Impact of primary local treatment on the development of distant metastases or death through locoregional recurrence in young breast cancer patients.

In this study, we tested the hypothesis whether breast conserving therapy (BCT) compared with mastectomy is associated with a negative outcome in terms of distant metastases or death (DMD) and investigated the relation between locoregional recurrence (LRR) and DMD in young breast cancer (BC) patients. This study included a consecutive series of 536 patients ≤40 years of age at diagnosis with pathological T1N0-3M0 BC, treated between 1989 and 2005. A multistate survival model was used to evaluate the influences of local treatment and LRR on DMD, adjusted for potential prognostic factors. Patients were treated with mastectomy (N = 213) or BCT (N = 323). Median age at diagnosis was 36.3 years, with a median follow-up of 9.0 years. The 10-year actuarial cumulative incidence of DMD was 30.6 % after mastectomy and 26.3 % after BCT (P = 0.04). In total, 81 (15 %) LRRs were observed. After BCT, patients had a threefold higher risk of LRR than after mastectomy (HR 2.9; 95 % CI 1.6-5.3). Patients with LRR had a higher risk of DMD compared with patients without LRR (HR 5.5; 95 % CI 2.1-14.5). However, BCT was not negatively associated with DMD-after-LRR (HR 0.47; 95 % CI 0.2-1.1, BCT vs mastectomy). In conclusion, although LRR significantly affected DMD, the increased risk of LRR after BCT compared with mastectomy did not lead to a worse DMD outcome in BC patients ≤40 years of age.

Continuously infused carboplatin used as radiosensitizer in locally unresectable non-small-cell lung cancer: a multicenter phase III study.

PURPOSE: To determine the radiosensitizing effect of prolonged exposure of carboplatin in patients with locally unresectable non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with histologically proven NSCLC, performance score <2, weight loss <10%, and normal organ functions were randomized between carboplatin 840 mg/m2 administered continuously during 6 weeks of radiotherapy or thoracic radiotherapy alone (both 60 Gy). Toxicity was evaluated with National Cancer Institute Common Toxicity Criteria (NCI CTC) and the Radiation Therapy Oncology Group (RTOG) criteria. Quality of life was measured with European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30/LC13 questionnaires. RESULTS: One-hundred and sixty patients were included. Pathologically confirmed persistent tumor was present in 53% of patients in the combination arm versus 58% in the radiotherapy alone arm (P=0.5). Median survival in the combination arm was 11.8 [95% confidence interval (CI) 9.3-14.2] months and in the radiotherapy alone arm 11.7 (95% CI 8.1-15.5) months; progression-free survival was not different between arms [6.8 and 7.5 months, respectively (P=0.28)]. Acute toxicity was mild, late toxicity was radiation-induced cardiomyopathy (three patients) and pulmonary fibrosis (five patients). Quality of life was not different between arms, but in all measured patients cough and dyspnea improved, pain became less, and slight paresthesia developed 3 months after treatment. CONCLUSION: Addition of continuously administered carboplatin as radiosensitizer for locally unresectable NSCLC does not improve local tumor control or overall survival.

Prognostic significance of single versus multiple lymph node metastases in cervical carcinoma stage IB.

From January 1, 1970, to December 31, 1985, 51 patients with stage IB (FIGO) carcinoma of the cervix with lymph node metastases were treated at the University Hospital, Groningen, The Netherlands. The survival rate was 54% and the average duration of follow-up was 78 months (range 47-132). Important clinical variables for survival were investigated retrospectively: the survival rate in patients with a single lymph node metastasis (with tumor confined to the node itself) (n = 23) appeared to be much better than that of patients with multiple node involvement and/or single nodes with extranodular tumor infiltration (n = 28); survival was 85 and 24%, respectively (P less than 0.001). The same applied to patients with only occult lymph node involvement: the survival rate in patients with occult involvement of the hypogastric, external iliac, or obturator nodes was 87% in 19 patients with a single metastasis and 53% in 15 patients with multiple node involvement (P less than 0.02). The survival rate in 8 patients with adenomatous histological components was 42%. In 42 patients with squamous cell carcinoma, the survival rate was 56%. This difference was not statistically significant. Treatment complications and the effect of treatment on the site of recurrence were investigated.

Is there a role for simple hysterectomy after irradiation for bulky cervical carcinoma?

Twenty eight patients with bulky cervical carcinoma, who were treated by irradiation and simple hysterectomy, were studied. Eight of these patients had non-radical pre-operative irradiation. The patients had various FIGO-stages. The prognostic significance of morphologically intact tumor cells in the hysterectomy specimen and the relationship between pre-operative irradiation dosage, intact tumor cells and recurrences is discussed. Positive pelvic lymph-nodes obtained by sampling had more prognostic significance than intact tumor cells in the hysterectomy specimen. The role of adjunctive hysterectomy in local tumor control was not evident. Non-radical pre-operative irradiation proved to be inadequate.

Bladder cancer: pattern of recurrence in 142 patients.

Recurrences were analyzed in 142 patients with invasive bladder cancer, who were treated either by definitive irradiation or preoperative irradiation and cystectomy. In 52 patients an estimation of the radiation response, by endoscopic re-examination soon after reaching 40 Gy, was done. The aim of this procedure was to select those patients who can probably be cured by radiotherapy alone. However, the predictive value of the examination seems to be low. It is concluded that for about 40% of all patients, removal of the bladder is of real benefit. The problem remains how to select this group of patients.

Radical surgery after preoperative intracavitary radiotherapy for Stage IB and IIA carcinoma of the uterine cervix.

During the years 1970-1978 one hundred nineteen patients with Stage IB and fifty-eight patients with Stage IIA carcinoma of the cervix were treated by combined preoperative radium and Wertheim hysterectomy with lymphadenectomy at the State University Hospital in Groningen. The overall 5-year survival was 87% for Stage IB and 70% for Stage IIA. The incidence of pelvic lymph node metastases was 14.8 and 35.4% in Stage IB and IIA, respectively. The presence of lymph node metastases was significantly related to the presence of residual tumour in the cervix after preoperative radium treatment (P less than 0.01) and was the most significant prognostic factor. The 5-year survival was 37% for those patients with node involvement as compared to 94% for those without lymphatic extension. Complications particularly concerned the urinary tract. The incidence of these complications was greatly reduced as experience grew.