After an initial course of radiation, 56 patients with cerebral metastases had their brain retreated at least once for recurrent neurologic symptoms. The most common primary was from either the lung or breast. The frequent symptoms were headache, weakness, seizures, visual problems, and/or mental changes. Forty-two (75%) of these patients responded to the second course of treatment. The median duration of response was 10 weeks and median survival was 14 weeks.
Some 9000 patients throughout the world have been treated by some form of neutron beam therapy. These include patients with advanced nonresectable tumors in many different sites treated with a variety of neutron beam generators varying widely in beam energy. Protocols were largely nonrandomized and included both mixed beam studies (neutrons + photons) and neutrons alone in varying doses. In spite of wide variation in equipment, treatment technique, and philosophy, some consistent trends have been identified: (1) in general, the neutron results have been at least as good as those of the photon controls measured in terms of local control, although the incidence of significant side effects have been higher; (2) in none of the randomized studies conducted so far, largely comprising epidermoid carcinomas of the head and neck, has a clear survival advantage for neutrons over photon controls been demonstrated at a statistically significant level; (3) results with mixed beam studies have been uniformly equivocal, with marginally significant differences in favor of the experimental groups compared with the photon controls; (4) adenocarcinomas of the gastrointestinal tract (GI) tract, including tumors of the salivary gland, pancreas, stomach, and bowel, appear to be responsive to high linear energy transfer (LET) radiation; (5) nonepidermoid, radioresistant tumors (sarcoma of bone and soft tissue and melanoma) yield a consistantly high local control rate, with neutron irradiation strikingly superior to those reported with photon therapy; and (6) in the central nervous system, both normal tissues and tumors appear to be exceptionally sensitive to neutron irradiation, therapeutic ratios are small, and the prospect of cure remains remote. It is concluded that neutrons are efficacious for certain specific tumor types, but that essentially new study designs, based on nonrandomized matched case comparisons, will be required to prove the merit of the new modality.
From 1973 to 1979, 163 patients with biopsy proven adenocarcinoma of the prostate were treated with a curative intent utilizing megavoltage external beam irradiation at Rush-Presbyterian-St. Luke's Medical Center or Lutheran General Hospital. The acturial survival at 5 years for the whole group is 78%. Survival was found to depend on initial stage and grade of disease. Local failure alone occurred in 3% of the patients, yet represented a component of failure in 7%. The effects of stage, grade, dose and field size on survival, patterns of failure and complications are discussed. Cancer 53:37-43, 1984.
Seventy-seven patients with locally advanced, nonresectable, biopsy-proven adenocarcinoma of the pancreas were treated by palliative bypass surgery followed by intensive neutron beam irradiation of the primary tumor site. Three dose levels, under 20, 21 to 23, and 24 to 25 Gy, were studied with the use of a treatment plan that included all known disease within a limited target volume, generally under 21. Symptomatic palliation was achieved in the majority of patients. The median survival time was 6 months. One patient remained alive and well without evidence of tumor 5 years after irradiation. Two were free of tumor at autopsy (one had died of intercurrent disease and one of radiation-related complications). A common cause of death was metastatic dissemination. Complication rates were dosedependent; life-threatening complications did not exceed 12% with doses of less than 23 Gy. Autopsies from 19 patients were reviewed. In all, the pancreatic tumor site showed extensive reactive fibrosis. Local control was achieved in two patients, but most had both residual tumor in the pancreas and metastases. Six patients had centrolobular veno-occlusive liver disease. These patients had all received the higher (22–24 Gy) neutron doses. Six patients had hemorrhagic radiation gastroenteritis. Mild skin atrophy and bone marrow hypoplasia were seen in the irradiated volumes. The kidneys and spinal cord showed no radiation effects. The authors conclude that neutron irradiation can provide a good local response with marked regression and fibrosis of the tumor. This response, coupled with many deaths due to metastases, suggests that combined treatment with neutrons and chemotherapy would be worth exploring.
