ABSTRACT
The exact risk of second cancer (S.C.) following treatment of testicular seminoma is not well determined in most series. At our institution, 122 patients with pure seminoma were treated by orchidectomy followed by radiation therapy from 1951 to 1986. Six were lost to follow-up. For the 116 remaining patients, the overall 5-, 10-, 15- and 20-year survival probability was 95%, 90%, 87%, and 84%, respectively. Eleven patients developed 12 second cancers, with a cumulative risk of 7%, 16%, and 16% at 10, 15, and 20 years, respectively. Overall, the risk of second cancer was increased (O/E = 1.97, p = 0.023). There were 3 controlateral seminoma (O/E = 50, p = 0.001), 2 transitional carcinoma of the bladder (O/E = 6.9, p = 0.035), 2 non-Hodgkin's lymphoma (N.S.), 1 acute myeloblastic leukemia, 1 chronic lymphocytic leukemia, 1 intracranial dysgerminoma, 1 rectal and 1 lung adenocarcinoma. Four tumors developed within the previously irradiated field (O/E = 2.2, N.S.). Excluding second seminoma, the overall risk of second cancer was not significant (O/E = 1.33). Five of the 11 patients with second cancer are currently alive without recurrent cancer. We conclude that patients treated for seminoma have an increased risk of second cancer but the overall prognosis remains excellent. The potential factors responsible for second cancer, including irradiation, are discussed.
Subject(s)
Dysgerminoma/therapy , Neoplasms, Multiple Primary/epidemiology , Testicular Neoplasms/therapy , Combined Modality Therapy , Dysgerminoma/epidemiology , Dysgerminoma/mortality , Humans , Male , Neoplasms, Multiple Primary/etiology , Orchiectomy , Radiotherapy, High-Energy , Retrospective Studies , Risk , Survival Rate , Testicular Neoplasms/epidemiology , Testicular Neoplasms/mortalityABSTRACT
In spite of progress in surgery and radiation therapy, esophageal squamous cell carcinoma's outlook remains grim with a cure rate of approximately 10%. The high failure rate is not only due to loco-regional failure but also to distant metastasis. The association of preoperative chemotherapy with radiation has gained interest with hope to improve control of this disease. The present pilot study is an alternating treatment of chemotherapy and radiotherapy for poor risk carcinomas of the esophagus, not primarily amenable to surgery. The chemotherapy is composed of Cis-Platinum 60 mg/m2 Day 1 (D), Mitomycin 8 mg/m2 D1 and Vindesin 3 mg/m2 D1 and D8, alternating with radiotherapy twice 20 Gy in fraction of 2 Gy per day. After reevaluation patients are if possible submitted to surgery and if not, to a third course of treatment to a total of 3 courses and 60 Gy. Seventeen patients were entered in our study with 15 evaluable. The radiochemotherapeutic association was overall well tolerated with no toxic deaths due to treatment. Seven patients had symptomatic improvement after the first treatment cycle. The presurgical evaluation showed 8 CR and 3 PR. Eight patients have been operated with 3 pathological CR and 3 PR. Five patients completed the 3 courses of chemo- and radiotherapy (without surgery) with no improvement compared to the workup before the third course. The survival is as follows: among the 8 operated: 4 are alive without evidence of disease and 4 are dead with 2 postoperative deaths and 1 local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
