A population-based prospective database targeting 15 key radiation therapy (RT) features was initiated in British Columbia in 1984. This 25-year outcome report assessed the utility of the database and demonstrated that such a database can be used to (1) describe population-based utilization of a health service, (2) inform treatment policy recommendations, (3) inform system planning and resource allocation, (4) audit regional and individual oncology practices, (5) assess whether new observations from randomized trials have been translated into population health gains and (6) produce peer-reviewed publications. Health system managers and researchers could benefit from the development and support of such databases.

BACKGROUND:Radiotherapy after mastectomy to treat early breast cancer has been known since the 1940s to reduce rates of local relapse. However, the routine use of postoperative radiotherapy began to decline in the 1980s because it failed to improve overall survival. We prospectively tested the efficacy of combining radiotherapy with chemotherapy.METHODS:From 1978 through 1986, 318 premenopausal women with node-positive breast cancer were randomly assigned, after modified radical mastectomy, to receive chemotherapy plus radiotherapy or chemotherapy alone. Radiotherapy was given to the chest wall and locoregional lymph nodes between the fourth and fifth cycles of cyclophosphamide, methotrexate, and fluorouracil.RESULTS:After 15 years of follow-up, the women assigned to chemotherapy plus radiotherapy had a 33 percent reduction in the rate of recurrence (relative risk, 0.67; 95 percent confidence interval, 0.50 to 0.90) and a 29 percent reduction in mortality from breast cancer (relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.99), as compared with the women treated with chemotherapy alone.CONCLUSIONS:Radiotherapy combined with chemotherapy after modified radical mastectomy decreases rates of locoregional and systemic relapse and reduces mortality from breast cancer.

At the Cancer Control Agency of British Columbia, 483 patients with cancer of the esophagus and cardia were seen from 1970-1980. Four hundred and one out of 483 (83%) had tumors larger than 5 cm (T2) and in 288/483 (60%) the disease had extended beyond the esophageal wall (T3). The overall 5-year survival rate was only 9% for all patients treated by external irradiation. The 5-year survival for a selected group having esophagectomy was 20%. Most patients died of persistent cancer at the primary site (83%); the cause of death was aspiration pneumonia (82%) due to obstruction caused by the persistent cancer. Our most recent experience using intracavitary irradiation either prior to or after external irradiation in 211 patients has been safe and simple and preliminary analysis of treatment results suggests that it has improved the therapeutic ratio. The analysis of quality of life at 6 months following therapy as it relates to performance status, swallowing ability, weight, and pain indicated significant improvement in all of these parameters. Of 171 patients, 33% were still alive at 1 year, 26% at 2 years, and 19% at 3 years following treatment. Of 43 patients suitable for preoperative irradiation, only 26 patients were actually resected and 19 of them are still alive with no evidence of disease, 8 to 30 months. The rationale and technical aspects of the combined treatment are described in detail. Treatment results, complications and an outline for future programs based on this experience are also described.

Six patients with primary seminoma of the mediastinum were treated at the Cancer Control Agency of British Columbia during the period from 1970 to 1982. Primary treatment used was external beam radiotherapy. Only one patient received both radiotherapy and chemotherapy. Tumor dose ranged from 3000 cGy in 16 daily fractions in 3 weeks to 3500 cGy in 20 daily fractions in 4 weeks using parallel opposed fields on megavoltage machines. Two patients received additional small-volume boost to the superior mediastinum, delivering 500 cGy and 1000 cGy, respectively. All patients had complete resolution of the mediastinal mass after treatment and are alive and free of disease. One patient developed a metastasis to the fifth lumbar vertebra 1 year after treatment. This metastatic lesion was treated with radiotherapy and the patient is alive and free of clinical disease. Mediastinal seminoma is radiosensitive and radiocurable.