Luis Delclos

Distant Metastases in Squamous-Cell Carcinoma of the Uterine Cervix

Scant attention has been paid to distant metastases from cancer of the cervix as it was considered generally not to spread above the pelvic brim. A review of the early literature reveals a wide variance in the reported incidence of metastases from cervical carcinoma, not only overall, but also in distribution (1, 3–5). Publications concerning unusual manifestations of metastases from cancer of the cervix have appeared sporadically, but a comprehensive evaluation of a large series of patients portraying the overall incidence of distant metastases as well as that of various organ involvements has not appeared. Modern radiotherapy achieves better control of cancer in the pelvis and allows more patients to survive longer, which, in turn, permits distant metastases to become clinically evident. The present study was undertaken to analyze the incidence and distribution of distant metastases in patients treated at The University of Texas M. D. Anderson Hospital and Tumor Institute, Houston, Texas, between Septem...

Causes, time of death, and sites of failure in squamous-cell carcinoma of the uterine cervix on intact uterus.

There is a considerable literature on five-year survival rates in patients with cancer of the uterine cervix who have been treated by radiations, surgery, or a combination of both. Reports on long-term follow-ups are few. Those from the Radiumhemmet (1) and Radium Centre in Copenhagen (8) are on patients treated prior to World War II. The purpose of this essay is to study the time distribution and causes of death (active disease, complications, intercurrent disease), as well as the sites of active disease at the time of death in 2,220 patients treated at The University of Texas M. D. Anderson Hospital and Tumor Institute from Sept. 1, 1948, through Dec. 31, 1963, for squamous-cell carcinoma of the uterine cervix on intact uterus. Of those 2,220 patients, 965 are known to be dead. In addition to this broad statistical review, specific aspects of the disease will be discussed, as will some sites of recurrent disease. Modalities of Treatment At the M. D. Anderson Hospital and Tumor Institute, irradiation has...

The treatment for dysgerminoma of the ovary

Thirty‐six patients with pure dysgerminoma of the ovary were treated at the University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute between 1947 and 1974. Twenty‐six of these patients had their initial surgery at the M. D. Anderson Hospital or were referred to the M. D. Anderson Hospital shortly after surgery at another hospital. The remaining 10 were referred after developing a recurrence of their tumor. Five of the 26 patients who were treated initially at the M. D. Anderson Hospital had only a unilateral salpingo‐oophorectomy and are alive and well at the present time. The remaining 31 patients have received postoperative radiotherapy. Ninety‐two percent of the patients receiving initial treatment at M. D. Anderson Hospital, and seventy percent of those referred for treatment after recurrence, are surviving at the present time without evidence of disease. The selection of treatment for the individual patient is discussed.

Malignant Tumors of the Ovary Managed with Postoperative Megavoltage Irradiation

The wide range of survival rates given by various authors for ovarian-cancer patients (1, 2) results from several factors. Ovarian cancer encompasses a group of diseases with different biological behavior. There is, furthermore, considerable variation in the histological interpretation of which tumors should be considered true carcinomas. There is still no uniformity of the clinical staging used for reporting results for different treatment modalities. As our knowledge of the complex ovarian structures increases, fundamental tumor types are more clearly defined. In recent decades, chemotherapy has played a greater role in managing ovarian carcinoma; the number of cases referred for postoperative radiation therapy, therefore, has diminished. Clinical Material This paper evaluates the role of postoperative irradiation in treating patients with ovarian cancer and analyzes results obtained with postoperative megavoltage irradiation in a group of 161 patients with ovarian carcinoma treated at the University of...

Minicolpostats, dome cylinders, other additions and improvements of the fletcher-suit afterloadable system: Indications and limitations of their use☆

Abstract The Fletcher prelosidable colpostat and intrauterine system was described in 1952. In the early 1960s it was made afterloadable by Suit et al; in 1968 we added cylindrical colpostats with specific indications for their use. Since the description of the first afterloadable system, several modifications have been made without departing from the fundamental features of the original preloadable model. The importance of these features was discussed at length in a recent publication. In this paper we describe improvements in design and introduce the minicolpostats and the dome colpostats. In addition, we discuss indications and limitations of their use.

Whole pelvis megavoltage irradiation with single doses of 1000 rad to palliate advanced gynecologic cancers.

Abstract This study reviews the experiences at M. D. Anderson Hospital of treating advanced gynecologic malignancies for palliation with single doses of 1000 rad per fraction. When feasible, this treatment was repeated twice (for a total of 3 treatments between intervals of 3–4 weeks. The patients who received 3 treatments had the best palliation; 2 treatments were more effective than 1. The palliative response was good in cervix, vagina and vulva, poor in endometrial and ovarian carcinoma. The follow-up was short in some cases, but the acute complications appear minimal.

Can the fletcher gamma ray colpostat system be extrapolated to other systems

The basic rules governing the intracavitary application or radium for the treatment of carcinoma of the uterine cervix at M. D. Anderson Hospital and Tumor Institute were established in the early 1950s. The Fletcher preloadable colpostats were designed with specific purposes. The aim was to provide a colpostat that could be easily applied and maintained in the lateral fornices, and that could allow an increase in paracervical and parametrial irradiation by better distribution of the radium sources and the addition of bladder and rectal shielding. In the 1960s, the original ovoids, and tandems were adapted so that they could be afterloaded with the standard radium tubes, but the original design restrictions were maintained in the afterloadable models. Additionally, a number of afterloadable colpostats, some with similar external design have become available commercially, but x‐ray and measurements of these colpostats show that the manufacturer did not adhere to the original design restrictions. In addition, several of these colpostats have been modified for use with cesium. Extreme caution is advised in the use of colpostats built elsewhere without proper supervision, other colpostats, and sources other than radium. Tables and guidelines outlined in Fletchers publication are to be used only with the recommended applicators and sources. The use of normalized doses at point A does not reflex the doses to bladder and rectal areas, because these doses vary with the type of applicator employed and the nature and physical characteristics of the radioactive source.

WHOLE ABDOMINAL IRRADIATION BY COBALT-60 MOVING-STRIP TECHNIC.

The moving-strip technic was developed in Manchester, England, during the 1940s for utilization with orthovoltage irradiation. Since 1957 it has been applied in the M. D. Anderson Hospital and Tumor Institute to Co60 therapy. The purpose of developing such a technic was to find a method of irradiating the whole abdomen, which would improve systemic tolerance. There are two main types of disease which require total abdominal irradiation: The ovarian carcinomas, and the abdominal manifestations of the lymphomas. A variety of clinical situations such as seminomas, with extensive involvement of the periaortic nodes, also call for such a technic. Static Field Technic of Whole Abdominal Irradiation Irradiation to the whole abdomen should be given preferably in one undivided volume with homogeneous dosage. With either conventional 250-kv or supervoltage roentgen therapy, the whole abdomen can be irradiated through large parallel opposed portals, if the distance from the skin to the target is sufficiently great,...

Mixed mesodermal sarcoma of the ovary. Treatment with combination radiation therapy and chemotherapy.

Twenty patients with mixed mesodermal sarcoma of the ovary treated at the M. D. Anderson Hospital and Tumor Institute in Houston, Texas are reviewed. This report focuses on 12 patients treated postoperatively with combination radiation therapy and chemotherapy with vincristine, dactinomycin, and cyclophosphamide (VAC). There were 4 patients achieving complete tumor control, including one who is alive without disease beyond 5 years and 3 who died of unrelated causes without disease at autopsy. One other patient had a significant disease‐free interval of 18 months. Compared to previous reports, combination radiation and VAC chemotherapy appears effective in this disease. Due to the observed myelosuppression and gastrointestinal and neurologic toxicities, however, treatment modifications have been recommended.

Afterloading Vaginal Irradiators

The authors describe a set of vaginal cylinders of variable diameter (2 to 5 cm) and of adaptable length. With these almost any vagina may be fitted at the time of surgery, and exposure to personnel is eliminated. Lead may be incorporated in the cylinders to partially shield either the vagina or the rectum.