Claes Silfverswärd

Prognostic factors in granulosa-cell tumors

Abstract A histological reevaluation was performed on 198 women with granulosa- and granulosa-theca-cell tumors treated at Radiumhemmet 1923–1972. Ninety-one percent of the patients were of clinical stage I (FIGO). The mean age at diagnosis was 52.6 years. All patients underwent surgery and all but 11% received complementary radiotherapy. Concomitant endometrial carcinoma was found in 6%. At the follow-up (1977–1978) 42 women had died from their granulosa-cell tumor. Advanced clinical stage, the presence of tumor rupture and pronounced nuclear atypia were associated with a poor prognosis. A high number of mitotic figures were of prognostic value only in stages II–IV. In stage I tumor size was related to outcome. The histological pattern of the granulosa-cell component was of no prognostic value.

Prognostic factors in uterine leiomyosarcoma: a clinical and histopathological study of 143 cases. The radiumhemmet series 1936-1981

One hundred and forty-three patients with uterine leiomyosarcomas treated at Radiumhemmet from 1936 through 1981 were reviewed. Clinical and histopathological findings were analysed by bivariate and multivariate analyses to assign prognostic factors. Mitotic count, menopausal status and stage showed to be significant predictors of survival. The series was divided into two periods of time and a significantly higher survival rate in the second period was noted for patients with stage I disease. Thirty-seven patients with tumors showing less than 10 mitotic figures per 10 high power fields had a 5-year survival rate of 65% compared with 17% for 106 patients with 10 or more mitotic figures per 10 high power field. No significant predictor of a bad outcome for these low mitotic count tumors was found.

Prognostic Factors in Mammary Carcinoma

The simultaneous prognostic influence of multiple clinical and microscopic features of mammary carcinoma was analysed in 581 women with radical mastectomy. The most important of these features were connected with the extent of the disease in the axillary lymph nodes. In substantial groups of patients, however, a favourable outcome could be predicted from microscopic features of the primary tumour, viz. tubule formation, mitotic frequency and elastosis.

Adjuvant radiotherapy in operable breast cancer: correlation between dose in internal mammary nodes and prognosis.

In a controlled clinical trial preoperative radiotherapy was compared to modified radical mastectomy followed either by no further treatment or by postoperative radiotherapy. The total number of patients was 960; 654 of these had a follow-up time of more than five years. The patients who were irradiated preoperatively, had a significantly better survival rate than the patients who were treated with surgery only (p = 0.05); however, this was not true for those irradiated postoperatively. The radiation dose in the ipsilateral internal mammary nodes was, on the average, lower with the postoperative treatment technique than with the preoperative technique. This difference in dose-distribution in the internal mammary nodes is analyzed. The result of the study indicates that adequate local treatment may increase survival in a subgroup of patients.

Adenocarcinoma of the uterine cervix

Between 1958 and 1969, 251 patients were treated at Radiumhemmet in Stockholm for adenocarcinoma of the uterine cervix. The histologic specimens were reevaluated. In the 211 cases of pure adenocarcinoma, the 5‐year survival rate was compared with that in the total of cervical epithelial malignancies. The rate was lower in the adenocarcinoma cases, with respective crude 5‐year survival rates of 84%, 50%, and 9% in Stages I, II, and III. Two modes of treatment, irradiation alone or irradiation plus radical surgery, were used in Stages IB and IIA. The combined treatment gave significantly improved 5‐year survival rates.

Preoperative radiotherapy in operable breast cancer: results in the Stockholm Breast Cancer Trial.

A randomized trial of preoperative radiotherapy in operable breast cancer was conducted from 1971 to 1976. The diagnosis was established by fine‐needle aspiration biopsy. A dose of 4500 rad over five weeks was given to the chest wall, the breast and the lymph nodes of the axilla, the supraclavicular fossa and the internal mammary chain. Modified radical mastectomy was performed six weeks or more after completed radiotherapy. In control patients the same operation was performed without prior radiotherapy. By random allocation, one control group received no further treatment and postoperative irradiation was given to the other controls. Preoperative radiotherapy reduced the incidence of local and regional recurrence and of distant metastases, and also the mortality, as compared with the surgery only group. Postoperative radiotherapy as given in this trial gave almost equal reduction of local and regional recurrence, but did not diminish the frequency of distant metastases or the mortality.

Symptoms and diagnostic difficulties in ovarian epithelial cancer.

OBJECTIVE: To investigate and analyze symptoms in patients with different types of ovarian cancer. METHOD: Records of 160 women with ovarian cancer were studied in detail following the patients from first consultation to operation and diagnosis at Sodersjukhuset, Stockholm. RESULT: No specific group of symptoms could be linked to type or stage of ovarian cancer. Gastrointestinal symptoms were more common in patients with class 1C tumors. Only 21% complained of gynecological symptoms. Women with class 1C cancer had significantly more advanced disease than those with 2C–5C cancer as 77% had a stage III‐IV tumor compared with 40% of class 2C–5C patients. CONCLUSION: Diagnosis of ovarian cancer is difficult due to the multitude of symptoms often appearing late in the disease. The majority of women did not experience symptoms in the genital organs. Methods to encourage early consultation should be investigated.

The value of preoperative radiotherapy in operable mammary carcinoma

In a randomized trial preoperative radiotherapy (4500 rad to the breast, the internal mammary, the supraclavicular and the axillary lymph node regions) was compared to radical mastectomy followed either by no further treatment or by postoperative radiotherapy. The total number of patients was 960; 356 of these had a follow-up time of more than five years. Both preoperative and postoperative irradiation increased the disease-free survival, compared to survival in patients who were treated only by surgery. The patients who were irradiated preoperatively had significantly better survival rates than the control patients (p = 0.05). Compared to patients who were treated with surgery only the survival improvement was even more certain (p = 0.03). Patients whose tumors were located in the inner half of the breast seemed to benefit more from preoperative or postoperative irradiation than those with lateral tumors. This could support the hypothesis of the value of adequate irradiation of the internal mammary nodes.

Mixed Mullerian tumours of the uterus - prognostic factors: a clinical and histopathologic study of 147 cases

One hundred and forty-seven women with uterine mixed Müllerian tumours (UMMT) treated at Radiumhemmet from 1936 through 1981 were reviewed. The prognostic value of clinical and histopathologic data was analysed with bivariate and multivariate techniques. Stage, age and abdominal pain were found to be significant predictors of survival. Surgery and combined radiotherapy (intracavitary + external irradiation) gave in stage I, a lower local failure rate (p = 0.006) and better overall survival (p = 0.001) than surgery in combination with either intracavitary or external irradiation.

Theca-Cell Tumors Clinical features and prognosis

During the period 1923 to 1972, 62 women with theca-cell tumors were treated at Radiumhemmet. The mean age at diagnosis was 59.5 years. Concomitant endometrial carcinoma was found in 13 patients. At 1978, after a mean observation time of 15.5 years, 30 patients were alive. No patient died from thecoma. Malignant disease caused death in 7 women. No difference in survival was found between 20 patients and 40 controls matched by age and place of residence.