John S. Spratt

Pseudomyxoma peritonei: New concepts in management with a report of seventeen patients☆

Abstract The clinical course of seventeen patients with pseudomyxoma peritonei is described. Superior survival rates were observed in five patients who underwent multiple excisional procedures combined with the use of alkylating agents. Oral estrogen therapy appeared to benefit two postmenopausal patients in whom it was utilized. Radiotherapy was ineffective. Implications for the therapeutic management of these patients are discussed.

Factors affecting survival in over 500 patients with stage II carcinoma of the cervix.

Charts were reviewed of 519 patients with stage II (League of Nations) carcinoma of the cervix to determine those factors in the history, work-up, and treatment which affected survival. Those factors which correlated with a significant decrease in five-year survival were abnormal admission blood urea nitrogen level or excretory urogram, a history of pelvic pain or weight loss over 10 kg (20 lbs.), or tumor extension to the endocervix or uterus. These factors, as well as the results of lymphangiography, should be included in the staging of carcinoma of the cervix.

The Detection and Treatment of Postirradiationally Recidivated Cancers of the Cervix Uteri

The purpose of this communication is to determine the value of follow-up examinations in the detection of post-irradiation persistent or recurrent carcinomas of the cervix uteri and the efficacy of various methods of additional therapy for their control. The importance of follow-up is emphasized for the collection of survival data, to evaluate the results of various forms of primary therapy. Our contention, however, is that follow-up examinations are expensive and time-consuming and should be scheduled to permit the early discovery of cancers uncontrolled by the primary course of treatment. This opinion is predicated upon the belief that some recidivated cancers of the cervix uteri can be controlled by additional therapy. Other important reasons for follow-up are the discovery of complications arising from the initial course of therapy and the palliation of symptomatic but incurable persistent cancer. The problems considered in the present study are: (a) the time elapsed after irradiation when persistent ...

Prognostic significance of radiographic ureteropathy before and after irradiation therapy for carcinoma of the cervix uteri

Abstract Nine hundred and forty-five cases of cervical uterine cancer were reviewed in reference to prognostic significance of intravenous pyelographic findings. A tumor recurrence rate of 93.5 per cent followed irradiation therapy when pretreatment abnormal intravenous pyelogram changes were present. This rate was essentially the same regardless of clinical state of disease. Persistence or development of obstructive pelvic ureteropathy after irradiation was associated in follow-up with tumor recurrence. The only exceptions were those cases developing vesicovaginal fistulas. Ureteropathy attributable to irradiation effect was rare, even in presence of severe postirradiation morbidity of pelvic viscera. Only 4 cases were so classified in this group. Abnormal intravenous pyelogram changes developing with posttherapy tumor recurrence were also associated with reduced tumor control by retreatment. Operative pelvic extenteration produced a 19 per cent control in a small group of such cases.

Endometrial carcinoma recurring after hysterectomy. A study of 64 cases, with observations on effective treatment modalities and implications for alteration of primary therapy

The treatment of post‐hysterectomy, recurrent endometrial carcinoma is unsatisfactory. Survival is prolonged by combinations of high voltage external radiotherapy and transvaginal therapy or radium applications, and progestins and alkylating agents have proved to be of value as well. Pelvic exenteration is of little help to these patients. The magnitude of this problem demands more attention to the prevention of implantation in dealing with the initial operable tumor.

Treatment Policies Affecting Survival in Patients with Carcinoma of the Cervix

Radiotherapy treatment techniques were evaluated according to survival rates among more than 800 patients with Stage I and II carcinoma of the cervix. An increased survival rate was noted when a Fletcher tandem and ovoids and the Fletcher technique of external irradiation and fractionated radium therapy were applied. This increase was due to a larger radiation dose to the anoxic tumor core and to external irradiation shrinking the tumor to within the high-dose range of radium therapy.

Problems in the management of advanced endometrial carcinoma

Abstract 1. The clinical course of 65 cases of Stage II endometrial carcinoma is described. 2. The value of combined radium with external therapy over irradiation alone in prolonging survival is demonstrated. 3. With the exception of the patient with clinically occult ovarian metastases there have been no survivors beyond the fifth year. 4. In this series 46 per cent could have been considered candidates for pelvic exenteration following radiotherapy. 5. That this is feasible is demonstrated by the cases cited in which pelvic exenteration was performed after primary radiotherapy. Both patients have survived 3 years free of disease.

Positioning and some variations in surgical technique used for combined inguinal, perineal, and abdominal cancer surgery

A simplified method of positioning, preparing, and draping patients for the performance of combined inguinal or abdominal and anterior perineal surgery is reported. Lower extremity orthopedic extensions available for most standard operating tables are used to keep the lower extremities horizontally extended but widely abducted. Some technical modifications, particularly in the performance of radical vulvectomy and bilateral groin dissection, using this position are discussed.