Evaluation of time-dose and fractionation for 252Cf neutrons in preoperative bulky/barrel-cervix carcinoma radiotherapy

Time-dose fractionation factors (TDF) were calculated for 252Cf (Cf) neutron therapy versus 137Cs for intracavitary use in the preoperative treatment of bulky/barrel-shaped Stage IB cervix cancers. The endpoint assessed was gross and microscopic tumor eradication from the hysterectomy specimen. We reviewed the data obtained in clinical trials between 1976-1987 at the University of Kentucky Medical Center. Preoperative photon therapy was approximately 45 Gy of whole pelvis irradiation in 5 weeks for both 137Cs and Cf treated patients. 137Cs implant was done after pelvic irradiation x1 to a mean dose of 2104 +/- 36 cGy at point A at a dose rate of 50.5 cGy/h. There were 37.5% positive specimens. Using Cf intracavitary implants, dose varied from 109 to 459 neutron cGy in 1-2 sessions. Specimens were more frequently cleared of tumor (up to 100% at appropriate dose) and showed a dose-response relationship, both by nominal dose and by TDF adjusted analysis of dose, dose-rate, number of sessions, and overall time. Limited understanding of relative biological effectiveness, schedule, effect of implants, and dose rate all made it difficult to use TDF to study neutron effects. Relative biological effectiveness (RBE) was estimated and showed that for Cf, RBE was a complex function of treatment variables. In the pilot clinical studies, a value of 6.0 had been assumed. The present findings of RBE for tumor destruction are larger than those assumed. Cf was effective for cervix tumor therapy and produced control without significant side effects due to the brachytherapy method used. The TDF model was of limited value in the present analysis and more information is still needed for RBE, dose-rate, and fractionation effects for Cf neutrons to develop a more sophisticated and relevant model.     

The value of preoperative radiotherapy in operable mammary carcinoma

In a randomized trial preoperative radiotherapy (4500 rad to the breast, the internal mammary, the supraclavicular and the axillary lymph node regions) was compared to radical mastectomy followed either by no further treatment or by postoperative radiotherapy. The total number of patients was 960; 356 of these had a follow-up time of more than five years. Both preoperative and postoperative irradiation increased the disease-free survival, compared to survival in patients who were treated only by surgery. The patients who were irradiated preoperatively had significantly better survival rates than the control patients (p = 0.05). Compared to patients who were treated with surgery only the survival improvement was even more certain (p = 0.03). Patients whose tumors were located in the inner half of the breast seemed to benefit more from preoperative or postoperative irradiation than those with lateral tumors. This could support the hypothesis of the value of adequate irradiation of the internal mammary nodes.     

A preoperative single course of high-dose cisplatin and bleomycin with glutathione protection in bulky stage IB/II carcinoma of the cervix.

One course of preoperative chemotherapy including high-dose cisplatin (40 mg/m2 daily for 5 consecutive days) with glutathione protection and bleomycin (15 mg on days 2, 8 and 9) was administered to 27 patients with bulky operable cervical carcinoma (stage IB/II) in a pilot study. In all patients the tumor diameter was greater than 4 cm. Surgery (radical hysterectomy with pelvic and para-aortic lymphadenectomy) was planned within one month of chemotherapy. In 27 evaluable patients, nausea/vomiting was the most pronounced side effect. Significant (but transient) increases in serum transaminases were detected in 19 patients. Electrolyte imbalance (hypokalemia) was detected in 6 patients (one with hypocalcemia). These reversible effects were not associated with other signs of renal toxicity. Objective clinical responses were observed in 21 patients, 18 of them partial and 3 complete responders (pathologically confirmed in 2). Radical hysterectomy with pelvic and para-aortic lymphadenectomy was performed with no particular complications. The shrinking of bulky tumor made the operation easier, especially in parametrial resections. High-dose cisplatin chemotherapy prior to surgery is feasible with acceptable toxicity. The encouraging results of this study warrant further investigations to define the role of neoadjuvant therapy.     

术前炎症指标对肝细胞癌肝切除术患者的预后预测价值

目的  探讨术前炎症指标中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和预后营养指数（PNI）在肝细胞癌（HCC）肝切除术后患者预后中的预测价值。方法 本研究为回顾性队列研究。选择2015年6月—2018年3月于本院行肝切除术的HCC患者为研究对象,随访截至2021年1月。主要研究指标为总生存期（OS）。采用限制性立方样条、Cox比例风险回归模型、时间依赖的受试者工作特征（ROC）曲线以及列线图评估术前NLR、PLR及PNI的预后预测价值。结果 共77例患者符合标准纳入分析,其中男性59例;中位年龄51岁。限制性立方样条分析结果显示,NLR、PLR、PNI与HCC患者的死亡风险均呈线性关系（非线性P>0.05）,Cox比例风险回归模型结果显示,NLR、PLR、PNI、肿瘤分化程度及肿瘤包膜是否完整是影响HCC患者OS的因素。NLR、PLR、PNI等炎症指标构建的列线图模型预测1年、3年总生存率的AUC均大于NLR、PLR、PNI（均P<0.05）,且联合预后影响因素肿瘤分化程度和肿瘤包膜是否完整后AUC进一步提高（均P<0.05）。结论 术前炎症指标NLR、PLR、PNI在预测肝细胞癌肝切除术患者预后中具有良好效能,联合临床因素可进一步提高预测效能。     

The value of radiotherapy in the treatment of vaginal carcinoma.

Herein we report the retrospective survey of 48 consecutive unselected cases of vaginal carcinoma, mainly treated with radiotherapy in our Institute from 1959 to 1970. In this series irradiation was delivered almost always with a single and continuous application of sources of radium 226. Radiumtherapy treatment varied according to the extension in surface of the neoplasm, the clinical stage and especially the vaginal step involvement, considering the length of the organ. Despite the very good immediate response, failures of treatment locally or in paravaginal and pelvic areas were frequently observed, and success of the treatment after a brief follow-up was poor. The actuarial survival was 41.6% and 33.3% at 3 and 5 years, respectively. Stage I cases showed at the follow-up better therapeutic results (48.6% survival at 5 years) than stage II and III cases (28.3%). The poorest results were observed in neoplasms extended to the whole vagina, and all these patients died within 4 years of the beginning of treatment. This report stresses that radiotherapy of vaginal carcinomas demands individualization and a properly planned therapeutic program that combines external irradiation with renewed techniques of low dose rate and continuous irradiation with radioactive sources.     

Sacral plexus injury after radiotherapy for carcinoma of cervix

A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.     

Vascular density in carcinoma of the uterine cervix and its predictive value for radiotherapy

The vascular density (VD) in stage-III tumors of the uterine cervix was determined by morphometric analysis of histologic, Masson-trichrome stained sections prepared from biopsies. In a retrospective study, VD was found to be related to results of radiotherapy, larger VD being associated with prolonged survival, in agreement with similar observations made earlier with stage-IB and -IIA tumors of the cervix. In a complementary study the variation of VD within tumors was investigated in relation to the variation between tumors using surgically removed cervical carcinomas in stage IB. Statistically significant F-ratios were calculated, suggesting a more or less individual pattern of vascularization of the tumors despite a considerable intra-tumoral heterogeneity of the vasculature. It is concluded that VD may reflect oxygenation of neoplastic tissue, and may have a predictive value in regard to the response of tumors to irradiation.     

Changes in oxygenation during radiotherapy in carcinoma of the cervix.

PURPOSE: The aim of this study was to investigate changes in tumor oxygenation, assessed by polarographic needle electrode measurements, following fractionated external beam radiotherapy in carcinoma of the cervix. METHODS AND MATERIALS: Normal and tumor tissue oxygenation was measured in 19 patients prior to radiotherapy and after 40-45 Gy of external beam radiotherapy delivered in 20 fractions over 4 weeks. All measurements were performed during anesthesia. RESULTS: There was no significant difference in the level of normal tissue oxygenation pre- and post radiotherapy. The individual patient median tumor pO2 values ranged from 0 to 31 mmHg pre-radiotherapy and 1 to 61 mmHg post-radiotherapy. The mean of the 19 median pO2 values increased from 8 (SD +/- 10) mmHg to 20 (+/- 20) mmHg following external beam radiotherapy. The increase was significant by paired Wilcoxon test (p = 0.011). There was also a significant fall in the proportion of values < 5 mmHg (p = 0.040). Although this value remained constant, or fell, in the majority of patients (15/19), it increased in 4 tumors. Tumor size pre- and postradiotherapy did not correlate with the level of pretreatment oxygenation; neither did the change in tumor size and change in level of oxygenation. CONCLUSION: The level of tumor oxygenation increased in the majority of patients (15/19) following 40-45 Gy of radiotherapy in carcinoma of the cervix.     

Predictive value of preoperative abdominopelvic CT for optimal cytoreduction surgery in ovarian carcinoma

Some patients underwent laparoscopy without optimal debulking surgery as initial treatment for advanced ovarian carcinoma. The amount of residual tumor following primary surgery was an important prognosis factor. Neoadjuvant chemotherapy is a new therapeutic approach. Secondary, optimal surgery could be done in better conditions. The purpose was to access the ability of preoperative abdominopelvic CT to predict success of debulking surgery for ovarian carcinoma: less than 1 cm of residual tumor size after initial surgery. We reviewed 39 patients (2 stages Ic, 1 stage IIc, 22 stages III and 14 stages IV) operated on for ovarian carcinoma between January 1992 and December 1997. Surgical criteria of inability to perform optimal surgical cytoreduction were compared with abdominopelvic CT done the month before. CT scans were prospectively assessed by radiologist A and retrospectively (3 months to 6 years delay) rewiewed separately by radiologists A and B without surgical data. Nineteen patients underwent optimal debulking surgery: 13 no residual tumor and 6 with residual lesions under 1 cm. The interreader (0.73) and intrareader (0.9) agreement, worked out by Kappa coefficient, was juged good to very good. The sensitivity of CT was 91% with a specificity of 95%. These results allowed us to determine wich CT criteria were accurate and reproducible to be a helpfull for therapeutic choice and to avoid laparotomy without optimal surgery.     

Apoptosis in rectal carcinoma: prognosis and recurrence after preoperative radiotherapy

BACKGROUND: Rectal carcinoma is common, with considerable local recurrence and death rates. Preoperative radiotherapy and refined surgical techniques can improve local control. The aim of this study was to investigate the interaction between apoptosis and the outcome of rectal carcinoma, with and without short-term preoperative radiotherapy. METHODS: Specimens were from 162 patients from the Southeast Swedish Health Care region included in the Swedish Rectal Cancer Trial between 1987-1990. New sections from the paraffin blocks of the preoperative biopsies and the surgical specimens were examined for apoptosis using the terminal deoxynucleotidyl transferase mediated digoxigenin nick end labeling (TUNEL) method. RESULTS: The mean percentage of apoptotic cells was 0.3% (0-4%) and 1.1% (0-14.5%) for the preoperative biopsy and the surgical specimen, respectively. The authors analyzed the surgical specimens from nonirradiated patients and divided them into three groups by apoptotic index (AI) as follows: 0%, 0-1%, and > 1%. A high AI was associated with a decreased local recurrence rate compared with an intermediate or a low AI (P = 0.024). There was no significant relation between AI and survival. There was a significant reduction in the local recurrence rate for irradiated patients compared with the nonirradiated in the low (P = 0.015) and intermediate (P = 0.038) AI groups. In the high AI group, there were few recurrences and no significant difference was observed between irradiated and nonirradiated patients. The relative risk of death from rectal carcinoma in Dukes A-C patients was not significantly decreased by radiotherapy, but, in the intermediate AI group, there was a trend (P = 0.08) in favor of the irradiated patients. CONCLUSION: A high AI in rectal carcinoma indicated a decreased local recurrence rate.     

Conservative surgery after preoperative radiotherapy in the treatment of breast cancer. Indications and results

From 1969 to 1983, 122 patients with unifocal breast cancer, equal or more than 3 centimeters in diameter, NON1a or N1b, were treated at the Institut Curie with conservative surgery after pre-operative external irradiation. Among them were 68% T2NON1a, and 26% N1b (with 21% T2N1b); 80% of the tumors were located in the upper part of the breast. Initial radiotherapy with a moderate dose (50 to 55 Gy for the breast and the lower axillary area) was followed 6 weeks later by a lumpectomy either alone (42 cases) or associated to an axillary node resection (80 cases). Five year survival rate with non evident disease T2NON1a cases is 79%, similar to the radical surgery rate in this group. We noted 8% local recurrences with no axillary recurrences. Post operative courses were a little more troubled than with initial lumpectomy. We noted 8% of upper limb oedema, only in patients who received both radiotherapy and surgery in the axilla. Cosmetic results are good in 65% of the cases, while they are good in 80% for initial lumpectomy. So this therapeutic method gives satisfactory results, but we need more cases with a longer follow-up to draw definitive conclusions.     

Postoperative radiotherapy for carcinoma of the uterine cervix

During the period between 1972 and 1978, 226 patients were operated on for carcinoma of the uterine cervix at Hiroshima University, and 91 patients were treated by postoperative external irradiation. Patients with lymph node metastasis showed markedly lower five-year survival rates stage I: 44.4%; stage II: 45.0%) than those without lymph node metastasis (99.3% and 84.0%, respectively). In view of benefits of postoperative radiotherapy in the treatment of cervical cancer, only to the node positive and tumor rest patients is recommended.     

术前放疗对子宫颈癌根治术后并发症的影响

目的：探讨术前放疗对子宫颈癌根治术后近期并发症的影响。方法：将374例子宫颈癌根治术后患者分为术前放疗组及未放疗组,进行回顾性对比分析两组并发症发生情况。结果：两组患者术后并发症的发生率无显著性差异。结论：术前放疗可使子宫颈癌手术适应证的选择扩大到Ⅱb期,且不增加术后并发症的发生。     

Is preoperative transrectal ultrasonography of value in localised prostatic carcinoma? A blind comparative study between preoperative transrectal ultrasonography and the histopathological radical prostatectomy specimen.

Digital rectal examination (DRE) for staging is subjective and unreliable. Understaging has been reported in 25-72% and clinical overstaging of T3 tumors varies from 24-50%. In the present study of 15 patients, transrectal ultrasound (TRUS) staging was compared, in a blind comparative fashion, with pathological staging of the surgical specimen. Multifocal lesions were present in 8/15 patients (53%). A distinction was made between capsular involvement and 'clear' capsular penetration. TRUS was more sensitive in predicting capsular involvement than DRE (83% vs 17%), but the specificity was low (67% vs 100%). If capsular perforation was considered, the sensitivity and specificity of TRUS are 43% and 91%, respectively. Sensitivity and specificity for seminal vesicle tumor involvement by TRUS was 63% and 86%. Using TRUS the overall staging was improved by 33% compared with DRE and therefore TRUS is considered to be a valuable acquisition in localising and staging prostate cancer.     

术前放疗对子宫颈癌根治术后并发症的影响

目的:探讨术前放疗对子宫颈癌根治术后近期并发症的影响.方法:将374例子宫颈癌根治术后患者分为术前放疗组及未放疗组,进行回顾性对比分析两组并发症发生情况.结果:两组患者术后并发症的发生率无显著性差异.结论:术前放疗可使子宫颈癌手术适应证的选择扩大到Ⅱb期,且不增加术后并发症的发生.     

The treatment of stage IV carcinoma of cervix by radical dose radiotherapy

During 1974-1979, 92 patients (14% of all carcinoma cervix cases) were assigned to Stage IV; 68 (10%) to Stage IVa and 24 (4%) to Stage IVb. Fifty-five patients were treated radically using 4 MeV X-rays (42.5 Gy in 20 fractions) followed by a 137Cs insertion (33.5 Gy to the A points). Twenty-six patients were treated palliatively and 11 received no treatment. Sixteen per cent of radically treated patients were alive at 5 years, whereas all patients treated palliatively were dead in 18 months. Pelvic tumour was eliminated in 22/55 (40%) treated radically, but in only 1/26 treated palliatively. The 5-year survival for Stage IVa treated radically was 18% and 19/44 (43%) had local tumour control. Only one patient in Stage IVb (involvement of vulva) was alive at 5 years. The overall 5-year survival for Stage IV patients in this series was 11/92 (12%).     

ALBI评分对符合米兰标准的肝细胞癌术后并发症的预测价值

目的:评估术前ALBI评分对符合米兰标准的肝癌患者术后并发症的预测价值。方法:纳入2009年至2016年间接受开放肝癌切除术的400例符合米兰标准的肝癌患者。采用受试者工作特征（ROC）曲线分析确定ALBI的最佳截断值。进行单因素和多因素分析以确定术后并发症发生的相关危险因素。研究术前ALBI评分与临床病理参数的相关性。结果:预测术后并发症ALBI评分的最佳截断值-2.62。多因素分析提示ALBI评分是术后并发症的独立预后因素。ALBI评分>-2.62的肝癌患者术中出血量、住院时间和术后并发症发生率也显著高于对照组（ALBI≤-2.62）。结论:术前ALBI评分是预测符合米兰标准的肝癌术后并发症的有效指标。在日常临床实践中ALBI评分可作为肝储备分层的生物标志物。     

Excellent results of radiotherapy for neuroendocrine carcinoma of the uterine cervix.

Neuroendocrine carcinoma of the uterine cervix is a rare neoplasm that is associated with a poor prognosis, and there have been no reports of excellent results of radiotherapy to treat it. We report a case of neuroendocrine uterine cervical carcinoma, as stage IIIa (FIGO), in which the patient showed a complete clinical response to radiotherapy.     

Clinical stage I carcinoma of the uterine cervix value of preoperative magnetic resonance imaging in assessing parametrial invasion

AIMS AND BACKGROUND: The purpose of this prospective study was to assess the efficacy of different MR imaging techniques in the evaluation of parametrial tumor invasion in patients with early stage cervical cancer. METHODS: A total of 73 consecutive patients, clinically considered to have invasive tumor (<3 cm in diameter) confined to the cervix, underwent MR imaging studies at 1 T, according to the following protocol: fast spin-echo (FSE) T2-weighted, gadolinium-enhanced SE T1-weighted, and fat-suppressed gadolinium-enhanced SE T1-weighted sequences. Images obtained with each sequence were evaluated for parametrial invasion with the use of histopathologic findings as the standard of reference. RESULTS: In the assessment of tumor infiltration of the parametrium, with FSE T2-weighted images accuracy was 83%, with SE T1-weighted gadolinium-enhanced images was 65%, and with SE T1-weighted gadolinium-enhanced fat-suppressed images was 72%. The difference between the accuracy rate achieved with FSE T2-weighted images and those obtained with the other two MR sequences was statistically significant (P <0.05). The high negative predictive value (95%) for the exclusion of parametrial tumor invasion was the principal contributor to the staging accuracy obtained with FSE T2-weighted imaging. CONCLUSIONS: Unenhanced FSE T2-weighted imaging is a reliable method for determining the degree of tumor invasion in patients with early stage cervical cancer. Our data suggest that contrast-enhanced sequences, even with the use of the fat suppression technique, have limited value in assessing tumor extension.