Factors influencing outcome of definitive radiotherapy for localized carcinoma of the prostate.

Definitive radiation therapy was administered to 577 patients with histologically confirmed carcinoma of the prostate localized to the pelvis. Results of therapy and prognostic factors are evaluated and compared with other reports. All patients were followed for a minimum of 3 years, the median period of observation is 6.5 years. The disease-free survival in stages A2 and B was 78% at 5 years and 60% at 10 years; in stage C, 60% at 5 years and 36% at 10 years. The overall actuarial survival in stage B patients was 76% at 5 years and 58% at 10 years, which is similar to the life expectancy of a comparable cohort of normal males. In stage C, the actuarial survival was 65% at 5 years and 38% at 10 years, approximately 15% below the normal life expectancy for a similar cohort. Histological differentiation of the tumor had a significant impact on survival, poorly differentiated tumors showing 20% lower survival rates, most likely related to a higher incidence of distant metastases. Age was not found to be a significant prognostic factor in patients with stage B tumors; however, in stage C, the 5-year disease-free survival was 43% in patients younger than 60 and 53% in those older than 60 years (p = 0.04). In stage B, patients who had control of the pelvic tumor exhibited a 80% actuarial 5-year survival and 60% at 10 years. This compares with an actuarial survival of 30% at 5 and 10 years when there was evidence of pelvic recurrence alone or combined with distant metastases. In stage C patients with pelvic tumor control, actuarial survival was 81% at 5 years and 50% at 10 years, in comparison with 20% 5-year and 10% 10-year survival when pelvic recurrence or distant metastases or a combination of both occurred. The method of diagnosis [transurethral resection of the prostate (TURP) versus needle biopsy] did not appear to be a major prognostic factor of survival or patterns of failure, except in patients with stage C moderately differentiated tumors. The interpretation of the lymphangiogram (normal, suspicious or abnormal) did not correlate with survival or tumor control. The pathologic status of the lymph nodes established at lymphadenectomy did not appear to relate to survival for patients with stage B disease.(ABSTRACT TRUNCATED AT 400 WORDS)

Definitive radiation therapy in carcinoma of the prostate localized to the pelvis: experience at the Mallinckrodt Institute of Radiology.

Definitive radiation therapy was administered to 577 patients with histologically confirmed carcinoma of the prostate localized to the pelvis between January 1967 and December 1983. All patients were available for a minimal 3-year follow-up, and the median period of observation is 6.5 years. The actuarial survival without tumor in stages A2 and B at 5 years was 78% and at 10 years 60%. In stage C, the corresponding survival figures were 60% at 5 and 40% at 10 years. The overall actuarial survival in stage B patients was 76% at 5 and 56% at 10 years, which is similar to the life expectancy of a comparable cohort of normal males. In stage C, the actuarial survival was 65% at 5 and 35% at 10 years. The pelvic failure rate in stage A2 was 12% (5 of 41), 17% in stage B (31 of 185), 28% (93 of 328) in stage C, and 48% (11 of 23) in stage D1. Distant metastases were noted in 12% of the patients with stage A2, 20% stage B, 42% stage C, and 65% stage D1. In stage B, patients who had control of the pelvic tumor exhibited an 85% actuarial 5-year survival and a 60% one at 10 years. This compares with an actuarial survival of 30% at 5 and 10 years when there was evidence of pelvic recurrence alone or combined with distant metastases. In stage C patients with pelvic tumor control, actuarial survival was 81% at 5 and 50% at 10 years, in comparison with 25% at 5 and 10% at 10 years when there was development of pelvic recurrence or distant metastases or a combination of both. There was a strong correlation between the survival and appearance of distant metastases with the histologic degree of differentiation of the tumor in all stages. However, the probability of tumor control in the pelvis was not significantly correlated with this parameter. The administration of hormones concomitantly with radiation therapy did not significantly influence the probability of tumor control, appearance of distant metastases, or survival. Major sequelae of therapy were noted in 2.2% of the patients, whereas minor sequelae were observed in approximately 12% of the patients. Radiation therapy has been shown to be an effective therapeutic alternative to radical prostatectomy or hormonal manipulation in patients with carcinoma of the prostate.

Para-aortic node biopsy in cervical and endometrial cancers: does it affect survival?

Two hundred ten patients with endometrial and cervical carcinoma had para-aortic node biopsies. Nineteen of the 210 patients (9.0%) had positive para-aortic nodes. These 19 patients received pelvic irradiation, and 18 patients received para-aortic irradiation. The incidence of para-aortic nodal involvement in cervical carcinoma was directly related to the stage of the disease. Eleven of the 12 patients with cervical carcinoma and positive para-aortic nodes received both pelvic and para-aortic irradiation. Three of these patients are alive without disease, resulting in a survival rate of 25%. These patients are surviving for 16, 30, and 41 months. The incidence of positive para-aortic nodes in endometrial adenocarcinoma was related to the uterine length and the histologic grade. The survival rate for patients with endometrial adenocarcinoma and positive para-aortic nodes in this study was 57.1%. Four patients have survived for 1, 30, 60, and 71 months. There were no surgical deaths or radiation therapy complications directly attributable to para-aortic biopsy or irradiation.

Tumor control in definitive irradiation of localized carcinoma of the prostate.

At the Mallinckrodt Institute of Radiology, Washington University, 343 patients with carcinoma of the prostate were treated with definitive radiotherapy. All patients are available for minimal 3 year follow-up; the median period of observation is 5.2 years. The incidence of pelvic recurrence with or without distant metastases was 0% in 10 patients with Stage A2, 11% in 113 patients with Stage B, 34% in 204 patients with Stage C, and 40% in 16 patients with Stage D1. There was no significant difference in pelvic tumor control when correlated with the degree of differentiation of the tumors in each stage. In Stage B, patients who exhibited complete regression 3 months after completion of therapy had a pelvic failure rate of 5%, those with 50-75% regression-8% and less than 50% regression-18%. In Stage C, patients with more than 50% tumor regression had a pelvic failure rate of 25%, in contrast to 37% when less than 50% regression was noted at 3 months after completion of irradiation. However, there was no correlation between tumor regression and NED survival. In patients with Stage B, there was no significant correlation between doses of irradiation ranging from 6000 to 7000 cGy and pelvic tumor control. In Stage C, patients receiving doses higher than 6500 cGy had a probability of failure rate in the pelvis of 25% (40/173), in comparison with 44% with doses between 6000-6500 cGy (15/32). The 10 year NED survival for Stage A2 was 100%, Stage B-70%, and Stage C-40%. In Stage B, there was no correlation between local tumor control and 5 year overall survival. However, at 10 years 88 patients without evidence of local failure or distant metastases had a survival rate of 70% in contrast to only 25% if they recurred. In Stage C, 110 patients without local recurrence or distant metastases had a 40% 10 year survival in contrast to 20% in 55 patients who had pelvic recurrence (with or without distant metastases) and 39 patients with distant metastases only. In 105 patients with Stage B tumor controlled in the pelvis, the incidence of distant metastases was 16%, in contrast to 50% in eight patients with pelvic failure. In Stage C, only 26% of 149 patients with pelvic tumor controlled developed distant disease, versus 60% in 55 patients failing in the pelvis. Ninety-five percent of the pelvic failures and 80% of the distant metastases appeared within 5 years after therapy. The administration of hormones did not significantly influence either the probability of pelvic tumor control or the appearance of distant metastases.

Carcinoma of the oral tongue: a study of patient selection and treatment results.

Retrospective review of 118 primarily treated cancers of the oral tongue was done to study patient selection and to search for improved treatment strategies. Small surface lesions were treated by local excision (LE); most small lesions invading muscle of the tongue without lymph node metastases were treated by radiation alone (RA) while larger lesions and those with palpable nodes were treated by preoperative radiation and surgery (R + S). Ultimate control of the primary tumor and lymph nodes after initial treatment and surgical salvage was high for the lesions by LE (91%), the T1N0 lesions treated by RA (88%) and for the TxN+ lesions treated by R + S (57%). Improved treatment strategies are suggested for T2N0 lesions treated by RA because of poor tumor control (53%) and a high rate of radiation complications (25%), and for T3N0 lesions because so many of these patients died from causes other than cancer within two years. Second primary cancers were most common in those patients with a good prognosis.

Metastatic thymoma with myasthenia gravis and pure red cell aplasia.

Metastatic malignant thymoma developed in a 64-year-old man after a 9-year history of myasthenia gravis. Following good response to irradiation of the mediastinal mass and osseous metastasis, pure red cell aplasia developed.

Prognostic significance of endometrial extension from primary carcinoma of the uterinecervix.

This is a retrospective analysis of 302 patients with histologically confirmed primary carcinoma of the cervix on whom a dilatation and curettage was performed during the initial workup. The prognostic significance of endometrial extension of the tumor was investigated. Four different types of specimen were identified: 1) endometrial extension of cervical carcinoma; 2) cervical carcinoma in the currettings only; 3) a mixture of normal endometrium and and epidermoid carcinoma in the curettings; 4) no cervical carcinoma noted (negative D&C). The patients were staged according to the FIGO classification. Patients with Stage I carcinoma and positive D&Cs showed significantly lower 3-5 year survival rates (50-60 percent), as opposed to those with D&C.