Mastectomy versus radiotherapy as treatment for stage I-II breast cancer: A prospective randomized trial at the National Cancer Institute

In 1979, the National Cancer Institute in Bethesda, Maryland initiated a randomized, prospective trial to compare surgery versus radiation therapy in the treatment of stages I and II breast cancer. Surgical treatment consists of total mastectomy with axillary lymph node dissection (modified radical mastectomy) and breast reconstruction; radiation treatment consists of gross tumor excision, axillary lymph node dissection, and comprehensive irradiation including a boost dose to the tumor bed. All patients with pathologically positive axillary nodes receive 11 cycles of adjuvant Adriamycin ® /Cytoxan ® chemotherapy. As of December 1984, there have been 175 patients entered in the study. Twenty-three patients have developed disease recurrence (12 mastectomy, 11 radiation), but it is too early to obtain definitive treatment-related results. En 1979 l'Institut National du Cancer de Bethesda a lancé une étude prospective randomisée permettant de comparer les résultats respectifs de la chirurgie et de la radiothérapie en ce qui concerne les stades I et II du cancer du sein. Le traitement chirurgical consiste en la mastectomie totale complétée par le curage ganglionnaire axillaire (mastectomie totale modifiée); le traitement dit radiothérapique consiste en l'exérèse large de la tumeur associée au curage ganglionnaire axillaire et à l'administration d'une dose élevée de rayons au niveau du lit tumoral. Toutes les opérées dont les ganglions sont envahis reçoivent en outre 11 cycles d'une combinaison d'Adriamycine et Cytoxan. De 1979 à Décembre 1984, 175 malades ont fait l'objet de cette étude. Vingt-trois ont accusé une récidive (12 après mastectomie et 11 après traitement dit radiothérapique) mais il est encore trop tôt pour tirer des conclusions définitives de ces résultats. El Instituto Nacional de Cáncer de Bethesda inició en 1979 un ensayo prospectivo y aleatorio orientado a comparar el tratamiento quirúrgico versus radioterapia en el manejo del cáncer mamario en estados I y II. El tratamiento quirúrgico consistió de mastectomía total con disección ganglionar axilar (mastectomía radical modificada) y reconstrucción mamaria; el manejo radioterapéutico consistió de resección del tumor, disección de los ganglios linfáticos axilares e irradiación comprensiva incluyendo una dosis de refuerzo al lecho tumoral. Todos los pacientes con ganglios axilares histológicamente positivos recibieron 11 ciclos de quimioterapia adyuvante con Adriamicina/Citoxán. Hasta diciembre de 1984, 175 pacientes habían entrado al estudio. Veintitrés pacientes han desarrollado recurrencia de la enfermedad (12 mastectomía, 11 irradiación), pero es todavía muy temprano para derivar resultados definitivos.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41319/1/268_2005_Article_BF01655179.pd

Long-term survival data of triple modality treatment of stage IIB-III-IVA cervical cancer with the combination of radiotherapy, chemotherapy and hyperthermia - an update

Background: Advanced cervical cancer is routinely treated with radiotherapy and cisplatin-containing chemotherapy. Hyperthermia has been shown to improve the results of both radiotherapy and cisplatin. The feasibility of the combination of all three modalities was demonstrated and reported in a study of 68 previously untreated cervical cancer patients in 2005. Long-term follow-up is presented here. Methods: Sixty-eight patients with advanced cervical cancer were prospectively registered in the USA, Norway and the Netherlands, and treated with a combination of radiotherapy (external beam radiotherapy and brachytherapy for a biologically effective dose of at least 86.7 Gy), chemotherapy (at least four courses of weekly cisplatin (40 mg/m(2))) and locoregional hyperthermia (four weekly sessions). Long-term follow-up was gathered and recurrence-free survival (RFS) and overall survival (OS) cur Results: Median follow-up was 81 months. Tumours in 28 patients have recurred, 21 of whom have died. Five-year RFS from the day of registration in the study is 57.5% (95%CI: 46.6-71.0) and five-year OS is 66.1% (95%CI: 55.1-79.3). Differences between countries can be explained by patient characteristics. Conclusion: The long-term survival results of the combination of full-dose radiotherapy, chemotherapy and hyperthermia fall well within previous reports for this patient group in randomised trials. The small trial size and lack of randomisation do not permit further interpretation

Linac Coherent Light Source (LCLS) at 2--4 nm using the SLAC linac

The authors describe the possible use of the SLAC linac to drive a unique, powerful, short wavelength Linac Coherent Light Source (LCLS). Using the FEL principle, lasing is achieved in a single pass of a high peak current electron beam through a long undulator by self-amplified-spontaneous-emission (SASE). The main components are a high-brightness electron RF gun with a photocathode, two electron bunch length compressors, the existing SLAC linac, beam diagnostics, and a long undulator combined with a FODO quadrupole focusing system. The RF gun, to be installed about 1 km from the end of the SLAC linac, would produce a single bunch of 6 x 10{sup 9} electrons with an invariant emittance of about 3 mm-mrad and a bunch length of about 500 {mu}m. That bunch is then accelerated to 100 MeV and compressed to a length of about 200 {mu}m. The main SLAC linac accelerates the bunch to 2 GeV were a second bunch compressor reduces the length to 30--40 {mu}m and produces a peak current of 2--3 kA. The bunch is then accelerated to 7--8 GeV and transported to a 50--70 m long undulator. Using electrons below 8 GeV, the undulator could operate at wavelengths down to 2 nm, producing about 10 GW peak power in sub-ps light pulses. At a linac repetition rate of 120 Hz, the average power is about 1 W. Linac operation at lower beam energies provides longer wavelength radiation. After the undulator, the beam is deposited in a dump. The LCLS light pulses are then distributed to multiple user stations using grazing incident mirrors. Length compression, emittance control, phase stability, FEL design criteria, and parameter tolerances are discussed. A demonstration experiment is also described which uses the SLAC linac and (possibly) the PALADIN undulator to study SASE to power saturation at wavelengths of 40--360 nm