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Biomedical subjects

B W Corn

Publications and source records attributed to B W Corn.

At least 73 records · Page 4Linked to original sources
PubMed1995

Conformal treatment of prostate cancer with improved targeting: superior prostate-specific antigen response compared to standard treatment.

PURPOSE: Conformal radiation therapy (CRT) decreases the morbidity of prostate cancer treatment, but no published data attest to the improved ability of CRT to control disease. Therefore, we compared Prostate-Specific Antigen (PSA) response at 1 year among similarly staged patients treated by conformal techniques to those treated with conventional approaches, looking for an early indicator of tumor response. METHOD AND MATERIALS: Patients with locally advanced disease were treated by pelvic field followed by prostate field conedowns; those with early stage/low grade disease received only prostate field irradiation. Between October, 1987 and November, 1991, conventional treatments used rectangular beams with or without corner blocks. Neither urethrography nor immobilization casts were used for conventionally treated patients. Between April, 1989 and December, 1992, conformal treatments have used rigid immobilization and Computed Tomography-based, beams-eye-view field design. As such, our conformal approach allowed improved targeting. Median prescribed doses (minimal doses to the Planning Target Volume) were 70 Gy (66-73 Gy) and 70.2 Gy (64.8-75 Gy) for conventionally and conformally treated patients, respectively. Median daily fraction size was 1.8 Gy for conventional treatment and 2.0 Gy for conformal therapy. Baseline PSA data were available on 170 consecutive patients treated conformally and 90 consecutive patients treated conventionally. RESULTS: Among those receiving only prostatic field irradiation, 12-month PSA values returned to normal in 96% and 85% of conformally and conventionally treated patients, respectively, when normalization was defined as < or = 4 ng/ml (p < 0.03) and in 76% vs. 55% of patients when PSA normalization was defined as < or = 1.5 ng/ml (p < 0.02). Among those receiving pelvic irradiation prior to prostatic conedown, PSA normalization (< or = 4 ng/ml) occurred in 82% and 61% (p < 0.01) of conformally and conventionally treated patients, respectively, and in 56% vs. 38% of patients when normalization was defined as < or = 1.5 ng/ml (p < 0.05). In a multivariate analysis, pretreatment PSA level (< or = 15 vs. > 15), and the use of conformal irradiation were statistically significant prognostic discriminants of PSA normalization at 1 year while total irradiation dose, clinical stage, and the addition of pelvic fields were not significant. CONCLUSIONS: As measured by PSA normalization, conformal techniques with improved targeting produced responses that were significantly better than conventional techniques among patients treated with definitive irradiation. These results, coupled with our previously documented reduction of acute and chronic sequelae, support the continued use of CRT as a more effective method of treatment for prostate cancer.

Humans↗
PubMed1995

Observations of pretreatment prostate-specific antigen doubling time in 107 patients referred for definitive radiotherapy.

PURPOSE: To determine pretreatment prostate-specific antigen doubling times (PSADT) in patients referred for definitive radiotherapy. METHODS AND MATERIALS: One hundred and seven patients with histologically proven nonmetastatic prostate cancer and an elevated prostate-specific antigen (PSA) who were referred for radiation therapy had three serum PSA values obtained prior to the start of definitive therapy. Prostate-specific antigen doubling times were calculated by linear regression. RESULTS: Prostate-specific antigen values increased during the period of observation in 78 patients (73%). Forty-three patients (40%) had calculated PSADT of less than 2 years and of those patients with pretreatment serum PSA values of greater than 10 ng/mL more than 50% has calculated PSADT of less than 2 years. CONCLUSIONS: A significant minority of patients referred for radiotherapy have calculated PSADT of less than 2 years. The significance of this relatively fast growth rate is as yet undetermined, but suggests that patients referred for radiotherapy may have aggressive disease prior to treatment.

Adenocarcinoma↗
PubMed1995

Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control?

PURPOSE: Only 50% of patients with retroperitoneal sarcomas undergo complete resection and of these, 47% develop local tumor recurrence. To determine whether irradiation with dose escalation improves locoregional control, we reviewed the experience with adjuvant radiotherapy in the treatment of retroperitoneal sarcomas at the Fox Chase Cancer Center and the Hospital of the University of Pennsylvania. METHODS AND MATERIALS: Twenty-one patients with retroperitoneal sarcomas were treated with curative intent with surgical resection and radiation therapy at Fox Chase Cancer Center or the Hospital of the University of Pennsylvania between May 1965 and July 1992. Follow-up ranged from 14-340 months. Nineteen patients were treated postoperatively and 2 preoperatively. Radiation doses were between 36.0 Gy and 90.0 Gy (median 54.0 Gy). RESULTS: The 2-year rates of local control and survival were 72% and 69%, respectively. Tumor size, stage, grade, and histology did not influence local control. Two of eight patients (25%) who received a total dose of > 55.2 Gy experienced local failure compared to 5 of 13 (38%) who received < or = 55.2 Gy. One patient experienced a small bowel obstruction that required surgical intervention. There were no other severe complications. CONCLUSION: Postoperative treatment with radiotherapy using a dose > 55.0 Gy is recommended for patients with retroperitoneal sarcomas following surgical resection due to the significant likelihood of local recurrence. Innovative adjuvant radiation techniques to escalate doses to greater than 55.0 Gy including intraoperative radiation therapy, brachytherapy, or use of small bowel exclusion devices to reduce small bowel toxicity should be considered for retroperitoneal sarcomas.

Adult↗
PubMed1995

Improved treatment planning for the Syed-Neblett template using endorectal-coil magnetic resonance and intraoperative (laparotomy/laparoscopy) guidance: a new integrated technique for hysterectomized women with vaginal tumors.

The Syed template (Alpha-Omega Services, Bellflower, CA) represents an advance in interstitial gynecologic brachytherapy; however, its appeal is diminished by inaccuracies in target definition secondary to suboptimal imaging of gynecologic tumors and the risk of viscus perforation during a "blind" procedure. Magnetic resonance (MR) scanning with an endorectal coil and computed tomography were studied as a possible tool to improve target definition and maximize treatment planning with Syed templates. Abdominopelvic contents could be visualized directly through a laparotomy incision or indirectly with a laparoscopic video display to allow further target definition and minimize complications associated with blind procedures after hysterectomy. The synthesis of these techniques with Syed template applications was attempted to potentiate the utility of this brachytherapy system. Five patients with apical vaginal tumors which arose after previous hysterectomies (two endometrial cancer recurrences, one recurrent uterine sarcoma, two primary vaginal cancers) were referred for radiotherapy. In three cases, external beam pelvic radiotherapy (median dose, 45 Gy; range, 45-50.4 Gy) was delivered initially. In all cases, the Syed applicator was used for the brachytherapy component of the treatment. In two cases, high-resolution MR images (400 x 400 microns) of the vaginal apex were obtained after insertion of an endorectal surface coil. The images defined the relationships between the template, target volume, bladder, rectum, and intestine. The other three cases were planned with computerized tomography (CT). In all cases, intraoperative examination of the abdominopelvic contents was provided when laparotomy and/or laparoscopy was performed by the surgical team. The median brachytherapy dose prescribed to the isodose envelope covering the target volume was 40 Gy (range, 31-50 Gy). In all cases, the target volumes could be encompassed by the 60 cGy/hr isodose line. Tumor volume estimation was better with MR than CT. Procedure time was shorter with laparoscopy than with laparotomy. In two cases, bowel displacement was performed (one tissue expander, one omental sling) to prevent viscus perforation by interstitial needles. Four of five patients responded completely to the treatment. In three cases, local control was maintained at a median follow-up of 11 months. In conclusion, endorectal coil MRI may be advantageous to CT of the pelvis in that it allows preplanning to be achieved with greater precision and with less planning time. Major intraoperative complications (i.e., perforation of hollow viscus organs) can be avoided when the course of interstitial catheters is visualized from above by the surgical team.(ABSTRACT TRUNCATED AT 400 WORDS)

Brachytherapy↗
PubMed1995

The efficacy of cranial irradiation in ovarian cancer metastatic to the brain: analysis of 32 cases.

OBJECTIVE: To determine the role of irradiation in the management of brain metastases from epithelial ovarian cancer. METHODS: Tumor registries from five university cancer centers were searched to identify ovarian cancer patients with brain metastases. During a 30-year period (1965-1994), 4027 ovarian cancer patients were evaluated, 32 of whom were found to have cerebral metastases. Each received fractionated whole-brain irradiation (median dose 30 Gy, range 20-52.5). Five patients received concomitant chemotherapy with whole-brain irradiation. RESULTS: The median survival time for the whole population was 4 months. For the entire series, symptomatic response (complete response and partial response) was achieved in 23, 16 of whom were palliated until death. Patients with higher Karnofsky performance status (70 or above versus below 70) were more likely to derive a palliative response and attained a statistically significant survival advantage. No other factor predicted the likelihood of deriving a palliative response or a survival advantage after treatment. CONCLUSIONS: In this large review of patients with cerebral metastases from ovarian cancer, we found that most of those treated with whole-brain irradiation achieved palliation until death. Nearly all women with high performance status derived durable palliation from cerebral irradiation. Whole-brain irradiation was an effective means of palliating ovarian cancer metastatic to the brain and provided a favorable alternative to other means of management.

Adult↗
PubMed1995

Do the current subclassifications of stage T3 adenocarcinoma of the prostate have clinical relevance?

OBJECTIVES: To compare the outcome of patients with T3a and T3c adenocarcinoma of the prostate and determine the utility of these substages as defined in the current American Joint Committee on Cancer and the International Union Against Cancer (AJCC/UICC) staging system. METHODS: An analysis was performed of patients with T3 (clinical) prostate cancer treated with definitive irradiation at the Fox Chase Cancer Center between 1986 and 1993. The series was composed of 66 patients with T3a tumors and 44 patients with T3c tumors. The endpoints studied included freedom from biochemical relapse (bNED) and rates of clinical local and distant failure. RESULTS: No statistically significant differences in freedom from biochemical relapse were observed when comparing patients with T3a and T3c disease (3 years bNED, 41%; difference not significant). Similarly, there was no difference in the patterns of clinical failure at 3 years when comparing patients with T3a and T3c disease (21% clinically detected distant metastases; < 10% local failure in either group). In a multivariate analysis, only a low baseline prostate-specific antigen (PSA) (eg, 20 ng/mL or less) independently predicted the likelihood of remaining biochemically free of disease. CONCLUSIONS: Anatomic substaging that is based on the findings of the digital rectal examination does not distinguish meaningful prognostic substages among patients with T3 disease. PSA should be used to establish biochemical substaging of patients who present with T3 prostate cancer.

Adenocarcinoma↗
PubMed1995

Preservation of cranial nerve function after treatment of acoustic neurinomas with fractionated stereotactic radiotherapy. Preliminary observations in 26 patients.

Twenty-seven acoustic tumors in 26 patients were treated with multiple fractionated linear-accelerator-based stereotactic radiotherapy (SRT). All patients with intact pretreatment facial nerve function with either small or large tumor volumes have thus far experienced no treatment-related facial neuropathy, including 9 patients with a mean follow-up of 22.4 +/- 1.6 months. The incidence of evaluable trigeminal neuropathy was 13%, and in 5 of 7 patients with serviceable pretreatment hearing, audiometry was unchanged in the immediate posttreatment period. Longer follow-up will be necessary to evaluate hearing preservation after SRT. Tumor response with central necrosis was seen in all assessable patients. SRT can be performed for cerebellopontine angle tumors with accuracy and reproducibility. It achieves a biological response similar to single fraction radiosurgery and may lower the incidence of facial and trigeminal neuropathies.

Adult↗
PubMed1995

Localized prostate cancer treated by external-beam radiotherapy alone: serum prostate-specific antigen--driven outcome analysis.

PURPOSE: To determine the 5-year rate of survival with no evidence of disease (NED) using strict biochemical criteria in men with prostate cancer treated by external-beam radiotherapy alone and to examine possible clinical and treatment factors that predict the likelihood of NED survival. MATERIALS AND METHODS: Five hundred men with clinically localized prostate cancer consecutively treated with external-beam radiotherapy alone with no prior, concomitant, or adjuvant endocrine therapy were identified. All patients had serial serum prostate-specific antigen (PSA) values determined after treatment and 451 patients had pretreatment PSA values determined. The median follow-up duration is 20 months (range, 2 to 72; mean, 36). RESULTS: The 5-year rate of overall survival in this group of patients was 80%. The 5-year rate of survival without clinical evidence of disease (cNED) was 72%. The 5-year rate of survival without evidence of clinical, radiographic, or biochemical relapse (bNED) was 51%. Multivariate analysis demonstrated that a pretreatment serum PSA level < or = 15 ng/mL was the most important predictor of bNED survival (P < .0001). Patients with early-stage (T1, T2a/b) tumors and a pretreatment serum PSA less than 15 ng/mL had a 3-year rate of bNED survival of 86%. The rate of bNED survival for patients with a pretreatment PSA level greater than 15 ng/mL was 38% at 3 years. CONCLUSION: Pretreatment serum PSA level is the most important predictor of treatment outcome in this group of patients treated with definitive radiotherapy alone. External-beam radiation alone can produce acceptable early rates of bNED survival in patients with clinically organ-confined tumors and a pretreatment PSA level < or = 15 ng/mL. To produce acceptable results in those patients with pretreatment PSA levels more than 15 ng/mL, effective adjuvant treatments in addition to aggressive local treatments are necessary.

Aged↗
PubMed1995

Prostate specific antigen density is not an independent predictor of response for prostate cancer treated by conformal radiotherapy.

Although prostate specific antigen (PSA) density appears to be an important discriminator between benign and malignant prostatic disease, conflicting data exist concerning its prognostic value. The present study was undertaken to confirm whether PSA density represents a new prognostic indicator of disease-free survival for prostate cancer treated with conformal radio-therapy. Between April 1989 and December 1992, 186 patients with organ confined prostate cancer were treated with definitive irradiation according to previously published conformal guidelines. The PSA density was defined as the ratio of the pretreatment serum PSA (ng./ml.) to the prostate volume (ml.) as determined from treatment planning computerized tomography. The median PSA density was 0.15 with a range of 0.02 to 2.12. A statistically significant advantage in actuarial freedom from biochemical relapse was noted for patients with pretreatment PSA levels less than 15 ng./ml. when compared to those with higher pretreatment PSA levels (3-year freedom from biochemical relapse 85% versus 28%, p < 0.001). Also, patients with PSA density of 0.15 or less had statistically superior freedom from biochemical relapse compared to their counterparts with higher PSA density (3-year freedom from biochemical relapse 88% versus 28%, p < 0.001). In a multivariate analysis only the baseline PSA (p < 0.002) and the Gleason score (p < 0.002) emerged as significant predictors of prolonged freedom from biochemical relapse. The PSA density had no impact on freedom from biochemical relapse whether it was entered into this multivariate model as a continuous or a dichotomous variable. In our data base baseline PSA levels remain the most powerful independent discriminant of response to conformal irradiation. PSA density is only a surrogate for baseline PSA levels and does not refine the ability to predict prolongation of freedom from biochemical relapse following conformal radiotherapy.

Actuarial Analysis↗
PubMed1995

The management of early ovarian cancer.

Approximately one third of patients with epithelial ovarian cancer present with localized or early-stage disease. Prognostic features identify certain subsets of patients with good risk characteristics who do not require adjuvant treatment after comprehensive surgical staging and cytoreduction. Only a minority of patients undergo such a complete procedure, which often results in understaging of these patients. In the United States, patients with poor prognostic features, such as stage IC to II disease, poorly differentiated histologic grade, clear cell histology, dense adhesions, and large volume ascites, have received adjuvant chemotherapy. Single-agent or combination chemotherapy, whole abdominal irradiation, and intraperitoneal phosphorus 32 have been evaluated, although no modality has been shown to improve overall survival. Randomized trials investigating the optimal therapy or whether any therapy is truly effective are in progress. Until the completion of these trials, the most common postoperative adjuvant therapy in these patients in this country remains combination chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Recurrent ovarian cancer. Effective radiotherapeutic palliation after chemotherapy failure.

BACKGROUND: Recurrent ovarian cancer after frontline chemotherapy is incurable; however, palliation of focal lesions often is needed to alleviate symptoms. Because published response rates to palliative irradiation (RT) among patients failing cisplatin-based chemotherapy are scarce, the authors attempted to define the palliative role of radiotherapy for symptomatic, localized ovarian cancer recurrences. Factors predicting a response to RT also were sought. METHODS: Between 1987 and 1993, 33 patients with ovarian cancer were irradiated at 47 sites with palliative intent after failing cisplatin-based chemotherapy regimens. Sites irradiated included the pelvis (n = 33), abdomen (n = 5), chest (n = 4), brain (n = 3), and other (n = 2). Median RT dose was 35 Gy (range: 7.5-45 Gy). The median fraction size was 2.5 Gy (range, 1-5 Gy). To determine dose effectiveness, the biologic effective dose (BED) was calculated according to the following formula: BED = total dose (1 + fractional dose/alpha/beta) using an alpha/beta value of 10. The median BED10 was 44 (range, 9-72). RESULTS: For the entire group, complete palliative response was 51% and overall palliative response was 79%. The median duration of palliation was 4 months, which reflected palliation until death in 90% of cases. The overall response rates by symptoms were: pulmonary symptom relief in 75%, vaginal bleeding control in 90%, rectal bleeding control in 85%, pain relief in 83%, and neurologic symptoms controlled in 50%. The likelihood of obtaining complete symptomatic response was significantly increased among those with high Karnofsky performance status (KPS > or = 70 vs. KPS < 70; 69% vs. 36%, P < 0.03) and among those who received a higher biologically effective dose of irradiation (BED10 > or = 44 vs. BED10 < 44; 68% vs 35%, P < 0.03). Complete palliative response rates were not influenced by histologic differentiation, the number of previously administered cisplatin regimens, or patient age. Treatment-related acute morbidities included diarrhea in 5 of 38 (13%) patients treated through abdominal or pelvic fields, and esophagitis in 2 of 5 treated through thoracic portals. Only one severe late morbidity (small bowel obstruction) was observed. CONCLUSIONS: Durable palliation of patients with ovarian cancer that recurs after cisplatin-based chemotherapy can be achieved with local radiotherapy, especially among patients with high performance status. Biologically effective doses of at least 44 Gy10 (e.g., 3500 cGy/14 fractions = BED10 of 44) should be sought to maximize the probability of complete response. Such dose-fractionation schedules can be delivered expeditiously with acceptable tolerance. These results are comparable to the published experience of second-line chemotherapy in the treatment of focally symptomatic ovarian cancer recurrences.

Age Factors↗
PubMed1994

White matter changes are correlated significantly with radiation dose. Observations from a randomized dose-escalation trial for malignant glioma (Radiation Therapy Oncology Group 83-02).

BACKGROUND: A Phase I/II randomized dose-seeking trial was performed to document the severity, time course, and significance of white matter changes seen on serial imaging scans (magnetic resonance imaging, computed tomography) associated with bis-chlorethyl nitrosourea (BCNU) and hyperfractionated cranial irradiation. METHODS: Long term survivors (> or = 18 months) were identified from a prospective randomized dose-escalation Phase I/II trial designed to evaluate twice-daily radiotherapy for supratentorial high grade malignant gliomas. All scans were reviewed by a neuroradiologist who had no information about the prescribed dose and fractionation. In the trial, patients were assigned to receive 64.8 Gy, 72.0 Gy, 76.8 Gy, or 81.4 Gy (all fractionated as 1.2 Gy twice a day [bid]), or 48.0 Gy or 54.4 Gy (both in 1.6-Gy bid fractions). Bis-chlorethyl nitrosourea was administered every 8 weeks for 1 year. Of 747 randomized patients, 177 had analyzable scans. The scans reviewed were those acquired preoperatively, immediately postoperatively, 3, 6, 12, and 18 months after radiotherapy. Radiographic endpoints included no white matter change (Grade 0), minimal patchy white matter foci (Grade 1), start of confluence of white matter disease (Grade 2), large confluent areas (Grade 3), confluence with cortical/subcortical involvement (Grade 4), leukoencephalopathy (Grade 5), and possible necrosis (Grade 6) according to the classification of F. Fazekas et al. The effects were scored relative to the baseline preoperative scans. The dose pairs of 48 Gy and 54.4 Gy, 64.8 Gy and 72 Gy, and 76.8 Gy and 81.4 Gy were grouped together for analysis (low, intermediate, and high dose, respectively). Toxicity was analyzed in three ways: Grade 2 or worse, Grade 3 or worse, and Grade 6. RESULTS: Grade 2 or worse changes were observed in 26.6, 27.6, and 40.4% of patients in the low, intermediate, and high dose groups, respectively. Grade 3 or worse changes were observed in 8.3, 20.0, and 36.5% of patients in the low, intermediate, and high dose groups, respectively. Grade 6 changes were observed in 1.6, 4.6, and 19.2% of patients in the low, intermediate, and high dose groups, respectively. No statistically significant differences were observed among treatment groups when toxicity was evaluated as Grade 2 or worse. For toxicity of Grade 3 or worse, an chi-square test revealed P values of 0.04 (low vs. intermediate dose), 0.09 (intermediate vs. high dose), and 0.0005 (low vs. high dose). With the endpoint of possible necrosis (Grade 6), P values were 0.21 (low vs. intermediate dose), 0.05 (intermediate vs. high dose), and 0.003 (low vs. high dose). The median time to radiographic appearance of an effect (15 months) was not influenced by total dose or fraction size. CONCLUSIONS: A well described toxicity scale for white matter injury was applied successfully to patients with malignant glioma treated with definitive irradiation. Severe white matter changes continued to increase significantly as the total dose of hyperfractionated cranial irradiation was escalated. The time to onset of the white matter abnormalities appeared to be independent of dose. An ongoing Radiation Therapy Oncology Group study will allow correlation of white matter injury with prospective neuropsychometric testing.

Brain↗
PubMed1994

Technically accurate intracavitary insertions improve pelvic control and survival among patients with locally advanced carcinoma of the uterine cervix.

The purpose of this study was to document whether the technical qualities of a brachytherapy application impacts on the outcome of patients with locally advanced cervix cancer treated by definitive irradiation. A previous report from the patterns of care study demonstrated the importance of brachytherapy in the treatment of locally advanced cervix cancer. Locally advanced disease was defined as FIGO stages Ib (if tumor diameter was < or = 4 cm), IIb (if disease was bilateral or involved the lateral aspect of either parametrium), and III. Localization films from 128 patients with locally advanced squamous cell carcinoma of the cervix were reviewed by a radiation physicist and a radiation oncologist with expertise in gynecologic radiotherapy. All patients received external beam irradiation followed by one brachytherapy application (median point A dose = 8040 cGy; range, 4083-10,020 cGy). Brachytherapy parameters assessed were (a) the distance between the right colpostat source and the distal tandem source, (b) the distance between the left colpostat source and the distal tandem source, and (c) the symmetry of colpostat placement. Implants were scored as "ideal" (n = 8) when all three parameters were deemed satisfactory, "unacceptable" (n = 17) when none of the parameters was deemed satisfactory, and "adequate" (n = 41) in all other cases. Significantly improved 5-year local control was seen when comparing ideal and adequate placements to unacceptable placements (68% vs 34%, P = 0.02). A strong trend toward improved 5-year survival was also noted among the group with ideal and adequate implants as opposed to unacceptable implants (60% vs 40%). Multivariate analysis showed that the technical adequacy of the brachytherapy implant was the most important prognostic discriminant of local control. In conclusion, these analyses demonstrate the direct influence of competent technical implant performance on tumor control and even survival. While only a small fraction of implants for cervical cancer are performed poorly in the United States, there is a need for continued emphasis of the principles for proper implant technique.

Adult↗
PubMed1994

Combined modality treatment for carcinomas of the uterine cervix and vulva.

Several attempts have been made during the preceding year to apply multimodality approaches to the treatment of carcinomas of the uterine cervix and the vulva. Neoadjuvant chemotherapy may render more cervical tumors resectable, but it does not necessarily improve curability when compared with similarly staged patients treated with definitive pelvic irradiation alone. Neither concurrent chemoradiotherapy nor adjuvant chemotherapy following hysterectomy have been shown to be superior to definitive radiotherapy in prospective randomized trials of cervical cancer patients. Exciting data continue to be reported for the integration of chemotherapy, radiotherapy, and conservative surgery in the management of vulvar cancer. Such initiatives are contingent on the close cooperation of oncologists during the design and implementation of prospective trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Impact of improved irradiation technique, age, and lymph node sampling on the severe complication rate of surgically staged endometrial cancer patients: a multivariate analysis.

PURPOSE: Limited information is available regarding factors that predispose to complications following postoperative pelvic radiotherapy (RT) for endometrial cancer. To address this issue, patients with clinically staged I/II endometrial cancer who received postoperative RT following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) with or without lymph node sampling (LNS) were studied. PATIENTS AND METHODS: From 1960 through 1990, 235 patients with adenocarcinoma of the endometrium received postoperative RT after surgical staging. Multiple factors were evaluated to determine associations with severe complications. Pretreatment factors included age, stage, comorbidities. Treatment-related factors consisted of LNS, total RT dose, volume of RT fields, dose per fraction, total number of RT fields, number of RT fields treated per day, machine energy, and addition of vaginal implant. RESULTS: The 5-year actuarial risk of a severe complication was 5.5%. Factors associated with an increased risk of complications in univariate analysis included age more than 65 years (11% v 2%), use of only one portal per day (40% v 3%), use of anteroposterior/posteroanterior fields (23% v 4%), total dose > or = 50 Gy (8% v 2%), and LNS (11% v 3%). In a multivariate analysis, only older age, LNS, and the use of one field per day were significant. Increased risks associated with a total dose > or 50 Gy and the anteroposterior/posteroanterior technique were entirely attributable to the use of one field per day. A subanalysis among patients who had adequate RT techniques (eg, multiple fields treated per day) showed a significant increase in complications (7% v 1%) for those with and without LNS, respectively. CONCLUSIONS: Severe complications associated with adjuvant RT for endometrial cancer were increased among patients who were older or underwent LNS or received suboptimal RT technique. Pelvic RT using proper methods can be delivered with acceptable risks.

Adenocarcinoma↗
PubMed1993

Limb-preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins.

BACKGROUND AND METHODS: Between 1970 and 1990, 74 patients with extremity soft tissue sarcomas began a regimen of limb-sparing surgery and irradiation. Ninety-two percent received postoperative irradiation, 7% received preoperative irradiation, and one patient was treated with radiation after an incisional biopsy only. Radiation was administered with a shrinking-field technique (median total dose, 63 Gy; range, 39.6-71 Gy), with 14 patients receiving interstitial brachytherapy as a component of treatment. Ten patients received adjuvant chemotherapy. RESULTS: Local control of disease was 82% at 5 years, and 95% after salvage therapy. The actuarial risk of distant disease recurrence was 27%, with an overall survival rate of 70% at 5 years. Histologic subtype, tumor grade, size of tumor, location of tumor, status of the surgical margins, use of chemotherapy, radiation dose, interval until initiation of radiation therapy, and use of a brachytherapy boost were analyzed to determine their effect on survival, local control, and freedom from distant metastasis. Microscopic involvement of the surgical margins predicted for local disease recurrence (P = 0.0002), distant disease recurrence (P = 0.008), and poorer overall survival (P = 0.02). Low histologic grade was favorably correlated with freedom from distant disease recurrence (P = 0.004) and survival (P = 0.002). Patients with liposarcomas had superior local control (P = 0.004) compared with patients with tumors of other histologic subtypes. Five patients experienced a complication of therapy, for an actuarial risk of 10% at 5 years. Only two patients required hospital admittance for treatment-related morbidity. CONCLUSIONS: These findings support the continued use of limb-preserving management for extremity sarcomas and emphasize the importance of the status of the surgical margins.

Adolescent↗