Management of biochemical failure following radical prostatectomy: salvage radiotherapy - a case series.

A retrospective analysis of the outcome of radical prostatectomy (RP) for prostate cancer in a single centre and assessment of the role of salvage radiotherapy (RT) for patients with biochemical relapse. Hundred and thirty-seven patients underwent RP for adenocarcinoma of the prostate in our centre between December 1994 and June 2003. Fifty-four of these patients developed a biochemical relapse prostate-specific antigen (PSA > or = 0.2 ng/ml). Thirty-two patients including five from elsewhere (one with a palpable local recurrence) received salvage RT. Twenty-five of these had positive margins at resection and four had involvement of seminal vesicles. Nine had Gleason score > or = 8. Median PSA before RT was 0.55 ng/ml (range 0.2-5.0). Median age at surgery was 63.5 years (range 52-71). Median age at RT was 65 years (range 53-73). Median time from surgery to biochemical relapse was 11 months (range 0-37) and median interval from surgery to RT was 22 months (range 3-71). Twenty-seven patients received 64 Gy in 32 fractions, three patients received 55 Gy in 20 fractions and two patients received 50 Gy in 20 fractions. Twenty-seven patients were managed by observation or hormone therapy. Twenty-seven patients (84%) achieved complete biochemical remission following RT. Eighteen (56%) remain in complete remission with a median follow-up since RT for the whole group of 30 months (range 8-85). Fourteen patients have relapsed, eight of whom had either clear margins or PSA >1.0 ng/ml at the time of RT (PSA > or = 0.2 ng/ml). Salvage RT is an effective treatment for achieving biochemical remission in selected patients who relapse following RP.

Sarcoma of the prostate treated with radiotherapy.

Sarcoma of the prostate is a rare primary tumour in adults. We report a 73-year-old man who presented with urinary outflow obstruction. He had histologically proven prostatic sarcoma and probably derived some benefit from radiotherapy. A brief review of the literature is included.

Merkel cell (trabecular) carcinoma of skin treated by radiotherapy.

Merkel cell tumour is a recently described aggressive primary neoplasm of the skin. It is commonly seen in the elderly, on the head and neck or extremities. Surgical excision is the recommended treatment, but local recurrence or dissemination is not an uncommon consequence of this form of therapy. Radiotherapy is usually used as a palliative treatment for metastatic disease. We present two patients, in one an extensive primary was controlled by superficial X-ray, in the other, lymph node metastases were controlled with radiotherapy after excision of the primary.

Radiotherapy: an effective treatment for extramammary Paget's disease.

Extramammary Paget's disease is a rare condition. Simple excision may result in local relapse, wide local excision may not be appropriate in elderly patients with extensive disease. The case records of six patients with extramammary Paget's disease treated by radiotherapy were reviewed retrospectively. Radical radiotherapy to the skin controlled the disease in four patients.

Radiotherapy for Paget's disease of the nipple: a conservative alternative.

The case records of 28 patients with Paget's disease of the nipple treated by radio-therapy alone were reviewed retrospectively. 16 of 19 patients who had no palpable underlying tumour and who were mammographically normal at the time of original treatment remain free of disease with a median follow-up of 5 years 3 months. In this selected group, radical radiotherapy with small fields localised to the involved skin is an effective alternative to mastectomy.

Radiotherapy and conservative surgery in the management of musculo-aponeurotic fibromatosis.

Fifty-four patients with musculo-aponeurotic fibromatosis treated with surgery, surgery and planned post-operative radiotherapy, or radiotherapy alone between 1936 and 1982 have been retrospectively reviewed. Twenty-seven patients had a previous excision before definitive treatment. All patients in whom surgery was known to be incomplete and who had no further treatment relapsed. Nine patients had a complete surgical excision alone and 1 relapsed. Twenty-nine patients were treated with surgery and post-operative radiotherapy and 7 relapsed. Relapse was associated with small field size, orthovoltage irradiation, and doses less than 50 Gy. Radiotherapy was effective in preventing relapse in 6 of 8 cases incompletely excised and in all of these cases the total dose was more than 50 Gy. In 13 assessable patients with clinically evident disease, 14 fields were treated with radiotherapy. Complete response was achieved in 9 fields (although one subsequently relapsed and 2 had a marginal relapse), partial response in 4, and disease stasis in one. Complete resolution took up to 21 months and total doses ranged from 35.2 Gy to 64 Gy. Radiotherapy is indicated in cases of incomplete excision and inoperable disease. Doses should be radical and fields should be sufficiently generous to encompass the anatomical limits of the infiltrated tissues.

Screening for breast cancer: some clinical aspects.

There is little doubt that screening by palpation and mammography will reduce the mortality from breast cancer. Most of the studies have been designed to test survival difference and, following diagnosis, patients were treated by a variety of surgeons and methods. We present clinical and pathological data on 32 asymptomatic patients who were screened and found to have breast cancer. Investigation and treatment was performed by one surgeon according to a defined protocol. We confirm that mammography is a more sensitive diagnostic tool than palpation and describe how a review of the patient with the suspicious mammogram will increase the incidence of palpable tumours. We stress the importance of fine-needle aspiration cytology as a diagnostic and localization method. The low incidence of axillary node metastasis in patients with invasive carcinoma is described. More importantly, no patient in this series required treatment by mastectomy. In our experience patients with breast cancer detected by screening are eminently suitable for treatment by breast conservation.

Medroxyprogesterone acetate: variation in serum concentrations achieved with three commercially available preparations.

Twenty-nine females with metastatic or locally recurrent carcinoma of the breast were treated orally with 1 g of medroxyprogesterone acetate (MPA) daily. This was used as a second- or third-line treatment. Serum concentration of MPA was measured over a 28-day period. We have demonstrated a significantly greater area-under-the-concentration-time curve, peak, and steady-state MPA concentration for Provera at 100- and 200-mg tablets (Upjohn) than for Farlutal at 500-mg tablets (Farmitalia). Relative bioavailability of preparations should be considered when prescribing or assessing treatment results when MPA is used.

Phyllodes tumour of the breast: response to radiotherapy.

A 47 year old woman presented with a rapidly growing recurrence in the chest wall following simple mastectomy for a malignant phyllodes tumour of the breast. Radical megavoltage irradiation led to histologically confirmed complete regression of her tumour.

Abdominal wall metastasis following laparoscopy: a case report.

Laparoscopy is commonly used for diagnosis and follow up of malignant disease. Metastatic infiltration of the scar is very rare. We report a case which presented as acute inflammation within 8 days of the procedure.

Gastro-intestinal malignancy in association with Peutz-Jeghers syndrome--three further cases.

Whether a relationship exists between the Peutz-Jeghers syndrome (PJS) and gastrointestinal (GIT) malignancies remains unclear. We here present three further cases of GIT malignancies in young patients with the PJS.