Adjusting to life after treatment: distress and quality of life following treatment for breast cancer.

Clinical and anecdotal findings suggest that the completion of cancer treatment may be marked by heightened distress and disrupted adjustment. The present study examined psychological adjustment during the 3 months following treatment among 89 women with stages 0-III breast cancer. Participants completed measures of depression, cancer-related anxiety, cancer concerns, and quality of life at three time points: during treatment, 3 weeks following the end of treatment, and 3 months post-treatment. Post-treatment scores were suggestive of good psychological adjustment among the majority of women. Moreover, distress did not increase following treatment; longitudinal analyses showed no significant changes in depression or recurrence worry, while intrusive thoughts decreased, and quality of life improved. Younger age predicted greater distress across measures. A history of depression or anxiety predicted greater depressive symptomatology, while more extensive treatment predicted greater cancer-related anxiety. Despite the lack of distress endorsed on general depression and anxiety indices, participants reported moderate distress associated with cancer-related concerns, including physical problems, fear of cancer recurrence, and resuming normal life. In sum, while breast cancer survivors demonstrate good adjustment on general distress indices following treatment, some women are at risk for sustained distress. Moreover, significant cancer-related concerns are prevalent and may be important intervention targets.

Uterine sarcoma: a retrospective study.

From 1965 to 1982, 86 analyzable patients with uterine sarcoma were treated. Nineteen patients (22%) presented with advanced disease. For the patients with curable diseases (67 patients), the disease-free survivals with a median follow-up of 4.5 years are 40% (surgery only), 53% (surgery + chemotherapy), 46% (surgery + radiation +/- chemotherapy). The local failure rates are 43%: 32%: 33%, respectively. There is no statistical significance. The most important prognostic factor is the clinical extent of the tumor. The role of radiation therapy and chemotherapy will be discussed.

An unusual site of presentation for Hodgkin's disease in the middle ear.

We are presenting a case history of a patient with advanced Hodgkin's disease, who had secondary involvement of his middle ear. To our knowledge this is the first case report of such clinical presentation where radiation therapy was of good help for bringing about symptomatic relief. Possible routes of spread are discussed and the literature is reviewed.

A clinical review of seventeen patients with ovarian dysgerminoma.

This is a retrospective evaluation of 17 patients with the diagnosis of ovarian dysgerminoma who were treated at the University of Iowa Hospitals from January 1938, to December 1976. Not a single patient was lost to follow-up. The majority of patients were between 11 to 30 years old. Seven patients died with disease, 3 during the 1st year, 3 during the 2nd year and 1 during the 4th year after diagnosis. In this series we have 10 patients with no evidence of disease (NED). The duration of follow-up of that group is from 51 months to 444 months with a median of 102 months. Postoperative radiation therapy is a valuable adjuvant to surgical treatment for dysgerminoma.

Para-aortic lymph node irradiation in carcinoma of the cervix after exploratory laparotomy and biopsy-proven positive aortic nodes.

From July 1970 to January 1977, 23 patients with previously untreated cancer of the cervix (CA CX), mostly Stage IIIB, were included in this study. The para-aortic lymph nodes (PALN) were histologically documented to have metastatic disease in all 23 patients. External radiation treatment (RT) was delivered using a Cobalt--60 machine to a spade-shaped field to treat the pelvic cavity and para-aortic area. The majority of the patients received 4000-6000 rad to the pelvic cavity and from 5000-5500 rad to the PALN's by external RT. In addition, intracavitary radium was used in 21 patients. Five patients are alive and free of disease at 115, 110, 90, 73 and 45 months after completion of RT. One survivor had clinical Stage IB, one had Stage IIB, and three had Stage IIIB cervical carcinoma. Two of 15 patients with clinically enlarged and suspicious para-aortic nodes are alive, while 3 of 8 patients with clinically normal appearing nodes survived. Three (60%) of the survivors developed late bowel radiation damage. Eighteen patients died--10 during the first year, 3 during the second year, 2 during the third year, 1 during the fourth year and 2 during the eighth year of the follow-up. Five (27.8%) of the patients who died had developed late bowel radiation damage. Fifteen of the 18 died with disease at an average of 21 months. Three patients died of intercurrent disease. Their average survival was 40 months, double that of patients dying of disease. This report suggests that in cancer of the cervix, radiation therapy can control some PALN metastatic disease, but the risk of complications is rather high. In the absence of better methods of management, this risk of complications is justifiable because the alternative is to leave known disease untreated.

The influence of ascorbic acid on the growth of solid tumors in mice and on tumor control by X-irradiation.

Swiss mice drank either distilled water or 0.1% ascorbic acid in distilled water for one week prior to and during the experiments. Solid tumors were induced by injecting Ehrlich ascites tumor cells i.m. into the hind limb of Swiss male and female mice. It was found that the tumor growth was significantly faster in the mice that were drinking distilled water. Beginning two days after tumor cell injection, the tumor bearing limbs were irradiated every 24 h as follows: a) 6 exposures of 400 R, 500 R, 600 R, or 700 R each, b) 10 exposures of 400 R each, and c) 11 exposures of 400 R each. Our results indicated that when 6 exposures of 700 R each were given every 24 h to mice drinking distilled water, about 80-85% tumor control was achieved; the percent tumor cure was even better in mice drinking ascorbic acid in water than in mice drinking water.

The influence of ascorbic acid on survival of mice following whole body X-irradiation.

Two strains of mice (Swiss and CF1), male and female, were used in this study. The mice drank either distilled water or 0.1% ascorbic acid in distilled water for one week prior to and during the experiments. Mice were irradiated in groups of 10; they received total body X-irradiation in a single exposure ranging from 200 R to 750 R. Time of death was recorded daily while weight changes and volume of water consumed were recorded every other day. At the low exposure levels, our results indicated that: a) mice drinking ascorbic acid in distilled water died about one week earlier than those drinking distilled water only, and b) the LD 50/30 was higher in mice drinking only distilled water. The differences between both groups were noticeable at exposures up to 550 R; at higher exposures, there was no difference. This study showed that high levels of ascorbic acid potentiated the effect of X-ray whole body irradiation.

Malignant fibrous histiocytoma: a retrospective evaluation of 24 patients.

Twenty-four patients with malignant fibrous histiocytoma are being analyzed: 54.2% occurred in the sixth, seventh, and eighth decades of life; 45.8% were located in the extremities. This is a soft tissue sarcoma noted for its pleomorphic histologic appearance. It is postulated that the origin cell is a histiocyte. The local recurrence of metastatic potential of this tumor is difficult to predict from its histological features. Local recurrence after complete excision is frequent. Also, there is a high incidence of distant metastases. Wide local excision with a wide margin around the tumor is the most important treatment modality. The use of postoperative radiotherapy and chemotherapy needs to be evaluated.

Postirradiation malignant fibrous histiocytoma.

Three patients who were treated successfully with postoperative external radiation therapy for ovarian carcinoma, endometrial adenocarcinoma and bilateral retinoblastoma respectively developed years later malignant fibrous histiocytoma (MFH) within the irradiated field. MFH is a recently described soft tissue sarcoma known for its dual fibroblastic and histiocytic differentiation resulting in a pleomorphic histologic appearance.

Radiotherapy-induced rib osteosarcoma after successful treatment of lung cancer.

Radiation-induced osteogenic sarcoma is recognized as a long-term complication of radiation therapy. The authors report a case of rib osteosarcoma which developed after successful treatment of adenocarcinoma of the lung.

Infantile hepatic hemangioendothelioma: a surviving case.

A surviving case of infantile hepatic hemangioendothelioma is presented. The patient was treated with a combination of radiation therapy, cytotoxan, and prednisone, resulting in regression of the tumor.