Symptom-free Survival Rates Research Articles

Controversial transplant issues

Background: Little information is available on the indications for, and the efficacy and timing of, liver transplantation in patients with primary sclerosing cholangitis (PSC). This issue is particularly relevant because prolonged survival has been reported in patients who do not undergo transplantation. Methods: Long-term results of therapeutic interventions including liver transplantation were assessed in a representative series of 51 patients. Patient survival was compared with that expected from prognostic models. Results: Actuarial symptom-free survival rate inpatients treated by nontransplantation biliary surgery (n = 23) was 35% at 10 years. Actuarial survival rate from onset of PSC (56% at 10 years) was identical to that expected from the prognostic model. Actuarial patient (n = 28) survival rate 5 years after transplantation was greater that expected from prognostic models (89% versus 31%; P < .05). Cumulative actuarial incidence of cancer 5 and 10 years after the onset of PSC was 13% and 31%, respectively. Conclusions: Liver transplantation improves the prognosis of patients with PSC. Failure to identify patients who will benefit from nontransplantation therapeutic interventions or in whom a cancer will develop, and the risk associated with previous abdominal surgery, suggest that liver transplantation should be indicated early after onset of symptoms. (Reproduced with permission from Mosby-Year Book, Inc.)

Carotid-subclavian bypass: A twenty-two-year experience

Purpose: A retrospective review of 124 patients who underwent carotid-subclavian bypass from 1968 to 1990 was done to assess primary patency and symptom resolution.Methods: Preoperative data included age, atherosclerosis risk factors, and indications for surgery. Perioperative data included mortality and morbidity rates and graft conduit. Postoperative follow-up assessed graft patency, resolution of symptoms, and late survival.Results: Age ranged from 42 to 78 years (mean 57.9). Indications for surgery were vertebrobasilar insufficiency in 24 (19%), extremity ischemia (EI) in 33 (27%), transient ischemic attacks (TIAs) in 13 (11%), both vertebrobasilar insufficiency and EI in 31 (25%), and both TIAs and EI in 23 (18%) patients. Graft conduits were polytetrafluoroethylene in 44 (35%) and Dacron in 80 (65%) cases. Concomitant ipsilateral carotid endarterectomy was done in 32 (26%) patients. During operation, death occurred in one patient (0.8%), and complications occurred in 10 (8%) patients. Thirty-day primary patency and symptom-free survival rates were 100%. Long-term follow-up ranging from 5 to 164 months was available for the 60 cases done between 1975 and 1990. Three grafts occluded at 30, 36, and 51 months after surgery for a primary patency rate of 95% at 5 and 10 years. Twenty-two patients died, yielding survival rates of 83% at 5 years and 59% at 10 years. Symptom recurrence occurred in six (10%) patients from 9 to 66 months after surgery. The symptom-free survival rate was 98% at 1 year, 90% at 5 years, and 87% at 10 years. Symptoms recurred in three patients with occluded grafts and three with patent grafts. The preoperative symptoms of drop attacks and TIAs did not recur. EI recurred in 5% and was noted only in the presence of graft occlusion. Dizziness recurred in 17% of patients admitted with this symptom and was observed despite graft patency.Conclusion: Carotid-subclavian bypass was a safe and durable procedure for relief of symptomatic occlusive disease of the subclavian artery. Long-term symptomatic relief appeared particularly likely in patients with drop attacks or upper extremity ischemia.

Is there a conduit of preference for a bypass between the carotid and subclavian arteries?

The conduit of choice for a bypass between the carotid and subclavian arteries remains controversial. We retrospectively evaluated 32 patients who underwent bypass between the carotid and subclavian arteries. Perioperative mortality was limited to a single patient who sustained a myocardial infarction. Long-term follow-up (mean: 46 months) revealed an 87% stroke-free survival rate, a 74% neurologic symptom-free survival rate, and a 77% primary patency rate at 5 years. No overall difference was discerned between a prosthetic or autogenous vein conduit. However, in bypasses constructed from the subclavian artery to the level of the carotid bifurcation, 100% (nine of nine) of vein bypasses remained primarily patent compared with 40% (two of five) of prosthetic grafts (p < 0.05). No distinct patency difference was identified between a short vein or a prosthetic bypass constructed between the proximal common carotid artery and subclavian artery. A vein bypass results in superior patency compared with a prosthetic graft for longer bypasses constructed from the subclavian artery to the carotid artery bifurcation.

Chordoma-natural history, treatment and prognosis. The Florence Radiotherapy Department experience (1956-1990) and a critical review of the literature.

Fifteen cases of chordoma, seen between 1956 and 1990 at the Florence Radiotherapy Department are reported. Twelve of them were treated with radiotherapy and surgery, while one was left untreated. We analyzed the course of the disease in the treated cases, with particular emphasis on the problem of symptom control. The natural history of the disease seemed to be only marginally affected by the treatment and new therapeutic options are strongly needed. While actuarial survival rates at 5 and 10 years were 58% and 35% respectively (owing to the slow growth rate of this neoplasm), 10 years' symptomatic progression-free, symptom-free, and disease-free survival rates were only 25%, 17% and 8% respectively.

5 years symptom-free survival rate of 414 consecutive cases of laryngeal cancer referred to the radium centre Copenhagen.

The results of treatment of 414 patients suffering from laryngeal cancer referred to the Radium Centre of Copenhagen have been recorded according to anatomical localization and stage of the disease.The choice of treatment has in most cases been made after joint consultation between the laryngeal surgeons and the radiotherapist in charge.Apart from patients with complete fixation of the chords, or subglottic localization of the disease, the primary treatment has usually been roentgen irradiation.

Can Radiosensitivity and Histopathology of Cervical Cancer Be Correlated?

The histopathology of cervical cancers can be correlated with the local radiocurability for (1) groups of cases and (2) the individual patient. The histological type of carcinoma influences the local radiocurability, since the five-year symptom-free survival rates are significantly better for cases with mature than for those with anaplastic carcinomas of the same clinical stage of the disease (Table 1). In addition to the series of 898 patients quoted in the introduction 3 a series of 1,633 cases 11 classified at the time of starting treatment between 1946 and 1953 gives very similar results. These figures show that (1) for the same clinical stage, differentiating (ie, mature) tumors are more amenable to radiotherapy than anaplastic cancers; (2) the incidence of mature types decreases and that of anaplastic forms increases with increasing clinical stage, ie, the latter account for 67% in stage I, 77% in stage II, and 85% in stages

The influence of histological structure on the radiosensitivity of tumours: a symposium. II. The influence of systemic factors on the differentiation and radiocurability of cervical cancers.

The histological structure as well as the local radiocurability of a tumour depend on systemic factors and are not immutable qualities. This is one of the reasons why in general the response to radiation treatment of a given individual tumour cannot be predicted from the histological appearance before treatment. On the other hand, a positive correlation between the degree of maturity of squamous cell cancers and local radiocurability can be established statistically for different sites (Glucksmann, 1948) and at the same site for tumours of comparable clinical extent (Gilmour, Glucksmann and Spear, 1949; Wood and Boag, 1950). This is brought out in Table I which shows the five-year symptom-free survival rates for patients with cancer of the uterine cervix, fully treated by intracavitary radium. Patients with incomplete treatments and those dying of intercurrent disease have been excluded from the analysis. There is a significant difference in the survival rate in favour of differentiated as compared with a...

The Influence of Tumour Histology, Duration of Symptoms and Age of Patient on the Radiocurability of Cervix Tumours

1. In a series of over 700 fully treated patients with epithelioma of the uterine cervix, more differentiated tumours than anaplastic ones of the same clinical stage responded favourably to treatment as measured by the five-year symptom free survival rate. 2. The incidence of differentiated tumours increased with age of patient. 3. The clinical extent of the disease depended on the growth rate of the tumour and on the length of time it had been present. There was no correlation between survival rate and length of history per se.