Treatment of pathologic stage I-II endometrial adenocarcinoma. A retrospective analysis of 139 patients.
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Biomedical subjects
Publications and source records attributed to F Volterrani.
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Isodose curves can be viewed on multiple planes along with the radioactive implant and anatomical structures by projecting them on a video-display. The main options offered are the parallel projection of the implant selecting all the possible rotations, zooming and shifting, calculation of distance between two points of a selected plane, stereoscopic display.
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Automatic treatment planning for calculation of absorbed dose in curietherapy has been performed at the Istituto Nazionale Tumori of Milano on a routine for some years. The radioactive implant is reconstructed from orthogonal or stereo-roentgenograms, a tabular listing of doses or dose rates can be obtained on the grid of points and the isodose curves are automatically drawn with the projection of sources onto the selected planes of calculation by an interactive plotter.
175 carcinomas of the floor of the mouth were treated by radiotherapy in the years 1971-81: 47 T1 (26.9%) 87 T2 (49.7%) 19 T3 (10.8%) 22 T4 (12.6%). According to local extension the primary was treated by curietherapy in 92 patients (52.6%), external radiotherapy plus curietherapy boost in 8 (4.6%), radiosurgical combinations in 25 (14.3%) and external radiotherapy alone in 50 (28.5%). 131 patients were initially N0 (74.9%) 23 N1 (13.1%) 21 N2-3 (12.0%). The treatment on the nodal areas was: wait and see in 84 patients (48.0%) surgery in 39 (22.3%) radiosurgical combinations in 21 (12.0%) external radiotherapy alone in 31 (17.7%). Relapses free survival at 2 and 5 years was respectively 52.5% and 44.1%. Local control was obtained for 37/41 T1 cases (90.2%) 58/71 T2 (81.7%) 9/25 T3-T4 (36.0%). 37/137 patients with adequate follow-up (greater than or equal to 1 year) experienced some radionecrotic complications (27.0%). The overall incidence of the second tumors was 7.3% (10 cases).
In the years 1971-76 we have treated 243 stage Ib cancers of the cervix. 104 (45.9%) were submitted to a radical surgery in the form of a classical Wertheim-Meigs operation in 32 of them, whilst in the other 72 lymphadenectomy was extended to the lumbar-aortic chains. When feasible, all the operated cases were submitted to a postoperative radiumtherapy on the vaginal vault and to external irradiation if N+ at histological examination. 114 cases (46.9%) were submitted to a complete course of radiotherapy. The remaining 25 cases (10.3%) were submitted to a preoperative radiumtherapy plus radical surgery. The 5-year NED survival was 89.5% in the surgical group, 93.0% in the radiotherapy group and 91.1% for the patients submitted to a preoperative radiumtherapy. In the time interval considered the stage II cases were 89. 14 (15.7%) were operated upon, 66 (74.2%) were treated with a complete course of radiotherapy and 9 (10.1%) were submitted to a preoperative radiumtherapy plus radical surgery. The 5-year NED survival was respectively 83.8%, 67.1% (only for proximal-stage II cases) and 100.0%. Radiotherapy is equivalent to surgery for the treatment of the stage Ib cervical cancers. On the contrary several arguments claim a combined therapeutic approach in the treatment of the stage II cases.
In this paper we analyze overall patients affected by inoperable adenocarcinoma of the endometrium, observed and treated with radiotherapy alone at the Milan Cancer Institute from January 1959 to December 1973. A total of 82 cases were collected for this study. Only the Stage IV cases have been excluded, as well as those treated for relapse. Inoperability were derived from various medical contra-indications in 70 patients (F85.4%) and from extrauterine spreading of the tumor in 12 (14.6%). The results achieved by the radiotherapy alone are not to be disregarded. The overall 5-years survival was 38.8% for the total number treated and 40.6% for Stage I and II cases. The most useful irradiation technique for the treatment of the primary tumor proved to be the uterine packing with cobalt-60 radioactive pearls and a 5-years survival of 45.7% was observed in 41 Stage I patients treated in this way. The most disappointing results were registered in Stage III cases (28.6% of 5-years survival). This paper confirms the interest of radiotherapy for the treatment of inoperable endometrial adenocarcinoma.
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A sixteen-years-old boy with a brain-stem neoplasia inducing coma was treated with chemotherapeutic agents. It resulted in dramatic clinical and instrumental improvement; radiologic findings were evaluated, showing decreasing dimension of intracranial mass. Brain-stem auditory evoked potentials were highly sensitive. We think that chemotherapy can be considered among the options a physician can offer to such a patient explaining informed consensus.