Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer.

We have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years. At 10 years from the date of salvage treatment, the overall survival rate for the 226 patients with invasive local recurrence was 39% (95% CI, 32-46), the distant recurrence-free survival rate was 36% (95% CI, 29-42), and the local control rate (i.e., survival without subsequent local recurrence or local progression) was 68% (95% CI, 62-75). Among patients with a local recurrence at or near the original tumour site a better distant disease-free survival was observed for patients with recurrences measuring 1cm or less, compared to those with larger recurrences. This suggests, though does not prove, that early detection of local recurrence can improve the treatment outcome but might as well point towards a different biologic behaviour, facilitating early detection.

Ethmoid and upper nasal cavity carcinoma: treatment, results and complications.

From 1970 to 1985, 45 patients with carcinoma of the upper nasal cavity and ethmoid sinuses were radically treated. The tumor parameters, treatment strategy, radiotherapy technique and the results of treatment of these patients are retrospectively analysed in this study with particular reference to complete blindness as a major complication. In most cases tumor was removed by meticulous surgical dissection, and thereafter quality-controlled radiation therapy (external therapy: mean dose 65 Gy in about 7 weeks, or external therapy with brachytherapy boost: mean dose 82 Gy in about 10 weeks) was used for this group of patients. The results show 68% recurrence-free survival at 5 years, adjusted for intercurrent deaths. Complications of treatment were seen in seven patients (16%) who developed eye damage with some loss of visual acuity, none however leading per se to complete blindness. It may be concluded that blindness may be avoided to a major extent while treating carcinomas in the nose-ethmoid areas without compromising loco-regional control.

A critical look at the TNM classification for laryngeal carcinoma.

A total number of 564 patients with glottic (427) and supraglottic (137) laryngeal carcinoma was prospectively staged clinicoendoscopically (CS) and radiologically (RS). These patients were treated from 1974 to 1985 with quality-controlled high-dose radiation therapy. The validity of CS versus RS was checked in this study with the parameter of recurrence-free adjusted survival (RFADS) at 3 and at 5 years. It appears that RS is more valid and has therapeutic implications in planning the target volume for irradiation. The CS should be regarded as inadequate for radiotherapeutic considerations. The International Union Against Cancer (UICC) 1987 norms for staging laryngeal carcinoma (clinical, endoscopic, and imaging) should be strictly followed.