The value of follow-up in stage II carcinoma of the cervix.

The optimal frequency of clinic follow-up after radical radiotherapy to early cervical cancer is not well established. A retrospective analysis was carried out of 392 patients with FIGO Stage IIA and IIB carcinoma of the cervix treated by radical radiotherapy who attended a radiotherapy clinic for follow-up. A total of 38 (43%) of the 87 locoregional and 25 (38%) of the 66 metastatic relapses were detected at routine clinic visits. There were 72 clinic visits per relapse detected. The majority of locoregional and metastatic relapses whether detected at routine or interval visits were symptomatic of the locoregional recurrences 78% (42/54) occurred in the first two years following treatment. The majority were advanced. 7% (4/54) of locoregional relapses occurred after 5 years. Only 17% (9/54) of patients with locoregional relapse underwent salvage surgery. More intensive follow-up in the first two years is recommended.

The value of follow-up in FIGO stage IB carcinoma of the uterine cervix.

The value of hospital follow-up in the detection of first locoregional or metastatic relapse was assessed in 276 patients with histologically confirmed FIGO Stage IB carcinoma of the cervix. All were treated by intracavitary and external beam irradiation. The maximum period of follow-up studied was 10 years (median follow-up was 55 months) during which 3190 routine and interval clinical visits were made. Fifteen (44%) of locoregional relapses (LRR) and eight (38%) of metastatic relapses were detected at routine visits (137 visits per relapse detected). Seventy-five per cent of relapses occurred within the first 5 years. Nine LRR occurred in the second quinquennium. Five (14.7%) of LRR underwent salvage surgery, three of whom were asymptomatic at the time of relapse. If routine visits had been stopped at 5 years the number of clinical visits would have been reduced by 15%, possibly at the cost of one patient whose asymptomatic LRR might not have been amenable to salvage surgery, had she not presented until she was symptomatic. Routine follow-up beyond 5 years is of dubious benefit in the detection of relapse.

Synchronous 5-fluorouracil, mitomycin-C and radiation therapy in the treatment of locally advanced carcinoma of the cervix.

Locally advanced carcinoma of the cervix has a poor prognosis with a high incidence of persistent or recurrent local disease contributing to distressing symptoms and poor survival. This has remained unaltered over the past 30 years in spite of the addition of other therapeutic modalities. Between 1983 and January 1986, 38 patients with locally advanced carcinoma of the cervix were treated with synchronous 5-fluorouracil, mitomycin-C, and radiotherapy. The results of this pilot study indicate both an improvement in pelvic control and in 3-year survival rate for the chemosensitized therapy compared to conventional radiotherapy alone (55% v 28%) using historical controls. Improved survival was only significant for bulky FIGO Stage IIb tumors. The toxicity of this combination was predominantly gastro-intestinal and led to modification of both radiation dose and technique with subsequent improvement in the incidence of side effects. The results suggest that the combination of synchronous chemotherapy with radiotherapy is an improved method of treatment for locally advanced carcinoma of the cervix and that a prospective randomized trial is now justified.

Extramedullary plasmacytoma of the rectum: two cases treated by radiotherapy.

Two cases of extramedullary plasmacytoma of the rectum treated by radiotherapy are reported. In one patient local control of disease was achieved at 36 months. A second patient treated by a palliative course of radiotherapy had initial good local regression and control of symptoms at 3 months. In view of the radiosensitivity of this tumour, consideration should be given to treating extramedullary plasmacytoma of the rectum by primary radiotherapy.

The pathogenesis of post-irradiation chronic diarrhoea: measurement of SeHCAT and B12 absorption for differential diagnosis determines treatment.

The absorption of vitamin B12 and of a synthetic bile acid analogue 75SeHCAT was measured simultaneously in 26 patients presenting with persistent diarrhoea following pelvic irradiation for treatment of carcinoma of the cervix. Four groups were identified, namely patients with isolated bile acid malabsorption, patients with isolated B12 malabsorption, patients with malabsorption of both and those with malabsorption of neither compound. The therapeutic implications are different for each. Measurement of B12 and bile acid absorption comprises an important new test for the management of patients with this disabling and unpleasant complication of radiotherapy.

The detection of DNA tumour virus-specific RNA sequences in abnormal human cervical biopsies by in situ hybridization.

We have used the technique of in situ nucleic acid hybridization and autoradiography of thin frozen sections of human tissue to search for virus RNA sequences in human cervical tumours. Of cervical biopsies with abnormal cytology, 67% bound herpes simplex virus type 2 (HSV2) 3H-labelled DNA probes and 39% bound adenovirus type 2 (Ad2) 3H-labelled DNA probes, whereas control experiments with phage lambda 3H-labelled DNA probes, under the same conditions, bound to only 7% of cases. In contrast, normal cervical biopsies bound the three probes in only 23%, 17% and 8% of cases respectively.