Lymphadenectomy during radical hysterectomy for cervical cancer (stage IB 1-2, HA): state of the art.

Pelvic lymphadenectomy during radical hysterectomy in surgical candidates with cervical cancer (stage IBI-1, IIA) has become a standard method of therapy starting from mid 20th century. More knowledge about the natural history, predictive and prognostic factors of disease and effectiveness of surgical and adjuvant treatments of early stage cervical carcinoma has been accumulated over the past 5 decades. During the latter part of the 20th century the accumulating information base led to more conservative approaches for cancer resection in an effort to decrease the morbidity of radical surgery and to preserve the fertility if possible. Lymph node metastasis is a bad prognostic factor in the early stages of disease and automatically classifies a patient in a high-risk group necessitating adjuvant therapy. Preoperative diagnostic procedures, such as echotomography, computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and lymphangiography are all helpful in determining lymph node status, although their accuracy rate is anywhere between 57-85%. Recent studies of sentinel lymph nodes and lymph node topography are still very controversial and neither give information on the extent of lymphadenectomy needed nor help in patient selection in planning additional adjuvant therapy. Published results on laparoscopic lymphadenectomy demonstrate decreased postoperative morbidity, but still pose questions whether laparotomic lymphadenectomy should be replaced by this technique. Thus the question remains: how many lymph nodes, of which groups and by which technique should be dissected during pelvic lymphadenectomy?

[Carcinoma of the anal canal--results of radical radiotherapy]. / Carcinoma of the anal canal--results of the radical radiotherapy.

From February 1995 to August 2001, 34 pts with squamous cell carcinoma of the anal canal (stage T2-35.3%, stage T3-44.1%, stage T4-20.6%, stage N1-29.4%) were treated prospectively by definitive radiotherapy only, delivered with megavoltage linear accelerator, combined with intracavitary brachytherapy in some patients, at the Institute for Oncology and Radiology of Serbia. Total tumor dose was range 55-75 Gy. Median follow-up time was 24.7 mounts (range 6-66 mounts). Overall survival and disease free survival at 5 years were 65.44% and 68.44%. Local control was 82.3% (28/34 pts). Eight pts had local or distant failure. Early and late complication rates were acceptable. In majority of patients the anal sphincter function was preserved.

[Radiotherapy of local recurrence of rectal carcinoma]. / Radioterapija lokalnih recidiva karcinoma rektuma.

In retrospective, non-randomized study were analyzed 45 patients with local recurrences of rectal carcinoma treated by combined external beam radiotherapy (EBRT) and "High dose rate (HDR) remote afterloading" brachytherapy in the period from January 1st, 1988 to May 1st, 1988. Depending on the localization of the local recurrent disease, 20 patients were with vaginal relapse, 13 with vaginal and presacral, 9 with perineal and 3 with presacral and rectal. Combined radiotherapy was applied as follows: 33 patients (73.3%) had EBRT with endovaginal brachytherapy, 3 (6.7%) EBRT plus intraluminal brachytherapy and 9 (20%) patients EBRT plus interstitial brachytherapy. Techniques with 3 and 4 field for EBRT were used and doses ranged 45-65 Gy with convenient fractionation were applied, combined with the doses ranged 15-35 Gy for brachytherapy. Radiotherapy was planned according to the computer tomography cross image on simulator with computer planning. Complete regression of the tumor was observed in 19 patients (42.2%), and partial in 23 patients (51.1%). Median follow-up period was 34 months (8-72). Acute radiation adverse effects were registered in 32 patients, and late sequels in 6 (13.3%). Overall 3-year survival rate was 54% and disease-free survival rate was 34% in the same period.

[Thyroid carcinoma in childhood]. / Karcinom stitaste zlezde kod dece.

A retrospective analysis of the thyroid gland carcinoma in children, cured at the Institute of Oncology, was more frequent in girls (76%) than in boys. The changes were analysed according to TNM classification using the protocol for diagnostic and treatment procedures. The approach of the protocol was the same for children and adult population. In children the primary process ecpanded very fast in regional lymph nodes. Surgery of different size with or without the functionally neck dissection, proved the pathohistological verification. After the surgery, in 10 of 29 children, 131-I was applied. Spreading of the disease in lungs was observed in four of 29 children. The parameters of the successful therapy of the thyroid gland carcinoma in childhood were the general status, local status, the concentration of thyroglobulin value (Tg), and the serum titres of antithyroglobulin antibodies.

[Treatment of locally advanced esophageal cancer by combined intralumenal brachytherapy and external beam radiotherapy]. / Lecenje lokalno uznapredovalog karcinoma jednjaka kombinovanom endoluminalnom i transkutanom radioterapijom.

The prognosis of patients with esophageal cancer is poor, due to frequent local recurrence and distant metastasis. The last decade has also seen that brachytherapy as a treatment with real potential to improve the therapeutic ratio of external irradiation. From March 1993 to October 1994 at the Institute of oncology and radiology in Belgrade, 18 patients with locally advanced esophageal cancer were treated by combined intralumenal brachytherapywith external beam irradiation. Median age was 59.6 years (range 43-70) and male/female ratio 2.6:1. Biopsy via endoscopy showed squamous cell carcinoma in 17 patients and adenocarcinoma in one case. External beam radiotherapywas applied on linear accelerator by locoregional texhnique with tumor dose of 30-60 Gy in 10-30 fractions. Intralumenal brachytherapy was eprformed on microselectron with tumor dose 5-20 Gy in 1-4 fractions. Response rate (complete response rate + partial response rate) was registrated in 13/18 (72%) patients. The good paliative effect for dysphagia, continuated passage for any food and increase body weight was shown in 16/18 (88%) patients. Six months after treatment, 7/13 patients were free of disease. Acute complications as irradiation pesophagitis occured in majority of patients.

Immunosuppressive and cytogenetic effects of pelvic irradiation on the peripheral lymphocytes of patients with cervical cancer. One year follow-up.

The circulating lymphocytes of patients treated for cervical cancer were examined by four independent manners: by evaluation of T-cell proportion in peripheral blood, proliferative response upon PHA stimulation, PHA-induced leukocyte migration inhibition, and by concomitant chromosome aberration frequency. The immediate and longer-term effects of pelvic irradiation on T lymphocytes were investigated in 19 patients prior to, during, and immediately after radiotherapy, and then at subsequent intervals of two, three and five months. Radiotherapy caused profound depression of already diminished T-cell number and their proliferative response; both parameters gradually recovered during post-treatment period, and achieved their pretreatment values at the end of follow-up. The leukocyte migration inhibition was much less affected; it slightly deteriorated in the middle of post-treatment period, but reached the pretreatment level at the end of monitoring. The chromosome aberration frequency increased during irradiation in dose-dependent manner; it decreased gradually thereafter, but remained high during follow-up. Their elimination rate correlated with the recovery of T-cell number and proliferative response. However, at the end of monitoring, when all immunological parameters were completely recovered from harmful effect of irradiation, the percentage of chromosome aberrations remained high (12.5%), although significantly lower than the post-treatment one.

Immune reactive proteins in patients irradiated for cervical cancer. One year follow up.

The parameters of nonspecific humoral immunity--serum immunoglobulins and immune complexes--were evaluated in irradiated group of patients with uterine cervix carcinoma (Stages IIB and IIIB), during one year follow up. The concentrations of IgA, which were elevated in patients before therapy, slowly declined after the radiotherapy, at the end of the follow up being returned to the normal range. The concentrations of IgG, which were significantly decreased in patients immediately after the therapy, were sharply and transiently elevated two months after the therapy; afterwards, the levels of IgG gradually decreased to the values which did not differ from their pre- or post-RT levels, as well as from control ones. The levels of CIC were not significantly changed after radiotherapy, although a transient increase was found seven months after radiotherapy, being not different from controls at the end of the follow up. The serum IgM remained in the range of control values immediately after radiotherapy, as well as during monitoring. The slow normalization of the serum IgA and CIC levels might reflect the success of the therapy.

Humoral immunity in patients with carcinoma of the uterine cervix--effects of radiation therapy.

The parameters of nonspecific immunity-serum immunoglobulins and immune complexes--were evaluated in patients with carcinoma of the uterine cervix (Stages IIB and IIIB) prior to, during and immediately after pelvic irradiation. In untreated patients, significantly elevated circulating IgA was found only in patients in Stage IIIB; serum IgG and IgM in both groups did not differ from control values. The level of circulating immune complexes in both groups was higher than in controls. Radiotherapy did not affect significantly any of the parameters examined; only the percentage of patients with elevated concentrations of IgA and IgG decreased during the treatment. These results showed that fractionated pelvic irradiation did not affect B cell function, these cells being more radioresistant than other lymphocyte subpopulations.

GH response to growth hormone releasing hormone and hypoglycaemia is unaltered by high endogenous plasma calcitonin levels in patients with medullary thyroid carcinoma.

OBJECTIVE: As it has previously been reported that calcitonin suppresses stimulated growth hormone release, we have studied the serum growth hormone response to growth hormone releasing hormone and insulin-induced hypoglycaemia in patients with high calcitonin levels due to medullary carcinoma of the thyroid. DESIGN: Growth hormone releasing hormone (100 micrograms i.v.) and insulin (0.15 units/kg i.v.) were given and the growth hormone responses in the patients with medullary carcinoma of the thyroid and normal healthy controls were compared. PATIENTS: Eight with histologically confirmed medullary thyroid carcinoma, two females and six males, aged 21-77 years, were studied and compared with seven healthy age and sex matched controls. MEASUREMENTS: Growth hormone and calcitonin were measured. RESULTS: No significant difference was found between the growth hormone responses observed in patients with medullary carcinoma when compared with normal controls either after GHRH or during insulin-induced hypoglycaemia. CONCLUSION: We conclude that calcitonin does not alter the pituitary response to GHRH in medullary thyroid carcinoma and is unlikely to play an important role in regulating growth hormone secretion because calcitonin did not modify the release of growth hormone after insulin-induced hypoglycaemia.