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Results for “Radiotherapy, Adjuvant”

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At least 19 recordsLinked to original sources

PubMed1986

Local recurrence of adenocarcinoma of the rectosigmoid. Is postoperative adjuvant radiotherapy justified?

Adjuvant postoperative radiation therapy has been suggested for adenocarcinoma of the rectum and sigmoid colon to reduce the incidence of local recurrences. Determination of this incidence is necessary to optimally employ such adjuvant therapies. Ninety-nine patients with adenocarcinoma of the rectum or sigmoid who had surgery from 1976-1984 were reviewed. Follow-up ranged from one to eight years (average 4.1 years). Twenty-three patients had gross unresected residual tumor due to local invasion. Fifteen of the remaining 76 have developed recurrences (20 percent). Two patients (2.6 percent) had local recurrences without concurrent regional or distant metastases. Thus local recurrences rarely are encountered without concurrent regional or distant metastases. Therefore, postoperative radiation therapy to prevent local recurrences is not justified, given the small number of patients potentially benefited. Treatment modalities will need to address regional and distant metastases in addition to local recurrences.

Adenocarcinoma↗

PubMed1990

Endometrial adenocarcinoma, adjuvant radiotherapy tailored to prognostic factors.

The optimal adjuvant radiotherapy for surgically treated endometrial cancer has not yet been defined. We report on 389 patients treated between 1970 and 1985 with adjuvant radiotherapy. The treatment was tailored to the known prognostic factors: myometrial invasion and grade of differentiation of the tumor. Ten-year overall survival was 67%, 10-year relapse-free survival 77%; 23% relapse, of which 21% distant and 6% locoregional relapse. In a multivariate analysis, stage (pT), grade, and myometrial invasion were prognostic factors. The number of locoregional failures was very small (n = 23). This small number, the fact that radiation treatment was tailored to prognostic factors, and the absence of a nontreated control group precluded an analysis of the effect of the adjuvant irradiation. Large randomized studies with a control (no treatment) arm should be performed to determine the value of adjuvant radiotherapy.

Adenocarcinoma↗

PubMed1987

Stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy: role of adjuvant radiotherapy.

A retrospective review of 194 patients with stage IB cervical carcinoma treated with radical hysterectomy between January 1977 and December 1984 revealed 30 patients (15%) with pelvic node metastases. Twenty patients with pelvic node metastases received postoperative radiotherapy and ten patients did not. Five of 20 patients who received adjuvant radiotherapy had recurrence, compared with five of ten patients who did not receive radiotherapy. No pelvic recurrences occurred in the adjuvant radiotherapy group compared with two in the no radiotherapy group. Only one serious complication occurred in a patient receiving radiotherapy. Adjuvant postoperative radiotherapy may reduce pelvic recurrences and improve survival in patients with pelvic node metastases treated with radical hysterectomy and pelvic lymphadenectomy.

Adenocarcinoma↗

PubMed1986

Breast tumours: adjuvant radiotherapy trials.

According to controlled trial results, adjuvant radiotherapy associated with radical surgery has significantly decreased local recurrences of breast tumours, but with no effects on survival. Nowadays, in controlled trials, the advantages of associating radiotherapy with surgery and adjuvant chemotherapy are not clear. A non-significant trend towards better control of local disease is observed in some trials, mainly in locally advanced disease. In most of the other trials no benefit has been found. Although some detrimental effects have been observed when adjuvant chemotherapy was delayed or reduced by radiotherapy, on the whole radiotherapy does not appear to have any harmful effects on final results.

Antineoplastic Agents↗

PubMed1986

Adjuvant radiotherapy following radical prostatectomy: results and complications.

Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year followup. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not. The groups were comparable with regard to significant prognostic variables. Patient selection was by surgeon preference. Local recurrences were seen in 1 of 22 patients (5 per cent) receiving adjuvant radiotherapy and 7 of 23 (30 per cent) undergoing an operation alone (p less than 0.05). Of 8 patients with local recurrence 7 died of the disease. Delayed radiotherapy of a local recurrence generally was not effective in controlling the disease. Of the 11 patients who died of prostatic cancer with a mean followup of 9.2 years 3 received adjuvant radiotherapy and 8 did not. Severe but nonfatal long-term complications were seen in 14 per cent of the irradiated patients and 6 per cent of those treated with an operation alone. Most of the complications occurred in the earlier years of the study in patients who received 60cobalt radiotherapy. When clinical stage B cancer of the prostate is found to be pathological stage C following radical perineal prostatectomy, adjuvant radiotherapy can decrease the incidence of subsequent local recurrence. The potential risk of adjuvant radiation therapy should be weighed and its use considered, particularly in patients whose tumor extends to the surgical margins or who have seminal vesicle invasion.

Adenocarcinoma↗

PubMed1991

Prospective multicenter trial for the response-adapted treatment of high-grade malignant non-Hodgkin's lymphomas: updated results of the COP-BLAM/IMVP-16 protocol with randomized adjuvant radiotherapy.

In a prospective multicenter trial the efficiency of the response-adapted COP-BLAM/IMVP-16 protocol to induce complete remissions (CR) in high-grade malignant non-Hodgkin's lymphomas as well as the prognostic relevance of adjuvant radiotherapy were investigated. From 1986-1989, 548 patients (median age 56 years) with stage II-IV (Ann Arbor) disease were treated with five cycles of COP-BLAM followed by two cycles of IMVP-16. If only a partial remission was obtained at the time of first restaging (RS) after three cycles (delayed response), treatment was switched to IMVP-16 (two to five courses) immediately. Patients achieving CR by the second RS after chemotherapy were randomized to adjuvant radiotherapy or observation. Responses to chemotherapy were 63% CR in patients completing the second RS (N = 350) or 72% if patients achieving late CR by consolidating radiotherapy are added; responses were 58% or 65% if all deaths prior to the second RS are included (N = 50). Overall and relapse-free survival were 71% and 68% at one year and 63% and 61% at two years. Multivariate risk factor analysis proved the early (by first RS) CR response to possess predominant prognostic relevance for survival. A significant advantage of adjuvant radiotherapy over no further treatment for duration of CR is not yet discernible. These results emphasize the importance of a rapidly achieved CR, thus contributing to the design of future trials.

Adolescent↗

PubMed1990

Silicone implant to prevent visceral damage during adjuvant radiotherapy for retroperitoneal sarcoma.

The incidence of local recurrence after surgery for retroperitoneal sarcoma is reduced by high-dose adjuvant radiotherapy but treatment is restricted by the effects of irradiation on adjacent viscera. By securing a silicone gel-filled implant (breast prosthesis) in the tumour bed after excision of the tumour, adjacent viscera are displaced from the site of maximum irradiation and may thereby be protected. We used this technique in three patients in whom excision of a retroperitoneal sarcoma was followed by high-dose adjuvant radiotherapy. Post-operative radiotherapy was well tolerated but local recurrence developed in one patient, and delayed perforation of the large bowel occurred in another. Both cases underwent further surgery at which the implant was removed. The same two cases also developed asymptomatic hydronephrosis on the side of the implant, attributed to local fibrosis.

Female↗

PubMed1992

Postoperative adjuvant radiotherapy in Astler-Coller stages B2 and C rectal cancer.

Between 1979 and 1983, 127 patients with Stages B2 or C rectal cancer treated with surgery plus postoperative adjuvant radiotherapy (RT group) and 122 patients treated with surgery alone (S group) were compared to evaluate the effect of postoperative radiotherapy on survival and disease recurrence. Each group was stratified into subgroups according to stage and tumor differentiation as follows: Subgroups BW (Stage B2 and well-differentiated tumor), BM (Stage B2 and moderately differentiated tumor), CW (Stage C and well-differentiated tumor), CM (Stage C and moderately differentiated tumor), and P (poorly differentiated tumor). Ninety-five percent of the patients were followed until death or, if alive, to five years after surgery. Postoperative radiotherapy was associated with a reduced five-year survival rate in Subgroup BW (67 vs. 87 percent; P = 0.02). In the remaining subgroups of the RT group, there was a statistically insignificant trend toward a worse survival rate (56 vs. 65 percent, 47 vs. 64 percent, 41 vs. 46 percent, and 50 vs. 36 percent for Subgroups BM, CW, CM, and P, respectively). The local failure rates for the S group and RT group were 10 vs. 23 percent (P = 0.15) in Subgroup BW, 32 vs. 21 percent (P = 0.4) in Subgroup BM, 24 vs. 25 percent (P = 0.6) in Subgroup CW, and 18 vs. 18 percent (P = 0.6) in Subgroup CM, respectively. Eight percent (9/127) had severe or life-threatening radiation-related complications. Postoperative adjuvant radiotherapy alone did not improve the survival of patients with Stages B2 or C rectal cancers. It may have led to worsened survival in the subgroup of patients with well-differentiated Stage B2 rectal cancer.

Adenocarcinoma↗

PubMed1992

Anxiety and depression in breast cancer patients at start of adjuvant radiotherapy. Relations to age and type of surgery.

Using a self-report questionnaire, the Hospital Anxiety and Depression (HAD) scale, feelings of anxiety and depression were assessed in 133 breast cancer patients referred for adjuvant radiotherapy following surgical treatment. Eighteen patients (14%) had scores indicating morbid anxiety. Significant depression was recorded for only 2 patients (1.5%). Severe anxiety was recorded for 10 out of 54 mastectomized patients (19%) and for 8 out of 79 patients treated with breast conserving surgery (10%). The difference was not significant (p = 0.13). In a subgroup aged 50-59 years, morbid anxiety was significantly more common among mastectomized patients than among patients operated conservatively, 4 out of 9 (44%) vs. 1 out of 23 (4%) (p = 0.01). Such a pattern was not discernable in the patients < 50 years of age or those > or = 60 years old. The results suggest that, at start of adjuvant radiotherapy, emotional distress is characterized by anxiety rather than depression and the risk of morbid anxiety is especially large for mastectomized women in their fifties.

Adult↗

PubMed1987

Adjuvant radiotherapy for stage I, grade 2 endometrial adenocarcinoma and adenoacanthoma with limited myometrial invasion.

All cases of endometrial adenocarcinoma from January 1970 to December 1980 treated at the Geisinger Medical Center were reviewed retrospectively. One hundred eighty-eight cases of stage I grade 2 adenocarcinoma of favorable histologic subtype (adenocarcinoma, adenoacanthoma) and limited myometrial invasion (less than one-third of the myometrium) were identified. Surgery and adjuvant radiotherapy was used in 136 cases, and 52 cases were treated with surgery alone. There was no statistically significant difference between the two groups in menopausal status, parity, exogenous estrogen, obesity, hypertension, diabetes, or uterine size. Five-year survival for the surgery and radiotherapy group was 94% (128 of 136), and the recurrence rate was 2.2% (three of 136). The five-year survival for the surgery-alone group was 98% (51 of 52), and the recurrence rate was 1.9% (one of 52). There was no statistically significant difference in five-year survival or recurrence between the two groups. This study suggests that surgery alone is adequate treatment for stage I grade 2 adenocarcinoma of favorable histologic subtype and limited myometrial invasion. This study also shows a possible benefit in the combined use of histologic subtype, grade, and myometrial invasion as prognostic indicators and as guides for adjuvant radiotherapy.

Adenocarcinoma↗

PubMed1987

Postoperative adjuvant radiotherapy for adenocarcinoma of the rectum and rectosigmoid.

One hundred five patients treated with potentially curative surgery and adjuvant postoperative radiotherapy for adenocarcinoma of the rectum and rectosigmoid from 1973 through 1981 were reviewed. Radiation therapy was given with 18-25 MeV X rays in doses of 40-50 Gy in 5 weeks (midline dose) using AP-PA fields in 97 patients. A boost of 6 to 10 Gy was directed to the area of maximum risk by anterior-posterior or perineal fields in 71 patients. Local failure occurred in 15 patients and was documented pathologically in 8 patients, or clinically or radiologically in 7 patients. The local recurrences according to the Modified Astler-Coller staging criteria were: B1: 0% (0/3); B2: 4% (1/24); B3: 31% (4/13); C1: 8% (1/12); C2: 18% (8/45); C3: 20% (1/5). Local failure after adjuvant radiotherapy versus surgery alone was compared. The comparison of local failure of combined treatment versus surgery alone, from our institution, is as follows: B2-4% vs 13%, B3-31% vs 26%, C2-18% vs 30%, and C3-20% vs 49%. Sixty-one patients (58.1%) have been followed for 5 years, with a median of 73 months and a minimum of 24 months. The actuarial 5-year survival (disease-free) for the entire group is 55% and is not statistically different for the groups with negative or positive nodes. Fourteen patients (13%) required surgery for small bowel complications; four others (4%) had symptomatic small bowel obstruction treated with conservative therapy only. Small bowel obstruction occurred in 4 of 16 (25%) treated with radiation fields above L5, whereas those treated below L5 had an 11% incidence. Postoperative adjuvant radiotherapy can increase local tumor control compared to surgery alone. The small bowel complication rate in this series most likely reflects AP-PA treatment technique and can be decreased by the use of multiple fields with maximum shielding of the small intestine.

Adenocarcinoma↗

PubMed1992

Adjuvant radiotherapy in patients post-radical prostatectomy with tumor extending through capsule or positive seminal vesicles.

Between 1976 and 1989, 115 patients at UCLA had radical retropubic prostatectomy for clinically localized prostate cancer with positive surgical margins, penetration of tumor into or through the capsule, or positive seminal vesicles. Twenty-four of those received adjuvant radiotherapy after having recovered from surgery. Complications of adjuvant treatment were uncommon and included urethral strictures in 3 patients and transient leg edema in 1. No patient in this group has had proved clinical disease progression though 6 have isolated detectable serum prostate-specific antigen (PSA) values. Clinical disease-free survival at five and seven years was 92 percent. If detectable PSA is also considered as evidence of tumor recurrence, the corresponding disease-free survival rates were 75 percent at five years and 54 percent at seven years. The 91 patients who received no postoperative radiotherapy had a clinical disease-free survival of 67 percent at five years and 56 percent at seven years. Disease-free survival drops to 43 percent and 24 percent, respectively, if detectable follow-up PSA is considered an indicator of disease progression. The comparisons of the survivorship curves in this retrospective study for the two treatment groups are statistically significant both for disease-free survival (p = 0.041), and disease-free survival with undetectable PSA (p = 0.043). Adjuvant radiotherapy has a beneficial effect after radical prostatectomy in patients with local tumor extension.

Aged↗

PubMed1992

[Assessment of the practice of adjuvant radiotherapy in cancer of the rectum in the department of Calvados].

The effectiveness of adjuvant radiotherapy (ART) in the treatment of rectal cancer (RC) is established for the local control of the tumor, but doubt remains as concerns improvement in survival. The aim of this work was to assess the present techniques and trends of ART in a French department based on a population-based study. From 1978 to 1986, 616 cases of RC were diagnosed in the department of Calvados (France). Tumor was removed in 346 patients (56 percent). Of these 346 cases, 29 percent were irradiated, 3/4 postoperatively and one forth preoperatively. Besides sex and age, the type of surgery (anal sphincter saving or not) and Dukes' tumor stade had an influence on the performance of ART. Thirty-one percent Dukes B tumors and 42.1 percent of Dukes C tumors were irradiated. The practice of ART for these tumors increased significantly from 1978 (18.5 percent) to 1986 (60 percent) (P less than 10(-4)). However, the practice and the distribution of centers performing ART were heterogenous within the department of Calvados. This heterogeneity was neither due to the environment (urban/rural) of the patient nor to the distance between the place of residence and the radiation therapy center. Such an heterogeneity could be explained only by the lack of consensus concerning the practice of ART. Such a consensus could be found considering the results of the latest controlled clinical trials, but definitive conclusions are needed about the effectiveness of ART on the improvement of survival.

Adenocarcinoma↗

PubMed1978

Adjuvant radiotherapy--preoperative, postoperative, or both: a proposal for a new approach.

A new approach to adjuvant radiotherapy is presented using a "sandwich technique" of low-dose preoperative irradiation (500 rads) and high-dose postoperative irradiation (4500 rads in 5 weeks) in the treatment of operable carcinomas of the rectum and bladder. The rationale for this approach and the preliminary results of a pilot study in 28 patients (19 with carcinoma of the rectum and nine with carcinoma of the bladder) are presented. This appears to be a very feasible and logical approach to treatment, with very few complications and excellent local control of disease.

Humans↗

PubMed1988

[Clinical evaluation of adjuvant radiotherapy and chemotherapy for esophageal carcinoma].

Surgical treatment is the most effective therapy for esophageal carcinoma, and adjuvant radiotherapy and chemotherapy are essential for the improvement of postoperative curability. The recurrence of carcinoma after curative surgery is often observed in the upper mediastinum and cervical portion. Fifty Gy of postoperative prophylactic irradiation has been given routinely and this has suppressed the local recurrence of the disease to a remarkable degree. Metastasis of carcinoma to internal organs was not controlled by radiotherapy. This occurs in the case of undifferentiated carcinoma, severe lymph node metastasis and positive invasion to vessels. Cisplatin, vindesine and bleomycin (DVB) combination chemotherapy and another cisplatin-based chemotherapy have been adapted for postoperative cases such as those in stages II, III and IV with radiotherapy. Cases of stage 0 and I with positive carcinomatous invasion to vessels have been treated reasonably with anti-cancer agents. Before chemotherapy, the anti-cancer activities of the drugs in subrenal capsule assay (SRCA) are tested using resected tumors and prospective clinical trials are being performed.

Animals↗

PubMed1985

The effect of adjuvant radiotherapy on the time of occurrence and prognosis of local recurrence in primary operable breast cancer.

A retrospective study was conducted of all patients with an isolated locoregional recurrence of carcinoma of the breast after modified radical mastectomy was performed with or without adjuvant radiotherapy. The findings are summarized as follows: adjuvant radiation therapy delayed the appearance of local recurrence; there was no difference in the length of time to the diagnosis of distant dissemination between the irradiated and nonirradiated patients after the treatment of locoregional relapse. 35% of the irradiated patients and 25% of the nonirradiated patients remained clinically free of disease for relatively long periods after the treatment of locoregional relapse.

Breast Neoplasms↗

PubMed1990

Preoperative versus postoperative adjuvant radiotherapy for surgically curable carcinoma of the rectum and distal sigmoid colon.

From January 1979 to October 1986, 86 patients with surgically resectable adenocarcinoma of the rectum or rectosigmoid were treated with adjuvant radiotherapy consisting of preoperative 2,400 cGy (22 patients), preoperative 4,000 cGy (14 patients), "sandwich" technique (27 patients), and postoperative irradiation (23 patients). Average follow-up was 42.9 months. The local recurrence rate was 4.5%, 9.1%, 7.4%, and 34.8%, respectively. The distant metastasis rate was 18.2%, 18.2%, 7.4%, and 30.4%, respectively. Preoperative radiotherapy with adequate surgical resection appears more effective in reducing the incidence of local recurrence.

Adenocarcinoma↗

PubMed1987

Carcinoma of the extrahepatic biliary system--results of primary and adjuvant radiotherapy.

From 1975-1983, 20 patients with primary carcinomas of the gallbladder (GB) or extrahepatic bile ducts (EHBD) were irradiated with curative intent at the Washington University Medical Center and affiliated hospitals. Of the 17 patients with EHBD cancer, one received adjuvant irradiation after gross resection with positive microscopic margins. All others received primary irradiation for unresectable tumors, or for gross residual tumor after incomplete resection. The 8 patients receiving Ir192 implant in addition to external radiation showed improved (p = 0.06) survival compared to the 9 receiving external only: median 15 months (range 1.5-34 + months) versus 7 months (range 2.5-21 months). Failures were predominantly local-regional, with only one patient showing metastatic spread without known local-regional tumor. Adjuvant radiation therapy was given after cholecystectomy to 3 patients with GB cancers showing tumor extension beyond the serosa or to regional lymphatics. Of these, two survived at 22+ and 27+ months; the third died of local recurrence at 5 1/2 months. Although numbers are small, these results appear to support the use of adjuvant radiotherapy in patients with microscopic residual GB cancer. Aggressive local and regional radiotherapy can add to the quality and length of survival in both patient groups, that is, those with resectable lesions with high likelihood of microscopic residual, and also those with unresectable or gross residual disease after surgery.

Adult↗