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Showing papers in "Cancer in 1981"


Journal ArticleDOI
01 Jan 1981-Cancer
TL;DR: Recommendations have been developed for standardized approaches to the recording of baseline data relating to the patient, the tumor, laboratory and radiologic data, the reporting of treatment, grading of acute and subacute toxicity, reporting of response, recurrence and disease‐free interval, and reporting results of therapy.
Abstract: On the initiative of the World Health Organization, two meetings on the Standardization of Reporting Results of Cancer Treatment have been held with representatives and members of several organizations. Recommendations have been developed for standardized approaches to the recording of baseline data relating to the patient, the tumor, laboratory and radiologic data, the reporting of treatment, grading of acute and subacute toxicity, reporting of response, recurrence and disease-free interval, and reporting results of therapy. These recommendations, already endorsed by a number of organizations, are proposed for international acceptance and use to make it possible for investigators to compare validly their results with those of others.

7,799 citations


Journal ArticleDOI
01 Jul 1981-Cancer
TL;DR: A new three‐stage classification in three prognostic groups only requires clinical examination and routine hemogram, has a good prognostic value which was confirmed on the series of Montserrat and Rozman (146 patients), and should therefore be helpful in planning new clinical trials.
Abstract: Survivals of two series of CLL patients (99 from a retrospective series and 196 from a prospective series) were studied separately The three main staging systems (Rai, Binet, Rundles) agreed well, but as far as survival is concerned, too many stages are defined The authors performed a Cox multivariate analysis of survival in order to isolate important prognostic factors at diagnosis and to use them to build a simple three-stage classification Thrombopenia and anemia appeared as the most important risk factors Among the nonanemic and nonthrombopenic patients, the number of involved areas was clearly related to prognosis in the authors' two series This study allowed the authors to propose a new classification in three prognostic groups Group C: anemia (Hb less than 10 g) and/or thrombopenia (platelets less than 100,000/mm3); about 15% of the patients; median of 2 years Group B: no anemia, no thrombopenia, three or more involved areas (counting as one each of the following: axillary, cervical, inguinal, lymph nodes, whether unilateral or bilateral, spleen and liver); about 30% of patients; median of 7 years Group A: no anemia, no thrombopenia, less than three involved areas; about 55% of patients; the survival of this group does not seem different from that of the French population of the same age and sex distribution This three-stage classification only requires clinical examination and routine hemogram, has a good prognostic value which was confirmed on the series of Montserrat and Rozman (146 patients), and should therefore be helpful in planning new clinical trials

1,752 citations


Journal ArticleDOI
01 Dec 1981-Cancer
TL;DR: Seven of 13 patients treated by subtotal resection survived more than five years with postopertive radiotherapy, and the five‐year survival rates of each clinical stage were 92.6% in Stage I, 85.7% in stages II and III, and 50% in stage IV.
Abstract: Follow-up data were obtained for 96 cases of thymoma. The one-year survival rate was 84.3%, the three-year 77.1%, the five-year 74.1%, and the ten-year 57.1%. The five-year survival rate of total resection group was 88.9%; that of non-radically treated group was 44.4%. Clinical stages were defined: Stage I--macroscopically encapsulated and microscopically no capsular invasion; Stage II--1. macroscopic invasion into surrounding fatty tissue of mediastinal pleura, or 2. microscopic invasion into capsule; Stage III--macroscopic invasion into neighboring organ; Stage IVa--pleural or pericardial dissemination; Stage IVb--lymphogenous or hematogenous metastasis. Five-year survival rates of each clinical stage were 92.6% in Stage I, 85.7% in Stage II, 69.6% in Stage III, and 50% in Stage IV. Recurrence after total resection was found in six of 69 cases. Seven of 13 patients treated by subtotal resection survived more than five years with postoperative radiotherapy.

1,552 citations


Journal ArticleDOI
15 Oct 1981-Cancer
TL;DR: One‐hundred‐ninety‐four eligible and evaluable patients with histologically confirmed locally unresectable adenocarcinoma of the pancreas were randomly assigned to therapy with high‐dose radiation therapy alone, to moderate‐dose (4000 rads) radiation + 5‐fluorouracil (5‐FU), and to high‐ dose radiation plus 5‐FU.
Abstract: One-hundred-ninety-four eligible and evaluable patients with histologically confirmed locally unresectable adenocarcinoma of the pancreas were randomly assigned to therapy with high-dose (6000 rads) radiation therapy alone, to moderate-dose (4000 rads) radiation + 5-fluorouracil (5-FU), and to high-dose radiation plus 5-FU. Median survival with radiation alone was only 51/2 months from date of diagnosis. Both 5-FU-containing treatment regimens produced a highly significant survival improvement when compared with radiation alone. Forty percent of patients treated with the combined regimens were still living at one year compared with 10% of patients treated with radiation only. Survival differences between 4000 rads plus 5-FU and 6000 rads plus 5-FU were not significant with an overall median survival of ten months. Significant prognostic variables, in addition to treatment, were pretreatment performance status and pretreatment CEA level.

999 citations


Journal ArticleDOI
15 Sep 1981-Cancer
TL;DR: The authors' cases displayed a morphologic range from well‐differentiated to those tumors that displayed virtually no evidence of differentiation by conventional microscopy, and it was therefore not surprising that most tumors were originally diagnosed as lymphoma.
Abstract: Granulocytic sarcoma is an uncommon tumor composed of granulocytic precursor cells. Because it occurs in a variety of clinical settings and because the tumor cells are primitive it is frequently unrecognized during life. This presentation details the authors' experience with 61 biopsy-proven granulocytic sarcomas. The patient age range was from 2 to 81 years (mean 48 years). In eight patients the tumors were multiple. Most common sites of involvement were bone, periosteum, soft tissue, lymph node and skin. Twenty-two tumors occurred in 15 patients with no known disease, 26 occurred in 24 patients with a known myeloproliferative disorder, and 13 occurred in 11 patients with proven acute myeloid leukemia. Thirteen of the 15 patients with no known disease developed acute leukemia in from one to 49 months after the biopsy of their tumors (mean 10 months). Most tumors occurring in patients with a known myeloproliferative disorder were associated with blast crisis. The authors' cases displayed a morphologic range from well-differentiated to those tumors that displayed virtually no evidence of differentiation by conventional microscopy. It was therefore not surprising that most tumors were originally diagnosed as lymphoma. Chloro-acetate esterase (CAE) stains were performed on 56 tumors and 47 were studied with antilysozyme immunoperoxidase technique. Fifty-six of the 57 specimens studied by either technique were positive. Antilysozyme immunoperoxidase stains were particularly useful in confirming the diagnosis.

892 citations


Journal ArticleDOI
15 May 1981-Cancer
TL;DR: Current data are consistent with the idea that the initiation step of chemical carcinogenesis is a mutagenic event and is caused by alteration of DNA by the ultimate carcinogens and there appears to be no requirement that they be electrophilic.
Abstract: Studies on a variety of chemical carcinogens have demonstrated that their ultimate reactive and carcinogenic forms are strong electrophiles. Some carcinogens, such as alkylating agents, are in their ultimate forms as administered, but most require metabolism to these active derivatives. The ultimate carcinogens react, usually non-enzymatically, with nucleophilic constituents in vivo. Of particular interest in regard to their possible importance in carcinogenesis have been the covalent interactions of these electrophilic reactants with cellular informational macromolecules, the DNAs, RNAs, and proteins. Current data are consistent with the idea that the initiation step of chemical carcinogenesis is a mutagenic event and is caused by alteration of DNA by the ultimate carcinogens. The nature of the carcinogen metabolite(s) involved in the promotion phase has not been determined, but there appears to be no requirement that they be electrophilic. The development of the concept of ultimate chemical carcinogens as strong electrophilic reactants is reviewed, especially with respect to the studies carried in the authors' laboratory.

748 citations


Journal ArticleDOI
01 Jun 1981-Cancer
TL;DR: Solitary fibrous tumors of the pleura are not associated with asbestos and nuclear pleomorphism and a high mitotic rate are seen in larger tumors but do not necessarily indicate a poor prognosis if the tumor is circumscribed.
Abstract: Three-hundred-sixty cases of solitary fibrous tumor of the pleura from the literature are analyzed, and eight new cases are described. Of patients reported on prior to 1972, 72% had symptoms due to the tumor at the time of diagnosis, but only 54% of patients reported on since then were symptomatic. This probably reflects earlier diagnosis as a result of increased use of chest radiographs in asymptomatic populations. Cough, chest pain, dyspnea, and/or pulmonary osteoarthropathy are each found in at least one-third of patients who have symptoms. Approximately 80% of solitary fibrous tumors of the pleura originate in the visceral and 20% in the parietal pleura. In the literature and in this experience these tumors are on the whole circumscribed. They range in size from 1–36 cm with a mean of 6 cm. Many are pedunculated on pleural-based pedicles that contain hypertrophic arteries and veins. Histologic examination of the tumor usually discloses cellular areas alternating with hyalinized and/or necrotic areas. Spindle-shaped cells typically have minimal nuclear pleomorphism and rare or absent mitoses. Numerous thin-walled vessels constitute an additional feature of large tumors. Electron microscopical examination reveals features of both fibroblasts and mesothelial cells. Solitary fibrous tumors behave in a benign fashion in 88% of cases after surgical resection. In 12% of the cases the tumor is responsible for the patient's death because of its extensive intrathoracic growth, by virtue of either late diagnosis or unresectable recurrence. No single histologic feature allows a definite prognosis. The best indicator of a good prognosis is the presence of a pedicle supporting the tumor. Also favorable is circumscription of the tumor without invasion of lung, mediastinum, or chest wall. Nuclear pleomorphism and a high mitotic rate are seen in larger tumors but do not necessarily indicate a poor prognosis if the tumor is circumscribed. Solitary fibrous tumors of the pleura are not associated with asbestos.

687 citations


Journal ArticleDOI
15 May 1981-Cancer
TL;DR: From January 1963 through December 1977, 300 adults with soft‐tissue sarcomas were treated by a conservative surgical excision and postoperative radiotherapy, and the absolute two‐ and five‐year disease‐free survival rates are 74% and 61.3% respectively.
Abstract: From January 1963 through December 1977, 300 adults with soft-tissue sarcomas were treated by a conservative surgical excision and postoperative radiotherapy. The absolute two- and five-year disease-free survival rates are 74% (222/300) and 61.3% (103/168), respectively. The five-year survival rate varies with: (1) anatomic site, e.g., 69.4% (75/108) for extremity lesions vs. 33% (5/15) for abdominal lesions; (2) histopathologic diagnosis, e.g., 86.4% (19/22) for fibrosarcoma vs. 50% (15/30) for neurofibrosarcoma; and (3) stage of the lesion. The overall local recurrence rate was 22.3% (67/300) and 27% (81/300) of the patients developed distant metastases. The incidence of lymph node metastases as an initial site of spread was only 2.7% (8/300); therefore, elective treatment of the regional lymphatics is not indicated. The 6.5% incidence of significant complications in extremities is low and might be further diminished by careful treatment planning. The combination of conservative surgery and postoperative radiation therapy maintains a functional limb in 84.5% (169/200) of patients with extremity lesions. This rate is comparable to the five-year survival rate attained with radical surgery.

571 citations


Journal ArticleDOI
15 Jul 1981-Cancer
TL;DR: Although the therapeutic goal in intracerebral metastases is generally palliative, it appears that there are categories of cases that may benefit from more aggressive treatment.
Abstract: In order to determine the natural history and results of treatment of intracerebral metastases in solid-tumor patients, the records of 191 patients with an antemortem diagnosis of intracerebral metastasis made during the period from August 1974 to November 1978 were reviewed. Malignancies included lung (122 patients), breast (26), unknown primary (16), melanoma (8), colorectal (6), hypernephroma (4), and others (12). Favorable prognostic factors included solitary brain metastasis (P less than 0.001), ambulatory performance status (P less than 0.001), symptoms of headache (P less than 0.001), or visual disturbances (P less than 0.02), and estrogen receptor positivity in breast cancer patients (P = 0.055). Poor prognostic factors included advanced age (P less than 0.04) and evidence of impaired consciousness, i.e., disorientation, lethargy, stupor, or coma (P less than 0.007). Median survival time after diagnosis of intracerebral metastasis was 3.7 months for the entire series. In those patients with a single intracerebral metastasis and minimal tumor burden, the type of treatment used had a significant impact on survival. Those cases treated with surgery and radiation had a median survival time of 9.7 months versus 3.7 months for those treated with radiation alone (P less than 0.02). When using a proportional hazard regression analysis to adjust for the three most important prognostic factors, treatment (surgery and radiation versus radiation alone) still appeared to be important. Intracerebral metastases were the immediate or contributing cause of death in 50% of the patients in this series. Patients at greater risk of dying of intracerebral metastases included those in whom the brain was the first site of distant metastasis, those with an intracerebral metastasis from an unknown primary site, and those whose presentation of malignancy was with symptoms of a brain metastasis. Although the therapeutic goal in intracerebral metastases is generally palliative, it appears that there are categories of cases that may benefit from more aggressive treatment.

558 citations


Journal ArticleDOI
15 Oct 1981-Cancer
TL;DR: Survition was generally poor in all groups, owing to frequent local recurrence and early metastasis, and only nine patients had long‐term, disease‐free survival.
Abstract: Forty-four cases of skin and soft tissue angiosarcoma seen at M. D. Anderson Hospital before 1976 were reviewed. The cases fell into six different clinical groups: scalp-face, 17 cases; postmastectomy, 14 cases; postradiation, 5 cases; leg with vascular stasis, 2 cases; breast, 2 cases; and miscellaneous, 4 cases. In all cases in the first four groups, the tumors involved primarily the dermis and subcutis and showed similar blends of vasoformative and solid histologic patterns. Two tumors in the miscellaneous group closely resembled those in the larger groups, but the other two in that group (both located in deeper soft tissue sites) and the two breast angiosarcomas had a somewhat different microscopic appearance. Survival was generally poor in all groups, owing to frequent local recurrence and early metastasis; median survival for the entire series was 20 months. Findings of significantly favorable prognostic importance were tumor size less than 5 cm (in the scalp-face group) and a moderate or marked lymphoid infiltrate in and around the tumor. Less significant favorable factors were a distal location ( in the postmastectomy group) and a low degree of pleomorphism. Only nine patients had long-term, disease-free survival.

478 citations


Journal ArticleDOI
01 Mar 1981-Cancer
TL;DR: Knowledge of the mechanisms of carcinogens by chemicals provides a useful basis for approaches to the prevention of human cancer.
Abstract: Of the known carcinogenic agents (viruses, ultraviolet and ionizing radiations, and chemicals), chemicals appear to be of major importance in the induction of human cancers. The known chemical carcinogens include a wide range of structures. Their common feature is that their ultimate forms are electrophilic reactants; in most cases, these reactants arise through metabolism in vivo. Carcinogenesis by chemicals is a multistage process. The first stage, initiation, occurs rapidly and appears to be irreversible. The available data indicate that initiation generally results from one or more mutations of cellular DNA. Covalent reactions of electrophilic derivatives of carcinogens with DNA are the major cause of these mutations. The second stage, promotion, occurs over a longer period of time. Promotion is a complex process, for which the early stages are largely reversible. The critical events appear to be epigenetic. Complete carcinogens have both initiating and promoting activities, but the ratios of these two activities for various chemicals may differ greatly. This knowledge of the mechanisms of carcinogens by chemicals provides a useful basis for approaches to the prevention of human cancer.

Journal ArticleDOI
01 Apr 1981-Cancer
TL;DR: Strong staining was also present in many anaplastic tumors and this together with the resistance of the antigen to formol fixation and paraffin embedding suggest that the antiserum has a valuable role to play in diagnostic tumor histopathology as an indicator of epithelial differentiation.
Abstract: An antiserum raised against human milk fat globule membranes has been used to stain a wide variety of human tissues by the indirect immunoperoxidase method. The antigen detected has been designated Epithelial Membrane Antigen and was confined to the luminal and surface membranes (and to a lesser extent the cytoplasm) of epithelial tissues in the normal state. Increased staining was observed in a variety of nonneoplastic disease states as well as in many neoplasms. The staining of tumors is related both to their histogenesis and degree of differentiation, being found only in lesions of surface epithelial or mesothelial origin and being more consistently present in well and moderately differentiated neoplasms. However, strong staining was also present in many anaplastic tumors and this together with the resistance of the antigen to formol fixation and paraffin embedding suggest that the antiserum has a valuable role to play in diagnostic tumor histopathology as an indicator of epithelial differentiation. The distinction of anaplastic carcinomas from malignant lymphomas and the recognition of spindle-cell epithelial malignancies are especially useful applications. The identification of minute metastatic deposits of carcinoma in organs such as the liver and bone marrow is also greatly facilitated. Malignant neoplasms often exhibit patterns of staining different from those of the normal tissues. The possible significance of these patterns is discussed.

Journal ArticleDOI
01 May 1981-Cancer
TL;DR: One‐hundred‐eighty‐eight children up to 16 years of age were randomized in the second National Wilms' Tumor Study (NWTS) with tumors that were confined to the kidney and that had been totally excised and most fared well whether treated for six or for 15 months with both actinomycin D (AMD) and vincristine (VCR).
Abstract: One-hundred-eighty-eight children up to 16 years of age were randomized in the second National Wilms' Tumor Study (NWTS) with tumors that were confined to the kidney and that had been totally excised (Group I). Most fared well whether treated for six or for 15 months with both actinomycin D (AMD) and vincristine (VCR). No postoperative radiation therapy (RT) was given. The two-year relapse-free survival (RFS) and two-year survival rates were 88 and 95%, respectively. Two-hundred-sixty-eight randomized patients with more advanced local lesions (Groups II and III) and 57 with distant metastases (Group IV) had postoperative RT and were scheduled for 15 months treatment with either AMD and VCR (Reg. C) or AMD plus VCR plus Adriamycin (Reg. D). The 77% two-year RFS rate for Reg. D was significantly different from the 63% with Reg. C. As in the first NWTS, patients with tumors of unfavorable histology (UH) had a significantly worse prognosis than those with favorable histology (FH), as did those with positive nodes. Survival rates at two years were 54% for UH vs. 90% for FH, and 54% vs. 82% for those with and without lymph node involvement.

Journal ArticleDOI
15 Feb 1981-Cancer
TL;DR: Patients in Group 3 deteriorated faster than patients in Groups 1 and 2, and Bleomycin had no positive or negative influence on survival.
Abstract: In a controlled, prospective, randomized investigation, started in 1974, 118 patients with supratentorial astrocytoma Grade III--IV were divided into three groups. Groups 1 and 2 received 45 Gy postoperatively to the whole supratentorial brain. Bleomycin in 15-mg doses and a total dose of 180 mg or placebo was given intravenously three times a week, one hour prior to radiotherapy, during weeks 1, 2, 4 and 5. Group 3 received conventional care but no radiotherapy or chemotherapy. Median survival rates of patients were 10.8 months in Groups 1 and 2, and 5.2 months in Groups 3, a statistically significant difference. With regard to performance, the patients in Group 3 deteriorated faster than patients in Groups 1 and 2. Bleomycin had no positive or negative influence on survival.

Journal ArticleDOI
15 May 1981-Cancer
TL;DR: Malignant schwannoma should be considered in the differential diagnosis of tumors developing in areas previously treated with radiation, as well as in the clinical course of both groups of patients, although local recurrence had a more ominous prognosis in patients with neurofibromatosis.
Abstract: One hundred and sixty-five cases of malignant schwannoma were reviewed. Sixty-five (40%) of the patients had evidence of disseminated neurofibromatosis. Patients with neurofibromatosis were younger, had malignant schwannomas that were centrally rather than peripherally located, and had a shorter five-year survival (23%) than patients with solitary malignant schwannomas (47%). Histologically, tumors developing in patients with neurofibromatosis had a collagenous appearance, while tumors in patients without neurofibromatosis were undifferentiated and highly cellular. The clinical course of both groups of patients tended to be that of multiple local recurrences, although local recurrence had a more ominous prognosis in patients with neurofibromatosis. Chemotherapy responses in all these patients were extremely poor; however, the results of adjuvant therapy after surgery appeared encouraging. Fourteen patients (8.5%) had a malignant schwannoma in an area of prior radiation therapy and died of disease a median of 14 months after diagnosis. Malignant schwannoma should be considered in the differential diagnosis of tumors developing in areas previously treated with radiation.

Journal ArticleDOI
01 Sep 1981-Cancer
TL;DR: This is the first immununohistochemical marker for prostate gland epithelium which does not represent prostatic acid phosphatase and is likely to be a diagnostic histologic marker for tumors of prostatic origin.
Abstract: Antiserum to a human prostate-specific antigen was raised in a rabbit and utilized by immunoperoxidase staining to evaluate its potential value as a diagnostic histologic marker for tumors of prostatic origin. All primary and metastatic prostatic malignancies reacted positively, whereas nonprostatic neoplasms did not stain with this procedure. This is the first immunohistochemical marker for prostate gland epithelium which does not represent prostatic acid phosphatase.

Journal ArticleDOI
01 Mar 1981-Cancer
TL;DR: The results of surgical treatment in 40 patients with a soft tissue sarcoma of the thigh were analyzed to determine the influence of the anatomic setting on the effectiveness of the procedure.
Abstract: The results of surgical treatment in 40 patients with a soft tissue sarcoma of the thigh were analyzed to determine the influence of the anatomic setting on the effectiveness of the procedure. The anatomic setting, based on functional anatomic compartments, was defined as either intra- or extracompartmental. The lesions were graded for aggressiveness as either high or low. The lesions were staged by biologic aggressiveness, anatomic setting, and metastases. The procedures, whether amputations or local resections, were classified by the relationship of the surgical margin to the pseudocapsule and reactive zone about the lesion as marginal, wide, or radical. Marginal procedures were done four times with two recurrences. Wide margins were achieved 12 times. When done for low grade lesions, there were no recurrences (0/2), but when done for high grade lesions, the recurrence rate was 30% (3/10). Radical margins were obtained 24 times. There was one recurrence after a radical procedure. Recurrence rates did not depend upon whether the procedure was a resection or amputation but upon the margin achieved. The anatomic setting of the lesion was intracompartmental in 13 cases and extracompartmental in 27. Not only were surgically adequate margins achieved more often for intracompartmental lesions (10/13) than for extracompartmental lesions (17/27), but there was a significant difference in the manner required to achieve an adequate margin. Although 9 of the 13 intracompartmental lesions were amenable to nonablative resection, only 3 of 27 extracompartmental lesions were resectable. The margin required for local control (wide vs. radical) was dictated by the biologic aggressiveness (grade) of the lesion. How the necessary margin was most satisfactorily achieved (resection vs. amputation) was determined by the anatomic setting (intra- vs. extracompartmental).

Journal ArticleDOI
Hiroshi Saitoh1
15 Sep 1981-Cancer
TL;DR: The number of metastatically involved organs is useful in analyzing the mode of metastasis, and a significant correlation was observed between metastases to the lung and those to the pulmonary and tracheal lymph nodes, but not between those toThe lung and Those to the retroperitoneal lymph node.
Abstract: Renal adenocarcinoma in 1451 autopsy cases was classified according to the number of organs involved in distant metastasis, and the mode of metastasis. In cases with single-organ metastasis, lung and lymph node involvement was low (32% and 12%, respectively), but increased as the number of metastatically involved organs increased. Frequency of metastases to the pancreas, heart, and intestine rapidly increased as the number of involved organs increased, while the incidence of metastasis to the brain remained unchanged, regardless of the number of organs involved. A significant correlation was observed between metastases to the lung and organs involved. A significant correlation was observed between metastases to the lung and those to the pulmonary and tracheal lymph nodes, but not between those to the lung and those to the retroperitoneal lymph nodes. While the frequency of metastases to the contralateral kidney and brain was significantly higher in cases with recurrence after nephrectomy than in those who did not undergo nephrectomies, the frequencies of metastases to other organs was similar in these two groups. The number of metastatically involved organs is useful in analyzing the mode of metastasis.

Journal ArticleDOI
01 Jan 1981-Cancer
TL;DR: Cutaneous leiomyosarcomas have a relatively benign biologic course and may be excised conservatively, but are less likely to recur if the local excision is wide enough to require a skin graft for closure of the surgical defect.
Abstract: In a study of 65 primary cutaneous leiomyosarcomas and 15 primary superficial subcutaneous leiomyosarcomas, tumors occurred at any age but were more common in middle age and most common on the extremities. They developed as solitary painful or tender intracutaneous or subcutaneous nodules. Microscopically, the cutaneous leiomyosarcomas consist of a poorly delineated proliferation of spindle-shaped atypical myomatous cells arranged in interlacing fascicles which merge into collagenous stroma. Subcutaneous leiomyosarcomas are more sharply circumscribed and typically include a vascular pattern. About 40% of the cutaneous leiomyosarcomas recurred, but none metastasized despite a high mitotic frequency and marked cytologic atypia. Among the 12 patients with subcutaneous leiomyosarcomas, one-half of the tumors recurred and one-third eventuated in metastasis or tumor-related death. Cutaneous leiomyosarcomas have a relatively benign biologic course and may be excised conservatively, but are less likely to recur if the local excision is wide enough to require a skin graft for closure of the surgical defect. For primary subcutaneous leiomyosarcoma, early wide local excision with adequate clear histologic borders constitutes rational treatment.

Journal ArticleDOI
01 Aug 1981-Cancer
TL;DR: Findings indicate that a human intercalated duct cell line carrying tumorigenicity is established from a human submandibular salivary gland with an exposure to irradiation.
Abstract: Transformed epithelial cells were isolated by using tissue culture techniques from an irradiated human submandibular salivary gland which showed no neoplastic lesion. These cells, carrying colony-forming ability in semisolid agar, formed a semiconfluent monolayer with occasional tubular arrangement. All transformed clones were demonstrated by electron microscopic examination to be only one type of cells having fine structure similar to intercalated duct cells. Of six clones isolated, one clone with stable growth was cultured within the sponge matrix, resulting in formation of duct-like structure with mucinous eosinophilic substance. Moreover, inoculation of the cloned cells into nude mice resulted in a production of adenocarcinoma with solid and trabecular pattern. These findings indicate that a human intercalated duct cell line carrying tumorigenicity is established from a human submandibular salivary gland with an exposure to irradiation.

Journal ArticleDOI
01 May 1981-Cancer
TL;DR: Recent experience with T‐9 CT has demonstrated that CT given prior to RT or surgery can cause a great reduction in the size of the primary tumor while allowing the pathologicallyeroded bone to heal prior to the initiation of RT; this also allows the high‐risk patient with an axial primary to tolerate the aggressive CT needed to prevent distant metastases.
Abstract: Since May 1970, 67 consecutive patients with primary (nonmetastatic) Ewing's sarcoma were treated with adjuvant chemotherapy (CT) in addition to radiation therapy (RT) or surgery for the primary tumor. The first 19 patients were treated with four-drug sequential CT (T-2). The second protocol was a seven-drug induction combination CT (T-6) followed by T-2 maintenance CT; in both protocols CT was continued for 18 months. The current protocol (T-9) consists of combination CT given continuously for a period of 9 months. Of the entire group of 67 patients, 47 (70%) had axial and proximal lesions (pelvis, spine, rib, humerus, and femur) and 20 (30%) had distal lesions (forearm, leg, and foot); 53/67 (79%) are surviving free of disease 12--118 months (median 41 months) from the start of treatment. Fifteen of 23 (65%) patients with axial lesions, 19/24 (79%) patients with proximal lesions, and 19/20 (95%) patients with distal lesions are free of disease. Disease-free survivors include 28/39 (72%) male patients and 25/28 (89%) female patients. Thirty-four patients had RT, and 33 had surgery or surgery and RT, in addition to chemotherapy, for local treatment. The disease-free survival rate was 76% in the RT group and 82% in the surgery group; failure in the RT group was attributable to local recurrence in 7/34 (21%) patients. Recent experience with T-9 CT has demonstrated that CT given prior to RT or surgery can cause a great reduction in the size of the primary tumor while allowing the pathologically-eroded bone to heal prior to the initiation of RT; this also allows the high-risk patient with an axial primary (pelvis or spine) to tolerate the aggressive CT needed to prevent distant metastases. In addition to dramatically increasing survival in patients with Ewing's sarcoma, combination CT has helped achieve permanent local control. The superior survival rates for all sites of primary tumor are attributable to the early use of aggressive combination CT.

Journal ArticleDOI
15 Dec 1981-Cancer
TL;DR: The authors estimated cancer risk among 579 patients hospitalized with Crohn's disease between 1960–1976 by calculating the ratios of observed number of cancers (O) in the hospital sample to the expected number of cancer rates (E) based on the age‐ and sex‐specific cancer rates of a standard population.
Abstract: The authors estimated cancer risk among 589 patients hospitalized with Crohn's disease between 1960-1976 by calculating the ratios of observed number of cancers (O) in our hospital sample to the expected number of cancers (E) based on the age- and sex-specific cancer rates of a standard population. The authors then compared these O/E ratios with the O/E ratios similarly calculated among 267 patients hospitalized with ulcerative colitis. The risk of colorectal cancer was significantly increased in Crohn's disease (O/E = 6.9, P less than 0.001). This increase was similar in magnitude to that found in left-sided ulcerative colitis (O/E = 8.6, P less than 0.001) but was much less than that found in universal ulcerative colitis (O/E = 26.5, P less than 0.001). The incidence of small bowel cancer was greatly increased in the combined group of regional enteritis and ileocolitis (O/E = 85.8, P less than 0.001), and even more so in the regional enteritis group alone (O/E = 114.5, P less than 0.001). The incidence of extraintestinal cancer did not increase in any of the patient groups.

Journal ArticleDOI
01 Jan 1981-Cancer
TL;DR: No difference was found in either in the length of disease‐free or overall survival in the two series of patients, and in no subgroups was a statistically significant difference found.
Abstract: From January 1964 to January 1968, 737 patients with breast cancer were randomized at the Cancer Institute in Milan to undergo either Halsted mastectomy or Halsted mastectomy with internal mammary node dissection; 716 were considered evaluable. The series was part of an international cooperative study. The two groups of patients were comparable in age, menopausal status, quadrant distribution, and frequency of axillary metastases. No patients received postoperative radiotherapy or adjuvant treatments. At ten years, no difference was found in either in the length of disease-free or overall survival in the two series. The overall survival was 60.7% in patients treated with Halsted mastectomy and 57.0% in patients treated with Halsted mastectomy plus internal mammary dissection. In no subgroups was a statistically significant difference found. In the series treated by extended mastectomy, the incidence of internal mammary metastases was 20.5% (24.6% in cases with tumor in medial or central quadrants and 17.7% in cases with tumor in lateral quadrants). The follow-up of the patients treated by Halsted mastectomy showed that only 15 had a parasternal recurrence; the expected number was 75. In nine patients, parasternal recurrences were the first site of relapse of the disease. All of them were treated with radiotherapy, and in four a complete control was obtained.

Journal ArticleDOI
15 Aug 1981-Cancer
TL;DR: Cis‐platinum appears to be a highly active agent in the treatment of squamous cell carcinoma of the cervix at the dose and schedule tested.
Abstract: Thirty-four patients with advanced or recurrent squamous cell carcinoma of the cervix no longer amenable to control with surgery and/or radiotherapy were treated with cis-platinum 50 mg/m2 intravenously every three weeks. Among 22 patients who had received no prior chemotherapy, three complete and eight partial responses were observed (response rate 50%), whereas only two partial responses were observed among 12 patients who had received prior chemotherapy (response rate 17%). The observed response rate was marginally significantly higher among those with no prior chemotherapy (p = 0.059). The overall frequency of response was 38% (13/34). Responses were observed in those with pelvic (7/20) as well as extrapelvic disease (6/14). Adverse effects included primarily leukopenia (11/34), thrombocytopenia (13/34), nausea and vomiting (29/34), and azotemia (17/34). Adverse effects were generally mild to moderate and hence tolerable. Cis-platinum thus appears to be a highly active agent in the treatment of squamous cell carcinoma of the cervix at the dose and schedule tested.

Journal ArticleDOI
15 Dec 1981-Cancer
TL;DR: The limited tendency to distant spread in schistosomal bladder cancer, despite its advanced local stage, is accounted for by the high frequency of low grade tumors rather than the limiting effect of local schistsosomal tissue reactions.
Abstract: In a series of 1095 Egyptian patients with carcinoma of the bladder treated by radical cystectomy, 902 cases (82.4%) contained schistosome eggs in the specimens, and 193 (17.6%) were egg-negative. The different tumor parameters were compared in these subgroups to explore any differences that could be related to schistosomal infestation. In egg-positive cases, the tumor developed at a younger age (46.7 years) than in egg-negative cases (53.2 years). Squamous cell carcinoma, commonly of low grade, predominated in the egg-positive group. No difference was observed in the frequency of tumor stages or lymph node metastases between the two subgroups. The limited tendency to distant spread in schistosomal bladder cancer, despite its advanced local stage, is accounted for by the high frequency of low grade tumors rather than the limiting effect of local schistosomal tissue reactions.

Journal ArticleDOI
01 Aug 1981-Cancer
TL;DR: It is concluded that solitary myeloma and multipleMyeloma are clearly different clinical entities; however, most patients with solitary Myeloma do eventually have multiple myelomas.
Abstract: Within plasma cell disorders, solitary myeloma is rare as compared with multiple myeloma. In order to evaluate their relationship, the clinical findings for 114 patients with solitary myeloma were compared with those for 70 patients having classic multiple myeloma. The period of follow up ranged from a few weeks to twenty-four years, and 68.5% of those with solitary myeloma alive at ten years. Although only 23% of patients with solitary myeloma had local or widespread recurrence after two years, at ten years 85% had experienced disease progression. Comparison of the 85% with disease progression with patients with multiple myeloma revealed that solitary myeloma occurred at a younger age (mean 52.1 years), more frequently in men (60.5%), less commonly with initial spinal involvement (61.8%), but more commonly with neurologic problems associated with spinal involvement (25%), and that much more commonly, no monoclonal component was detectable in serum and/or urine at the time of initial diagnosis (82.5%). There were only two significant differences between those patients with (85%) and without (15%) progression at ten years; the patients were younger (mean, 45.7 years) and spinal involvement (26.7%). However, was less common among patients without progression, and component monoclonal always disappeared following treatment with surgery and/or radiation therapy. It is thus concluded that solitary myeloma and multiple myeloma are clearly different clinical entities; however, most patients with solitary myeloma do eventually have multiple myeloma.

Journal ArticleDOI
01 Aug 1981-Cancer
TL;DR: The authors studied 51 patients who had small bowel tumors that contained adenomatous epithelium, finding that adenomas originating in the small bowel mucosa probably are premalignant lesions and that many primary adenocarcinomas of the small intestine arise inAdenomas.
Abstract: The authors studied 51 patients who had small bowel tumors that contained adenomatous epithelium. These rare lesions were identified among 392,000 surgical pathology cases seen during a 62-year period. Grossly and histologically, adenomas arising in the mucosa of the small intestine are similar to the adenomas found in the colon. Of the 51 patients, 18 had adenomas, and 33 had tumors that contained both adenoma and carcinoma in the same lesion, including five intramucosal and 28 invasive carcinomas. The location of the tumor usually determined which clinical problems were produced. The data indicate that adenomas originating in the small bowel mucosa probably are premalignant lesions and that many primary adenocarcinomas of the small intestine arise in adenomas. Of the authors' 130 apparently primary small bowel carcinomas (including the papilla of Vater), 33 (25%) histologically demonstrated adenomatous epithelium in the same lesion. Factors associated with an increased chance of finding carcinoma in an adenoma include adenoma type, size of lesion, location, and multicentricity. Carcinomas appear to develop more frequently in papillary (villous) adenomas than in ordinary adenomas. The larger the lesion is, the more likely carcinoma will be identified. Adenomas involving the ampulla contain carcinoma more often than do lesions found elsewhere in the duodenum and small intestine. Three patients had multiple adenomatous polyps of the small bowel; two of these individuals also had duodenal carcinomas. Various problems in pathologic diagnosis and clinical management are discussed.

Journal ArticleDOI
15 Apr 1981-Cancer
TL;DR: The most important risk factor for the development of osteonecrosis was the radiation dose to bone, particularly in the less vascular mandible, and the risk was significantly greater when teeth were removed after therapy compared with those individuals with extractions before radiation or no extractions at all.
Abstract: One hundred patients irradiated for cancers of the oral cavity, oropharynx, and nasopharynx were evaluated for the occurrence of osteonecrosis and associated predisposing factors. Selection was based on availability of complete dental records, a minimum of six months follow-up, and treatment fields, which included maxilla and/or mandible. Bone doses were calculated by using radiotherapy treatment records, port films, and isodose distributions. Osteonecrosis developed in 19 of 78 dentulous patients and in 3 of 22 edentulous patients. The time of development of osteonecrosis varied; in 15 cases osteonecrosis occurred more than one year after treatment. The most important risk factor for the development of osteonecrosis was the radiation dose to bone, particularly in the less vascular mandible. Osteonecrosis 7500 rads to the bone. None of the patients who received less than 6500 rads developed osteonecrosis. The risk was significantly greater when teeth were removed after therapy compared with those individuals with extractions before radiation or no extractions at all.

Journal ArticleDOI
15 Mar 1981-Cancer
TL;DR: A clinicopathologic staging method for colorectal carcinoma was applied prospectively to 503 patients treated by surgical resection and formed an improved guide to prognosis when compared with the original Dukes' method.
Abstract: A clinicopathologic staging method for colorectal carcinoma was applied prospectively to 503 patients treated by surgical resection over a period of 7 1/2 years. The method grouped separately those patients known to be incurable at the time of resection and allowed for an anatomically precise definition of the extent of tumor spread. Survival studies showed that prognosis did not significantly deteriorate with spread of tumor beyond the bowel wall unless there were demonstrable metastases, infiltration of a free serosal surface, or if local resection was incomplete. Highly significant decrements in survival occurred when lymph node metastases were demonstrable and when unresected tumor was known to be present. The staging system from which these observations were made formed an improved guide to prognosis when compared with the original Dukes' method. Patients with histologically high-grade tumors had a poorer survival rate than those with low or average tumors with the same extent of spread.

Journal ArticleDOI
15 Sep 1981-Cancer
TL;DR: The clinical and pathological features of patients with ILL suggest that this entity is closely related to PDLL and should be distinguished from WDLL.
Abstract: A clinicopathologic analysis of 42 cases of non-Hodgkin's lymphoma of the intermediate lymphocytic type (ILL) having morphologic features between those of well-differentiated (WDLL) and poorly differentiated lymphocytic lymphoma (PDLL) is presented. In lymph node sections, ILL was characterized by a diffuse proliferation consisting predominantly of small lymphoid cells with slightly irregular or indented nuclei. A mixture of lymphoid cells with entirely round nuclei and lymphoid cells with angulated and cleaved nuclei was also present, but each of these two cell populations did not comprise more than 30% of the total. The median age of the patients was 65 years, and the male-to-female ratio was 5:1. Generalized lymphadenopathy was evident in 74% of the patients, and B symptoms were presented in 36%. Peripheral blood involvement was present at the onset of disease in 21% of the patients, and the bone marrow was involved by lymphoma in 76% of those examined. Five percent of the patients had Stage I disease, 24% had Stage III disease, and 71% had Stage IV disease. Ninety-three percent of the patients received multiagent chemotherapy and 41% achieved a complete remission. The overall median survival was 31 months. Clinical features which appeared to influence survival adversely included the presence of B symptoms (P = 0.007), age greater than 70 years (P = 0.09), an absolute lymphocyte count above 5000/mm3 (P = 0.05), and anemia (P = 0.09). Achievement of a complete remission influenced survival favorably (P = 0.02). Pathologic features which appeared to influence survival included sinus obliteration, which had an adverse effect (P = 0.05), and the presence of residual germinal centers which had a favorable effect (P = 0.06). Patients with 0-5 mitoses/10 high power fields (HPF) had a significantly longer survival than those with more than 20 mitoses/10 HPF (P = 0.02), while those with 6-20 mitoses/10 HPF had an intermediate survival. The clinical and pathological features of patients with ILL suggest that this entity is closely related to PDLL and should be distinguished from WDLL.