Postoperative radiotherapy in stage IB squamous cell cervical cancer.

OBJECTIVE: The purpose of the study was to evaluate postoperative whole pelvic radiation for high-risk patients with FIGO Stage IB cervical cancer. METHODS: One hundred and forty-eight patients with Stage IB squamous cell carcinoma of the cervix underwent radical hysterectomy and pelvic lymphadenectomy. The low-risk group included patients without unfavorable prognostic factors who were treated only by surgery. The high-risk group included women with pelvic node metastases, with positive or close surgical margins, clinical tumor size > 4.0 cm, depth of stromal invasion > 1/3 the cervical wall, grade 3 tumor and presence of lymphovascular space involvement. High-risk patients received whole pelvic radiotherapy between two and four weeks after surgery. RESULTS: Seventy patients (47.3%) were low risk and 78 patients (52.7%) were high risk. Locoregional recurrences were diagnosed in nine cases (12.8%) in the surgery group and in 11 patients (14.1%) assigned to radiotherapy. The incidence of distant metastases was 2.8% in the surgery group and 6.4% in the surgery and radiotherapy group. Overall survival at five years was 88.6% in the low-risk group and 84.7% in the high-risk group. CONCLUSION: Five-year overall survival, locoregional and distant metastases were similar in the low-risk and high-risk groups of patients, thus emphasizing the value of whole pelvic radiation in patients with unfavorable prognostic factors in Stage IB cervical cancer.

Breast cancer in the elderly.

The study population was derived from 482 patients with breast cancer treated at the Department of Oncology, University Hospital Center Zagreb, between 1992 and 1999. The main purpose of our study was to evaluate differences in breast cancer characteristics and treatment in a population of women with breast cancer older than 65 years compared to younger women group (less than 65 years). We have analyzed disease parameters (stage of the disease, size of primary tumor, tumor differentiation grade and steroid receptor status) and parameters associated to treatment modalities (surgery, radiotherapy, hormonal therapy and chemotherapy) in both age groups. In older women, we found significantly higher rates of tumors grade 1 (p = 0.0049), tumors > 2 cm and tumors with a high steroid receptor status (p = 0.0013). Evaluation of treatment modalities showed that in older women a significantly higher proportion were treated with hormonal therapy (p < 0.001) compared to younger patients. In evaluation of clinical outcome after a median follow-up of 58 months, in older women the cumulative 5-year disease-free survival rate was 65%, while cumulative 5-year survival was 83%, which was not significantly different from the younger women (p > 0.005).

Postoperative radiotherapy in stage I endometrial adenocarcinoma.

OBJECTIVE: To evaluate postoperative whole pelvic radiation for high-risk patients with Stage I endometrial adenocarcinoma. METHODS: One hunderd and twenty-two patients with irregular premenopausal or postmenopausal haemorrhage were included into the study. Fractional curettage was performed in all cases. When the pathohistological report confirmed endometrial adenocarcinoma, abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Low-risk patients include women with Stage IA tumours and Stage IB grade 1 or 2 histology. High-risk group include patients with Stage IB grade 3 tumours and Stage IC carcinomas. High-risk patients received whole pelvic radiotherapy between two and four weeks after surgery. RESULTS: Eighty-two patients (67.21%) were low-risk and forty patients (32.79%) were high-risk. In the low-risk group of patients, CA-125 was negative in ten cases and positive in 72 patients with a mean value of 30.12 +/- 12.42 U/ml serum. In the high-risk group of the patients, CA-125 was negative in two cases and positive in 38 patients with a mean value of 60, 48 +/- 20, 14 U/ml serum. Locoregional recurrences were diagnosed in four patients (4.87%) in the surgery group and in two patients (5.00%) assigned to radiotherapy. The incidence of distant metastases was 2.43% in the surgery group and 2.50% in the radiotherapy group. Overall survival at five years was 90.25% in the low-risk group and 87.50% in the high-risk group of patients. CONCLUSION: Five-year overall survival, locoregional and distant metastasis were similar in the low-risk and high-risk groups of patients. That emphasizes the value of whole pelvic radiation in patients with unfavourable prognostic factors in Stage I endometrial cancer.

Serum CA-125 tumor marker in endometrial adenocarcinoma.

One hundred and seventy-four patients, mean age 61.23 +/- 9.41 years old, with irregular perimenopausal haemorrhage were included in the study. Fractional curettage was performed in all patients. When the pathohistologic findings were adenocarcinoma the concentration of CA-125 tumor marker was determined. Hysterectomy with bilateral salpingo-oophorectomy was determined. In 142 cases carcinoma was restricted to the uterus and in 32 patients extrauterine metastatic disease was found. In the former group CA-125 was positive in 130 patients with a mean value of 64.12 +/- 22.41 U/ml serum. In the latter group the cancer antigen was positive in 29 patients with a mean value of 244.82 +/- 68.11 U/ml. High production is associated with increased metastatic potential.

The influence of radiotherapy and chemotherapy on cerebral metastases.

A group of 110 patients (68 male and 42 female) with cerebral metastases, treated at the Institute of Clinical Oncology and Radiotherapy, Zagreb University School of Medicine, during the period 1978-1984, were included in the study. Most patients were aged 50-60 years. Out of 110 patients, 52 were treated by radiotherapy and 58 by radiotherapy plus chemotherapy. Metastases from the bronchus carcinoma, breast carcinoma, melanoma and gastrointestinal carcinoma were present in 59%, 21.8% and 4.6% of patients, respectively. In 1.8% metastases from hypernephroma and in 3.6% from other malignant tumors were observed. In 4.6% cases, the origin of metastases could not be identified. Fifty-two out of 110 patients were treated by radiotherapy alone. They received 3000 cGy in 8-10 fractions, to the whole brain, with two parallel opposed fields. Fifty-eight out of 110 patients treated with radiotherapy and chemotherapy were given the same radiotherapeutic treatment. Chemotherapeutically, they were treated with BCNU and CCNU with or without Vincristin in standard doses. In the group of 52 patients treated by radiotherapy alone the median survival was six months (1-16 months), i.e. the same as in the group treated by both radiotherapy and chemotherapy (1-26 months).

[Treatment of neoplastic hematologic diseases with intensive radio-chemotherapy and transplantation of cryopreserved autologous bone marrow]. / Lijecenje neoplastickih hematoloskih bolesti intenzivnom radiokemoterapijom i transplantacijom krioprezervirane autologne kostane srzi.

Autologous bone marrow transplantation (ABMT) allows application of intensive myeloablative therapy aimed at eradication of neoplastic disease by facilitating haematopoietic reconstitution. Between March and June 1988, four patients (two with acute myelogenous leukaemia in first remission, one with acute lymphoblastic leukaemia in second remission, and one with Burkitt lymphoma, stage IV with CNS involvement in second remission) received this treatment. Methods of collecting, processing and freezing bone marrow as well as thawing and reinfusion of the marrow into patients after intensive chemoradiotherapy are described. Viability of bone marrow cells tested by the dye exclusion method after freezing and thawing process was 89, 88, 91 and 78%, respectively. CFU-GM recovery in culture, as a test of marrow stem cells clonogenicity was between 63,3 and 156,5%. Patients received between 1,7 and 3,0 x 10(8)/kg nucleated cells and 4,0 to 7,6 x 10(4)/kg CFU-GM, respectively. In all four patients stable haematopoietic reconstitution was achieved. The bone marrow function was evident mainly at 11th day after marrow reinfusion. Leukocyte count reached 1,0 x 10(0)/L in 11 to 15 days, and granulocyte count raised more than 0,5 x 10(9)/L in 19 to 37 days after transplantation. Platelet recovery was prolonged with the minimum of 29 days and maximum of more than 60 days to reach 20 x 10(9)/L. Side effects caused by the intensive radiochemotherapy were moderate. Bacterial, fungal and viral infections in early posttransplant period were successfully treated. All patients have survived and left the hospital 63, 54, 36 and 65 days after ABMT, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)