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[Impact of computed tomography (CT) and 18F-deoxyglucose-coincidence detection emission tomography (FDG-CDET) image fusion for optimisation of conformal radiotherapy in non-small-cell lung cancers].

UNLABELLED: To report a retrospective study concerning the impact of fused 18F-fluorodeoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on three-dimensional conformal radiation therapy (3D-CRT) planning for patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: One hundred and one patients consecutively treated for stages I-III NSCLC were studied. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. Images were coregistered using five fiducial markers. Target volume delineation was initially performed on the CT images and the corresponding FDG-PET data were subsequently used as an overlay to the CT data to define target volume. RESULTS: FDG-PET identified previously undetected distant metastatic disease in 8 patients making them ineligible for curative CRT (one patient presented some positive uptakes corresponding to concomitant pulmonary tuberculosis). Another patient was ineligible for curative treatment because fused CT/PET images demonstrated excessively extensive intrathoracic disease. The gross tumor volume (GTV) was decreased by CT/PET image fusion in 21 patients (23%) and was increased in 24 patients (26%). The GTV reduction was > or = 25% in 7 patients because CT/PET image fusion reduced pulmonary GTV in 6 patients (3 patients with atelectasis) and mediastinal nodal GTV in 1 patient. The GTV increase was > or = 25% in 14 patients due to an increase of the pulmonary GTV in 11 patients (4 patients with atelectasis) and detection of occult mediastinal lymph node involvement in 3 patients. Among 81 patients receiving a total dose > or = 60 Gy at ICRU point, after CT/PET image fusion, the percentage of total lung volume receiving more than 20 Gy (VL20) increased in 15 cases and decreased in 22 cases. The percentage of total heart volume receiving more than 36 Gy increased in 8 patients and decreased in 14 patients. The spinal cord volume receiving at least 45 Gy (2 patients) decreased. After multivariate analysis, one single independent factor made significant effect of FDG/PET on the modification of the size of the GTV: tumor with atelectasis (P = 0.0001). Conclusion. - Our study confirms that integrated hybrid PET/CT in the treatment position and coregistered images have an impact on treatment planning and management of patients with NSCLC. FDG images using dedicated PET scanners with modern image fusion techniques and respiration-gated acquisition protocols could improve CT/PET image coregistration. However, prospective studies with histological correlation are necessary and the impact on treatment outcome remains to be demonstrated.

Adult↗

Laparoscopic splenectomy reverses thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension.

Pegylated-interferon (IFN) plus ribavirin remains the most effective therapeutic regimen for patients with chronic hepatitis C infection. Thrombocytopenia is a common side effect of this treatment, often leading to discontinuation of a potentially curative therapy. We sought to determine the safety and efficacy of laparoscopic splenectomy in correcting thrombocytopenia, thus allowing completion of IFN therapy. Data were collected prospectively from September 2000 to May 2003 on all patients undergoing laparoscopic splenectomy for thrombocytopenia associated with IFN therapy and/or hepatitis C cirrhosis with portal hypertension. Demographic data, model of end-stage liver disease (MELD) score, platelet count, operative time, blood loss, spleen weight, complications, length of stay, and follow-up time were calculated. Eleven patients (7 men, 4 women) underwent laparoscopic splenectomy; their mean age was 45.4 years (range 27 to 55 years) and mean body mass index was 27 kg/m(2) (range 21 to 44 kg/m(2)). All patients were Child's class A, with a mean preoperative MELD score of 9.1 (range 6 to 11). Mean operative time was 189 minutes (range 70 to 245 minutes), and blood loss averaged 141 ml (range 10 to 600 ml). A hand-assisted laparoscopic technique was used in four cases. Six patients received empiric intraoperative platelet administration. None required transfusion with packed red cells. Splenic weight averaged 1043 g (range 245 to 1650 g). Average length of stay was 2.6 days (range 1 to 6 days). Four patients had the following minor postoperative complications: self-limited atrial fibrillation (n=1), trocar site cellulitis (n=1), and atelectasis (n=2). There have been no major complications over an average follow-up of 11 months (range 1 to 18 months). Mean postoperative MELD score was 8.3 (range 6 to 10). Platelet counts improved from a preoperative mean of 55000/ul (16000 to 88000/microl) to 439000/microl (200000 to 710000/microl) postoperatively and have remained above 100000/microl (104000 to 397000/microl) during subsequent pegylated-IFN therapy. Three patients have completed a full course of IFN therapy and have obtained a sustained virologic response. Treatment is ongoing in the remaining patients. Laparoscopic splenectomy is safe in the setting of portal hypertension and thrombocytopenia associated with chronic hepatitis C infection. It can be performed with little blood loss, no need for red cell transfusion, and minimal perioperative morbidity. Laparoscopic splenectomy appears to effectively reverse thrombocytopenia and may allow these patients to safely complete IFN therapy.

Adult↗

Access point analysis on the state of health care services in South African prisons: a qualitative exploration of correctional health care workers' and inmates' perspectives in Kwazulu-Natal and Mpumalanga.

This paper explores inmates and prison health care workers perceptions of the state of health care services in four correctional facilities in South Africa. Structural and organisational issues are explored in terms of how they impact the delivery and provision of health care to inmates within correctional facilities. Additionally, the study forms an access point analysis of prisons as a health care setting as part of the development and testing of a STI/HIV health education intervention for soon to be released inmates. Focus group discussions (6-8 participants per group) were conducted with male inmates in four facilities in KwaZulu-Natal and Mpumalanga provinces. Individual face-to-face interviews were conducted with eight health personnel to get a view from both providers and end users of health care in correctional settings. Data were analysed thematically. We found strong evidence of prison being a strategic point to increase access to health services for offenders. Curative services within prisons were well established and running despite the presence of certain challenges varying across institutions. Prevention programmes emerged as an area that requires stronger emphasis to facilitate imparting skills and promoting safer practices for inmates upon release. Peer-led education programmes emerged as a key aspect of preparation for release and community reintegration amongst inmates.

Adolescent↗

High oral doses of mebendazole interfere with growth of larval Echinococcus multilocularis lesions.

The natural development of the larval stage of Echinococcus multilocularis in man has been studied in 7 patients after presumed radical operation 2 8/12-11 2/12 years prior to detection of a relapse. The volumes of the recurring lesions were assessed by CT-scanning, and assuming linear growth a median increase of 14.8 ml/year (range 3.8-220 ml/year) was calculated. In 6 patients treated for a median duration of 4 5/12 years with high oral doses of mebendazole a median growth rate of -3.0 ml/year (range-470- + 10.2 ml/year) was found, which differed significantly from the natural growth rate (P less than 0.01). Although the patients improved clinically, there was evidence of persistent infection. These data are the first controlled evidence that high oral doses of mebendazole may be parasitostatic in alveolar echinococcosis in man. Although not curative, this pharmacological effect appears to be clinically beneficial.

Adult↗

Late urologic morbidity in 177 consecutive patients after radiotherapy for cervical carcinoma: a longitudinal study.

PURPOSE: To provide longitudinal data on urologic morbidity after radiotherapy and brachytherapy for cervical carcinoma. METHODS AND MATERIALS: Five-year longitudinal urologic morbidity data were recorded from 177 consecutive patients of median age 59 years (range: 22-86 years) with cervical carcinoma receiving radiotherapy with curative intent at the Copenhagen University Hospital, Denmark. FIGO stages (%) were as follows: Stage I (15), Stage II (30), Stage III (54), and Stage IV (1). Late morbidity was calculated as cumulative incidence based on actuarial estimates. RESULTS: The 5-year cumulative incidence based on actuarial estimates of urologic morbidity Grades 1 + 2 + 3, Grades 2 + 3, and Grade 3 were 62%, 32%, and 5%, respectively. Frequencies of urologic morbidity in the 54 recurrence-free survivors at the end of follow-up indicated some reversibility in the case of Grades 1 and 2 morbidity. CONCLUSION: With the longitudinal design used in the present study, a rate of mild and moderate morbidity higher than that found in most of the previously reported literature was observed, giving cause for concern and underlining the importance of further longitudinal studies on this subject, specifically studies that relate to the background urologic morbidity in the female population, as well as to the fact that urologic morbidity might regress.

Adult↗

Surveillance of basaloid oral squamous cell carcinoma: the value of [18F]FDG-PET.

Basaloid squamous cell carcinoma (BSCC) represents a rare but exceptionally aggressive variant of oral cancer. Hence, when tumors have been characterized to belong to this specific high-risk subpopulation, it remains an open issue how to manage the patients in terms of diagnostic surveillance and reconstruction. Therefore we explored whether glucose metabolism as measured by [18F]FDG-PET can accurately assess the disease status in the follow up of oral BSCC. The data of four patients with pathologically proven BSCC were analyzed in this study. These patients had [18F]FDG-PET scans after curative therapy to screen for local recurrence or disease generalization. The [18F]FDG-PET findings were correlated with clinical outcome. [18F]FDG-PET identified a site of recurrent tumor that was invisible to morphological imaging. None of the three patients with a normalized pattern of glucose uptake had secondary tumor progress within the further follow up period. Thus, [18F]FDG-PET proved valuable to identify those patients who will profit from early onset of reconstruction measures even though they originally belonged to a high-risk population.

Adult↗

[Staging and neoadjuvant therapy of squamous cell carcinoma of esophagus].

Once the diagnosis of esophageal cancer is established, the decision on treatment will depend on the stage of the disease. Since improvement of prognosis can only be expected in patients with complete removal of their tumor, preoperative staging plays a pivotal role in the decision-making process. Preoperative diagnostic procedures should define the tumor in its relation to the tracheal bifurcation (site), determine the depth of tumor invasion (T status), evaluate regional lymph node metastases (N1 disease) and exclude distant metastases (M1 disease). Endosonography represents currently the most accurate imaging technique for detecting the correct T stage over the correct N stage. A higher accuracy rate may be achieved by combining endosonography with other staging modalities such as computed tomography. Chest x-ray, and percutaneous ultrasonography (abdominal, neck) form the diagnostic basis in staging M1 disease. Computed tomography (neck, chest and abdomen) is currently the best method to detect metastases in the liver and in celiac nodes. Staging laparoscopy when combined with laparoscopic ultrasonography shows a higher sensitivity than ultrasonography and computed tomography in the diagnosis of smaller metastases and peritoneal seedings. En bloc esophagectomy together with the regional lymph nodes remains the treatment of choice in medically fit patients with localized esophageal carcinoma (Stage I-IIB, T1-T2/N0-N1/M0). Due to early involvement of mediastinal structures, curative resection is unlikely to be achieved in patients with locally advanced esophageal carcinoma (Stage III, T3-T4/N0-N1/M0). Most available data indicate that neoadjuvant radiochemotherapy leads in a significant number of patients to downstaging of the tumor, increases the rate of R0 resection, improves local tumor control, and prolongs the recurrence free interval. However, neoadjuvant radiochemotherapy resulted in a marked increase of morbidity and postoperative mortality without improvement of survival. At present, neoadjuvant therapy is still experimental and there is no consensus for an optimal treatment regimen. Its use outside of an investigational setting can not be recommended. Future research must focus on more effective and less toxic neoadjuvant modalities (e.g. new chemotherapy agents, hyperthermia).

Carcinoma, Squamous Cell↗

Hematopoietic stem-cell transplantation from unrelated donors in elderly patients (age >55 years) with hematologic malignancies: older age is no longer a contraindication when using reduced intensity conditioning.

Allogeneic stem cell transplantation (SCT) is a potentially curative approach for patients with hematological malignancies. Reduced-intensity conditioning regimens allow SCT in elderly patients; however, there are only limited data on the feasibility and outcomes of unrelated donor SCT in these patients. In this study, we analyzed, retrospectively, data of 36 patients with various hematological malignancies and median age 58 years (range, 55-66), who were given unrelated donor SCT after reduced-intensity conditioning. The preparative regimen consisted of fludarabine combined with oral busulfan (8 mg/kg, n=8), intravenous busulfan (6.4 mg/kg, n=11), treosulfan (30 g/m(2), n=5) or melphalan (100-150 mg/m(2), n=12). Patients were also given serotherapy, ATG (n=32), or alemtuzumab (n=4). The probabilities of overall survival, disease-free survival, and nonrelapse mortality at 1 year after SCT were 52, 43, and 39%, respectively. Acute graft-versus-host disease (GVHD) grade II-IV and chronic GVHD occurred in 31 and 45%, respectively. Multivariable analysis determined that survival rates were higher in patients with chemosensitive disease (HR 4.5), and patients conditioned with intravenous busulfan or treosulfan (HR 3.9). Unrelated donor SCT is feasible in elderly patients, with outcomes that are similar to younger patients. Favorable outcome was observed in patients with myeloid malignancies, and those transplanted in remission and early in the course of disease. Age alone should not be considered a contraindication to unrelated donor SCT.

Aged↗

BioGRID: a general repository for interaction datasets.

Access to unified datasets of protein and genetic interactions is critical for interrogation of gene/protein function and analysis of global network properties. BioGRID is a freely accessible database of physical and genetic interactions available at http://www.thebiogrid.org. BioGRID release version 2.0 includes >116 000 interactions from Saccharomyces cerevisiae, Caenorhabditis elegans, Drosophila melanogaster and Homo sapiens. Over 30 000 interactions have recently been added from 5778 sources through exhaustive curation of the Saccharomyces cerevisiae primary literature. An internally hyper-linked web interface allows for rapid search and retrieval of interaction data. Full or user-defined datasets are freely downloadable as tab-delimited text files and PSI-MI XML. Pre-computed graphical layouts of interactions are available in a variety of file formats. User-customized graphs with embedded protein, gene and interaction attributes can be constructed with a visualization system called Osprey that is dynamically linked to the BioGRID.

Animals↗

Effective long-term palliation of symptomatic, incurable metastatic medullary thyroid cancer by operative resection.

OBJECTIVE: To evaluate the short- and long-term consequences of palliative reresection of specific symptomatic lesions in patients with widely disseminated (incurable) medullary thyroid cancer (MTC). SUMMARY BACKGROUND DATA: Although reoperative neck microdissections can normalize calcitonin levels in patients with metastatic MTC confined to regional lymph nodes, there is no curative therapy for widely metastatic disease. However, these patients frequently have prolonged survival, but often with debilitating symptoms. METHODS: Between October 1981 and January 1997, 16 patients (mean age, 46 +/- 3 years; 10/16 female) underwent 21 palliative reoperations for unresectable MTC at the Johns Hopkins Hospital. All patients had significant symptom(s) or impending compromise of vital structures by a discrete lesion and had unequivocal preoperative evidence of a total disease burden that was unresectable. RESULTS: The mean interval from initial thyroidectomy to palliative surgery was 5.8 +/- 1.5 years. All patients had significant tumor burdens as evidenced by preoperative calcitonin values ranging from 900 to 222,500 pg/mL (nL < or = 17 pg/mL). The palliative operations consisted of reoperative neck dissection/mass excision (11), mediastinal mass resection (4), esophagectomy (1), liver trisegmentectomy (1), sigmoidectomy (1), bilateral simple mastectomies (1), pituitary resection (1), and subcutaneous mass excisions (1). All but two of the operative specimens contained MTC. There was no perioperative mortality. The long-term morbidity rate was limited to one recurrent laryngeal nerve injury. All patients had initial relief of the index symptom(s) after the palliative surgery, followed by a median actuarial symptom-free survival rate of 8.2 years. CONCLUSIONS: Patients with widely metastatic MTC often live for years, but many develop symptoms secondary to tumor persistence or progression. Judicious palliative, reoperative resection of discrete, symptomatic lesions can provide significant long-term relief of symptoms with minimal operative mortality and morbidity. In selected patients with metastatic MTC lesions causing significant symptoms or physical compromise, palliative reoperative resection should be considered despite the presence of widespread incurable metastatic disease.

Adult↗

Colonoscopic follow-up of adenomas and colorectal cancer.

Increasing experience with colonoscopy has altered recommendations for the frequency of follow-up surveillance examinations for adenomatous polyps and colorectal cancer. Current recommendations include a follow-up colonoscopy at 1 year for patients with more than two adenomatous or highly suggestive polyps and after curative surgery for colorectal cancer. Other patients can safely receive a follow-up colonoscopy at longer intervals of 3 years. Published data and a review of the Ochsner Clinic experience are presented to support these recommendations.

Adenoma↗

Identification and classification of ion-channels across the tree of life provide functional insights into understudied CALHM channels.

The ion channel (IC) genes encoded in the human genome play fundamental roles in cellular functions and disease and are one of the largest classes of druggable proteins. However, limited knowledge of the diverse molecular and cellular functions carried out by ICs presents a major bottleneck in developing selective chemical probes for modulating their functions in disease states. The wealth of sequence data available on ICs from diverse organisms provides a valuable source of untapped information for illuminating the unique modes of channel regulation and functional specialization. However, the extensive diversification of IC sequences and the lack of a unified resource present a challenge in effectively using existing data for IC research. Here, we perform integrative mining of available sequence, structure, and functional data on 419 human ICs across disparate sources, including extensive literature mining by leveraging advances in large language models to annotate and curate the full complement of the "channelome". We employ a well-established orthology inference approach to identify and extend the IC orthologs across diverse organisms to above 48,000. We show that the depth of conservation and taxonomic representation of IC sequences can further be translated to functional similarities by clustering them into functionally relevant groups, which can be used for downstream functional prediction on understudied members. We demonstrate this by delineating co-conserved patterns characteristic of the understudied family of the Calcium Homeostasis Modulator (CALHM) family of ICs. Through mutational analysis of co-conserved residues altered in human diseases and electrophysiological studies, we show that these evolutionarily-constrained residues play an important role in channel gating functions. Thus, by providing new tools and resources for performing large comparative analyses on ICs, this study addresses the unique needs of the IC community and provides the groundwork for accelerating the functional characterization of dark channels for therapeutic intervention.

CALHM1↗

Creating the gene ontology resource: design and implementation.

The exponential growth in the volume of accessible biological information has generated a confusion of voices surrounding the annotation of molecular information about genes and their products. The Gene Ontology (GO) project seeks to provide a set of structured vocabularies for specific biological domains that can be used to describe gene products in any organism. This work includes building three extensive ontologies to describe molecular function, biological process, and cellular component, and providing a community database resource that supports the use of these ontologies. The GO Consortium was initiated by scientists associated with three model organism databases: SGD, the Saccharomyces Genome database; FlyBase, the Drosophila genome database; and MGD/GXD, the Mouse Genome Informatics databases. Additional model organism database groups are joining the project. Each of these model organism information systems is annotating genes and gene products using GO vocabulary terms and incorporating these annotations into their respective model organism databases. Each database contributes its annotation files to a shared GO data resource accessible to the public at http://www.geneontology.org/. The GO site can be used by the community both to recover the GO vocabularies and to access the annotated gene product data sets from the model organism databases. The GO Consortium supports the development of the GO database resource and provides tools enabling curators and researchers to query and manipulate the vocabularies. We believe that the shared development of this molecular annotation resource will contribute to the unification of biological information.

Animals↗

Surgical therapy of hepatic colorectal metastasis.

This review summarizes data demonstrating the safety and efficacy of liver resection for colorectal metastases. Hepatic resection in appropriately selected patients remains the only potentially curative treatment for patients with such metastases. Recommendations for preoperative patient evaluation, patient selection, adjuvant therapy, and postoperative follow-up are presented. Other surgical modalities utilized in the treatment of unresectable or recurrent hepatic colorectal metastases, including ablative modalities and surgical delivery of regional chemotherapy, are described.

Colorectal Neoplasms↗

Radiotherapy for cancer of the cervix in morbidly obese women: preliminary results.

A retrospective four-year review showed that six morbidly obese (> or = 40 kg/m2) women, two of whom underwent pre-irradiation simple hysterectomy, were definitively treated with radiation for cancer of the cervix. All cases were FIGO stage IB. The average age was 49 years and average body mass index 49 kg/m2. Radiotherapy consisted of external beam pelvic irradiation and low-dose rate or high-dose rate brachytherapy applications. During a follow-up period ranging from 9 to 46 months, all women were alive and free of neoplastic disease as well as complications. Albeit long-term outcome data are not yet available, we believe that morbidly obese women with early stage cervical cancer who are not suitable candidates for curative surgery may derive beneficial effects from appropriately applied definitive radiotherapy.

Adult↗

[Effects of transcatheter closure of perimembranous ventricular septal defects: intermediate and long-term follow-up of 68 cases].

OBJECTIVE: To evaluate the curative effects of transcatheter closure on perimembranous ventricular septal defects (PMVSDs) using unbalanced Amplatzer asymmetric ventricular septal defect occluder (AAVSDO). METHODS: The data of 68 patients of PMVSDs with a diameter of 6.7 mm (3 to 12 mm) and the diameter of ventricular septal rim below the aortic valve of 2.7 +/- 1.1 mm (1-5 mm), 27 males and 41 females, aged 15.6 +/- 11.5 (1.5-44), weighing 42.8 +/- 15.2 kg (10-72 kg), treated with AAVSDO, the diameter of which was 1-2 mm larger than the largest diameter of the defects determined by angled left ventriculography, from September 2002 to January 2005 were prospectively analyzed. The patients were followed up for 221 +/- 130 days (90 to 750 days). RESULTS: Seventy-one procedures were performed. The device was implanted successfully in 65 of the 68 patients (95.6%). The selected device diameter was 8.4 mm (4 to 14 mm). Device was lost in one patient during the procedure, which was successfully managed by recapturing the device with a snare device and redeploying it. During the procedure, transient complete left bundle branch block and right bundle branch block occurred in 6 and 5 patients respectively. On follow-up evaluation, transient junctional rhythm occurred in one patient, and accelerated ventricular rhythm in 1. After deployment of the device, the immediate complete closure rate was 43% (28/68), increased to 81.5% (53/68) on the day next to the procedure, and reached 100% 6 months after. One patient adopted surgical reparation because hemolysis occurred after the device implanted. The hospitalization time was 4.5 +/- 3.6 days (2-8 days). The X-ray exposure time was 14.8 +/- 10.7 min (6-48 min). The procedure time 72.6 +/- 38.7 min (35-186 min). One patient was diagnosed as with deep vein thrombosis because of right leg swelling at the seventh day after the procedure. The symptoms disappeared after anticoagulation treatment with low molecule weight heparin. During the scheduled long-term follow-up all patients were doing well. No episode of endocarditis, procedure-related death, or wire disruption was recorded. CONCLUSION: The initial and long-term follow-up results of transcatheter closure of PMVSDs are promising with high success and occlusion rates. Transcatheter closure of PMVSDs using AAVSDO appears to be the first line choice for suitable patients with such defects.

Adolescent↗

Domestic health expenditure in Hong Kong: 1989/90 to 2001/02.

OBJECTIVE: To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. METHODS: The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. RESULTS: Total domestic health expenditure was $68,620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals' share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting. CONCLUSION: These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies.

Ambulatory Care↗

Radical radiotherapy for carcinoma of the uterine cervix using high dose rate brachytherapy--a preliminary report.

From April 1992 to December 1994, a total of 61 patients with carcinoma of the cervix were treated with curative intent using initially external beam therapy followed by high dose rate brachytherapy. On reviewing 57 patients with adequate follow-up data, the local failure rate was found to be 12.3% and metastatic failure rate was 15.8%. Local pelvic failure rates for stage II and III patients were 10% and 13.6% respectively, but for stage I disease, there was one local failure out of 5 patients, at a rate of 20%. This is probably due to the small number in this subgroup. Complication rate was low with only one patient with grade IV problems, giving a serious complication rate of 1.7% only. Overall actuarial rate in this group was 50.1%. These results are encouraging but further review on achieving adequate follow-up is needed before firm conclusions can be drawn.

Actuarial Analysis↗