A prospective trial of postoperative vaginal radium/cesium for Grade 1-2 less than 50 percent myometrial invasion and pelvic radiation therapy for Grade 3 or deep myometrial invasion in surgical Stage I endometrial adenocarcinoma

Article Abstract:

In the 1950s and 1960s, the recommended treatment for Stage I endometrial cancer was hysterectomy with the removal of the ovaries and the associated tissues as well (bilateral salpingo-oophorectomy). It was observed that patient survival was strongly dependent on the histological appearance of the tumor. Patients with moderately differentiated tumors, such as Grades 1 and 2, tended to fare well, while patients with poorly differentiated tumors, such as Grade 3, tended to do poorly. A poor prognosis was also noted in patients with Stage I tumors that were observed to have an invasion of the underlying myometrium of greater than 50 percent. In the 1970s it became clear that the reason for this disparity was the greater likelihood of unsuspected metastases to the lymph nodes among patients with Grade 3 tumors. Stage I endometrial cancer patients with Grade 3 tumors or with more than 50 percent myometrial invasion now receive pelvic radiation in an attempt to improve the prognosis by eradicating any unobserved metastatic spread to the lymph nodes. In a prospective study of the efficacy of current methods of treatment of endometrial cancer, 133 patients with Stage I disease were treated. Ninety-two patients with Grade 1 or Grade 2 tumors and less than 50 percent myometrial invasion (called group 1 for purposes of this study) were treated with hysterectomy and bilateral salpingo-oophorectomy. Postoperatively, a radioactive cylinder containing radium or radioactive cesium was placed in the vagina to provide a dose of 6,000 cGy to the vaginal surface (a Gy, or Gary, is 1 joule of energy absorbed per kilogram of tissue). Patients with Grade 3 tumors or greater than 50 percent myometrial invasion (group 2 patients) received the same surgery, followed by 5,000 cGy to the whole pelvis. Of the 92 patients falling into group 1, the five-year estimated disease-free survival was 99 percent. Five-year disease-free survival was estimated at 88 percent for the patients in group 2. Three of the four recurrences observed in group 2 occurred outside the pelvic area. Overall, the estimated five-year disease-free survival was 96 percent, and only one patient suffered a pelvic recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Surgery, Endometrial cancer

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Radiotherapy of retinoblastoma: a review of 63 children treated with different irradiation techniques

Article Abstract:

Retinoblastoma is a tumor of the eye which occurs in infants and children. Radiotherapy is generally the treatment of choice, and in many cases some useful vision can be preserved. In a review of 63 children with retinoblastoma, who were treated between 1975 and 1988, various aspects of treatment and complications were analyzed. Three techniques of radiotherapy were used in these patients: episcleral plaque irradiation, external beam irradiation, and a combination of the two. In episcleral plaque irradiation, a plaque containing a radioactive isotope is applied to the appropriate area of the eye; isotopes used may be cobalt-60, iodine-125, iridium-192, and ruthenium-106. A primary advantage to the episcleral plaque method is that the radiation exposure of surrounding areas may be minimized. External beam irradiation is, of course, the commonest type of radiotherapy for most cancers, and differs only in the geometry of how the beam is applied to the tumor. Retinoblastoma is quite susceptible to radiotherapy, and most therapeutic protocols are designed to maximize exposure of the tumor while limiting the radiation dose to healthy tissues. Twenty-four patients with retinoblastoma were suitable for treatment with episcleral plaques only; all are alive and 22 of the 25 affected eyes are free of disease. Twelve patients, with 21 involved eyes, had 13 eyes which received only external beam irradiation. Disease progression necessitated the removal of three of these eye. The remaining 10 eyes showed no evidence of tumor, although 4 eyes developed cataracts, which were induced by the radiation. Patients receiving a combination of both treatment modalities generally had more advanced disease. Of 29 eyes, 14 required removal due to recurrent disease; 15 remain free of tumor. Nine of these eyes developed cataracts. (Consumer Summary produced by Reliance Medical Information, Inc.)

Retinoblastoma

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I-125 interstitial implantation for prostate cancer: what have we learned 10 years later?

Article Abstract:

From 1975 to 1984, 123 patients in various stages of cancer of the prostate were treated using the implantation of a radioactive seed of iodine-125 (I-125) as an adjunct to surgery. A comparison of the 120 patients available for follow-up with 246 patients who were treated with radiation from an external beam revealed that the implantation of I-125 was ineffective. Local recurrence was noted in 29 percent of the implanted patients compared with recurrence in 17 percent of the externally irradiated men. However, it is worth noting that the recurrences tended to occur later in the I-125 group. In those who experienced recurrence, 83 percent of the implanted patients developed distant tumor spread, while only 18 percent of the externally irradiated patients developed distant metastases. The objective of the implantation of radioactive iodine seeds was to obtain a more precise placement of radiation and to preserve normal tissue. In all but the most differentiated and early stage cancers, the implantation treatment was less effective than external irradiation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prostate cancer

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