Proceedings of the 22nd Annual ASTR Meeting

RADIATION THERAPY IN THE MANAGEMENT OF PATIENTS WITH MESOTHELIOMA

William Gordon, M.D.; Karen H. Antman, M.A.; Joel S. Greenberger, M.D.; William Kaplan, M.D.; Ralph R. Weichselbaum, M.D.; Matthew Corson, M.D.;

Kenneth Koster, M.D. and John T. Chaffey, M.D.

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Joint Center for Radiation Therapy, Dept. of Radiation Therapy Peter Bent Brigham Hospital Depts. of Thoracic Surgery and Pathology, and Sidney Farber Cancer Institute, Department of Nuclear Medicine,

Boston, MA 02115

During the period of 1968-1979, 44 patients with a diagnosis of malig- nant mesothelioma were seen at our Radiation Therapy Department. Of these patients, 40 were found on review to have a pathologically confirmed diagno- sis. Five patients had peritoneal primary sites and 35 had primary thoracic mesothelioma. Twenty-eight of the 40 were irradiated, 8 with curative intent and 20 with a palliative philosophy for relief of symptoms of cough, hemoptysis, and/or pain. Three radically treated patients are alive at nine months, 9 months, and 5 years. Five additional radically treated patients were dead with locally and metastatic recurrent disease at one month, one month, six months, ten months, and I2 months after treatment. The dose-response curve for palliative relief of symptoms increased from 3000 to 5000 Rad. The duration of palliative effect varied from 3 to 13 months. Responsiveness of palliative lesions in mesothelioma more closely approximates soft tissue sarcomas than epithelial tumors. Based on this review, a protocol for curative treatment has been designed. Patients undergo diagnostic staging including whole lung tomography, bone scan, liver scan, and C-T scan of the chest. Then subtotal or total resection is carried out with pneumonectomy or radical exci- sion. Intraoperative radiogold seed implant of gross residual disease is performed followed by colloidal P32 chromic phosphate instillation through several chest tubes, if residual disease is found covering the visceral pleura. This is followed by radiation therapy to the visceral pleura, mediastinum, and chest wall to doses of 3000-5000 Rad. Anger camera imaging is carried out to determine the distribution of colloidal P32. In one patient, the new protocol was used with serial imaging of colloidal P32 uptake in the pleura and revealed distribution in the anterior aspect of the left hemithorax after total parietal pleurectomy. There was poor distribution of P32 in the post- erior chest indicating that at a minimum anterior and posterior chest tubes should be placed in future cases and the colloidal solution should be diluted prior to administration. A radical approach to patients with mesothelioma appears justified in view of the high likelihood of local recurrence and anecdotal reports of long term cure with radical surgery and high dose x-ray therapy.

MALIGNANT LYMPHOMA OF THE TESTIS - THE PRINCESS MARGARET HOSPITAL EXPERIENCE

B.S. Tepperman, M.K. Gospodarowict, R.S. Bush

Department of Radiation Oncology, Ontario CafXfY Institute /Princess Margaret Hospital, Toronto, Ontario, Canada.

16 of 2789 patients with non-Hodgkin's lymphomas treated at Princess Margaret Hospital between 1967 and 1978 presented initially with testicular involvement. 11 presented with local disease only (stages IE and IIE). All but one patient had diffuse histologies, most cornnonly diffuse lymphoma (8 patients). Median age was 68 years (range 56-88). All patients underwent inguinal orchiectomy prior to referral. 12 received regional irradiation, and 5 systemic chemotherapy; one patient (stage IEA DLPD) received no addi- tional therapy.