Analysis of multiple prognostic factors in patients with stage IB cervical cancer: age as a major determinant.

To evaluate the prognostic importance of age in patients with Stage IB cervical cancer we reviewed the results of 131 patients treated between 1974 and 1985. Patients ranged in age from 25 to 87 (mean 48) and were followed for a median of 65 months. One hundred twenty-five patients had complete follow-up information for survival analysis. Patients were divided into two groups; Group A comprising 43 patients less than or equal to age 40 and Group B comprising 88 patients greater than age 40. Both Group A and Group B patients were comparable with respect to all covariables studied. The 5-year actuarial survival for the 125 patients studied was 80%, whereas that for Group A (42 patients) and Group B (83 patients) was 54% and 91%, respectively (p = .0001). The 5-year survival for 100 surgical patients was 79% and that for Group A (36 patients) and Group B (64 patients) was 53% and 90%, respectively (p = .0001). The 5-year survival for 25 patients treated with curative RT was 65% and that for Group A (six patients) and Group B (19 patients) was 42% and 90%, respectively (p = .005). Eighteen patients were treated with adjuvant RT following surgery and their 5-year survival was 69% with three out of nine Group A and nine out of nine Group B patients alive at 65 months (p = .004). In 18 patients with pelvic nodal involvement, the 5-year survival was 48% compared to 84% in patients with negative nodes (p = .007). The difference in survival at 5 years between Group A (nine patients) and Group B (nine patients) with positive nodes was 25% and 75%, respectively. Finally, there was an increase in both local and distant failure in Group A patients. Our data illustrate that age has a profound influence on survival in women with Stage IB cervical cancer independent of potentially confounding variables.

Role of adjuvant radiotherapy following radical prostatectomy for microscopic residual disease.

Radical prostatectomy and lymphadenectomy remain common therapy for stages A or B prostatic cancer. If surgical margins are positive, adjunctive radiotherapy is sometimes given. There is no clear evidence that such therapy alters the natural history of the disease. In an attempt to answer this question, we reviewed all 40 radical prostatectomy specimens seen at New York University Medical Center and Bellevue Hospital from 1977 to 1984. Twelve cases with microscopic disease at the surgical margins were found. Six of these patients received postoperative radiation and 6 observation only. In theory, microscopic residual disease following prostatectomy confers a high risk of local recurrence. Our retrospective study did not confirm this and questions the beneficial role of postoperative radiotherapy in such patients.

Toxicity of oral radiotherapy in patients with acquired immunodeficiency syndrome.

Although radiotherapy is a standard form of management of head and neck tumors, treatment of the oral cavity in patients who have the acquired immunodeficiency syndrome has produced unacceptable toxicity. Five such patients are described as a warning of enhanced toxicity of oral radiotherapy in this patient population.

Defining the role of radiation therapy in the management of epidemic Kaposi's sarcoma.

The role of radiotherapy in the treatment of epidemic Kaposi's sarcoma needs to be defined. Over the past 4 years, we have irradiated 47 Kaposi's sarcomas in 38 patients having AIDS. Doses ranging from 800 cGy in 1 fraction to 3000 cGy in 10 fractions over 2 weeks were applied on an individualized basis. Treatment generally was successful in achieving palliation; however, toxicity in certain circumstances argues against indiscriminate use of this modality.

Initial observations of the effect of radiotherapy on epidemic Kaposi's sarcoma.

Fifteen patients who had Kaposi's sarcoma in conjunction with the acquired immune deficiency syndrome (AIDS) received radiotherapy to a total of 17 selected lesions. All tumors exhibited at least partial regression, and the majority responded completely. The radiosensitivity of these lesions is similar to that observed in the classic form of the disease. We conclude that in appropriately selected cases radiotherapy should be considered the treatment of choice.