Radiation therapy in the management of cancer of the cervix

In general, reported 5-year survival rates are 85% to 90% for stage IB, about 75% for stage IIA, 60% to 65% for IIB, 25% to 50% for stage IIIB, and 10% or less for stage IV. For bulky lesions, a combination of preoperative irradiation and hysterectomy has been tried; however, in some studies the results are no better than those noted with higher doses of irradiation alone.

Clinical trials with local (external and interstitial) irradiation and hyperthermia. Current and future perspectives

There is a growing body of experience in the clinical use of either external or interstitial (local) hyperthermia. A great deal has been learned about the technical and prognostic factors that influence the efficacy of heat combined with irradiation. Despite some technologic advances, substantial limitations remain to the optimal delivery of heat and monitoring of the temperature throughout the treatment volume with localized techniques. Additional efforts to improve present equipment are paramount, and further studies should be encouraged to establish the optimal conditions for the delivery and temperature monitoring of local hyperthermia combined with irradiation or cytotoxic agents. It is possible to induce tumor regression and produce satisfactory palliative results in selected groups of patients with recurrent or advanced tumors. The clinical application of hyperthermia, particularly in previously irradiated patients, should be continued. Adequately designed clinical trials to amplify our understanding of this modality and its optimal clinical applications should be strongly supported.

New trends in prostatic cancer research. Hormone therapy in localized carcinoma of the prostate

Seventy-five per cent of patients with carcinoma of the prostate exhibit some response to hormonal therapy. Emphasis from the very beginning to the present time has been on mechanisms of action. Studies on total androgen suppression were also developed for many years. Although the majority of the trials concerned locally advanced tumors, neo- or adjuvant hormonal therapy seems closely related to an increase in disease-free and metastasis-free survival, and local tumor control, no significant correlation was found between neo- or adjuvant radiotherapy and overall survival. Present ongoing studies are focused on patients with early cancer stage, PS > 70% and PSA < 20 ng/ml. In particular three areas are currently under investigation: dose escalation, particle therapy and radiotherapy combined with intermittent androgen suppression. Well-designed clinical trials are highly desirable to compare efficacy and specifically analyze patterns of failures with radical prostatectomy or irradiation, taking into account patient selection, staging methods, tumor characteristics, prognostic factors, etc. Endpoints should include survival, morbidity, and quality of life as well as cost-benefit of each therapeutic modality.

Surgical ligation of patent ductus arteriosus in very low birth weight infants: is it safe?

We evaluated the outcome of a combined medical and surgical treatment of patent ductus arteriosus (PDA) in newborns weighing less than 1500 g. Charts were retrospectively reviewed for 76 newborns with a PDA between 1993 and 1997. Thirteen infants had pre-existing conditions prohibiting the use of indomethacin; eight were managed surgically, five medically. The remaining 63 infants received indomethacin therapy. Thirty-two medical failures occurred, requiring surgical ligation of the PDA. Those requiring surgery had a lower average birth weight (847 versus 997 g) and gestational age (26 versus 28 weeks; P < 0.05). Indomethacin treatment was successful in 27 infants. There were only three operative complications: a small pneumothorax, wound bleeding, and a small aortic tear. All recovered uneventfully and no deaths were attributable to the surgical procedure itself. There was no difference in the incidence of respiratory distress syndrome, duration of intubation, sepsis, neonatal enterocolitis, renal dysfunction, bleeding disorders, or intraventricular hemorrhage among both groups. Surgical ligation of a PDA is associated with a high success rate, a low incidence of complications, and no additional morbidity than indomethacin alone. We propose that surgical ligation should be regarded as a first line therapy for very small premature infants who are at higher risk of medical failure.