Given the high cure rate of patients with Hodgkin's disease, the complications related to therapy take on great significance. Mantle irradiation to the thorax is used in virtually all patients with early stage Hodgkin's disease. Prior studies of patients receiving mantle irradiation demonstrated short-term (up to 24 months) abnormalities of pulmonary function. In the present study, we prospectively studied 13 patients for up to 60 months after irradiation only with serial pulmonary function tests, arterial blood gas tests, diffusing capacity of carbon monoxide, chest radiographs, and ventilation-perfusion scans. No respiratory symptoms attributable to therapy were noted. Frequent radiographic changes (62%) were found consisting of apical fibrosis, paramediastinal fibrosis, or pleural thickening. Two patients developed an asymptomatic spontaneous pneumothorax that resolved with conservative management. Ventilation-perfusion scans often (73%) revealed decreased perfusion to the lung apices with associated ventilatory deficits in one-half of these patients. Patients with intrathoracic disease had decreased lung volumes prior to therapy, and lung volumes did not change following irradiation. Lung mechanics were normal throughout the study. Gas exchange at rest was normal in patients with extrathoracic disease. Patients with intrathoracic disease often presented with an abnormal arterial PO2 and widened alveolar-arterial partial pressure gradient for oxygen. However, these parameters normalized by 9 months after therapy. Despite the frequent development of radiographic and V/Q scan abnormalities in the lung apices, patients tolerated mantle radiotherapy remarkably well. In fact, patients with intrathoracic disease demonstrated improved gas exchange at rest following therapy.

This is a retrospective review of 193 evaluable patients treated with radiation therapy to the mediastinum for Stages I, II and III-A Hodgkin's disease. Eligible patients were those receiving 3000 rad or more to the mediastinum and no chemotherapy prior to the radiation. During the study period, 13 patients developed symptomatic pericarditis. The interval post treatment to the development of symptoms was six to 34 months. The incidence of pericarditis was studied as a function of: (1) the dose of radiation at a depth of 2 cm, 5 cm and the midplane of the mediastinum; (2) the ratio of anterior to posterior weighting of dose; (3) the presence or absence of intrathoracic tumor; (4) the size of the tumor when present; and (5) the fraction of the heart exposed to the radiation beam. There was a significant increase in the incidence of pericarditis with an increased dose of radiation at 2 cm, 5 cm and midplane depths and also with the presence of a large intrathoracic tumor. A reduction in mediastinal dose is recommended.

The use of total body irradiation (TBI) to ablate malignant stem cells in leukemia patients prior to bone marrow transplantation and the use of hemibody irradiation (HBI) for treating osseous metastases have focused attention on the dose rate effects, if any, exhibited by normal or malignant hematopoietic stem cells. Using male BALB/c mice 10 to 12 weeks old, we investigated dose rate effects at 103, 45 and 8 rad/min over the dose range from 100 to 500 rad. Bone marrow cells from the femurs of irradiated donor mice were transplanted into lethally irradiated (720 rad) mice of the same age, sex, and strain. Recipient mice were sacrificed 9 days later, their spleens fixed, stained with Bouin's solution, and the macroscopic colonies counted to determine the number of colony forming units (CFU) per femur. Surviving fractions were determined by comparisons to the CFU's of non-treated controls. The logarithms of the surviving fractions, S, versus dose, D, (in rad) were least squares fitted and the extrapolation number, n, and D0 obtained. The extrapolation numbers ranged from 0.65 +/- 0.15 to 0.81 +/- 0.08, and D0 ranged from 61.7 +/- 3.4 to 69.0 +/- 2.8. There are no statistically significant differences between the n's and D0's for these different dose rates over the dose range from 100 to 500 rad, as measured by spleen CFU assay of normal femoral marrow. The D0's are appropriate for this radiosensitive mouse strain. These data are compared to those from other studies using the same method of CFU assay.

This report is a retrospective study of 101 patients referred with the diagnosis of Hodgkin's disease, all of whom had a staging laporotomy and were treated initially with radiation therapy alone. The results of treatment are analyzed in terms of the relapse rate and 5-year actuarial survival by the following prognostic factors identified from the literature: age, stage, the presence or absence of systemic symptoms, histology, splenic involvement and intrathoracic involvement. There was a significant difference in the relapse rates and survival rates between those patients without the poor prognostic factors and those with one, or more than one.

Adults with acute leukemia and malignant lymphoma in relapse after conventional therapy are treated with cyclophosphamide and total body irradiation (TBI) followed by autologous bone marrow transplants. Phantom dosimetry and dosimetry on patients treated reveals that doses are delivered within 5% accuracy. Patient tolerance of treatment, and some biological considerations of low dose rate therapy are reviewed. Certain dosimetry features of an alternate treatment at 370 cm SAD, using 25 MV photons are also presented.

Adults with acute leukemia and malignant lymphoma in relapse after conventional therapy are treated with cyclophosphamide and total body irradiation (TBI) followed by autologous bone marrow transplants. For cobalt TBI, patients seated in a stand angled 45° above the floor are treated in a single fraction with sequential right and left lateral 87 cm ×87 cm fields at 220 cm source-axis distance (SAD) using a 5000 Ci cobalt unit. Typical lateral diameters, mid-plane dose rates, mid-plane doses, and maximum doses are: Hips, 34 cm, 8 rad/min, 900 rad, and 1050 rad; and shoulders, 38 cm, 7.7 rad/min, 800 rad, 1080 rad. The estimated lung dose is 1000 to 1100 rad. A compensator limits the dose to the head to 1000 rad. Estimated organ doses are: small intestine, liver and kidneys-1100 rad, and heart-1200 rad. Phantom dosimetry and dosimetry on patients treated reveals that these doses are delivered within 5 % accuracy. Patient tolerance of treatment, and some biological considerations of low dose rate therapy are reviewed. Certain dosimetry features of an alternate treatment at 370 cm SAD, using 25 MV photons are also presented.

Adults with acute leukemia are treated with cyclophosphamide and total body irradiation (TBI) followed by autologous marrow transplants. For TBI, patients seated in a stand angled 45° above the floor are treated for about 2 hours at 220 cm source-axis distance (SAD) with sequential right and left lateral 87 cm × 87 cm fields to a 900 rad mid-pelvic dose at about 8 rad/min using a 5000 Ci cobalt unit. Maximum (lateral) to minimum (mid-plane) dose ratios are: hips—1.15, shoulders—1.30, and head—1.05, which is shielded by a compensator filter. Organ doses are small intestine, liver and kidneys—1100 rad, lung—1100–1200 rad, and heart-1300 rad. Verification dosimetry reveals the prescribed dose is delivered to within ± 5%. Details of the dosimetry of this treatment are presented.

We have reviewed the records of 76 patients with Stage I or II extranodal non-Hodgkin's lymphoma who were referred to the Division of Radiation Oncology, Mallinckrodt Institute of Radiology, during the years 1964 through 1974. The histologic slides were reviewed in the 67 cases in which they were available. Forty-three percent of Ann Arbor Stage I and II patients relapsed after primary radiation treatment.Seventy-three percent of these failed in sites distant from the irradiated volume. Failures in the treated volume were infrequent (7%) except in those patients presenting with primary lesions of the brain (4/5). Those patients presenting with lesions of Waldeyer's ring experienced a decrease in survival with increasing tumor size. Because of the high rate of failure in distant sites with tumors in the lingual and palatine tonsils, we are recommending the study of adjuvant chemotherapy in these cases, after primary radiation treatment.

A retrospective analysis of 116 primary cases of stage I, II and III-A Hodgkin's disease demonstrated 27 failures, fourteen confirmed by biopsy. Twenty of the 27 (74%) were in lymph node areas only and seven had extranodal extensions. The most frequent site of failure was the hilar nodes and contiguous lung. The majority of failures (78%) occurred within 30 months of treatment and the cause of failure determined in 23 (85%), sixteen of which were due to technical errors of irradiation. Analysis of the dosimetry in the mediastinal, hilar nodes and contiguous lung failures revealed three factors which may have contributed to a low dose. These factors are: 1) the equivalent square, 2) off-axis beam diminution, and 3) the anteroposterior dose profile. Combined radiation therapy and chemotherapy was more effective than either modality alone in the treatment of these failures.

This report analyzes the results of radiation treatment of patients with extranodal Non-Hodgkin's lymphoma presenting in the head and neck area.Between the years 1964 through 1974 inclusive, 130 patients were seen at the Mallinckrodt Institute of Radiology with this diagnosis.The records and histological slides of these patients have been reviewed.The parameters evaluated include sites of presentation, stage, histologic subtype according to the Rappaport classification, evaluation, treatment, sites of failure, disease free and overall survival.Emphasis has been given to the definition of errors in strategy and treatment.

A secondary gonadal shield for use in the pelvic irradiation of males was designed and built using material and apparatus available with the Cerrobend blocking system. The gonadal dose was reduced to approximately 1.5 to 2.5% of the given dose.

A secondary gonadal shield for use in the pelvic irradiation of males was designed and built using material and apparatus available with the Cerrobend blocking system. The gonadal dose was reduced to approximately 1.5 to 2.5% of the given dose.

In this retrospective study of 76 patients with myeloma, the indications for radiation therapy are reviewed and its value analyzed. Eleven patients presented with a "solitary plasmacytoma" and 65 patients presented with disseminated disease. Radiation therapy is successful in both the palliation of pain (81% of cases) and in producing long-term remission and possibly cure in solitary lesions.