(84) LYMPHADENOPATHY IN AXILLA OR GROIN FROM OCCULT PRIMARY CANCER

S.R. Schell, M.D., M.A. Batata, M.D., and F.C.H. Chu, M.D.

Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, New York NY 10021

One hundred and ninety-eight patients with the diagnosis of metastases to axilla or groin lymph nodes from cancer of unknown primary site, were seen at the Memorial Sloan-Kettering Cancer Center from 1949 to 1974. The patients' ages ranged from 15 to 85 years, and the ratio of male to female patients was 68 to 44 in the axilla group and 42 to 45 in the groin group.

Initial investigations, pathological features, treatment methods with emphasis on radiation therapy, 5-year survival according to tumor extent and histologic type , subsequent findings including autopsy data, and prognosis according to site of lymph nodal ihvolvement, will be presented,

(85) MENINGEAL CARCINOMATOSIS: A SERIOUS THREAT TO THE CONTROL OF OAT CELL CARCINOMA OF THE LUNG BY RADIATION THERAPY INCLUDING

PROPHYLACTIC BRAIN IRRADIATION AND EXTENSIVE CHEMOTHERAPY

Wagih Shehata, M.D., Richard L. Meyer, M.D., James M. Hall, M.D., and Charles A. Cook, M.D.

Good Samaritan Hospital, Cincinnati, Ohio

Twenty patients with oat cell carcinoma of the lung were treated by radiation therapy to the priate site, three drug chemotherapy

( Cyclophosphamide, Vincristine Sulfate and Doxorubicinhydrochloride) and prophylactic brain irradiation. We are reporting two cases of fatal meningeal metastases, one as the only site of failure of therapy documented by autopsy. A third patient is still living with neck and meningeal metastases. Other patterns of failures and alternatives to avoid such outcome, are discussed.

(86) SURVIVAL CHARACTERISTICS OF LUNG CANCER PATIENTS TREATED WITH RADIATION THERAPY

David Sherman, M.D.* and Samuel Hellman, M.D., Joint Center for Radiation Therapy and Department of Radiation Therapy, Harvard Medical School, Boston, MA 02115

This report examines the characteristics of long-term survivors of lung cancer primarily treated with radiation therapy. There were 66 such patients treated between July, 1968, and December, 1975, who survived greater than 18 months. Of these, there are 31 patients

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who are NED from 18 to 96 months with-a median survival of 34 months, and 35 patients are dead of disease. Of those 35 patients, there were 13 (36%) who failed with locally recurrent disease. This was related to dose in that 80% (4/5) occurred in patients receiving less than 5000 rad, 60% (6/10) in those receiving 5000 to 5500 rad, and 25% (3/12) in patients receiving 5600 to 6000 rad. Treatment tech- nique was also important, in that the use of treatment planning with simulation might have eliminated 46% (6/13) of the local failures. Treatment was accomplished with a low complication rate (6%) which included 1 patient with esophogeal fibrosis, 2 with radiation pneu- monitis and 1 with persistant shortness of breath. We conclude that while most patients with advanced lung carcinoma will die of distant disease, there are a significant number of patients who will achieve long-term survival. For this group of patients, treatment technique is critical for it permits the delivery of a high dose of radiation while incurring a low complication rate. This will become even more important if distant metastases can be prevented by adjuvant systemic treatment since then the consequences of local therapy will affect a much larger patient population.

(87) TREATMENT OF REGIONALLY ADVANCED EPIDERMOID CARCINOMA OF THE TRUNK AND EXTREMITIES

Man H. Shiu, M.D.? Florence C. Chu, M.D., and Joseph G. Fortner, M.D.

Departments of Surgery and Radiation Therapy Memorial Sloan-Kettering Cancer Center, New York, New York

Large and locally advanced epidermoid carcinomas of the trunk and extremities can present many difficulties in management. We have conducted a retrospective study of 108 patients with such carcinomas treated at Memorial Center from 1949-1070. Thirty-nine patients presented with tumors measuring larger than 5 cm in diameter or showing invasion of the under- lying bone (Group I); 69 other patients had regional lymph node metastases (Group II). Most of the patients were elderly.

All patients underwent surgical resection with curative intent as initial therapy. Amputation was necessary for about half of the extremity tumors. Enlarged regional lymph nodes were biopsied, and when pathologically positive, removed by radical node dissection or high exarticulation.

In Group I (T3NO,T4NO), 12 of 30 patients (40%) survived five years, 15 patients having been lost to follow-up or died of other causes. In the 69 patients of Group II (Nl,N2,N3), there were 16 five-year survivors (37%), with 8 patients lost to follow-up or dead of other causes. Bony invasion, with or without nodal metastasis, carried a bad prognosis, for only 2 of 15 patients survived five years free of disease. Metastases to multiple regional lymph nodes resulted in death for all except three patients, whereas of 15 patients showing involvement of single nodes, only one was known to have died of disease. Death resulted from relentless infiltration of tumor into a body cavity, or from distant metastases, usually pulmonary.

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