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Treatment of bulky, barrel-shaped stage IB carcinoma of the uterine cervix with irradiation alone or in combination with surgery
258
SOCIETY OF GYNECOLOGIC
ONCOLOGISTS-ABSTRACTS
scalpel and its effect on wound healing. A serial evaluation of cutaneous incisions in pigs was made at Postincisional Days 1, 4, 7, 14, and 22. Microscopic studies of biopsy specimens evaluated completion of epithelial migration, average residual scar widths, and zone of thermal necrosis. A tensiometric study assessed “wound breaking strength.” Analysis of the histologic preparations revealed consistent differences at any time period. The average residual scar width was least with the standard cold scalpel. The scar was greater in increasing order for the Shaw, the ESU, and the CO2 laser for each time period. Completion of epithelial migration occurred during Day 1 for the standard cold scalpel, between Days 1 and 4 for the Shaw scalpel, and between Days 4 and 7 for the ESU and CO2 laser. The lateral thermal necrotic zone was absent for the standard cold scalpel and evident with increasing density for the Shaw scalpel, ESU, and CO, laser, respectively. The tensiometric evaluation revealed no significant differences (P > 0.05) for the first 7 days of wound healing, regardless of the incisional instrument. The standard cold scalpel had significantly (P < 0.01) more breaking strength on Day 14 than all other incisional instruments. At Day 22, a highly significant difference (P < 0.001) existed between the standard cold scalpel and both the ESU and the Shaw scalpel. Thermal injury, induced to varying degrees by the thermal knives, clearly delays the wound healing process. of Bulky, Barrel-Shaped Stage IB Carcinoma of the Uterine Cervix with Irradiation Alone or in Combination with Surgery. HOLLY GALLION, M.D., J. R. VAN NAGELL, JR., M.D., E. S. DONALDSON, M.D., M. B. HANSON, M.D., E. J. PAVLIK, PH.D., J. YONEDA, M.D., AND Y. MARUYAMA, M.D., Department of Obstetrics and Gynecology, University of Kentucky Medical
15. Treatment
Center, 800 Rose Street, Lexington, Kentucky 40536. The therapy of all patients with bulky (>4 cm diameter), barrel-shaped stage IB carcinoma of the cervix treated at the University of Kentucky Medical Center between 1962 and 1980 was reviewed. Seventy-five patients were followed for a minimum of 24 months after completion of therapy (mean 53 months), and none were lost to follow-up. The mean age of patients was 47 years (range 25 to 68 years). All patients received a combination of approximately 4000 rad whole pelvis radiation followed by an additional 1000 rad to the pelvic sidewalls. Intracavitary therapy delivering an additional 2000 rad to point A was then given. Thirty-two patients were treated with radiation alone and 43 patients received radiation followed by extrafascial hysterectomy. Recurrence was noted in 15 of 32 patients (47%) treated by radiation alone versus 7 of 43 (16%) in patients treated by radiation and extrafascial hysterectomy (P < 0.05). In patients treated by radiation therapy alone, there were 6 pelvic recurrences, 4 recurrences in both pelvic and extrapelvic sites, and 5 extrapelvic recurrences. Of the 7 patients who developed recurrent disease after combination therapy, there was only one isolated pelvic recurrence. There were no major operative complications in patients treated with radiation and surgery. In the group treated with combined therapy, those patients with microscopic residual tumor in the hysterectomy specimen had a recurrence rate of 36% (5/14) as opposed to only 7% (2/29) in those patients whose specimens were negative for residual disease. Analysis of these data suggests that the addition of extrafascial hysterectomy to radiation therapy is beneficial in the treatment of patients with stage IB bulky, barrel-shaped cervical cancer.
Recurrence Treatment method Radiation Radiation and extrafascial hysterectomy
No. patients
NED
Pelvic
Pelvic and Extrapelvic
Extrapelvic
32
17 (53%)
6 (19%)
4 (12%)
5 (16%)
43
36 (84%)
1 (2%)
3 (7%)
3 (7%)
Recurrence rate significantly (P < 0.05) reduced in patients treated by combination therapy.
SOCIETY OF GYNECOLOGIC
ONCOLOGISTS-ABSTRACTS
scalpel and its effect on wound healing. A serial evaluation of cutaneous incisions in pigs was made at Postincisional Days 1, 4, 7, 14, and 22. Microscopic studies of biopsy specimens evaluated completion of epithelial migration, average residual scar widths, and zone of thermal necrosis. A tensiometric study assessed “wound breaking strength.” Analysis of the histologic preparations revealed consistent differences at any time period. The average residual scar width was least with the standard cold scalpel. The scar was greater in increasing order for the Shaw, the ESU, and the CO2 laser for each time period. Completion of epithelial migration occurred during Day 1 for the standard cold scalpel, between Days 1 and 4 for the Shaw scalpel, and between Days 4 and 7 for the ESU and CO2 laser. The lateral thermal necrotic zone was absent for the standard cold scalpel and evident with increasing density for the Shaw scalpel, ESU, and CO, laser, respectively. The tensiometric evaluation revealed no significant differences (P > 0.05) for the first 7 days of wound healing, regardless of the incisional instrument. The standard cold scalpel had significantly (P < 0.01) more breaking strength on Day 14 than all other incisional instruments. At Day 22, a highly significant difference (P < 0.001) existed between the standard cold scalpel and both the ESU and the Shaw scalpel. Thermal injury, induced to varying degrees by the thermal knives, clearly delays the wound healing process. of Bulky, Barrel-Shaped Stage IB Carcinoma of the Uterine Cervix with Irradiation Alone or in Combination with Surgery. HOLLY GALLION, M.D., J. R. VAN NAGELL, JR., M.D., E. S. DONALDSON, M.D., M. B. HANSON, M.D., E. J. PAVLIK, PH.D., J. YONEDA, M.D., AND Y. MARUYAMA, M.D., Department of Obstetrics and Gynecology, University of Kentucky Medical
15. Treatment
Center, 800 Rose Street, Lexington, Kentucky 40536. The therapy of all patients with bulky (>4 cm diameter), barrel-shaped stage IB carcinoma of the cervix treated at the University of Kentucky Medical Center between 1962 and 1980 was reviewed. Seventy-five patients were followed for a minimum of 24 months after completion of therapy (mean 53 months), and none were lost to follow-up. The mean age of patients was 47 years (range 25 to 68 years). All patients received a combination of approximately 4000 rad whole pelvis radiation followed by an additional 1000 rad to the pelvic sidewalls. Intracavitary therapy delivering an additional 2000 rad to point A was then given. Thirty-two patients were treated with radiation alone and 43 patients received radiation followed by extrafascial hysterectomy. Recurrence was noted in 15 of 32 patients (47%) treated by radiation alone versus 7 of 43 (16%) in patients treated by radiation and extrafascial hysterectomy (P < 0.05). In patients treated by radiation therapy alone, there were 6 pelvic recurrences, 4 recurrences in both pelvic and extrapelvic sites, and 5 extrapelvic recurrences. Of the 7 patients who developed recurrent disease after combination therapy, there was only one isolated pelvic recurrence. There were no major operative complications in patients treated with radiation and surgery. In the group treated with combined therapy, those patients with microscopic residual tumor in the hysterectomy specimen had a recurrence rate of 36% (5/14) as opposed to only 7% (2/29) in those patients whose specimens were negative for residual disease. Analysis of these data suggests that the addition of extrafascial hysterectomy to radiation therapy is beneficial in the treatment of patients with stage IB bulky, barrel-shaped cervical cancer.
Recurrence Treatment method Radiation Radiation and extrafascial hysterectomy
No. patients
NED
Pelvic
Pelvic and Extrapelvic
Extrapelvic
32
17 (53%)
6 (19%)
4 (12%)
5 (16%)
43
36 (84%)
1 (2%)
3 (7%)
3 (7%)
Recurrence rate significantly (P < 0.05) reduced in patients treated by combination therapy.