Management of subdiaphragmatic early-stage XXXX .

@entity1 @entity66 @entity34 @entity5 @entity2096 @entity978
Twenty-six @entity1 with @entity978 confined below the diaphragm were treated at the Mayo Clinic over a 9-year period (1974-1982). Ten of the twenty-six @entity1 presented with intra-abdominal disease alone, and the remaining 16 @entity1 presented with palpable @entity2096 . One hundred thirty @entity1 with pathologically staged supradiaphragmatic disease were treated over the same period and serve as a comparison group. The median age of 52 years among @entity1 with @entity66 was significantly higher than the median age of 27 years in supradiaphragmatic group. There was no difference in sex distribution between the two groups. One-fifth of the subdiaphragmatic @entity1 presented with B symptoms compared to one-tenth in the supradiaphragmatic group. No significant histological differences were seen. The majority of @entity1 were treated with radiation therapy alone. The overall failure rate was 42% in the subdiaphragmatic group versus 22% in @entity1 with supradiaphragmatic disease. All of the failures occurred in @entity1 treated with radiotherapy alone. Stage and the presence of B symptoms were the most important prognostic factors. The type of subdiaphragmatic presentation (intra-abdominal versus inguinal-femoral) did not influence the outcome. Despite decreased 5-year recurrence-free survival (57% subdiaphragmatic vs. 79% supradiaphragmatic, p = 0.03), the overall 5-year survival rate of 85% is comparable to that of @entity1 with supradiaphragmatic disease. It appears that inverted Y irradiation alone is sufficient for @entity1 with @entity5 , but that @entity1 with B symptoms or @entity34 require more aggressive initial therapy if recurrence-free survival is to be improved.
