Radical hysterectomy versus radiation therapy for Stage IB squamous cell cancer of the cervix

Article Abstract:

Early stage cancer of the cervix is usually treated with either radiation or radical surgery. Most reports of the success of these treatments studied only one or the other, and there have been few comparative studies. Furthermore, most of the comparative studies have lumped together the two main forms of cervical cancer, squamous cell carcinoma and adenocarcinoma of the cervix. For this reason, the outcome of 345 cases of early Stage IB cervical cancer treated at a single institution were reviewed to compare the effectiveness of radiation therapy with the effectiveness of radical hysterectomy (surgical removal of the uterus). The overall five-year survival rate was 89 percent, and the 10-year survival was 86 percent. Radical hysterectomy was performed in 213 cases, and 111 patients received radiation therapy. Of the 111 patients who received radiation therapy, 14 had been candidates for hysterectomy which was not performed after high-risk factors were identified; these 14 patients had a poor survival rate of 50 percent. However, the remaining 97 patients receiving radiotherapy enjoyed a five-year survival rate of 86 percent. This survival was not significantly different from the 92 percent five-year survival rate for the patients treated with radical hysterectomy. The size of the tumor only modestly affected the chances for survival. Among the patients treated with radiation, the five-year survival rate for patients with tumors smaller than three centimeters was 88 percent, while for those with tumors larger than three centimeters the rate was 73 percent. The presence of cancer in the lymph nodes had a greater impact on the final outcome. A total of 19 node-positive patients had fewer than four positive lymph nodes; 16 of these patients survived. Of the seven patients with four or more positive lymph nodes, only three of seven survived. Since the complications resulting from radical hysterectomy and radiation therapy are comparable to those resulting from radiation therapy, there are no clear reasons why one treatment might be superior to the other. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Cervical cancer, Hysterectomy

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Radiation therapy in the management of early stage Hodgkin's disease presenting in later life

Article Abstract:

Older patients with Hodgkin's disease (a lymphatic cancer) tend to fare less well than their younger counterparts. Even when conditions such as stage at diagnosis and histological type of tumor are taken into account, older patients, overall, have a poorer prognosis than younger patients. However, older patients are more likely to have other pre-existing health problems and to be in overall poorer condition. In turn, patients in poorer health are less able to tolerate the adverse side effects of radiation therapy; if some elderly patients are given less-than-optimal radiotherapy due to frail health, these patients may bias the average survival statistics for older patients with Hodgkin's disease. A study was therefore conducted to determine if suboptimal treatment of older patients influences the outcome of the disorder. In an analysis of 29 Hodgkin's disease patients over the age of 60, it was found that 14 received the treatments which were considered optimal. The remaining 15 patients received treatment which was compromised in some way due to their general ill health. The overall five-year survival rate was 61 percent for the patients treated optimally and only 19 percent for the patients who received suboptimal treatment. Patients in this age group may die from many causes, of course; when only Hodgkin's disease is considered as a cause of death, the five-year survival was 100 and 39 percent for the optimal and suboptimal treatments, respectively. These observations suggest that older patients with Hodgkin's disease who are robust enough to tolerate surgery for adequate tumor staging and a full course of radiation therapy may be just as likely to survive as younger patients with this disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hodgkin's disease, Prognosis, Demographic aspects

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