Preoperative radium irradiation and radical hysterectomy in the treatment of cancer of the cervix

Burch, John C.; Chalfant, Robert L.

doi:10.1016/s0002-9378(16)34091-1

Cited by 27 publications

(2 citation statements)

References 20 publications

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“…(2,27,28) On the other hand, some studies have shown that radiotherapy can also be effective for the sterilization of metastatic lymph nodes. (29,30,31) Many of these retrospective studies suggest that patients submitted to radiotherapy before surgery had a lower percentage of lymph nodes involved compared to those submitted to surgery alone, without previous radiotherapy. In view of the wide variation in the mean number of lymph nodes obtained by lymphadenectomy from patients, whether previously irradiated or not, it is quite difficult to judge the effects of ionizing radiation on metastatic lymph nodes.…”

Section: Pathology Of the Surgical Specimenmentioning

confidence: 99%

Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

Coelho

Franco

Kowalski³

et al. 1998

Sao Paulo Med. J.

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OBJECTIVE: To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy. DESIGN: A retrospective analysis of prognostic factors. LOCATION: Hospital A.C. Camargo, São Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre. PATIENTS: A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied. Criteria for inclusion in the study were: confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C. Camargo itself). At the end of the follow-up period, 410 patients (65%) had no evidence of disease and 219 (34.8%) had died because of the tumor. INTERVENTION: The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982. MAIN OUTCOMES MEASURES: Multivariate analysis of the different variables was performed according to the Cox regression method. RESULTS: The variables of prognostic value were, in decreasing order of importance: the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575). CONCLUSIONS: Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.

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Section: Pathology Of the Surgical Specimenmentioning

confidence: 99%

Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

Coelho

Franco

Kowalski³

et al. 1998

Sao Paulo Med. J.

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“…Lange (1960) reviewed the question of positive lymph nodes. The incidence of lymph metastases is fairly constantly given as 10 to 20 per cent for stage I carcinoma of the cervix and 20 to 40 per cent for stage I1 (Burch and Chalfant, 1970;Chien-Tien et a1 1972;Christensen et a1 1964;Churches et a1 1974;Kelso and Funnel, 1973;Landgreen et a1 1964;Pilleron et a1 1972;Rampone et a2 1973;Rousseau et a1 1971). In all series, lymph node involvement adversely affected survial rates.…”

Section: Table VII the Influence Of Lymph Node Metastases On Prognosimentioning

confidence: 99%

Treatment and Survival in 631 Patients With Invasive Carcinoma of the Cervix

C¹

1976

BJOG

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Summary From 1951 to 1972, a total of 631 cases of invasive carcinoma of the cervix were diagnosed in Frederiksberg, Copenhagen, Denmark. Treatment was either by surgery or radiotherapy, a combination of both being rarely used. The crude five‐year survival rates were 99 per cent in stage Ia, 79 per cent in stage Ib, 67 per cent in stage IIa, 45 per cent in stage IIb, 23 per cent in stage III, 5 per cent in stage IV and 63 per cent for all stages. The relative survival rates were respectively 100 per cent, 81 per cent, 73 per cent, 48 per cent, 26 per cent, 5 per cent and 66 per cent. Radical hysterectomy was found more effective than radiotherapy in stage Ib carcinoma of the cervix. This difference was not explained by age but other factors possibly playing a role are considered. The combination of surgery and radiotherapy is discussed and only seems indicated for patients with stage Ib carcinoma and lymph node metastases.

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Perspectives on research in gynecologic oncology.Treatment protocols

DeVita

Wasserman

Young

et al. 1976

Cancer

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Gynecologic cancers present unusual opportunities to explore the fruits of well-designed clinical trials to assess the value of existing treatment using a combined modality approach soon after diagnosis. Cancers of the ovary and uterus have well-defined, familiar natural histories. Pathways of spread are clear and reasons for treatment failure are often blatantly obvious. In the case of ovarian cancer, regional treatment with surgery and radiotherapy has been relatively ineffective and generally has not improved the survival statistics in the last two decades. Spread of tumor cells widely throughout the abdominal cavity outside radiation or surgical fields, even in patients with apparently early disease, is the obvious reason. Studies are underway to assess the impact of long-term postoperative adjuvant chemotherapy with L-phenylalanine mustard, an alkylating agent effective in patients with advanced disease, in early stages of ovarian cancer following surgery and or x-irradiation. The search is on for more effective drugs, or combinations of drugs, that could subsequently serve as more effective adjuvant treatments. In carcinoma of the uterine cervix, chemotherapy as an adjunct to surgery and/or radiotherapy in patients with localized, or locally inoperable disease has been poorly evaluated; little data are available and the value of many established drugs in patients with metastatic cervical cancer is undermined. Some recent evidence suggests the use of hydroxyurea, a drug that by itself is not effective in controlling tumor, may enhance the effect of radiotherapy in patients with Stage II disease. Uterine fundal cancer is often successfully treated by surgery alone. The data for the use of pre- or postoperative radiotherapy are open to considerable question. While the relative nontoxic progesterone compounds are effective in a small but significant fraction of patients with advanced uterine cancer, no properly designed clinical trial has truly evaluated their role as postoperative adjuncts in patients who have resectable tumor but a definite high risk of recurrence. Systemic chemotherapy has been rarely used with any consistency against this tumor but, even so, some chemotherapeutic leads, such as the use of adriamycin, are worthy of exploration. The absence of useful information on systemic treatment of gynecologic malignancies can be traced to the excessive rigid compartmentalization of medical practice. Only recently have investigators of all persuasions begun to explore and exploit some of the therapeutic opportunities, which have been available for some time.

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Preoperative radium irradiation and radical hysterectomy in the treatment of cancer of the cervix

Cited by 27 publications

References 20 publications

Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

Treatment and Survival in 631 Patients With Invasive Carcinoma of the Cervix

Perspectives on research in gynecologic oncology.Treatment protocols

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