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Background. There is little published information pertaining to elective inguinal lymph node irradiation for carcinomas originating in the pelvis that place the inguinal lymph nodes at risk. Methods. Between October 1964 and October 1988, 164 patients with primary carcinomas originating in the pelvis that placed the inguinal lymph nodes at risk for subclinical disease received elective inguinal lymph node irradiation at the University of Florida. All patients had a minimum follow-up of 2 years from the start of radiation therapy. Primary sites included the penis, urethra, vulva, anal canal, distal rectum (within 4 cm of the verge), and the cervix or vagina when the tumor involved the distal one-third of the vagina. In 148 patients, both groins were clinically negative; in 16 patients, one groin was positive and the other negative by clinical examination. Treatment techniques were individualized according to the primary site. Tumor doses to the inguinal lymph nodes varied, although more than 70% of patients received 4500-5000 cGy (range, 2650-6780 cGy) over 5 weeks (range, 2-7 weeks) at 180-200 cGy per fraction. Patients were excluded from the analysis of disease control in the inguinal area if they died less than 2 years from treatment with the inguinal lymph nodes continuously disease free or if they experienced recurrence at the primary site with the inguinal lymph nodes clinically negative at the time of recurrence. Results. The inguinal lymph node control rate was 96% (101 of 105). No patient in whom recurrent disease developed in the inguinal lymph nodes underwent salvage therapy. Conclusions. Elective irradiation of the inguinal lymph nodes is highly effective in controlling subclinical disease from carcinomas originating in the pelvis and can be accomplished with minimal acute or long-term complications. Cancer 1993; 72:2058-65.

Background. Small cell (oat cell) carcinoma of the bladder is a rare entity characterized clinically by an aggressive behavior with a high incidence of systemic metastases. Radical cystectomy has been the therapeutic focal point for this disease, but systemic relapse is almost universal. Results. The authors report that combination chemotherapy with cisplatin, methotrexate, and vinblastine, followed by external beam irradiation to the bladder, gave a durable continuous complete remission (more than 4.5 years). In addition, this bladder-sparing approach has preserved normal bladder function and an excellent quality of life. Conclusion. This experience shows that radical cystectomy may not be necessary for small cell carcinoma of the bladder and that early intervention with systemic chemotherapy offers greater potential for cure. Cancer 1993; 71:2581-4.

Aggressive fibromatosis, or desmoid tumor, is a noncancerous but aggressive condition characterized by a firm rubbery mass of skeletal muscle and fascia. Treatment is usually surgical removal of the tumor. Local recurrences are common and patients may require many operations. Eventually many of these patients will either refuse further surgery or develop lesions that are unable to be removed. Amputations are often necessary. Radiation therapy may control tumors that cannot be surgically removed and reduce local recurrence. A report is presented of 29 patients with aggressive fibromatosis who were treated with radical radiation at the University of Florida. Patients received radiation treatment after surgery; 16 of 30 sites had grossly apparent residual disease, and 14 had microscopic quantities of disease that was locally controlled. All patients were followed for at least two years; 76 percent for more than five years. Aggressive fibromatosis was controlled in 25 of the 30 sites (83 percent). The six-year control rate was 79 percent. Of the five failures, two occurred in patients who had grossly apparent disease and three in patients with microscopic disease. Patients being treated for the first time did not have a difference in disease control from patients who were treated for one or more recurrences. These findings indicate that when wide margins of disease-free tissue cannot be achieved at surgery, local tumor control can be improved substantially if radiation therapy is used postoperatively. Radiation therapy alone is suggested when a disabling or deforming operation is necessary to achieve a wide surgical margin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Radiation therapy, alone or combined with surgery, is often effective in treating the early stages of laryngeal cancer (cancer of the larynx). In many cases, the patient initially receives radiation therapy, and surgery is reserved for those cancers that do not respond to radiation. Patients with early-stage laryngeal cancer, but with advanced disease of the lymph nodes in the neck, may receive radiation for the laryngeal cancer and surgery for the lymph node involvement. Even patients with advanced stages of laryngeal cancer, which are normally treated surgically, may choose radiation treatment to preserve the voice. Radiation therapy can also be used as a follow-up to surgery. In a group of 129 patients with supraglottic cancer (cancer above the vocal cords) who treated at the University of Florida, control of the cancer was possible in over 80 percent of the patients with early-stage cancer after radiation therapy alone. For those with advanced cancer, surgical treatment of cancer recurrence after radiation therapy was successful in 65 percent. In a study reported by the MD Anderson Cancer Center in Texas, radiation therapy after total laryngectomy (surgical removal of the larynx) significantly improved two- and five-year survival rates in patients with advanced supraglottic cancer. Radiation is the treatment of choice for early-stage glottic (vocal cord) cancer, since it preserves the quality of the voice. Patients with advanced glottic cancer are advised to have a laryngectomy, followed by radiation if necessary. Data from the University of Florida indicate that control of early-stage glottic cancer can be accomplished with radiation therapy in over 70 percent of the patients studied. Complications of radiation therapy include sore throat, loss of taste, and xerostomia (dry mouth). Severe complications can include swelling of the larynx, which can hinder breathing, and damage to the jawbone. Patients with early-stage cancer tend to have fewer complications. Higher total dose of radiation is also associated with more complications. (Consumer Summary produced by Reliance Medical Information, Inc.)