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PubMed1997

[Epidemiologic data of uro-oncologic pathology in a urology service of a university general hospital. Comments regarding cancer of the prostate].

Data from 92, 93 and 94 tumoral records is analyzed based on the first visit system, staging at time of diagnosis, intervals between visits and management. After finding data unsatisfactory, a program for health care improvement is developed in order to secure diagnosis at earlier stages which may allow for curative radical treatment. The program was implemented in 1995. Results are communicated, and compared with those from previous years; the effectiveness of the program is verified.

Humans↗
PubMed1997

Female sex hormone receptor status in advanced hepatocellular carcinoma and outcome after surgical resection.

BACKGROUND: There is a limited amount of data regarding the estrogen receptor (ER) and progesterone receptor (PgR) status of hepatocellular carcinomas (HGCs), and the relationship between receptor status and clinicopathologic features of tumors has not been reported. METHODS: Between April 1992 and December 1993, cancerous tissues for cytosolic preparation and receptor quantification in a monoclonal solid-phase enzyme immunoassay were obtained from 28 patients undergoing resection, three patients with total hepatectomy and subsequent liver transplantation, and two patients suffering from nonresectable HCC. RESULTS: ER and PgR were detected in the HCCs of 13 (39%) and 6 patients (18%), respectively. A lower age was observed among the female patients whose receptor status was negative for ER or PgR or both, as compared with the respective receptor-positive groups. No significant differences with respect to tumor stage and grading could be observed. There was one perioperative death (3%). In patients undergoing curative resection, 1-year survival in the ER(+) group was significantly lower than in the ER(-) group (40% versus 79%, p < 0.05). The 2-year survival rates in the ER(+) and ER(-) groups were 40% and 71%, respectively. A comparable trend did not become evident for PgR(+) and PgR(-) patients. CONCLUSIONS: Our data suggest a negative effect of an ER(+) tumor on patient survival after curative resection of advanced HCC.

Aged↗
PubMed2001

Trends in the utilization of androgen-deprivation therapy for patients with prostate carcinoma suggest an effect on mortality.

BACKGROUND: After a surge in the incidence of prostate carcinoma in the early 1990s, diminishing rates of mortality became apparent in 1993. This decrease in mortality is unlikely to be explained entirely by treatment with curative intent alone following screen-detected cases, because the time frame between detection and mortality remains relatively brief. METHODS: This study used incidence and initial treatment data from the Detroit area SEER registry between 1973 and 1998 in addition to mortality data covering the Metropolitan Detroit area obtained from the Michigan Department of Community Health. Data for Caucasian and African-American men were analyzed. The use of androgen-deprivation therapy, which evolved during the study period, was evaluated in conjunction with mortality and incidence trend data for consideration of etiologic contributions. RESULTS: The incidence of prostate carcinoma, as noted previously in national data, increased sharply in 1988, peaking in 1992 in Southeast Michigan, whereas mortality rates began to decrease in approximately 1993, with a sustained decrease to the latest recorded data in 1998. These trends were identical in Caucasians and African Americans. A sharp increase in the use of androgen-deprivation therapy began in 1990. This use of androgen-deprivation therapy is high and sustained for patients with early-stage disease, increases for several years, and then diminishes for patients with regional disease. The use also diminished through the 1990s for patients with late-stage disease, paralleling the decrease in the incidence rate for late-stage disease. CONCLUSIONS: The pattern of androgen-deprivation therapy usage was consistent with that for hormonal monotherapy and adjuvant and neoadjuvant therapy. These findings suggest that androgen-deprivation therapy may contribute, along with advances in diagnostic techniques and curative therapy with radiation or surgery, toward decreasing prostate carcinoma mortality rates in Southeast Michigan.

Adult↗
PubMed2001

[Resection of liver metastases--goal, timing and results].

If left to run their natural course, numerous malignant diseases will eventually produce liver metastases. Without treatment, afflicted patients have a life expectancy of only eight months. At the present time, the only therapeutic option that offers the patient with liver metastases from colorectal carcinoma the chance of a cure is resection of the metastases. Depending on the primary tumour, this also applies to some patients with carcinomas at sites other than the colorectum. A point of continuing controversy is the timing of such resection. While some authors recommend a test 'of time' ranging from several weeks to months, others call for resection of the metastases immediately after their detection. Solitary synchronous liver metastases involving only a single segment can be resected at the same time as surgical treatment of the primary when, in particular, the surgical access is readily possible and the risk of complications calculable. Most authors advocate surgery in two sessions. The location, number and size of the metastases, together with the presence of concomitant diseases, provide the basis for the decision to perform a resection. At the same time, however, the risk to the patient must be within justifiable limits. This applies in particular to non-colorectal, non-endocrine metastases. Following curative resection of colorectal hepatic metastases, 25-51% of the patients are still alive after 5 years. During the same period, some 51-76% of the patients develop a recurrence. From these data, the calculated resulting median survival for all patients undergoing resection is roughly 30 months. A tumour-free 5-year survival rate of up to 34% is achieved. In view of their different clinical course and prognosis, non-colorectal liver metastases should be classified into non-colorectal neuroendocrine (NCNE) and non-colorectal non-endocrine (NCNN) metastases. While the former group has a 5-year survival rate following curative resection of up to 62%, the figure for the latter group is only 15-35%.

Colorectal Neoplasms↗
PubMed2001

Israeli nurses' knowledge of health care reforms.

OBJECTIVES: This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses' knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses' knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses' roles (managerial vs. staff nurses), years of experience, and level and type of education? METHOD: The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses' knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. RESULTS: Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms' knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non-nursing academic degree were all positively related to higher levels of reforms' knowledge. CONCLUSION: These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.

Adult↗
PubMed2007

Diagnostic accuracy of serum-carcinoembryonic antigen in recurrent colorectal cancer: a receiver operating characteristic curve analysis.

BACKGROUND: Serial measurements of carcinoembryonic antigen (CEA) are frequently used in the follow-up after colorectal cancer (CRC), but its usefulness remains debatable. Choosing the appropriate cut-off point is crucial to the diagnostic accuracy (DA) of continuous test variables. Receiver operating characteristic curve (ROC) analysis is the appropriate statistical method for this purpose, but has not been applied in previous studies. METHODS: One hundred ninety-four consecutive patients surgically treated with curative intent for CRC between July 1996 and June 1999 had systematic follow-up for five years. Follow-up included imaging, coloscopy and serial CEA measurements. Complete data including CEA measurements were available from 153 patients. ROC analysis of CEA was done with regard to detection of recurrent disease. RESULTS: Depending on the chosen cut-off value of CEA, DA varied widely within the normal range (CEA 4 U/ml provided the highest sensitivity (0.78) and specificity (0.91), compared to a sensitivity and specificity at the upper normal range (CEA = 10 U/ml) of 0.51 and 0.99, respectively. Thirty-three patients (24%) developed recurrence. Among 11 (5%) asymptomatic patients diagnosed by elevated CEA levels, only two patients (1.5%) were amenable to secondary curative surgery. A threefold increase of CEA in an individual patient had the same DA as the best cut-off value (>4 U/ml). CONCLUSIONS: Diagnostic accuracy of CEA in follow-up after curative surgery for CRC is influenced by the chosen cut-off value. A threefold increase of CEA may indicate recurrent disease. The value of serial measurement of CEA was limited.

Adenocarcinoma↗
PubMed1997

Genetic alterations in patients with esophageal cancer with short- and long-term survival rates after curative esophagectomy.

OBJECTIVE: The objective of this study was to ascertain the exact relation between specific oncogenes and long- and short-term survival rates in patients with esophageal cancer. SUMMARY BACKGROUND DATA: Recent developments in molecular biology have shown that several oncogenes and suppressor genes are involved in the development of esophageal cancer. However, the role of these genes still is unknown. METHODS: The clinical outcome of 84 cases of R0-resected esophageal carcinomas (from 1986-1993) and the molecular and biologic characteristics of these tumors were studied. The patients studied were divided into three groups, which were designated as follows: shortest term survivors (up to 6 months), short-term survivors (7-12 months), and long-term survivors (>5 years). These groups included 23, 17, and 44 subjects, respectively. For the genomic analysis, CyclinD1, int-2, murine double minute 2 (MDM2), retinoblastoma, p53, adenomatous polyposis coli (APC), deleted in colorectal carcinoma (DCC), and human papillomavirus were studied in these patients. The regrowth capability of primary cultures and the clinicopathologic characteristics of these patients also were analyzed. RESULTS: The CyclinD1 and int-2 genes, which are located in the 11q13 chromosome, and the MDM2 gene were related to short survival. However, the p53 mutation and human papillomavirus infection were not related to short-term survival. The average ratio of genomic abnormalities to genes examined was higher in the shortest and short-term survival groups than in the long-term survival group. Regrowth capability in primary cultures also was related to short-term survival. Among the long-term survival patients, 7 (16%) of 44 cases suffered further cancer after esophagectomy. CONCLUSIONS: These results suggest that the 11q13 amplicon and MDM2 may play an important role in the progression of esophageal cancer, and an accumulation of genomic abnormalities may result in poor prognosis. Careful follow-up testing for double cancer is needed in long-term survivors of esophageal cancer.

Chromosome Aberrations↗
PubMed2003

Long-term seizure outcomes following amygdalohippocampectomy.

OBJECT: Analyses of the results of surgery for epilepsy are hindered by inconsistent classifications of seizure outcome, small numbers of patients, and short postoperative follow-up periods. The authors conducted a retrospective study with a reassessment of the long-term seizure outcomes in patients who underwent selective amygdalohippocampectomy (SelAH) for pharmacotherapy-resistant mesial temporal lobe epilepsy (MTLE) at the Zurich University Hospital from 1975 to 1999. METHODS: Year-by-year data and the last available data on seizure outcomes were retrospectively assessed for 369 consecutively surgically treated patients who had participated in a follow-up period longer than 1 year as of 1999 and whose outcomes were classified according to the Engel scale and the proposed new International League Against Epilepsy (ILAE) scale. Patients were grouped into nonlesional and lesional MTLE groups depending on whether they harbored a gross anatomical lesion that caused the MTLE. Differentiation was made between curative and palliative operations. Complications related to surgery are reported for 453 patients who underwent SelAH and participated in more than 3 months of follow-up review. The last available outcome data according to the Engel scale were found to be generally similar to those of the new ILAE classification, with 66.9% of patients free from disabling seizures (Engel Class I) compared with 57.1% who were completely seizure and aura free (ILAE Class 1). The last available data on seizure outcome were not significantly different between patients in the lesional and nonlesional MTLE groups. In the lesional group, seizure outcomes were significantly better when patients underwent surgery early in the course of the disease. Overall, 70% of the patients received reductions in their antiepileptic drug treatment at the time of the last available follow-up review. Complications related to the surgical procedures were rare. CONCLUSIONS: The authors conclude that SelAH is a safe and effective surgical procedure for MTLE.

Adult↗
PubMed1978

Carcinoma of the rectum and rectosigmoid colon: role of radiation therapy.

Surgery is the modality of choice in curative treatment for cancer of the colon and rectum. Since a majority of the patients present advanced disease where the surgical outlook is poor, adjuvant therapy may be warranted. Clinical and experimental data demonstrate the benefits from preoperative radiation therapy and some clinical reports indicate the beneficial effects of postoperative radiotherapy. Two national studies are underway to determine the effectiveness of preoperative radiation therapy in moderate doses. A similar study is suggested to establish the effectiveness of postoperative radiation therapy.For patients who are poor surgical risks, or for a tumor which is considered to be inoperable, and in a selected group, radiation therapy can be used as a curative procedure. Advantages include eliminating the need for a permanent colostomy. In case of failure, electrocoagulation and abdominal perineal resection are still available alternatives.A modest amount of radiation therapy can afford maximum palliation with minimum discomfort to the patient. About 80-90 percent of patients with pain and bleeding and 50 percent of patients with symptomatic liver metastasis respond favorably.

Humans↗
PubMedDate not supplied

Histopathologic prognostic score in colorectal adenocarcinomas.

OBJECTIVE: To analyze the prognostic value of a set of pathological variables after curative resection for large bowel adenocarcinoma and to test a prognostic score derived from factors with independent effect. PATIENTS AND METHODS: The study is based on data from 292 consecutive unselected patients (B-C Astler-Coller stages). Histopathological features were evaluated prospectively on the resected primary tumors. Relationship between these factors and risk of recurrence was assessed by a Cox's proportional regression analysis. RESULTS: Four variables retained independent prognostic significance: extent of bowel wall invasion, peritumoral lymphocytic infiltration, number of positive nodes and vascular invasion. A prognostic score based on the regression coefficients attained by such variables was developed. This system revealed four prognostic groups. Group I included 14% of patients, with 94% 5-year disease-free survival. These figures were: 35% and 60% in group II; 43% and 46% in group III; and 7% and 24.4% in group IV. Histopathologic score applied to bearers of Astler-Coller B2 tumors permitted the identification of two populations, one characterized by a low risk of relapse and another with high risk (p = 0.002). CONCLUSION: A prognostic score based in the evaluation of four histopathologic parameters concerning the tumor phenotype enables the identification of groups of patients at risk of relapse after curative resection for colorectal adenocarcinoma.

Adenocarcinoma↗
PubMed2001

Cyclin E overexpression as an independent risk factor of visceral relapse in breast cancer.

AIM: Prognostic value of the cyclin E overexpression in breast cancer has not been clearly established, especially in relation to the pattern of recurrence. We investigated the implication of cyclin E overexpression for the pattern of recurrence in Korean breast cancer patients. METHODS: Using immunohistochemical methods, we retrospectively examined the cyclin E expression level in breast cancer specimens from 128 women who underwent curative breast surgery, and correlated the levels of expression with the pattern of relapse in patients. RESULTS: Cox model-based multivariate analysis indicated that distant relapse could be predicted by the number of positive axillary lymph nodes, high cyclin E expression, and the younger age (<35 years) of the patient. We tested further the association of cyclin E overexpression with the specific types of recurrence; multivariate analyses indicated that adjusted relative risks of bone and visceral relapse as the first events among high cyclin E group were 2.46 (95% confidence interval (CI), 0.86-7.02) (P=0.092), and 3.98 (95% CI, 1.23-12.94) (P=0.022), respectively. On the other hand, cyclin E overexpression was not associated with the risk of locoregional relapse. CONCLUSION: Our data suggest that cyclin E overexpression in primary breast carcinoma tissue could independently predict the risk of distant relapse, especially of visceral relapse, as the first failure after curative breast surgery.

Adult↗
PubMed2000

Laparoscopic abdominoperineal resection: early postoperative results of a prospective study involving 116 patients. The Laparoscopic Colorectal Surgery Study Group.

PURPOSE: Although laparoscopic colorectal surgery is attracting ever more attention, its use for curative treatment of colorectal carcinoma in particular continues to be controversial. The present study was an attempt to analyze the results of the perioperative course, oncologic quality, and preliminary long-term results. METHOD: The data considered here were collected within the framework of a prospective, observational study initiated on August 1, 1995, and involving a total of 18 institutions in Germany and Austria. At the end of three years, the results are now being presented selectively, i.e., focusing only on abdominoperineal resection. RESULTS: A total of 116 patients underwent laparoscopic abdominoperineal resections, 98 (84.5 percent) of which were performed with curative intent. The mean operating time was 226 (confidence interval, 140-365) minutes. Seven patients (6 percent) experienced an intraoperative complication, which in more than one-half of the cases was a vascular injury involving the presacral venous plexus; the conversion rate was 3.4 percent. Postoperatively, 40 patients developed 97 complications--including those of a very minor nature--giving an overall morbidity rate of 34.4 percent. Reoperation in six patients (5.2 percent) had to be performed for an afterbleed in one-half of the cases and ileus in the other one-half. Postoperative mortality was a low 1.7 percent. In most of the curative resections, an oncologically radical operation with high transection of the inferior mesenteric artery and a complete dissection of the pelvis down to the floor was performed. The median number of lymph nodes investigated was 11.5, and there was wide fluctuation in the numbers among the individual institutions. Tumor cell dissemination occurred intraoperatively in five patients. In the meantime, 79 patients (81 percent) underwent at least one follow-up examination, the mean follow-up period being 491 days. Seven patients developed a local recurrence, and a further six patients developed distant metastases. For recurrence-free survival rate, the Kaplan-Meier estimation calculated a probability of 71 percent. CONCLUSION: Not all of the reservations about laparoscopic abdominoperineal resection, in particular with regard to resection with curative intent, have yet been eliminated. The present study does, however, show that a laparoscopic approach can in principle meet oncologic requirements of radicality and, with regard to the postoperative course, is associated with considerable benefits to the patient.

Abdomen↗
PubMed2026

Unifying multimodal single-cell data with a mixture-of-experts &#x3b2;-variational autoencoder framework.

Multimodal single-cell assays profile complementary layers of cell state, but integration is complicated by modality mismatch, sparsity, and uneven cohort coverage. Here, we present Unified Variational Inference (UniVI), a scalable mixture-of-experts &#x3b2;-variational autoencoder that learns a shared latent space while preserving modality-specific structure. UniVI couples modality-specific encoders/decoders with a shared latent prior and a symmetric cross-modal alignment objective, enabling consistent integration of paired measurements without curated feature-link graphs or preannotated reference atlases; optional supervised heads can be added when labels are available. Across paired RNA-protein (CITE-seq) and RNA-chromatin (10x Genomics Multiome, SHARE-seq) data spanning human PBMCs and mouse back skin-a nonhematopoietic tissue with continuous differentiation hierarchies-UniVI produces coherent embeddings, improves label transfer, and enables cross-modal reconstruction and denoising. Extending to trimodal measurements, UniVI maintains robust three-way alignment among RNA, chromatin accessibility, and surface proteins (TEA-seq), and accommodates DNA methylation in a paired scNMT-seq mouse gastrulation proof-of-concept under beta-binomial likelihoods. Performance degrades gracefully under severe cell type imbalance and in the presence of modality-exclusive populations. In an acute myeloid leukemia mosaic design, a paired RNA-protein bridge anchors independent RNA-only and protein+genotype cohorts, revealing genotype-associated neighborhoods that sharpen with mutation-aware fine-tuning. UniVI thus provides a flexible, interpretable framework for multimodal integration across paired, trimodal, and mosaic study designs and supports practical reference-to-query projection in partially observed studies.

Journal Article↗
PubMed1994

Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients.

BACKGROUND: Patients with colorectal carcinoma found to have regional lymph node metastases after curative resection form a large and prognostically diverse group. This study aims to determine which pathology variables have independent prognostic effects. METHODS: The data from the 579 patients used in this analysis were collected prospectively during a period of 21.5 years. The patients were from one institution, and the pathologic documentation was standardized. Patient follow-up ranged between 6 months and 21.5 years. Survival analysis was by the Kaplan-Meier method. Multivariate models were examined using Cox proportional hazards regression. RESULTS: On univariate analysis, eight pathology variables had a significant association with survival. Six of these variables showed significant independent effects on survival on multivariate analysis. In diminishing potency, these variables were: apical lymph node involvement; spread involving a free serosal surface; invasion beyond the muscularis propria; location in the rectum; venous invasion; high tumor grade. Significant independent effects also were shown for patient age and gender. The number of involved lymph nodes added no significant independent prognostic information. CONCLUSION: Six pathology variables have been identified that act independently in determining the survival of patients with colorectal carcinoma and lymph node metastases. The most potent of these variables, apical lymph node involvement, was used by Dukes to subclassify Stage C tumors. Another variable, direct spread beyond the muscularis propria, defines the Astler-Coller subclassification. It is recommended that all six independent variables be included in any future protocol for stratifying this prognostically diverse group of patients.

Adult↗
PubMed1996

Prognostic value of ploidy, cell proliferation kinetics, and conventional clinicopathologic criteria in patients with colorectal carcinoma: a prospective study.

PURPOSE: The aim of this study was to obtain additional biologic determinants that may be of use in segregating into subgroups with different prognosis patients with similarly staged colorectal cancers. METHODS: Between 1989 and 1991, a prospective study of prognostic factors has been performed in a group of 98 consecutive, unselected patients who underwent curative resections for primary untreated large bowel carcinoma. The fate of all patients is known at three years after operation. Clinical and pathologic data were recorded at the time of presentation and operation, and patients have been the subjects of regular follow-up. Tumor DNA content was determined by flow cytometry, and cell proliferative activity was determined by autoradiography with tritiated thymidine labeling index (LI). RESULTS: Univariate analysis revealed that the most important predictors of survival (P < 0.001) were the presence of positive lymph nodes, the presence of preoperative complications, Dukes stage, and LI. The multivariate analysis showed that Dukes stage (P < 0.002) and LI (P < 0.0001) were the only factors significantly related to survival. Disease-free survival was influenced significantly by Dukes stage (P < 0.001), LI, according to the classification in the two groups of high and low proliferative activity, respectively, (P < 0.0001), LI, calculated as a continuous variable (P < 0.0002), and the presence of lymph node metastases (P < 0.003). Outcome (favorable/unfavorable) was influenced significantly by Dukes stage (P < 0.0001) and LI (P < 0.0001). Concordance for each patient between Dukes stage and outcome was 73.1 percent and between LI, calculated as a continuous variable, and outcome was 74.1 percent. If, on the other hand, Dukes stage and LI are used together, concordance with outcome reaches 89.2 percent. CONCLUSION: We can conclude that, from a practical point of view, LI is an essential factor that must be combined with pathologic variables for a better prediction of patient outcome.

Adult↗
PubMed2005

Liver metastasis from thyroid carcinoma 32 years after resection of the primary tumor: report of a case.

Follicular thyroid carcinoma is a differentiated cancer originating from the follicular cells in the thyroid gland. A 73-year-old woman, who had undergone curative resection of thyroid carcinoma 32 years earlier, was referred to our hospital after ultrasonography showed a solid mass in the liver. Laboratory data revealed positive hepatitis B core antibody, but all other values were normal. Computed tomography showed a round tumor, about 1.5 cm in diameter, which was enhanced early and washed out later, in segment 5 of the liver. She underwent laparotomy and partial resection of the liver. Microscopic examination showed follicular cells with minimal atypia growing in a thyroid follicular pattern with colloids, whereby a diagnosis of metastatic liver cancer from thyroid follicular carcinoma was made. This is a rare case of solitary liver metastasis appearing 32 years after eradication of primary follicular carcinoma. Although the reason for the delayed presentation of the metastatic lesion remains unclear, this case shows that patients with differentiated thyroid cancer should be followed up for their entire life.

Adenocarcinoma, Follicular↗
PubMed1984

Radiation therapy in adenoid-cystic carcinoma.

Between 1949 and 1977, 74 patients with adenoid-cystic carcinoma of various head and neck sites were treated by radiation therapy at Memorial Sloan-Kettering Cancer Center. Radiation therapy alone was employed in 49 patients for recurrent, unresectable disease, and in 25 patients it was given as an adjunct to surgical resection. Among the 49 patients treated with radiation therapy alone, tumor regression was seen in 47 (96%). However, 44 of the 47 (93.5%) subsequently relapsed locally. Relapse occurred within 18 months in one-half of the patients and within 5 years in all of them. Of the 25 patients who received adjunctive radiation therapy about one-half relapsed locally within five years. There were 9 patients in this group, however, whose field size exceeded 8 X 8 cm and the dose of radiation also exceeded 4500 rad: 88% of these patients remained relapse-free at 5 years, compared with only 22% of the other 16 whose dose, or field size, or both, were inadequate by comparison. These data suggest that when irradiation is employed for advanced, inoperable adenoid-cystic carcinoma, it offers useful palliation but is rarely, if ever, curative. Postoperative irradiation, on the other hand, might improve the local control and the survival in patients with operable adenoid-cystic carcinoma who are at high risk for relapse, but only if the field size and the dose are adequate.

Adult↗