Palliative treatment of advanced cancer using multiple nonconfluent pencil beam radiation. A pilot study

In the era of orthovoltage radiation, multiple nonconfluent pencil beam radiation (GRID) therapy was utilized to minimize superficial normal tissue damage while delivering tumorcidal doses at specified depths in tissues. The success of GRID therapy was based on the fact that small volumes of tissues could tolerate high doses of radiation. Since the development of megavoltage radiation and skin sparing, GRID therapy has been abandoned. In a pilot study, the authors adapted the principles of GRID therapy to megavoltage photon beams to treat patients with massive tumors or recurrent tumors after tolerance doses of radiation. Twenty-two patients have been entered in the study. All patients were symptomatic and had exhaustive conventional surgery, chemotherapy, and radiotherapy approaches to treatment. A 50:50 GRID (open to closed areas) was utilized, and a prescribed dose of 1000 to 1500 cGy to the open areas was given using a single photon field. In four patients, a second GRID treated was delivered at a split course interval of 4 weeks. The follow-up in these patients ranges from 1 month to 18 months. The results of treatment have been remarkable with 20 of 22 patients achieving dramatic relief of severe symptoms, and several patients showing significant objective regression. No acute effects have been observed, including those patients having large volumes of the abdomen irradiated. No unusual skin or subcutaneous early or late damage has been observed in follow-up.