Uterine body carcinoma: the staging anomaly.

An analysis of 379 patients with T2 and T3 tumours treated in Birmingham between 1960 and 1974 shows that the stages are anomalous, containing two groups widely separated in survival rates and failure pattern. A modification to TNM staging is suggested.

Single radium insertion for treatment of early carcinoma of the cervix: rationale and results.

Treatment of 1429 Stage 1B, 2A and 2B carcinomas of the cervix by a single radium insertion technique proved this to be a simple and effective method for the management of early carcinoma. The success of a single insertion at the lower of the two levels of dosage used, questions the value of multiple insertions.

Early uterine body carcinoma: has post-operative vaginal irradiation any value?

A retrospective study of 1703 Stage 1A and 1B adenocarcinomas of the uterine body, treated with and without post-hysterectomy vaginal irradiation in Birmingham between 1960 and 1974 inclusive, showed a vaginal failure rate of 3.76%. Vaginal irradiation eliminated recurrence in non-invasive tumours, and reduced the incidence in the invasive ones. Treatment had no influence on the incidence of pelvic recurrence, metastatic disease or the survival rate of any histological type of tumour, invasive or non-invasive. Treatment of late recurrence reduced the final vaginal failure rate to 0.83%. Prognosis depended on the size of uterine cavity, the histological grade and invasive character of the tumour, and was unrelated to post-operative local treatment.

Carcinoma of the cervix: the staging anomaly.

An analysis of 3625 carcinomas of the cervix treated in Birmingham between 1960 and 1974 showed FIGO staging to be anomalous. State 2B and 3B each contain two subgroups with differing prognosis, depending on whether one or both parametria are involved. Unilateral Stage 2B disease has a prognosis identical with Stage 2A. Bilateral Stage 2B, Stage 3A and unilateral Stage 3B disease have identical survival figures. Stages 1A, 1B and 4 and bilateral Stage 3B disease have unique survival characteristics. A system of staging combining FIGO clinical stages with prognosis facilitates interpretation of treatment results, survival figures and comparisons of series.

Treatment of MOPP-refractory Hodgkin's disease with vinblastine, doxorubicin, bleomycin, CCNU, and dacarbazine.

Eighteen patients with advanced Hodgkin's disease, refractory to combination chemotherapy with nitrogen mustard, vincristine, prednisone, and procarbazine (MOPP), were treated with vinblastine, doxorubicin (Adriamycin), bleomycin, CCNU, and dacarbazine (DTIC) (VABCD). Fifteen patients had Stage IV disease and 11 had systemic symptoms. Although hematologic toxicity was considerable, there was no drug related mortality. Eight patients achieved a complete remission (CR), and five are currently in a continuous CR of five, 24, 30, 34, and 36 months duration, respectively. An additional patient had a 30-month CR and relapsed with localized lymphadenopathy and is currently disease-free following involved-field radiotherapy 46 months from initiation of VABCD. This study suggests that long-term disease-free survival and potential cure can be achieved with VABCD in MOPP-refractory Hodgkin's disease.

Random prospective study cyclophosphamide, doxorubicin, and methotrexate (CAM) combination chemotherapy versus single-agent sequential chemotherapy in non small cell lung cancer.

A group of 104 patients with unresectable non-small cell lung cancer were randomized to receive combination chemotherapy with cyclophosphamide, doxorubicin, and methotrexate (CAM) or single-agent sequential chemotherapy with the same three agents. CAM combination chemotherapy produced a 22% objective response rate, including two complete remissions, compared to a 9% response rate, including one complete remission, produced by single-agent therapy (P = 0.16). The median survival time was 32 weeks (range, 3-116) for CAM, compared to 25 weeks (range, 4-179 +) for sequential single agents (P = 0.24). Overall survival was 31% (1-year), (16%) (1 1/2-year), and 5% (2-year), with no difference between the study arms. Although there was no statistically significant survival advantage for the CAM arm, both arms had survival superior to that in historical controls, presumably because of better patient selection. This study indicates that cyclophosphamide, doxorubicin, and methotrexate are, at best, marginally active as single agents, and new drugs with more efficacy are needed before combination chemotherapy can be expected to result in any meaningful prolongation of survival in non-small cell lung cancer.

Long-term results in combined-modality treatment of small cell carcinoma of the lung.

Fifty eight patients with small cell carcinoma of the lung were treated with a combined-modality regimen: chemotherapy with adriamycin, cyclophosphamide, and vincristine; BCG immunotherapy; radiotherapy to the lung primary and prophylactic cranial irradiation. Ninteen patients had limited disease, and 39 had extensive disease. There were 27 (48%) partial remissions and 23 (41%) complete remissions, and median survival was 51 wk. Initial performance status and extent of disease had a definite effect on survival. Only 1 patient developed CNS metastases on prophylactic cranial irradiation. Five of 19 patients (26%) with limited disease remain alive and in complete remission at 26-45+ mo. It is becoming clear from this and other recent studies that we can significantly prolong median survival in small cell lung cancer. However, even more important is the fact that limited-extent small cell lung cancer may be a potentially curable disease.

Remission induction with daunomycin, vincristine, and prednisone in adult acute lymphocytic leukemia.

Prednisone plus vincristine plus daunomycin induced complete remission in nine adults with acute lymphocytic leukemia. The median duration of complete remission will be between 14 and 18 months, with three patients remaining in hematological remission at 10+, 11+, and 18+ months. The median survival will be between 19 and 23 months, with all patients surviving at least one year. This remission induction regimen produced rapid complete remission in adult acute lymphocytic leukemia (ALL) with minimal toxicity, and could be administered predominantly on an outpatient basis.

Results of therapy in adult acute lymphocytic leukemia.

27 adult patients with acute lymphocytic leukemia have been analyzed. Complete remission was induced in 9 of 113 patients treated with prednisone +6-MP, 4 of 6 patients treated with prednisone + vincristine, and the one patient treated with a combination of prednisone, vincristine, 6-MP, and methotrexate. The median survival for these 20 patients was 11 months and the median duration of complete remission was 71/2 months. Two of these patients remain in complete remission at 8+ years. Our most recent regimen for remission induction, prednisone + vincristine + daunomycin, has produced complete remission in 7 of 7 patients, with a median duration of complete remission of 15 months. Three patients remain in their original complete remission from 16+ to 24+ months, and 5 of these 7 patients remain alive from 16+ to 24+ months.