RESUMEN
Following mastectomy, patients aged 35 to 76 years with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy (NT), ovarian irradiation (R) 2000 rads in 5 days, or ovarian irradiation in the same dosage plus prednisone (R + P) 7.5 mg daily for up to five years. A total of 703 eligible patients received the randomly assigned treatment. The median follow up was 21 years with a range of 14 to 25 years. Overall, there was a delay in recurrence (p = 0.03) and survival was prolonged (p = 0.19) for patients who received R, but in neither case was the difference significant after adjusting for the multiplicity in our data. Overall, patients who received R + P experienced a significant delay in recurrence (p = 0.0003) and a significantly prolonged survival (p = 0.005), even after adjusting for multiple comparisons. In premenopausal patients who received R, the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more, R + P therapy significantly prolonged survival (p = 0.0004), while the delay in recurrence although significant (p = 0.02) was only marginally so after allowance for multiple comparisons. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients. A new finding in this review was that contralateral breast cancer as the first failure was reduced by R + P compared to NT in the overall group.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/radioterapia , Carcinoma/tratamiento farmacológico , Carcinoma/radioterapia , Recurrencia Local de Neoplasia/prevención & control , Ovariectomía , Prednisona/uso terapéutico , Adulto , Anciano , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Posmenopausia , Premenopausia , Radioterapia Adyuvante , Tasa de Supervivencia , Factores de TiempoRESUMEN
Patients with muscle invasive carcinoma of the bladder treated with radical radiation were prospectively documented and followed in an attempt to identify prognostic factors predictive of the response to treatment. Data on 121 consecutive patients treated with radical radiation between 1981 and 1985 are presented. Over-all actuarial survival of the patient population (median age 70 years) was 31.6% at 5 years and cause-specific survival was 44.8%. At analysis 33 of 121 patients (27.3%) were alive with preserved bladder function. Independent prognostic factors for cause-specific survival and for complete response with radical radiation were tumor configuration, hemoglobin level and clinical stage. The rate free of local relapse was significantly influenced by stage and presence of coexistent carcinoma in situ. The study suggests that factors other than stage and grade influence prognosis in invasive bladder cancer and should be considered in interpreting treatment results.
Asunto(s)
Carcinoma de Células Transicionales/radioterapia , Neoplasias de la Vejiga Urinaria/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Carcinoma de Células Transicionales/mortalidad , Carcinoma de Células Transicionales/patología , Terapia Combinada , Cistectomía , Cistoscopía , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Dosificación Radioterapéutica , Factores de Tiempo , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
Wide resection with adjuvant radiotherapy is generally accepted as the optimal treatment for patients with extremity soft-tissue sarcomas. However, there is a subset of patients with "difficult" tumours who sustain such marked loss of function from limb-salvage procedures that amputation might offer a superior functional alternative. To evaluate this issue, the authors prospectively designated 19 of 52 patients registered in Toronto's Princess Margaret Hospital Prospective Sarcoma Database in 1986 as "difficult" cases, on the basis of tumour size and anatomical location. Complications and functional results of wide resection and adjuvant radiotherapy were documented. The most frequent complication was related to wound healing (8 of 19 patients). Functional analysis at 1 year follow-up demonstrated that all 19 patients had results superior to those that would be expected with amputation.
Asunto(s)
Brazo/cirugía , Fibroma/cirugía , Pierna/cirugía , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Adulto , Anciano , Brazo/fisiología , Terapia Combinada , Femenino , Fibroma/patología , Fibroma/radioterapia , Estudios de Seguimiento , Humanos , Pierna/fisiología , Locomoción , Masculino , Persona de Mediana Edad , Movimiento , Complicaciones Posoperatorias , Estudios Prospectivos , Sarcoma/patología , Sarcoma/radioterapia , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/radioterapiaRESUMEN
Between 1970 and 1978, 202 patients with carcinoma of the prostate were treated with radical external beam radiation with curative intent. Intracapsular disease was present in 38% and the remaining 62% had disease extending through the prostatic capsule. The overall survival is 72% at five years, and despite the large number of patients with advanced disease the five-year disease-free survival is 46%. Significant prognostic factors include: i) tumor, grade, ii) extent of primary disease, iii) procedure done to determine diagnosis (TURP vs. needle biopsy) and iv) tumor dose. There was a significant improvement in survival at a minimum dose of 5000 Gy. Prostate carcinoma is radiosensitive and a dose-response relationship in treatment has been demonstrated by this review.
Asunto(s)
Adenocarcinoma/radioterapia , Neoplasias de la Próstata/radioterapia , Fosfatasa Ácida/sangre , Análisis Actuarial , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Biopsia , Humanos , Linfografía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Dosificación RadioterapéuticaRESUMEN
The results of radiation therapy as applied to patients with squamous cell carcinoma of the hypopharynx seen during the period 1972-1976 at the Princess Margaret Hospital are presented. Approximately 2/3 of the patient population presented with disease involving the regional lymph nodes or with systemic metastases. Ninety percent (127/141) of all patients registered were treated primarily with radiation therapy with surgery reserved for the management of residual or recurrent disease only. Seventy-seven percent (98/127) of those who received radiation therapy were treated with radical intent. The uncorrected actuarial 5 year survival rate for those patients treated radically was 19%. Five year actuarial survival rates by the UICC TNM (1974) staging system, showed that nodal disease was the most significant determinant of survival. Five year survival rates were as follows: N0 36%; N1 20%; N2N30%. When considered within each nodal category the survival of the combined T1T2 group was not significantly different from the T3 category. Forty-five percent of those patients who failed with local or regional disease had an attempt at salvage surgery. Of these, 6/24 ultimately achieved local and regional control. Comparisons with other series in the literature are discussed and reasons for differences in published results are considered.
Asunto(s)
Carcinoma de Células Escamosas/radioterapia , Hipofaringe , Neoplasias Faríngeas/radioterapia , Radioisótopos de Cobalto/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radioterapia de Alta Energía , Estudios RetrospectivosRESUMEN
Following mastectomy, patients with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy, ovarian irradiation (2000 rad in five days) or ovarian irradiation in the same dosage plus prednisone, 7.5 mg daily. A total of 705 patients received the randomly assigned treatment and were followed for up to 15 years. In premenopausal patients who received ovarian irradiation, the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more, ovarian irradiation plus prednisone therapy significantly delayed the recurrence of breast cancer (p = 0.04) and prolonged survival (p = 0.02). No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.
Asunto(s)
Neoplasias de la Mama/radioterapia , Ovario/efectos de la radiación , Prednisona/uso terapéutico , Adulto , Anciano , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Ensayos Clínicos como Asunto , Terapia Combinada , Femenino , Humanos , Ganglios Linfáticos/efectos de la radiación , Mastectomía , Menopausia , Persona de Mediana EdadRESUMEN
Four hundred and forty-four patients with the histological diagnosis of pure seminoma were treated at The Princess Margaret Hospital between 1958 and 1976. Using the Walter Reed Hospital staging classification, 338 patients (76.1%) were Stage I, 86 (19.4%) were Stage II, and 20 (4.7%) were Stage III. The 5 year actuarial survival rate (5 yr Sa) for all stages was 87%, and for Stages I, II and III: 94%, 74% and 32% respectively. In Stage II the 5-year Sa was significantly worse when palpable abdominal disease was present (62%, vs 87% when it was absent, p less than .02). Prophylactic mediastinal irradiation was not used for patients with Stage II disease. None of 40 Stage II patients without palpable abdominal disease recurred in the non-irradiated mediastinum. Ten of 46 Stage II patients with palpable abdominal disease recurred in the mediastinum; 7 of the 10 were cured with mediastinal irradiation at the time of relapse. Prophylactic mediastinal irradiation appears unnecessary in Stage II patients. The Stage III category includes a subgroup of patients who were curable with radiation therapy:L 5/6 with supradiaphragmatic nodal disease without palpable abdominal or visceral disease were cured. Exploration of new treatment methods appears indicated for the salvage of patients recurring in sites other than the mediastinum or supraclavicular fossa and for patients presenting with visceral disease.
Asunto(s)
Disgerminoma/radioterapia , Neoplasias Testiculares/radioterapia , Adolescente , Adulto , Anciano , Niño , Disgerminoma/mortalidad , Disgerminoma/secundario , Humanos , Masculino , Neoplasias del Mediastino/radioterapia , Neoplasias del Mediastino/secundario , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Testiculares/mortalidadRESUMEN
Patients (383) with stage Tis, Tla and Tlb NoMo glottic cancer are reviewed. Radiotherapy cured 93% of Tis patients and 86% of Tla and Tlb cases. Of all recurrences, 63% were cured. No patient with stage Tis died as a result of tumor and only 5% of stage Tla and Tlb died from tumor. Involvement of the anterior commissure or both vocal cords did not influence control rates by radiotherapy. Mobility of the vocal cord and size of radiotherapy field were significant factors influencing control by radiotherapy. Late recurrences and/or second primaries in the larynx following radiotherapy are rare. Second primaries in the respiratory tract (especially lung) are common and are as important a cause of death as laryngeal cancer in T1 cases. It is concluded that moderate dose radiotherapy with surgery for salvage is a highly effective method of management for early glottic cancer.
Asunto(s)
Glotis , Neoplasias Laríngeas/radioterapia , Estudios de Evaluación como Asunto , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Ontario , Dosificación Radioterapéutica , Neoplasias del Sistema Respiratorio/secundarioAsunto(s)
Neoplasias de la Mama/terapia , Ovario/efectos de la radiación , Prednisona/uso terapéutico , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Ensayos Clínicos como Asunto , Femenino , Humanos , Menopausia , Persona de Mediana Edad , Distribución Aleatoria , Recurrencia , Factores de TiempoRESUMEN
Following mastectomy, patients with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy, ovarian irradiation (2000 rads in 5 days) or ovarian irradiation in the same dosage plus prednisone, 7.5 mg daily. A total of 705 patients received the randomly assigned treatment and were followed for up to 10 years. In premenopausal patients who received ovarian irradiation the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more ovarian irradiation plus prednisone therapy significantly delayed the recurrence of breast cancer (P = 0.02) and prolonged survival (P = 0.02); the survival expectancy of these patients was similar to that of the general population of the same age from the third year after the cancer operation. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.
Asunto(s)
Neoplasias de la Mama/terapia , Ovario/efectos de la radiación , Prednisona/uso terapéutico , Adulto , Factores de Edad , Anciano , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/cirugía , Ensayos Clínicos como Asunto , Femenino , Estudios de Seguimiento , Humanos , Recuento de Leucocitos , Linfocitos , Mastectomía , Menopausia , Menstruación , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Prednisona/administración & dosificación , Prednisona/efectos adversos , Radiografía , Radioterapia/efectos adversos , Dosificación RadioterapéuticaRESUMEN
Following surgery and regional radiotherapy for operable carcinoma of the breast in premenopausal women, ovarian irradiation (2000 rad in five daily fractions) plus prednisone (7.5 mg per day) results in delayed recurrence and prolonged survival.
Asunto(s)
Neoplasias de la Mama/radioterapia , Ovario/efectos de la radiación , Prednisona/uso terapéutico , Adulto , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metástasis Linfática , Menopausia , Persona de Mediana Edad , Dosificación RadioterapéuticaAsunto(s)
Neoplasias Laríngeas/radioterapia , Anciano , Femenino , Glotis , Humanos , Neoplasias Laríngeas/terapia , Metástasis Linfática/radioterapia , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia , Estadística como Asunto , Tecnología Radiológica , Factores de TiempoRESUMEN
All patients with cancer of the glottis seen at the Ontario Cancer Institute from 1955 to 1971 are reviewed. Changes in referral patterns and treatment policy are noted. Particular attention is given to those patients who received radiation for cure, and the place of laryngectomy in their subsequent management is examined. Of the estimated incidence of the disease in the geographic region served, 95 percent are now being seen and of these 97 percent receive treatment with curative intent. Two-thirds or 67 percent are cured at five years and their larynges intact, while a further 18 percent are cured by subsequent laryngectomy.