DNA flow cytometry: a predictor of a high-risk group in cervical cancer.

We studied the relationship between the 5-year disease-free interval or the occurrence of distant metastases, and the flow cytometric nuclear DNA content in a group of 55 patients treated by radiation for squamous cell carcinoma of the uterine cervix, stages Ib-IIIb (FIGO). The diploid DNA content was associated with a better prognosis and a lower incidence of distant metastases, while aneuploid tumors tended to be prognostically unfavorable and had distant metastases more often. We consider the flow cytometric nuclear DNA content a prospective prognostic parameter in squamous cell carcinoma of the uterine cervix treated by radiotherapy.

[Cytokeratin expression in spinocellular carcinoma of the uterine cervix]. / Exprese cytokeratinu u spinocelulárního karcinomu delozního cípku.

Expression of cytokeratins 7, 8, 10, 14, 18 and 19 was studied in 48 cases of advanced (stage II and III) squamous cell carcinomas of the uterine cervix. Despite of the degree of differentiation, the expression of simple epithelia cytokeratins 8 (72.9%) and 19 (97.9%) was high. A subset of eight (16.6%) predominantly poorly differentiated tumours had the expression restricted to simple epithelia pattern (cytokeratin 7 and/or 8 and 18 and/or 19). In twenty cases (41.7%) the cytokeratin 14 was added to this pattern, representing an intermediate differentiation level, while the other twenty tumours, usually exhibiting more pronounced squamous differentiation had the most complete cytokeratin pattern including class 10. This grouping was of no prognostic significance but might represent a valuable tool in the classification of cervical squamous cell carcinoma.

[DNA flow cytometry: perspective prognostic parameters in carcinoma of the uterine cervix]. / DNA flow cytometrie: perspektivní prognostický parametr karcinomu delozního cípku.

We studied the relation between the 5-year disease free interval and the flow cytometric DNA content in a group of 55 patients treated by radiation for squamous cell carcinoma of the uterine cervix, stages Ib-IIIb (FIGO). The diploid DNA content was associated with a better prognosis, while prognostically unfavourable tumours tended to be aneuploid. The relation was statistically significant in the whole group (p = 0.016), in stage II disease (p = 0.003) and in the subgroup formed by the combination of stages I and II (p = 0.000). In stage III we did not prove the relation. Analysis of the survival function revealed also a better prognosis of diploid tumours (p = 0.041) in the whole group. The division into clearly diploid and non-diploid tumours seems to be more suitable for evaluation (p = 0.012). The difference between the prognostically favourable and unfavourable groups is expressed more clearly. We consider the flow cytometric DNA content a perspective prognostic parameter in squamous cell carcinoma of the uterine cervix. Its significance is apparent especially in patients treated by radiotherapy, because the size of the tumour cannot be assessed reliably in these cases.

Hypoxyradiotherapy of uterine cervix cancer to decrease of acute side-effects and treatment complications.

The authors have reported on preliminary results of hypoxyradiotherapy in the course of external irradiation in patients with uterine cervix cancer from a view-point of the occurrence of acute reactions and treatment complications. A mixture of nitrogen and oxygen containing 8.0 to 8.5% of O2 was used to provoke acute hypoxia during irradiation. The applied doses of external irradiation was simultaneously increased by 40%. On the basis of a randomized study with 120 patients, acute hypoxia was found to protect healthy tissues against post-radiation damage. When the doses of 96 Gy in the paracervical space and that of 75 Gy in the pelvic wall were applied, acute side-effects decreased significantly if compared with a conventional radiotherapeutic procedure (p less than 0.01). Radiological preconditions for using acute hypoxia in radiotherapy are discussed.

Complications of radiotherapy of uterine cervix carcinoma.

The retrospective analysis of 242 patients treated for uterine cervix cancer at VUKEO Brno within 1977-1982 has been realized. The patients being only treated with radiotherapy alone using the external 42 MeV X-ray betatron beam irradiation of the pelvis, and the vaginal and intrauterine application of 226Ra, were included in this study. The complications of therapy were evaluated in accordance with the grade of severity, location and time of their source. The radiotherapeutical complications of the 2nd stage appeared for 27 patients (11.2%), and the complications of the 3rd stage appeared for 8 patients (3.3%). The total five-years' survival rate is 71%, 92% for 37 patients in the Ib stage, 78% for 105 patients in the IIa, b stages, and 54% for 100 patients in the IIIa, b stages.

[Regression of cervix uteri neoplasms in combined radiotherapy using low dose gamma-neutron irradiation]. / Regrese nádoru hrdla delozního v prubehu kombinované radioterapie s pouzitím malých dávek gama-neutronového zárení.

The authors compared the results in the regression of uterus cervix tumour after intracavital therapy with gamma-neutron irradiation by 252cf and conventional sources of radiation gamma 226Ra in the course of a combined radiotherapy procedure. On the basis of a randomized study in 20 patients for a group it became obvious that due to the irradiation of the tumour in the initial phase of therapeutic cycle by physical dose 2 Gy of neutron component of 252Cf in the point A there was an increased regression of the tumour process causing in the 6th week since the beginning of the therapy a significant difference in the size of the tumours in both groups of patients. The time period required for 50% tumour reduction from the beginning of the therapy proved to be 23 days in patients treated with the 252Cf nuclide as compared with 48 days in the group of patients after conventional therapy.

[Granulosa cell tumor of the ovary; evaluation of therapeutic results]. / Granulózo-celulární tumory ovaria, zhodnocení lécebných výsledku.

In 1956-1985 in the Oncological Research Institute in Brno a total of 70 patients was treated on account of granulosa-cell tumours of the ovary. This accounts for 10% of all ovarian malignities treated in the Institute during this period. The initial treatment of all patients was surgery, i.e. abdominal hysterectomy with bilateral adnexectomy, performed in 54.5% of the patients, uni- or bilateral adnexectomy in 35.7%, supravaginal amputation of the uterus with adnexectomy in 7.1% and in 2.7% (two patients) exploratory laparotomy only. All patients had irradiation of the pelvic area, in recent years the area of external irradiation was extended with regard to the lymphographic finding. This examination has become an integral part of the pre-treatment routine examination of every single patient. Comprehensive treatment of the tumour comprised chemotherapy involving in a major number of patients an adjuvant chemotherapeutical regime of CVF (Cyclophosphamide, Vinblastin, Ftorouracil), later a MAFC regime (Methotrexate, Actinomycin D, Cyclohosphamide, Ftorouracil). In more advanced tumours or mixed tumours according to histopathological analysis, in recent years a chemotherapeutic regime of CAP is used (Cyclophosphamide, platinum, Adriblastina) or VAB (Vinblastin, Adriblastina, Bleomycin), or a combination of platinum, Vinblastin and Bleomycin. In the submitted group a recovery extending over five years has been recorded in 63.6%, 60.5% of the patients survive 10 years and 54.1% of the women 15 years. In stage I 5-year survival is 82.5%, in stage Ia 85.3%.

[Intraperitoneal administration of high doses of cisplatin in advanced ovarian carcinoma]. / Intraperitoneální aplikace vysokých dávek cis-platiny u pokrocilého karcinomu ovaria.

42 patients with advanced ovarian carcinoma were treated with large doses of cis-DDP by the i.p. route. The toxic effects of platinum were reduced by the i.v. administration of thisulphate. Depending on age and the general condition of the patient, 200-270 mg cis-DDP were administered in one series. Ascites disappeared in 54.7% patients, partial remission of the tumour was achieved in 28.5%, complete histopathological remission confirmed by second look operation in 26.2% and in 21.4% the result was doubtful.

Adenocarcinoma cervicis uteri. An appraisal of treatment results for a period of 40 years.

A retrospective study was done in 316 patients with primary cervical adenocarcinoma treated at the Research Institute for Clinical and Experimental Oncology in Brno over a period of 40 years (1939-1978). The treatment results were compared to those in 2571 patients with epidermoid carcinomas of the uterine cervix treated at the Institute over the same period. The 5-year survival rate was significantly lower in adenocarcinoma patients (in Stage I patients, 77.8% vs. 84.5%, and, in the whole group, 60.8% vs. 70.3%). The assessment of the treatment results of this study has clearly showed that in cervical adenocarcinomas, surgery combined with radiotherapy was much more effective than radical radiotherapy alone (77.4% vs. 64.7%). In contrast to this, in epidermoid carcinomas the treatment results were better after radical radiotherapy (86.5% vs. 81.3%). Thus, in the prognosis of cervical adenocarcinomas the mass of the tumor, the size of the uterus, as well as the grading play a role. That means that primary cervical adenocarcinomas at early stages can be successfully treated by a combination of radical surgery and radiotherapy, while radiotherapy of advanced stages of this tumor is less successful.

Stage IIb, IIIb, and IVa carcinoma of the uterine cervix--results of treatment by radiotherapy in 649 patients.

During the period of January 1969 to December 1980, 649 patients have been treated by radical radiotherapy for Stage IIb, IIIb, and IVa carcinoma of the cervix uteri. This retrospective study was performed to assess therapeutical results in two groups of patients. Clinical staging and the methods of treatment were standard in both groups. Group I was treated by external irradiation of the pelvis minor with 60Co in combination with intracavitary radium administration. Group II patients were irradiated with a 42 MeV betatron according to the findings of lymphography, again in combination with radium brachytherapy. In Group I the 5-year survival rate was 59.2%, that in Group II was 66.7%. There was a statistically significant difference in the 5-year survival rate in Stage IIb patients of Group II (85.5%) against that in Group I (75.6%). The incidence of serious complications elicited by radiotherapy increased from 4.8% in Group I patients to 7.5% in Group II. Clinical stage, age at the time of diagnosis, findings of lymphography and tolerance to irradiation are prognostically important factors that influence the cure of the patients. On the basis of these findings, the possibilities of further therapeutic improvements are discussed.

No difference in delayed hypersensitivity between breast and cervical carcinomas.

DNCB and PPD skin testing was performed in 130 breast and 110 cervical cancer patients. BATES' instruction with a plea for uniformity was used [1]. Patients were tested while being diagnosed and prior to the treatment. No significant differences either in the frequency of a reactivity or grade of response in corresponding stages of breast and cervical cancer were found.

Multiple tumors in gynecology.

Two large groups of patients, i.e. 1893 patients treated at the Institute for carcinoma cervicis uteri and 1184 patients with Ca corporis uteri were selected and evaluated for a follow-up study and statistical processing of tumor duplicity of gynecological origin. Double tumor in the group with Ca cervicis uteri was found in 88 women, i.e. 4.6%, and in that treated for Ca corporis uteri in 85, i.e. 7.2% of the patients. The most frequent combination in the two groups of carcinoma is breast cancer amounting to 28.4% in Ca cervicis uteri and to 35.3% in Ca corporis uteri. The second most frequent primary carcinoma in Ca cervicis uteri is dermal carcinoma--23.9%, and in Ca corporis uteri that of the digestive tract--21.1%. A statistical follow-up over 40 years indicates a rise in tumor duplicity in both groups of gynecological carcinoma--cervical and endometrial, with the number in the former having increased more than twofold.