Appearance Of Distant Metastases Research Articles

Distant metastases in squamous-cell head and neck carcinoma (SHNC) patients who achieved loco-regional control (LRC)

5519 Background: One of the reasons for failure in patients with SHNC who achieve loco-regional control with treatment is the appearance of distant metastases. The objective of this study was to ev...

Systemic chemotherapy for pancreatic cancer.

Surgical resection offers the only curative strategy for pancreatic cancer. Yet, because early detection of pancreatic cancer is so difficult and diagnosis is delayed, pancreatic cancer in most patients is surgically unresectable. Even in patients with resectable disease, the long-term outcome remains unsatisfactory due to early recurrence after resection. Early appearance of distant metastasis suggests that systemic treatment, such as chemotherapy, should play a major role in improving patient survival. Although the recently developed gemcitabine has renewed interest in clinical research for pancreatic cancer, other currently available chemotherapeutic agents have little impact on survival. Studies to identify more effective agents or treatment regimens must have the highest priority. The expanding understanding of molecular and genetic biology should facilitate research to develop novel molecule-targeted agents and to establish individualized therapy regimens for this disease.

Malignant mixed müllerian tumors of the uterus: Analysis of patterns of failure, prognostic factors, and treatment outcome

PurposeTo determine the survival outcomes, prognostic factors, and patterns of failure in patients with malignant mixed Müllerian tumor (MMMT) of the uterus. Methods and materialsBetween 1954 and 1998, 300 patients with clinical Stage I–III MMMT of the uterus were treated with curative intent at The University of Texas M. D. Anderson Cancer Center. Their hospital records were reviewed to obtain patient and tumor characteristics; details of surgery, radiotherapy (RT), and chemotherapy; and long-term outcome. Surviving patients were followed for a median of 109 months (range 15–138). Survival rates were calculated using the Kaplan-Meier method, with differences assessed by log–rank tests. ResultsOf the 300 patients, 113 (38%) were treated with surgery alone, 160 (53%) with surgery plus adjuvant EBRT or ICRT, and 27 (9%) with RT alone. Forty-eight patients received adjuvant chemotherapy. At 5 years, the overall rates of survival and cause-specific survival were 31% and 33%, respectively. Women who were postmenopausal or had a history of prior pelvic RT, pain at presentation, clinical Stage II-III disease, uterine enlargement (≥12 weeks), or an abnormal Papanicolaou smear finding had a significantly poorer prognosis than the other patients in the series. Of the 273 patients who underwent surgery, those who had positive abdominal washings, uterine length >10 cm, or extrauterine spread of disease to the cervix, adnexa, or peritoneum had a significantly worse prognosis than the other patients. Factors found on multivariate analysis to have an independent adverse influence on cause-specific survival included postmenopausal status (p = 0.0007, relative risk [RR] 3.3), uterine length >10 cm (p = 0.0001, RR 2.2), cervical involvement (p = 0.002, RR 1.8), and peritoneal involvement (p = 0.0001, RR 4.3). At 5 years, the rates of pelvic and distant disease recurrence for the entire group of 300 patients were 38% and 57%, respectively. The most common site of distant recurrence was the peritoneal cavity. Patients treated with pelvic RT had a lower rate of pelvic recurrence than patients treated with surgery alone (28% vs. 48%, p = 0.0002), but the overall survival rates (36% vs. 27%, p = 0.10) and distant metastasis rates (57% vs. 54%, p = 0.96) were not significantly different. However, patients treated with pelvic RT had a longer mean time to any distant relapse (17.3 vs. 7.0 months, p = 0.001) than patients treated with surgery alone. The use of adjuvant chemotherapy did not correlate with the survival rate or rate of distant metastasis. ConclusionAdjuvant pelvic RT decreased the risk of pelvic recurrence and may delay the appearance of distant metastases after hysterectomy for MMMT. However, the survival rates remain poor because of a high rate of distant recurrence. As more effective systemic chemotherapy is developed to control microscopic distant disease, the role of RT in controlling locoregional disease in the pelvis and abdomen may become more important. Future research should consider programs that integrate surgery, RT, and chemotherapy to maximize the probability of cure.

Factores de riesgo de recidiva local en cáncer invasivo de mama

ObjectivesTo identify and evaluate the predictive factors of local recurrence in those patients who have had surgery for invasive breast cancer. Given that local recurrence is directly related with the appearance of distant metastases, and may therefore be considered the best indicator of mortality. Material and methodsA descriptive, retrospective study. A total of 66 and 93 patients who had been operated on in our center between 1996-98, for primary invasive breast cancer, having either conservative surgery or mastectomy. The variables studied are: age, size, site, side, type and hystological grade, axilla, margin, metastases and local recurrence. These variables have been related using multiple regression. ResultsThe age, size and margins are the only variables that have statistically significant differences in the descriptive analysis in both surgical groups. The levels of local recurrence were 7.7% and 9.8% at 5 years, in the conservative and radical surgery respectively (NS). ConclusionsNone of the variables studied were significantly related to the presence of local recurrence as the number of cases was too small. Although the affected margin was the variable which was closest to having significance, being able to relate this factor to a greater risk of metastases and a worse pronostic.

Inflammatory breast cancer: Where are we now?

Inflammatory breast cancer is perhaps the most aggressive form of breast neoplasm, with a poor prognosis. Clinically, inflammatory breast cancer is characterized by erythema and edema of the skin of the breast, called "peau d`orange", with or without an associated palpable mass. This form represents 1% to 6% (doubled during the past two decades) of all newly diagnosed breast malignancies and is often considered together with local advanced breast cancer, despite specific differential features. The reported 5-year survival rates range from 10% to 75%. On mammography, a diffuse increase in density and skin thickening may be present. Pathologic confirmation of invasion of dermal lymphatics by malignant cells can help distinguish this condition from benign mastitis. Most inflammatory breast cancers are on biopsy poorly differentiated ductal carcinomas, mainly estrogen and progesterone receptor negative. HER2/neu-overexpression and p53 gene mutations are frequently present. The probability of axillary node involvement is approximately 90%. Contralateral breast cancer develops in 25% to 50% of the patients, usually in the presence of metastases. Inflammatory breast cancer has a high rate of locoregional recurrence after surgery and/or radiotherapy and the rapid appearance of distant metastases. However, long-term survival is possible for these patients if treated with multimodality therapy including polychemotherapy, mastectomy, and loco-regional radiotherapy. The optimal sequencing of combined modality therapy has not been determined. Although not all patients are candidates for such a regimen (often due to progression during treatment), for those that complete all phases of therapy, more than one-third will be alive without disease at 10 years.

Follow-Up with Serum Cyfra 21-1 in Patients with Squamous Cell Carcinomas of the Head and Neck

Objective: Finding tumor markers for disease progression, and especially development of distant metastases, is desirable for patients with squamous cell carcinoma of the head and neck (SCCHN). Elevated serum levels of Cyfra 21-1 (cytokeratin fraction 21-1) have been frequently associated with disease progression in patients with lung cancer. In SCCHN, Cyfra 21-1 has not been established as a routine tumor marker yet, probably due to difficulties in finding the appropriate cut-off for the serum level. The aim of this study was to investigate whether assessment of changes in serum Cyfra 21-1 over time can predict distant metastases in patients with SCCHN, without attempting to establish an arbitrary cut-off for abnormal levels. Methods: Cyfra 21-1 serum levels of 25 patients with SCCHN and distant metastases were evaluated by means of an ELISA test kit. Results: There was a wide range of Cyfra 21-1 serum levels at the time of primary diagnosis, without correlation with tumor size, lymph node status, time to recurrence, or presence of distant metastases. All patients had a clear increase of Cyfra 21-1 levels which preceded the appearance of distant metastases clinically. Conclusions: Due to the wide range of Cyfra 21-1 levels at the time of primary tumor diagnosis, Cyfra-21-1 is neither a suitable screening marker for SCCHN, nor for diagnosis of distant metastases at the time of initial diagnosis of the tumor, but is of evident prognostic value for follow-up, especially for early detection of distant metastases.

Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases.

To assess whether failure to maintain local control (LC) of prostate cancer after radiation therapy results in a higher incidence of distant metastasis (DM). From 1972 to 1999, 1,469 patients with clinically localized prostate cancer were treated with radical radiation therapy. Disease outcome was retrospectively reviewed for all patients with more than 2 years of follow-up. The actuarial 10-year LC rate was 79%. Gleason score > or = 7, prostate-specific antigen (PSA) more than 15, and T3 to T4 tumors predicted a higher incidence of local failure (LF) (palpable recurrence or positive rebiopsy). The 10-year distant metastasis-free survival (DMFS) was 74%. Gleason score > or = 7, PSA more than 15, and T3 to T4 tumors predicted a higher incidence of distant failure. LF was the strongest predictor for DM in a multivariate model. The 10-year DMFS for LC and LF patients was 77% and 61%, respectively. Median time to distant failure was prolonged in patients with LF compared with patients with locally controlled disease (54 v 34 months). Hazard rate analysis of the time to DM revealed that patients who maintain LC have a lower rate of DM, which remains constant over time. Patients who ultimately develop LF have a higher initial rate of DM, which increases with time. Patients with locally persistent prostate cancer are at greater risk of DM. The higher initial hazard of DM is consistent either with an increased likelihood of subclinical micrometastases before treatment or with posttreatment tumor embolization. The prolonged time to appearance of DM in locally failing patients and the increasing hazard of DM over time is most consistent with a late wave of metastases from a locally persistent tumor.

Malignant Rhabdoid Tumor of the Vulva: Case Report and Review of the Literature with Emphasis on Clinical Management and Outcome

Background. Malignant extrarenal rhabdoid tumors (ERTs) of the vulva are rare but aggressive neoplasms. We describe the eighth reported case and the first to have long-term survival despite initial rapid recurrence.Case. A 40-year-old woman presented with a painless lump on the mons pubis. It was excised and revealed an ERT. One month later, the tumor had regrown. A wide local excision and superficial right groin node dissection was performed. Local recurrence was noted 11 months after the initial excision and was treated by wide excision and radiotherapy. She is without evidence of disease 61 months after initial presentation.Conclusion. A review of previously reported cases of ERT reveals that the median survival is 9 months. Local recurrences are common and the appearance of distant metastases is almost invariably rapidly fatal. Chemotherapy and radiotherapy do not appear to be effective in controlling disease. Initial surgical extirpation may offer the best chance of cure.

Distant metastases in head and neck cancer patients who achieved loco-regional control.

One of the reasons for failure in patients with head and neck carcinoma who achieve locoregional control with treatment is the appearance of distant metastases. The objective of this study was to evaluate the frequency of distant metastases in this group of patients and to determine the relative role of several prognostic factors in the subsequent development of distant metastases. Retrospective study from a database that collects the information prospectively in a cohort of patients with head and neck carcinoma. Patients and Methods The study was carried out in 1244 patients with oral cavity, pharyngeal, or laryngeal carcinoma who achieved locoregional control. We evaluated the frequency of distant metastases and the influence of different variables in their appearance. Five percent of patients with locoregional control had distant metastases. In the univariate study, the variables that influenced the appearance of distant metastases were tumor site, T stage, N stage, and histologic differentiation. On multivariate analysis, the variables that increased the risk of distant metastases were N stage, T stage, and the location of the tumor at the hypopharynx and the supraglottis. Five percent of patients with oral cavity, pharyngeal, or laryngeal carcinomas who achieved locoregional control died as a consequence of the development of distant metastases. The factors that significantly increased the risk of distant metastases in this group of patients were the advanced local and regional extension of the tumor and the location at the hypopharynx or supraglottis.

Neoadjuvant cisplatin,methotrexate,and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial

<h2>Summary</h2><h3>Background</h3> Several non-randomised trials have shown that transitional-cell carcinoma of the bladder is a moderately chemosensitive tumour. We investigated whether the addition of neoadjuvant cisplatin-based chemotherapy to radical surgery or radiotherapy would improve survival. <h3>Methods</h3> Patients with T2 G3, T3, T4a, N0-NX, or MO transitional-cell carcinoma of the bladder undergoing curative cystectomy or full-dose external-beam radiotherapy were randomly assigned three cycles of neoadjuvant chemotherapy (cisplatin, methotrexate, and vinblastine, with folinic acid rescue, n=491) or no chemotherapy (n=485). When possible, clinical tumour response was assessed cytoscopically after completion of chemotherapy but before cystectomy or radiotherapy; histopathologically assessed response was on cystectomy samples. We recorded every 6 months locoregional persistence or relapse of tumour, appearance of distant metastases, survival, and cause of death. <h3>Findings</h3> Median follow-up of patients still alive was 4·0 years. 485 patients died, and 78·6% of deaths were due to transitional-cell carcinoma. Chemotherapy mortality was 1% and operative (cystectomy) mortality was 3·7%. Kaplan-Meier curves compared by means of the log-rank test gave a calculated absolute difference between groups in 3-year survival of 5·5% (95% CI _0·5 to 11·0, p=0·075; 55·5% for chemotherapy, 50·0% for no chemotherapy). Median survival in the chemotherapy group was 44 months compared with 37·5 months for the no-chemotherapy group. 32·5% of cystectomy samples contained no tumour after neoadjuvant chemotherapy. <h3>Interpretation</h3> Three cycles of neoadjuvant chemotherapy before cystectomy or radiotherapy did not give the 10% improvement in 3-year survival that was judged to be necessary for introduction into routine use. The chemotherapy regimen was associated with a higher pathological complete-response rate in primary tumours, but there was no clear evidence that it would increase survival.

Second neoplasm in patients with head and neck cancer.

The improvement in locoregional control of head and neck carcinomas over the last decades does not appear to modify the final survival of these patients, mainly due to the appearance of distant metastases and second neoplasms. We ran a study to evaluate the incidence of second neoplasms and their characteristics in patients with head and neck carcinoma treated in our hospital. A retrospective study was undertaken to analyze the appearance of second neoplasm, its characteristics, and repercussion on the survival in 1845 patients with carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx diagnosed and treated in our department between 1984 and 1995. A group of 302 patients (16%) developed a second neoplasm. The incidence of second neoplasms was 4% per year and was constant during the follow-up period. Second neoplasms were mainly carcinomas located in head and neck (40%), lungs (31%), or esophagus (9%). Twenty percent of second neoplasms were tumors located outside the aerodigestive tract. The appearance of a second neoplasm significantly worsened the survival. Four percent per year of patients with carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx develop a second neoplasm, most frequently a carcinoma of the aerodigestive tract. This leads to a significant worsening of survival.

Surgery for metastatic melanoma

The appearance of distant metastases in a patient with malignant melanoma usually prophesies an early death: median survival is only 5 to 8 months. Surgery definitely can palliate certain patients and lead to a prolongation of life for others. In selected surgical candidates, an isolated nonvisceral metastasis, complete resection with free surgical margins, and a longer disease-free interval all favorably affect prognosis. In such cases, median survival can even approach 10 years, with a 5-year survival of up to 35%. Lung metastases are often incidental findings, but if complete resection can be accomplished, sometimes a median survival of 19 months and a 5-year 25% survival can be seen. Patients rarely survive long-term after brain or gastrointestinal metastases present themselves, but surgical resection extends median survival to about 10 months in this group with a significant improvement in quality of life. General guidelines should be reasonably applied for surgical intervention, with each metastatic melanoma patient given special individual assessment. Little has changed since the topic of the surgical role in metastatic melanoma was last reviewed in this journal by Coit in 1993.

Prolonged survival by 'early' salvage treatment of breast cancer patients: a retrospective 6-year study

Between 1977 and 1993, 384 breast cancer patients were followed up post-operatively every 4 or 6 months with a serum tumour marker panel (CEA-TPA-CA15-3) and the usual imaging techniques. Twenty-eight patients were treated 13.5 +/- 10 months (mean +/- s.d.) before the clinical and/or radiological occurrence of distant metastases that were suspected because of an increase in the tumour markers (patients treated 'early'). Their outcome was compared with that of 22 similar patients who were treated only after a definite radiological diagnosis was achieved (patients treated 'not early'). The median survivals from mastectomy and salvage treatment were also compared for the two groups. The groups were similar for all the major prognostic factors (menopause, staging, hormone dependency). In the group treated 'early', the lead time from the tumour marker increase to the clinical and radiological signs of metastases was significantly longer than that of the group not treated 'early' (13.5 +/- 10 vs 3.4 +/- 2.8 months respectively; P < 0.001 by unpaired t-test). For patients treated 'early', the survival curves up to 30 months after salvage treatment and up to 72 months after mastectomy showed greater survival than those for the patients treated later (42.9% vs 13.6% and 42.9% vs 22.7% respectively; P = 0.04 in both instances). These data suggest that treatment triggered by rising tumour markers before clinical and/or radiological appearance of distant metastases can be useful in prolonging both the asymptomatic interval and the duration of response of some relapsed patients. Randomized prospective trials must be encouraged to confirm these data and to better evaluate the effect on the disease-free survival (DFS) and overall survival (OS) of 'early' salvage treatment protocols.

A Combined Analysis of European Organization for Research and Treatment of Cancer, and Medical Research Council Randomized Clinical Trials for the Prophylactic Treatment of Stage TaT1 Bladder Cancer

Purpose The use of prophylactic agents after primary resection can decrease the incidence of tumor recurrence in patients with stage TaT1 bladder cancer. However, the long-term impact on progression to muscle invasive disease as well as on duration of survival is unknown. A combined analysis of individual patient data from previously performed European Organization for Research and Treatment of Cancer (EORTC) and Medical Research Council (MRC) randomized clinical trials was done in an attempt to answer these crucial questions. We compared immediate versus no adjuvant prophylactic treatment after transurethral resection with respect to disease-free interval, time to progression to muscle invasive disease, time to appearance of distant metastases, duration of survival and progression-free survival. Materials and Methods All EORTC and MRC prophylactic, randomized phase III trials with primary or recurrent, stage TaT1 transitional cell bladder cancer that compared transurethral resection alone or with adjuvant prophylactic treatment were included in the study. Four EORTC and 2 MRC trials using intravesical chemotherapy or oral agents and including a total of 2,535 patients were studied. Results A statistically significant effect of adjuvant treatment over no adjuvant treatment was found in terms of the duration of the disease-free interval (p less than 0.01). No clear advantage of adjuvant treatment was shown with respect to progression to invasive disease, time to appearance of distant metastases or duration of survival and progression-free survival. Median survival followup was 7.8 years. Conclusions Despite prologation of the disease-free interval adjuvant treatment has no apparent long-term impact on the evolution of stage TaTi bladder cancer.

Radical parotid surgery of metastatic malignant melanoma

With an increasing incidence of the malignant melanoma we also have to expect an increasing number of metastases of the parotid lymph nodes. Up to now there are no definite guidelines concerning the surgical treatment of these metastases. What is important is the question whether the facial nerve should be resected or retained. Between 1987 and 1991 in the ENT-clinic of the University Hamburg-Eppendorf eight patients were treated for metastases of a malignant melanoma in the parotid gland. The clinical course demonstrates that there is no indication for a radical surgical treatment of these patients. It neither leads to a delayed appearance of distant metastases, nor does it improve the life expectancy.

Resectable gastric carcinoma. An evaluation of preoperative and postoperative chemotherapy

Patients with locoregional gastric carcinoma often die because of the low rates of curative resection and frequent appearance of distant metastases (mainly peritoneal and hepatic). To evaluate the feasibility of preoperative and postoperative chemotherapy, 25 consecutive previously untreated patients with potentially resectable locoregional gastric carcinoma received two preoperative and three postoperative courses of etoposide, 5-fluorouracil, and cisplatin (EFP). Ninety-eight courses (median, five courses; range, two to five courses) were administered. Six patients had major responses to EFP. Eighteen patients (72%) had curative resections, and three specimens (12%) contained only microscopic carcinoma. At a median follow-up of 25 months, the median survival of 25 patients was 15 months (range, 4 to 32+ months). Peritoneal carcinomatosis was the most common indication of failure. One patient died of postoperative complications, but there were no deaths due to chemotherapy. EFP-induced toxic reactions were moderate. Preoperative and postoperative chemotherapy for locoregional gastric carcinoma is feasible, and additional studies to develop regimens that could result in 5% to 10% complete pathologic responses may be warranted.

The biological basis for conformal three-dimensional radiation therapy

The recent introduction of new computer technology for treatment planning and computer-driven treatment delivery systems, such as multi-leaf collimators and on-line verification systems, has accelerated the development of 3-dimensional (3-D) radiation therapy as a modality for curative cancer treatment. The goal of 3-D treatment planning is to conform the spatial distribution of the high radiation dose to the shape of the tumor contour while concomitantly decreasing the volume of the surrounding normal tissues receiving high radiation doses. The improved precision of tumor coverage and the exclusion of normal tissues should permit tumor dose escalation and may enhance local tumor control. It has been suggested that any survival gains derived from improvements in local control may be offset by the subsequent appearance of distant metastases arising from micrometastases already present at the time of initial diagnosis. However, clinical and laboratory studios indicate that failure to control the primary tumor at the time of initial treatment significantly increases the incidence of metastatic dissemination. This phenomenon is consistent with the hypothesis that the enhanced mitotic activity associated with the re-growth process of locally recurring primary tumors promotes the mallti-step transformation of non-metastatic tumor cells into clonogens with metastatic potential, leading to increased overall rates of metastatic disease. These biologic considerations provide support for the need to focus attention on the identification of more effective therapeutic strategies designed to eradicate the primary local tumor completely at the time of initial therapy and serve as the rationale for clinical studies using 3-D conformal radiation therapy.

Uncontrolled local recurrence after treatment of breast cancer with breast conservation

Three hundred fifty-six patients with early (Stage I and II) breast cancer and 55 with advanced (Stage III and IV) breast cancer were treated between 1979 and 1985 with a consistent policy of breast conservation irrespective of tumor site, size, or histologic features. Only three patients underwent primary mastectomy (Stage III), and the remainder were treated either by wide local excision and postoperative radiotherapy (357 cases) or by needle biopsy and primary irradiation (51 cases). A total of seven of 356 (2%) Stage I and II patients have developed uncontrolled local or nodal recurrence at a median follow-up of 5 years, and nine of 55 (16%) of Stage III and IV patients. Of the 62 Stage I and II patients who have died, seven (11%) have died with uncontrolled locoregional disease. Of the 22 Stage III and IV patients who have died, eight (36%) have died with uncontrolled locoregional disease. Although the majority of local recurrences within the conserved breast could be salvaged by secondary surgery (37/38 Stage I and II patients), the development of chest wall or nodal recurrence was usually associated with the appearance of distant metastases and a poor prognosis. Data on uncontrolled local recurrence should be given in all studies of breast cancer treatment, since it represents an important end-point of therapy and a difficult clinical problem.

Factors influencing outcome of definitive radiotherapy for localized carcinoma of the prostate

Definitive radiation therapy was administered to 577 patients with histologically confirmed carcinoma of the prostate localized to the pelvis. Results of therapy and prognostic factors are evaluated and compared with other reports. All patients were followed for a minimum of 3 years, the median period of observation is 6.5 years. The disease-free survival in stages A 2 and B was 78% at 5 years and 60% at 10 years; in stage C, 60% at 5 years and 36% at 10 years. The overall actuarial survival in stage B patients was 76% at 5 years and 58% at 10 years, which is similar to the life expectancy of a comparable cohort of normal males. In stage C, the actuarial survival was 65% at 5 years and 38% at 10 years, approximately 15% below the normal life expectancy for a similar cohort. Histological differentiation of the tumor had a significant impact on survival, poorly differentiated tumors showing 20% lower survival rates, most likely related to a higher incidence of distant metastases. Age was not found to be a significant prognostic factor in patients with stage B tumors; however, in stage C, the 5-year disease-free survival was 43% in patients younger than 60 and 53% in those older than 60 years ( p = 0.04). In stage B, patients who had control of the pelvic tumor exhibited a 80% actuarial 5-year survival and 60% at 10 years. This compares with an actuarial survival of 30% at 5 and 10 years when there was evidence of pelvic recurrence alone or combined with distant metastases. In stage C patients with pelvic tumor control, actuarial survival was 81% at 5 years and 50% at 10 years, in comparison with 20% 5-year and 10% 10-year survival when pelvic recurrence or distant metastases or a combination of both occurred. The method of diagnosis [transurethral resection of the prostate (TURP) versus needle biopsy] did not appear to be a major prognostic factor of survival or patterns of failure, except in patients with stage C moderately differentiated tumors. The interpretation of the lymphangiogram (normal, suspicious or abnormal) did not correlate with survival or tumor control. The pathologic status of the lymph nodes established at lymphadenectomy did not appear to relate to survival for patients with stage B disease. However, in stage C, the 10-year actuarial survival was 85% for patients with negative nodes as compared to 17% for patients with positive nodes. The administration of hormones concomitantly with radiation therapy did not significantly influence the probability of tumor control, appearance of distant metastases or survival. Radiation therapy is an effective therapeutic alternative to radical prostatectomy or hormonal manipulation in patients with carcinoma of the prostate. Prognostic factors have been identified that should be taken into consideration for stratification in clinical trials as well as in the design of innovative therapeutic strategies.

Radiotherapy of prostate carcinoma: Results of treatment and complications

During October 1974 and December 1981, 204 patients with a localized prostate carcinoma were treated by radiotherapy. One hundred and eighty two patients were suitable for this evaluation. The minimal time of follow-up was 30 months, the mean time 54 months. All patients had a split-course radiotherapy starting by equally weighted opposed pelvic fields with daily doses between 1.8 and 2 Gy, a rest period of 6-7 days and a total dose between 60 and 70 Gy. The overall survival rates (actuarial) for all patients were 64% after 5 years and 55% after 8 years. Several prognostic factors were evaluated. The main factor was tumor grading, the 5 year survival rates fall off from 81% for G1, 65% for G2 to 40% for G3. Split according to T-categories, 5 year survival rates were 73% in T1, 74% in T2, 59% in T3, and 50% in T4. When using the American staging system, we found 75% in stage B and 59% in stage C. There was no statistically significant influence of age and dose on survival, but a clear trend for better survival with higher doses. 36.8% of all patients relapsed, 79% of them developed only distant metastases. Comparing grading and appearance of distant metastases, we found 58% in the group of G3 tumors. There was no influence of transurethral resection (TUR) on survival. Side effects were observed frequently, but mostly mild and transient, late effects were rare.