Radiotherapeutic alternatives to standard management of adenocarcinoma of the endometrium

Primary radiotherapy as an alternative management for adenocarcinoma of the endometrium was chosen for 117 patients treated at the University of Michigan Medical Center and University of Virginia Medical Center. Cases were selected for radiation because of contraindications to surgery (52.2%) or by protocol for disease outside the endometrium (47.8%). An overall 5-year actuarial survival rate of 49.6% was attained for all stages, with 55% 5-year survival for disease limited to the uterus or cervix. Stage and grade were the most significant risk factors. The addition of external-beam irradiation did not improve local failure rates or survival. Heyman's uterine packing technique was slightly more successful than uterine "line sources" in controlling local disease (P = 0.08). Treatment-related mortality (0.8%) and morbidity (6.8%) were minimal. Surgery, whenever possible, remains the "best standard therapy" but the radiotherapeutic alternative is of significant benefit for those deemed nonsurgical candidates.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25049/1/0000477.pd

Assumption without representation: the unacknowledged abstraction from communities and social goods

We have not clearly acknowledged the abstraction from unpriceable “social goods” (derived from communities) which, different from private and public goods, simply disappear if it is attempted to market them. Separability from markets and economics has not been argued, much less established. Acknowledging communities would reinforce rather than undermine them, and thus facilitate the production of social goods. But it would also help economics by facilitating our understanding of – and response to – financial crises as well as environmental destruction and many social problems, and by reducing the alienation from economics often felt by students and the public

Invasive cervical cancer treated initially by standard hysterectomy

Ninety-two patients with invasive cervical cancer initially treated by standard hysterectomy were evaluated for features related to survival. The cell type included squamous cell (64) and adenocarcinoma (28). Posthysterectomy therapy included radiation therapy (78), pelvic lymphadenectomy (3), and radical parametrectomy (1). Hysterectomy was initially performed for the following indications: invasive lesion missed on cone biopsy, 17; hemorrhage at cone biopsy, 2; bleeding, 16; abnormal cytology, 13; presumed endometrial cancer, 9; known cancer, 7; pelvic relaxation, 5; planned therapy, 3; fibroids, 3; adnexal mass, 2; chronic discharge, 1; pyometra, 1; postpartum endometritis, 1. The cumulative 5-year survival for all patients was 68%, for squamous cell 80%, and for adenocarcinoma 41% (P = 0.0001). On postoperative evaluation 84 patients had presumed Stage I and 7 had parametrial involvement (Stage II). Patients with Stage I disease were then examined separately by cell type. Fifty-seven patients with squamous cell disease had cumulative 5-year survival of 85%. Radiation therapy in the immediate postoperative period produced a survival of 88%, compared to observation only with a 69% survival (P = .10). Patients with squamous cell disease and more than 50% cervical invasion had a 75% survival compared to a 96% survival for those with less than 50% (P = .02). The presence of disease at the surgical margins, grade, age, and increase in radiation therapy did not influence survival. Twentyseven patients with presumed Stage I adenocarcinoma had a cumulative 5-year survival rate of 42%. Survival was significantly influenced by tumor grade (P = .018) and the amount of postoperative radiation therapy (P = .03), while age, amount of residual tumor, and presence of tumor at surgical margins did not influence survival. Patients with invasive squamous cell carcinoma treated by standard hysterectomy and postoperative radiation therapy have a prognosis similar to those treated initially by either radical surgery or radiation therapy. Patients with adenocarcinoma appear to have a significantly decreased survival when compared to patients with squamous cell disease and their prognosis is related to tumor grade and the amount of postoperative pelvic radiation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28762/1/0000592.pd

Data from: An experimental test of whether pyrodiversity promotes mammal diversity in a northern Australian savanna

1. The increasing awareness that a fire regime that promotes biodiversity in one system can threaten biodiversity in another has resulted in a shift away from fire management based on vague notions of maximising pyrodiversity, towards determining the optimal fire regime based on the demonstrated requirements of target species. 2. We utilised a long-running, replicated fire experiment on Melville Island, the largest island off the northern Australian coast, to test the importance of pyrodiversity for native mammals in a northern Australian savanna landscape. We first developed statistical models to determine how native mammal abundance has responded to nine years of experimentally-manipulated fire frequency. Next, given each species’ modelled response to fire frequency, we identified the level of pyrodiversity and optimal mix of fire frequencies that would be expected to maximise mammal diversity and abundance, and minimise extinction risk. This was done for both the entire mammal assemblage and for the mammal species currently declining on Melville Island. 3. Fire frequency was a significant predictor of abundance of the northern brown bandicoot (Isoodon macrourus), black-footed tree-rat (Mesembriomys gouldii), brush-tailed rabbit-rat (Conilurus penicillatus), grassland melomys (Melomys burtoni), pale field-rat (Rattus tunneyi), and mice/dunnarts but not for the common brushtail possum (Trichosurus vulpecula). 4. The geometric mean abundance (GMA) of the entire mammal assemblage was positively associated with pyrodiversity, but peaked at an intermediate value. Hence, maximising pyrodiversity would reduce native mammal assemblage GMA below its potential maximum. The fire history for an area that maximised the entire native mammal assemblage GMA consisted of 57% long-unburnt, 43% triennially burnt and <1% annually burnt. Pyrodiversity did not reduce the extinction risk, nor increase the GMA of declining mammals above that predicted in areas entirely annually or triennially burnt. 5. Synthesis and applications: We demonstrate a useful approach with which to develop fire management strategies based on the demonstrated requirements of target species. By comparing the optimal fire regime identified for the conservation of threatened species and that identified for the entire mammal assemblage, we demonstrate the flexibility of this approach to tailor fire management to address specific management priorities in other fire-prone environments