Twelve consecutive cases of non-Hodgkin's lymphomas with initial testicular involvement have been considered in this retrospective evaluation. In 801 cases with referred for treatment to the Istituto Nazionale Tumori of Milan from 1962 to 1974 evidence of initial testicular involvement was observed in 1,4% of cases. Of the whole group of testicular tumors treated in our Institute only 3% were classified as non-Hodgkin's lymphomas. Six out of 12 patients with stage I (2 cases) and II (4 cases) diseases were treated with Cobalt therapy to the retroperitoneal nodes. Only one patient remained free of disease after radiotherapy. Three patients relapsed after primary irradiation and six patients classified as stage IV were treated with chemotherapy. Patients receiving combination chemotherapy had in general a better quality of response and a larger, but not significantly different, survival, compared to patients given simple agent sequential chemotherapy. Since the differential diagnosis between testicular lymphomas and seminomas may cause some difficulties and therapeutic implications are different, clinicians should be alert to this problem: in our case series testicular non-Hodgkin's lymphomas was the most frequent non-germinal tumor of the testicle.

Adolescent↗

PubMedDate not supplied

A statistical approach to detection of the primary cancer based on the site of neck lymph node metastases.

Preoperative differential diagnosis of a swelling in the neck is mandatory for a good therapeutic planning. Indiscriminate biopsy as first approach is to be disregarded, since it can compromise the result of a radical neck dissection in cases where a metastasis of epidermoid cancer is histologically recognized. A cervical biopsy is not to be performed until a complete HNT examination (including the thyroid and major salivary glands) has excluded the presence of a primary tumor in these regions. Since every localization of the head and neck malignancies shows rather fixed patterns in its lymphatic spreading, a correlation between site of T and particular localizations of N within the neck can be found. The knowledge of the probabilities that an adenopathy in a given region of the neck correlates with a primary tumor located in a given site of the body could strongly aid the physician in detecting the latter, following a rational statistically based approach. This study was performed applying Bayes theorem for probability calculus to the maps of distribution of metastases of tumors of different site in 3,700 patients who were taken into National Cancer Institute of Milan during 7 consecutive years. The results are gathered in tables and text-figures showing the great significance of some correlations, who become more evident when the adenopathies are multiple, but who usefully direct the physician also when the adenopathy is only one.

Adult↗

PubMedDate not supplied

Indications, results and techniques of radiotherapy in the treatment of small-cell lung cancer.

AIMS AND BACKGROUND: To define the role of radiotherapy in the treatment of small-cell lung cancer (SCLC) on the basis of clinical data reported in the medical literature. METHODS: Published reports are critically reviewed, with particular attention to randomized trials. RESULTS: Thoracic radiotherapy has an important role in improving local control and 3-year survival in limited-stage SCLC; radiation should be delivered early in the course of the chemotherapy program, avoiding large volumes and total doses exceeding 40-50 Gy. Thoracic radiotherapy probably has no role in resected patients treated with adjuvant chemotherapy and may even be detrimental in patients with extensive SCLC. Prophylactic cranial irradiation has been shown to reduce the risk of brain relapse, but it is not associated with a consistent increase in survival or cure rate: its use in clinical practice is therefore not advised. CONCLUSIONS: Survival rates approaching 50% at 2 years are now possible in limited SCLC with the integrated effort of the surgeon, the medical oncologist and the radiation oncologist; their strict cooperation appears to be of the utmost importance in the earliest phase of treatment planning.

Brain Neoplasms↗

PubMedDate not supplied

On extravisceral soft tissue sarcomas. Effectiveness of radiation treatment and problems of radiotherapy and radiosurgical treatment.

A series of 355 extravisceral soft tissue sarcomas is presented with reference to the effectiveness of radiation treatment for each histological type and the problems of radiotherapy and surgical treatment. Liposarcoma was the most radiosensitive soft tissue sarcoma. By utilizing all types of treatment and especially radiosurgery with postoperative radiotherapy, the percentage of disease-free patients after a minimum of 3 years from treatment varied from 27% to 52.9% for the different types of sarcoma. Nevertheless, in most cases the effectiveness of radiotherapy was unpredictable. It was found that doses varying from 52-60 Gy, with 2 Gy for each of 26-30 applications within 6-8 weeks, were sufficient for radical treatments. In relation to unpredictability of radiotherapy results, it was concluded that preoperative was more advisable than postoperative treatment owing to the possibility to prove the effectiveness of radiotherapy. Postoperative treatment is useless in nonradiosensitive cases and might negatively affect surgical modalities.

Combined Modality Therapy↗

PubMedDate not supplied

[Somatic sequelae induced by radiotherapy in bone segments in adults].

The authors, on the basis of reports found in literature and of a personal series, discuss the radiological aspects, the differential diagnosis, the main factors that lead to bone sequelae, and the possible contributory causes and complications. The radiological aspects is characterized by the association of sclerotic and atrophic changes, with a prevalence of the latter in the involvement of the mandible and the cranial bones. Among the main factors there are the radiation dose and its chronological distribution. In fact, the higher the values of the nominal standard dose (NSD), the higher the incidence of such alterations and the more difficult to carry out the efficacy of their treatment. These alterations are found almost exclusively after treatment with administration, in terms of NSD, of more than 1352 rets. Among the contributory causes there are all the factors that may change the physiological condition of the bony tissue. The most common complications are fractures and septic osteitis, the last particularly frequent in the mandible. These alterations and mainly fractures may be solved even spontaneously, even if rather late, so that conservative treatments are indicated. After osteitis it is usually possible to avoid pseudoarthrosis. In cases irradiated with higher doses, osteotomy is often necessary sometime followed by poor results.

Femur↗

PubMedDate not supplied

[Supplementary radiological treatment after surgery of metastatic lymph nodes of the neck in cases of carcinoma of the upper respiratory and digestive tracts].

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Head and Neck Neoplasms↗