Lymph node positivity in cervical cancer

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results superior to our prior conventional therapies, especially in iramnosuppressed patients. The "cbznrmrgery" technique and results are described and illustrated. All 16 patients treatedwentinto remissions ranging fran 5-4Omnths. Therewere two recurrences of m&rate dysplasia after remissions of 14 and 15 mnths respectively. Th2seoc-in~ immmosuppressedpatientswlm hadbemoff the usual maintenance 5-FUbecause of pregnancy. Cur experience suggests that 5-FU/chsmsurgery, follcwed z rtiyts5-FU mintenance, may be the Fea-t of.choice for the folkwing groups : Dmunmsuppressed patients with mtraepithelial neoplasia of the lwer genital tract; patients with alawer genitaltractneoplastic syndxcma; patientswith vaginalintraepithelialneoplasia. 5-FU/chemsurgery is also a oonservati~ option for other patients with isolated foci of cervical, vulvar and perineal intraepithelial necplasia.

~~OFTHE~FDLu)GJ~RADIcAz~S~~ANDpELvIC~~ DISSECI'IOh'. H-B. Krebs, B. F. Helmkanp, B-U. Sevin, M. Nadji, H. E. Averette, ~epartmants of Obstetrics and@mcology andPathology, University of Mimi Schcol of Medicine, Miami, FL. Fmn 1965 to 1977 a total of 319 patients were treated at the University of Mimi Msdical surgeqforearlycemical cancer. Threehundredand twelve patients Centerbyradical had prinmy cancers, 7 had failed previous radiation tbsraw. Thirty-eight patients were given additional radiation tkrapypostoperatively fortumr spread to pelviclyqh nodes (29 cases) or for close or positive mrgins (9 cases). Recurrences were diagmsed in 14% of the patients. Sixty-onepercmltoftherecuTxen ceswereobsemedwithinthe &cumencesafter that first12mnths after surgery and 84%within the fixat2years. timawere aonfinedminlytopatients whohadradiation therapy. The siteof recurreme was found to iafluence diagnosis, synptcaMtolcgy, clinical findings, prognosis, causeof deathandtherq, allofwhich arediscussedindetail. Ihepmgnosisofrecurrent cervical cancerwas poorwithonly 5patients (11%) surviving their rmmrrence witlmut disease for over 5years. One patient is presently alive aridwitirmtdisease for over two years. Patients not anenable to curative radiation therapy at the tim of diagnosis facedahopelessprognosis as noneof ~patients~~byexenterativeprocedwres orchmtherapy survived. Guidelines for postoperative follm-up are given.

LYMPHMDEF0SITMTYINCERVICALCAXER. Medical Center, Washington, D.C.

P. B. Heller,

R. C. Park, Walter Reed Amy

EYcm January 1962 until July 1978,44 patients with invasive cervical cancer at exploratory surgery (Wertheirn-Taussig hysterectomy or staging lapamtmy) were found to have psitive lynphmdes. Forty-three of these patients received radiation as definitive therapyafterthe disccveryofl~noden-etastases. One patient had a positive left scalene biopsy andwas treatedonlywith chen-otherapy. Thirty-three oft&patients were clinically Stage I. One patient was Stage IIA while seven were IIB. There was one irKiividualstaged IIIB. One patient was unstagable because of carcinma found at operation for a tkc-ovarian abscess. A re-exploration wasperfonnad at Walter Reed revealing mtastaticdisease in thelyxphncdes. Histologically, 35 of the 44 were squamus cell Fivewereademcaxircmas, CarChclM. while twowereadenosquamus. one patientwas noted to have glassy cell type and one patient had a small cell undifferentiated carcinolm. Ihe biopsy-proven nodal involvemat revealed that 33 patients (75%) had tmmr only in lmer iliac or obturator nodes. Five patients (11%) had ommn iliac and lmer iliac/obtuxatir no& involverrent. Three patients (7%) had only ccmmn iliac nodes found to be positive. One patient (2%) had n&astatic foci in lmer,iliac/obturatir and aortic I-C&S. One patient initially had only left external iliac r-odes biopsied but clinically was nctedto havs the pxkbilityofaortic ncdemtastasis. A left scalene biopsy was positivein this patient. It is well known that clinical staging in cervical cancer is inaccurate. At least 22 patients (50%) of this stmly had coqleted radical hysterectomies. It is evidentthata nuaberof patientswho are tlmughttohave early disease clinically myhavemre advanceddisease surgically ardpatholagically. k@ny institutions treat

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cervicaloarcincmawith radiation ttmzapy aloe, perhapswithoutpretreatmentnoninvasive studies (lymphangiography or CAT scan). Itmay be more rationalto perform staginglaparoties even inclinicallyearlycarcinumofthecemix. Treatmantplans couldthenbe adjusted to include theextentofnodalinvolvemnt. Appmximatelyonethirdof the patients hadno conplicationswith this treatmnt. Themminderhadminor postoperative applications or effects of radiation. Although the results of this study are preliminary asllotall~patientshavereached~five-year~t-~~~tinterval, the survival appears toapproach 50%.

C~TIONOFAPHYSIO~~ARTIFICIALB~~~NEW~. M. M. Makii, C. R. Division of Gynecologic Oncology, Departmnt of OB/GYN Wheeless, Jr. and S. L. Miller. UniversiQof Chicago, Chicago, IL; The Department of Gynecology andobstetrics, Union Mmorial Hospital, Baltimore, MD, and the Cordis cO?qmration. Sponsored by Arthur L. Herbst, M.D. There are ah estimated 10,000 to 15,000 urinary diversion procedures and total cystectanies perfornkzdin the United States each year, prehninantly for cancer. The pmblemof developingan improvedsubstitute fortheurinarybladderhasledus toattarpttodesignacontinent, physiologically fumtioniag urinary bla&ler in the &g. Distal jejuurm-proximal ileumwas used to create the pouchwith a terminal nipple to preseme continemy. Tb prevent chronic ascending urinaq tract infections and to diminish residual mine, nwdifiedcardiacpace-makerelectmdeswere inplanted into thewallof the neo-intestinal bladder, whichwhen stimulatedproduce contractions of the intestinal pouch inaway that closely tics mrml urinary voiding. In slmrt-termtrialswith freshly created neo-bladders,we havebeen able togenerate intralmina 1 pressures of 4-10 mof water without leakage. Theresultsofthesee~~ts,includingthe~thodofcons~g this pouch and the long tern clinical applications of our stwdy will be discussed.

Berek, J.S., UKUXIC OPEPATICFJS XKiNG cyTcQIEDucIVESURQXYFoRWARIAN -R. Hacker, N.F., Leuchter, R.S., Lagasse, L.D., Byrm, R.L., Divisicm of Gynecologic cklcolcqy, UCLA Center for the Health Sciences, Los &qeles, Ca., and Tba City of HEX? National Medical Center, Duarte, Ca. Thenty-five patients undemt primary extirpative, reconstructive or divertive urological procedures as part of cytoreductive surgery for marian epithelial maliqancy fran 1960 to 1979 at UCLA and the City of Hcpe National Medical Center. Six patients had partial cystectanies with reinplantation of the ureter, 11 hadvarioustypes of uretalresection and reanastamsis, 5 underwent urinary diversian, 3 had exenterations. Partial lower urinary tract resection appears justified as part of a major cytoreductive effort, while exenteration my be rarely if ever warranted for this disease. Urinary diversion was appropriate in selected patients. Morbidity fm surgery involving the urinary tract was acceptable in this series and is discussed in detail. Patients wbc presented with an obstructedureter surviveda significantly shorter time thanthosewithoutobstructicms. Cptimal cytoreduction was associated with a lcmger nean survival. Indicaticms, ccnplications and surgical methods are discussed.

RADIOACI'IVECHBXHCPHOSPHATESUSPENSION: STUDIFS ON DISTRIBUl'ION, co5EABS3RPTION ANDEEFECTIVE7XERAPE~ICIFUXATION INPH?@?IOMS,DXS,ANDPATIENIs. J. L. Currie, F. Bagne, C. Harris, D. L. Sullivan, E. A. Surwit, R. H. Wilkinson, W. T. Cxeasman, Division of Gynecologic Oncology, Depa?YmentofObstetrics andGynea3logy, andthe Divisions of Nuclear Medicine and Radiation Oncology, Department of Radiology, Luke University School of Medicine, Durham, N. C. Aseries of studiesinphantcm, properties of the comercial

dogs, andpatiebtswas undertaken to investigatephysical preparation of P-32 suspension, distribution of intraperi-