From 1958 to 1982, 58 patients with craniopharyngioma were treated with external beam radiation, 56 post surgery. Nineteen were pediatric (< 16 years) and 39 were adult. Forty patients underwent primary treatment while 18 (7 pediatric and 11 adult) were treated for recurrence. Median follow-up is 17 years. Tumor dose and 'maximum dose' (i.e. dose to smallest isodose > 1 cm) were recorded. The mean tumor and maximum dose for pediatric patients was 5588 and 5870 cGy vs. 6243 and 6542 cGy, respectively for adults. The actuarial 5- and 10-year survivals for pediatric patients were 84% and 72%, respectively and were significantly better than the 54% and 51% for adults (p = 0.01). However, overall disease recurrence rates were 26% (5/19) for pediatric patients and 18% (7/39) for adults. Of the multiple patient and treatment parameters analyzed, initial disease type (i.e. primary vs. recurrence) in pediatric patients, surgical extent, tumor dose, maximum dose, age of adults and use of pretreatment CT evaluation appeared to impact on patient outcome. Pediatric patients treated for primary disease showed improved survival over those treated for recurrence. The same was not observed in adults and appeared to be due to treatment toxicity. Surgical morbidity correlated with extent of surgery. All patients who underwent total resection developed surgical sequelae. Forty-four percent (4/9) of patients receiving tumor doses of < or = 5400 cGy developed recurrences vs. 16% (8/49) in those receiving > 5400 cGy. Nine of the 12 recurrences were in patients who did not undergo pretreatment CT evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

This is a report of a 10-year median follow-up of a randomized, prospective study investigating the optimal sequencing of radiation therapy (RT) in relation to surgery for operable advanced head and neck cancer. In May 1973, the Radiation Therapy Oncology Group (RTOG) began a Phase III study of preoperative radiation therapy (50.0 Gy) versus postoperative radiation therapy (60.0 Gy) for supraglottic larynx and hypopharynx primaries. Of 277 evaluable patients, duration of follow-up is 9-15 years, with 7.6% patients lost to follow-up before 7 years. Loco-regional control was significantly better for 141 postoperative radiation therapy patients than for 136 preoperative radiation therapy patients (p = 0.04), but absolute survival was not affected (p = 0.15). When the analysis was restricted to supraglottic larynx primaries (60 postoperative radiation therapy patients versus 58 preoperative radiation therapy patients), the difference for loco-regional control was highly significant (p = .007), but not for survival (p = 0.18). In considering only supraglottic larynx, 78% of loco-regional failures occurred in the first 2 years. Thirty-one percent (18/58) of preoperative patients failed locally within 2 years versus 18% (11/60) of postoperative patients. After 2 years, distant metastases and second primaries became the predominant failure pattern, especially in postoperative radiation therapy patients. This shift in the late failure pattern along with the increased number of unrelated deaths negated any advantage in absolute survival for postoperative radiation therapy patients. The rates of severe surgical and radiation therapy complications were similar between the two arms. Because of an increased incidence of late distant metastases and secondary primaries, additional therapeutic intervention is required beyond surgery and postoperative irradiation to impact significantly upon survival.

We studied the effect of patient age on treatment decisions related to radiation therapy using data obtained through the Patterns of Care Study. Definitive treatment given for breast cancer (191 patients) and palliative therapy given for a variety of symptoms (784 patients) were investigated using data collected from 49 facilities selected on a random basis to reflect fairly the national practice of radiotherapy. Elderly (aged 70 or older) patients accounted for 28.6% of the palliatively treated patients and 19.5% of the definitively treated breast patients. No correlation was found between patient age and the dose or number of days used in palliative therapy. Older patients were more likely to have the "boost" dose of radiation to the tumor bed delivered through external rather than implant techniques. While statistically significant, this difference is not felt to be clinically important. We conclude that once a patient is selected for a course of radiation therapy, age per se, is not a basis for prejudicial treatment.

We studied the effect of patient age on treatment decisions related to radiation therapy using data obtained through the Patterns of Care Study. Definitive treatment given for breast cancer (191 patients) and palliative therapy given for a variety of symptoms (784 patients) were investigated using data collected from 49 facilities selected on a random basis to reflect fairly the national practice of radiotherapy. Elderly (aged 70 or older) patients accounted for 28.6% of the palliatively treated patients and 19.5% of the definitively treated breast patients. No correlation was found between patient age and the dose or number of days used in palliative therapy. Older patients were more likely to have the "boost" dose of radiation to the tumor bed delivered through external rather than implant techniques. While statistically significant, this difference is not felt to be clinically important. We conclude that once a patient is selected for a course of radiation therapy, age per se, is not a basis for prejudicial treatment.

The increasing utilization of radiation therapy as a curative modality in cancer and the increasing contribution that full-time radiation oncologists have made to the practice has led to the “ Patterns of Care Study” which has documented the level of care as well as the changes taking place in the management of patients across the whole spectrum of facilities in the United States. The study began in 1971 with the objectives to improve the quality and accessibility of radiation therapy in the United States. Supported by the National Cancer Institute and developed and performed under the aegis of the American College of Radiology (ACR), it took as its starting point a statement in A Prospect for Radiation Therapy in the United States (1968), the first “blue book” of the, then, Committee for Radiation Therapy Studies, which said “... cancer patients in the United States are being treated well in a few places, reasonably well in many others, and quite inadequately in a great many places.”

An hypothesized relationship between level of social support during a life-threatening health crisis and subsequent armelioration of psychological distress - the stress buffering hypothesis - was tested with a longitudinal, quasi-experimental research design. A sample of 181 adult patients who had recently been diagnosed with cancer and were about to undergo curative radition therapy was followed through two months post-treatment. Perceived satisfaction with socioemotional support was assessed at the onset of treatment and at its completion six weeks later. Patients' responses were used to develop an index of sustained social support. Distress associated with depressive symptoms was assessed at the completion of treatment and two months later using SCL-90-R. Depression at the two-month follow-up was not significantly related to level of support after controlling for depression when treatment was completed (p < .05, p v .10). The results echo those of other empirical studies with oncologic samples questioning the cost-effectiveness of psychosocial interventions that merely increase the level of social support for patients.

The American College of Radiology periodically collects data on radiation oncology facilities with megavoltage equipment. The results of the 1986 survey are summarized, with specific reference to the substantial growth in free-standing facilities.

This paper provides an introduction into the clinical activities of the RTOG (Radiation Therapy Oncology Group), its goals, its organization, its format for protocol development, and presents major areas of achievement. It provides an organizational chart of the group, a disease site modality cross-reference for protocols, and appendices which provide the key published results of the Group's clinical activities. This paper presents an important overview of the RTOG clinical research activities, which are designed to improve the role of radiation therapy.

Three hundred and thirteen patients with UICC T-1 N-0 M-0 prostate cancer were treated with external beam irradiation in 1973 and 1974 or in 1978, and their outcome determined 3–10 years after treatment. Survival over the first 5 years was comparable to that expected for a group of age matched normal males (77% vs. 81%), but during the second 5-year interval, there was a decrease in survival below that expected (51% vs 62%), a reflection of death in patients who developed metastasis as a first recurrence (18%). Overall, 72% of patients were free of any recurrence at 5 years and, 88% free of infield recurrence. The development of metastatic recurrence was significantly related to grade; at 5 years 87% of grade I, 79% of grade II and 69% of grade III patients were free of metastasis. There was a trend for increased local recurrence with increasing grade, but it was not statistically significant. There was a dose/response relation for complications, and radiation doses above 6500 cGy are associated with an increase in complication from 6% to 11% (p = .09). Complications requiring hospitalization for evaluation or management occurred in 30 (10%) of 313 patients. There were no deaths from complications and less than 2% of patients required surgical correction of complications. External beam radiation offers the patient with early prostate cancer a favorable opportunity for cure without the morbidity of impotence, incontinence, and occasional death experienced following LND and radical prostatectomy. Lymph node dissection does not seem necessary for most patients with T-1 prostate cancer as the positive yield in those with Grades I and II cancers is less than the complications of the procedure, and extensive involvement can be detected by non-invasive means.

This study reports the national averages for patterns of palliative radiation therapy observed in the United States for patients treated in 1984–1985 and compares those patterns to the pertinent literature. The data were collected in 1984–1985 by the Patterns of Care Study Survey of Palliative Care conducted in 49 institutions selected to provide valid national averages for the practice patterns reported. Data were collected from 784 patient records selected from five "strata" of practice. Demographic data and process data were tabulated and national averages were calculated from the data. Four metastatic sites were selected, weight bearing bones (401), non-weight bearing bones (102), brain metastasis (224), and lung-mediastinum (57). The median patient age was 63 years, equally divided by sex. In 52% of patients this was the first metastasis. Common Karnofsky performance scores ranged from 40 to 80%. Lung, breast, and prostate were the most common primaries. Two-thirds of the patients were treated by linear accelerators, one-third by cobalt. The median number of fractions was 10, median dose 3000 cGy, median fraction size 300 cGy, and median treatment duration 15 days. The goal of treatment was relief of pain (98%) and return of function (30%) for weight bearing bones, for brain metastasis it was preservation of function (68%), pain relief (330!0), and relief of compression (25%). All sites showed TDF values that ranged from 33–85, and a TDF of approximately 65 was most common for weight bearing bones and brain metastasis with no consistent pattern of TDF selection for the other sites. Compliance by strata of practice with work-up criteria was excellent with isolated poor compliance seen in several strata.

Proceedings of the 29th Annual ASTRO Meeting 85 transient case of radiation pneumonitis (lxJ), no cases of myelitis and 2 cases of late subcutaneous fibrosis (lxJ) in whom the treatment energy employed (CO-60 as opposed to 12 MeV photons) may have been responsible.At this time, the protocol has closed with a total entry of 150 patients.Of these, 30 pts. did not complete the prescribed treatment but the reasons of non-compliance, progression of disease or death due to intercurrent disease were of equal incidence in both groups.Of the 120 evaluable patients, 63 were treated 5xW and 57 with 1xW therapy.Complete tumor responses have remained similar in both arms with 1xW pts still demonstrating a numerical advantage (24% vs 15%).The average follow-up of the entire series is myrs with a range of 6-60 months.Survival data have remained comparable in both groups with the 12 and 24 month acturial survival of 48% and 19% for the 5xW arm and 45% and 19% for the 1xW arm continuing to show a better tolerance than 5xW pts.There are sufficientlong-term surviving patients inboth arms to assess chronic toxicity.The number of patients alive at 12, 18 and 24 months were 25, 13 and 6 for the 5xW arm and 19, 8 and 5 for the 1xW arm.No significant differences in late reactions have been noted.The longexsurviving patient in the 1xW ?i6i is now 57 months after treatment.

This report extends the follow-up of patients studied in the Patterns of Care Survey of Prostate Cancer treated in the United Staten between 1973 and 1975 from a maximum of 5 years to a maximum of 10 years. Survival for 60 Stage A patients was the same as expected for their age distribution (83% at 5 years and 62% at 10 years). Survival for 312 Stage B patients was 73% at 5 years and 46% at 10 years and for 296 Stage C patients was 58% at 5 years and 38% at 10 years Infield recurrence was determined by clinical means, at 5 years 97% of Stage A patients, 86% of Stage B patients, and 74% of Stage C patients were free of local recurrence. At 10 years 97% of Stage A patients, 74% of Stage B patients, and 69% of Stage C patients remained free of local recurrence. Patients with Stage B and C cancer who developed their first failure infield show a long-term survivorship after recurrence of 40% and 20% respectively. This is in contrast to Stage B and C patients who develop a first recurrence at a metastatic site where the rate of progress to death was slower in Stage B patients than for those with Stage C disease (mean survival 32 months versus 19 months), but eventually all are dead by 7 years after recurrence. Complications were infrequent, actuarial analysis shows 93% of patients free of serious complications at 5 years and 89% free at 10 years. There were 14 patients (2%) whose complications required surgical correction and 2 of the 682 patients died of complications.

Between March 1973 and June 1979, patients with advanced operable squamous cell carcinoma of the supraglottic larynx or hypopharynx were randomly allocated to receive either preoperative radiation therapy (5,000 rad) or postoperative radiation therapy (6,000 rad). Patients with oral cavity or oropharynx lesions were randomly assigned either preoperative radiation, postoperative radiation, or definitive radiation therapy (6,500-7,000 rad), with surgery reserved for salvage if residual disease was present 6 weeks after completion of irradiation. Three hundred twenty patients were evaluable with a median follow-up of 60 months. Based on results in 277 patients across all four regions combined, locoregional control was significantly better for patients assigned to receive postoperative radiation therapy (65%) compared with those assigned to receive preoperative radiation therapy (48%, P = 0.04). This was due to a higher rate of both persistent and recurrent local and regional disease in the preoperative group. Survival also showed a trend to be better in the postoperative group (38%) compared with the preoperative group (33%, P = 0.10). Rates of severe surgical and radiation therapy complications were similar overall. Forty-three patients were evaluable for each of the three treatment regimens assigned to patients with oral cavity or oropharynx lesions. Due to the small number of patients available for this portion of the trial, the observed differences for overall survival (4-year percentage 33% overall; 30% preoperative, 36% postoperative, 33% definitive radiation therapy) and for locoregional control (45% overall; 43% preoperative, 52% postoperative, 38% definitive radiation therapy) were not statistically significant. The use of definitive radiation therapy with surgical rescue as an ethically justified alternative treatment for these tumors remains a question for further research.

Previous research that showed relatively higher levels of psychopathological symptomatology among women than men, both in the general population and among patients suffering from a serious illness, was supported in a sample of 181 patients who were receiving definitive radiotherapy for cancer. In repeated psychometric assessments, patients reported significantly (p < .05) less depression and anxiety after treatment, although depressive symptoms were still higher than nonpatient norms for both sexes (p < .001) in the three-month period between the onset of treatment and second follow-up interview. There were no apparent differences between the men and women in reduction of psychic distress, which is interpreted as indicating that the men and women were equally effective in coping with their disease and treatment.

For the identification of predictive factors for local (head and neck) control and metastases and impact on survival in squamous cell cancer of the head and neck, we have used data from over 2000 patients from the Patterns of Care Study (PCS) and the Radiation Therapy Oncology Group (RTOG) studies. Complete local response (C.R.) is significantly related to T stage, N stage, general performance status (Karnofsky), and site of primary tumor. There is a strong association between T and N stage. T1N0 tumors showed a C.R. of 99%, whereas, TIN' had a C.R. of 57%. T4N0 showed a C.R. of 75%, but this went down to 31% in the T4N3 lesions. Glottic tumors showed a C.R. of 96% versus the other sites, which ranged from 81% for the nasopharynx to 59% for the hypopharynx. Patients with a performance status (KPS) of less than 90% showed a C.R. of 60% versus 88% for AKPS 90% or higher. Absence of local recurrence after C.R. is significantly related to T stage, N stage, and the site of primary tumor (glottis versus the rest). The appearance of distant metastases is significantly related only to N stage and primary site. This relationship persists in control of loco/regional tumors. In Stages III & IV in non-glottic head and neck cancer, metastases as the cause of death play an increasingly important role. This can be as high as 30%. The appearance of new malignant tumors and death unrelated to cancer, that is, death related to lifestyle, assumes an important role in patients with advanced head and neck cancer. The number of advanced glottic larynx was too small to examine this question. The use of a surgical procedure in carcinomas of the anterior tongue and floor of the mouth was associated with a smaller percentage of infield recurrences at 2 years, than when radiation therapy alone was used (27% versus 88% p < .01). The same observation was noted at 3 years in the glottic and supraglottic Stage III & IV tumors (p < .01).

The American College of Radiology periodically collects data on all radiation therapy facilities with megavoltage equipment n the U.S. The following is an overview of the five surveys conducted between 1974 and 1983.