give elective treatment to the neck. There is no significant difference in control in the pre- vs. the postoperative group. Combined treatment is indicated in those patients with a high risk of failure if treated by either modality alone.

Sixty-three patients who had either previously treated primary tumors or unknown primary tumors and developed metastatic cervical adenopathy in their previously untreated necks received the combination of surgery and megavoltage irradiation. Within two years, 12 patients died of intercurrent disease, nine patients died with distant metastases only, and five patients had disease recur at a primary site. The remaining 37 patients were evaluable for control of neck disease; 26 patients had previous treatment to a primary head and neck cancer that was under control at the time cervical adenopathy was treated; and 11 patients had an unknown primary tumor that was believed to be in the head and neck area. The combination of pre- or postoperative irradiation and surgery controlled neck disease in 86% of the evaluable patients. Because of the extent of neck disease, these patients would have been at a high risk of failure in the treated area if only a single modality of treatment were used. Analysis of the data shows an association of extranodal connective tissue involvement with both a decreased rate of control within the treated area and distant metastases.

A total of 151 patients with Stage I carcinoma of the uterine cervix received treatment with intracavitary irradiation alone between 1948 and 1971. All patients had a minimum follow-up of five years. There were no local failures. No patient with microinvasive carcinoma (Stage IA) had a regional failure. A maximum of 4% (4/93) of patients with invasive cancer less than 1 cm in diameter (Stage IB-Small Volume) had regional failures. The five year determinate survival rates for patients with Stage IA and IB (Small Volume) lesions were 100% and 96% respectively. The incidence of severe complications was low, with a fistula developing in only one patient. Treatment with intracavitary radium alone is sufficient for patients with invasive cancer less than 1 cm in diameter who have adequate anatomy that allows effective irradiation of the primary lesion and paracervical lymphatics.

The charts of 431 patients with squamous cell carcinoma of the supraglottic larynx observed at the M. D. Anderson Hospital between January, 1954, and June, 1971, were analyzed. This study is concerned with those patients who had a technically resectable lesion. Emphasis is directed to the analysis of the effectiveness of primary irradiation instead of partial laryngectomy for those lesions which are technically suitable for a partial resection and to define the groups of patients which are best treated by combining surgery and planned postoperative irradiation. One hundred forty-seven patients with T1 and T2 lesions, selected exophytic T3 lesions of the suprahyoid epiglottis and aryepiglottic folds and some selected exophytic T4 lesions of the suprahyoid epiglottis received irradiation for their laryngeal lesion. A satisfactory control of the laryngeal disease has been obtained with preservation of a normal voice ranging from 88.5 percent for T1 lesions to 60 percent for T4 lesions. Comparing the groups of patients who had surgery alone or postoperative irradiation an NED rate of 63 percent was found in the latter group which is clearly superior to the 37 percent found in the surgery only group. There is no difference for the five-year NED rates, because the patients who had surgery and postoperative irradiation had more advanced neck disease which is a cause for distant metastases. The incidence of recurrences above the clavicles is clearly less in the patients having had surgery and postoperative irradiation than in those who had surgery alone. Correlating in the two groups, surgery only and surgery followed by planned irradiation, the surgical staging of the neck metastases with recurrences above the clavicles within 24 months after treatment, it was found that the planned combined treatment has reduced the recurrence rate from 45 percent to 15 percent in the N2 and N3 patients. Postoperative irradiation should be given routinely after resection for all T4 lesions and for any T3 lesion which extends to the pharyngeal wall(s), vallecula, base of tongue, and pyriform sinus. Postoperative irradiation should also be given for any patient whose nodal classification is greater than N1. Irradiation should be given within six weeks (preferably three to four weeks) after the surgical procedure. To achieve this goal, the operation need only remove grossly detectable disease.

This study is designed to analyze the complications of extended-field radiotherapy for carcinoma of the uterine cervix uncomplicated by recent prior surgery. Forty-two patients with carcinoma of the uterine cervix and lymph node metastases established by unequivocally positive bipedal lymphangiograms were treated with extended-field radiotherapy. External beam radiation to extended pelvic portals was limited to 4500 cGy using the linear accelerator and approximately 6000 mg-hr brachytherapy. Nodal boosts up to 500 cGy were generally limited to fields measuring less than 50 cm2. Higher doses were administered in 12 patients because of poor tumor regression. Eleven of these 12 patients experienced severe complications, and only three achieved control of their tumor. The type of treatment complication appeared to be directly related to specific modifications of the initial treatment plan. Treatment failures occurred within and outside of treatment portals with equal frequency.

From January, 1967 to December, 1974, 325 patients with carcinoma of the uterine cervix were treated with a minimum of 4,000 rad whole pelvis irradiation plus intracavitary radium. These patients had large, sometimes massive, tumors. Generally, the larger the primary tumor the greater the amount of external irradiation delivered, with an appropriate reduction in the amount of intracavitary radium. Patients who had a positive lymphangiogram or a pre- or postirradiation hysterectomy or lymphadenectomy are not included in this analysis. All patients were followed for a minimum of 5 years. Local and regional failure rate in 193 patients receiving 4,000 rad whole pelvis irradiation plus radium was 1% and 4%, respectively, with a 3.1% incidence of severe complications. In 111 patients who received 5,000 rad whole pelvis irradiation plus radium, the local and regional failure rate was 3.5% and 4.5%, respectively, with a 10% incidence of severe complications. In patients who received 5,000 rad whole pelvis irradiation, complications were associated with unilateral parametrial boosts and with protruding vaginal sources. Of 21 patients who received 6,000 rad whole pelvis irradiation, three patients developed fistulae associated with high doses to the vagina delivered with protruding vaginal sources.

Sixty-three patients who had either previously treated primary tumors or unknown primary tumors and developed metastatic cervical adenopathy in their previously untreated necks received the combination of surgery and megavoltage irradiation. Within two years, 12 patients died of intercurrent disease, nine patients died with distant metastases only, and five patients had disease recur at a primary site. The remaining 37 patients were evaluable for control of neck disease; 26 patients had previous treatment to a primary head and neck cancer that was under control at the time cervical adenopathy was treated; and 11 patients had an unknown primary tumor that was believed to be in the head and neck area. The combination of pre- or postoperative irradiation and surgery controlled neck disease in 86% of the evaluable patients. Because of the extent of neck disease, these patients would have been at a high risk of failure in the treated area if only a single modality of treatment were used. Analysis of the data shows an association of extranodal connective tissue involvement with both a decreased rate of control within the treated area and distant metastases.

The effect of (biopsy-determined) endometrial involvement on the prognosis of squamous cell carcinoma of the cervix was analyzed for 180 patients. The presence in an endometrial biopsy of squamous cell carcinoma without stromal invasion does not alter the prognosis, stage for stage, from that previously reported for an overall group of patients with squamous cell carcinoma of the cervix. The patient with endometrial stromal invasion may have a poorer prognosis due to increased local recurrence rate, but too few patients are available for a valid statistical analysis. The addition of adjunctive conservative hysterectomy and a reduced dose of radiation may be considered when endometrial stromal invasion is present.

Between February 1977 and August 1979, 75 patients with locally advanced carcinoma of the uterine cervix were randomized to receive treatment with: (a) a combination of 50-MeV neutrons and 25-MeV photons ± intracavitary radium (mixed beam group) or (b) 25-MeV photons ± intracavitary radium (photon group). The analysis of the total population revealed no difference between the mixed beam and photon groups with regard to local tumor control, frequency of major complications, or patient survival. There was a significant difference between the two groups with regard to the number of patients completing treatment with intracavitary radium. When the patients who completed treatment with intracavitary radium or an external beam boost are analyzed separately, the results with mixed beam irradiation are slightly better than those achieved with photon irradiation, although the difference is not statistically significant.

This review is a retrospective analysis of 263 patients with carcinoma of the cervical stump treated at The University of Texas M. D. Anderson Hospital and Tumor Institute between 1963 and 1975. Symptomatology, stage distribution, and histology of carcinoma of the cervical stump showed no significant differences from cervical carcinoma of the intact uterus. Depending on the tumor stage, tumor volume, and distorted anatomy, treatment consisted of various combinations of intracavitary radium and transvaginal and external radiation. The 5-year survival was 100% in stage 0, 91% in stage I, 77% in stage II, 46% in stage III, and 37% in stage IV. The results achieved are similar to those in cervical cancer of the intact uterus. The complication rate was 30% and there were 9 (3.7%) deaths related to radiation complications.

Sixty-four patients who developed metastatic cervical adenopathy in a previously untreated neck received treatment with a combination of surgery and megavoltage irradiation between January 1969 and December 1974 at the M.D. Anderson Hospital and Tumor Institute. Forty-four patients had had previous treatment to a primary head and neck cancer which-was under control at the time that the cervical adenopathy was treated. In 20 patients, the primary site was unknown but felt to be from the head and neck area. The results of treatment will be presented and analyzed with respect to clinical and pathological extent of neck disease. The possible significance of extranodal connective tissue involvement will be discussed.