Outcomes following surgery and adjuvant radiation in stage II endometrial adenocarcinoma.

PURPOSE: To evaluate locoregional control, disease free survival, and overall survival in patients treated with surgery and adjuvant radiation for stage II adenocarcinoma of the endometrium. Secondary goals include identification of prognostic factors and the comparison of toxicity profiles after vaginal cuff brachytherapy (VB) alone or combined with pelvic external beam radiation therapy (EXT). MATERIALS AND METHODS: All patients receiving adjuvant radiation at the University of Wisconsin following surgery for FIGO stage II adenocarcinoma of the endometrium between January 1991 and December 2006 were retrospectively reviewed. RESULTS: Between January 1991 and December 2006, 71 patients with FIGO stage II adenocarcinoma of the endometrium (23 stage IIA, 48 stage IIB) received adjuvant radiation at the University of Wisconsin. Fifty patients were treated with EXT and VB, twenty with VB alone, and one with EXT alone. At a mean follow-up of 5.1 years (range, 0.5-16.8 years), 5-year overall and disease-free survival were both 82%. Factors associated with an increased risk for recurrence include depth of myometrial invasion (p=0.005) and lymphovascular invasion (p=0.02). Receiving EXT was significantly associated with increased depth of myometrial invasion (p=0.007), higher grade (p=0.003), and less extensive surgery (p=0.01). Of the nine recurrences, three were initially local and six were distant recurrences alone. Grade 2 or greater acute and late side effects were significantly greater with EXT therapy compared to VB alone (p<0.0001 and p=0.02, respectively), although severe toxicities (grade 3 or greater) were limited with either modality. DISCUSSION: Local recurrence rates remain low after surgery and adjuvant radiation therapy for stage II endometrial cancer using a combination of VB and EXT tailored to the surgical and pathologic features. VB alone resulted in fewer toxicities without an increased recurrence risk compared to the combination of EXT and VB, suggesting that VB without EXT is sufficient for patients with low-risk histopathologic features and comprehensive surgical staging with complete lymphadenectomy.

Vascular endothelial growth factor (VEGF) expression and survival in human epithelial ovarian carcinomas.

Vascular endothelial growth factor (VEGF) expression and microvessel density were studied in cases of advanced epithelial ovarian carcinoma to evaluate their usefulness as prognostic variables. Tumor samples from 18 patients with advanced stage serous epithelial ovarian cancer were evaluated for VEGF expression by reverse-transcriptase polymerase chain reaction (RT-PCR) analysis. Immunohistochemical study of corresponding archival tissues with an antibody to von Willebrand factor (vWF; FVIII-RA) was used for tumor microvessel count determinations. The correlation of VEGF expression and mean microvessel counts was determined by an unpaired t-test. Survival analysis for known prognostic factors and VEGF expression was performed. Survival distributions were calculated by the product limit of Kaplan and Meier and significant differences between distributions were analyzed with a log rank test. From the RT-PCR analysis of tumor VEGF expression, 12 samples were found to be strongly positive, whereas six samples had low/negative VEGF expression. The median survival was 60 months for the VEGF-low/negative group and 28 months for the VEGF-positive group (P = 0.058). Other prognostic variables had minimal impact on survival, i.e. age < 65 years (P = 0.873), FIGO stage (P = 0.06), grade (P = 0.236) and debulking status (P = 0.842). Fourteen of 18 tumor specimens were suitable for microvessel counting. The mean microvessel counts of the VEGF-positive group and the VEGF-negative group were 27/hpf and 35/hpf, respectively (P = 0.16). In this preliminary analysis, high VEGF expression in epithelial ovarian carcinomas was associated with poor overall survival. Further study will be necessary to elucidate the lack of association of VEGF expression and tumor microvessel counts.

Familial ovarian germ cell cancer: report and review.

Ovarian germ cell cancers are rare malignancies accounting for less than 5% of all ovarian cancers. We present a family in which three closely related women were diagnosed with ovarian germ cell malignancies. This family's cancer history prompted a family history investigation of women treated for ovarian germ cell malignancies in the Gynecologic-Oncology Clinic at the University of Wisconsin. One of the eight patients whose family histories were reviewed had an uncle who had been diagnosed with testicular germ cell cancer. A review found six other previously reported families in which more than one relative had been diagnosed with a malignant ovarian germ cell tumor. Additionally, several cases of families with both males and females diagnosed with germ cell cancers have been documented. The low incidence of ovarian germ cell cancers suggests that multiple occurrences in the same family may not be due to chance. Rather, it is possible that a gene conferring susceptibility to ovarian germ cell cancers, and possibly to germ cell tumors in males as well, is present in at least some of these families.

Trends in United States ovarian cancer mortality, 1979-1995.

OBJECTIVE: To describe the epidemiology of ovarian cancer mortality in the United States from 1979 to 1995. METHODS: The mortality data of the Centers for Disease Control and Prevention were accessed using the Wide-ranging Online Data for Epidemiologic Research (WONDER). We selected all deaths among women with International Classification of Diseases, Ninth Revision (ICD-9) code 183.0 (ovarian malignant neoplasm). Mortality data for the years 1979-1995 were age-adjusted to the United States 1990 female population, and mortality rates for each year were calculated for females of all ages by age category, by race, and by geographic location. Trends were obtained for the periods 1979-1983 to 1991-1995, and the impact on the number of ovarian cancer deaths was calculated. RESULTS: Age-adjusted ovarian cancer mortality rates have changed little in the United States from 1979 to 1995, but rates are increasing in older women (65 years and older) and decreasing in younger women. Age-adjusted mortality rates are higher among whites than in blacks. Ovarian cancer mortality rates are higher in northern compared with southern states. CONCLUSION: The trends in ovarian cancer mortality among younger and older women parallel published changes in incidence and may be due to changes in risk factors, such as the use of oral contraceptives. The reasons for the higher ovarian cancer death rates in northern states are unknown. Better understanding of how modifiable risk factors and treatment methods affect ovarian cancer mortality trends is needed.

Flow characteristics in benign and malignant gynecologic tumors using transvaginal color flow Doppler.

OBJECTIVE: To assess flow characteristics of benign and malignant gynecologic tumors by transvaginal color flow Doppler. METHODS: Records of the Ultrasound Laboratory, Women's Cancer Center, University of Minnesota were analyzed retrospectively. Gray scale findings were recorded as either "diagnostic" or "nondiagnostic." Color flow assessment was performed on intratumor vessels or ovarian and/or uterine arteries. Flow was recorded as either "absent" or "present." Spectral analysis allowed determination of the systolic, diastolic, and mean velocities and calculation of the pulsatility and resistance indices. Malignancy was then predicted based upon color flow findings alone, with malignant tumors demonstrating increased color flow and a pulsatility index of at most 1.0 or a resistance index of at most 0.4. Color flow Doppler findings were then recorded as "giving additional useful information" that either confirmed questionable gray scale findings or changed the gray scale sonographic diagnosis, or as "not giving additional information" over the gray scale diagnosis. RESULTS: Two hundred thirty-one patients had gray scale sonography, and 167 also had color flow Doppler performed. Gray scale sonographic findings were sufficient to make a diagnosis in 156 (93%) of the scans. Color flow Doppler findings added useful information in 49 scans (30%). Increased color flow was highly significant (P < .0001), as was the calculated pulsatility index (P < .02) and resistance index (P < .008), in distinguishing benign from malignant tumors. Ovarian and uterine artery and intratumor assessments of the systolic, diastolic, and mean velocities were not significantly different between the benign and malignant tumors. Regression analysis confirmed the presence or absence of color flow as an independent predictor of malignancy or benignity (P < .0001). CONCLUSIONS: Our large study confirms the overall accuracy of gray scale scanning. When used alone, color flow Doppler--although specific--lacks sensitivity and predictive value as an independent predictor of malignancy. When findings were combined with those obtained from gray scale scanning, sensitivity, specificity, and predictive value were improved to acceptable levels. Significant differences existed between benign and malignant tumors for calculated pulsatility index and resistance index, but neither was sufficiently sensitive, specific, or predictive to be used alone as sole criteria of malignancy prediction. Other flow indices studied (systolic, diastolic, and mean velocities) in general did not differ significantly between groups. Physicians should be cautioned against using color flow findings alone for clinical decision making. We recommend a multi-institutional study to investigate the multiple vascular assessments to determine the role of color flow Doppler in the preoperative prediction of pelvic tumors and in screening for gynecologic abnormality.

Outpatient vaginal cuff brachytherapy for endometrial cancer.

Petereit DG, Tannehill SP, Grosen EA, Hartenbach EM, Schink JC. Outpatient vaginal cuff brachytherapy for endometrial cancer. The objective of this study was to determine the efficacy and complications of postoperative high-dose-rate (HDR) vaginal-cuff brachytherapy (VCB) in patients with endometrial carcinoma. Between August 1989 to September 1997, 191 patients were treated postoperatively after a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) with outpatient adjuvant HDR VCB for low-risk endometrial cancer (IB-84%, grade 1 or 2-96%). Patients were treated with 2 HDR fractions, delivered one week apart while under conscious sedation (16.2 Gy X 2 to the vaginal surface). All clinical endpoints were calculated using the Kaplan Meier method. The median time in the brachytherapy suite was 60 min in which no acute complications were observed. The 30-day morbidity and mortality rates were both 0%. With a median follow-up of 38 months (12-82 months), the 4-year survival, relapse-free survival, and vaginal-control rates were 95%, 98%, and 100%, respectively. One patient developed a colo-vaginal fistula at 5 years. Adjuvant HDR VCB in 2 outpatient insertions produced 100% vaginal control rates with minimal morbidity. The advantages of high dose-rate compared to low dose-rate vaginal brachytherapy include patient convenience, markedly shorter treatment times (1 h per insertion), and reduction in the cost and potential morbidity of hospitalization. HDR brachytherapy approach is a cost-effective alternative to either low-dose-rate brachytherapy or whole pelvic radiotherapy in carefully selected patients.

Metastatic placental site trophoblastic tumor.

Since our publication, which first defined the malignant potential of placental site trophoblastic tumor (PSTT), we have had a keen interest in this rare, unique entity. This histologic entity is noted by its monomorphic population of trophoblast-like cells which are classified as originating in the intermediate trophoblast. These cells contain hymman placental lactogen (HPL). This is in contrast to cytotrophoblastic and syncytiotrophblastic tissues as the histologic, cytologic and immunohistochemical stain characteristics are disparate. Its rarity and the wide spectrum of clinical behavior combined with the lack of sensitivity of serum levels of beta hCG in predicting disease recurrence and spread have lead to anecdotal reports outlining clinical management. Most discerning to the clinician is the high mortality of metastatic placental site trophoblastic tumor. At our institution, we have treated two patients with a metastatic disease with a successful conclusion. The durability of responses is 3 and 8 years. This report will present these patients in detail and define the important characteristics of successful treatment. The use of dose-intensive, multi-agent chemotherapy, early intervention when metastatic disease is discovered, imaging techniques to define disease spread, surgery for localized disease and the use of growth factors, most notably granulocyte colony-stimulating factor (G-CSF), are the fundamentals of clinical care of placental site trophoblastic tumor in patients with metastatic placental site trophoblastic tumor.

Local anesthesia for cryosurgery on the cervix.

Forty-five patients were evaluated in a prospective, randomized study to determine the effectiveness of a local injection of lidocaine in reducing pain during cervical cryosurgery. Study patients received a submucosal cervical injection of 1% lidocaine with a 1:100,000 dilution of epinephrine. Control patients did not receive an injection. Both groups received a single dose of naproxen sodium or ketoprofen prior to the procedure. The patient and the observing nurse recorded the pain experienced with a visual analog scale (VAS). Nurse and patient response for the control and study groups showed a high correlation (r = .573 and P < .01, r = .673 and P < .001, respectively). The mean VAS score recorded for the 26 control patients was 4.27, significantly greater than the mean score for the 19 study patients, 1.16 (P < .001). These findings indicate that a submucosal local injection of lidocaine with epinephrine is effective in reducing pain during cervical cryosurgery.

Exfoliative cytology of primary poorly differentiated (small-cell) neuroendocrine carcinoma of the uterine cervix in ThinPrep material: a case report.

Poorly differentiated neuroendocrine (small-cell) carcinoma of cervical origin is a rare neoplasm that frequently metastasizes. Although the cytologic features have been described for conventional cervical smears, we know of no reports of its appearance in ThinPrep (TP) material. Therefore, we present a TP case of primary, small-cell carcinoma arising in a 46-yr-old female, confirmed by histologic and immunohistochemical analysis. Similar to conventional smears, the neoplastic cells occurred either individually or in small clusters. The cells were relatively monomorphic, with stippled chromatin and minimal amounts of cytoplasm. Unlike conventional smears, nuclear molding was not prominent (although overlap was observed), and nuclear smearing was not identified. The features are compared to TP cases of squamous-cell carcinoma, small-cell type, and endometrioid adenocarcinoma, which are close mimics of small-cell carcinoma. We conclude that correct diagnosis of small-cell carcinoma in TP is difficult, requiring a high degree of suspicion and immunohistochemical confirmation.

The role of operative laparoscopy in gynecologic oncology.

The potential applications of operative laparoscopy have expanded with improvements in technology and instrumentation. With newly developed techniques to complete both pelvic and paraaortic lymph node dissection, the use of the laparoscope has increased in patients with pelvic malignancies. Gynecologic oncologists are currently incorporating the techniques of operative laparoscopy in the management of patients with cervical, endometrial, and ovarian cancer. Multicenter prospective clinical trials are necessary to further define the role of laparoscopy in gynecologic oncology.

The genetics of ovarian cancer: concepts in testing and counseling.

The discovery and sequencing of the BRCA1 gene is an exciting breakthrough for women and health care providers. BRCA1 is associated with inherited breast and ovarian cancer and the body of scientific information regarding its role in ovarian cancer is growing rapidly. The impact of this knowledge on counseling women with a family history of breast or ovarian cancer is profound. This review provides information about familial ovarian cancer syndromes and the emerging role of genetic testing in women with an inherited susceptibility for cancer.

Screening for occult nodal metastasis in squamous cell carcinoma of the vulva.

Metastases to inguinofemoral lymph nodes in patients with carcinoma of the vulva alter the prognosis and treatment of this disease. Our goal was to determine if immunohistochemical staining could reveal occult metastatic nodal disease not detected with routine hematoxylin and eosin staining. We retrospectively examined a total of 110 lymph nodes from 10 patients who had undergone lymph node dissection and found to have all negative nodes. Paraffin embedded lymph nodes were immunostained with a monoclonal antibody directed against multiple low- and high-molecular weight cytokeratins. Micrometastases were not detected in any lymph nodes examined with immunohistochemistry. All positive and negative controls yielded satisfactory results. It is concluded that immunohistochemistry with cytokeratin antibodies does not provide greater sensitivity than routine hematoxylin and eosin staining for the detection of nodal metastases in vulvar carcinoma.

Metastatic placental site trophoblastic tumor.

Since our publication, which first defined the malignant potential of placental site trophoblastic tumor (PSTT), we have had a keen interest in this rare, unique entity. This histologic entity is noted by its monomorphic population of trophoblast-like cells which are classified as originating in the intermediate trophoblast. These cells contain hymman placental lactogen (HPL). This is in contrast to cytotrophoblastic and syncytiotrophblastic tissues as the histologic, cytologic and immunohistochemical stain characteristics are disparate. Its rarity and the wide spectrum of clinical behavior combined with the lack of sensitivity of serum levels of beta hCG in predicting disease recurrence and spread have lead to anecdotal reports outlining clinical management. Most discerning to the clinician is the high mortality of metastatic placental site trophoblastic tumor. At our institution, we have treated two patients with a metastatic disease with a successful conclusion. The durability of responses is 3 and 8 years. This report will present these patients in detail and define the important characteristics of successful treatment. The use of dose-intensive, multi-agent chemotherapy, early intervention when metastatic disease is discovered, imaging techniques to define disease spread, surgery for localized disease and the use of growth factors, most notably granulocyte colony-stimulating factor (G-CSF), are the fundamentals of clinical care of placental site trophoblastic tumor in patients with metastatic placental site trophoblastic tumor.

A novel strategy using G-CSF to support EMA/CO for high-risk gestational trophoblastic disease.

EMA/CO (etoposide-methotrexate-actinomycin D and Cytoxan-Oncovin) is an effective and well-tolerated chemotherapy regimen for the treatment of high-risk gestational trophoblastic disease. However, it is associated with significant neutropenia often requiring dose reductions and treatment delays. We describe the use of granulocyte colony-stimulating factor (G-CSF) in three patients in order to maintain the treatment schedule. A subcutaneous injection of 5 micrograms/kg/day was administered on Days 3-6 and 9-14 of each chemotherapy cycle. No patients had any adverse effects and all received full chemotherapy doses without any treatment delay. The addition of G-CSF to the EMA/CO regimen may benefit patients by achieving dose intensity in the treatment of high-risk gestational trophoblastic disease.

Invasive vulvar tumors in young women--a disease of the immunosuppressed?

Twenty-seven patients under the age of 40 years were treated for invasive vulvar cancer at the Women's Cancer Center, University of Minnesota. Seventeen patients had Stage I, five patients had Stage II, two patients had Stage III, and two patients had Stage IV disease. Twenty patients (80%) gave a history of smoking. Associated medical and immunosuppressive conditions present in these patients included vulval HPV (N = 3), diabetes mellitus (N = 3), pregnancy (N = 2), autoimmune connective tissue disease (N = 2), renal transplant (N = 2), previous chemotherapy for invasive malignancies at other sites (N = 1), chronic hepatitis (N = 1), schizophrenia (N = 1), and one patient on Imuran for herpes zoster and multiple sclerosis. Two of the nonsmokers were in this group of immunosuppressed patients. Three patients have died of intercurrent disease while another is currently alive with invasive disease. All others are alive without evidence of disease. The mean duration of follow-up is 45.2 months (range, 1-158 months). Invasive vulvar tumors are uncommon in young women. Smoking and a history of an immunosuppressive medical illness is common in this patient population.

Persistent postmolar gestational trophoblastic disease: use of transvaginal sonography and colour flow Doppler.

Invasive moles have been difficult to diagnose except at hysterectomy. Many patients with persistent gestational trophoblastic disease (GTD) have been treated without ever demonstrating the site of the persistent trophoblastic focus. High resolution transvaginal sonography (TVS) has provided a technique of demonstrating very small uterine lesions, previously unsuspected by transabdominal sonography. The addition of colour flow Doppler further increased diagnostic sensitivity and provides another means of monitoring response to therapy. Three patients with persistent GTD, scanned by TVS and CFD (colour flow Doppler) performed as part of their metastatic work-up are presented. The only abnormalities detected were foci demonstrated within the myometrium that demonstrated increased flow on CFD. Single agent chemotherapy was commenced and the patients were monitored periodically through their course with repeat ultrasonography. After an initial lag period, the lesions decreased in size as the beta-HCG titres fell. An unsuspected adnexal mass was diagnosed on 1 patient, later proving to be a mature ovarian teratoma.

Quality of life assessment in gynaecological cancer patients.

The feasibility of quality of life (QOL) assessment in a heterogeneous group of gynaecological cancer patients undergoing chemotherapy was determined. All new patients being prescribed cytotoxic chemotherapy were asked to complete a modified QOL assessment tool. The elected assessment tool is the Functional Assessment Cancer Therapy-General (FACT-G) tool, comprising 33 questions under 5 broad categories: physical well-being, social well-being, relationship with doctor, emotional well-being and functional well-being. Raw scores were calculated and then transformed to a 0-100 scale. Twenty eight patients received a total of 75 treatment cycles of chemotherapy. Four patients were not offered the assessment due to language difficulties. All patients offered the test satisfactorily completed the test to allow statistical analysis. The average number of chemotherapy courses received was 2.5 (range: 1-6). Of a total possible 2,475 study items (33 items x 75 cycles), 240 items were not answered (10%). Of these 240 unanswered items, 2 items (#14 and #15) comprised 38%. The mean transformed score for physical well-being was 32 (SE 2.5), for social well-being the mean transformed score was 50 (SE 1.7), relationship with doctor 86 (SE 2.4), emotional well-being 41 (SE 2) and functional well-being was 54 (SE 2.6). The assessment of QOL indices in gynaecological cancer patients undergoing chemotherapy is feasible. Further research needs to determine the optimal QOL tool for this patient population.

Pelvic adhesion formation after pelvic lymphadenectomy: comparison between transperitoneal laparoscopy and extraperitoneal laparotomy in a porcine model.

Compared to extraperitoneal laparotomy, the transperitoneal approach is associated with increased enteric morbidity. Recently, transperitoneal laparoscopy has been employed as a method to surgically stage patients with gynecologic malignancies. The objective of this study was to investigate pelvic adhesion formation in a porcine model after pelvic lymphadenectomy performed via transperitoneal laparoscopy (LS) compared to extraperitoneal laparotomy (EP). Ten adult, female hogs underwent LS and 10 underwent EP. A complete pelvic lymphadenectomy was performed in each animal. Three weeks after the lymphadenectomy, the animals underwent exploratory laparotomy, and the adhesions were quantified. Nineteen animals were evaluable. The adhesion scores for the laparoscopy group (N = 10, mean = 0.075 +/- 0.17) were not statistically different from those of the laparotomy group (N = 9, mean = 0.28 +/- 0.52, P > 0.5). Eight of 10 (80%) and 5 of 9 (56%) animals in the LS and EP groups, respectively, had no adhesions after pelvic lymphadenectomy. Adhesion formation is one of many critical issues concerning the utility of pretreatment surgical staging, especially for cancer of the cervix. It is remarkable that only 20% of the animals undergoing laparoscopy in this study had de novo adhesions after pelvic lymph node dissection and that the mean total adhesion score was not statistically different from the extraperitoneal laparotomy. Therefore, transperitoneal laparoscopic pelvic lymphadenectomy may not induce the degree of adhesion formation associated with the transperitoneal laparotomy technique.

The utility of preoperative screening colonoscopy in gynecologic oncology.

The American Cancer Society (ACS) recommends that asymptomatic women, age 50 and over, undergo sigmoidoscopy every 3 to 5 years, after two negative yearly exams. Epidemiologic evidence suggests that women with gynecologic or breast cancers have an increased risk of developing colon cancer. It is unclear whether the ACS guidelines are applicable for women with a new diagnosis of gynecologic malignancy. This retrospective study was undertaken to assess the usefulness of preoperative colonoscopy in our gynecologic oncology patient population. Patients undergoing evaluation for a major operative procedure for known or suspected gynecologic malignancies were referred for colonoscopy at the discretion of their attending surgeon. Five hundred patients' charts were reviewed to identify 212 patients in whom preoperative colonoscopy was performed (the study group). In this group, 17 cases of colonic polyps, 5 cases of synchronous colon cancer, and 2 cases of cancer metastatic to the colon were discovered, representing 11% of the study group. Whereas 23% of the patients screened were less than 50 years of age, only two cases of polyps occurred in this age group, and no cases of cancer. Patients aged 70 or greater made up 28% of the study group, but accounted for 41% of the cases of polyps and 40% of the colon cancers. Twenty-nine percent of the study group had adenocarcinoma of the endometrium, representing 7 of 17 cases of polyps, 1 of 5 colon cancers, and 1 of 2 metastatic cancers. Although this retrospective study involved colonoscopy, the locations of the observed lesions were within the theoretic reach of a flexible sigmoidoscope in 75% of cases. We conclude that in the preoperative workup of gynecologic oncology patients, no colon screening is needed in the asymptomatic patient less than 50 years of age. ACS guidelines are appropriate for patients aged 50-70, but for those 70 or greater we would consider full colonoscopy.

Nonsurgical management strategies for the functional complications of ileocolonic continent urinary reservoirs.

Urinary diversion with creation of a continent ileocolonic reservoir was performed in 25 patients with gynecological malignancies at our institution between September 1989 and September 1994. A retrospective review was conducted and cases were analyzed for functional complications associated with reservoir formation. Functional reservoir complications were defined as (1) difficulty with catheterization, (2) reservoir fistulae, (3) reservoir stones, and (4) ureteral stenosis. Management strategies and outcomes for these complications were determined. All patients had received prior pelvic radiation therapy. There was no surgical mortality. Median follow-up was 21 months, and 16 patients (64%) are currently alive. Fourteen of the patients (56%) had one or more complications attributable to a functional aspect of the continent reservoir. Two patients had difficulty with catheterization (8%), two patients had reservoir leak (8%), and one patient had reservoir stones (4%). Nonsurgical management strategies were used in these cases including balloon dilation of the ileocecal valve, stomal dilation, ureteral stenting, percutaneous nephrostomy, and endoscopic lithotripsy. All cases of catheterization problems, reservoir fistulae, and reservoir stones were resolved with nonoperative techniques. Thirteen of 50 ureters (26%) had some degree of stenosis. Percutaneous balloon dilation was utilized in nine cases of ureteral stenosis. Relief of stenosis was complete in five, partial in two, and not achieved in two of the cases. No patients required a reoperation for a reservoir complication. In conclusion, continent ileocolonic urinary diversion can be performed in patients previously treated with radiotherapy; however, functional reservoir problems may occur. Interventional radiology strategies are useful in managing many of these problems and reexploration can be successfully avoided.