The narrow vagina, the antecedent for irradiation injury.
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Biomedical subjects
Publications and source records attributed to H Nussbaum.
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A retrospective study has been made of 15 patients who had developed severe complications to the bladder, rectum and ureters after radiation therapy for carcinoma of the cervix. Comprehensive dose distribution in the pelvis were calculated with computer assistance to visualize how the normal organs had been irradiated. The risk of normal tissue injury was analysed graphically with respect to the maximum radium dose, dose-rate and irradiation time. The two groups of data representing the injured and non-injured organs separate much better in a dose-rate versus dose plot than in a conventional Strandqvist type dose-time plot. This implies that in radium therapy, the dose-rate rather than the treatment time, is the important parameter in modifying the risk of normal tissue injury. Our results show a good separation of injured from non-injured cases only when the maximum values of dose and dose-rate were used. This suggests that clinically significant injury may develop from relatively small regions of high dose and dose-rate. Since the dose-rate varies from point to point in the pelvis (unlike treatment time), comprehensive determinations of dose-rate distributions are required in order to locate the sites of potential injuries.
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Forty-two patients with squamous cell carcinoma of the nasal vestibule were reviewed. The patients were treated at either the Southern California Permanente Medical Group or the UCLA Medical Center. Thirty-eight patients (90%) had early lesions and 4 (10%) had late disease (involving the nodes or bone). The following conclusions were formed from this study: (1) Patients without bone destruction or lymph node metastases will do well with either irradiation or surgery. Those with bone destruction or lymph node metastases will do poorly in spite of radical treatment. (2) Early lesions can often be cured with either partial rhinectomy or irradiation. (3) A surgical recurrence following partial rhinectomy can be salvaged with irradiation. (4) A radiation recurrence of an early lesion can be salvaged with surgery. (5) The routine use of total rhinectomy for early carcinoma or radiation failure is unwarranted. (6) Other primary cancers are not uncommon when followup is extended to the 5- to 10-year interval.
Ninety-one patients with T1 vocal cord carcinoma received primary irradiation treatment. The 5- and 10-year determinate disease-free survival was 80%; the 5- and 10-year determinate survival including surgical salvage was 92%. Tumors involving more than one-half of a vocal cord or involving the anterior commissure or exhibiting an exophytic growth pattern had numerically, but not statistically, higher local failure rates than tumors without these characteristics. Precise radiation treatment technique appears more important for local control (LC) than tumor character. The crucial treatment factors for high LC with few radiation complications are reproducible daily patient positioning, use of contour-compensating devices (wedges), field size of 5 X 5 cm, and a radiation prescription with a time-dose fractionation value of 101 to 106.
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