Stage II seminoma: results of postorchiectomy irradiation

Article Abstract:

This study investigated a treatment for testicular seminoma, the most common cancer of the testicles that accounts for about 40 percent of all testicular tumors. There are two variations of this type of testicular cancer. In stage 1 cases radiation treatment of the paraaortic and iliac nodes after orchiectomy, or surgical excision of a testicle, remains the most standard treatment. Stage 1 is the initial diagnosis in 70 to 80 percent of the patients with testicular cancer. On the other hand, the best treatment for the remaining patients, who fall into the stage 2 category, or about 20 to 25 percent of all patients with testicular seminoma, remains an area of controversy. In this less-common variation of the disease, it has not been possible to mount prospective studies to define the relative effectiveness of irradiation versus chemotherapy, and the researchers carefully reviewed the existing medical literature in order to formulate treatment plans. The best treatment for stage II seminoma has been in dispute for several years, spurred by the development of effective, multiple-drug chemotherapy. A technique that consisted of irradiation therapy below the diaphragm after a radical orchiectomy was the chosen treatment for patients with stage 2 seminomas. During a five-year follow-up of the 32 patients in their study, the actuarial survival rate was 100 percent. This high rate of success reflects the use of salvage chemotherapy in two of the three patients with recurrences of the disease. In larger studies, which include more patients, further improvements in the treatment and management of stage 2 testicular seminoma will come from more effective drugs, less toxic regimens of chemotherapy, and careful integration of irradiation and surgery for effective treatment.

Care and treatment, Testicular cancer, Lymphatic diseases

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Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma

Article Abstract:

More patients with cancer of the breast are requesting breast-preserving treatment. This has raised several important clinical questions: what are the prognostic factors for local recurrence of breast cancer? What factors influence the surgical preservation of the breast? This study reviewed patients with various stages of breast cancer in an attempt to address these issues. It was shown that the overall survival rate of the patients who had breast preservation surgery was not different from that in other major medical centers. The overall recurrence rate of breast cancer is six percent. The outcome of breast conservation depends on both biologic and technical factors. The most important prognostic factors for local control were age and estrogen receptor assay (ERA) status. It is important to note that most treatment failures resulting in the recurrence of cancer in the breast occurred within two and one-half years. Local failure at the biopsy site or elsewhere in the breast occurred within a similar time interval. In 77 percent of the cases in which local failure occurred, the area of disease was small and detected early. All patients, even the 14 percent with a poor cosmetic result, were satisfied with the aesthetic results of irradiation. Among patients, the most frequent complication was arm edema. The four major factors favorably affecting surgical preservation of the breast were: utilization of a wedge; treatment of two fields per day; failure to use a separate treatment port to the regional lymph nodes; and small size of the specimen.

Prognosis, Breast cancer

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Diabetic fibrous breast disease

Article Abstract:

Women suffering from long-standing insulin-dependent diabetes mellitus (IDDM) were discovered to have dense mammary gland tissue on mammograms. Researchers identified a little-known benign condition known as "diabetic fibrous breast disease (DFBD)" in 36 patients aged 20 to 54 years who had required insulin therapy for an average of 13 years. The indications of DFBD are: a long history of IDDM, dense glandular tissue on mammogram, and one or more hard, irregular, easily movable, discrete, painless, palpable breast masses with strong acoustical shadowing on ultrasound and firm resistance to the motion of the needle used in fine-needle aspiration cytology (FNAC, the withdrawal of fluid from a mass for the purpose of biopsy). This group of women was monitored for an average of six years and during that time cancer did not develop in any of the DFBD masses. On examination DFBD is similar to breast cancer and can be a perplexing problem for the evaluating physician. However, an understanding of DFBD can enable the physician to provide the patient with better care and prevent her from having unnecessary surgical biopsies since DFBD can be monitored by FNAC. The clinical and mammographic characteristics of DFBD are described and patient care is discussed.

Usage, Complications and side effects, Diabetes, Diabetes mellitus, Breast, Diagnosis, Ultrasonic, Diagnostic ultrasonography

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