BACKGROUND:Results of salvage therapy in patients with carcinoma of the uterine cervix recurrent after surgery have been dismal even when the disease was apparently confined to the pelvis. Concurrent chemoradiation is one of the several avenues being investigated to improve these results.PATIENTS AND METHODS:Thirty-five women with recurrent cervical carcinoma were enrolled in the trial. Twenty-eight patients (80%) had disease limited to the central pelvis (ten), lateral pelvis (fourteen) and vagina (four) and seven had paraortic metastases. Patients were treated with a combination of external radiotherapy (50-70 Gy) along with three cycles of 5-fluorouracil (1000 mg/m2/24-hour continuous infusion days 1-4) and carboplatin (75 mg/m2 in bolus days 1-4).RESULTS:Treatment was well tolerated, with 30 patients (86%) completing the protocol as planned. Acute toxicity was severe but manageable; 11 patients (31%) experienced grades 3-4 acute toxicity. Late morbidity occurred in five patients (14%). Overall response rate was 74% (11 partial responses and 15 complete). After a median follow-up of 27 months (range 18-90), 13 patients (37%) are alive without disease, 4 (11%) are alive with persistent disease and 18 (52%) are dead of their disease. Actuarial two-year survival rate for the series as a whole is 44% and three-year survival is 25%. Stage of the primary disease, site of recurrence, interval from the primary therapy to recurrence, lymph node involvement, ureterohydronephrosis at the time of recurrence and diameter of the relapse are the most significant factors for survival, while complete response is related to diameter and site of relapse and lymph node status at the time of relapse.CONCLUSION:The acceptable toxicity, high response rate and satisfying survival would suggest that concomitant carboplatin/5-fluorouracil and radiotherapy is a safe and tolerable treatment for recurrent cervical carcinoma. Further studies are needed to demonstrate an eventual survival benefit of this type of chemoradiation over standard radiotherapy alone and to identify the subsets of patients who in particular might benefit from this.

AIMS AND BACKGROUND:Isolated vaginal recurrences of endometrial carcinoma are rare, and prognostic factors that predict treatment outcome are still not well defined. The aim of the present study was to evaluate the results of brachytherapy in isolated vaginal recurrences from endometrial carcinoma.METHODS:Thirty-five patients with isolated vaginal recurrences were treated with brachytherapy with intravaginal ovoids or cylinders that were calculated to deliver 6000 to 7000 cGy at the surface. Patients were assessed for size and location of recurrence at presentation, response and complications from therapy.RESULTS:Treatment was well tolerated by most patients. Grade 2 toxicity occurred in 4 patients (3 cases of partial vaginal stenosis and one proctitis). Complete response to radiation was observed in all patients, and an overall 9 failures were observed (4 local, 4 distant and 1 local plus distant). Twenty patients (57%) were alive without evidence of disease at 3 to 11 years following treatment. Site of vaginal recurrence (upper third versus others) and long (more than 12 months versus less than 12 months) interval from hysterectomy were the only factors significantly related to local failures.CONCLUSIONS:Isolated vaginal recurrences following hysterectomy for endometrial carcinoma can be treated with brachytherapy with a low rate of severe toxicity.

Despite innovative techniques in radiotherapy delivery no significant improvement in survival rates for cervical carcinoma has been achieved during the last few decades, Concurrent chemoradiation (CR) is one of the several avenues being explored to improve these results.Forty-seven women with locally advanced (IB2-IVA) squamous cell carcinoma of the uterine cervix were treated with CR, comprising a combination of external and intracavitary radiation along with three cycles of 5-FU and carboplatin.Treatment was well tolerated with 81% of the patients completing the CR protocol as planned. Acute toxicity was severe but manageable: 16 patients (34%) experienced grade 3-4 acute toxicity. Late morbidity occurred in 15% of the patients. Overall response rate was 88%. At a median follow-up time of 19 months (range 12-59) 62% of the patients are alive without disease and 18% are dead of disease. Actuarial two-year survival rate for the whole group of patients is 64%.Concomitant carboplatin/5-FU and radiotherapy is a safe and tolerable mean of treatment for locally advanced cervical cancer. The true advantage for survival, however, can be demonstrated only after completion of randomized trials comparing CR with conventional radiation therapy.

Aims and background Despite the introduction of innovative techniques in radiotherapy (RT) delivery, no significant improvement in survival has been achieved in the last decades. Concurrent chemoradiation therapy (CRT) is one of the several avenues being explored to improve the results. Methods and study design Twenty-eight women with locally advanced squamous cell carcinoma of the uterine cervix were treated with CRT comprising a combination of external and intracavitary RT, along with 3 cycles of 5-fluorouracil (5-FU) and carboplatin. Toxicity, pelvic control rate and disease-free survival achieved in this group of patients were compared in a case-control study with those of a group of 28 patients with similar clinicopathologic characteristics treated with radical RT alone at our institution. Results CRT was well tolerated, with 97% of the patients completing the protocol as planned. Acute toxicity, primarily hematologic, was significantly (P=0.05) higher in the cases than in the controls (25% vs 3%). One treatment-related death occurred in a stage III patient in the CRT group. The median follow-up was 55 months (range, 20–156) in the RT group and 20 months (range, 14–46) in the CRT group. Pelvic control rate, disease-free survival and overall survival were not significantly different in the two groups. Estimated 5-year survival rate was 70% and 66% respectively for the RT and CRT group. Conclusions Concomitant carboplatin/5-FU and radiotherapy is a safe and tolerable means of treatment for locally advanced cervical cancer. In our study, however, concurrent CRT did not result in a significant improvement in pelvic control rate or survival compared to standard conventional radiotherapy.

To prospectively evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy in locally advanced or recurrent vulvar carcinoma, 58 patients referring for primary (41) or recurrent (17) disease received preoperative external radiotherapy to a dose of 54 Gy, divided into two courses with an interval of 2 weeks. 5-Fluorouracil (750 mg/m2daily for 5 days) and mitomycin-C (15 mg/m2single bolus) were given at the start of each cycle. Wide local excision and inguinal lymphadenectomy were planned after treatment. Eighty-nine percent of patients completed the chemoradiotherapeutic treatment, whereas 72% underwent surgery. Objective responses were observed in 80% of vulvar diseases and in 79% of groin metastases. Pathologic complete response of both the vulvar and inguinal disease was confirmed in 13 patients (31%). Early severe toxicity was recorded in 3 patients and severe worsening of performance status in 3. Three deaths occurred shortly after treatment and at least one is directly related to toxic effects. This treatment allows good control of locally advanced and recurrent vulvar cancer with acceptable side effects. Further follow-up is required to determine the long-term outcome and the effectiveness of the surgical procedure.

Adjuvant treatment of patients with risk factors after surgery for cervical carcinoma remains unsatisfactory. A combination of radiotherapy and chemotherapy might improve the control of microscopic metastases. In this prospective study, 28 patients with risk factors after surgery for cervical carcinoma underwent a sequential treatment consisting of two courses of chemotherapy with vincristine, bleomycin, mitomycin c and cis-platin (VBMP), followed by radiotherapy with 54 Gy to the pelvis and the aortic nodes. Risk factors mainly consisted of nodes metastases (25 patients), but patients with parametrial invasion or histologic evidence of neoplastic vascular permeation outside the tumor were also included in the study. The treatment was well tolerated and all patients received the planned dose of chemotherapy and radiotherapy; in the follow-up one patient died of ileal necrosis and one died of pulmonary embolism after being medically treated for subocclusion. With a minimal follow-up of 70 months, 15 patients are alive and free of disease, two have died of complications (one with local recurrence), one has died of intercurrent disease and 10 have died of disease (six distant, four local). The site of recurrence was outside the field of irradiation in six cases (lungs in two cases, liver and para-aortic nodes in one and distant nodes in three). This treatment is feasible but control of distant metastases in high-risk patients after surgical treatment remains unsatisfactory.

OBJECTIVE:To evaluate in an Italian population the prevalence, characteristics at first diagnosis and outcome of HIV-seropositive individuals with cervical carcinoma referred to a tertiary-care institution.DESIGN:A retrospective evaluation of all patients referred for invasive cervical carcinoma from 1991 to 1994.SETTING:The departments of obstetrics and gynaecology, and radiotherapy at San Gerardo Hospital, University of Milan, Italy.PATIENTS:A total of 340 women were treated over a 3-year period (186 aged < 50 years). Six patients were found to be HIV-seropositive.INTERVENTIONS:Seropositive patients were treated according to current institutional protocols, irrespective of HIV status. Four underwent radiotherapy and two radical hysterectomy as primary treatment.RESULTS:Although five HIV-seropositive patients were known to be infected 13-81 months before diagnosis of cervical cancer, none had received a PAP smear in the last year and only one in the last 2 years. HIV patients were younger than general population (P = 0.02), with a significant history of intravenous drug use (P = 0.000001) and with more advanced disease (P = 0.04). Two HIV-positive patients also received polychemotherapy (one adjuvant and one salvage treatment) and both completed the planned treatment. Within 24 months two patients had died of cancer and one of AIDS; one is alive with AIDS and cancer and two are free of disease.CONCLUSIONS:This study confirms that in a southern European population, HIV-seropositive women present to tertiary-care institutions with more advanced disease and have a poorer prognosis than the general population. Strict screening programs for cervical dysplasia and cancer are warranted for HIV-seropositive patients.

Medical and Pediatric OncologyVolume 25, Issue 2 p. 109-112 Proceedings of the Tumor Board of the Clinica Pediatrica Isolated bilateral anterior chamber eye relapse in a child with acute lymphoblastic leukemia Giuseppe Masera MD, Giuseppe Masera MD Guest EditorSearch for more papers by this authorGiulio J. D'Angio MD, Corresponding Author Giulio J. D'Angio MD Series Editor Department of Radiation Oneology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104–4283Department of Radiation Oneology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104–4283Search for more papers by this authorAudrey E. Evans MD, Audrey E. Evans MD Associate EditorSearch for more papers by this authorMomcilo Jankovic MD, Momcilo Jankovic MD Clinica Pediatrica, Università di Milano, Ospedale S. Gerardo, Monza, Italy With the collaboration of Monica Limonta, M.D., and Daniela De Poli, M.D. (Clinica Pediatrica), Patricia Ridling, M.D. (Clinica Oculistica), Alessandro Colombo, M.D. (Divisione di Radioterapia) of the Ospedale S. Gerardo, Monza; and Massimo Zucchetti, M.D. (Laboratorio di Chemioterapia Antitumorale, Istituto M. Negri, Milan), and Anastasia Guerriero, M.D. (Divisione Pediatrica, Ospedale SS. Annunziata, Naples).Search for more papers by this authorValentino Conter MD, Valentino Conter MD Clinica Pediatrica, Università di Milano, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this authorGiorgio Pretto MD, Giorgio Pretto MD Clinica Oculistica, Università di Milano, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this authorFranco Placa MD, Franco Placa MD Divisione di Radioterapia, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this authorMaurizio D'Incalci MD, Maurizio D'Incalci MD Laboratorio di Chemioterapia Antitumorale, Istituto M. Negri, Milan, ItalySearch for more papers by this authorGiuseppe Masera MD, Giuseppe Masera MD Clinica Pediatrica, Università di Milano, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this author Giuseppe Masera MD, Giuseppe Masera MD Guest EditorSearch for more papers by this authorGiulio J. D'Angio MD, Corresponding Author Giulio J. D'Angio MD Series Editor Department of Radiation Oneology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104–4283Department of Radiation Oneology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104–4283Search for more papers by this authorAudrey E. Evans MD, Audrey E. Evans MD Associate EditorSearch for more papers by this authorMomcilo Jankovic MD, Momcilo Jankovic MD Clinica Pediatrica, Università di Milano, Ospedale S. Gerardo, Monza, Italy With the collaboration of Monica Limonta, M.D., and Daniela De Poli, M.D. (Clinica Pediatrica), Patricia Ridling, M.D. (Clinica Oculistica), Alessandro Colombo, M.D. (Divisione di Radioterapia) of the Ospedale S. Gerardo, Monza; and Massimo Zucchetti, M.D. (Laboratorio di Chemioterapia Antitumorale, Istituto M. Negri, Milan), and Anastasia Guerriero, M.D. (Divisione Pediatrica, Ospedale SS. Annunziata, Naples).Search for more papers by this authorValentino Conter MD, Valentino Conter MD Clinica Pediatrica, Università di Milano, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this authorGiorgio Pretto MD, Giorgio Pretto MD Clinica Oculistica, Università di Milano, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this authorFranco Placa MD, Franco Placa MD Divisione di Radioterapia, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this authorMaurizio D'Incalci MD, Maurizio D'Incalci MD Laboratorio di Chemioterapia Antitumorale, Istituto M. Negri, Milan, ItalySearch for more papers by this authorGiuseppe Masera MD, Giuseppe Masera MD Clinica Pediatrica, Università di Milano, Ospedale S. Gerardo, Monza, ItalySearch for more papers by this author First published: August 1995 https://doi.org/10.1002/mpo.2950250211Citations: 3 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume25, Issue2August 1995Pages 109-112 RelatedInformation

In March 1989 we started a feasibility study of combined radio-chemotherapy in patients with locally-advanced head and neck cancer. The first phase of treatment consisted of conventional radiotherapy (2 Gy/day, 5 days/week for a total dose of 70 Gy to primary tumor and +/- 50 Gy to nodes) and cisplatinum (20 mg/m2, i.v., for 4 days) +5FU (200 mg/m2, i.v., for 4 days) every 4th week, during radiant sessions. The second phase of treatment was started about one month after the end of simultaneous chemotherapy and radiotherapy: patients in complete remission received 1 more cycle of chemotherapy, as consolidation, while patients in partial remission received two more cycles of chemotherapy. Non-responding patients received no more chemotherapy. During the second phase the days of cisplatinum and 5FU were 5. Up to April 1990, 17 patients have been included in the study. They were stage III (64%) and IV (36%). The mean administered dose of radiotherapy was 66 Gy (range: 60-70 Gy) to primary tumor and 60 Gy (range: 40-70 Gy) to nodes. The total number of chemotherapy cycles administered during radiant sessions was 37, the mean number of cycles was 2 (range: 1-3), with 100% dose percentage. The interval between cycles was 3 weeks in 84% of patients. The relationship between number of cycles administered and planned cycle was 37/39 (feasibility: 95%). Acceptability was 100% (no patient refused the treatment). Feasibility of the second phase was 77% and acceptability 90% (1 patient refused the treatment). Toxicity was moderate during the first and the second phases. After the first phase 14/15 evaluable patients (92%) had major response (complete remission: 46%). After the second phase 10/10 evaluable patients had a complete remission. In conclusion, this combined treatment is very easy to administer, and very well accepted. Moreover, it yields a high number of objective responses.

About 5-10% of boys with acute lymphoblastic leukemia (ALL) present with isolated testicular relapse. Very frequently these relapses occur during treatment or in the following six months, and in these cases the prognosis is very severe. The patients are usually treated with radiotherapy and chemotherapy or bone marrow transplantation (BMT). Testicular relapses after BMT are relatively rare. We report the case of a child with ALL who presented testicular relapse during therapy and was treated with local radiotherapy (2000 cGy), chemotherapy and allogeneic matched BMT. The preparative regimen consisted of Cyclophosphamide (60 mg/kg/day x 2 days) and total body irradiation (200 cGy x 2/day x 3 days). Engraftment was documented at day + 14. The patient presented again with testicular relapse at day + 146, and was therefore treated with orchiectomy, local radiotherapy and systemic chemotherapy. A marrow relapse followed, however, at day + 284 and the patient died of progressive disease.

Nineteen patients with locally advanced head and neck cancer were treated from November 1983 to January 1986 with standard loco-regional Radiotherapy: 2 Gy for 5 days/week up to a total dose of 70 Gy and simultaneous Cisplatinum 20 mg/m2 weekly. All patients achieved a response: 10 (52%) obtained a complete remission (CR) and 9 (48%) a partial remission (PR). Four of 9 patients in PR after chemoradiotherapy were disease-free after radical resection of the residual masses, while another patient was completely cured after second-line chemotherapy. The overall CR was then 79% (15/19). The results were analyzed according to the nodal status and showed that: 92% (11/12) of patients with initial nodal involvement (N1-2) achieved a CR and 75% of them were disease-free after a median follow-up of 23+ months, while only 57% (4/7) of patients with advanced nodal involvement (N3) obtained a CR (p greater than 0.05; NS) and 28% (2/7) of them were alive without evidence of disease (p less than 0.05) after 4+ and 30+ months. Toxicity was moderate: nausea and vomiting (grade 2-3) occurred in about 50% of patients, mucosal toxicity (grade 1-2) in 58%. Myelosuppression was negligible. No patient developed renal failure. Weekly cisplatinum administration during radiotherapy deserves further study especially in the management of patients with advanced primary tumor and minimal lymph node involvement.