Urethral carcinoma in women: results of treatment with primary radiotherapy.

BACKGROUND AND PURPOSE: Urethral carcinoma in women is uncommon. This study was undertaken to evaluate the role of radiotherapy in the treatment of these tumors. MATERIALS AND METHODS: The hospital records of 34 women with primary urethral carcinoma were retrospectively reviewed. There were 15 squamous cell carcinomas, 13 transitional cell carcinomas, and six adenocarcinomas. The primary tumor was >4cm in size in eight patients, involved the proximal urethra in 19 and extended to adjacent organs in 22. Inguinal or iliac lymphadenopathy was present in nine patients. There were eight TNM stage I/II tumors, 11 stage III tumors and 15 stage IV tumors. Radiotherapy was administered only to the primary tumor in 15 patients, and to the primary tumor and regional lymph nodes in the remaining 19 patients. Brachytherapy with or without external radiation was used to treat the primary tumor in 20 patients. RESULTS: Tumor recurred in 21 patients. The 7-year actuarial overall and cause-specific survivals were 41 and 45%, respectively. Large primary tumor bulk and treatment with external beam radiation alone (no brachytherapy) were independent adverse prognostic factors for local tumor recurrence. Brachytherapy reduced the risk of local recurrence by a factor of 4.2. The beneficial effect of brachytherapy was most prominently seen in patients with bulky primary disease. Large tumor size was the only independent adverse predictor of overall disease recurrence and death from cancer. CONCLUSIONS: Radiotherapy is an effective treatment for carcinoma of the female urethra and preserves normal anatomy and function. Brachytherapy improves local tumor control, possibly as a result of the higher radiation dose that can safely be delivered.

0-7-21 radiation therapy for the palliation of advanced cancer in dogs.

The 0-7-21 radiation therapy protocol was investigated as a palliative treatment in dogs with advanced malignancies. Twenty-four dogs with a variety of tumor types were irradiated using 800 cGy fractions given on days 0, 7, and 21. Twenty-three dogs were evaluated. Palliative response was assessed using a quality of life instrument developed for veterinary use. This pain score was based on owner response to questions regarding analgesic requirement, activity level, appetite, and degree of lameness in the affected dogs. Seventeen (74%) of the 23 dogs experienced complete pain relief, and 3 (13%) obtained partial relief. Of the 17 dogs that achieved a complete response, pain recurred in 8 at a median time of 70 days. Six dogs were alive and free of pain up to 557 days after irradiation. The 0-7-21 protocol was well tolerated; pain relief occurred quickly, and acute radiation reactions were negligible.

0-7-21 radiation therapy for the treatment of canine oral melanoma.

Eighteen dogs with malignant melanoma of the oral cavity were treated with high-dose per fraction (0-7-21) radiation therapy. Eight hundred cGy was administered on days 0, 7, and 21 for a total dose of 2,400 cGy in 3 weeks. Of 17 dogs evaluated, 9 (53%) had a complete remission and 5 (30%) achieved a partial remission with an overall response rate of 83%. Local failure occurred in 2 of the 9 dogs where a complete response was initially observed. One dog died of intercurrent disease, and one died of metastatic disease without evidence of local recurrence. Five dogs are alive and free of disease 9 to nineteen months from the initiation of therapy. The 0-7-21 protocol was well-tolerated, and acute radiation reactions were low-grade and limited to the skin. The results of this study demonstrate that oral melanomas in dogs are responsive to radiation. 0-7-21 radiation therapy offers a viable alternative to radical excision, especially when tumor volume or location would require cosmetically or functionally debilitating surgery.

The impact of prostatic manipulation upon serum PSA in patients with adenocarcinoma of the prostate.

A prospective study was carried out to evaluate the possible impact of prostatic manipulation upon the serum prostate specific antigen (PSA) in a cohort of 98 patients prior to treatment of adenocarcinoma of the prostate. The PSA levels were assessed before and 1 hour after examination under anaesthetic (EUA). There were 87 complete pairs of observations. In 71 patients there was either no change (n = 2) or a rise (n = 69); in 16 there was a fall. The median change in the group as a whole was +2.0 ng/ml (range -10.8-36.2). The average percentage rise in PSA was 42.3% (median 17.4%) with the largest percentage changes seen in those with the lowest initial PSA levels, with those in the range < 4 ng/ml exhibiting a 66.7% rise and those with > 35 ng/ml a 3.2% rise (median values). An attempt is made to express these changes in a clinical sense by allocating patients (pre-EUA) to one of four ranges of values as follows, 0-4.0, 4.1-10.0, 10.1-35.0 and > 35 ng/ml and observing the frequency with which they climbed to a higher category after EUA. This occurred in 23%, 50%, and 15% of patients respectively. The changes in PSA were statistically significant but their clinical significance might depend upon the clinical setting. Thus no patient would have had their management changed as a result of such a rise in PSA, but this might assume greater importance during the months of follow-up after radiation therapy, where a rise in PSA after prostatic manipulation might result in undue patient anxiety and unnecessary investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostate cancer presenting with malignant ascites: signet-ring cell variant of prostatic adenocarcinoma.

A case of prostate cancer presenting with malignant ascites as the sole clinical manifestation is reported. The clinical course simulated occult gastrointestinal malignancy. At the histologic level, the tumor had a signet-ring morphology. Detailed immunocytochemical and ultrastructural studies, however, confirmed the prostatic origin of this neoplasm. Signet-ring carcinoma of the prostate is a rare aggressive form of prostatic cancer which may present with a malignant effusion and may mimic gastrointestinal cancer.