Clinical results of medium dose rate brachytherapy combined with external beam radiotherapy in the treatment of advanced cervical carcinoma.

PURPOSE: To evaluate the overall and disease-free survival of patients with advanced cervical carcinoma (FIGO stages IIB-IIIB) treated with external beam radiotherapy (EBRT) and medium dose rate brachytherapy (MDR-BT) plus/minus surgery. PATIENTS AND METHODS: One hundred and seven patients received preoperative RT (group A) and 154 were treated with definitive RT (group B); 73 patients in both groups also received cisplatin as radiosensitizer. EBRT delivered as preoperative reached a total dose of 44-46 Gy/pelvis, whereas the definitive RT reached a total dose of 62-64 Gy with standard fractionation. MDR-BT was performed with a LDR/MDR Cs-137 Selectron machine; 10 Gy/point A were delivered in the preoperative group A and 14 Gy/point A/, 1-2 fractions in group B. Cisplatin as radiosensitizer was administered during EBRT at a dose of 20 mg/m(2)/day for 5 days with 21 days interval between cycles. RESULTS: With a median follow-up of 44.4 months (range 3.4-61.6) the overall survival at 3 years in group A was 92% vs. 68% for group B (p<0.01). According to FIGO stages 3-year overall survival was 88% in stage IIB, 79% in IIIA and 60% in IIIB (p<0.01). Three-year local control was 73.5% (192 patients). Thirty-three (13%) patients developed locoregional recurrences, and another 8 (3.07%) locoregional recurrences plus distant metastases. CONCLUSION: The association of EBRT with MDR-BT represents an effective treatment in advanced cervical carcinoma. A significant difference in 3-year overall survival was found, favoring preoperative RT, with a very good rate of local control.

[Current therapeutic management in retinoblastoma with invasion of the optic nerve--a case report]. / Conduita terapeutica actuala în retinoblastomul cu invadarea nervului optic--prezentare de caz.

INTRODUCTION: Retinoblastoma is the most frequent primitive intraocular tumour in children. The extension of retinoblastoma at the optic nerve level gives a dark prognosis implying a complex treatment and a long period of supervision. OBSERVATION: An eleven-months-old child, female, is taken in the hospital with the suspicion of retinoblastoma left eye. The diagnosis was suspected when the child was six months old within another ophthalmologic department, but the treatment was postponed. Surgical treatment consisted of enucleation with at least a 10 mm resection of the optic nerve. The anatomo-pathologic examination shows a retinoblastoma with the optic nerve invasion (stage II b 2--after Grabowski's classification). Because of the early age of the patient, we are obliged to give up applying radiotherapy (technical reasons) and systemic chemotherapy is recommended, in six cycles, under very severe clinic and paraclinic control. CONCLUSIONS: The extension of retinoblastoma at the optic nerve level indicates a severe prognosis with high lethal risk. The correct treatment during thus phase implies the association of radiotherapy (40-45 Gy) and chemotherapy. After 24 months from the finishing of the treatment the patient is in total remission (clinic and paraclinic), but the supervision is going on for at least another 3 years. The early enucleation as well as its appliance with the removal of a large part of the optic nerve represents a therapeutical manner and leads to an important prognosis.

[Controversies connected with the therapeutic approach in palpebral epitheliomas]. / Controverse legate de atitudinea terapeutica în epitelioamele palpebrale.

OBJECTIVE: We try to clarify some controversies related to the palpebral epitheliomas, controversies related to the therapeutical applied attitude (surgery, radiotherapy or the association of the two therapeutical methods), to the indications and contraindications of their application. MATERIAL AND METHOD: It is a review study of the Military Hospital and Oncologic Institute Cluj-Napoca casuistry between 1984-1994, which comprises 244 patients with palpebral epitheliomas, histologically confirmed. This casuistry was followed taking into consideration the age, sex, histological type, anatomo clinical presentation, TNM clinical stage, the localisation of the tumor, the type of the applied treatment, complications, healing and the therapeutical failures. RESULTS: The efficiency of the applied therapeutical methods was considered related to their obtained results to the therapeutical failures. The rate of healing at 5 years was 90.57% for the whole group. CONCLUSIONS: 1. The two methods of treatment seems to be equally sensible concerning the therapeutical efficiency in stages I and II. 2. In the advanced stages (III and IV) our option is for mixing the two methods. An optimum treatment for each patient is possible only if there is a close cooperation between the ophthalmologist-surgeon, plastic surgeon and the radiation oncologist.

[Carcinomas of the inner canthus--combined treatment]. / Carcinoamele cantusului palpebral intern--tratament asociat.

It is described a therapeutical protocol which combines surgery and radiotherapy in a "particular" way for carcinomas of the medial palpebral canthus. This consist of a surgical excision of tumors without covering the denuded area after 2-3 weeks of external radiotherapy--Chaoul type.