Impact of peritoneal cytology on survival of endometrial cancer patients treated with surgery and radiotherapy.

Stage IIIA endometrial cancer includes patients with serosal or adnexal invasion and patients with positive peritoneal cytology only. In this study, we assessed the impact of peritoneal cytology on endometrial cancer survival. All endometrial cancer patients receiving surgery and radiotherapy at the Geneva University Hospitals between 1980 and 1993 were included. Stage IIIA cancers were categorised into 'cytological' stage IIIA (only positive peritoneal cytology) and 'histological' stage IIIA (serosal or adnexal infiltration). Survival rates were analysed by Kaplan-Meier method and compared using log-rank test. The prognostic importance of peritoneal cytology was analysed by multivariate regression analysis. This study included 170 endometrial cancers (112 stage I, 17 cytological stage IIIA, 18 histological stage IIIA, 9 stage IIIB+). Disease-specific survival of cytological stage IIIA was not different from stage I (94 vs 88% respectively, P=0.5) but better than histological stage IIIA (94 vs 51% respectively, P<0.01). Histological stage IIIA patients were at increased risk to die from cancer compared to stage I patients (HR 2.7, 95% CI 1.0-7.7), while cytological stage IIIA patients were not (HR 0.3, 95% CI 0.3-2.0). Cytological stage IIIA endometrial cancer has similar prognosis as stage l and better prognosis than histological stage IIIA. Additional research, definitively separating stage and cytology is warranted.

[Osteoradionecrosis at the level of coxo-femoral articulation in the adult]. / Radionécrose au niveau de l'articulation coxofémorale chez l'adulte.

Two cases of either cervical or acetabular osteoradionecrosis were described. One patient had endoprosthetic replacement of the hip, the other did not receive any surgical treatment. Regarding the literature, osteoradionecrosis occurs in 0.3 to 4% of the irradiated bones. Histologically there is a destruction of the bone by direct toxicity of the radiation and by destruction of the vascular supply. The threshold of irreversible bone destruction is 30 Gy. Fractures are epiphenomenons of osseous radionecrosis. The diagnosis can be suspected either by radiographies or by bone scans. Sometimes a bone biopsy is necessary to differentiate between bone necrosis, bone metastasis and eventually a radiation-induced sarcoma of the bone. If the osteoradionecrosis affects the acetabulum, even in the case of a stress fracture without acetabular protrusion of the femoral head, no surgical treatment is recommended. Weight bearing is avoided and spontaneous resolution occurs in most cases. If, on the other hand, there is a fracture through the femoral neck, hemiarthroplasty or total joint replacement is the treatment of choice. Total joint replacement is also recommended in case of an extensive radiation induced coxopathy.

[Adjuvant treatment in cancer of the stomach]. / Les traitements adjuvants dans les cancers de l'estomac.

Surgical excision remains up to now the first potentially curative treatment for patients who are suffering from stomach cancer. The encouraging results recently obtained in the survival of these patients are to be attributed essentially to the screening for this disease. Unfortunately, in the countries of the Western World, 80 to 90% of patients with a stomach cancer still consult their physician at an advanced stage of the disease. This makes it necessary to look for new efficient adjuvant treatments to be implemented after surgery. Numerous chemotherapeutic combinations have been studied. The FAM association is the best known among all these; results of these treatments are reviewed. Other encouraging perspectives come from the association of chemotherapy and biochemical modulators, chemotherapy and radiation-therapy, IORT and other adjuvant treatments. These results are also reviewed.