J.G. Moore

Pelvic lymphnodectomy following radiation in cervical carcinoma

Abstract 1. 1. A review of the recent literature revealed: (1) an average incidence of lymph node metastases of 16,3 per cent for Stage I cases, 32.5 per cent for Stage II cases, and 45.6 per cent for Stage III cases and (2) that there was a reduction in the incidence of node metastases after radiation therapy. 2. 2. Thirty-eight patients with Stage I cervical cancer were treated by lymphnodectomy followed by radiation therapy while 32 patients treated concurrently had their radiation before lymphnodectomy. The percentage of pelvic lymph node metastases in the former group was 23.7, and in the latter, 12.5. It was tentatively surmised that radiation destroyed cancer in the regional lymph nodes as demonstrated in a significant number of cases.

Vaginal reconstruction following extensive treatment for pelvic cancer

Since 1970, 23 patients at UCLA and The City of Hope who have undergone extensive treatment for pelvic malignancy have had vaginal function successfully restored. A combination of methods, including split-thickness skin graft and the construction of an external vulvar pouch, is often necessary to obtain maximal functional results. The external vulvar pouch was very useful, although not as anatomically appealing as internal methods of reconstruction. In young patients who required an exenteration, a new technique using part of the anterior bladder fundus was developed. Preliminary experience with this method was promising. Among the gorup of 23 patients, there have been no overt failures. By combining restoration of rectal function with vaginal reconstruction, two major steps have been taken toward total rehabilitation of the patient undergoing extensive treatment for pelvic malignancy. Persistence, ingenuity, and planning by the surgeon are essential to obtain a maximum functional result for each patient.

The early assessment of irradiation therapy in cervical cancer

Abstract 1. 1. The response to radiation therapy was evaluated early in the course of treatment in a series of 87 patients with cervical cancer followed for a period of 1 to 6 years. 2. 2. The cytologic response to irradiation was determined 7 to 10 days after the first radium treatment (IRR), and at the end of therapy (RR). Three to 6 weeks following the conclusion of therapy, the clinical response to therapy (CR) was evaluated. 3. 3. With the use of specific cytologic standards with the local conditions of radiation therapy of this series, it was established that a favorable RR evaluation correlated well with radiocurability. 4. 4. The initial response to irradiation (IRR) correlated with patient survival, with almost equal validity as the conventional RR evaluation. 5. 5. The highest accuracy in predicting the outcome of radiation therapy was obtained in the combined RR and CR assessment. 6. 6. With the extension of these data to a larger and more meaningful series analyzed as a replicate study, it would seem possible to identify probable treatment failures sufficiently early to allow effective surgical intervention. 7. 7. It is apparent that the statistical validity of such prognostic correlations must be established within a given laboratory along with the specific regimen of radiation therapy. It appears to be inadvisable to apply the conclusions found to be valid in one institution to the cytologic evaluation and treatment experience of another clinic.

The effects of chemotherapy and irradiation on ovarian and cervical cancer cells in tissue culture

The effects of thio-TEPA (triethylenethiophosphoramide) and Co/sup 60/ radiation on various types of cultured ceils were investigated. Ovarian cancer cells developed tolerance to thio-TEPA when it was added in sublethal doses, but did not develop tolerance to sublethal radiation exposure. The ID/sub 50/ (inhibitory dose) of radiation for the cells was approximates 200 r, and a linear reiation was found between log cloning capacity and radiation dose between l00 and 500 r. Cloning capacity declined from 8.3% after 100 r to 11.1% at 500 r. Utilizing ID/sub 50/ doses of Co/sub 60/ and thio-TEPA, no significant difference could be determined between the depressive effect of the injurious agents on celi population and their effect on cloning capacity of ovarian cancer ceils (3-59) and cervical cancer cells (HeLa) in tissue culture. Whereas the primary effect noted following exposure to the alkylating agent was cytoplasmic shrinking and nuclear swelling, irradiation largely effected the nucieus with an increase in the numbers of multinuclear cells and aberrant nuclear forms. When the ceils were subjected to both agents, nuclear aberrations became extreme and the development, of long spinous cytopiasmic extensions from cell to cell was prominent. (H.H.D.)