Prognostic value of lymph node status and number of removed nodes in patients with squamous cell carcinoma of the vulva treated with modified radical vulvectomy and inguinal-femoral lymphadenectomy

PURPOSE OF INVESTIGATION

To assess the outcome of patients with squamous cell vulvar carcinoma treated with deep partial or total vulvectomy and inguinal-femoral lymphadenectomy.

MATERIALS AND METHODS

The authors assessed 87 patients who underwent primary surgery.

RESULTS

Tumor recurred in 34 patients, and the first relapse was local in 19, inguinal in ten, and distant in five. Five-year disease-free survival was 56.7% and was related to Stage (p < 0.0001), grade (p = 0.023), and node status (p < 0.0001). Groin failure occurred in 4.9% of node-negative patients compared with 29.6% of node-positive patients (p = 0.0096). Distant recurrences only developed in women with positive nodes. Among the 47 patients who underwent bilateral lymphadenectomy and who had negative nodes, groin recurrence occurred in 12% of those who had < or = 15 nodes removed and 0% of those who had > 15 nodes removed.

CONCLUSIONS

Stage and node status were the most important prognostic variables. There was a trend favoring a better groin control in patients with node-negative disease who underwent extensive lymphadenectomy.

Combined Nd-YAG laser/HDR brachytherapy versus Nd-YAG laser only in malignant central airway involvement: a prospective randomized study

BACKGROUND

Laser debulking and prosthetic stents are useful modalities in the palliative treatment of initial inoperable or recurrent lung cancer. Recently, endobrochial brachytherapy was introduced to extend the duration of palliation and reduce the number of endoscopic treatments. This trial compares Nd-YAG laser alone and associated to high dose rated (HDR)-brachytherapy.

PATIENTS AND METHODS

From 1995 to 1998, 29 consecutive patients, with non-small cell lung cancer (NSCLC) and central airway involvement, were randomized in two groups: group 1 (15 patients) received Nd-YAG laser only; group 2 (14 patients) underwent a combined Nd-YAG laser/ HDR brachytherapy treatment.

RESULTS

There was no mortality or morbidity related to the treatment. The period free from symptoms was 2.8 months for group 1 and increased to 8.5 months in group 2 (P<0.05). The disease's progression free period grew from 2.2 months of group 1 to 7.5 months of group 2 (P<0.05) and the number of further endoscopic treatment reduced from 15 to 3 (P<0.05).

CONCLUSION

The results confirm the potential of brachytherapy to prolong relief from symptoms, lessen disease progression and reduce costs of treatment. A detailed analysis is presented of both groups.

A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844

PURPOSE

Cerebral low-grade gliomas (LGG) in adults are mostly composed of astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas. There is at present no consensus in the policy of treatment of these tumors. We sought to determine the efficacy of radiotherapy and the presence of a dose-response relationship for these tumors in two multicentric randomized trials conducted by the European Organization for Research and Treatment of Cancer (EORTC). The dose-response study is the subject of this article.

METHODS AND MATERIALS

For the dose-response trial, 379 adult patients with cerebral LGGs were randomized centrally at the EORTC Data Center to receive irradiation postoperatively (or postbiopsy) with either 45 Gy in 5 weeks or 59.4 Gy in 6.6 weeks with quality-controlled radiation therapy. All known parameters with possible influences on prognosis were prospectively recorded. Conventional treatment techniques were recommended.

RESULTS

With 343 (91%) eligible and evaluable patients followed up for at least 50 months with a median of 74 months, there is no significant difference in terms of survival (58% for the low-dose arm and 59% for the high-dose arm) or the progression free survival (47% and 50%) between the two arms of the trial. However, this prospective trial has revealed some important facets about the prognostic parameters: The T of the TNM classifications as proposed in the protocol appears to be one of the most important prognostic factors (p < 0.0001) on multivariate analysis. Other prognostic factors, most of which are known, have now been quantified and confirmed in this prospective study.

CONCLUSION

The EORTC trial 22844 has not revealed the presence of radiotherapeutic dose-response for patients with LGG for the two dose levels investigated with this conventional setup, but objective prognostic parameters are recognized. The tumor size or T parameter as used in this study appears to be a very important factor.

Recurrence patterns in patients with early stage cervical cancer treated with radical hysterectomy and external pelvic irradiation

One hundred and fifty patients with clinical FIGO stage IB-II cervical cancer who underwent radical surgery followed by external pelvic irradiation between 1978 and 1991 were reviewed. Until June 1994, 28 (18.7%) patients developed recurrent disease. Seventeen (60.7%) of them experienced a pelvic failure, 7 (25.0%) an extrapelvic failure and 4 (14.3%) both a pelvic and an extrapelvic failure. The median time to recurrence was 16 months for patients with pelvic failure (range = 4-50 months), 27 months for those with extrapelvic failure (range = 6-49 months), and 21 months for those with both pelvic and extrapelvic failure (range u 8-56 months). Recurrence rates were significantly related to surgical-pathologic stage, tumor size and lymph node status, but not to histologic type. An extrapelvic recurrence, alone or associated with a pelvic failure, was found in 0.9% of 117 patients with negative lymph nodes, 6.2% of 16 patients with one or two positive lymph nodes, and 52.9% of 17 patients with three or more positive lymph nodes, (p = 0.0001). It is worth noting that 9 (81.8%) out of the 11 patients who developed extrapelvic recurrences had three or more involved lymph nodes. The number of positive lymph nodes (p = 0.0001) and the tumor size (p = 0.0046) were independent prognostic variables for disease-free survival.

Analysis of treatment failures in patients with early-stage uterine leiomyosarcoma

This retrospective study aimed to investigate the treatment failures in 26 patients with stages I-II uterine leiomyosarcoma (> or = 10 mitoses per 10 high-power field (HPF) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy +/- adjuvant external pelvic irradiation. Thirteen (50%) patients developed recurrent disease, after a median time of 10 months from surgery (range = 4-72 months). Recurrence was pelvic in 3 (23%) patients, extrapelvic in 9 (69%) patients, and both pelvic and extrapelvic in 1 (8%) patient. Disease-free survival was better for premenopausal than for postmenopausal patients (p = 0.002) and for patients with < 20 mitoses per 10 HPF than for those with > or = 20 mitoses per 10 HPF (p = 0.006). In conclusion, patients with early-stage disease who had undergone locoregional treatment experienced a high recurrence rate. Most of the treatment failures were extrapelvic. Multicentric randomized trials on the role of adjuvant chemotherapy are advocated.

Postirradiation meningioma

A case of meningioma of the posterior cranial fossa is reported. The tumor developed 12 years after radiation treatment for a polar spongioblastoma of the cerebellum in an 8-year-old boy. The possible role of the radiation in the oncogenesis of the second tumor is discussed. In light of the information in the literature concerning the malignancy of such postirradiation tumors, the authors recommend careful evaluation for the real necessity of radiation therapy, particularly for children in whom the meninges may be hypersensitive to ionizing radiation.