RESUMEN
OBJECTIVE: The impact of adjuvant pelvic radiation therapy on the rate and location of recurrences was evaluated in patients with early-stage (IA1-IB2) neuroendocrine cervical carcinoma who underwent prior conization or polypectomy with no residual disease and negative nodes in the subsequent upfront radical hysterectomy specimen. As a secondary objective, disease-free and overall survival were analyzed. METHODS: We searched the Neuroendocrine Cervical Tumor Registry (NeCTuR) to identify patients with clinical early-stage neuroendocrine cervical carcinoma with no residual disease in the specimen from upfront radical surgery and negative nodes. Patients who received pelvic radiation therapy were compared with those who did not, regardless of whether they received adjuvant chemotherapy. RESULTS: Twenty-seven patients met the inclusion criteria, representing 17% of all patients with clinical early-stage disease who underwent upfront radical hysterectomy included in the NeCTuR registry. The median age was 36.0 years (range 26.0-51.0). Six (22%) patients had stage IA, 20 (74%) had stage IB1, and one (4%) had stage IB2 disease. Seven (26%) patients received adjuvant radiation therapy and 20 (74%) did not. All seven patients in the radiation group and 14 (70%) in the no-radiation group received adjuvant chemotherapy (p=0.16). Fifteen percent (4/27) of patients had a recurrence, 14% (1/7) in the radiation group and 15% (3/20) in the no-radiation group (p=0.99). In the radiation group the recurrence was outside the pelvis, and in the no-radiation group, 67% (2/3) recurred outside the pelvis and 33% (1/3) recurred both inside and outside the pelvis (p=0.99). In the radiation group the 5-year disease-free and overall survival rates were 100% while, in the no-radiation group, the 5-year disease-free and overall survival rates were 81% (95% CI 61% to 100%) (p=0.99) and 80% (95% CI 58% to 100%) (p=0.95), respectively. CONCLUSIONS: For patients with no residual disease and negative nodes in the upfront radical hysterectomy specimen, our study did not find that pelvic radiation therapy improves survival.
RESUMEN
PREMISE OF THE STUDY: Mediterranean-type climate ecosystems experience significant variability in precipitation within and across years and may be characterized by periods of extreme drought followed by a brief, high-intensity precipitation pulse. Rapid root growth could be a key factor in effective utilization of precipitation pulses, leading to higher rates of seedling establishment. Changes in root growth rate are rarely studied, however, and patterns in seedling root traits are not well explored. We investigated the influence of an extreme postdrought precipitation event on seedlings that occur in southern California coastal sage scrub. METHODS: We measured root elongation rate, root tip appearance rate, new leaf appearance rate, and canopy growth rate on 18 mediterranean species from three growth forms. KEY RESULTS: Root elongation rate responded more strongly to the precipitation pulse than did root tip appearance rate and either metric of aboveground growth. The majority of species exhibited a significant change in root growth rate within 1 week of the pulse. Responses varied in rapidity and magnitude across species, however, and were not generally predictable based on growth form. CONCLUSIONS: While the majority of species exhibited shifts in belowground growth following the pulse, the direction and magnitude of these morphological responses were highly variable within growth form. Understanding the implications of these different response strategies for plant fitness is a crucial next step to forecasting community dynamics within ecosystems characterized by resource pulses.
