Postoperative radiotherapy in the treatment of uterine sarcomas: long-term results and analysis of prognostic factors.

PURPOSE: To evaluate the role of postoperative radiotherapy (RT) in local control and survival and to identify treatment-related prognostic factors in uterine sarcomas. METHODS: Sixty patients with uterine sarcomas treated with postoperative RT were retrospectively analyzed. Median age was 49.5 years (range 24-78). The stage distribution was as follows: stage I: 60%, II: 11.7%, and III: 28.3%. All patients were treated with pelvic irradiation (dose range 45.6-54.6 Gy). Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were calculated. Age, stage, histology, tumor size, type of surgery, residual disease, time interval between surgery and RT were selected as possible prognostic factors for PC and OS. Age, total treatment time, pelvic dose, dose per fraction, and acute side effects were analyzed as probable prognostic factors for late complications. RESULTS: Median follow-up was 84 months. The 10-year PC, DMFS, DFS and OS rates were 84, 67.3, 64 and 61.5%, respectively. Univariate analysis showed that age, residual disease, type of surgery and stage were significant factors for PC; residual disease, type of surgery and stage were significant factors for DMFS; stage was found as the only significant factor for DFS and OS. Total treatment time, pelvic dose, dose per fraction, and acute side effects were significant factors for late complications. CONCLUSION: Although our results suggest improved PC, the role of postoperative RT should be tested in prospective randomized trials.

Endometrial carcinoma and an unusual presentation of bone metastasis: a case report.

BACKGROUND: Although metastasis to bone is common in solid tumors, it seldom occurs in endometrial carcinoma. It is usually seen together with abdominopelvic recurrences and/or other organ metastases. Furthermore, bone metastases involving only the lower limbs are seen extremely rare. CASE: 67-year-old woman was referred for a vaginal recurrence from endometrial carcinoma. Pelvic irradiation and intracavitary brachytherapy failed to control the disease. Subsequently, she was presented with swelling of her left foot resembling an abscess, and bone scan revealed an increased uptake in both lower extremities below the knees. Furthermore, biopsy showed metastatic disease. She died 2 months after palliative irradiation with progressive disease. CONCLUSION: It should be remembered that bone metastasis at unusual sites might be seen in endometrial carcinoma.

Multidisciplinary approach to Wilms' tumor: 18 years of experience.

BACKGROUND: The aim was to evaluate the characteristics of Wilms' tumor and the results of combined modality treatment obtained in our center in Turkey. METHODS: From January 1978 to December 1996, 106 patients with Wilms' tumor were diagnosed. Of these 106 patients, 61 were male and 45 were female (M/F = 1,35); the median age at diagnosis was 39 months. The distribution of the 106 patients according to clinical stage was stage I 10%, stage II 42%, stage III 35%, stage IV 9% and stage V 4%. Histologically, 102 of the cases could be evaluated: favorable histology was diagnosed in 88.2% and unfavorable histology in 11.8% of the patients. Ninety-eight patients were treated according to NWTS and eight patients according to SIOP protocols. RESULTS: The EFS and overall survival rates at 2 years were 74.2 and 79.5% respectively, and at 5 years 72.4 and 76.6% respectively. CONCLUSION: As a developing country we evaluated our survival rates and report an improvement in treatment in recent years.

A randomised study of ornidazole as a radiosensitiser in carcinoma of the cervix: long term results.

This paper presents long-term results of a randomised study of ornidazole as a radiosensitiser in locally advanced carcinoma of the cervix. A total of 76 patients were randomised and followed-up with a median of 85 months. All patients were treated with external and intracavitary irradiation. The 10 year actuarial local control rate was 61% in patients receiving ornidazole, compared with 50% for placebo group. This difference was not statistically significant. Ten year actuarial overall and disease-free survival rates were also similar in the two treatment groups. Although, when analysed by stage, there was a significant advantage in the local control (54% vs 15%; P = 0.044) and disease-free survival rates (37% vs 8%; P = 0.047) in ornidazole group for stage IIIB cases, its implication is obscure because of the small number of patients. In this study moderate and severe complication rates were found to be 30%. These results suggest that ornidazole seems to have relatively weak sensitisation and it may show a possibility of a marginal benefit with unconventional irradiation using relatively large radiation doses. However, the results are insufficient for a real gain in the probability of local tumour control and survival.

Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors.

In order to assess the role of postoperative radiotherapy and prognostic factors, 126 patients who were treated with radiotherapy after surgery for clinical early-stage carcinoma of the cervix were reviewed. All patients received external pelvic radiotherapy and 37 patients were treated with additional vaginal cuff irradiation. The 5-year overall survival, disease-free survival and locoregional control rates were 71.1, 69.9 and 78.1%, respectively. The 5-year disease-free survival rates were 40% for grade 3 vs. 75.4% for grade 1 tumours (p = 0.05), 76.5% for pathological stage IB versus 54.1% for pathological stage IIA (p = 0.04), 36.6% for node-positive patients versus 82.5% for node-negative patients (p = 0.0017), 54% for full thickness cervical invasion versus 100% superficial cervical invasion (p = 0.01), 34.8% for positive margins versus 78.1 for negative margins (p < 0.0001). After a multivariate analysis, tumour grade (p = 0.026) and presence of positive margins (p = 0.006) were found to independently influence the outcome. Grade II and III complication rate was 5.5% in all patients. In conclusion, postoperative radiotherapy should be used in patients treated with simple hysterectomy as well as those treated with radical hysterectomy with unfavorable pathological findings.