Stage II adenocarcinoma of the endometrium treated by two standard regimens of combined preoperative irradiation and surgery.

We retrospectively analyzed 77 patients with stage II endometrial carcinoma treated with standard regimens of preoperative radiotherapy (RT) and surgery (S). The age range was 31-74 years with a median of 56.3 years. Thirty-three patients received 40 Gy whole pelvis RT followed by either radical or modified radical hysterectomy. Forty-four patients received 50 Gy whole pelvis RT and sequential intrauterine and intravaginal cesium-137 brachytherapy followed by a simple hysterectomy. Median follow-up was 111 months. No patient was lost to follow-up. The overall 5-year actuarial survival was 78%. There was no significant difference between the two treatment groups. Several prognostic variables were analyzed. Those with histologic grade I and II had 5-year survival of 89% and 83%, respectively, compared to 62% for grade III (P =0.045). The 5-year survival for microscopic cervical involvement was 87% compared to 59% for gross involvement (P= 0.008). Patients with negative or microscopic residual tumor in the surgical specimen and those with negative lymph nodes had less risk of treatment failure. Local failure occurred in only 9%. Major complications (3%) were seen only in the radical surgery group. Combined preoperative RT and S provide high cure rates with minimal complications for patients with stage II endometrial carcinoma. Patients with adverse prognostic factors are candidates for trials of more aggressive local and systemic therapy.

Electron beam therapy for skin cancer of the head and neck.

We retrospectively analyzed 99 patients with 115 sites of skin cancer, predominantly involving the head and neck, treated with electron beam therapy. Our objective was to determine the local control rate, radiotherapy reactions, cosmesis, and salvage treatment. Forty-three percent of patients received radiotherapy after biopsy, 41% were treated for recurrence following other modalities of treatment, and 16% had positive margins after surgical excision. With minimum and mean follow-up of 24 and 47 months, respectively, local control was achieved in 88% of patients. Six of 14 local recurrences were salvaged by surgery (five patients) and radiotherapy (one patient) for a total local control of 93%. Serial photographs and data were available to analyze cosmesis in 56 patients. Excellent or good cosmesis was achieved in 91%. Side effects were mild and self-limiting. EBT is highly efficacious and offers excellent cosmesis.

Results of surgery and radiotherapy for early breast cancer.

Primary radiotherapy for 127 early breast cancers produced five-year local control of 96.1 percent and NED results of 81.1 percent. Results from a large community cancer center in New Jersey are comparable to results of major university cancer centers.

Early stage pure seminoma testis.

Forty-three patients with early stage pure seminoma of the testis were analyzed retrospectively. All patients were treated with orchiectomy and radiation therapy. Overall survival was 97.7 percent, with followup ranging from 4.3 to 17.4 years.

Reconstructive breast surgery following mastectomy and adjunctive radiation therapy.

With modern radiation, surgical therapy, and surgical reconstructive techniques, it is now possible to give adequate treatment for breast cancer and to reconstruct the breast as well, using a silicone implant prosthesis. Twelve mastectomies and reconstructions were performed on 8 patients. Seven of these had pre- or postoperative irradiation to one breast region, and 1 patient received irradiation to both breast areas. The clinical staging of patients with combined irradiation and surgery was Stage I--3 cases; Stage II--4 cases; and Stage III--1 case. Primary surgical procedures consisted of modified radical mastectomy for ten breast lesions and simple mastectomy for two others. Megavoltage radiotherapy was administered with a CO-60 Unit. Pre-operative irradiation of 4000 rads to the breast, chest wall, and regional lymphatics was given to 3 patients. Postoperative radiation therapy of 5000 rads to the chest wall and 4400-5000 rads to the regional lymphatics was given to 5 other patients, one of whom received bilateral irradiation. Adjunctive chemotherapy was employed in 5 patients with interruption during the period of implant surgery. Reconstructive surgery was performed 5 months to 14 months after irradiation in 7 patients and 51/2 years later in one patient. The procedure was a single stage operation with placement of a silicone prosthesis under the pectoralis muscle. No significant morbidity was encountered from radiotherapy, chemotherapy, or from the surgical procedures. Healing of surgical wounds after implantation was uncomplicated. Cosmetic results have been good. All patients are alive and well, 8 months to 6 1/2 years postirradiation and three months to three years post-breast reconstruction. Results to date have been most gratifying.