56 Radiation Oncology ??Biology ??Physics October 1984, Volume 10, Sup. 2

106 INDICATIONS FOR INTERSTITIAL AND INTRACAVITARY BRACHYTHERAPY

Robert Parker, M.D. “Luther W. Brady, M.D.

Department of Radiation Oncology, University of California, Los Angeles, CA and “Department of Radiation Therapy and Nuclear Medicine, Hahnemann Medical College and Hospital, Philadelphia, PA

The application of Brachytherapy techniques require a broad understanding of the various radionuclides used in cancer therapy, the indication for Interstitial as opposed to lntracavitary placement techniques and how these might be integrated with external beam radiotherapeutic programs. The advantages and disadvantages of these techniques will be discussed as well as their application with specific reference to prostatic, uterine, and cervical cancers and tumors of the head and neck.

107 CAUSES OF FAILURE IN THE RADIATION THERAPY OF HEAD AND NECK CANCER

Gilbert H. Fletcher, M.D., and Lester J. Peters, M.D.

Division of Radiotherapy, The University of Texas M.D. Hous ton, Hous ton Texas 77030

Anderson Hospital and Tumor Institute at

Causes of failure of radiation therapy will be reviewed and illustrated with examples from cancers of the head and neck region. The distinction is made between those causes of failure that can be minimized by optimal application of concepts and techniques readily available to all radiotherapists, those that are not amenable to any modification of radiotherapeutic technique, and those that are Potentially remediable by new treatment strategies based on the radiobiological attributes of individual tumors.

108 THE ROLE OF RADIATION THERAPY IN THE TREATMENT OF NON-HODGKIN’S LYMPHOMA

Peter Mauch, M.D.

Joint Center for Radiation Therapy, Department of Radiation Therapy, Boston MA

Radiation therapy has played a variety of roles in the treatment of non-Hodgkin’s lymphoma. It has been used as potentially curable treatment for patients with localized lymphomas (Stage I-II). In patients with stage III-IV lymphocytic lymphomas both total nodal irradiation and low dose total body irradiation have been used. Currently for patients with advanced recurrent lymphoma, high dose total irradiation has been used in conjunction with bone marrow trasplantation.

This current refresher course will first discuss the different histologic classifications for non- Hodgkin’s lymphomas. The Rappaport classification has the most wide spread use and accepted clinical relevance and will be used throughout this review. However , some reference will be made to the new classification which divides lymphomas into favorable, intermediate, and unfavorable categories. There are a number of different studies reporting results of staging laparotomy in patients with non-Hodgkin’s lymphomas. It is important to consider the thoroughness of staging in the different studies that report the use of radiation therapy alone in the treatment of localized non-Hodgkin’s lymphoma. The more aggressive the surgical staging the higher percentage of patients who will be discovered to have stage III or IV disease and thus would not benefit from the use of localized treatment alone. The use of radiation therapy in carefully staged patients with localized lymphomas should result in a higher freedom from relapse than for patients treated with localized lymphoma in whom less thorough staging has been performed. Several groups continue to use surgical staging in the work-up of patients with non-Hodgkin’s lymphomas and the results of these groups will be discussed and conclusions made as to the current role of surgical staging in the treatment of non-Hodgkin’s lymphoma. The role of bone marrow biopsy, bipedal lymphangiogram, gallium scanning, abdominal CAT scanning as well as one of the new marker tests will also be discussed.

A major portion of this course will discuss the use of radiation therapy alone for stage I and 11 non- Hodgkin’s lymphoma. This will be discussed by histologic types and the discussion will center around radiation doses needed, the patterns of failure, the field sizes needed, the potential role for salvage chemothkrapy as opposed to the initial use of chemotherapy in patients with localized lymphomas. Also poor prognostic factors such as the presence of large bulky disease will be discussed and therapeutic alternatives for the treatment of these patients will be addressed. Some patients with localized diffuse

histiocytic lymphoma are now being treated with chemotherapy alone. The role of radiation therapy in conjunction with chemotherapy vs. the use of chemotherapy alone will be addressed for this histologic subgroup.

Total lymph node irradiation has played a role in the treatment of favorable histology stage IIt and IV patients. It has been combined with combination chemotherapy in one randomized series and was found not to be different from combination chemotherapy alone or from the use of single agent chemotherapy. Another

series whole abdominal radiation was combined with total lymph node irradiation for stage 111 patients and 60% were alive and disease free 4 years after the treatment. The use of low dose TBI will also be discussed as well as early results of high dose bone marrow transplantation for patients with advanced Tymphomas.