Consolidation whole abdominal irradiation in advanced stages of ovarian cancer may be of value in patients with negative or microscopic disease at second-look laparotomy. Unfortunately, despite the initial survival advantage observed in irradiated patients, owing to late recurrences there was no significant difference in their long-term survival probability.
The Northern Israel Cancer Center serves 1 million inhabitants. Between 1968 and 1982, 33 patients with a diagnosis of nonseminomatous tumors of the testis were referred to this center. Of these patients inguinal lymph node metastasis developed in 4, each of whom had had risk factors for such metastasis. Two patients had undergone previous orchiopexy, and 2 had extension of the tumor to the epididymis and the tunica vaginalis testis. The inguinal region should be examined and watched carefully in patients with testicular tumor, especially those at high risk for inguinal metastases. Today, disease in patients with inguinal metastasis is curable by lymph node dissection and/or combination chemotherapy.
Eighty-four patients with testicular seminoma were treated at the Northern Israel Oncology Center during the years 1968-1988. Using the staging classification of Hussey, 69 patients (82%) had Stage I, eight (10%) had Stage IIA, four (5%) had Stage IIB, one (1%) had Stage IIIA, and two (2%) had Stage IIIB disease. Sixty-nine patients (82%) had classic pure seminoma, nine (11%) had anaplastic seminoma and six (7%) had spermatocytic seminoma. Seventy-four patients (88%) underwent high inguinal orchiectomy and ten (12%) had a scrotal approach. Seventy-five patients (85%) were treated with postoperative irradiation. Stage I patients received 26-30 Gy to the paraaortic and ipsilateral pelvic lymph nodes. Stage IIA patients were treated in the same manner with a boost to the involved lymph nodes. With a mean follow-up of 97 months, 65 patients (77%) are alive and well with no evidence of disease, 7 patients (8%) are dead due to disease progression. The 5-, 10-, 15-, and 20-year actuarial survival for all patients was 90%, and for early stage patients 94%. Eight patients (14%) relapsed; 3 of them were salvaged by chemotherapy. Serious side effects of irradiation included lethal respiratory failure due to bleomycin-induced pulmonary fibrosis in one patient, peptic ulcer in three patients, hydronephrosis due to paraureteral fibrosis in one patient and recurrent paralytic ileus in one patient. Eight patients (10%) developed nine second cancers, three of them within the previous radiation field.(ABSTRACT TRUNCATED AT 250 WORDS)
The survival, and the patterns and mechanisms of failure of 41 patients with pure testicular seminoma treated at the Northern Israel Oncology Center from 1968 to 1983 were analyzed. The actuarial 5-year survival of all patients was 85.4% and of stage I patients, 92.2%. Treatment failures were analyzed. The following conclusions were reached: in order to increase the cure rate, the use of combination chemotherapy as the initial treatment modality in advanced seminoma is recommended. In cases of transscrotal approach, the scrotum should be irradiated. Adjuvant mediastinal irradiation is not needed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.