John H. Webster

Metastasis to organs in carcinoma of the uterine cervix: Influence of treatment on incidence and distribution

Two hundred seventy‐eight autopsied cases of various stages of cervical cancer treated at Roswell Park Memorial Institute, Buffalo, New York, were evaluated to determine the effect of treatment on the spread of the disease. Patients were categorized, according to the primary treatment, into four groups: radiation, 183 cases; surgery, 44 cases; combined radiation and surgery, 34 cases; and other methods, 17 cases. The main clinical parameters of prognostic value were equally present except for earlier clinical stages in the “surgery” and “combined” groups. Clinically, the patterns of recurrence varied with the treatment: increased central pelvic recurrences after surgery, lateral deep pelvic recurrences after combined treatment and distant metastases after radiation. The mean survival in all cases was higher than previously reported, and still higher after radiation. Renal failure and sepsis were the leading causes of death. In the autopsy findings patients having radiation showed an increased risk of extrapelvic metastases whereas the surgical group revealed an increased risk of general pelvic and extrapelvic metastases. This may be explained by the longer survival in both groups, with more frequent local control after radiation. Distant metastases were widespread and the distribution was unaffected by the kind of treatment given for the primary disease.

Hydroxyurea and radiation therapy in advanced cervical cancer

Abstract A prospective randomized double blind study on women with locally advanced cervical cancer was carried out to evaluate the combination of hydroxyurea and irradiation therapy. The results of the clinical trials are discussed as well as a method for improving similar future studies.

Radiotherapy in the treatment of sarcomas of the corpus uteri

One hundred forty‐seven cases of sarcomas of the corpus uteri, including 71 leiomyosarcomas, 30 endometrial stromal sarcomas, 23 mixed mesodermal sarcomas, and 23 carcinosarcomas were treated at Roswell Park Memorial Institute. These tumors represent 6.7% of all cancers of the uterine corpus. Treatment varied from surgery (56 cases) to radiotherapy (37 cases) or combined surgery and irradiation (54 cases). The 5‐year crude survival rate of the entire series was 37% with no significant difference between the 4 histologic groups. The clinical extent of tumor was the most significant prognostic factor. Suggestive evidence of increased survival rates was seen in those treated by combined surgery and irradiation. A significant decrease in the recurrence rates followed this combined approach.

Oral Monilia study on patients with head and neck cancer during radiotherapy

One hundred one cases of head and neck cancer were subjected to oral culture for Candida albicans before, during, and 1 month after radiotherapy. Thirty percent of the patients had a positive culture before radiotherapy. During the course of radiotherapy, almost half of the negative patients turned positive. The severity of the acute radiation reaction of the oropharyngeal mucosa was not related to the apparent presence or absence of Candida albicans. Amphotericin B (1 cm3 (100 mg) q.i.d.) converted about one‐third of the positive patients to negative. However, only 1 of these converted patients showed some clinical improvement of the acute „radiation reaction.”︁ It would appear that „sterilization”︁ of the oral cavity with this fungicide during radiotherapy in patients with head and neck cancer is not justified.

The prognostic significance of tumor response during radiotherapy in cervical carcinoma.

Abstract Tumor response was assessed in 532 patients with epidermoid carcinoma of the uterine cervix. Tumor regression was estimated during weekly intervals up to eight weeks after the start of radiotherapy. Four response groups with distinct prognoses were identified: (a) excellent (75–100% tumor regression by the eighth week, 77-mo. median survival time); (b) good (50–75% tumor regression, 57-mo. median survival time); (c) fair (25–50% tumor regression, 29-mo. median survival time); and (d) poor (0–25% tumor regression, 17-mo. median survival time). Clinical staging and treatment factors contributed little that would explain this behavior. The significance of tumor response during radiotherapy is explained analytically. When tumor response is assessed during radiotherapy, a prognosis can be made.

End results of radiation therapy, alone and combination with 5‐fluorouracil in colorectal cancers

The authors retrospectively analyzed the results of irradiation in 148 cases of primary inoperable and recurrent adenoearcinoma of the colon and rectum treated at the Department of Radiation Therapy, Roswell Park Memorial Institute between 1962 and 1970. This group includes 95 recurrences and 53 inoperable primaries. Uninterrupted radiotherapy was used in 118 cases and split‐course technique in 30 cases. Eleven patients received combined radiotherapy and surgery. Seventy‐eight patients received a combination of 5‐fluorouracil (5‐FU) and irradiation. The response rate and survival of individual groups is discussed in detail. This study indicated that perineal recurrences should receive whole pelvic irradiation in addition to perineum field. Split‐course technique appeared to yield a better survival than the uninterrupted course. The best 5‐year survival rate (64%) is found in the group treated with a combination of radiation and surgery. For locally advanced, inoperable cancers, split‐course technique, combined 5‐FU and irradiation gave the best results, achieving longer palliation with improved quality of life and sometimes yielding cure (5‐year survival).

Evaluation of Primary Radiation Therapy in Stage I, Group 2, Endometrial Carcinoma

TOTAL HYSTERECTOMY preceded by intracavitary radium therapy has been the treatment of choice in clinically operable Stage I carcinoma of the endometrium (3, 9, 11, 12). In about one-third of patients with Stage I tumors, the medical conditions are such as to preclude surgery (6, 7). In this group (Stage I, Group 2: International Classification), radiation has been the primary treatment and it is with this group and its radiotherapy that this study is primarily concerned. The role of external radiation will be discussed, and radium technics will be compared to evaluate the influence of the methods of radiation on the prognosis. In addition, the rate of post-treatment residual and recurrent tumors and the relative morbidity associated with each method will be assessed. Material And Method Between January 1940 and January 1963, 837 primary cases of Stage I endometrial carcinoma were treated at Roswell Park Memorial Institute, Buffalo, N. Y. This series included 285 (268 adenocarcinomas and 17 adenoacanthomas...

Treatment of cancer of the paranasal sinuses

Three hundred forty‐four cases of cancer of the paranasal sinuses were treated by radiation (132 cases), surgery (35 cases), and combined surgery and radiation (177 cases). The maxillary sinus was the site of origin in 88% of the cases, and the ethmoids in 9%. Squamous cell carcinoma accounted for 80% of the lesions. The 5‐year cure rate in the entire series was 14%. The degree of extension and histology of tumors and the type of treatment influenced the prognosis. Early antral lesions showed 18–35% 5‐year cure Adenocarcinoma had the best prognosis, followed by well‐differentiated squamous cell carcinoma. A combined approach of surgery and radiation produced the best results with more adequate control of the primary than either modality alone.

Para-aortic node irradiation in carcinomas.

The authors have retrospectively analyzed the results of para‐aortic node irradiation in 75 cases of metastatic carcinoma treated at the Department of Radiation Therapy, Roswell Park Memorial Institute, between 1963 and 1972. This group includes 62 patients with primary squamous cell carcinoma of the uterine cervix, 6 with adenocarcinomas of the sigmoid colon, 2 with adenocarcinomas of the endometrium, 3 with carcinomas of the vulva, 1 with adenocarcinoma of the ovary, and 1 with squamous cell carcinoma of the anus. The clinicopathologic behavior of para‐aortic metastasis is studied in detail, including the relationship with the primary site, histologic grade, and degree of lymphatic invasion at the primary site. The group of cervical cancer patients seems to consist predominantly of those with advanced clinical stage, less differentiated tumors, endophytic or endocervical lesions, and those with endometrial or myometrial involvement. This study showed that the presence of metastatic carcinomas in the para‐aortic nodes does not necessarily indicate the existence of more distant metastasis. These carcinomas can be safely irradiated and cured in a significant percentage of cases. Survival appears more favorable with higher radiation dosages. Six thousand rads delivered in 8 weeks, alone or concomitantly with pelvic irradiation, can be safely applied with minimal acute normal tissue reaction, and can eradicate the para‐aortic node metastasis.

Second primary cancers of endometrial carcinoma

Of 984 patients with corpus cancer treated at Roswell Park Memorial Institute (between 1940 and 1960), 116 (11.8%) were found to have second primaries; of these, 47 had breast cancer, 15 skin cancer, 27 other pelvic cancers, 15 abdominal cancer, 3 head and neck cancer, and 3 lymphoma or leukemia the incidence of second cancers increased with time and age, especially in the sixth and seventh decades the risk of developing mammary cancer was found to be high within 5 years before the development of the uterine cancer. This time relationship is very interesting in that it supports the presumed association between corpus and breast cancer the results of the present study also suggest that there is a subgroup of women who have abnormal estrogen stimulation of both the corpus and the breasts, leading to the development of both corpus and breast cancer.