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Survival of patients with positive aortic nodes in clinical stage I and IIA carcinoma of cervix
18 ARS 63rd Annual Meeting
Radiation Oncology
e Siology 9 ?hysrcs
SCIENTIFICPAPERS TO BE PRESENTED (1)
STAGE II ENDOMETRIAL
CARCINOMA:
TEN YEAR FOLLOW-UP OF
COMBINED RADIATION AND SURGICAL TREATMENT Timothy J. Kinse!la, M.D., Wiliiam
3. Bloomer, M.D.,
Philip T. Lavin, Ph.D. and Robert C. Knapp, M.D. From the Joint Center for Radiation Therapy, the Departments of Radiation Therapy and Obstetrics and Gynecology, Harvard Medical School, and the Department of Biostatistics, Harvard School of Public Health, Boston, MA. Fifty-five patients with histologically confirmed Stage II adenocarcinoma of the corpus uteri were treated with combined radiation therapy and surgery The overall survival at 5 and 10 years is and followed for 2 to 10 years. 75% and 56% respectively; the age adjusted survival is 93%.and 73% respecDisease free survival is 88% at 2 years and 83% at both 5 and ID tively. Although 10 patients (18%) failed treatment, each local pelvic years. Histological grade recurrence was accompanied by dissemination elsewhere. and extent of involvement of the uterine cervix at time of examination under Age, depth of anesthesia are statistically significant prognostic factors. uterine sounding, and depth of myometrial invasion by tumor were not of prognostic value. We conclude that combined pre-operative external beam and intracavitary radiation with total abdominal hysterectomy and bilateral salpingo-oophorectomy is the preferred treatment for stage II endometrial Furthermore, carcinoma because of the excellent survival and low morbidity. both histologic grade and extent of cervical involvement predict the natural history of stage II disease.
(2)
SURVIVAL OF PATIENTS WITH POSITIVE AORTIC NODES IN CLINICAL STAGE I AND IIA CARCINOMA OF CERVIX Robert E. Girtanner, M. 0. Hervy E. Averette, 11. 0. John H. Ford, M. D. Bernd-Uwe Sevin, M. D., Ph.C. Division of Gynecologic Oncology Department of Obstetrics and Gynecology Jackson Memorial Hospital University of Miami Medical Center
For the last ten years, a surgical staging protocol for the treatment of carcinoma of the cervix and endometrium has been employed by the Division of Gynecologic Oncology at the University of Miami. Therapy could then be individualized based on the operatively determined spread of disease. As part of this protocol, all explorations were begun by para-aortic lymphadenectomy. Of 318 cases of early stage carcinoma of the cervix in whom radical hysterectomy with pelvic lymphadenectomy would be the surgical treatment based on clin, ical examination, 25 patients were identified at surgery with disease beyond the usual surgical or radiotherapeutic treatment fields. It is the outcome of this group of patients with biopsy-proven metastasis in the para-aortic nodes that will be the subject of this paper. All patients received pelvic plus para-aortic radiotherapy. Twentyane patients with clinical stage IB cervical carcinoma were found to be surgical stage IV.
Radiation Oncoiogy
3f and one Cf treated C3)
??Bioiogy
4RS 63rd Annual Meeting
??Physics
IS
focr clinical stage IIA cases, three have diea within one year of theran:j, is now twelve months without evidence of recurrence. all cases, the three and five-year survival rates of those with known drld disease in the para-aortic area are 47% and 42% respectively. PARAAORTIC LYMPH NODE IRRADIATION IN CARCINOMA OF THE CERVIX AFTER EXPLOF!ATORY LAPAROTOMY AND BIOPSY-PROVEN POSITIVE AORTIC NODES
Y.H. Tewfik, M,B., Ch.B., M.D.,' H.J. Buchsbaum, M.D.,3 S.G. Lifshitz, M.D.,3 & F.A. Tewfik, M.D., Ph.D.2 H.B. iatourette, M.D., University of Iowa Hospitals & Clinics: - Radiation Therapy Section,' Radiation Research Laboratory;2 Dept of Obstetrics & Gynecology - Division Of hCO10!JY3
Dept of Radiology
From JIJ~Y 1970 to January 1977, 23 patients with previously untreated cancer of the cervix (CA CX), mostly stage III B, were included in this stub. Ages ranged from 34 to 75 years with a median of 57 years. Patients had the Exploratory laparotomy was usual tumor workup for carcinoma of the cervix. performed to either biopsy enlarged paraaortic nodes or to perform ParaaOrtiC lymphadenectomy in those patients without grossly enlarged aortic nodes. NO In all 23 patients, the paraaortic pelvic lymphadenectomy was performed. lymph nodes (PALN) were histologically documented to have metastatic disease. External radiation treatment (RT) was delivered using the Cobalt - 60 machine to a spade-shaped field to treat the pelvic cavity and paraaortic area. The daily tumor dose was 180 rad, 5 fractions per week, through anterior and posterior fields. The majority of the patients received 4000-6000 rad to tt?e pelvic cavity and from 5000-6000 rad to the PALN's by external RT. In addition, intracavitary radium was used in 21 patients. Five patients are alive and free of disease at 106, 101, 81, 64 and 36 months after completion of RT. Two (40%) of the survivors developed late bowel radiation damage. Eighteen patients died - 10 during the first year, 3 during the second year, 2 during the third year, I during the fourth year and 2 during the eighth year of the follow-up. Five (27.8%) of the deceased developed late bowel radiation damage. Fifteen of the 18 died with disease. One death was due to radiation enteritis; 2 were due to other reasons. This report suggests that in CA CX, RT can control some PALN metastatic disease, but the risk of complications is rather high. In the absence of better methods of management, this risk of complications is justifiable because the alternative is to leave known disease untreated. RADIATION TREATMENT
OF CANCER OF THE VAGINA
Ann M. Chu, M.D. * Robert Beechinor, M.D. Department of Therapeutic Radiology Tufts-New England Medical Center 171 Harrison Avenue Boston, MA 02111 From 1958 through 1977, 50 patients with carcinoma of the vagina were treated at Tufts-New England Medical Center Hospital. All but 2 were treated after 1969. 37 patients presented with primary vaginal carcinoma and the rest were metastatic in nature. The mean age was 62 years. 8 were nulliparous, 29 were postmenopausal, 7 pre-menopausal and 1 para-menopausal. 32137 were squamous cell carcinoma. Treatment technique varied but consisted of a combfnation of external beam ra'diation and interstitial transvaginal intracavitary technique. The 5 year survival rate was 85% for stage I; 50% for stage II; 26% for stage III and 0% for stage IV. An analysis of prognostic factors, treatment and local-regional control w:'ll be gresented.
Radiation Oncology
e Siology 9 ?hysrcs
SCIENTIFICPAPERS TO BE PRESENTED (1)
STAGE II ENDOMETRIAL
CARCINOMA:
TEN YEAR FOLLOW-UP OF
COMBINED RADIATION AND SURGICAL TREATMENT Timothy J. Kinse!la, M.D., Wiliiam
3. Bloomer, M.D.,
Philip T. Lavin, Ph.D. and Robert C. Knapp, M.D. From the Joint Center for Radiation Therapy, the Departments of Radiation Therapy and Obstetrics and Gynecology, Harvard Medical School, and the Department of Biostatistics, Harvard School of Public Health, Boston, MA. Fifty-five patients with histologically confirmed Stage II adenocarcinoma of the corpus uteri were treated with combined radiation therapy and surgery The overall survival at 5 and 10 years is and followed for 2 to 10 years. 75% and 56% respectively; the age adjusted survival is 93%.and 73% respecDisease free survival is 88% at 2 years and 83% at both 5 and ID tively. Although 10 patients (18%) failed treatment, each local pelvic years. Histological grade recurrence was accompanied by dissemination elsewhere. and extent of involvement of the uterine cervix at time of examination under Age, depth of anesthesia are statistically significant prognostic factors. uterine sounding, and depth of myometrial invasion by tumor were not of prognostic value. We conclude that combined pre-operative external beam and intracavitary radiation with total abdominal hysterectomy and bilateral salpingo-oophorectomy is the preferred treatment for stage II endometrial Furthermore, carcinoma because of the excellent survival and low morbidity. both histologic grade and extent of cervical involvement predict the natural history of stage II disease.
(2)
SURVIVAL OF PATIENTS WITH POSITIVE AORTIC NODES IN CLINICAL STAGE I AND IIA CARCINOMA OF CERVIX Robert E. Girtanner, M. 0. Hervy E. Averette, 11. 0. John H. Ford, M. D. Bernd-Uwe Sevin, M. D., Ph.C. Division of Gynecologic Oncology Department of Obstetrics and Gynecology Jackson Memorial Hospital University of Miami Medical Center
For the last ten years, a surgical staging protocol for the treatment of carcinoma of the cervix and endometrium has been employed by the Division of Gynecologic Oncology at the University of Miami. Therapy could then be individualized based on the operatively determined spread of disease. As part of this protocol, all explorations were begun by para-aortic lymphadenectomy. Of 318 cases of early stage carcinoma of the cervix in whom radical hysterectomy with pelvic lymphadenectomy would be the surgical treatment based on clin, ical examination, 25 patients were identified at surgery with disease beyond the usual surgical or radiotherapeutic treatment fields. It is the outcome of this group of patients with biopsy-proven metastasis in the para-aortic nodes that will be the subject of this paper. All patients received pelvic plus para-aortic radiotherapy. Twentyane patients with clinical stage IB cervical carcinoma were found to be surgical stage IV.
Radiation Oncoiogy
3f and one Cf treated C3)
??Bioiogy
4RS 63rd Annual Meeting
??Physics
IS
focr clinical stage IIA cases, three have diea within one year of theran:j, is now twelve months without evidence of recurrence. all cases, the three and five-year survival rates of those with known drld disease in the para-aortic area are 47% and 42% respectively. PARAAORTIC LYMPH NODE IRRADIATION IN CARCINOMA OF THE CERVIX AFTER EXPLOF!ATORY LAPAROTOMY AND BIOPSY-PROVEN POSITIVE AORTIC NODES
Y.H. Tewfik, M,B., Ch.B., M.D.,' H.J. Buchsbaum, M.D.,3 S.G. Lifshitz, M.D.,3 & F.A. Tewfik, M.D., Ph.D.2 H.B. iatourette, M.D., University of Iowa Hospitals & Clinics: - Radiation Therapy Section,' Radiation Research Laboratory;2 Dept of Obstetrics & Gynecology - Division Of hCO10!JY3
Dept of Radiology
From JIJ~Y 1970 to January 1977, 23 patients with previously untreated cancer of the cervix (CA CX), mostly stage III B, were included in this stub. Ages ranged from 34 to 75 years with a median of 57 years. Patients had the Exploratory laparotomy was usual tumor workup for carcinoma of the cervix. performed to either biopsy enlarged paraaortic nodes or to perform ParaaOrtiC lymphadenectomy in those patients without grossly enlarged aortic nodes. NO In all 23 patients, the paraaortic pelvic lymphadenectomy was performed. lymph nodes (PALN) were histologically documented to have metastatic disease. External radiation treatment (RT) was delivered using the Cobalt - 60 machine to a spade-shaped field to treat the pelvic cavity and paraaortic area. The daily tumor dose was 180 rad, 5 fractions per week, through anterior and posterior fields. The majority of the patients received 4000-6000 rad to tt?e pelvic cavity and from 5000-6000 rad to the PALN's by external RT. In addition, intracavitary radium was used in 21 patients. Five patients are alive and free of disease at 106, 101, 81, 64 and 36 months after completion of RT. Two (40%) of the survivors developed late bowel radiation damage. Eighteen patients died - 10 during the first year, 3 during the second year, 2 during the third year, I during the fourth year and 2 during the eighth year of the follow-up. Five (27.8%) of the deceased developed late bowel radiation damage. Fifteen of the 18 died with disease. One death was due to radiation enteritis; 2 were due to other reasons. This report suggests that in CA CX, RT can control some PALN metastatic disease, but the risk of complications is rather high. In the absence of better methods of management, this risk of complications is justifiable because the alternative is to leave known disease untreated. RADIATION TREATMENT
OF CANCER OF THE VAGINA
Ann M. Chu, M.D. * Robert Beechinor, M.D. Department of Therapeutic Radiology Tufts-New England Medical Center 171 Harrison Avenue Boston, MA 02111 From 1958 through 1977, 50 patients with carcinoma of the vagina were treated at Tufts-New England Medical Center Hospital. All but 2 were treated after 1969. 37 patients presented with primary vaginal carcinoma and the rest were metastatic in nature. The mean age was 62 years. 8 were nulliparous, 29 were postmenopausal, 7 pre-menopausal and 1 para-menopausal. 32137 were squamous cell carcinoma. Treatment technique varied but consisted of a combfnation of external beam ra'diation and interstitial transvaginal intracavitary technique. The 5 year survival rate was 85% for stage I; 50% for stage II; 26% for stage III and 0% for stage IV. An analysis of prognostic factors, treatment and local-regional control w:'ll be gresented.