Radiation therapy in stage III ovarian cancer following surgery and chemotherapy: prognostic factors, patterns of relapse, and toxicity: a preliminary report

Twenty patients with FIGO stage III epithelial ovarian cancer who had undergone maximum cytoreductive surgery (including pelvic and paraaortic lymph node dissection) and combination chemotherapy (4-10 cycles, median 6) were treated with irradiation to the abdomen and pelvis with 30 Gy followed by diaphragmatic/paraaortic and pelvis boost fields to 42 and 51.6 Gy, respectively. Second-look laparotomy was not performed. Seventeen of 20 patients completed the planned course of radiation. In 2 cases, failure to complete treatment was related to acute hematologic toxicity, and 1 patient refused further treatment. Five patients (29%) required treatment breaks ranging from 8 to 16 days (median, 12 days) due to pancytopenia. Actuarial overall survival and relapse-free survival at 3 years for the 17 patients who completed radiation was 69 and 47%, respectively, with follow-up ranging from 19 to 53 months (median: 24, mean: 27.6 months). Seven patients (41%) relapsed within the abdomen alone and 2 patients developed extraabdominal lymph node metastasis as their sole site of failure. The prognostic factors evaluated for correlation with relapse-free survival included histologic subtype, grade, amount of residual disease at the time of surgery, and nodal involvement; only residual tumor at surgery (none vs less than or equal to 2 cm or greater than 2 cm) was found to be statistically significant (P less than 0.01). Three-year overall survival correlated with amount of residual disease following the initial cytoreductive surgery. It was 100% for patients with no residual disease, 66.7% for less than or equal to 2 cm, and 26.7% for those with greater than 2 cm residual disease, respectively. Radiation treatment was well tolerated, with only one patient developing treatment-related bowel obstruction 7 months after radiation therapy. The results of this planned trimodality treatment approach compare favorably with those reported following surgery and chemotherapy, particularly in patients who have been maximally cytoreduced.     

Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay

Presented is a retrospective review of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate or a delayed hysterectomy. The three groups were comparable in age, weight, and major preoperative medical problems. The mean estimated blood loss during surgery and transfusion requirements during hospitalization were similar for all three groups. The duration of the surgery in the immediate group was longer than the other two groups. The occurrence of febrile morbidity and major postoperative complications in the three groups was similar, except for bacteriuria, which was significantly more common in the immediate group. The length of the postoperative hospitalization was the same for each group; however, the delayed group as compared with the immediate group had a total hospitalization of two days longer. Hence, in the current study, immediate hysterectomy did not significantly increase the surgical or postoperative morbidity rate, compared with delayed hysterectomy. The single hospital stay in the former treatment group represented cost containment.     

Symptomatische Therapie der atopischen Dermatitis

The optimal treatment of atopic dermatitis requires regular medical supervision. The course of this chronic skin disease is influenced by multiple triggers which are relevant for the treatment. The mainstays of topical therapy include regular use of emollients coupled with antimicrobial substances, corticosteroids and immune modulators as required. Ultraviolet radiation and immunosuppressive regimens represent further options for the treatment of severe exacerbations and may lead to long term improvement. Data from experimental studies provide insight into possible future treatment methods.     

Absence of HHV-8 DNA in hobnail hemangiomas

BACKGROUND: Hobnail hemangioma (HH) is a rare subtype of hemangioma that shares the morphological feature of hobnail endothelia with retiform hemangioendothelioma (RHE) and has to be considered in the differential diagnosis of Kaposi sarcoma. Since DNA of the human herpesvirus type 8 (HHV-8) has been detected in more than 90% of Karposi sarcomas and could recently be demonstrated in RHE, we sought to detect HHV-8 DNA in HH. METHODS AND RESULTS: DNA from 12 HH was extracted and subjected to polymerase chain reaction analysis for HHV-8 DNA using two independent protocols with a single set of primers and a nested PCR approach, respectively. PCR amplification was performed using the LightCycler as well as using a thermocycler. HHV-8 DNA could not be detected in HH, although each sample contained DNA adaequately preserved for PCR reactions, as determined by amplification of the beta actin gene. CONCLUSIONS: HHV-8 appears to play no rule in the pathogenesis of HH. Absence of HHV-8 DNA in HH might be important in the differential diagnosis to other vascular tumours, in particular Kaposi sarcoma.