Kozo Morita

The prognostic significance of number of positive nodes in cervical carcinoma stages IB, IIA, and IIB

Radical hysterectomy and bilateral pelvic lymphadenectomy were done on 875 patients diagnosed with cervical carcinoma Stages IB (484 patients), IIA (96 patients), and IIB (295 patients). The number of positive nodes was 0 in 620 patients (NO), one in 98 patients (N1), two to three in 80 patients (N2), four to 18 in 45 patients (N4), and unresectable in 32 patients. Cumulative 5‐year survival rates were 89%, 81%, 63%, 41%, and 23%, respectively. Significant survival reduction rates (P < 0.05) from N0 to N1 were insignificant in Stage IB patients (92% versus 91%), in those patients without parametrial invasion (92% versus 90%), and in those with parametrial invasion (76% versus 72%). Survival reduction rates (P < 0.01) from N1 to N2 resulted from a reduction in IB patients without parametrial invasion (100%‐71%, P < 0.01). Survival reduction rates (P < 0.05) from N2 to N4 resulted from a reduction in Stage IIB patients with parametrial invasion (60%‐ 29%, P < 0.05). These figures suggest that the number of positive nodes is a more indicative prognostic factor than the existence of nodal metastasis, and that the 5‐year survival rates of those patients with one positive node can be improved up to the level of those without nodal metastasis.

The prognostic significance of the size of the largest nodes in metastatic carcinoma from the uterine cervix

Sizes of the largest metastatic nodes were evaluated as a prognostic factor in 152 patients with Stage IB to IIB cervical carcinomas treated by radical hysterectomy and postoperative irradiation. Of the 152 cases, the largest positive nodes were less than 10 mm in 24 (16%), 10-20 mm in 74 (49%), greater than or equal to 20 mm in 37 (24%), and unresectable in 17 (11%). The frequency of patients with one positive node decreased, and those patients with greater than or equal to 4 positive nodes increased along with an increase in the size of the largest nodes (P less than 0.05). Disease-free periods for 58 patients with recurrent cancer were less than 1 year in 26 (45%), 1-2 years in 18 (31%), 2-3 years in 9 (15%), and greater than or equal to 3 years in 5 (9%). There was a significant increase in cases with node sizes of greater than or equal to 20 mm with recurrence within 1 year after surgery over those with less than 20 mm (P less than 0.001). Incidence rates of 3-year recurrence were significantly different between cases with sizes of less than 10 mm and those with greater than or equal to 10 mm (P less than 0.05), as well as between cases with resectable and unresectable positive nodes (P less than 0.001). These results indicate that the size of the largest positive nodes is a good indicator of the number of positive nodes and the patients prognosis.

5-Year results of postoperative extended-field irradiation on 76 patients with nodal metastases from cervical carcinoma stages IB to IIIB

Extended‐field irradiation was administered after radical surgery to 76 patients with nodal metastases from cervical carcinoma Stages IB (37 patients), IIA (six patients), IIB (29 patients), and IIIB (four patients). The first recurrent sites of disease were distant organs via hematogenous routes of 12 patients and in the pelvic fields of eight patients. The 5‐year disease‐free survival rates were 95% for 27 patients with one positive node, 64% for 37 patients with multiple positive nodes, and 44% for 12 patients with unresectable nodes; 72% in total. Poor disease‐free survival rates were associated with Stage IIB (60%), more than 30 mm invasion depths (44%), small cell cancer (0%), adenocarcinoma (57%), adenosquamous carcinoma (50%), and premenopause (60%). In 52 patients with nonkeratinizing large cell carcinoma, the disease‐free survival rates were significantly different between Stage IB and IIB (87% versus 47%, P < 0.05). This dissimilarity was caused by significant differences between Stage IB and IIB patients with less than 30 mm invasion depths (90% versus 53%, P < 0.05), with parametrial extension (100% versus 39%, P < 0.005), and with unresectable nodes (100% versus 0%, P < 0.05). These results indicate that postoperative extended‐field irradiation can control distant spread via lymphatic routes with significant improvement of patient survival, and that the number of positive nodes, tumor cell types, depth of tumor invasion, and clinical stages are important prognostic factors subsequent to this combined therapy.

The treatment results of 40 patients with localized endobronchial cancer with external beam irradiation and intraluminal irradiation using low dose rate 192Ir thin wires with a new catheter

BACKGROUND AND PURPOSE While bronchial intraluminal irradiation is valued highly as a useful palliative treatment for lung cancer, its role as a curative treatment is unclear. The treatment results of 40 localized enbobronchial tumors (including tracheal cancer) who underwent external beam irradiation (EBR) and intraluminal irradiation (IR) as a curative treatment is reported, and the role of combined EBR and IR as a curative potential treatment is examined. MATERIALS AND METHODS Forty patients, including 22 with roentgenographically occult lung cancer (ROLC), 14 (18 lesions) with postoperative recurrent lung cancer (PORLC) and four with tracheal cancer, who underwent EBR and IR from February 1987 to August 1996, were studied. IR was conducted using low dose rate (1.48 GBq) (192)Ir thin wires at a bronchial mucosal dose of 4-6 Gy per fraction, with a total dose of 10-57 Gy (median 28 Gy). All patients were also given combined external Linac X-ray irradiation for a total dose of 30-77 Gy (median 52 Gy). RESULTS As for the primary effect, complete response (CR) was obtained in all 22 ROLC cases; CR was obtained in 12 (16 lesions), partial response (PR) in one and minor response (MR) in one of the PORLC cases; and CR was obtained in three and PR in one of the tracheal cancer cases. The 3-year and 5-year local control rate by Kaplan-Meier method was 75 and 65%, respectively. Twenty-two patients survived for 3 years or longer. Complications included one case each of fatal tracheal hemorrhage, bronchial mucosal ulcer and bronchial stenosis. CONCLUSIONS Combined EBR and IR is useful as a curative potential treatment, and long-term survival can be expected in ROLC, tracheal cancer and a portion of PORLC cases.

The prognostic significance of the minimum thickness of uninvolved cervix in patients with cervical carcinoma stages IB, IIA, and IIB

The minimum thicknesses of uninvolved cervical tissues at the sites of deepest tumor invasion were evaluated in 899 patients with Stage IB, IIA, and IIB cervical carcinoma. Minimum thicknesses were greater than or equal to 10 mm in 126 (14%), 5-10 mm in 247 (27%), and less than 5 mm in 335 (38%) patients. Parametrial extension was found in 191 (21%) patients. Nodal metastasis rates were 6, 10, 22, and 55%, respectively. Patients with greater than or equal to 10-mm thicknesses did not have two or more positive nodes (P less than 0.05). The proportion of patients with two or three positive nodes increased from 3 to 10% (P less than 0.005) as the minimum thickness decreased from 5-10 to less than 5mm. The proportion of patients with four or more positive nodes increased from 3 to 22% (P less than 0.001) in cases in which tumor invaded the parametrial tissues. Five-year disease-free rates were 99, 93, 88, and 65%, respectively. Each percentage decrease was significant (P less than 0.05, 0.05 less than P less than 0.01, and P less than 0.001). These results indicate that uninvolved cervical thickness is a good indicator of nodal metastases, number of positive nodes, and patient prognosis.

Postoperative extended-field irradiation in patients with pelvic and/or common iliac node metastases from cervical carcinoma Stages IB to IIB

Radical hysterectomy with pelvic and common iliac lymphadenectomy was done for 207 Stage IB (148), IIA (19), and IIB (40) cervical carcinomas. Pelvic nodal involvement was limited in 30 (14.5%) cases, whereas common iliac nodes were involved in 16 (7.7%) cases. Common iliac node metastases were significantly increased, when the number of positive pelvic nodes increased from 2 to 3 or 4 or more (21.4% to 73.3%, P less than 0.05), when the tumor invaded deeper than 20 mm (3.7% to 22.2%, P less than 0.001), and when the tumor extended into parametrial tissues (4.8% to 14.8%, P less than 0.05). Postoperative extended-field irradiation was administered to 40 patients with nodal metastases. The 3-year disease-free rates were 85% in 24 patients with positive pelvic nodes, and 51% in 16 patients with common iliac node metastases; 70% in total. These results indicate that postoperative extended-field irradiation is essential for those patients with nodal metastases from locally resectable cervical carcinomas.