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PubMed1978

Sixth interim progress report of the British Institute of Radiology fractionation study of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx.

The results are reported of the multicentre BIR fractionation trial of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx. 687 patient records have been analysed with respect to survival rates, recurrence-free rates and laryngectomy-free rates. For the group as a whole these analyses show no difference between the two fractionation regimes. Analysis of the sub-group which had early disease confined to the vocal cords does, however, show a better recurrence-free and laryngectomy-free rate for those patients treated with 5F/week, though the survival rate for the two groups remains similar. Acute and late normal tissue reactions are reported for up to six years after treatment. It appears that treatment with 3F/week can be given safely to patients with advanced disease. The differences between the two treatment groups who had early disease of the vocal cords are discussed, but until more data become available in the future the problems raised cannot be resolved.

Dose-Response Relationship, Radiation↗
PubMed1975

Parotid gland tumors. Clinicopathologic study.

The clinical findings and histologic features of 154 parotid gland tumors treated at the Health Sciences Centre, Winnipeg, Canada, from 1957 to 1970 were reviewed. The study illustrates a wide variation in the natural history and degree of malignancy of parotid tumors. Approximately 80 per cent were benign; among these, mixed tumors were by far the commonest. For most benign tumors, the recommended surgical treatment is wide local excision with an adequate margin of normal glandular tissue, except when subtotal or conservative total parotidectomy is required because of the size or location of the tumor. The facial nerve should be visualized and preserved. This approach prevents recurrences and minimizes facial nerve injury, since risk of neural injury increases with the extent of the surgical procedure. Total removal of the gland on the basis of the multicentricity or malignant transformation of these tumors is not supported by the findings of this study. For malignant tumors a more radical procedure, that is, subtotal or total parotidectomy with or without node dissection, with sacrifice of the facial nerve if necessary is advisable, depending on the type and anatomic location of the tumor.

Adenocarcinoma↗
PubMed1978

Natural history of radiation-associated thyroid cancer.

The clinical courses of 91 patients with radiation-associated thyroid cancer were compared with courses in a control population. Radiation-associated carcinoma appears to be a disease of younger persons, and 90% of the tumors are papillary. No anaplastic or medullary tumors were observed. Ninety percent of the tumors were larger than those found in an autopsy series that surveyed for "biologically benign" thyroid tumors. There was a higher incidence of multicentric disease, locally invasive disease, and distant metastases in the population that had had x-ray exposure. Although the population with x-ray exposure had had more aggressive treatment, more recurrences were present in patients who had had radiation therapy. The death rate was similar in both groups. Parathyroid adenoma occurred more frequently in the population that had radiation exposure than in controls and appears to be a radiation-associated illness.

Adenoma↗
PubMed1979

The relative roles of surgery and radiotherapy in the management of soft tissue sarcomas of adults. A personal appraisal.

The literature of the last 25 years pertaining to the treatment of sarcomas of the soft somatic tissues by surgery and radiotherapy, both separately and in combination, has been reviewed. Surgery alone, if it is to be successful in an appreciable proportion of cases, must be radical. There is a growing body of evidence which suggests that less-than-radical surgery in combination with postoperative radiotherapy may give results equal or superior to those of radical surgery alone. There is need for a multicentre controlled clinical trial to compare the results of the two modes of treatment.

Adult↗
PubMed1977

Leiomyomatosis of the colon.

Excluding the rectum, smooth muscle cell tumors of the large bowel are extremely rare lesions. A unique case is reported of an infiltrating multinodular myomatous growth of semi-constrictive type affecting the ascending and transverse colon along its entire circumference and over a length of 35 cm. In the mesocolon near the colonic wall two tumor foci were present. Contrary to expectations from the growth behavior, histological examination revealed well differentiated smooth muscle cells with distinct myofilaments and absence of nuclear abnormalities and mitotic figures. No clinical evidence of malignancy was found and no recurrence was detected during a 39-month follow-up period which included a second-look operation. The contrasting fidings are discussed and it is concluded that the tumor should be considered a benign multicentric lesion, for which the term "leiomyomatosis of the colon" is suggested.

Adult↗
PubMed1978

Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: interim results.

In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastrict vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4.3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups-6 after PGV, usually for recurrent ulcer, and 7 after TVA, mostly for gastric retention. PGV showed a marked superiority in the number of patients with a good clinical result Visick I or II) at 1 year after operation, i.e. 82 per cent compared with 56 per cent for TVA.

Chronic Disease↗
PubMed1978

Reappraisal of solitary bronchiolar (alveolar cell) carcinoma of the lung.

Twelve patients with solitary bronchiolar carcinoma had lobectomy and were followed for up to 16 years. The concept of a multicentric origin of bronchiolar carcinoma, maintained for more than eight decades, should be discarded. The neoplasm arises indolently and usually in an area of pulmonary fibrosis. After lobectomy patients can now expect to follow one of four courses: (1) to be alive and well without recurrence; (2) after several years to have pulmonary recurrence or a new carcinoma; (3) with minute spread at the time of lobectomy to have metastasis develop in a short period; or (4) to die of unrelated conditions. The overall 5-year survival with this tumor is about 75%. Late recurrence or the development of another primary tumor, however, prompts the need for prolonged follow-up. Immunologically, patients have circulating antibodies when well and demonstrable circulating antigens with recurrence. The survival rate of selected patients with solitary bronchiolar carcinoma (eliminating those patients with microscopic spread from the primary neoplasm at the time of resection and those dying of other causes) was 100% after 5 years and 75% after 10 years.

Adenocarcinoma↗
PubMed1979

[Non-infiltrating intraductal carcinoma of the breast (author's transl)].

Non-infiltrating intraductal carcinoma may be considered a type of "carcinoma in situ" of the breast. In a review of 47 cases diagnosed and treated at Gustave-Roussy Institute between 1956--1972, it appears that the early symptoms of this rare type of breast carcinoma (it occurs only in 2.4% of all breast cancers) were a bloody discharge (38%) or Paget's disease of the nipple (11%). The histological examination was of the utmost importance in these cases due to the diagnostic uncertainties between benign hyperplastic lesions and authentic carcinomas as well as between infiltrating carcinomas and strictly intraductal carcinomas. Frozen section was only accurate in 30% of cases. The high frequency of multicentric foci (76%) contrasted with the absence of lymph node involvment (none of the 23 cases in which at least one node was excised, showed lymph node metastases). Treatment was only of ablation of the whole mammary gland, except in 6 patients who had a tumorectomy, two of whom also received radiotherapy. Local recurrence occurred in 4 patients, 3 of whom had only tumorectomy. The contralateral breast was affected in 2 cases. No patient under follow-up died of cancer within 5 years. The peculiar and highly favorable course of non-infiltrating intraductal carcinoma calls for an adequate therapy which could later be followed by a plastic reconstructive surgery should the patient wish to have this procedure.

Adult↗
PubMed1977

Recurring digital fibrous tumor of childhood.

A case of digital fibrous tumor of childhood is described. This tumor is multicentric, of possible viral origin, and is characterized histologically by intracytoplasmic inclusion bodies within proliferating fibroblasts. The tumor recurred despite wide local excision and skin grafting.

Child↗
PubMed2026

Reduced Length of ADT and ARTA With XRT in High-Risk Prostate Cancer (RELAX): A Randomised Controlled Trial.

AIM: To assess the efficacy of a short, intensified regimen of androgen deprivation therapy (ADT) and androgen receptor-targeted agent (ARTA) with curative-intent external beam radiotherapy (XRT) for high-risk prostate cancer (HRPCa) staged with prostate specific membrane antigen (PSMA) imaging. MATERIALS AND METHODS: The RELAX (Reduced Length of ADT and ARTA with XRT in high-risk prostate cancer) trial is a multicentre, phase II randomised non-inferiority trial comparing 9 months of ADT and 6 months of ARTA against the standard 24-month ADT, with definitive dose-escalated hypofractionated pelvic radiotherapy for PSMA-staged non-metastatic HRPCa. The primary endpoint is 5-year disease-free survival (DFS), defined from randomisation to first biochemical or clinico-radiological recurrence or any-cause death. Secondary endpoints include biochemical failure-free survival, metastasis-free survival, overall survival, testosterone recovery, treatment-related adverse effects, and patient-reported outcomes. Participants are monitored with serial serum PSA and testosterone levels, CTCAE and PRO-CTCAE assessments, and PSMA-PETCT at recurrence. The non-inferiority margin is set at 10% absolute difference from an expected 5-year DFS of 85% in the standard arm, with intention-to-treat analysis. The trial is ethics board approved and funded by institutional intramural grant, and registered on clinicaltrials.gov (NCT06818682). RESULTS: The planned accrual of 206 participants commenced in February 2025, with nearly a third of enrolment completed till date. CONCLUSION: The RELAX trial incorporates contemporary standards of PSMA-based staging, dose-escalated hypofractionated radiotherapy, and ARTA for HRPCa. The results are expected to inform the efficacy of a shorter, intensified androgen suppression strategy against the prevailing standard of long-term ADT for these patients.

Humans↗
PubMed1977

Multicentric giant-cell tumor of bone.

The presence of more than one distinct giant-cell tumor in the same patient is rare; seven cases have been reported in the literature. The present series involves eleven patients with thirty-five individual tumors. Multifocal giant-cell tumors may pose a diagnostic problem. It is difficult to distinguish a multicentric giant-cell tumor from a primary giant-cell tumor with metastatic spread. This problem is magnified when the second lesion is not noted at the onset or is metaphyseal in location. Moreover, these lesions present a therapeutic challenge to the surgeon. Multiple lesions tend to exhibit the same aggressive clinical behavior as a solitary giant-cell tumor. A high recurrence rate after curettage indicates that aggressive surgical management is necessary.

Adolescent↗
PubMedDate not supplied

Papillary adenocarcinoma of the thyroid invading the upper air passages.

The clinical course of papillary adenocarcinoma of the thyroid is delayed but aggressive and lethal in an estimated 11-16% of the patients. Death results in the majority of patients from respiratory obstruction produced by a collar of tumor that has proliferated from residual or multicentric thyroid disease. Review of a large series of cases reveals an incidence of invasion of the aerodigestive tract of 1-6.5%. Six such cases are presented in which resection of the larynx, trachea and pharynx were performed along with total thyroidectomy with local control of the disease and prolonged survival. In five cases conservation surgery was done. Three patients had prior thyroid lobectomy with recurrence and invasion of the air passages 2-5 years later. Intraluminal thyroid carcinoma may be confused with a primary lesion of the larynx, trachea or hypopharynx.

Adenocarcinoma, Papillary↗
PubMed1976

Management of early cancer of the breast. Report on an international multicentre trial supported by the Cancer Research Campaign.

In the largest controlled clinical study so far undertaken on the management of early cancer of the breast in women the results of a radical regimen (simple mastectomy and radiotherapy) were compared with those of a conservative policy (simple mastectomy alone). The study included enough patients (2268) to ensure that small but significant differences between the two treatments would emerge. With a five-year follow-up there was no evidence that routine postoperative radiotherapy was harmful or that it conferred further benefit as regards survival or distant recurrence. Radiotherapy did, however, reduce the incidence of local recurrence. Neither form of treatment can counter occult disease far from the breast that is present at the time of initial treatment, which probably accounts for the high death rate from breast cancer, but the results of the study would support the view that conservative primary treatment and subsequent adjuvant chemotherapy may be the treatment of choice in future.

Adult↗
PubMed1976

[Therapeutic results with the combination pramiverine/metamizole in a multicentre trial (author's transl)].

279 physicians took part in a multicentre trial to assess the efficacy and acceptability of the combination of 4,4-diphenyl-N-isopropyl-cyclohexylamine-hydrochloride (pramiverine, Sistalgin) and N-methyl-N-(2,3-dimethyl-5-oxo-1-phenyl-3-pyrazolin-4-yl)-aminomethanesulfonate (metamizole) (Sistalgin comp) in the forms of ampoules, coated tablets and suppositories. 1301 out of 1329 case reports could be evaluated; in 28 cases treatment was discontinued. The trial included 59% acute colics and 41% subacute recurrent painful spasms of the caval organs. A single presentation form was used in 44%; all other patients were treated with the combined regimen of ampoules/coated tablets/suppositories. A good or very good result was obtained in 91% of cases, with a low rate of undesired side-effects. In 3%, the result was unsatisfactory. The patients' judgment was in agreement with that of the physician. Both judgments confirmed the rapid onset, long duration and reliable effect of pramiverine/metamizole in treating colics of the intestinal, biliary and urinary tracts as well as recurrent spastic pain. Similarly favourable results were obtained with all presentation forms.

Adolescent↗
PubMed1977

Stroke in the Africans.

Stroke is increasingly becoming a major cause of death and morbidity in African population among most of which the frequencies of hypertension are considerable, although hard data based on community surveys are lacking and most of the information available is from hospital data. The epidemiology of stroke in the Africans is reviewed. The frequencies in hospital populations varied from 0.9% to 4.0% and stroke accounted for 0.5% to 45% of neurological admissions. There is male predominance in published series. The main risk factors are hypertension, diabetes mellitus and homozygous sickle cell disease (in children only). Ischaemic stroke is by far the commonest clinical type encountered. These conclusions are further supported by experience at Ibadan, of over 1100 Africans seen over 18 years reported briefly in this communication. The results of the first community study over a 2-year period on the incidence of stroke in an African Urban (Ibadan) Community are presented. The study was carried out as part of a multinational multicentric study initiated and sponsored by the World Health Organization. The male to female ratio was five to two. Incidence rates reached peaks in the eighth decade in males and in seventh decade in females and were higher in males in all age groups, and the rates are comparable with those recorded in European populations, except in those under the age of 40 in Ibadan, in which age-specific incidence rates are considerably lower than in European and Japanese populations. Hypertension, diabetes mellitus constituted the main risk factors. Mortality and recurrence rates are described and are similar to experience in the Caucasians. Hypertension in the Nigerians predispose to a high frequency of cerebrovascular disease other than through mainly cerebral atherosclerosis. With increasing longevity of Nigerians and other Africans, the mortality and morbidity caused by cerebrovascular disease would probably become of enormous dimensions and adequate control of high blood pressure on a community basis may be the only way of preventing this: this would be desirable as myocardial infarction in contradistinction to hypertensive heart disease is an uncommon complication of high blood pressure in the Africans and prevention of hypertensive heart disease as shown by experience elsewhere can be achieved by control of high blood pressure, which does not seem to prevent ischaemic myocardial disease.

Adolescent↗