No Evidence Of Disease Survival Research Articles

Adenocarcinoma of the oesophagus: neoadjuvant chemoradiation and radical surgery

To retrospectively evaluate long-term treatment results following neoadjuvant chemoradiation (CRT) and radical surgery in patients with advanced adenocarcinoma (AC) of the oesophagus. Between 2005 and 2015, atotal of 102 consecutive patients with amedian age of 64years (range, 44-86years) and AC of the oesophagus were evaluated of whom 84 received afull CRT. Agroup of 51patients was treated with neoadjuvant intent followed by radical surgery. Atotal dose of 50.4 Gy with mostly weekly paclitaxel/fluorouracil chemotherapy was administered. Six to eight weeks following CRT, atransthoracic subtotal oesophageal and proximal gastric resection was performed. Survival curves for overall survival and no evidence of disease (NED) survival (primary endpoints) were calculated according to Kaplan-Meier, and possible prognostic factors were evaluated by the log-rank test as well as by aCox regression analysis. Median follow-up time of the surviving patients was 48months (range, 14-134 months). Overall and NED survival rates for patients of the study group (n = 51) were 40 and 32%, respectively, at 5years. Age (p = 0.04), ypT category (p = 0.1) and the development of distant metastases (p = 0.05) were identified as (marginally) independent prognostic variables with impact on survival. Median survival time for patients of the study group (n = 51) was 45 ± 18months (95%CI 9-81months). Clear resection margins were achieved in 46/51 patients (92%). Regression rates with complete regression rare residual cancer and increased number of residual cells, but predominantly fibrosis were 33, 41, and 10%, respectively. Patterns of failure revealed local with distant recurrence in 2/51 (4%), regional recurrence alone in 2/51 (4%), and distant metastases in 27/51 (53%) patients. Neoadjuvant CRT in patients with AC of the oesophagus followed by thoracoabdominal surgery is alocally very effective concept. Asignificant tumour regression in almost 75% of the patients may stimulate prospective trials on the omission of radical surgery for some elderly patients. Due to ahigh rate of distant metastases further investigations in terms of effective systemic therapy may be warranted.

Malignant phyllodes tumor of the breast: treatment and prognosis.

Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50years (21-76), and the mean size of the tumor was 6cm. Thirty-four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1cm. Remaining 6 (8.6%) patients treated with BCS margins were <1cm and subsequently radiotherapy was performed. Among 70 patients, 58 (82.9%) had no evidence of disease (NED) after 5years. The extent of surgery was not significantly related to the 5-year NED survival rates (82.4% in patients who underwent mastectomy and 83.3% in patients who underwent BCS only or BCS with adjuvant irradiation). The 5-year NED survival rates in BCS (tumor-free margin ≥1cm) and BCS with irradiation (tumor-free margin <1cm) groups were identical (83.3%). Our data support the potential use of BCS in patients with MPTB. Mastectomy is indicated only if tumor-free margins cannot be obtained by BCS. Adjuvant radiotherapy may be considered if tumor-free margins are <1cm.

Indications for frontolateral laryngectomy and prognostic factors of failure.

The aim of this study was a retrospective analysis of the oncological results in a group of patients treated by frontolateral laryngectomy using clinical and histopathological correlations in order to review the indications for surgery. In all, 150 patients underwent frontolateral laryngectomy as described by Leroux-Robert. All were staged according to the 1992 UICC TNM classification. Factors examined were clinical T, histopathological T, tumor infiltration of the anterior commissure and the vocal cord muscle, survival without disease and the percentage of local relapses. Twenty-one patients had local relapses (14%), while four patients developed second primary tumors (2.7%). Among the different correlations examined, microscopic infiltration of the anterior commissure was related to a greater number of local relapses (25.5% vs 5%) and a 55% survival with with no evidence of disease (NED). The crude 5-year NED survival was 66% and was influenced by second primary tumors and metastases (7.4%) and non-oncological diseases (14.6%). These data show the need for a re-evaluation of the indications for frontolateral laryngectomy because subtotal reconstructive laryngectomy could be performed more safely in the more advanced cases. In contrast, cases with more limited tumors might be better treated by laser for a more functional and cost-beneficial result.

Overexpression of p53 protein and outcome of patients treated with chemoradiation for carcinoma of the anal canal

Despite encouraging results with chemoradiation as the primary means of managing carcinoma of the anal canal, approximately 20% of patients will develop a local recurrence. This study examined the prognostic significance of p53 nuclear protein overexpression in the pretreatment biopsies of patients treated with chemoradiation for epidermoid carcinoma of the anal canal. All patients were treated in a prospective, randomized Radiation Therapy Oncology Group trial (RTOG 87-04) in which radiotherapy to the pelvis was compared with concurrent 5-fluorouracil (5-FU) or 5-FU and mitomycin-C. Formalin fixed, paraffin embedded blocks or unstained slides from the pretreatment biopsies of 64 patients were obtained from referring institutions and evaluated immunohistochemically with the polyclonal p53 antibody CM-1. A multivariate analysis was conducted to analyze overexpression of p53 in terms of locoregional control, no evidence of disease (NED), and overall survival. p53 protein was overexpressed in 48.4% of the cases. Although not statistically significant, there was a trend for patients whose tumors overexpressed p53 to have inferior locoregional control (52% vs. 72%, P = 0.13), NED survival (52% vs. 68%, P = 0.27), and absolute survival (58% vs. 78%, P = 0.14). Of all the pretreatment factors analyzed, only International Union Against Cancer stage was predictive of outcome in multivariate analysis. Among those patients whose tumors overexpressed p53, there was a trend toward improved outcome in the arm that received 5-FU and mitomycin-C compared with the arm that received 5-FU only. Overexpression of the p53 protein may be associated with inferior outcome for patients managed with definitive chemoradiation for epidermoid carcinoma of the anal canal.

Prognostic factors for local and distant recurrence in Stage I and II cervical carcinoma

Purpose : The effects of tumor size, parametrial involvement, and other variables on treatment outcome for patients with Federation Internationale de Gynecologie et d'Obsterique (FIGO) Stage I or II cervical carcinoma, as well as treatment complications, were analyzed retrospectively. Methods and Materials : Records of 125 patients with FIGO Stage I or II carcinoma of the uterine cervix selected for curative radiotherapy between January 1980 and December 1990 were reviewed. Twelve patients (9.9%) underwent adjuvant extrafascial hyterectomy and 8 patients (6.4%) received chemotherapy. Median age was 55 years. Median follow-up time was 40 months, and minimum follow-up time was 24 months. The data were analyzed for site of first relapse, survival, overall incidence of complications, and incidence of grade 4 complications. Results : The overall 5-year was: Stage IA: 100%, Stage IB: 72%, Stage IIA: 90%, and Stage IIB: 72%. The 5-year survival with no evidence of disease (NED) was: Stage IA: 100%, Stage IB: 67%, Stage IIA: 90%, and Stage IIB: 50%. Patients with bulky (> 5 cm) tumors had a shorter overall and NED survival than patients with nonbulky tumors (53% vs. 83%; p = 0.0008 and 44% vs. 78%; p = 0.0001, respectively). Thirty-nine tumor recurrences (39 out of 125 = 31%) occurred and were scored as local (23 out of 125 = 18.3%), if initial failure had a local component, or distant (16 out of 125 = 12.7%), if initial failure was distant only. Patients with bulky (more than 5 cm) tumors (32 out of 125) were more likelyto experience a recurrence (18 out of 32 = 56%) than patients with nonbulky tumors (21 out 93 = 22%; p = 0.0004). The initial site of recurrence was more likely to be local for bulky tumors (14 out of 18 = 78%) than for nonbulky tumors (9 out of 21 = 43%; p = 0.03). The profitability of a recurrence increased with the number of involved parametria (none: 20 out of 78 = 25%; one: 12 out 34 = 35%; two 7 out of 13 = 54%; p = 0.04 for linear trend), as did the probability that the initial failure was distant rather than local (none: 4 out of 20 = 20%; one: 7 out of 12 = 58%; two: 5 out of 7 = 71%; p = 0.01 for linear trend). Positive lymph nodes, vessel invasion, and low hemoglobin level all correlated with an increased risk of a recurrence (RR 2.41, p = 0.004; RR 2.20, p = 0.01; OR 2.02, p = 0.01, respectively). There were 46 complications among 37 (29%) patients. The incidence of grade 4 complications was 8.8% (11 out of 125). History of pelvic surgery and bulky tumor were significantly predictors of a grade 4 complications ( p < 0.0001 and 0.021, respectively). Also, a dose rate to point A of > 0.6 Gy/h increased the chance of a grade 4 complication ( p = 0.007). Conclusion : For patients with FIGO Stage I or II cervical carcinoma, tumor size was more predictive of local recurrence than was overall stage, and the extent of parametrical involvement was strongly predictive of distant recurrence, as was the stage. These findings suggest that tumor size and extent of parametrial involvement should be incorporated into the stagling system. Patients with bulky tumors had a shorter survival and were more likely to experience a grade 4 toxicity of therapy. Dose rate to point A of > 0.6 Gy/h was associated with the increased risk of grade 4 complications.

Long-term results of treatment of cervical carcinoma in the United States in 1973, 1978, and 1983: Patterns of Care Study (PCS)

Purpose : To extend the observations of patients with carcinoma of the cervix treated in 1973 for over 15 years, in 1978 for over 10 years, and in 1983 for over 5 years for survival and local control to compare treatment times and outcome. Methods and Materials : A nationwide survey of the patterns of practice in radiation therapy for patients with squamous carcinoma of the cervix collected pretreatment and treatment data using external surveyors who reviewed patients' records. Outcome information was updated for the three separate databases by mail survey. Overall survival, no evidence of disease (NED) survival, and local control curves by stage were plotted using the estimates derived by the Kaplan—Meier method. Results : Total number of patients surveyed was 1686: 937 patients in 1973, 565 patients in 1978, and 184 patients in 1983. These are the results from changes in treatment policy, particularly the increasing use of brachytherapy. Of Stage III patients, the percentage receiving brachytherapy was 60.5% in 1973, 76.5% in 1978, and 87.9% in 1983 ( p < 0.001 by linear trend test). Also, there was an increased proportion in use of higher energy for external pelvic irradiation during the more recent time period, e.g., 28% in the 1973 study, 60% in the 1978 study, and 87% in the 1983 study compared to the usage of cobalt-60 equipment. Comparison of results including overall survival, local control, and NED survival for the three different time periods showed improvement in outcome for Stage III in 1983, but not Stages I and II. The 5-year survival for Stage III increased from 25% in the 1973 survey to 47% in the 1983 survey, a linear trend that is statistically significant ( p = 0.02). Conclusion : The long-term results of radiotherapy for patients with carcinoma of the cervix show improved outcome for Stage III patients, which probably results from improved treatment, including higher energy for pelvic irradiation and increase in use of brachytherapy contributing better local control and fewer complications.

Proliferative activity measured by flow cytometry and Ki‐67 of nodal negative breast cancer as a prognostic parameter for local recurrences and distant metastases ‐first results

AbstractThe prognostic value of proliferative activity [percentage of S‐phase cells = S‐phase fraction (SPF) and Ki‐67] was determined in nodal negative breast carcinomas and correlated with no evidence of disease (NED) survival and analysis of recurrence. Overall 193 breast carcinomas were investigated. SPF of 183 breast carcinomas was determined by one‐dimensional flow cytometry. Histochemically the percentage of Ki‐67‐positive cells was measured in 188 patients. Slowly proliferating tumors determined by SPF (SPF &lt; median) had a better 5‐year NED survival (91%), a lower rate of distant metastases (1%), and a lower rate of loco‐regional recurrences (4.5%) compared to fast proliferating tumors (SPF &gt; median; NED survival 63%; distant metastases 15.7%; loco‐regional recurrences 21%). Slowly proliferating tumors determined by Ki‐67 (Ki‐67 &lt; 20%) had a better 5‐year NED survival (77%) and a lower rate of distant metastases (6.1%) compared to fast proliferating tumors (percentage of Ki‐67‐positive cells &gt; 20%; NED survival 63%; distant metastases 17.9%). However, there was no significant difference in loco‐regional control. Stepwise multivariate analysis showed that SPF (P = 0.002) was the only independent prognostic factor for NED survival: SPF in interaction with grading (P = 0.001) and family history (P = 0.044) for distant metastases; and SPF (P = 0.0039), method of surgical treatment (P = 0.071), and grading (P = 0.0956) for loco‐regional recurrences. In conclusion, proliferative activity is a relevant prognostic parameter for nodal negative breast Cancer. © Wiley‐Liss, Inc.

Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome

Between 1977 and 1986, 75 black and 615 white women with American Joint Committee (AJC) Stages I and II breast cancer were treated with excisional biopsy, axillary dissection, and radiation therapy for breast conservation. Cyclophosphamide, methotrexate, and 5-fluorouracil, with and without prednisone and tamoxifen, was given to 92% of premenopausal, 83% of perimenopausal, and 63% of postmenopausal node-positive women; 20 of 106 (19%) postmenopausal node-positive women received tamoxifen only. The clinical characteristics of the similarly treated patients were compared. The 5-year actuarial local only first failure rate was 5% for black women and 6% for white women (P = 0.53). Regional only failure as the first site of failure was 9% for blacks versus 1% for whites (P = 0.002), with regional recurrence as any component of first failure being 16% for blacks and 4% for whites (P = 0.001). The supraclavicular fossa was identified as the primary site of regional recurrence in black patients with either pathologically positive or negative axillae. Distant metastases as the only site of first failure were significantly greater in the black population with a 20% 5-year actuarial failure rate versus 11% in white patients (P = 0.01). The 5-year actuarial overall survival for the black patients was 82% versus 91% for the white patients (P = 0.01), with no-evidence-of-disease (NED) survival being 64% and 83% (P = 0.0002) and relapse-free survival (RFS) being 61% and 77% (P = 0.01), respectively. Black patients younger than 40 years of age or with pathologically positive axillary nodes had significantly worse NED, RFS, and overall survival compared with similarly staged white patients. Cosmetic results were analyzed at 3 and 5 years after completion of therapy. Although significantly fewer black patients had an excellent-to-good cosmetic result at 3 years compared with white patients, the results were not significantly different at 5 years. These results show that appropriately selected black patients with early stage breast cancer have excellent local control after conservative surgery and radiation therapy and should continue to be offered breast preservation as an alternative to mastectomy. Patterns of failure, however, demonstrated higher regional and distant recurrence rates and lower NED, RFS, and overall survival rates in most subsets of black patients reviewed.

Breast recurrence and survival related to primary tumor location in patients undergoing conservative surgery and radiation for early-stage breast cancer

Between 1977 and 1986, 886 pts with Stage I and II breast cancer underwent excisional biopsy, axillary dissection and radiation. Median follow-up was 5 years (range 2 months–13 years). The patients were divided into four groups according to the primary tumor location: 1) outer (495 patients), 2) inner (202 patients), 3) central (119 patients), and 4) subareolar (70 patients). Subareolar tumors were defined as those immediately beneath the nipple-areolar complex or within 2 cm of the areolar margin. The comparability of the groups was assed in terms of clinical T stage, patient age, histology, final pathologic margin status, estrogen and progesterone receptor status, pathologic nodal status, and use of adjuvant chemotherapy. There were no significant differences among the four groups in the distribution of these factors except for the pathologic nodal status (outer 38% positive nodes, inner 24%, central 23%, subareolar 31%) p = .0004. There were no significant differences in 5 year actuarial overall survival (91% vs 86% vs 92% vs 91%, p = .34), relapse-free (75% vs 74% vs 80% vs 79%, p = .77), or NED survival (82% vs 78% vs 87% vs 84%, p = .29) for the four groups. A separate analysis for pathologic node negative and node positive patients revealed similar findings. For node-negative patients, the 5 year actuarial overall survival was 93% vs 88% vs 94% vs 91% ( p = .20), the relapse-free survival was 78% vs 76% vs 82% vs 79% ( p = .49), and the NED survival was 86% vs 81% vs 88% vs 86% ( p = .46). For node-positive patients, the 5 year actuarial overall survival was 87% vs 82% vs 84% vs 90% ( p = .59), relapse-free survival was 69% vs 66% vs 77% vs 80% ( p = .78), and NED survival was 75% vs 68% vs 85% vs 80% ( p = .66). Patterns of first failure were also not significantly different among the four groups: local only first failure (7% vs 4% vs 5% vs 8%, p = .49), any local first failure, i.e., ±simultaneous distant metastases (8% vs 5% vs 5% vs 9%, p = .61), regional only (2% vs 1% vs 1% vs 0%, p = .65), any regional (4% vs 3% vs 3% vs 3%), or distant metastases (11% vs 17% vs 9% vs 10%, p = .16). A separate analysis of node negative and node positive patients revealed similar findings. The present analysis demonstrates no significant correlation between primary tumor location and patterns of first failure, overall survival, relapse-free, or no evidence of disease (NED) survival in 886 pts with Stage I and II breast cancer treated with conservative surgery and radiation. Subareolar tumor location was not associated with an increased risk of breast recurrence in appropriately selected patients.

Conservative treatment of early breast cancer

At our Institution, the treatment policy for early carcinoma of the breast (Tl–2, NO, AJC) is lumpectomy followed by radiotherapy to the breast and peripheral lymphatics. From October 1976 until December 1982, 171 patients have been admitted and treated. Radiotherapy was administered with 60 Co, 5.000 cGy in 5 weeks to the breast and lymphatics plus a boost to the scar giving q.s.p. 6.400 cGy at maximum tumor depth. With a minimum follow-up of 3 years and a median follow-up of 61.7 months the locoregional control was 94.2% and survival at 8 years with no evidence of disease (NED) was 77.2% with an overall survival rate of 90%. No difference in NED survival rate was found between Stage I and II. There was a tendency to better survival rate in those patients older than 50 years and also for post menopausal patients, however the difference did not reach statistical significance (66.7% NED survival at 8 years for premenopausal and 81.8% NED survival for post menopausal, also at 8 years, p = 0.056 Gehan). The time elapsed between surgery and radiation therapy (between 1 and 2 months) was found to be nonsignificant. Only 1 out of 171 patients has had axillary dissection. The importance or lack of it, is discussed.

Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group

From November 1977 to July 1981, 441 patients with cervical carcinoma were randomized between pelvic irradiation and pelvic and para-aortic irradiation. Included were patients with stage I and IIB with proximal vaginal and/or parametrial involvement with positive pelvic lymph nodes either on lymphangiogram or at surgery, and stage IIB with distal vaginal and/or parametrial involvement and III regardless of pelvic node status on lymphangiogram. Patients with clinically or surgically involved para-aortic nodes were not included. The external beam dose to the para-aortic area was fixed at 45 Gy. There was no tatistically significant difference between the two treatment arms in terms of local control, overall distant metastases and survival with no evidence of disease (NED), although the incidence of para-aortic metastases and distant metastases without tumor at pelvic sites was significantly higher in patients receiving pelvic irradiation alone (pelvic group). The 4-year NED survival rate was 51%. The incidence of severe digestive complications was significantly higher in patients receiving para-aortic irradiation (para-aortic group). Routine para-aortic irradiation for all high risk patients with cervical carcinoma is of limited value, but patients with a high probability of local control can benefit from extended field irradiation, despite an increase in severe digestive complications.

Oral verrucous carcinoma. Treatment with radiotherapy.

Fifty-two cases of oral verrucous carcinoma treated with radiotherapy at the Regional Cancer Centre, Trivandrum, Kerala, India in 1982 were evaluated to determine the distribution within the oral cavity, clinical extent, and effectiveness of radiotherapy in controlling the disease. The most common site was the buccal mucosa. Fifty percent of the patients had clinically negative regional lymph nodes and 33% were in earlier stages (T1, T2, N0, and M0). The overall 3-year no evidence of disease (NED) survival rate was 44%. The 3-year NED survival rate with radium implant was 86%. We cannot comment on anaplastic transformation after radiotherapy because our treatment failures have not been subjected for biopsy concerning this matter. Because the results are comparable with those of well-differentiated squamous cell carcinoma, we think that the treatment policies advocated for oral squamous cell carcinoma are also applicable to oral verrucous carcinoma.

Therapeutic concepts of brachytherapy/megavoltage in sequence for pharyngeal wall cancers. Results of integrated dose therapy.

This is a follow-up report on lateral, posterior oro-, hypopharyngeal wall cancer treatment based on a new therapeutic concept. Ir-192 or I-125 brachytherapy and craniocervical megavoltage irradiation are effective with improved local control and NED (no evidence of disease) survival rates. Local failure rate is 14% and actuarial survival (NED) is 82% at 5 years in 14 patients treated thus far.

Blood transfusion and outcome in stage III head and neck carcinoma.

Treatment outcome was correlated retrospectively with blood transfusions received in 179 surgical patients with stage III squamous cell carcinoma of the head and neck. Seventy-three percent of patients requiring no blood transfusion survived three years with no evidence of disease (NED). By comparison, patients receiving 3 or 4 U of transfused blood experienced a 47% three-year NED survival. Patients receiving 5 U or more of blood perioperatively experienced a 40% two-year NED survival. Seventy patients underwent surgery and postoperative radiation therapy. Life-table analysis demonstrated statistically significant differences in survival for patients who received 2 U or fewer of blood when compared with patients who received more than 2 U. These differences were not present in patients having surgery subsequent to previous radiation therapy or surgery alone. Blood transfusion may be detrimental to the management of patients with malignant neoplasms. The mechanisms through which blood transfusion affects malignant neoplasm is unknown.

Radiotherapy for Prostate Carcinoma

The charts of 96 patients who received radiotherapy at The M. S. Hershey Medical Center for their prostatic carcinoma were reviewed. The 4-year NED (no evidence of disease) survival rates for patients receiving between 6,500 and 7,000 rad of external beam radiation (EBR) were 92, 78, 56, and 50% for stages A, B, C, and D1, respectively. The 4-year NED survival rate for stage B patients was 90% for those receiving approximately 6,500 rad of EBR, 75% for those receiving approximately 7,000 rad of EBR, and 71% for those receiving interstitial implants. Bowel or urinary complications occurred in 27% (21% grade I, 3% grade II, and 3% grade III) of those receiving approximately 6,500 rad of EBR, 40% (25% grade I, 10% grade II, and 5% grade III) of those receiving 7,000 rad of EBR, and 0% of those receiving interstitial implants. The effects of stage, grade, and treatment type on NED survival and complications are discussed.

Radiotherapy for prostate carcinoma.

The charts of 96 patients who received radiotherapy at The M. S. Hershey Medical Center for their prostatic carcinoma were reviewed. The 4-year NED (no evidence of disease) survival rates for patients receiving between 6,500 and 7,000 rad of external beam radiation (EBR) were 92, 78, 56, and 50% for stages A, B, C, and D1, respectively. The 4-year NED survival rate for stage B patients was 90% for those receiving approximately 6,500 rad of EBR, 75% for those receiving approximately 7,000 rad of EBR, and 71% for those receiving interstitial implants. Bowel or urinary complications occurred in 27% (21% grade I, 3% grade II, and 3% grade III) of those receiving approximately 6,500 rad of EBR, 40% (25% grade I, 10% grade II, and 5% grade III) of those receiving 7,000 rad of EBR, and 0% of those receiving interstitial implants. The effects of stage, grade, and treatment type on NED survival and complications are discussed.

Nasopharyngeal carcinoma: an evaluation of 134 patients treated between 1971-1980.

An analysis is made of 134 patients with nasopharyngeal carcinoma treated from 1971-1980 at the Cancer Control Agency of British Columbia. Incidence rate for Chinese born in the Orient was 20.5 per 100,000 per year compared to 1.32 per 100,000 for Canadian born Chinese. The Caucasian rate was .19 per 100,000 per year. These figures confirm a 15 times greater incidence of the disease in Chinese born in the Orient over those born in North America. The 86 Chinese patients were noted to have a 10% poorer survival than the 48 Caucasian patients on long-term follow-up. The main factor affecting survival was initial staging. Overall survival rates were 46.3% three year, no evidence of disease (NED) and 38.3% five year NED survival, but when disease was limited to the nasopharynx (T1, T2, N0) they were 73.9% three year NED and 66.6% five year NED survival. One-third of the patients ultimately developed distant metastases below the clavicle. Although lower T and N stage cases had fewer of these, the overall correlation with staging was poor. Female patients showed statistically significant better survival which was not related to better initial staging. They did, however, have 11% fewer eventual distant metastases.

Evaluation of adjuvant postoperative radiotherapy lung cancer

One hundred eighteen patients with lung cancer were retrospectively analyzed to determine whether postoperative radiotherapy (RT) improves survival. Patterns of treatment failure and three year NED (no evidence of disease) survival rates were assessed according to extent of tumor spread, histology, and treatment method. Patients with hilar or mediastinal node metastases were at higher risk of local failure compared to those with negative nodes. Postoperative RT reduced local recurrence and improved 3 year survival among patients with positive nodes. However, postoperative RT did not improve survival among those with negative nodes. Our data indicated that patients with positive hilar or mediastinal nodes may require postoperative RT to improve survival.

Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma

In order to improve our understanding of the role of postoperative radiotherapy and to search for new strategies in the management of N 1 N 2 T 3 stage carcinoma of the lung, we analyzed results of treatment in 148 of 166 patients who were registered at the Massachusetts General Hospital Tumor Registry from 1971–1977 with a pathological diagnosis of N 1 N 2, T 3 carcinoma of the lung after pulmonary resection. Ninety-three patients received postoperative radiotherapy and another 55 were followed without further treatment. Patients with adenocarcinome showed significant improvement of survival by postoperative radiotherapy; actuarial NED (no evidence of disease) survival rates were 85 % and 51 % at 1 year, and 43 % and 8 % at 5 years for S + RT (patients treated with surgery plus postoperative radiotherapy) and S (patients treated with surgery only) groups, respectively, (P < 0.01). The brain was the most common site of failure in adenocarcinoma, 53 % and 58 % of all failures occurred in the brain in S and S + RT groups suggesting elective whole brain irradiation in a future trial. For the sguamous cell carcinoma group, there was no improved survival in the irradiated patients, actuarial NED survival rates were 63 % for both S + RT and S groups at 2 years, and 42 % and 33 % for S + RT and S groups at 4 years. These figures should be considered in the light of the following: In 52 % (24/46) of S + RT vs. 27% (8/29) of S group, disease was in N 2, T 3 stages. Regional recurrence was the most common failure in squamous cell carcinoma; 76% (13/17) and 45% (10/22) of all failures were in the regional area in S and S + RT groups. Regional failure in S + RT group was noted with radiation dose up to 5000 rad (TDF 82) which suggests radiation dose higher than 5000 rad in future trial.

Hyperbaric oxygen as a radiotherapeutic adjuvant in advanced cancer of the uterine cervix.Preliminary results of a randomized trial

From September 1968 to March 1974, a randomized clinical trial was carried out, using conventional fractionation, i.e., five treatments per week, in 233 patients with advanced cancers of the uterine cervix--Stages IIB, IIA, IIIB and IVA. The age limit was 70 years and all patients had medical clearance. Lymphangiography and, in some patients, an exploratory laparotomy with selective lymphadenectomy, were done prior to treatment to determine the extent of nodal disease. The staging has not been changed either by lymphangiogram or lymphadenectomy findings. A few patients with bulky Stage I and IIA lesions were entered into the trial because of extensive nodal disease demonstrated either by lymphangiogram and/or lymphadenectomy. First, the patients were grouped according to the clinical stage. The secondary stratification was according to the lymphangiogram and/or selective lymphadenectomy findings. The patients were then randomized to air or hyperbaric oxygen within each group. The patients were pressurized in a Vickers chamber at 3 atmosphere absolute, using a 20-minute soak time prior to the irradition. The size of the external beam portal was determined by the status of the nodes. The difference in absolute NED (no evidence of disease) survival rates for both groups as a whole and by stages is not statistically significant. There is no difference in the incidence of failures in the irradiated area between the HPO and air patients. There is no increase in distant metastases in the HP group. It does not seem that the HPO has had an effect on the major complications. However, there was an increase in the incidence of complications with extended fields. The addition of lymphadenectomy had increased the incidence of fatal complications, even with routine pelvic portals. The negative results of this trial with conventional fractioantion should not lead to the conclusion that HPO could not be useful with schemes using a few high dose fractions.