[Management of soft tissue sarcomas in first isolated local recurrence: a retrospective study of 83 cases]. / Prise en charge des sarcomes des tissus mous en première rechute locale isolée: étude rétrospective de 83 cas.

PURPOSE: To analyse the management and clinical outcome of patients treated for a first isolated local recurrence of soft tissue sarcoma (trunk or extremities) and to identify prognosis factors. PATIENTS AND MATERIAL: This is a retrospective study of 83 adult patients treated between 1980 and 1999. Mean tumor size was 6 cm. Most sarcomas were located in extremities (N =74), were deep (N =60), and proximal (N =53). Thirty involved nerves or vessels. Histologic subtypes were mainly grade 2 (42%) or 3 (36%) histocytofibrosarcomas (49%) and liposarcomas (20%). Surgical treatment of recurrences consisted in wide excision (32 cases), marginal resection (46 cases), five patients requiring amputation. Final results were R0 (N =33), R1 (N =47) or R2 (N =3) resection. Beside surgery, six patients received neoadjuvant and seven others adjuvant chemotherapy. Twenty-three patients received postoperative external beam radiotherapy (EBRT) (mean dose 55 Gy) and 26 interstitial (192)Ir low dose rate brachytherapy (BCT) (mean dose 45 Gy for BCT alone, 22 Gy when associated with EBRT), 19 patients being re-irradiated. RESULTS: Mean follow up was 59 months. Thirty-seven (45%) tumors relapsed, 62% locally as first event. Nineteen patients developed secondary distant metastases. Multivariate analysis showed only tumour depth (P =0.05) and re-resection for primary R1 resection for the recurrence (P =0.018) being independent prognosis factors for tumour control, radiotherapy (EBRT and/or BCT) being significant in univariate analysis (P =0.05). Overall survival rate was 73, 54, and 47% at respectively 3, 5 and 10 years, and was 65, 35 and 32% after a further local recurrence. Multivariate analysis showed trunk (P =0.0001) or inferior extremity locations (P =0.023), symptomatic (P =0.001), high grade (P =0.01), deep (P = 0.01) tumours, and the occurrence of a further local failure (P =0.004) as unfavourable characteristics for overall survival. CONCLUSION: Because of the high relapse rate in this series, a first isolated local recurrence of STS increases mainly the risk of a subsequent local relapse. Quality of local treatment for the first local relapse is decisive. When a conservative treatment is feasible, it should combine surgical resection and radiotherapy, brachytherapy being the best suited in previously irradiated patients. Efforts have to be pursued to increase quality of the treatment of primary tumours, at best performed in centers that have expertise in this field.

[First surgery followed by vaginal curietherapy in small-volume uterine cervix cancer: an alternative to the association of uterovaginal curietherapy and surgery]. / Chirurgie première suivie de curiethérapie vaginale dans les cancers du col utérin de petit volume: une alternative à l'association de curiethérapie utérovaginale et de chirurgie.

PURPOSE: Evaluate the results of the treatment of small uterine cervix cancer with the association of surgery and postoperative vaginal brachytherapy, without unfavourable prognostic factors. PATIENTS AND METHODS: After radical hysterectomy with lymphadenectomy, 29 women (mean age: 44 years) with carcinoma < 25 mm (26 stage IB1, 3 IIA, mean size: 15 mm) were treated by post-operative prophylactic vaginal brachytherapy using low dose rate. Ovarian transposition was performed at the surgical time in 14 young women (mean age 35 years). RESULTS: The actuarial specific survival rates at 5 and 10 years were 100% and 90% respectively, with a mean follow-up 75 months. Only one local recurrence was observed. The rate of grade 1 post-operative complication was 7%. The conservation rate of the ovarian function was 85% for young women. CONCLUSION: Treatment of small volume uterine cervix cancer using first surgery and post-operative vaginal brachytherapy is a reliable therapeutic option. The results in terms of specific survival and complications are the same with those after standard association of preoperative uterovaginal brachytherapy and surgery.

Analysis of 676 cases of ductal carcinoma in situ of the breast from 1971 to 1995: diagnosis and treatment--the experience of one institute.

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

[Conservative treatment of extremity soft tissue sarcomas. Functional evaluation using LENT-SOMA scales and Enneking scoring]. / Traitement conservateur des sarcomes des tissus mous des membres. Evaluation du résultat fonctionnel selon l'échelle LENT-SOMA et le score de Enneking.

OBJECTIVE: The aim of this prospective study is the feasibility of late effects assessment by LENT-SOMA scales after conservative treatment of soft tissue sarcomas of the extremities and a comparison with the functional evaluation by the Enneking score. PATIENTS AND METHODS: During the systematic follow-up consultations, a series of 32 consecutive patients was evaluated in terms of late effects by LENT-SOMA scales and functional results by the Enneking score. The median time after treatment was 65 months. The treatment consisted of conservative surgery (all cases) followed by radiation therapy (29 cases), often combined with adjuvant therapy (12 concomitant radio-chemotherapy association cases out of 14). The assessment of the toxicity was retrospective for acute effects and prospective for the following late tissue damage: skin/subcutaneous tissues, muscles/soft tissues and peripheral nerves. RESULTS: According to the Enneking score, the global score for the overall series was high (24/30) despite four the scores zero for the psychological acceptance. According to LENT-SOMA scales, a low rate of severe sequellae (grade 3-4) was observed. The occurrence of high-grade sequellae and their functional consequences were not correlated with quality of exerese, dose of radiotherapy or use of concomitant chemotherapy. A complementarity was observed between certain factors of the Enneking score and some criteria of the LENT-SOMA scales, especially of muscles/soft tissues. CONCLUSION: The good quality of functional results was confirmed by the two mean scoring systems for late normal tissue damage. The routine use of LENT-SOMA seems to be more time consuming than the Enneking score (mean time of scoring: 13 versus five minutes). The LENT-SOMA scales are aimed at a detailed description of late toxicity and sequellae while the Enneking score provides a more global evaluation, including the psychological acceptance of treatment. The late effects assessment by the LENT-SOMA scales should be carried on in prospectives studies, especially in case of concomitant radio-chemotherapy.

[Results of 10 years of a randomized trial of neoadjuvant chemotherapy in breast cancers larger than 3 cm]. / Résultats à 10 ans d'un essai randomisé de chimiothérapie néo-adjuvante dans les cancers du sein de plus de 3 cm.

AIM OF THE STUDY: The aim of this randomised trial was to determine advantages and drawbacks of neo-adjuvant chemotherapy in patients with operable breast cancers > 3 cm. MATERIAL AND METHODS: Two hundred and seventy-two women (age 70) with operable breast cancers larger than 3 cm (T2-3/N0-1/M0) were included in a randomised trial from January 1, 1985 to April 30, 1989. Patients in group A (n = 138) were treated by mastectomy and axillary node dissection. Adjuvant chemotherapy was indicated for 104 patients with axillary node involvement (n = 82) or negative oestrogen and progesterone receptors (EPR-) (n = 22). Patients in group B (n = 134) were treated by initial chemotherapy (identical as in group A) followed by locoregional treatment according to the response. Before treatment, the average of clinical tumoural diameter was 43 mm. RESULTS: The median follow-up was 124 months. In group B, 49 patients (36.5%) were resistant to chemotherapy; a conservative breast surgical treatment was performed in the other 84 patients sensitive to chemotherapy (62.6%). In this last subgroup, 19 (22.6%) needed a secondary mastectomy because of locoregional recurrence. Survival rates were not different in groups A and B, but loco-regional recurrences were frequent in group B. At 10 years, the overall survival rate was 60% and half of living patients in group B were free of cancer and with their breast. CONCLUSION: Neoadjuvant chemotherapy permitted in two-thirds of cases breast conservation treatment, initially considered to be impossible. Locoregional recurrences are more frequent than after mastectomy and adjuvant chemotherapy.

[Recurrence after treatment of breast intraductal carcinoma]. / Les récidives après traitement des carcinomes intracanalaires du sein.

OBJECTIVE: To assess the risk of local recurrence of intraductal carcinoma of the breast with a large series and a review of literature. METHODS: We present a retrospective study of 331 cases treated for intraductal carcinoma of the breast. Only patients with at least 5 years follow-up were selected. We were specially interested in recurrence risk factors. In these patients with a long follow-up; pathology was reevaluated with new investigation technique. RESULTS: After a median follow-up of 109 months, 40 local recurrences were observed; these lesions were invasive in 23 cases. Only one patient had recurrence after mastectomy. For the others, they had lumpectomy associated with radiotherapy in 12 cases. Histologic features, grade and therapeutic options were evaluated as risk factors of local recurrence. CONCLUSION: Follow-up after lumpectomy for intraductal carcinoma was studied. The status of tumor margins was important; irradiation appeared useful, specially in case of high grade carcinoma but further large prospective randomized studies are needed. The use of prognostic index is interesting, but there are still unanswered questions.

[Chemotherapy of soft tissue sarcoma in the adult]. / Chimioradiothérapie [correction of Chimiothérapie] des sarcomes des tissus mous de l'adulte.

The goal of postoperative treatment in adult soft tissue sarcoma is local control, and in high-risk patients prevention of distant failures. Radiation therapy is essential after non-radical surgery. The role of adjuvant chemotherapy on improvement of overall survival remains to be evidenced; however, recent meta-analysis data have confirmed its impact on both local and metastatic evolution of the disease. Because for both radiotherapy and chemotherapy, delay of treatment may be crucial for efficacy following tumor excision, concomitant radiochemotherapy should be considered. Review of the literature as well as personal results showed the feasibility of postoperative radiochemotherapy in adult soft tissue sarcoma, even when the chemotherapeutic associations used included an anthracycline. Prospective study of radiochemotherapy should be performed in order to assess its real impact in terms of efficacy and toxicity.

Predictive factors for complete removal in soft tissue sarcomas: a retrospective analysis in a series of 592 cases.

BACKGROUND AND OBJECTIVES: In order to specify the indications for conservative surgery and preoperative therapeutic approaches of soft tissues sarcomas (STS), we looked for the clinico-pathological parameters associated with the failure to obtain a complete removal (CRm) of the tumor. METHODS: We retrospectively analyzed a series of 592 cases of primary non-metastatic STS. Surgery was performed in 495 cases as a primary treatment and in 88 cases after chemo- or radiotherapy. Nine patients were treated by chemotherapy-radiotherapy. In a univariate analysis, 20 parameters were tested for their association with CRm. A multivariate analysis was then used to define the independent parameters linked to the achievement of a CRm. RESULTS: In the univariate analysis, 15 parameters were found to be linked to the achievement of a CRm. Three of them proved to be independent in the multivariate analysis: T in the TNM classification, tumor location, and tumor necrosis. By the combination of these risk factors, four groups of patients were defined, with respective rates of CRm of 97% (no factor), 95% (one factor), 70% (two factors), and 48% (three factors). CONCLUSIONS: The achievement of a CRm after surgery of STS depends not only on the accessibility of the lesion, but also on tumor aggressiveness, a reflection of which is necrosis. The detection of necrosis by imaging procedures may thus help predicting the resectability of tumors and defining the indications for neoadjuvant therapies, likely to broaden the use of conservative surgery.

[Role of adjuvant chemotherapy in the treatment of soft tissue sarcoma]. / Place de la chimiothérapie adjuvante dans le traitement des sarcomes des tissus mous de l'adulte.

Important improvements in local control with increasing function-sparing treatment have been achieved in adult soft tissue sarcomas (STS). However, the global prognosis of these diseases remains poor and 40% of patients with STS currently die of metastases within 5 years. In fact, the impact of chemotherapy remains debated, particularly in the adjuvant setting. Thirteen randomized clinical trials with no-treatment control arms have been published to assess adjuvant chemotherapy. A benefit has been demonstrated in 2 studies for overall survival, and in 5 studies when considering disease-free survival (DFS). Globally, despite large differences between studies (patient selection and treatment modalities), overall survival, DFS and local control of the chemotherapy arm were always better than those of the observed arm. These effects were also confirmed in 3 meta-analyses on published data. However, according to the preliminary results of a meta-analysis on individual patient data, overall survival does not appear to be significantly affected. Therefore, adjuvant chemotherapy for STS remains investigational. Randomized studies have to be pursued on the basis of previously performed trials in order to assess which patient group really benefits from adjuvant chemotherapy.

[Intravenous leiomyomatosis of uterine origin with cardiac extension. A case report and review of the literature]. / Léiomyomatose intraveineuse d'origine utérine avec extension cardiaque. A propos d'un cas et revue de la littérature.

A case of intravenous leiomyomatosis of the uterus with extension into the heart discovered in a 34-year old patient who suffered from dyspnea is reported. The findings suggest that intravenous leiomyomatosis originates from the smooth muscle component of uterine veins. Only 30 cases of intravenous leiomyomatosis with intracardiac extension have been reported. Two-dimensional echocardiography showed an abnormal mass in the right atrium. Pelvic echography showed an abnormal mass in the pelvis. In case of cardiac involvement, spontaneous prognosis remains poor. The primary goal of surgery is the complete removal of the tumor. Hormonotherapy should also be considered in case of unresectable residual tumor. A long-term follow-up of patients after resection of intravenous leiomyomatosis is needed because recurrences up to 17 years after primary resection have been reported.

[New surgical techniques in soft tissue sarcoma]. / Nouvelles techniques chirurgicales des sarcomes des tissus mous.

PURPOSE: To elaborate a new classification of surgery of soft tissue sarcoma (STS). PATIENTS AND METHODS: This was a multicentre study. Purely descriptive terms of surgery of STS have been established. The classification results in a synthesis of surgery terms and conclusion of the pathological report defining the resection (R): R0 = in sano, R1 = microscopic residual disease, R2 = macroscopic residual disease. Validity of the terms has been evaluated by questionnaire, first concerning previous operations, then prospectively during 15 months on the following operations. RESULTS: One hundred and seventy six operating forms established prospectively by eight centres were analyzed. The majority of surgeons were satisfied with the new items. Most of them judged the terms appropriate to surgery. In 96 cases, confrontation between the surgical terms and pathological items was made. Concordance between them was found in 2/3 of the cases. Discordance was observed essentially in cases of re-excision. In all 96 cases the synthesis was judged reliable, permitting treatment adaptation. The study is ongoing. Following propositions of participants, modifications of the surgery terms are included. CONCLUSION: Subject to confirmation of these promising results, the proposed classification should contribute to optimize treatment of STS.

Conservation treatment in subareolar breast cancers.

The results of centromammary conservation in 37 patients with 20 mm-median-size breast cancer, located in the subareolar area (SAA), with an infiltration of the nipple-areolar-complex (NAC) in 12 patients and a retraction in 24, are reported. Breast conservative surgery was initially performed in 30 patients; five patients were first treated with chemotherapy; two patients received initial tamoxifen. Surgery comprised tumorectomy plus axillary dissection, with complete resection of the NAC (20 patients), or partial resection (nine patients), or without resection (eight patients). Post-operatively, all patients received 50 Gy external radiotherapy, with an additional external electron boost in 13 patients; 14 patients received adjuvant tamoxifen and two patients adjuvant chemotherapy. With a median follow-up of 49 months, one patient experienced a local failure and four a metastatic failure; 5-year overall actuarial survival and disease-free survival rates were 97%, and 75%. Cosmetic results were excellent in three patients, good in 25, and poor in seven. Breast conservation appears a satisfying treatment in small breast cancer located in SAA.

[Locally developed sarcoma of the thoracic wall]. / Sarcome localement évolué de la paroi thoracique.

Important advances have been obtained in the care of soft tissue sarcoma in adults, mainly in the field of locoregional treatment. Surgery or combination of surgery and radiotherapy allow adequate tumor control with preservation of function for the majority of patients. However, the management of locally advanced primaries remains problematic. Moreover, although patients survival mainly depends on the metastatic risk of the disease, controversies remain in definition of pronostic factors as well as in the evaluation of the role of chemotherapy in curative therapeutical strategies. The case reported here allows a discussion of the different modalities of treatment for adults with soft tissue sarcomas and stresses the necessity of a multimodal approach in these patients.

Retroperitoneal soft tissue sarcomas: a pilot study of intraoperative radiation therapy.

This pilot study was conducted to evaluate the feasibility and tolerance of a multimodal therapy of retroperitoneal soft tissue sarcoma (STS), including intraoperative radiation therapy (IORT). Nineteen patients (14 primarily treated patients and 5 treated for a recurrent tumor) were included. Surgery included a complete resection (14), a partial resection (2), and no resection (2). The median IORT dose was 17 Gy. Thirteen patients also received an external radiation therapy (ERT). Nine patients received chemotherapy. There was no postoperative mortality. Immediate postoperative complications occurred in four patients (21%). Delayed complications occurred in six patients, including one lethal iliac artery disruption. With a median follow-up of 17 months, the 2-year disease-free survival rate was 60%, and the 2-year actuarial local control rate was 76%. A multimodality approach of treatment, including IORT and ERT and eventually chemotherapy, appears feasible in patients with retroperitoneal STS. However, the treatment-related morbidity appeared relatively high in this study.

[Carboplatin and etoposide combination for the treatment of recurrent epithelial ovarian cancer]. / Association de carboplatine et étoposide dans le traitement des rechutes des cancers épithéliaux de l'ovaire.

UNLABELLED: The objective of this phase II study was to determine the efficacy and toxicity of a combination of carboplatin and etoposide as salvage treatment, in previously treated patients with persistent or recurrent ovarian cancer following first-line cisplatin-based chemotherapy. PATIENTS AND METHODS: From July 1990 to August 1994, 58 patients were treated with 3-week cycles of chemotherapy consisting of carboplatin (200 mg/m2, D1) and etoposide (120 mg/m2, D1, D2). Criteria for evaluating previous response to cisplatin were strictly defined. RESULTS: The overall response rate was 36%, with five complete responses (CR, 9%), 16 partial responses (PR, 27%) and the median duration of response was 10 months (range: 4 to 38). In the group of patients who progressed during the first year following the diagnosis, the response was 1 CR and 2 PR (12%) and in the group of patients who progressed from the second year after diagnosis, 4 CR and 14 PR (56%), with a median survival of 8.5 and 21 months respectively (p = 0.0013). The response rate was 59% in the potentially platinum sensitive group versus 8.7% in the primary resistant group (0.02 < p < 0.05). Myelotoxicity was the main side-effect but did not appear to be cumulative. Grade 3 and grade 4 anemia were observed in 26% and 3% of the patients respectively, neutropenia in 14% and 2% and thrombocytopenia in 14% and 8.5%. One patient died of sepsis associated with neutropenia. CONCLUSION: Treatment was easily manageable and well tolerated. The advantage of carboplatin and etoposide combination in potentially responsive patients is represented by the reduced nephrotoxicity, neurotoxicity and ototoxicity as compared with cisplatin containing regimen, with durable feasibility in outpatients. This second-line chemotherapy for ovarian cancer is effective as salvage treatment in potentially responsive patients with late recurrent tumors, while paclitaxel is the drug of choice for patients who have developped primary or secondary resistance to platin therapy.

[Surgery of soft tissue sarcoma (with the exception of the retroperitoneum)]. / Chirurgie des sarcomes des tissus mous (rétropéritoine excepté).

The place of surgery in the treatment of soft-tissue sarcoma is defined in the light of a review of the recent litterature. Usual treatment combines conservative surgery and radiotherapy. The essential risk factor of local recurrence is the quality of surgical resection, defined by the definitive resection margins. The addition of radiotherapy after inadequate surgery can improve local control, but cannot ensure that obtained after adequate surgery. Some limited tumours can be treated by surgery alone, but radiotherapy remains essential in more advanced tumours. Under these conditions, local recurrence rates after surgery alone, surgery and systematic radiotherapy and surgery with radiotherapy, as required are 27%, 28% and 30% respectively. The development of a local recurrence appears to affect survival in tumour with a good initial prognosis, early recurrence determining unfavourable outcome. Serious postoperative morbidity is observed in 14% of the cases and is responsible for delayed treatment and functional disorders. The use of muscle flaps to fill the surgical defects can reduce these complications. Evaluation of the functional results must be based on predefined objective criteria.

[Functional outcome of laparoscopically transposed ovaries in the multidisciplinary treatment of cervical cancers. Analysis of risk factors]. / Avenir fonctionnel des ovaires transposés par coelioscopie dans le traitement multidisciplinaire des cancers du col utérin. Analyse des facteurs de risque.

OBJECTIVES: To evaluate the place of ovarian transposition by laparoscopy in the treatment of cervical cancers. METHODS: From March 1992 to November 1994 at Institut Bergonié, 11 patients (mean age: 40 years; 36-44 years) with invasive squamous cell carcinoma of the uterine cervix stages Ib (4 cases) and IIb (7 cases) underwent lateral high ovarian transposition by laparoscopy performed during a staging inter-iliacal lymphadenectomy. There was no complication during surgery but one phlebitis occurred postoperatively. The treatment for the cervical cancer included: brachytherapy (11 cases), external beam radiotherapy (EBRT) (9 cases), surgery (6 cases), chemotherapy (2 cases). Ovarian radiation dosis was calculated and hormonal status assessed. RESULTS: Ovarian preservation was achieved in 30% of the cases. The mean lowest cumulative dosis to the ovaries was 1.78 Gy. Age was the most predictive factor for ovarian preservation. CONCLUSION: With ovarian laparoscopic transposition, ovarian function can be preserved in selected patients requiring first line radiotherapy for cancer of the cervix. After the age of 40 years, transposition should be restricted to small T1 tumors treated by brachytherapy. When EBRT is required for larger lesions, transposition should be reserved to younger patients.

[Breast cancer and hMG treatment: is there a relationship?]. / Cancer du sein et traitement par hMG: y a-t-il un lien?

The promoter effect of oestradiol in breast cancer, the higher risk of breast cancer in infertile nulliparous women and the increased use of treatments to include ovulation would suggest that the risk of cancer after this type of treatment might be affected. We thus evaluated the files of patients under 45 years of age treated for breast cancer at the Bergonié Foundation. Six such cases were found. Due to the small number of cases observed to date, no statistical analysis could be performed. Nevertheless, several cases may have gone unrecognized or unpublished. Two hypothesis might be involved: the facilitating effect of stimulation on infraclinical or undiagnosed cancers, initiation of new cancers. We thus propose: a register to follow treated women in order to monitor the appearance of new cases of cancer, improved surveillance in patients with other associated risk factors.

Evaluation of whole abdominal irradiation in ovarian carcinoma with a four orthogonal fields technique.

PURPOSE: The purpose of this study is to evaluate the toxicity and the results of abdominopelvic irradiation with a four orthogonal field's technique in patients with ovarian carcinoma. METHODS AND MATERIALS: Between May 1981 and December 1990, 167 patients with ovarian carcinoma have been treated with whole abdominal irradiation: 62 patients with no or minimal residual disease < 2 cm after initial surgery (group 1) and 105 patients with no residual disease or macroscopic residual disease < 2 cm assessed by second-look surgery after incomplete debulking surgery and cisplatin-based polychemotherapy (group 2). Irradiation was performed by a four orthogonal field's technique. Thirty grays were given with a 25 MV photon beam (1.5 Gy/fraction/day, 20 fractions over 30 days). Boosts were performed in 50 cases (median dose of 15 Gy). RESULTS: With a median follow-up of 68 months, the 5-year actuarial survival rate was 50% in the entire group, 67% in group 1, 40% in group 2, and 84% in T1, 61.5% in T2, 38% in T3. Five-year actuarial survival was analyzed according to the residuum: (a) after initial surgery (no residual disease: 70%, residual disease: 36.5%), (b) after second-look surgery: 76% in patients with a negative second look, 66% in patients with microscopic residual disease, 22% in patients with macroscopic residual disease and secondary surgical reduction, and 10% in patients with small unresectable nodules. Nine percent of the patients failed to complete irradiation acute side effects related. Five percent required surgery for bowel obstruction. CONCLUSION: The abdominopelvic irradiation with this four orthogonal field's technique was associated with tolerable acute toxicity and a low risk of serious late complications. Similar late results to have been reported whole abdominal irradiation with chemotherapy in patients with negative or microscopic residual disease after surgery. Randomized trials comparing these two adjuvant treatments are warranted.