Implication of new figo surgical staging on patterns of failure and survival in endometrial carcinoma.

Continued emphasis on treating endometrial cancer primarily as a surgical disease has led to the institution, in 1988, of a new staging system based on operative findings. Since the system is new, limited experience has been published confirming its theoretical advantage in predicting clinical outcome. In a four year period, 117 patients with newly diagnosed endometrial cancer were referred for adjuvant radiation therapy to the Department of Radiation Oncology. All patients were restaged based on surgical findings according to the revised 1988 FIGO Staging System. This requires an assessment of peritoneal washings, myometrial invasion, cervical involvement, adnexal and pelvic/para-aortic lymph node metastasis. 39 patients were excluded, leaving 78 patients who were distributed in each stage as follows: Stage I-39 pts (IA 2 pts, IB 24 pts, IC 13 pts), Stage II-10 pts (IIA 5 pts, IIB 5 pts), Stage III-21 pts (IIIA 6 pts, IIIB 1 pt, IIIC 14 pts). and Stage IV-8 pts (IVA 1 pt, IVB 7 pts). The median follow-up time was 40 months, ranging from 3-82 months. The three year absolute and disease-free survival in each stage were: Stage I-97% and 97%, Stage II-79% and 80%, Stage III-37% and 24%, and Stage IV-13% and 0%, respectively. The locoregional and distant failure rates were: Stage I-3% and 5%, Stage II-20% and 0%, Stage III-10% and 76%, respectively. This retrospective analysis suggests that the survival and distant failure are well predicted by the revised FIGO Staging System, which relies completely on findings at surgical staging.

The unrewarding results of curative therapy in esophageal cancer.

The mortality from carcinoma of the esophagus in the non-white male population of the metropolitan Washington, DC, area is probably the highest in the United States. Data from the National Center for Health Statistics indicates a mortality figure of 27.9/100,000 for the period 1969-1971.(1) Between 1971 and 1976, 114 patients were seen at Howard University Hospital with the diagnosis of carcinoma of the esophagus, of which only 48 were suitable for definitive therapy. All patients were black. The male/female ratio was 4 to 1. Postoperative irradiation appeared to confer benefit on surgically respected patients. In this selected group of patients, treatment had little influence on the natural history of the disease and the adjusted direct five-year survival was 2.1 percent.(*)

Extrahepatic bile duct carcinoma: a case report.

The potential of local radiotherapy with intraoperative electron beam irradiation and trans t-tube iridium(192) brachytherapy for the management of carcinoma of the extrahepatic ducts is illustrated by this case report.

Carcinoma of the rectum: 508 patients with failure analysis and implication for adjuvant therapy.

Five hundred and eight patients with carcinoma of the rectum, seen between 1970 and 1980, were reviewed. The numbers of patients in each of the Astler-Coller stages were: stage A: 86; B1: B2: 145; C1: 19; C2: 116; and D (those with metastatic disease): 78. Resection was possible in 92.4% of the patients and operative mortality was 2.3%. Excluding stage D patients, the 5- and 10-year actuarial survivals were 56.9% and 43.7% respectively. When adjusted for deaths from intercurrent disease the 5- and 10-year survivals were 66.8% and 56.3%. Frequency of local recurrence by stage at five years was as follows: stage A: 5.8%; B1: 14%; B2: 20%; C1: 31.5%; and C2: 33.6%. An isolated local recurrence was seen in 5.8% of stage A patients, 12.5% of B1, 13.1% of B2, 15.8% of C1 and 2.6% of C2 staged patients. Histological grade was an important prognostic factor independent of stage. Distance of the tumor above the anus and presence of venous invasion1 could not be assessed. Among stage C patients, survival was 57% when there was one node involved, but this figure fell to approximately 30% with involvement of two or more nodes. Analysis of failure rates suggests that adjuvant radiation treatment is of potential benefit in patients with stages B2, C1, or C2 disease and in stage B1 patients with additional risk factors. The data indicate that adjuvant local treatment is unlikely to increase survival in stage C2 patients, since almost all recurrences in this stage are accompanied by distant metastases.

Effect of delayed radiation therapy on local control in breast conservation therapy.

PURPOSE: To assess local control when radiation therapy is delayed to complete chemotherapy in breast conservation therapy. MATERIALS AND METHODS: Breast conservation therapy was performed in 310 cases in 297 patients (aged 24-85 years) with stage 0-II breast cancer. Adjuvant chemotherapy was used in 76 cases. The authors analyzed the time between diagnosis and radiation therapy and correlated these findings with local control of disease. RESULTS: The time between diagnosis and radiation therapy in the 247 cases treated without chemotherapy-related delay was 2-59 weeks (mean, 8 weeks). The interval in the 63 cases with chemotherapy-related delay was 12-63 weeks (mean, 31 weeks; P < .001). Ten of the 11 cases with an in breast relapse were in the group treated without a delay (P = .57). CONCLUSION: Delaying radiation therapy for chemotherapy does not compromise local control.