RESUMEN
OBJECTIVE: To try and reduce the amount of routine postoperative radiotherapy that we prescribed without causing an unacceptable rise in locoregional recurrences. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 836 women who were treated for breast cancer between January 1980 and December 1989. INTERVENTIONS: These 836 had been treated by modified radical mastectomy (n = 534), excision of the tumour and axillary dissection (n = 279), lumpectomy (n = 15), or total mastectomy (n = 8). In December 1984 we stopped giving routine postoperative irradiation to women with T1 or T2 tumours unless there was any doubt about the operative specimen. MAIN OUTCOME MEASURES: The rate of locoregional recurrence 1985-9 compared with that from 1980-December 1984. RESULTS: Only 1 patient of 836 had a clinically detectable recurrence in the internal mammary chain. There were only 2 recurrences in the 235 axillas that had not been irradiated. CONCLUSION: By a process of careful selection of patients for locoregional irradiation, the number of fields of irradiation given to patients with breast cancer can be reduced by up to 80% without causing a rise in the rate of locoregional recurrences.
Asunto(s)
Neoplasias de la Mama/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/cirugía , Terapia Combinada , Estudios de Factibilidad , Femenino , Humanos , Mastectomía Radical Modificada , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
Thirty-five patients with oesophageal cancer were treated with external beam irradiation (50-60 Gy) followed by a boost-dose of 15-20 Gy by means of low dose rate intraluminal brachytherapy. Of the 35 patients treated 17 (48%) were pretreated with laser therapy or dilation alone. Although the intraluminal application time was long (up to 36 h) the treatment was feasible with minor acute toxicity. The palliative effect of the combined treatment was excellent; a 6 weeks post-treatment 32 of the 35 patients were able to eat solid food. Late complications were seen in six patients (17%), of which only one was severe and probably treatment-related. The median survival was 11 months; the 1- and 2-year survival were 42% and 10% respectively. The survival was strongly dependent on local control. Distant metastases became evident in 23% of patients. The interval between external radiotherapy and brachytherapy seemed to be critical. The results were compared with 68 historical controls. A significantly better survival was observed at 6 months. It is concluded that low dose rate intraluminal brachytherapy is a useful and feasible technique to increase the total dose for obtaining a better local control. The shortcomings are discussed and ideas for further improvement are mentioned.
Asunto(s)
Braquiterapia , Neoplasias Esofágicas/radioterapia , Anciano , Anciano de 80 o más Años , Braquiterapia/efectos adversos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Dilatación , Neoplasias Esofágicas/complicaciones , Esofagitis/etiología , Esofagoscopía , Femenino , Estudios de Seguimiento , Alimentos , Humanos , Radioisótopos de Iridio/uso terapéutico , Masculino , Métodos , Recurrencia Local de Neoplasia , Cuidados Paliativos , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Inducción de Remisión , Tasa de SupervivenciaRESUMEN
Thirty-five patients with an inoperable or non-resectable oesophageal carcinoma were treated with external radiotherapy to a maximum dose of 60 Gy followed by a booster irradiation by means of intraluminal brachytherapy at a low dose rate (40-112 cGy/h). For this extra irradiation, which lasted 20-36 h, a catheter with a thickness of 3 mm was introduced through the nose. This treatment could be carried out without sedation. The total radiation dose after the combination therapy amounted to 65-75 Gy. Of the 35 patients, 17 were pretreated with dilatation or laser therapy. The palliative effect after the external and internal irradiation was very good; only one patient still had minor dysphagia 6 weeks after the treatment. Transient irradiation oesophagitis occurred in 16 patients. In three patients, a secondary benign stenosis developed. The median duration of survival was 11 months, the 2-year survival rate was 10%. A comparison of these results with a historical control group treated only with external irradiation shows that the duration of survival of these patients appears to be increased during the first 45 weeks.
Asunto(s)
Braquiterapia , Neoplasias Esofágicas/radioterapia , Radioterapia de Alta Energía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Radioisótopos de Iridio/administración & dosificación , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Dosificación RadioterapéuticaRESUMEN
The choice of treatment for patients with cancer of the esophagus and cardia is controversial. Since overall survival is poor, the most important aim of treatment should be improvement of the main complaint: the inability to eat. In a retrospective analysis of 265 patients, referred to the University Hospital in Leiden, The Netherlands, comparisons were made between palliative effects of surgical resection (N = 92) and irradiation (N = 128). Several methods of comparing surgery with irradiation are possible: (1) all surgical patients vs. all irradiated patients; (2) only those surgical patients who survived the operation (N = 70) vs. all irradiated patients (N = 128); and (3) survivors after resection (N = 70) vs. only those irradiated patients treated with "curative" radiation (N = 62). Analysis of prognostic factors showed that in both surgical and irradiated patients, the only statistically significant factor was the (dis)ability to eat. Criteria to be considered to make individual recommendations for either treatment are presented.
Asunto(s)
Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/cirugía , Neoplasias Gástricas/radioterapia , Neoplasias Gástricas/cirugía , Adulto , Anciano , Algoritmos , Cardias , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Cuidados Paliativos , Estudios Retrospectivos , Neoplasias Gástricas/mortalidadRESUMEN
The value of DNA-flow cytometry and clinico-pathological prognostic factors for the prediction of local recurrences after breast-conserving therapy (BCT) were evaluated in a retrospective study. Thirty-one patients with a local recurrence were compared with 31 matched patients without a local recurrence. Morphology and DNA-indices of the local recurrences and their corresponding primary tumours were compared. Ductal carcinoma in situ was present significantly more often in the group with a primary recurring tumour, than in the matched group (P less than 0.001), and the same holds for lobular carcinoma (n = 5). Half of the tumours that recurred had macroscopically positive surgical margins compared to about one-fourth of the matched group. Fifty-six per cent of the DNA-aneuploid stemlines in cases with local recurrence were present in the corresponding primary tumour as well (confidence limits 45%-75%), an indication that the majority of local recurrences are true recurrences and not independently developed tumours. The lack of similarity of DNA stemlines between some primary DNA-aneuploid tumours and their local recurrences indicates that these tumours had developed independently. The percentage of DNA-aneuploid cases in the group with local recurrence (89%) did not differ significantly from that in the matched group (70%). However, the findings suggest a selective recurrence of DNA-diploid stemlines. This might indicate increased resistance of DNA-diploid tumour cells to radiotherapy as compared with the resistance level in DNA-aneuploid cells.
Asunto(s)
Neoplasias de la Mama/patología , ADN de Neoplasias/genética , Ploidias , Aneuploidia , Neoplasias de la Mama/genética , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , ADN de Neoplasias/análisis , Femenino , Citometría de Flujo/métodos , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
From 1976 through 1984 46 patients with locally advanced breast cancer were treated by either radiotherapy alone or by combination of surgery and postoperative radiotherapy. Eleven of the 21 patients treated by radiotherapy alone had a local or regional recurrence, while no recurrences occurred in the combined treatment group. From this study it was concluded that "locally advanced" breast cancer is a heterogeneous disease and that further study concerning the role of surgery is justifiable for a selected subgroup of patients with non-inflammatory resectable tumours (meeting the criteria of "locally advanced" breast cancer).
Asunto(s)
Neoplasias de la Mama/terapia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios RetrospectivosRESUMEN
A group of 127 patients with esophageal cancer treated with radiotherapy at different dose levels was retrospectively analysed. It was found that 70.5% of the patients showed improvement of dysphagia and that 54% remained palliated with respect to food passage until their death. The two major prognostic variables with respect to the palliative effect on dysphagia as well as survival were the passage score and the radiation dose. Patients with severe dysphagia (PASS 0 or 1) had a median actuarial DFI and SURV of 3.7 and 6.4 months, respectively, in contrast to 16.0 and 8.7 months for patients who were able to use (semi)solid food (PASS 2 and 3). The median actuarial DFI and SURV of patients treated with a relatively low dose (less than 50 Gy in 5 weeks) were 2.5 and 4.8 months, respectively, compared to 10.1 and 8.3 months, respectively, for patients treated with a relatively high dose.
Asunto(s)
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Carcinoma/radioterapia , Trastornos de Deglución/radioterapia , Neoplasias Esofágicas/radioterapia , Adenocarcinoma/complicaciones , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/complicaciones , Carcinoma/mortalidad , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/mortalidad , Trastornos de Deglución/etiología , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
Flow cytometric DNA ploidy measurements using frozen or deparaffinized tumor specimens were performed on 565 primary breast cancers from patients treated in the period 1975-1984. Twenty-nine percent of the cases were diploid, 61% had a single aneuploid stemline, and 10% were multiploid. Aneuploid tumors more often had negative estrogen receptor values than diploid tumors, but no significant correlation was found between ploidy class and TNM stage. Patients with more than ten positive axillary lymph nodes had predominantly aneuploid tumors. Overall and distant relapse-free survival were higher for patients with diploid tumors and low-aneuploid tumors. Stratification of the patients according to degree of lymph node involvement, TNM stage, and menopausal stage showed that the prognostic effect of aneuploidy was apparent predominantly in patients with locally advanced disease. Postmenopausal node-positive patients with diploid tumors had a significantly better prognosis than those with aneuploid tumors, but this difference was not found for the comparable premenopausal group. Multivariate analysis with the Cox proportional hazards model indicated that ploidy is an additional, independent prognostic factor in postmenopausal patients.
Asunto(s)
Neoplasias de la Mama/genética , ADN de Neoplasias/análisis , Ploidias , Aneuploidia , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Femenino , Citometría de Flujo , Humanos , Pronóstico , Receptores de Estrógenos/análisis , Estadística como AsuntoRESUMEN
In 95 patients with inoperable squamous cell carcinoma of the bronchus, nine potential serum "markers" were analysed for their prognostic significance. Lactate dehydrogenase, alpha 1 HS-glycoprotein, ferritin, carcino-embryonic antigen and immunoglobulin E did not prove to be useful as prognostic indices. The erythrocyte sedimentation rate and the acute phase proteins alpha 1 acid glycoprotein, C-reactive protein and prealbumin were correlated with survival. After taking the performance status and tumour stage into account, C-reactive protein still proved to be a strong prognosticator. The clinical relevance of the acute phase proteins signifying a so-called "biochemical status" next to the "clinical status" is discussed.
Asunto(s)
Proteínas Sanguíneas/análisis , Neoplasias de los Bronquios/sangre , Carcinoma de Células Escamosas/sangre , Proteínas de Fase Aguda , Anciano , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Orosomucoide/análisis , Pronóstico , RiesgoRESUMEN
Small bowel transit was performed in 50 patients with bladder or prostatic carcinoma. The patients were all examined in supine and prone positions; some were also studied in 25 degrees Trendelenburg position and 25 degrees inclined procubitus to investigate the effect of the various positions on the displacement of the small bowel loops out of the true pelvis. The prone position proved to be superior to the supine position in 78% of patients. A mean displacement of 0.9 cm was obtained. Greatest shifts generally were found in the Trendelenburg position and inclined procubitus, with a mean displacement of 1.9 and 2.0 cm, respectively. The patients' height, weight, maximal abdominal circumference and Quetelet's index were analyzed with regard to the shifts of bowel loops under the various conditions. Only weight and Quetelet's index were correlated with the shifts in the Trendelenburg and inclined procubitus positions. The shifts were generally larger in case of heavier patients. We conclude that pelvic irradiation should preferably be done in the Trendelenburg or inclined procubitus position, especially in case of obesity.