Effective palliative radiation therapy in advanced and recurrent ovarian carcinoma.

PURPOSE: To retrospectively review our experience using radiation therapy as a palliative treatment in ovarian carcinoma. METHODS AND MATERIALS: Eighty patients who received radiation therapy for ovarian carcinoma between 1983 and 1998 were reviewed. The indications for radiation therapy, radiation therapy techniques, details, tolerance, and response were recorded. A complete response required complete resolution of the patient's symptoms, radiographic findings, palpable mass, or CA-125 level. A partial response required at least 50% resolution of these parameters. The actuarial survival rates from initial diagnosis and from the completion of radiation therapy were calculated. RESULTS: The median age of the patients was 67 years (range 26 to 90 years). A median of one laparotomy was performed before irradiation. Zero to 20 cycles of a platinum-based chemotherapy regimen were delivered before irradiation (median = 6 cycles). The reasons for palliative treatment were: pain (n = 22), mass (n = 23), obstruction of ureter, rectum, esophagus, or stomach (n = 12), a positive second-look laparotomy (n = 9), ascites (n = 8), vaginal bleeding (n = 6), rectal bleeding (n = 1), lymphedema (n = 3), skin involvement (n = 1), or brain metastases with symptoms (n = 11). Some patients received treatment for more than one indication. Treatment was directed to the abdomen or pelvis in 64 patients, to the brain in 11, and to other sites in 5. The overall response rate was 73%. Twenty-eight percent of the patients experienced a complete response of their symptoms, palpable mass, and/or CA-125 level. Forty-five percent had a partial response. Only 11% suffered progressive disease during therapy that required discontinuation of the treatment. Sixteen percent had stable disease. The duration of the responses and stable disease lasted until death except in 10 patients who experienced recurrence of their symptoms between 1 and 21 months (median = 9 months). The 1-, 2-, 3-, and 5-year actuarial survival rates from diagnosis were 89%, 73%, 42%, and 33%, respectively. The survival rates calculated from the completion of radiotherapy were 39%, 27%, 13%, and 10%, respectively. Five percent of patients experienced Grade 3 diarrhea, vomiting, myelosuppression, or fatigue. Fourteen percent of patients experienced Grade 1 or 2 diarrhea, 19% experienced Grade 1 or 2 nausea and vomiting, and 11% had Grade 1 or 2 myelosuppression. CONCLUSIONS: In this series of radiation therapy for advanced ovarian carcinoma, the response, survival, and tolerance rates compare favorably to those reported for current second- and third-line chemotherapy regimens. Cooperative groups should consider evaluating prospectively the use of radiation therapy before nonplatinum and/or nonpaclitaxel chemotherapy in these patients.

Collecting data on women's employment in rural Java.

PIP: A research study was conducted to determine the economic roles of rural women in Java, Indonesia, who work outside the agricultural sector. The study was designed to create a system of job classification for small trade and industry which would distinguish among women's economic activities. The research consisted of 3 phases: 1) 8 case studies which included time observations of the women's days; 2) a household survey, selected according to the woman's primary occupation; and 3) a market survey among women traders of various commodities. The focus of the data collection was family roles and relationships and women's occupations. This collection of information is important because development and the introduction of technology in rural Indonesia is changing the fields of employment traditionally dominated by women. A summary of 1 of the case studies is presented. The data showed trends in occupational choice according to the life-cycle stage of the woman's family. It is hoped that these findings can be used in regional development planning geared to using the labor of rural women.^ieng

Development of a community mammography registry: experience in the breast screening program project.

PURPOSE: To assess the formation, implementation, and operation of a community mammography registry, which is a consolidated database for all mammography and breast biopsy reports within a community. MATERIALS AND METHODS: A registry was created in Lee County, Fla. Mammography interpretation data were provided by 13 facilities and 38 radiologists organized in several private practice groups. RESULTS: The registry contains data on 87,926 mammograms and 3,234 breast biopsies performed between June 1991 and May 1994. The registry calculates individual and group mammography interpretation accuracy measures, such as sensitivity, specificity, positive predictive value, false-positive and false-negative rates, and clinical outcome measures such as sizes and stages of malignant lesions detected. CONCLUSION: The registry allows community radiologists and mammography practices to compare their outcomes with those of their local peers and to published data and encourages focused interventions for quality improvement based on objective experience.

Assessment of self-reward strategies for maintenance of breast self-examination.

This study examined the relative impact of different self-reward strategies on maintenance of breast self-examination (BSE) practice among 1649 women trained to do BSE. Training groups were randomized into four conditions: (a) self-reward instructions and materials delivered at the end of the BSE training session; (b) self-reward suggestions delivered through the mail each month, contingent upon the BSE performance; (c) external monetary rewards and self-reward suggestions delivered through the mail each month on an intermittent schedule, contingent upon BSE practice; and (d) a no-reward control condition. Follow-up assessments 12 months following training revealed a pattern of evidence in support of the benefits of external monetary rewards and self-reward prompts on BSE frequency and quality; however, it is likely that the value of that condition lies in the external reward component.