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The question of whether surgical treatment in early-stage cervical cancer should be aggressive or restricted to less radical techniques is still controversial. To answer this question it was thought useful to investigate the correlation of parametrial lymph node metastases with extension and stage of disease. Two-hundred and sixty-three consecutive primary radical surgical procedures were performed in our institute in clinical stage IB or stage IIA cervical cancer. Positive parametrial nodes were found in 6.9% of cases: 5% in stage IB (3% in the proximal part of the parametrium and 2% in the distal part, near the pelvic wall) and 16.3% in stage IIA (7% proximal and 9.3% distal) (P = 0.0193). During a median follow-up period of 92 months, disease recurred in 17.1% and 17.6% of cases, in negative and positive parametria, respectively. The 5-year overall and disease-free survival rates were 80.4% and 81.6% for patients with negative and positive parametria, respectively. From this experience it is concluded that the extent of radical hysterectomy should be related to the extent of the disease on the basis of modern knowledge of the pattern of spread. The principal key to prognosis remains pelvic and paracavoaortic nodal status.

OBJECTIVE:\ud Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure.\ud METHODS:\ud Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes.\ud RESULTS:\ud Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT.\ud CONCLUSION:\ud This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.\ud ADVANCES IN KNOWLEDGE:\ud Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome