子宫颈鳞癌和腺癌的放射敏感性比较

目的比较子宫颈鳞癌和腺癌的放射敏感性。方法二次后装治疗后,比较宫颈鳞癌和腺癌肿瘤缩小和肿瘤细胞放射性损伤程度,同时用免疫组织化学ＡＢＣ法检测放射治疗前后宫颈鳞癌和腺癌的增殖细胞核抗原指数（ＰＩ）并进行比较。结果二次后装治疗后,宫颈鳞癌局部肿瘤缩小≥５０％者占７０％（２１／３０）,腺癌为２７％（４／１５）,差异有极显著性（Ｐ＜０．０１）。宫颈鳞癌放射性损伤为Ⅱｂ～Ⅲ级者占６０％（１８／３０）,腺癌为２０％（３／１５）,差异有显著性（Ｐ＜０．０５）;宫颈鳞癌放射治疗后ＰＩ从５３５０％±４３４％降至３９３０％±４０２％,差异有极显著性（Ｐ＜０．００１）,而腺癌ＰＩ自３５４７％±３８３％降至３１８０％±３０６％,差异无显著性（Ｐ＞０．０５）。结论宫颈鳞癌放射敏感性高于腺癌,放射过程中ＰＩ的降低,可能是宫颈鳞癌放射敏感性的生物学基础。     

Monitoring the course of cervical carcinoma with the squamous cell carcinoma serum radioimmunoassay

Serum samples were collected from 611 gynecologic patients for measurement of squamous cell carcinoma antigen levels using the Abbott Laboratories squamous cell carcinoma antigen radioimmunoassay kit. Sixteen of 83 patients (19.3%) with cervical dysplasia and 72 of 135 (53.3%) with primary or recurrent cervical carcinoma had levels above 2.4 ng/mL. In contrast, only seven of 373 women (1.9%) without genital tract squamous cell intraepithelial neoplasia or carcinoma had squamous cell carcinoma antigen levels above 2.4 ng/mL. Fifty-six patients with cervical cancer were followed for correlation of squamous cell carcinoma antigen levels to disease course, and 20 had persistent or recurrent disease after therapy; rising squamous cell carcinoma antigen levels predicted disease in 15 of these 20 patients with recurrence (13 of 15 with elevated pre-treatment levels and two of five with normal pre-treatment levels). Rising squamous cell carcinoma antigen levels preceded the clinical detection of disease in ten patients by a mean of 4.6 months (range 2-7.5 months); in the remaining five, squamous cell carcinoma antigen levels were elevated only when disease recurrence was documented. Although measurement of squamous cell carcinoma antigen levels is not a sensitive screening method for cervical cancer (sensitivity 53.3%), the test has good specificity (94.3%); the majority of patients with false-positive elevations had other genital tract squamous cell neoplasias. The squamous cell carcinoma antigen assay may be a useful aid for monitoring the disease course of cervical carcinoma.     

Recurrent squamous carcinoma of the vulva.

OBJECTIVE: This study reviews experience at Indiana University with recurrent squamous carcinoma of the vulva over an 18-year period from 1971 to 1989. The pattern of recurrence, time interval to recurrence, and efficacy of salvage therapy are evaluated in the context of the primary tumor. STUDY DESIGN: This is a retrospective study of 40 patients, 21 of whom underwent primary therapy for invasive squamous carcinoma of the vulva at Indiana University. RESULTS: Vulvar recurrences were observed in 17 patients (43%), the groin was involved in 12 (30%), whereas pelvic and distant recurrences were observed in 2 (5%) and 9 (22.5%) patients, respectively. Salvage surgery and/or radiotherapy were successful in 25 patients (62.5%) alive from 1 to 144 months (median 8 months) from secondary therapy. Survival after retreatment varied significantly by site of recurrence (p = 0.002), tumor grade (p = 0.009), and interval to recurrence (p < 0.001). Best outcomes were in patients with initial stage I or II disease (International Federation of Gynecology and Obstetrics), grade 1 tumors, local failure, and interval to relapse of > 16 months' duration. Two of 12 patients with groin recurrences were salvaged with surgery and radiotherapy. CONCLUSION: Long-term follow-up of patients with vulvar cancer and careful restaging at the time of recurrence are mandatory. Although local and nodal recurrences may be controlled with surgery and/or radiotherapy, regional recurrences are usually fatal.     

鳞状细胞癌抗原与子宫颈鳞状细胞癌的临床病理特征及预后的关系

目的 探讨治疗前血清鳞状细胞癌抗原（SCCAg）滴度与宫颈鳞状细胞癌（鳞癌）临床病理特征的关系,以及作为预测预后的因素的意义。方法 选择114例治疗前检测过血清SCCAg并经治疗后长期随访的Ⅰb1～Ⅱa期宫颈鳞癌患者,结合临床资料对SCCAg与临床病理特征及预后的关系进行单因素和多因素分析。结果 单因素分析显示,治疗前血清SCCAg滴度升高（正常值≤1．5mg／L）与肿瘤直径、深肌层浸润及盆腔淋巴结转移相关（P〈0．05）;多因素分析显示,SCCAg滴度升高与深肌层浸润（P=0．029）、盆腔淋巴结转移（P=0．049）相关。114例患者的5年累积无瘤生存率为78．6％,总复发率为27．2％。单因素分析显示,SCCAg滴度升高、盆腔淋巴结转移与5年累积无瘤生存率及复发相关（P〈0．05）;多因素分析显示,影响预后的独立因素为SCCAg滴度升高（P=0．030）和盆腔淋巴结转移（P=0．003）,影响复发的显著相关因素为盆腔淋巴结转移（P=0．006）。盆腔淋巴结转移且SCCAg滴度正常者与盆腔淋巴结转移且SCCAg滴度升高者,5年累积无瘤生存率（分别为50．0％、50．9％）、复发率[分别为60．0％（6／10）、47．1％（8／17）]、局部复发率[分别为3／8、20．0％（3／15）]和远处复发率[分别为1／8、20．0％（3／15）]分别比较,差异均无统计学意义（P〉0．05）。盆腔淋巴结无转移且SCCAg滴度正常者与盆腔淋巴结无转移且SCCAg滴度升高者,5年累积无瘤生存率（分别为98．0％、71．8％,P=0．003）、复发率[分别为9．8％（5／51）、33．3％（12／36）,P=0．006]、局部复发率[分别为2．1％（1／47）、26．5％（9／34）,P=0．001]分别比较,差异均有统计学意义。结论 治疗前血清SCCAg滴度升高和盆腔淋巴结转移是影响Ⅰb1～Ⅱa期宫颈鳞癌患者预后的独立因素。治疗前血清SCCAg滴度升高且盆腔淋巴结无转移患者的局部复发风险显著升高。     

Changes of Ki-67 index in squamous cell carcinoma of the cervix during the early course of radiotherapy and prediction of prognosis

PURPOSE: To determine whether changes in the Ki-67 index during the early course of radiotherapy could predict the prognosis in squamous cell carcinoma of the uterine cervix and be of value in clinical practice. MATERIALS AND METHODS: Biopsy specimens from 23 cases of histologically confirmed squamous cell carcinoma of the cervix were stained with anti-Ki-67 monoclonal antibody prior to radiotherapy and after 9 Gy. The correlation between the Ki-67 index, local control and distant metastasis was determined by Spearman's correlation test. RESULTS: Median age of the patients was 49. According to the FIGO staging system four patients had Stage IIA, 16 had Stage IIB, one had Stage IIIA and two had Stage IIIB disease. Among the whole group brachytherapy was applied to 17 patients (17/23) and weekly cisplatin (40 mg/m2) was applied to 15 patients (15/23). The mean Ki-67 index prior to radiotherapy and after 9 Gy for the entire group were 58.5% and 46.0%, respectively. The Ki-67 index after 9 Gy decreased in most of the patients (74%). During a median follow-up of 23 months four patients developed local recurrence and four patients developed distant metastasis. No significant correlation was detected among the local control and changes in Ki-67 index after 9 Gy, whereas there was a moderate correlation between distant metastasis and changes in Ki-67 index after 9 Gy (r = 0.51, p = 0.01). CONCLUSION: The Ki-67 index can be used safely as a proliferation marker in cervical carcinomas, and changes in the Ki-67 index during the early course of radiotherapy may predict the metastatic potential. However prospective studies including a large number of patients with long-term follow-up are necessary to confirm the clinical utility of this marker in cervical cancer.     

Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

OBJECTIVE: The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma. METHODS: Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death. RESULTS: The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n = 18), Stage II (n = 7), and Stage III (n = 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n = 5) or at distant sites (n = 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n = 2), fistula (n = 2), and radiation stricture (n = 1). CONCLUSION: Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.     

Expression of thymidine phosphorylase as an effect prediction factor for uterine cervical squamous cell carcinoma after radiotherapy: an immunohistochemical study

Prognoses in cases of uterine cervical squamous cell carcinoma treated with radiotherapy were investigated in association with immunohistochemical expression of an angiogenic factor, thymidine phosphorylase (TP). Forty-six cases of uterine cervical squamous cell carcinoma mainly treated with radiotherapy during 1992-2001 at our clinic were studied. All were diagnosed as stages IIB to IVA. Paraffin-embedded biopsy specimens excised before radiotherapy were stained immunohistochemically using anti-TP monoclonal antibody. The extent of staining in both tumor and interstitial cells was graded as (-), (+/-), (+), and (2+). Specimens with TP expression levels of (2+) and (+) were regarded as positively stained and those with TP expression levels of (+/-) and (-) as negatively stained. The efficacy of radiotherapy in both groups was analyzed by the Kaplan-Meier method. With tumor cells, 5-year survival rates for the positive (n= 38) and negative (n= 8) staining groups were 73.9% and 42.9%, respectively; the rate being significantly higher for the TP-positive group (log rank, P= 0.0096). Contrarily, with staining for interstitial cells, the 5-year survival rates for the positive (n= 20) and negative (n= 26) staining groups were 74.1% and 64.6%, respectively, with no significant difference (log rank, P= 0.406). The efficacy of radiotherapy in the group with positive staining of tumor cells was significantly better than in the negative staining group. Immunohistochemical expression of TP in tumor cells is suggested as a useful prognostic factor for uterine cervical squamous cell carcinomas treated with radiotherapy. Choosing therapy for individual cases by referring to factors including TP expression should contribute to an improved prognosis.     

An evaluation of squamous cell carcinoma antigen in patients with cervical squamous cell carcinoma

In a prospective study, serum concentrations of squamous cell carcinoma antigen, a subfraction of tumor antigen (TA-4), were determined by radioimmunoassay from healthy donors, pregnant women, and subjects with various benign and malignant gynecologic diseases. Ninety-six percent of 99 healthy persons including all 52 female controls, the 15 pregnant patients, and all 23 subjects with benign gynecologic tumors, had squamous cell carcinoma antigen levels less than 2.0 ng/ml. Seven of 51 (14%) patients with cervical intraepithelial neoplasia and 16 of 24 (67%) patients with cervical squamous cell carcinoma had squamous cell carcinoma antigen levels greater than 2.0 ng/ml. Declining and rising levels of squamous cell carcinoma antigen, which were determined sequentially in nine cases of cervical carcinoma that were associated with elevated pretreatment levels of squamous cell carcinoma antigen, correlated with regression and progression of the disease. Serial serum levels of squamous cell carcinoma antigen provide a noninvasive means of monitoring the effects of individual therapy in patients with cervical squamous cell carcinoma.     

The curative role of radiotherapy in patients with isolated para-aortic node recurrence from cervical cancer and value of squamous cell carcinoma antigen for early detection

The objective of this study was to examine the clinical benefits of routine squamous cell carcinoma antigen (SCC-ag) monitoring of patients with locally advanced cervical cancer. Recurrent disease occurred in 99 uterine cervical cancer patients with elevated pretreatment SCC-ag before primary radiotherapy. Elevated SCC-ag levels persisted in 23 patients after primary radiotherapy (group 1), and SCC-ag was normalized in 76 patients after primary radiotherapy (group 2). The overall survival (OS) rate was higher for patients with SCC-ag elevation as the first sign than for patients with recurrence predicted by other modalities for group 2 patients (P = 0.033). The prediction of isolated para-aortic node recurrence significantly correlated with SCC-ag elevation as an initial sign (P = 0.001). The SCC-ag level before primary radiotherapy (> or = 10.8 ng/mL) significantly affected recurrence predicted by SCC-ag elevation as an initial sign (P = 0.002). For multivariate analysis, the presence of para-aortic node recurrence was statistically significant in OS (P < 0.0001). Routine SCC-ag monitoring of patients with carcinoma of the uterine cervix can lead to the early diagnosis of isolated para-aortic lymph node recurrence, and prolonged survival can be achieved by applying radiation therapy to the para-aortic region. To reduce the number of patients monitored for SCC-ag, we recommend monitoring group 2 patients with pretreatment SCC-ag level before primary radiotherapy > or = 10.8 ng/mL.     

Vulvar squamous cell carcinoma. Prognostic factors for local recurrence after primary en bloc radical vulvectomy and bilateral groin dissection

OBJECTIVE: To evaluate clinical prognostic factors for local recurrence of vulvar squamous cell carcinoma after primary surgical treatment. STUDY DESIGN: Of 104 patients treated for squamous cell carcinoma of the vulva in an 11-year period (1987-1997) at the Portuguese Cancer Institute, we selected for study 56 patients who meet the following criteria: (1) International Federation of Gynecology and Obstetrics (FIGO) stage Ib-IVa, (2) primary treatment of en bloc radical vulvectomy and bilateral groin dissection, and (3) follow-up reports. Files were retrieved for retrospective analysis. Fifteen patients (26.8%) had local recurrence at the fifth year. At the 24th month, 11 patients had local recurrence, and 31 were in follow-up, without recurrence. We evaluated age at initial diagnosis, date of surgical treatment, tumor size, results of tumor macroscopy, histologic differentiation, groin lymph node status, FIGO stage, resection limits, adjuvant radiotherapy, duration of stay, associated vulvar skin disease, date of detection of recurrence, site/sites of recurrence and follow-up status at the 24th month after surgical treatment between the 11 patients with local recurrence and 31 in follow-up without recurrence. RESULTS: The 11 patients with local recurrence had a significant initial FIGO stage, IVa (P = .049) and a significant association with the number of groin lymph nodes containing metastasis in comparison to the 31 patients without local recurrence. No other statistically compared data were significant. CONCLUSION: These results suggest that vulvar squamous cell carcinoma local recurrence after a primary surgical procedure is related to poor tumor prognostic factors (number of groin nodes containing tumor metastasis and FIGO stage IVa). On multivariate analysis, the presence of metastasis in two or more groin nodes was a powerful factor related to local recurrence. Postoperative radiotherapy to the vulva for such patients with a high risk of local recurrence is advisable.     

Squamous cell carcinoma (SCC) antigen in patients with invasive cervical carcinoma during primary irradiation

In a prospective study, serum concentrations of squamous cell carcinoma (SCC) antigen were determined by radioimmunoassay from 74 healthy volunteers and 54 patients with cervical carcinoma who underwent irradiation therapy. 5.4% of the controls had SCC levels greater than 3.0 ng/ml, which was considered as upper limit of the normal range. 31/54 (57.4%) patients and 60% of the patients with SCC had elevated pretreatment levels. In all patients with pretreatment serum levels above 3.0 ng/ml, SCC serum levels decreased during irradiation therapy. 4/5 patients with posttreatment levels greater than 0.5 ng/ml developed recurrence or persistence of tumor, 1 patient could not be followed up. Good conformity was found between SCC antigen serum levels and therapy response. SCC antigen determinations during and after therapy provide a useful tool in detecting progression and persistence of tumor.     

子宫颈鳞状细胞癌复发患者血清鳞状细胞癌抗原监测的意义

目的探讨血清鳞状细胞癌抗原（SCCAg）在监测宫颈鳞癌患者复发中的意义。方法对1999-2005年收治的72例宫颈鳞癌复发患者血清SCCAg水平与诊断、预后的关系进行单因素和多因素分析。结果72例复发患者中,术后复发30例、放化疗后复发42例,其中血清SCCAg水平升高者61例（占85％）。此61例患者中,20例在随诊中首先出现血清SCCAg水平升高而临床及影像学检查未发现肿瘤,血清SCCAg水平提前升高的中位时间为3个月,平均4．6个月（1～13个月）。72例复发患者中,45例患者无任何临床症状,仅因血清SCCAg水平升高或常规随诊发现复发;27例患者有症状,其中单侧下肢水肿或疼痛15例,阴道不规则流血7例,出现远处转移相关症状5例。细胞或组织病理学检查诊断复发者33例;临床及影像学检查结合血清SCCAg水平诊断复发者39例,其中29例仅依靠血清SCCAg水平升高及影像学检查即诊断复发。72例复发患者的中位生存时间为11个月,平均生存时间为23个月（2～62个月）,总的3年生存率为25％,5年生存率为19％。单因素分析发现,初治前患者血清SCCAg水平、病理分级、复发部位、复发后治疗方式以及复发时、复发后治疗中、治疗后血清SCCAg水平对患者的3年生存率有明显影响（P〈0．01）;但20例血清SCCAg水平提前出现升高的患者与52例血清SCCAg水平未提前升高的患者相比,3年生存率分别为22％、27％,差异无统计学意义（P=0．5761）。多因素分析发现,复发患者仅病理分级、复发后的治疗方式是独立的预后影响因素（P〈0．05）;而复发部位及各种血清SCCAg状态不是独立的预后影响因素（P〉0．05）。结论血清SCCAg水平监测在宫颈鳞癌复发患者中的诊断及其对预后的判断中有一定的价值。     

A clinical study on multiple tumor markers following therapy in patients with uterine cervical carcinoma

In order to evaluate the clinical significance of multiple tumor markers, plasma levels of carcino-embryonic antigen (CEA), squamous cell carcinoma-related antigen (SCC), tissue polypeptide antigen (TPA) and immunosuppressive acidic protein (IAP) were measured before and after treatment in 136 patients (89 surgery cases and 47 radiotherapy cases). The patients had invasive cervical carcinoma (stages I-IV). The effect of radiotherapy was examined by cytology and biopsies obtained by colposcopy. For CEA, SCC and TPA there was a significant reduction (p less than 0.01) in values between the pretreatment and posttreatment periods, but plasma IAP was transiently increased after operation. Cytology and histology revealed negative rates of 95.6% and 86.7%, respectively, after radiotherapy. Regarding recurrence, for the negative groups and positive groups plasma CEA, SCC, TPA and IAP were determined in 24 patients with stage IIIb before radiotherapy. Only the CEA concentration showed a good correlation with the outcome (p less than 0.01). Effective serial plasma determinations of CEA, SCC and TPA in patients with cervical carcinoma following therapy may often be useful in the evaluation of therapy as well as in the earlier detection of recurrent disease.     

Clinical significance of interleukin-1 receptor antagonist in patients with cervical carcinoma

OBJECTIVE: Our purpose was to determine the clinical significance of interleukin-1 receptor antagonist (IL-1ra), which is an endogenous inhibitor cytokine of IL-1, in patients with cervical carcinoma. METHODS: Tissue IL-1ra expression and serum IL-1ra level were examined by enzyme-linked immunosorbent assay (ELISA), Western blotting, and immunohistochemistry in normal controls and patients with cervical carcinoma. RESULTS: Tissue IL-1ra protein level by ELISA was significantly higher in squamous cell carcinoma (n = 9) than in the normal cervix (n = 7) and adenocarcinoma (n = 3). Western blotting confirmed the main presence of intracellular IL-1ra type 1 in squamous cell carcinoma. Immunohistochemistry demonstrated significant IL-1ra expression only in tumor cells of squamous cell carcinoma. Elevation of serum IL-1ra level was found in patients with squamous cell carcinoma (n = 38) compared to normal women (n = 13), but not in patients with adenocarcinoma (n = 9). Although serum IL-1ra level did not correlate with clinical stage or any other tumor marker, high serum IL-1ra level was associated with pelvic lymph node metastasis and poor prognosis in patients with squamous cell carcinoma. On the other hand, these results were not obtained in patients with cervical adenocarcinoma. CONCLUSION: IL-1ra may play important roles in local and general malignant behaviors in patients with cervical squamous cell carcinoma, and measurement of serum IL-1ra level may be useful in predicting patient survival.     

Patients with squamous cell versus adeno(squamous) carcinoma of the cervix, what factors determine the prognosis?

Patients with squamous cell carcinoma of the cervix FIGO stages IB to IV ( n = 306) were compared to patients with adeno(squamous) carcinoma ( n = 70). There was no difference between the mean ages of the groups. In the patients who underwent radical surgical treatment, whether or not in combination with radiotherapy ( n = 209), stepwise regression analysis showed that a positive lymph node status was the most unfavorable prognostic factor, followed by the histologic type (adeno(squamous) carcinoma) and the tumor diameter (> 3 cm). Vascular-space invasion had no additional prognostic value. Patient's age did not affect the prognosis. Distant metastases were not found to be more prevalent in the patients with adeno(squamous) carcinoma. In patients with adeno(squamous) carcinoma and positive lymph nodes, it is worth considering more intensive locoregional treatment than is usually prescribed for these patients and/or adjunctive chemotherapy, because there is a high risk of tumor recurrence.     

Serum squamous cell carcinoma antigen in the monitoring of radiotherapy treatment response in carcinoma of the cervix

In this study, squamous cell carcinoma antigen (SCC) was detected in 96 of 157 patients with squamous cell carcinoma of the cervix and the percentage of patients with raised SCC levels increased with the stage of disease (P less than 0.01). The use of serial SCC assays and cervical biopsy histology during the course of radiotherapy to predict tumor response to irradiation was assessed. In patients who were given external irradiation before intracavitary radium, a high SCC level or the presence of viable tumor cells in the biopsy was found to be of no predictive value. However, at completion of radiotherapy, i.e., after intracavitary radium application, patients with persistently high SCC levels had a significantly higher incidence of residual tumor than patients whose SCC levels returned to normal (P less than 0.01). In 60% of patients with a persistently high SCC level, viable tumor was found in the cervical biopsy at the end of radiotherapy. On the other hand, only 5.4% of patients whose SCC level returned to normal had residual tumor.     

Patterns of recurrence and disease-free survival in advanced squamous cell carcinoma of the vulva

OBJECTIVE: To compare patterns of recurrence and disease-free survival (DFS) of node-positive and node-negative patients with advanced vulval squamous cell carcinoma (SCC). METHODS: Fifty-five patients with FIGO stage III/IVA vulval SCC who had surgery at the Queensland Centre for Gynaecological Cancer from 1989 to 1999 were included. Patients were grouped as follows: Group A, pT3 N0; Group B, pT3 N1; Group C, pT4 N2. Treatment included surgery +/- postoperative radiotherapy. Multivariate Cox models were calculated to identify independent prognostic factors. RESULTS: After a median follow-up of 96 months, 25 patients (45.5%) experienced recurrence at the vulva (n = 2), pelvis (n = 8), or distant sites (n = 15). Recurrence in the pelvis and at distant sites was more likely for patients in groups B and C (P 0.003). At 5 years the probability of DFS was 66.6%, 35.3%, and 39.8% for patients in groups A, B, and C, respectively (P 0.085). Patients with negative nodes (n = 15), one microscopic positive node (n = 11), and two or more positive nodes (n = 29) had a probability of DFS of 66.6%, 67.3%, and 26.1% at 5 years, respectively (P 0.005). CONCLUSION: Patients with > or =2 positive groin nodes are at risk for distant failure. The DFS of patients with negative groin nodes and those with only one microscopic positive node is very similar. The prognosis of patients with > or =2 positive unilateral or bilateral groin nodes is similar. The current FIGO staging system inaccurately reflects prognosis for patients with advanced vulval cancer. Clinical trials are warranted to investigate the benefit of systemic treatment.     

Serum squamous cell carcinoma antigen levels in women with neoplasms of the lower genital tract and in healthy controls

Summary Squamous cell carcinoma antigen levels in 74 healthy volunteers, 57 patients with CIN and 91 patients with cervical carcinoma were determined by radioimmunoassay. 5.4% of healthy volunteers were above and all patients with CIN were below 3.0 ng/ml. 63.1% of 65 patients with primary squamous cell carcinoma, 1 out of 7 adenocarcinomas and 68.4% of 19 patients with recurrence of squamous cell carcinoma of the cervix had elevated SCC antigen levels. Elevated posttreatment levels carried a high risk factor of tumor persistence. Increases in SCC antigen levels during follow up usually signified recurrent carcinoma.     

Monitoring of serum squamous cell carcinoma antigen levels in invasive cervical cancer: is it cost-effective?

OBJECTIVE: The aim of this study was to assess the cost-effectiveness of serial squamous cell carcinoma antigen (SCC) monitoring in the clinical setting. METHODS: All patients with squamous cell carcinoma of the cervix and SCC measurement from 1994 to 1999 were reviewed. The cost of the investigations, including blood tests, X rays, and computer tomography; and clinic visits were adjusted to 2001 dollars for all cases over the 6-year study period. The effectiveness measure was the number of cases detected by SCC monitoring before the onset of clinical symptoms or abnormal physical examination findings. Altered clinical management due to early detection was considered successful. RESULTS: Two thousand eight hundred fifty-one SCC antigen assays were performed from 384 patients. An elevated pretreatment SCC level was associated with poorer cumulative survival over time (P < 0.05). Fifty-five patients had recurrences, with 10 local and 45 distant recurrences. SCC levels were elevated in 47 patients (85%). The median lead time was 7.8 months. The cost of finding 1 recurrence was US$4750. SCC monitoring does not alter clinical management and has no advantage over clinical examination in detecting local recurrence. Most of the recurrent diseases were detected too late for curative treatment. Only 1 patient, in whom the diagnosis could have been made by clinical examination without SCC monitoring, may have potentially benefited from exenteration. CONCLUSION: Posttreatment SCC monitoring is not cost-effective in the absence of curative treatment for distant spread of disease.     

Treatment results following breast-conserving therapy in primary breast cancer

OBJECTIVE: To evaluate mono-institutional results concerning tumor free survival, overall survival, local tumor control and rate of distant metastasis following breast-conserving therapy. PATIENTS AND METHODS: Retrospectively, 274 breast cancer patients who were treated between 1990-1997 in our institution were analysed. The whole breast was homogeneously irradiated (2.0 Gy to 50 Gy), followed by a boost of 10-16 Gy to the tumor bed. Mean follow-up was 55 months. Overall survival, local tumor control and rate of distant metastasis were analysed. RESULTS: Cause-specific survival at 5 years after treatment was 93 %. Within 3 to 60 months following treatment, 18 (7 %) patients suffered from ipsilateral breast recurrence. 24 (9 %) patients developed contralateral carcinoma. Survival from local recurrence (single manifestation) was 78 % at 5 years after treatment, 20 % at 7 years. Occurrence of local failures was significantly correlated to receptor status, contralateral carcinoma, distant metastasis and surgical technique and not to tumor size, margins, grading, nodal status, age or lymphangiosis. 9 % of the patients developed distant metastases, predominantly bone metastases (71 %). Survival from distant metastasis was 64 % at 5 years, 10 % at 7 years. Occurrence of distant metastasis was significantly correlated to grading, tumor size, receptor status, lymphangiosis or local recurrence. CONCLUSION: Our institutional results show that tumor free survival, overall survival, local tumor control and distant failure rate achieved by breast conserving therapy are within the range of literature data.