Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: a randomized clinical trial.

INTRODUCTION: Despite the large number of clinical trials on breast cancer, patient-related factors such as perioperative anxiety and level of knowledge about the disease and treatment have not been included in mainstream research efforts. This randomized trial was performed to evaluate the impact of information, provided preoperatively, on anxiety and knowledge of women undergoing mastectomy for breast cancer. METHODS: Sixty consecutive patients with breast cancer, admitted for a mastectomy, as primary treatment for breast cancer, with no previous cancer history, were randomized to receive structured information (short video about practical aspects of the hospital stay, surgical and adjuvant treatment) in addition to the routine informed consent procedure for surgery or the routine informed consent only. Anxiety and subjective knowledge levels were measured with the visual analogue scales; in addition, knowledge was assessed with a questionnaire. RESULTS: There was no significant effect of the additional information on perioperative anxiety or knowledge (subjective). Significantly more patients in the additional information group correctly listed all major available treatment options compared to the patients that received routine information (preoperatively 54% vs. 19%; p = 0.0101; 7 days postoperatively 50% vs.19%; p = 0.0367). CONCLUSIONS: Use of an informational video, preoperatively, did not significantly affect perioperative anxiety or subjective knowledge. Additional research is needed on effective delivery of disease- and treatment-specific information perioperatively.

Prognostic factors in patients with carcinoma of the vulva--our own experience and literature review.

AIM OF THE STUDY: The objective was the analysis of prognostic factors and treatment outcomes of 104 patients with vulvar cancer, treated between 1990 and 2003 in the Center of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow, Poland. MATERIAL AND METHODS: The median age of patients was 67. Advanced disease (TNM III and IVA) was found in 54 (51.9%) patients and grade 2 and 2 in 50 (48.1%). Inguinal lymph nodes were clinically uni- or bilaterally involved in 40.4% of patients. Fifty-seven (54.8%) patients underwent radical vulvectomy with bilateral inguinal lymphadenectomy and 47 (45.2%) radical vulvectomy only. Cancer differentiation was well in 38 (36.2%) of patients, moderate in 38 (36.2%) and poor in 28 (36.6%). Adjuvant radiotherapy was applied in 30 (28.8%) cases. RESULTS: Five-year overall survival rate was observed in 44.4% of patients. Depending on TNM grade, 5-year OS rates were 61.4% for grade 1, 54.9% for grade 2, 40.1% for grade 3 and 13.3% for IVA. In patients aged < 70, 5-year OS rate was 54.7% compared to 30.5% for those > or = 70. Among patients with G1 cancer differentiation 64.4% survived five years, with G2 39.1% and with G3 24.9%, respectively. CONCLUSION: Univariate analysis revealed a statistically significant, unfavorable impact of age > or = 70, with G3 cancer differentiation, clinically confirmed inguinal lymph node involvement and TNM classification stage on 5-year overall survival. Cox multivariate analysis demonstrated that independent prognostic factors for 5-year survival were the age of the patient, clinical status of inguinal lymph nodes and TNM classification grade.

[Follow-up of 70 patients with advanced ovarian cancer after negative second-look laparotomy]. / Abstention thérapeutique dans les cancers ovariens avancés après laparotomie de second look négative.

OBJECTIVES: To analyze the results of treatment of 70 patients with stage III and IV ovarian cancer after second look laparotomy with negative findings and to identify causes of failure and prognostic factors. MATERIALS AND METHODS: Between 1985 and 1998, seventy patients with ovarian cancer stage III and IV were treated with surgery and at least six courses of chemotherapy with cisplatin doxarubicin and cyclophosphamide. Then a second look laparotomy was performed. RESULTS: The actuarial survival rate without evidence of disease was 50% at 5 years. Locoregional failure was observed in 31 patients (88%) and distant metastases in 9, but they were the sole reason for unsuccessful treatment in only 4 (12%). Adverse prognostic factors were: grade 3 differentiation, primary stage IIIC and IV, and residual infiltration exceeding 2 cm after first laparotomy. CONCLUSION: Our results are comparable with reports in the literature. The actuarial survival rate without evidence of disease at 5 years in patients with advanced ovarian cancer after second look negative laparotomy is 50%.

The efficiency of treatment in patients with uterine-confined endometrial cancer.

AIM: To present our experience regarding the efficiency of treatment in patients with uterine-confined endometrial cancer. PATIENTS AND METHODS: 775 patients with uterine-confined endometrial cancer (UCEC) were treated between July 1985 and June 2000 in the Krakow Branch of Sklodowska Memorial Institute. RESULTS: Among the 775 patients, 5-year disease-free survival was observed in 82.8% patients; 96% patients with low risk of disease recurrence, 93.6% patients with intermediate risk and 78.3% patients with high risk survived five years with no evidence of disease. In the group with a high-risk disease recurrence rate, 5-year disease-free survival was statistically higher among patients treated with adjuvant brachytherapy plus external beam radiotherapy (EBRT) in comparison to patients treated with adjuvant brachytherapy (BRT) alone (82.4% vs 72.1%). CONCLUSIONS: The recommended treatment in patients with high and moderate differentiation of UCEC with FIGO Stage IA is surgery alone. Surgery with adjuvant EBRT in the group of patients with intermediate risk of cancer recurrence allows over 90% of patients to be cured. In the group of patients with a high risk of disease recurrence adjuvant BRT with EBRT is statistically more efficient in comparison to BRT alone.

Prognostic significance of pretherapeutic and therapeutic factors in patients with advanced cancer of the uterine cervix treated with radical radiotherapy alone.

The prognostic importance of various pretherapeutic and therapeutic factors was analysed in a group of 413 cervical cancer patients with stage IIB (183 pts) and IIIB (230 pts) treated with radical radiotherapy, which consisted of external irradiation and intracavitary brachytherapy. Univariate analysis of pretherapeutic factors revealed the prognostic significance of patient age, history of abortion, stage, haemoglobin and hematocrit levels. Five-year overall survival rate in stage IIB patients was 51%, in stage IIIB 40% and the respective rates for local control at each stage were 61%, and 46%. Univariate analysis of therapeutic factors showed that survival and local control rates increased with the dose, but a significant difference was found only in the case of a paracentral (point A) dose. In a multivariate analysis only patient age, abortions, and clinical stage appeared to have a significant and independent impact on survival. Linear regression analysis results indicated that prolongation of treatment time between 33 and 108 days caused a loss of local control of 0.36% per day.

Whole abdominal external beam radiation in the treatment of primary carcinoma of the fallopian tube.

Thirty-two patients with adenocarcinoma of the fallopian tube, treated between 1975 and 1990, were studied. Thirteen patients had stage I disease, 9 stage II, and 10 stage III. All patients underwent bilateral salpingo-oophorectomy, total abdominal hysterectomy, and subcolic omentectomy. All patients received postoperative primary whole abdominal external beam radiotherapy. Seventeen patients (53.1%) of the treated group survived NED for at least 5 years. Survival was 76.9% for stage I, 55.6% for stage II, and 20% for stage III. In the Cox multivariate analysis, two variables were independently related to survival: stage of disease and size of residual disease after surgery. Postoperative teleradiotherapy was totally ineffective in gross residual (>2 cm in diameter) disease (0% 5-year NED survivors) and not effective enough in small residual disease (<2 cm in diameter) (33% 5-year NED survivors). Despite postoperative whole abdominal external beam radiotherapy, 3 patients with microscopic, 4 with small, and 4 with gross residual disease did fail within the peritoneal cavity.

[Primary fallopian tube carcinoma. Analysis of 32 cases]. / Pierwotny rak jajowodu. Analiza 32 przypadków.

A retrospective analysis of 32 patients with primary fallopian tube carcinoma treated at Center of Oncology in Kraków is presented. In all cases therapy consisted of primary total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjunctive radiotherapy. Five year without evidence of disease survived 53.1% of the patients. Stage of disease was the only prognostic factor: survival at 5 years was 76.9% for stage Io, 55.6% for stage IIo, and 20% for stage III.

[Cervix neoplasms in women younger than 36 years of age]. / Rak szyjki macicy u kobiet ponizej 36 roku zycia.

Between 1970 and 1986, 252 women under 36 years of age with cervical carcinoma were treated in the Center of Oncology in Cracow. The five-year disease-free survival for all patients was 52.8%. In the multivariate analysis tumor stage IIB and III and the age under 30 years were adverse prognostic factors.

[A case of advanced vulvar cancer treated with combination therapy]. / Przypadek zaawansowanego raka sromu leczonego metoda skojarzona.

Presented is a patient with advanced vulvar cancer involving the vagina, the perineum and the anus, with metastases to inguinal lymph nodes. The patient received irradiation and next, an artificial sigmoidal anus was made, with simultaneous vulvectomy performed with an electrosurgery. The patient's survival of 3 years and 3 months encourages to consider in such cases an attempt at applying aggressive surgical treatment combined with external radiotherapy.

[Teratoma of the ovary. Analysis of prognostic factors]. / Potworniaki jajnika. Analiza czynników rokowniczych.

Forty-one patients with teratoma of the ovary were operated in the Center of Oncology in Kraków. The five-year disease-free survival for all patients was 68.3%. The histological grading appear to be an important prognostic factor. The five-year disease-free survival for patients with grade 0 was 100%, grade I--80%, grade II and III--14.3%.

Adjuvant progestagen therapy improves survival in patients with endometrial cancer after hysterectomy. Results of one-institutional prospective clinical trial.

A prospective study was conducted to determine the effectiveness of adjuvant hormonotherapy in endometrial cancer after surgery. Two hundred and five patients were randomly assigned to adjuvant progestagen treatment or were given no additional therapy. The follow-up was 5-years. We concluded that there was evidence of gain from adjuvant progestagen therapy in postoperative endometrial cancer. The group of patients who received progestagens had significantly longer survival than the control group without hormonotherapy (Logrank test; P < 0.001).

[Morphological and clinical evaluation of non-epithelial and mixed neoplasms of the female reproductive organs. II. Leiomyosarcoma]. / Ocena morfologiczno-kliniczna zlosliwych nienablonkowych i mieszanych nowotworów narzadu rodnego. II. Miesniak gladkokomórkowy miesakowaty.

Among 12886 malignant neoplasms of female sex organ 34 leiomyosarcoma were found. Average age of suffering women was 50 years. Metrorrhagia and lower abdominal pain were most common symptoms reported. Surgical treatment was supplemented with radiotherapy. Significant impact on prognosis showed: number of mitoses, number of bizarre and giant cells, massive necrosis and hyalinization. Efficient early diagnosis these neoplasms still awaits improvement.