PURPOSE:To define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions and to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. METHODS AND MATERIALS:Ninety-five tandem and ovoid insertions were performed at the Fox Chase Cancer Center between 1985 and 1992 for cervical (n = 91) and endometrial (n = 4) cancer. Patients were placed on antibiotics in 19%, usually for a positive routine preoperative urine culture, but no patient was given prophylactic antibiotic therapy. Deep-vein thrombosis prophylaxis was practiced for 70% of implants and included subcutaneous heparin (40%), graduated compression elastic stockings (16%), and external pneumatic calf compression (14%). All patients were placed on prophylactic diphenoxylate hydrochloride, with doses ranging from three to eight tablets/day. RESULTS:Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants (5%) were removed emergently secondary to presumed sepsis (n = 1), exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status (n = 3), and myocardial infarction/congestive heart failure (n = 1). No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age (p < 0.005) and spinal/epidural anesthesia (p < 0.02) to be associated with increased perioperative morbidity, and older age (p < 0.05) and higher ASA classification (p < 0.02) to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age (p < 0.01) to be significantly related to perioperative morbidity. CONCLUSIONS:Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, our data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases and was related to older age in multivariate analysis.

Purpose:Stamey and colleagues have reported that irradiation controls only 1 l-20% of prostate adenocarcinomas, as assessed by persistently normal prostatic specific antigen (PSA) measurements, and accelerates tumor growth in the 80% of patients who are not cured (I.Urol.141:1084-7 and 150:1856-9).To evaluate these concerns, similar criteria were used to identify the cohort of patients treated by external beam irradiation (XRT) in the Department of Radiation Oncology.Materials and Methods: Among 1245 patients treated for prostate cancer with XRT prior to January 1, 1993, 128 patients had an initial or followup PSA measurement between April 1985 and January 1988.PSA trends could not be analysed in 18 patients with fewer than 3 PSA values, who were excluded.The study group comprised 110 patients.Age at treatment averaged 63.4 years (range 46-82); followup averaged 10.7 years (range: 2. l-27 years).The median dose to the prostate was 70 Gy; 87 patients received 50 Gy to pelvic nodes; 6 patients received 50 Gy to pa.ra-aortic nodes for lymphangiographic (5) or biopsy-proven node disease(l).PSA values were plotted against the time interval from initial radiation for each patient.Patients whose PSA values declined to and remained in the normal range were scored as non-relapsing.Curves were fitted for patients with rising PSA values to measure PSA doubling times (PSA-DTs) during periods of unchanged prostate cancer therapy.A separate group of 65 patients were irradiated after radical prostatectomy for involved margins or extracapsular soft tissue extension (28), nodal involvement (lo), persistent or rising PSA (27), or local recurrence (8).PSA-DTs were also determined in 21 of these who had rising PSA after combined surgery and irradiation.

BACKGROUND:This review was done to assess the outcomes and patterns of recurrence in a group of patients with Stage III endometrial carcinoma that might help guide adjuvant therapy.METHODS:A retrospective review was performed of 105 patients treated from 1970-1990 at three institutions. All patients underwent abdominal hysterectomy, with 60 having pathologic node assessment and 45 having cytologic examination of peritoneal washings. A single extrauterine site was involved in 75% of patients; 20% and 5% had two and three sites involved, respectively. All patients received postoperative external beam irradiation to the pelvis or pelvis and paraaortic regions for pathologically positive paraaortic nodes. Actuarial techniques were used to estimate the survival and recurrence rates.RESULTS:The 5-year disease-free survival rate for all patients was 64%. Univariate analysis revealed that the depth of myometrial penetration, the clear cell or papillary serous pathologic type, the histologic grade, and the number of extrauterine sites predicted disease-free survival. Cox regression revealed the grade and pathologic findings to be independent predictors of disease-free survival. The overall 5-year pelvic recurrence rate was 21%, with multivariate analysis revealing the grade to be the strongest prognostic factor. Pathologic findings and the number of involved extrauterine sites were the most important prognostic factors for abdominal recurrence and other sites of distant relapse.CONCLUSIONS:The subgroup of patients with low-grade endometrial tumors or superficial myometrial penetration has a low distant relapse rate. Local control remains the goal of therapy in these patients. Patients with high-grade tumors, deep myometrial penetration, clear cell or papillary serous histologic types, or two or more involved extrauterine sites are at high risk for distant recurrence that may include the abdomen. Investigative strategies delivering aggressive adjuvant therapy are appropriate.

Little information is available concerning the influence of specific extrauterine sites in patients with stage III endometrial carcinoma. To define better the prognostic factors and patterns of failure, we reviewed 105 patients with pathologic stage III disease (1988 FIGO system) who were treated between 1970 and 1990. Following hysterectomy, all patients received postoperative external beam irradiation to the pelvis alone (88 patients) or to the pelvis and paraaortic regions (17 patients) for pathologically positive paraaortic nodes. Actuarial techniques were used to analyze survival and recurrences. Range of follow-up was 7–251 months (median 83 months). Five-year disease-free survival (DFS) for all patients was 64%. Multivariate analysis revealed clear cell/papillary serous histology and histologic grade to be significant predictors of DFS. Based on our analysis, four prognostic groups are described for the purpose of predicting outcome and patterns of disease recurrence. Patients who have a single extrauterine site of involvement and histologic grade 1 tumors have an excellent prognosis. Patients with a single extrauterine site of involvement and grade 2 or 3 tumors have a lower DFS rate, as do patients with two or more sites of extrauterine involvement. However, patterns of disease recurrence for these groups are different, and these are discussed. Radiat Oncol Invest 1996;4:122–128. © 1996 Wiley-Liss, Inc.

Purpose: This study was designed to document the incidence and degree of vaginal stenosis, sexual activity, and satisfaction in women treated with intracavitary radiation therapy for cervical or endometrial carcinoma.Methods and Materials: The incidence of vaginal stenosis in 90 patients treated for either cervical carcinoma (n = 42) or endometrial carcinoma (n = 48) with standard doses of intracavitary radiation from 1989 to 1992 with at least 6 months follow-up was recorded. Vaginal length was measured using a modified vaginal dilator calibrated in centimeters. Semistructured patient interviews documented pretreatment and posttreatment sexual activity and sexual satisfaction.