Radiotherapy in the management of cervical cancer in elderly patients.

PURPOSE: To report treatment results and complications experienced by elderly patients treated with curatively intended radiotherapy for cancer of the uterine cervix. PATIENTS AND METHODS: One hundred and fourteen elderly patients (median 75.5 years, range 70.0-85.9) consecutively referred for curative radiotherapy in the period 1987-1996 were prospectively followed with regard to tumour control and complications. The importance of age, stage (FIGO), tumour size, histology, tumour fixation, haemoglobin, concurrent disease, performance status (WHO) and type of radiotherapy were assessed using univariate and multivariate analyses. RESULTS: Treatment was completed as planned in 68%, delayed in 29% and stopped prematurely in 3%. The frequency of grade 3 late complications was 11% and the actuarial probability at 5 years was 20%. Overall 5-year survival according to FIGO was 61% (I), 34% (II) and 25% (III). Cox multivariate analysis identified tumour size as independent prognostic factor for tumour control, disease-free survival and overall survival. FIGO stage was predictive for late grade 2 complications. We were unable to identify significant factors with respect to grade 3 complications. Age was not a significant parameter for any of the investigated endpoints. CONCLUSION: Elderly patients in good performance status with advanced cancer of the uterine may tolerate radical radiotherapy with acceptable morbidity and reasonable survival. Radiotherapy may also be a good alternative in early stage disease for surgically unfit elderly patients.

[Post-partum stay at the maternity ward vs. ambulatory delivery--seen from the women's point of view]. / Barselsophold versus ambulant fødsel--set fra kvindernes synsvinkel.

The purpose of the present study was to examine the benefit of post-partum in-hospital maternity stay among primi- and multipara and to explore the attitude to post-partum in-hospital stay versus outpatient delivery in the future. The study design was a prospective survey with 335 participants. Independent of parity 95% of the women in confinement found it important/very important to be able to have the reassurance and safety of staying on the maternity ward and to be able to obtain help when needed. Concerning future births, 86% of the women in confinement wanted to stay in the hospital post-partum, while 12.5% would consider outpatient delivery, if the same midwife visited them daily at home during the first week. Among the women wanting a future outpatient delivery, there was an excess of women who did not feel that their need for peace and quiet had been fulfilled at the present post-partum in-hospital stay, and the women had needed more help in establishing nursing. Twice as many primi- as third/fourth para wanted a future out-patient delivery. In conclusion, if it were decided to do away with the post-partum maternity in-hospital stay for multiparae due to budget cuts, it would clearly be against the women's wishes. The in-hospital maternity stay was appreciated among all women irrespective of parity.

[Optimization of radiotherapy of cervical cancer. Introduction of an extern radiotherapy based on CT and low-dosage afterload technique at the Rikshospitalet]. / Optimering af strålebehandling af cervixcancer. Introduktion af ekstern strålebehandling baseret på CT og lav dosishastigheds afterloading-teknik på Rigshospitalet.

In September, 1987 remote controlled afterloaded caesium in treatment of carcinoma was introduced at the Department of Oncology, Copenhagen University Hospital. All patient data, treatment, complications and deaths were registered prospectively. This study describes treatment results of the first 178 consecutively treated patients. The four year survival rates for patients stage I, II and III were 70%, 68% and 43%, respectively. The stage I patients were all considered unfit for surgery due to age or other medical conditions. During the observation period 13 patients developed severe complications requiring surgery, and three of these patients died. It was concluded that treatment with afterloaded caesium for carcinoma of the cervix has reduced radiation of the medical personnel to an almost unmeasurable dose, that the treatment results were comparable to those of the larger centres in the world and that the new treatment technique suggests further improvement in the treatment of cervical carcinoma.

[Genital Chlamydia trachomatis infection in abortion seekers. Strategy of examination and treatment in order to reduce the sequelae of the infection]. / Genital Chlamydia trachomatis infektion hos abortsøgende. Undersøgelses- og behandlingsstrategi for at mindske infektionssequelae.

Among women applying for termination of pregnancy, 5-17% are infected with Chlamydia trachomatis. The prevalence is higher among women under 20 years of age (12-30%), in nulliparae and when Neisseria gonorrhoeae are found simultaneously. If women applying for termination of pregnancy with Chlamydia infection are not treated, 10-60% will develop pelvic infection after abortion. Salpingitis caused by Chlamydia runs a milder clinical course than salpingitis caused by gonococci or other etiology but salpingitis due to Chlamydia is regarded as one of the most important causes of tubal infertility and extrauterine pregnancy. The symptoms may be discharge and dysuria or objective findings such as cervicitis and pathological findings in wet smears of the cervical secretion. The majority of women applying for termination of pregnancy with Chlamydia infection have no symptoms. Only few investigations have analysed Chlamydia infection in connection with sexual behaviour and association between Chlamydia infection and the number of sexual partners has been demonstrated. Direct immune fluorescent microscopic examination or enzyme immune examination of material from the cervix and urethra may be employed in women applying for termination of pregnancy on account of the rapid results. Tetracyclines and erythromycin may be employed for treatment of demonstrated Chlamydia infection. Completion of treatment prior to abortion is probably not necessary. The sexual partners should be treated.

[Presence of genital Chlamydia trachomatis in abortion seekers--correlates with young age and nulliparity but not with previous genital infection]. / Genital forekomst af Chlamydia trachomatis hos abortsøgende--korrelerer med ung alder og nulliparitet, men ikke tidligere underlivsbetoendelse.

Out of 432 women applying for termination of pregnancy, 7.9% (34/428) had cervical Chlamydia trachomatis and 0.7% (3/431) genital Neisseria gonorrhoeae. The prevalence of Chlamydia was 19.2% among the women applying for termination who were under 20 years and 12.8% among those aged 21-25 years. The finding of Chlamydia among nulliparae was 14.5%. Only 2.8% of the women with Chlamydia had previously had pelvic infections. Women with Chlamydia did not have significantly greater frequency of previous venereal diseases. It is concluded that women under the age of 25 years and nulliparae who apply for termination of pregnancy should be examined for Chlamydia and should be treated in connection with the intervention. Previous pelvic infections are observed significantly more rarely in women with Chlamydia applying for termination and thus do not constitute an indication for examination for Chlamydia. It is not yet elucidated whether women with previous venereal diseases should be examined for Chlamydia. On account of the low prevalence, there are no indications for performing routine smears in women applying for termination of pregnancy for gonococci but, on the other hand it appears relevant to examine women with Chlamydia for gonococci as double infections are frequently present.