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Biomedical subjects

H Kucera

Publications and source records attributed to H Kucera.

At least 19 recordsLinked to original sources
PubMed1992

[Prognostic factors of radically operated stage Ib cervix cancer].

The present retrospective study attempts to evaluate the significance of factors such as age, histological type, histological grading, tumour size, lymph node metastases and tumour infiltration of the corpus uteri. Between 1975 and 1988, 312 patients were operated at our department or referred to postoperative radiotherapy. They fulfilled the inclusion criteria: histopathological stage Ib and radical hysterectomy with pelvic lymphadenectomy. The multivariate analysis confirmed, that the factors histological grading (G3 vs G1 + G2: relative risk (RR) = 2.66; 95% confidence interval (CI) = 1.36-5.18), tumour size (tumour infiltration of the cervix greater than 2/3 vs less than 2/3: RR = 2.36; 95% CI = 1.07-5.17), and pelvic lymph node metastases (positive vs negative: RR = 5.36; 95% CI = 2.70-10.65) are of significant importance for the survival. The results show, that patients with a cervical carcinoma in FIGO stage IB, with an infiltration of more than two thirds of the cervix with a more or less differentiation and with or without positive lymph node status, should be classified as high risk patients. In these unfavourable situations, a prospective randomised study should clarify the success rate of adjuvant therapy.

Adult↗
PubMed1992

[The value of adjuvant irradiation in lymphatic vessel invasion in patients with a cervical carcinoma in histopathological stage Ib and with negative lymph nodes].

The present retrospective study attempts to evaluate the significance of adjuvant radiotherapy as a prognostic factor for stage Ib cervical carcinoma without lymph node metastases but with lymph-vascular space invasion. 54 patients fulfilled the inclusion criteria: histopathological stage Ib, radical hysterectomy with pelvic lymphadenectomy, negative pelvic lymph nodes and lymph-vascular space involvement. Though larger tumors were found (tumor infiltration of the cervix greater than 2/3) in the irradiated group (chi 2-test p = 0.003), there was no significant difference in the five-year overall survival (92% five-year survival without vs. 90% with adjuvant irradiation). In contrast statistical significant difference was found in recurrence-free interval between these groups (Wilcoxon test p = 0.02).

Carcinoma↗
PubMed1991

Radiation management of primary carcinoma of the vagina: clinical and histopathological variables associated with survival.

Data are presented on 434 patients treated at the Gynecologic Radiotherapy Department of the University of Vienna for invasive primary carcinoma of the vagina between 1952 and 1984; data on 110 patients treated in the last few years are more detailed. In stage I, 5-year survival was 76.7%; in stage II, 44.5%; in stage III, 31%; and in stage IV, 18.2%. The overall uncorrected 5-year survival rate was 39.9%. The disease is primarily one of the elderly as 78% were found to be older than 60 years of age. Younger patients had a 5-year survival of 50%; patients between 61 and 75 years of age, 41.2%; and those 76 years of age or older, 34.3%. Patients with presenting symptoms had a cure rate of 36.9%, whereas 61.1% of asymptomatic cases survived. Best results (60%) were obtained when the lesion was in the upper third of the vagina; only 37% of patients with lesions of the middle third and lower third survived more than 5 years. Well-differentiated tumors were associated with a 5-year survival of 62.5%; and poorly differentiated tumors, with a rate of 34.9%. Our results indicate that stage of disease is the most significant prognostic factor, but age of the patient, location of lesion in the vagina, and differentiation of the tumor influence outcome too. The majority of patients were managed by a combination of external pelvic irradiation and local application of radium. In stage I and II patients treated with radium alone, good results were obtained, but no patient with stage III or IV disease survived 5 years when external irradiation was not performed.

Adult↗
PubMed1991

[Color Doppler flow measurements in uterine cancers].

Pulsed Doppler Flow Measurements in patients suffering from collum cancer using a coloured pulsed Doppler technique measurements of blood flow of the uterine artery were performed in a group of 35 patients suffering from an inoperable collum cancer (stage II and III according FIGO) and compared with a collective of 30 healthy women with normal anamnesis. The mean pulsatility index (PI) was significantly lower in the sick group (stage II 1.6 +/- 1.17, stage III 0.76 +/- 0.21) than in the healthy group (PI = 3.18 +/- 0.99) (p less than 0.01). In 14 subjects of the last group there was no significant difference in PI between the left and right uterine artery (left: PI 2.81 +/- 0.83), right: PI 2.78 +/- 0.76).

Adult↗
PubMed1991

[Recurrence of stage I endometrial cancer: effect of prognostic factors on therapeutic results].

Endometrial carcinoma is the most common gynaecological invasive cancer. Since its incidence is increasing, more patients will develop recurrent disease. In an attempt to identify possible prognostic factors associated with survival, we reviewed the results of 45 patients treated in our department for recurrent clinical stage I endometrial carcinoma. All patients received primary therapy consisting of surgical resection. 16 patients developed recurrent disease after initial operative treatment and adjuvant radiotherapy. The minimum follow-up of 3 years was available in 43 patients and the actual 3-year survival rate was estimated 42% (median 16 months). Significant prognostic factors were recurrence site--vagina, 51% (17/33 pts) vs extravaginal, 20% (2/10 pts) (p = 0.01), and histological cell type--non-papillary carcinoma, 50% (17/34 pts) vs papillary adenocarcinoma, 22% (2/9 pts) (p = 0.02). Late recurrences have been reported to carry a better prognosis, than those that recur early. In the present study, time of onset did not appear to be a significant factor--recurrence occurs within 24 months, 36% (9/25 pts) vs recurrence appearing after 2 years, 55% (10/18 pts). We suggest, that systemic therapy should be prospectively evaluated in high-risk patients. Selected patients with recurrent disease--cases of non-papillary histological cell type and vaginal recurrence--can be cured by radiotherapy.

Brachytherapy↗
PubMed1991

[A risk score for operated endometrial cancer and its importance for adjuvant radiotherapy (histopathology and results of treatment based on 208 cases with pelvic lymph node excision)].

In a retrospective study of 208 surgically treated cases of endometrial cancer with pelvic lymphadenectomy, histomorphology with subtypes, tumour grading, infiltration of the myometrium, blood- and lymphatic vessel invasion and pelvic lymph node metastases, were analysed. Typical adenocarcinomas had lymph node involvement in 9% of the patients, whereas unfavourable subtypes showed in 27%. In patients with tumour grading I, the lymph nodes were involved in only 4.5% and with grading 3 in 31.4%, respectively. If the carcinoma was limited to the endometrium, no lymph node metastases could be detected. If the inner half of the myometrium was involved, pelvic nodes were positive in 9.2% with deeper infiltration in 27.3% of the cases. With obvious invasion of blood or lymph vessels, lymph nodes were positive in 43.2% of the cases. A simple score for these histopathological risk factors is proposed, enabling the allocation to patient groups of similar risk on the basis of a point system for individual prognostic factors. With a score of 1-2 points (13.5% of the cases) the prognosis is good and adjuvant irradiation does not seem necessary. With 3-4 points (34.1% of the cases), local vaginal irradiation is recommended. With 5 or more points, we recommended, in addition to vaginal irradiation, aggressive irradiation of the small pelvis, 52.4% were in this group, from which 85% were symptom-free at the critical 5 year point. In case of positive pelvic lymph node, 67% of the patients survived after adequate adjuvant follow-up irradiation.

Adenocarcinoma↗
PubMed1991

[Melanoma of the vulva. Report of 12 cases].

The present retrospective study includes 12 patients with melanoma of the vulva who underwent vulvectomy between 1977 and 1987. Six patients were less than 55 and 6 other patients more than 69 years old. Three women of the younger age group survived (31, 44 and 116 months, respectively), whereas three of them died of the tumour. In the patient group of over 69 years of age 4 patients died of the tumour, one patient did not appear for follow-up and one further patient died in the meantime. Nine patients suffered from deeply infiltrating tumours (Clark levels IV and V), 2 patients had a Clark level II tumour, and in one case the Clark level was unknown. Depth of infiltration correlated with the prognosis of disease, i.e. only one patient with deep tumour infiltration, but both patients with Clark level II tumours survived. Therefore, the importance of early diagnosis of melanoma of the vulva should be emphasized, and accurate inspection of the vulva should be indispensable in the course of routine gynaecological examination also in younger women.

Adult↗
PubMed1991

[Effects of primary radiotherapy on uterine circulation in advanced cervix cancer].

We examined 11 patients suffering from advanced cervical carcinomas, who were treated primarily with radiation. The blood flow through the uterus was established by measuring the Doppler pulse flow through the arteria uterina before and after radiotherapy. In a reference group of 25 women, free from cervical carcinomas, we established a median PI of the arteria uterina of 3.52 (+/- 1.10) with values between 1.64 and 5.06. In contrast, the group of 11 patients suffering from inoperable cervical carcinomas, were found to have a PI of 1.80 (+/- 1.40), with values between 0.41 and 4.41 (Wilcoxon Test: p = 0.001). After completion of the radiotherapy, 7 of the 11 patients showed no measurable pulsations of the arteria uterina, 3 patients had only systolic blood flow and only one patient had the same unchangingly high rate of blood flow as registered before radiotherapy. The significantly reduced flow of blood through the tumour tissue after radiotherapy, indicates a very limited response to chemotherapy. Therefore, chemotherapy should be administered before radiotherapy.

Adenocarcinoma↗
PubMed1991

[The value of and indications for radiotherapy in endometrial carcinoma].

Today the endometrial carcinoma is the most frequent malignant tumor found in female genital tract. Endometrial carcinoma ought to be operated in all cases, if possible. Traditionally some form of adjuvant radiotherapy has been given. Despite the large number of patients treated by combined therapy over the last 30 years, surprisingly there is a lack of hard data on which to establish a theory for an improved outcome. It is generally accepted that the risk of local relapses in the vagina is lowered when postoperative vaginal irradiation is applied. The question of the value of additional external irradiation in stage I endometrial cancer still is unsettled. Only two prospective studies led to the conclusion that only patients with poorly differentiated tumors and with deep infiltration of the myometrium might benefit from additional external radiotherapy. Therefore a simple score for these risk factors is proposed enabling assignment into patient groups of similar risk on the base of a point system due to individual prognostic factors. With a score of one to two points prognosis is very good and adjuvant irradiation seems not to be necessary. With three to four points local vaginal irradiation is recommended, with five and more points additionally external beam irradiation to the pelvis should be given. This is necessary in more than the half of the operated cases of endometrial carcinoma. The indication for such a treatment has become more individual and "high risk" cases are treated more intensively, but "low risk" cases have to be excepted from unnecessary adjuvant therapy. In order to judge an individual case of endometrial cancer histopathologic prognosticators have to be considered. Typical adenocarcinomas have a five-year survival of more than 80%, but unfavourable subtypes (adenosquamous, clear-cell, serous-papillary carcinomas) of only 40%, respectively. Tumor grading and depth of myometrial invasion are of high importance for individual prognosis. The new histopathologic staging system of FIGO (1988) takes these items into account. Only patients with severe internal diseases should be treated with radiation therapy alone. Although radiation therapy alone can cure endometrial cancer (five-year-survival approximately 60%), the survival figures are poorer than for the operation (five-year survival 80%, respectively). It should be outlined that in inoperable cases radiotherapy is the best form of treatment.

Carcinoma↗
PubMed1991

[The value of adjuvant irradiation in patients with cervical carcinoma in histopathological stage Ib and negative lymph nodes].

The present retrospective study attempts to evaluate the significance of adjuvant radiotherapy as a prognostic factor for stage Ib cervical carcinoma without lymph node metastases in addition to factors such as age, histological type, histological grading and tumor size. Between 1975 and 1987 224 patients were operated at our department or referred to postoperative radiotherapy and fulfilled the inclusion criteria: histopathological stage Ib, radical hysterectomy with pelvic lymphadenectomy and negative pelvic lymph nodes. The multivariate analysis confirmed that tumor size (tumor infiltration of the cervix greater than 2/3 vs less than 2/3: RR = 4.48) and histological grading (G3 vs G1 + G2: RR = 3.12) are significant prognostic parameters for survival. Postoperative adjuvant irradiation is a marginal significant factor for survival in stage Ib cervical carcinoma and negative nodes (RR = 3.22; p = 0.057). For women with negative nodes but high-risk prognostic factors in the cervix, a prospective randomized trial proving the value of postoperative irradiation would be of therapeutic interest.

Combined Modality Therapy↗
PubMed1991

[Radiotherapy of primary vaginal carcinoma and effects of histological and clinical factors on the prognosis].

434 cases of primary vaginal carcinoma were treated from 1950 to 1984 at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna. The five-year survival rate for various clinical stages is as follows: Stage I 76.7%, stage II 44.5%, stage III 31%, stage IV 18.2%. In this retrospective study 110 patients seen from 1975 to 1984 were reviewed in detail and evaluated with a view toward their clinical and morphological aspects and survival rates. Patients up to the age of 60 have a five-year survival rate of 50%, those over 75 years of age reach only 34.3%. If the carcinoma was discovered in a routine check up the survival rate is 61.1%, whereas in cases with symptoms the rate decreases to 36.9%. Survival differences were also observed for patients with a carcinoma in the upper third of the vagina (61.1%) versus patients with a carcinoma in the lower third (33.3%); for patients with well-differentiated tumours (62.5%) versus patients with grades II and III (41.5% and 34.9%). It can be seen, that with brachytherapy local control of the carcinoma can be achieved with excellent results in early stages. Treatment of patients with more advanced carcinomas should include external beam therapy. The importance of gynecological screening especially for older women is emphasized.

Adenocarcinoma↗
PubMed1990

Benefit of external irradiation in pathologic stage I endometrial carcinoma: a prospective clinical trial of 605 patients who received postoperative vaginal irradiation and additional pelvic irradiation in the presence of unfavorable prognostic factors.

Six hundred and five cases of endometrial carcinoma, pathologic stage I, without definable extrauterine disease were initially treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by high-dose-rate iridium-192 irradiation of the vagina. External irradiation of the pelvis was performed only for patients with poor prognostic factors. Five-year survival was calculated by the product-limit method of Kaplan and Meier. Three hundred and forty-eight patients with tumor invasion of the inner third, of any tumor grade, received postoperative vaginal irradiation only. Twenty-eight patients with grade 1 tumor invasion of the middle third received vaginal irradiation only. One hundred and six patients with grade 2 or 3 tumor and infiltration of the middle third received vaginal and external irradiation of the pelvis. One hundred and twenty-three patients with deep muscle invasion of the external third of the myometrium received vaginal and pelvic irradiation. Differences in survival figures were not significant. Survival of the treatment group with good prognosis who received vaginal irradiation alone (91%) was similar to that of the group with poor prognosis who received additional pelvic irradiation (87.7%). Despite the unfavorable situation of patients with poor prognostic factors, treatment results after additional external irradiation were relatively equal to the results for patients with good prognostic factors who had not received external irradiation. Therefore, the benefit of external irradiation in patients with stage I endometrial carcinoma with unfavorable prognostic factors seems evident.

Aged↗
PubMed1990

[Value of irradiation alone of generally inoperable endometrial cancer with high dose rate iridium 192].

Surgery should be an integral part of the management of the patient suffering from endometrial cancer. Only patients with severe internal diseases should be treated with radiation therapy alone. Although radiation therapy alone can cure endometrial cancer, the survival figures are poorer than for the operation. At the University of Vienna (1st Department of Gynaecology), 267 patients with endometrial cancer were treated by radiation therapy alone (Afterloading iridium192 technique). 5-year survival (life table method) for all patients was 65.2%. In stage I, 5-year survival was 66.9%, and in stage II 46.7%, respectively. For up to 69 years of age the survival was 76.6%, for 70 years and more 61.8%, for grading I 78.8%, for grading II and III only 55.4%, respectively. With radium226 technique, the survival rate was only 56%, while 65.2% were reached with the Iridium technique. All differences are significant. External irradiation (cobalt60) was employed as combined treatment in only 9.4% of the cases. Intrauterine and intravaginal applications were performed without anaesthesia and the hospitalisation time was only one day per week. The relapse rate in stage I/b was 14.8% and in stage II 30%, respectively. Therefore, the dose of intracavitary treatment should be changed and external irradiation used more often.

Aged↗
PubMed1979

[Epidemiology of breast cancer in Austria (author's transl)].

In cooperation with the Austrian National Institute for Statistics the incidence-rates of breast cancer in Austria in the period of 1971-1975 were investigated. The incidence-rate of breast cancer (50 new cases/year/100,000 women) is higher than the incidence-rate of cervical or endometrium carcinoma. The increasing risk of the higher age-groups, which is especially expressed by the incidence-rate of 145 in the age-group of 70 or more years, is pointed out. This findings are of great consequence to the system of preventive medical care. In urban areas the incidence of breast cancer seems to be higher than in rural district.

Adolescent↗
PubMed1979

[Perinatal mortality in twin pregnancies. Progress in perinatology].

162 twin pregnancies of the I. Univ.-Clinic of Gynecology and Obstetrics in Vienna between 1969 and 1977 have been analysed (1969--1974 = group I; 1975--1977 = group II). It was found that the main risk factors of twin gravidity are the high rate of babies born before term, the high rate of operative deliveries and the high rate of perinatal mortality. The twin pregnancy should be diagnozed early. This allows the possibility of prophylactic therapy of onset of labour before term. According to our observations the difference in mortality rates between the first and the second group is very high (13,3 in comparison to 5,5%). The management of twin pregnancies as a high risk delivery with continuous fetal monitoring has doubled the number of indications for caesarean section. The essential problem of twin pregnancy seems to be the high rate of premature deliveries. Therefore an adequate increase of the legal antenatal and postnatal maternal protection period is emphasized.

Birth Weight↗