Tony Panzarella

Papillary and follicular thyroid cancer: impact of treatment in 1578 patients.

We report the experience from 13 Canadian radiotherapy centres concerning the treatment and outcome for 1074 papillary and 504 follicular thyroid cancer patients followed for 4-24 years. Surgical resection was carried out in almost all patients; there was no correlation between the type of operation and recurrence or survival. Treatment with external irradiation (201 patients) radioiodine (214 patients), or both (107 patients) was used more often in poor prognosis patients than in those with good prognostic factors, and was effective in reducing local recurrences and improving survival, especially in patients with microscopic residual disease postoperatively. Treatment complications were common but rarely fatal. Thyroid cancer was the cause of death in over half of the papillary cancer deaths and in two-thirds of the follicular cancer deaths.

Glioma arising after radiation therapy for pituitary adenoma. A report of four patients and estimation of risk

Background. Many case reports in the literature associate cranial radiation therapy with the development of brain tumors. Quantitation of the risk of second brain tumors after irradiation in childhood is available, but it is seldom reported for those treated by radiation therapy as adults.

Radiation therapy for pituitary adenoma: Treatment outcome and prognostic factors

PURPOSE Radiation therapy is often an integral part of postoperative treatment in patients with nonfunctional pituitary adenomas. The Princess Margaret Hospital (PMH) experience was reviewed and analyzed to establish the role of radiation therapy in local control relative to its complications, and to see if subgroups of patients with a greater or lesser risk of recurrence postsurgery can be defined. METHODS AND MATERIALS Records of 160 patients with nonfunctional pituitary adenoma treated between 1972 and 1986 were reviewed retrospectively. The review focused on 128 patients treated with surgery and postoperative radiation as initial therapy. The median total dose was 45 Gy. Local tumor control was defined as lack of progression or recurrence of adenoma as assessed clinically and by imaging studies. The following factors were analyzed for prognostic significance in local tumor control: age, sex, direction of tumor extension, radiation dose, and preoperative tumor size as reflected by the radiation field size. Complications including hypopituitarism and second tumors were analyzed. Hypopituitarism was defined as requirement for permanent hormone replacement therapy. RESULTS With a median follow-up duration of 8.3 years, the 10-year actuarial local control rate was 87% for the entire 160 patients and 91% for the 128 patients given postoperative radiation as initial treatment. For the 29 patients referred for treatment of recurrent tumor, the 10-year local control rate was 78%. Prognostic factors for local control identified in univariate analysis included age (p = 0.005) and radiation field size (p = 0.0001). Older patients and those with larger tumors requiring large radiation portals were less likely to achieve durable local control. These two factors remained significant in a multivariate analysis (p < 0.005). The major complication, hypopituitarism requiring hormonal replacement with thyroxine, glucocorticoid, and sex hormone was observed to date in 65% (100 out of 155), 68% (105 out of 154), and 67% (85 out of 127) of evaluable patients, respectively. Radiation was the contributing cause of the hypopituitarism in only 23%, 16%, and 13%, respectively. There were no cases of brain necrosis or radiation damage to the optic pathways. Two patients developed a fatal in-field glioma of the brain stem at 10 and 15 years following radiation. CONCLUSION Postoperative external beam radiation therapy is highly effective in preventing recurrence of hormonally inactive pituitary adenomas. Hypopituitarism is commonly observed, but radiation can only be incriminated as the contributing cause in approximately one-fifth of the cases. Treatment of patients at the time of recurrence gave comparable local control rates to those irradiated initially. Favorable patients (age < or = 50, with small tumors removed totally) probably can be safely observed postoperatively with radiation reserved for recurrence.

A comparison of different staging systems predictability of patient outcome

There is no consensus regarding the comparison of staging classifications. Recently, numerous staging classifications for thyroid carcinoma have been described. This study was performed to evaluate the relative discriminating ability of these different staging systems.

ROLE OF RADIATION THERAPY IN CLINICAL HORMONALLY-ACTIVE PITUITARY ADENOMAS

BACKGROUND AND PURPOSE The outcome following radiation therapy (RT) of hormonally-active pituitary adenomas was assessed. The purpose of this analysis was to determine the control rate after radiation, identify any prognostic factors and evaluate the late toxicity. MATERIALS AND METHODS From 1972 to 1986, 145 patients received RT for hormonally-active pituitary adenomas. The median age was 39 years (range 15-76), with 81 males and 64 females. There were 52 patients with acromegaly, 64 with prolactinoma, and 29 with Cushings disease. The median follow-up was 7.3 years. RT was given as primary treatment in 17 patients, after initial surgery in 65 patients, and as part of salvage therapy in 63 patients. The median total dose was 50 Gy (daily fraction: 2 Gy). Tumor control was defined as normalization of basal hormonal level and lack of progression of adenoma assessed by imaging studies. The following factors were analyzed for prognostic significance in tumor control: age, sex, tumor type, direction of tumor extension, radiation dose, and radiation field size. RESULTS The 10-year actuarial proportion of patients with persistent elevated hormone level were 61% following RT alone, and 44% with the addition of medical management. The progression-free rate was 96% at 10 years. Of the 20 deaths, three patients died with uncontrolled pituitary adenoma and three died of treatment complications. The actuarial 10-year overall and cause-specific survival rates were 86% and 97%. The actuarial rates of radiation-induced hypopituitarism were 35%, 22% and 22% at 10 years for thyroid, glucocorticoid and gonadal functions, respectively. None of the factors examined were found to be significant predictors of tumor control. CONCLUSIONS Post-operative external beam RT is highly effective in preventing recurrence of space-occupying effects of hormonally-active pituitary adenomas. However, long-term biochemical remission is observed only in approximately 40% of patients (at 10 years), with an additional 20% requiring medical therapy. Malignancies of the CNS can develop as an infrequent late event.

Weight gain in women with localized breast cancer — a descriptive study

SummaryA retrospective study was undertaken of weight gain during the first year after diagnosis of breast cancer in three groups of women with localized disease. Group I consisted of 307 women with clinical or pathological node-negative breast cancer and Group II of 139 women with clinical or pathological node-positive breast cancer. Neither of these groups received systemic adjuvant therapy. Group III consisted of 191 women with pathological node-positive breast cancer who received adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) (Group IIIA) or CMF plus prednisone (7.5 mg per day) and ovarian ablation (Group IIIB).In the absence of systemic therapy, weight gain was greater in those with involved nodes than in those with uninvolved nodes (p = 0.001). When women with involved nodes were studied, those who received prednisone and ovarian ablation in addition to CMF gained more weight than those who received CMF alone (p<0.0001). The use of CMF alone did not significantly affect weight gain. Neither initial weight nor weight gain after diagnosis affected prognosis.It was concluded that the observed weight gain was not due to the use of adjuvant CMF and did not affect prognosis. Further investigation was recommended to replicate the above findings and to determine the cause of weight gain after diagnosis in women with localized breast cancer.

Two techniques for measuring invasion in solid tumors

Two methods are described which measure invasion in solid tumors: 1) average tumor extension, i.e. the distance between the edge of the primary tumor mass and the furthest extension of tumor nests in the adjacent stroma, and 2) total surface of tumor exposed to stroma, obtained by multiplying the volume within 1 mm of the outer margin of the primary tumor by the stereologically derived ratio of tumor surface to its volume. These techniques are applied to a retrospective review of 73 consecutive cases of female breast cancer with known lymph node status and without distant metastases at the time of the original diagnosis. The study explores how these parameters discriminate 10‐year survivors from non‐survivors and compares them with other known significant parameters of tumor aggressiveness, i.e. axillary lymph node status, mitotic count, tumor diameter, tumor/desmoplasia ratio, necrosis/tumor ratio, gland space/tumor ratio, nuclear volume (= nuclear grade), and age at diagnosis. This study concludes: 1) Each parameter of invasion, adjusted in the analysis for lymph node status and mitotic count, emerges as statistically significant with low invasion in the primary tumor conferring a better prognosis than high invasion. 2) The associations low mitoses/low invasion, high mitoses/low invasion and low mitoses/high invasion tend to indicate a favorable 10‐year survival, while the combination high mitoses/high invasion results in poor survival. 3) There was a greater percentage of high invasion cases in the LN > 0 subgroup compared to the LN 0 subgroup, suggesting that high invasion in the primary tumor predisposes to metastases, but this trend did not always reach statistical significance. 4) The proposed methodology offers a practical approach for measuring invasion in solid tumors.

Maternal and fetal outcome after breast cancer in pregnancy

Early “nopause in long-term survivors of caacer during adolescence Byrne J; Fears TR; Gail MH; Pee D, Connelly RR; Austin DF; Holmes GF; Holmes FF; Latourette HB; Meigs JW; Strong LC; Myers MH; Mulvihill JJ Clinical Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892. USA AM J OBSTET GYNECOL 1992 166/3 (788-793) Objective: We attempted to investigate the risk of early menopause after treatment for cancer during childhood or adolescence. Study design: We interviewed 1067 women in whom cancer was diagnosed before age 20, who were at least 5-year survivors and who were still menstruating at age 2 1. Selfreported menopause status in survivors was compared with that in 1599 control women. Results: Cancer survivors, with disease diagnosed between ages 13 and 19, had a risk of menopause four times greater than that of controls during the ages 21 to 25; the risk relative to controls declined thereafter. Significantly increased relative risks of menopause during the early 20s occurred after treatment with either radiotherapy alone (relative risk 3.7) or alkylating agents alone (relative risk 9.2). During ages 21 to 25 the risk of menopause increased 27fold for women treated with both radiation below the diaphragm and alkylating agent chemotherapy. By age 3 1,42% of these women had reached menopause compared with 5% for controls. Conclusion: Treatment for cancer during adolescence carries a substantial risk for early menopause among women still menstruating at age 2 1. Increasing use of radiation and chemotherapy, together with the continued trend toward delayed childbearing, suggests that these women should be made aware of their smaller window of fertility so that they can plan their families accordingly.