Preoperative measurement of cancer antigen 125 (CA 125) in the differential diagnosis of ovarian tumors

The purpose of the present study was to evaluate the information preoperative measurements of cancer antigen 125 (CA 125) may give concerning the nature of an ovarian tumor. Serum samples from 61 patients were analyzed and the results compared with regard to malignancy, FIGO-stage, and histologic type of the tumor. All patients were deemed to have a malignant tumor by clinical examination. Elevated serum levels (greater than 35 U/ml) were found in 44 patients and of these patients 38 had carcinomas, 5 had borderline tumors, and one had a benign tumor (false positive). Normal serum levels (less than or equal to 35 U/ml) were registered in 17 patients. Fourteen of these had benign tumors and 3 had malignant (false negative). The false positive sample and the 3 false negative samples observed in the present study result in a positive and negative predictive value of the CA 125 analysis of 98% (43/44) and 82% (14/17) respectively. The positive predictive value of the clinical examination was 75% (46/61). It is concluded that measurement of CA 125 is a valuable adjunct to the preoperative examination of patients with ovarian tumors.

Measurement of the ovarian cancer-associated antigen CA 125 prior to second look operation

CA 125 was measured in serum samples from 81 patients with a diagnosis of epithelial ovarian cancer. The samples were drawn prior to second look laparotomy performed in patients with complete or partial clinical remission after finishing cytostatic or radiation treatment. The positive and negative predictive value of the CA 125 measurements was 100% and 64%, respectively; the sensitivity and specificity were found to be 44% and 100%, respectively. At the second look operation no evidence of disease was observed in 40 patients, microscopic tumor was found in 10, and macroscopic tumor in 31 patients. All 81 patients had a gynecologic examination under anesthesia prior to the second look operation. Measurement of CA 125 was found superior to this examination with respect to positive and negative predictive value as well as to sensitivity and specificity. It is concluded that CA 125 values above 35 U/ml without exception announced residual tumor. Therefore, in cases with elevated CA 125 values, gynecologic examination under anesthesia or explorative laparotomy gave no further information concerning the result of treatment. CA 125 levels below 35 U/ml were without predictive value owing to a high number of false negative results.

A regression analysis of prognostic factors after resection of Dukes' B and C carcinoma of the rectum and rectosigmoid. Does post-operative radiotherapy change the prognosis?

The prognostic value of several clinical and histopathological characteristics has been evaluated in patients with Dukes' B and C carcinoma of the rectum and the rectosigmoid. Data on 260 Dukes' B and 208 Dukes' C tumours entered into a prospective, randomized clinical trial of post-operative radiotherapy (50 Gy given with 2 Gy/fraction in an overall time of 7 weeks) were analyzed by means of the Cox proportional hazards model. The Dukes' stages B and C were analyzed in two separate multivariate analyses. In patients with Dukes' B tumours, a poor prognosis was associated with age above 60, perineural and venous invasion, tumour located less than 10 cm from the anal verge and elevated pre-operative carcinoembryonic antigen (CEA) (greater than 3.2 ng ml-1). In patients with Dukes' C tumours, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and elevated pre-operative CEA were associated with a poor prognosis. In addition, a large tumour diameter had a strong, negative influence on the prognosis. Males seemed to have a poorer prognosis than females among the Dukes' C patients. Resection of neighbouring organs was also associated with a poor prognosis in this stage. Post-operative radiotherapy as administered in the present series had no significant influence on prognosis. Based on the derived prognostic models patients with a hazard of death above the median in each stage were selected. A separate analysis of the survival in these high risk patients showed no survival benefit from radiotherapy. The proportional hazards model may be a useful tool in selecting patients for more aggressive adjuvant treatment.

Cyclic hormonal treatment in ovarian cancer. A phase-II trial

Twenty-nine patients with advanced epithelial ovarian cancer were included in a phase-II trial of cyclic hormonal treatment. The schedule consisted of tamoxifen 10 mg X 3 daily for 14 days followed by medroxyprogesterone acetate 400 mg X 2 daily for 14 days. No objective response was recorded in 17 evaluable patients and cyclic hormonal treatment appears to be ineffective in advanced ovarian cancer.

Orgotein in radiation treatment of bladder cancer. A report on allergic reactions and lack of radioprotective effect

The possible protective effect of orgotein (a superoxide dismutase) on radiation cystitis and proctitis was studied in patients with carcinoma of the urinary bladder. A double-blind study in 60 patients was planned but due to unacceptable side effects only 30 patients were included. Radiation treatment was given with curative intent at a dose of 63 Gy in 30 fractions. Orgotein was injected 15 min after each daily radiation treatment at a dose of 4 or 8 mg. No effect of orgotein on tumour radiation response or on the acute radiation reactions in the bladder and rectum was detected. Marked subcutaneous infiltration and redness was seen at the local injection site in 5 patients. No general symptoms were observed. Intradermal tests and antibody titration tests showed that the local reactions were due to allergic reactions to the drug itself. The lack of radioprotective effect and the high frequency of unacceptable side effects makes orgotein an unsuitable drug in clinical radiation therapy.

Major or local surgery for cure in early rectal and sigmoid carcinoma--a prospective evaluation

The results of different types of treatment for early cancer in 158 out of 1,300 patients with rectal and sigmoid cancer were evaluated in a prospective study from 1979 to 1984. Radical surgery was performed in 121 patients (mean age 66 years) with cancer Dukes' A (median diameter 3 cm), while 37 patients (mean age 71) with smaller cancers (median 2 cm) had polypectomy or local excision. Post-operative complications were significantly more frequent in the first group. No patients in any of the two groups with carcinoma in pedunculated adenomas or within the upper half of the submucosa or above 9 cm from the anal verge had recurrent cancer. CEA-measurements had no prognostic value. No difference was found in crude or cancer-related death between the two groups. The overall results support the use of local treatment in elderly patients with complicating disease, having small cancers, not penetrating the tunica muscularis externa of the rectosigmoid wall.

Postoperative radiotherapy in Dukes' B and C carcinoma of the rectum and rectosigmoid. A randomized multicenter study

Results obtained during the first 5 years of a randomized study of postoperative radiotherapy (50 Gy) are presented. Criteria for randomization were fulfilled in 494 of 861 patients with Dukes' B and C tumors, when the trial was closed. Severe complications from radiotherapy approximated 10%. Probability of survival without local failure within 24 months was significantly higher after radiotherapy in patients with Dukes' C tumors, and the time of local failure was delayed 1 year. Patients with Dukes' B tumors had no benefit from radiotherapy. Risks of distant metastases and death were not influenced by radiotherapy in the main groups. Plasma-CEA measurements were evaluated blindly, and radiotherapy changed the critical levels of CEA for detection of recurrent cancer. It was concluded that patients with Dukes' C tumors may benefit from radiotherapy and plasma-CEA levels are influenced by radiotherapy, which may be important, when these are used in screening for recurrent cancer.

Postoperative radiotherapy in Dukes' B and C carcinoma of the rectum and rectosigmoid. A randomized multicenter study

Results obtained during the first 5 years of a randomized study of postoperative radiotherapy (50 Gy) are presented. Criteria for randomization were fulfilled in 494 of 861 patients with Dukes' B and C tumors, when the trial was closed. Severe complications from radiotherapy approximated 10%. Probability of survival without local failure within 24 months was significantly higher after radiotherapy in patients with Dukes' C tumors, and the time of local failure was delayed 1 year. Patients with Dukes' B tumors had no benefit from radiotherapy. Risks of distant metastases and death were not influenced by radiotherapy in the main groups. Plasma-CEA measurements were evaluated blindly, and radiotherapy changed the critical levels of CEA for detection of recurrent cancer. It was concluded that patients with Dukes' C tumors may benefit from radiotherapy and plasma-CEA levels are influenced by radiotherapy, which may be important, when these are used in screening for recurrent cancer.

Carcinoma of the prostate limited to the pelvis. Treatment with curative radiation therapy

A retrospective analysis of external radiation therapy of 43 patients with carcinoma of the prostate limited to the pelvis is presented. The tumours were classified according to the UICC TNM system and in the range T2-4, Nx, 0-2, M0; 86 per cent had extracapsular disease. The 5-year crude survival rate was 52 per cent, the corrected survival 62 per cent compared with an expected survival of 81 per cent. Eight patients (18%) had clinical recurrence, all with distant metastases in bones and one with local recurrence as well. After 6 months mild side effects were found in 10 patients (23%), severe complications in none. In conclusion, external radiation therapy offers the possibility of partial or complete regression of carcinoma of the prostate limited to the pelvis and apparently improves the 5-year survival. If radical prostatectomy and lymphadenectomy is not used or impossible, external radiation therapy is recommended instead of hormone therapy with oestrogens.

Small cell anaplastic carcinoma of the lung. The Aarhus experience 1976-1981

Over a 6-year period 179 patients with small cell carcinoma of the lung (SCLC), 152 with limited disease, 25 with extensive disease, and 2 who were not staged, were treated with chest irradiation and combination chemotherapy with CCNU, adriamycin and vinblastine. For all patients the 2-year survival was 19.9 +/- 3 per cent, and the 5-year survival 11.9 +/- 3 per cent. No patients with extensive disease survived for 5 years. This type of treatment has curative potential for SCLC limited disease, which calls for further trials based on this approach.

Impact of CT-based treatment planning on radiation therapy of carcinoma of the bladder

Computed tomography (CT) has been an integrated step in the treatment planning of radiation therapy of carcinoma of the bladder in stages T1-T3 in 49 consecutive patients referred to Radiumstationen in Aarhus. The introduction of this technique has led to a considerable increase (26 +/- 4%) in the mean effective target volume of these patients compared with that of 51 conventionally simulated patients. The largest field expansions have been performed in the cranial and ventral directions. The field margins to the bladder have been correlated with the position of the tumour mass. The findings are compared with previously published results on CT-based treatment planning of patients with bladder carcinoma.

Radiumstationen in Aarhus from 1962 to 1984

An overview is given of the development at Radiumstationen in Aarhus from 1962 to 1984. Within the field of radiation therapy the period has been characterized by the transition to megavoltage units, an extended use of dosimetry and dose planning, the clinical application of radiobiologic principles and the recent introduction of CT scanning for dose planning. The past ten years have seen a growing importance of chemotherapy and an intensified collaboration with the specialized branches of surgery, which among other things has brought about a change in the structure of the Department; a change towards sub-specialization according to the site of the organs treated. The period has also been characterized by an increasing number of patients with cancer and a very intensive utilization of wards and equipment, as well as by a busily engaged staff . The present function of the Department is that of Department of Oncology at one of the 5 Danish oncologic centres serving its specific region.

Dose-response relationship for radiation therapy of recurrent, residual, and primarily inoperable colorectal cancer

One hundred and thirteen patients with advanced locoregional recurrent (77), residual (18) or primarily inoperable (18) colorectal carcinoma were treated with radiotherapy. Eighty-five patients had locoregional disease only and 28 had both local disease and distant metastases. The treatment was given with varying dose levels (23-73 Gy) in daily fractions of approximately 2 Gy in 3-8 weeks. This dose variation allowed an evaluation of the dose-response relationship for radiation treatment of this tumour. A good subjective response was obtained in 63%. This effect showed no dose-response relationship except for doses greater than or equal to 56 Gy, where all patients received relief of symptoms. Eighty-two per cent of evaluable patients achieved an objective response (PR 53%, CR 29%). The frequency and duration of the complete responses showed a marked dose-response relationship. Thus, at doses greater than or equal to 56 Gy, a 2-year actuarial complete response rate of 40% was found compared with 7, 4 and 0% at doses of 46-55 Gy, 36-45 Gy and less than or equal to 35 Gy, respectively. The dose-response relationship for local control also influenced the survival rate, although a number of patients died from distant metastases even when local control was obtained. However, with regard to locoregional disease, the 2-year survival was 53% for patients with complete tumour regression but only 8% for patients without complete tumour regression.

A case-control study of female bladder cancer

A case-control study was performed on 47 female bladder cancer patients and 94 female controls matched in age and geographic area. Twenty-five determinants of assumed importance were examined. The bivariate associations revealed a significantly increased relative risk (RR) for bladder cancer associated with use of tobacco, cheroot smoking and saccharin consumption, and some subgroups like never-smokers in combination with use of saccharin. The population attributable risk percentages were estimated. Through a multivariate logistic analysis of selected determinants cheroot consumption was the most pronounced independent variable.

Prostatic hypertrophy and venereal disease as possible risk factors in the development of bladder cancer

In three urological predictors, nocturia, prostatic surgery for prostatic hypertrophy and a previous venereal disease, a significantly increased relative risk (RR) of developing bladder cancer was detected. An epidemiological case control investigation was performed on 165 male bladder cancer patients and an equal number of male controls matched concerning age and geographical area. The sample was obtained from a predominantly rural district. The theoretical individual risk factors were calculated by the aid of a multivariate logistic analysis. Twenty-four patients versus 11 controls had a history of prostatic surgery (RR = 2.38) for benign prostatic hypertrophy, 60 patients versus 36 controls complained of nocturia at least 2 years before presenting symptoms of bladder cancer (RR = 2.05), and 16 patients versus seven controls had a history of venereal disease (RR = 2.42). The results seems to indicate that prostatic hypertrophy and previous venereal disease may at least in part be factors of importance associated with bladder cancer.

Presenting symptoms, treatment delay and survival in bladder cancer

In 212 consecutive patients with bladder tumour, relationships between symptoms, demographic factors, delay before treatment and survival rate were investigated. The presenting symptom was haematuria in 79% of the patients. The interval from onset of symptoms until treatment averaged 28 weeks (median = 15 weeks). The general practitioner delay comprised half of the total delay. Patients with cystitis as the presenting symptom and women with haematuria had the longest doctor delay. The length of delay did not influence the crude survival rate in patients with tumours in the two highest TNM stages. In T1 and T2 tumours, shorter delay tended to give a better survival rate.

An epidemiological study of bladder cancer in a predominantly rural district

A case-control study was performed on 212 bladder cancer patients (165 male + 47 female) and 259 control persons (165 male + 94 female) matched according to age and geographic area. Twenty-five determinants of assumed importance were examined. Bivariate analysis revealed a significantly increased relative risk (RR) of developing bladder cancer associated with cigarette smoking, cigarillos smoking, pipe smoking, tobacco chewing, industrial work, previous venereal disease, work with petroleum or asphalt, consumption of alcohol, work with oil or gasoline, and work with chemical materials. A multivariate logistic analysis showed that cigarette and cigarillos smoking involved the highest significant risks. An analogous logistic analysis of the negatively associated determinants revealed never smokers and farmers to be the weakest independent variables.

An epidemiological case-control study of bladder cancer in males from a predominantly rural district

A case-control study was performed on 165 male bladder cancer patients and an equal number of male control persons matched in age and geographic area. Thirty determinants of assumed importance were examined. A multivariate logistic analysis was performed. A significant increment in the relative risk (RR) for bladder cancer was associated with cigarette smoking (RR = 1.89), a history of prostatic surgery (RR = 2.38), nocturia (RR = 2.05), previous venereal disease (RR = 2.42), industrial work (RR = 1.82), work with oil or gasoline (RR = 2.71) and work with various unspecified chemical materials (RR = 1.58).