Showing papers in "Cancer in 1986"

Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases.

Abstract: A review was done of 120 cases of malignant peripheral nerve sheath tumor (MPNST) seen during a 71-year period. Of the 120 patients, 52 were males and 68 were females with a mean age at diagnosis of 35.3 years; 12 patients were younger than 20 years. The series included 62 (52%) patients with neurofibromatosis, 13 (11%) with postradiation sarcomas, and 19 (16%) with metaplastic foci. The incidence of MPNST arising in neurofibromatosis was 4.6% in the current series and 0.001% in the general clinic population. Tumors greater than 5 cm and the presence of neurofibromatosis adversely affected the prognosis (P less than 0.05). When both features were present, survival was greatly decreased. Patients with tumor in the extremities did better than those with head or neck lesions. Metaplastic foci or previous radiation at the tumor site did not alter the prognosis. Each tumor was graded 1 to 4 on the basis of cellularity, pleomorphism, mitotic index, and necrosis. No significant correlation was noted between survival and either grade or mitotic rate. Survival was improved when total rather than subtotal resection was done. This was most marked in patients with a small lesion, which may reflect the difficulty in adequately excising large tumors. Adjuvant radiation or chemotherapy did not appear to affect survival. The MPNST is an aggressive uncommon neoplasm, and large tumor size, the presence of neurofibromatosis, and total resection are the most important prognostic indicators.

Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). I. Intraductal carcinoma (DCIS).

Abstract: Seventy-eight examples of intraductal carcinoma (DCIS) were identified after pathologic review of 2072 specimens obtained from National Surgical Adjuvant Breast Project protocol 6. This randomized clinical trial compares the therapeutic merit of total mastectomy (TM) with lumpectomy (L), with (LX) and without (LO) postoperative irradiation. All patients were subjected to axillary lymph node dissection. Seven (14%) of the 51 patients with DCIS treated by L exhibited breast recurrence within or close to the site of the initial lesion 4 to 53 months (average, 16 months) after L. Only 2 (7%) of these events occurred in the 29 women treated by LX, as opposed to 23% in the LO group. No pathologic features were noticed that might have been considered predictive of local breast recurrence. The three DCIS recurrences and the four invasive forms noted are considered to represent overlooked or incompletely excised foci of cancer because of the multifocality (not multicentricity) of some breast cancers. The possibility that DCIS may represent a marker of risk for the development of cancer rather than a precursor lesion per se is suggested. Despite apparent difficulties in the pathologic diagnosis of DCIS as well as uncertainty concerning its natural history, no evidence was found to indicate that it represents a more ominous disease than invasive cancer. Indeed, treatment failure occurred in only one patient treated by LX and a similar number subjected to TM (4% versus 2%). Although these observations are short term (average follow-up, 39 months), estimates of the probability of local recurrence or survival suggest that they will not be significantly altered after longer periods of surveillance. Thus, there are no compelling reasons why DCIS may not be treated in a cosmetically acceptable manner by LX. A randomized clinical trial addressing this issue is now in progress.

Cancer incidence, survival, and mortality for children younger than age 15 years

Abstract: Incidence and survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program for the 10-year period 1973-1982 are presented. Childhood cancer incidence rates have remained relatively stable over the last decade. The overall incidence rate increased slightly from 124 to 127 per million children from 1973-1977 to 1978-1982 while rates for leukemias remained unchanged over this same time period at 38 per million for all races combined. Leukemias and lymphomas accounted for 44% of all cancers among white children and 33% among blacks. For all forms of cancer combined, the 5-year relative survival rate was 57% for both whites and blacks. The 5-year relative survival rate exceeded 80% for fibrosarcomas, retinoblastomas, Hodgkin's disease, and gonadal and germ cell tumors. Survival rates for children have shown improvement during the last decade, the most dramatic improvements occurring among patients with leukemia (15% 5-year relative survival in 1967-1973 versus 51% in 1973-1981), non-Hodgkin's lymphoma (24% versus 51%), and bone tumors (28% versus 48%).

International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption

Abstract: The 1978-1979 mortality rates for cancers of the breast, prostate, ovary, and colon in 26 to 30 countries were related to the average 1979-1981 food availability data published by the United Nations. The previously described relationship between breast cancer mortality rates and animal fat consumption continues to be evident, and applies also to the other three tumor types. The correlation with breast cancer was particularly strong in postmenopausal women. Since 1964, particularly notable increases in both breast cancer mortality rate and dietary fat intake have occurred in those countries with a relatively low breast cancer risk. The international comparisons support evidence from animal experiments that diets in which olive oil is a major source of fat are associated with reduced breast cancer risk. The excess in mortality rates for breast and ovarian cancer in Israel relative to the national animal fat consumption may be due to the mixed ethnic origin of the Israeli population. Positive correlations between foods and cancer mortality rates were particularly strong in the case of meats and milk for breast cancer, milk for prostate and ovarian cancer, and meats for colon cancer. All four tumor types showed a negative correlation with cereal intake, which was particularly strong in the case of prostate and ovarian cancer. Although, in general, there was a good positive correlation between prostate and breast cancer mortality rates and between prostate cancer and animal fat, discrepancies in national ranking indicate the operation of other etiologic factors that modify risk. The observed positive correlations between the four cancer mortality rates and caloric intake from animal sources, but negative correlations for vegetable-derived calories, suggest that, of the two, animal fat and not energy is the major dietary influence on cancer risk.

Reproducibility of a histopathologic grading system for adult soft tissue sarcoma.

Abstract: Tumor grade has been proposed as an essential factor in the staging of patients with soft tissue sarcomas. In a previous study, a histopathologic grading system using the evaluation of tumor differentiation, mitosis count, and tumor necrosis was described. The current study was conducted to test its reproducibility. The pathologic sections of 25 soft tissue sarcomas were submitted to a study group composed of 15 pathologists who had not been involved in the development of the grading system. The results were compared with those of a panel group. The crude proportion in agreement observed between the study group and the panel group was 81% for the evaluation of tumor necrosis, 74% for tumor differentiation, and 73% for the mitosis count. The crude proportion in agreement for the tumor grade was 75%, which was significantly better than the crude agreement rate of 61% for the diagnosis of histologic type (P = 0.001). A kappa statistical analysis, to check the possibility of chance-related concordance, showed a proportion in agreement of 68%. A two-way variance analysis showed that the homogeneity of the evaluation of tumor grade is impaired by tumor-related and observer-related factors. However, an improvement may be obtained by better training of pathologists. We conclude that the tumor grading system developed inside the French Federation of Cancer Centers, although perfectible, already provides reliable prognostic information and its use in prospective clinical studies may provide more information about its clinical usefulness.

Granulocytic sarcoma in nonleukemic patients.

Abstract: Sixteen patients presenting with granulocytic sarcoma without evidence of acute leukemia were seen and diagnosed at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston from 1962 to 1985. Seven of them (44%) did not develop acute leukemia. Of these seven, four are alive with no evidence of disease 3.5 to 16 years after initial presentation; the remaining three patients died of their disease within 2 to 8 months of presentation. Two of 16 patients were diagnosed within the last 15 months and do not have adequate follow-up. The seven remaining patients developed acute leukemia within 1 week to 13 months of the diagnosis of granulocytic sarcoma. Six of them died 5 weeks to 16 months after diagnosis; one patient has been in complete remission for 8 years. Twelve of these 16 cases (75%) were initially misdiagnosed, most frequently as large cell lymphoma. The remaining four cases were correctly diagnosed as granulocytic sarcoma. The naphthol-ASD-chloroacetate esterase stain was required to make the correct diagnosis in all cases. Contrary to findings in other series, granulocytic sarcoma arising in nonleukemic patients does not necessarily progress to acute leukemia. At least four of 16 (25%) patients in this series did not develop acute leukemia during the 3.5 to 16 years they have been followed. No prognostic factors were identified in this series to predict which patients would develop acute leukemia and which ones would not.

Pathologic findings from the national surgical adjuvant breast project (protocol 6). Relation of local breast recurrence to multicentricity

Abstract: One hundred ten local breast recurrences were observed in 1108 pathologically evaluable patients enrolled in NSABP protocol 6 who were treated by lumpectomy and followed for 5 to 95 months (average, 39 months). Eighty-six percent and 95% of all local breast recurrences were noted within 4 and 5 years, respectively, following lumpectomy. Life table analysis revealed their incidence to be 24% for those not and 6% for those receiving lumpectomy and breast irradiation. One hundred four (95%) of the breast recurrences involved the mammary parenchyma and the remaining 6 (5%) involved the skin and/or nipple only. Eleven (10%) of the former were noninvasive. The most common (86%) presentation of breast recurrence appeared to be a localized mass within or close to the quadrant of the index cancer. In 14% the recurrence not only involved the same quadrant, but was more diffuse within the breast extending to remote areas as well. This type was characterized pathologically by marked intralymphatic extension as well as involvement of the overlying skin and/or nipple after the fashion of so-called inflammatory or occult inflammatory breast cancer. The recurrences noted in the skin and/or nipple only were also pathologically characterized by intralymphatic involvement at these sites in the majority of instances. These two forms of breast recurrences appear to reflect the localized growth of highly aggressive invasive breast cancers. The concordance of histologic types and grades of the index and recurrent cancers implies that such events represent growth of overlooked tumor, a deficiency attendant with lumpectomy due to the extreme multifocal nature (not multicentricity) of some breast cancers and/or inadequacies in evaluating the lines of resection of lumpectomy specimens. Sources of error in regard to this latter are identified and guidelines for the examination of such specimens, as well as the assessment of margins, are presented. The observation that local breast recurrences noted following lumpectomy occurred within or close to the same quadrant as the index cancer, despite the presence of multicentric noninvasive cancers in 10% of the patients treated by total mastectomy, minimizes the biological and clinical significance of multicentric foci of cancer present in some breast cancers. Cancer measuring greater than or equal to 2.0 cm, having high histologic and nuclear grades, or intralymphatic extension, were found to have a statistically significant association with local breast recurrence in all patients following lumpectomy. A converse relationship was noted with tubular and scar cancers of types 1 and 4.(ABSTRACT TRUNCATED AT 400 WORDS)

Mesenchymal chondrosarcoma of bone and soft tissue. a review of 111 cases

Abstract: A series of 111 mesenchymal chondrosarcomas was reviewed. The ages of the patients ranged from 5 to 74 years, and approximately 60% of them were in the second and third decades of life. There was no significant sex predilection. Seventy-two tumors, including 5 that involved multiple skeletal sites, arose in bone. Thirty-eight tumors were found in extraskeletal sites. At initial diagnosis, multifocal involvement, both in bone and in soft tissue, was observed in one case. Roentgenographically, the lesions in bone frequently resembled ordinary chondrosarcomas, showing osteolytic and destructive appearances with stippled calcification. Tumors in extraskeletal sites were almost always identified as calcified masses. Histologically, a combination of cellular zones composed of undifferentiated small cells and chondroid zones typically presented a bimorphic appearance that was virtually pathognomonic in most cases. Ablative surgical treatment seemed to be the procedure of choice. The value of irradiation or chemotherapy (or both) was difficult to assess in the current study. Prognosis for patients with mesenchymal chondrosarcoma is usually poor, and long-term follow-up is necessary. In a group of 23 patients from the Mayo Clinic, the 5-year survival rate was 54.6% and the 10-year survival rate was 27.3%. Cancer 57:2444–2453, 1986.

Clinical effects and toxicity of interleukin-2 in patients with cancer

Abstract: Interleukin-2 (IL-2) is a 15,000 dalton glycoprotein produced naturally by human T-cells during an immune response. IL-2 has been demonstrated to have substantial activity alone or in combination with the adoptive transfer of lymphokine-activated killer cells in murine tumor models. IL-2 derived from both natural (Jurkat human T-cell tumor) and recombinant (Escherichia coli) sources has been studied in Phase I protocols designed to evaluate toxicity in patients with a variety of solid tumors and to ascertain improvement in clinical parameters and immunologic status. A total of 16 patients (7 with acquired immune deficiency syndrome [AIDS] and 9 with non-AIDS malignancies) were treated with Jurkat derived IL-2. The total maximum dose (1.3 X 10(5) U/kg) was limited only by supply of this reagent. A total of 25 patients have been treated with recombinant IL-2 (RIL-2) alone. Dose-limiting toxicity manifested by marked malaise and weight gain was achieved with doses of RIL-2 of 10(6) U/kg as a single bolus or 3000 U/kg/hr. IL-2 could be administered intraperitoneally with similar toxicity. Minimal renal or hepatic toxicity was demonstrated. Hematologic toxicity was limited to mild anemia (25/25), thrombocytopenia (10/25), and marked reversible eosinophilia (15/25). Pronounced weight gain greater than 2 kg (16/25) occurred in most patients, primarily those who received cumulative doses of greater than 1-3 X 10(5) U/kg of IL-2. The weight gain amounted to as much as 10% to 20% of the pretreatment weight over 3 weeks of treatment and limited our ability to give higher doses. Two partial responses (greater than 50% decrease in cross sectional diameters) were seen in two patients with melanoma metastatic to the lung.

Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases.

Abstract: There is a 100-fold increase in the incidence of carcinomas of the vulva and anus in renal transplant recipients compared with the general population. Anogenital (anus, perianal skin, and external genitalia of both sexes) carcinomas occurred in 65 of 2150 renal transplant recipients who presented with 2298 different types of malignancy. Two-thirds of the patients were female and one-third male. They were much younger than persons with similar tumors in the general population. The average age of the females at the time of diagnosis was 37 years (range, 20–64) and of the males, 45 years (range, 34–62). The neoplasms occurred late after transplantation, an average of 88 months (range, 9–215), compared with an average of 56 months (range, 1–225.5) for all other post-transplant malignancies. The lesions involved the vulva, penis, scrotum, anus, or perianal area. Two patients also had involvement of the urethral meatus. In several female patients, there was a “field effect” with multiple tumors of the squamous epithelium of the anogenital area, vagina, or uterine cervix. Lesions ranged from in situ carcinomas (in one-third of the cases) to those with invasion of adjacent organs and lymph node metastases. Treatment varied from local excisions to radical vulvectomy, abdominoperineal resection, or penile resection, sometimes combined with excision of the inguinal lymph nodes. In several patients, there was a previous history either of condyloma acuminatum or herpes genitalis, suggesting a possible viral etiology of these tumors. Cancer 58:611-616, 1986.

Malignant lymphoma of bone

Abstract: A total of 422 patients with malignant lymphoma of bone who were seen at the Mayo Clinic from 1907 through 1982 were placed into four major groups based on stage of disease. There was one group with primary lymphoma of bone, one group with multifocal osseous lymphoma, and two groups with lymphoma of bone and nodal or soft tissue (or both) disease. The last-mentioned two groups were separated on the basis of time of onset of osseous lymphoma in relation to the nonosseous disease. The stage of disease was the single most important prognostic indicator of overall survival in malignant lymphoma of bone. The 5- and 10-year survival rates were, respectively, 58% and 53% for patients with primary bone lymphoma, 22% and 12.5% for patients with bone and nodal or soft tissue (or both) disease, and 42% and 35% for patients with multifocal osseous disease. Features having no significant prognostic value were sex of the patient, histologic grade of the lymphoma (according to the Working Formulation and the Kiel system), and presence of T-cell features or cleaved cells (or both). This study is not able to adequately address efficacy of treatment. In fact, treatment may be very important in outcome.

Differential effects of tobacco and alcohol in cancer of the larynx, pharynx, and mouth

Abstract: Two thousand five hundred forty male patients with cancer of larynx, pharynx, and mouth were examined in the same hospital between 1975 and 1982. Different sites were compared according to alcohol and tobacco consumption: oropharynx, hypopharynx, larynx supraglottis, larynxglottis, epilarynx, lip, tongue-tip, and tongue lateral border, other tongue sites, gum, floor of the mouth, and buccal mucosa. For tobacco, the mean daily consumption of smokers and exsmokers did not differ according to location (except in patients with cancer of the lip, in whom the consumption was lowest). Cancer locations differed significantly according to the daily alcohol consumption. The consumption was the lowest for patients with cancer of the lips and the glottis, the highest for patients with cancer of the epilarynx, hypopharynx, and the floor of the mouth. Significant differences were observed in the percentage of nonsmokers or nondrinkers, even between adjacent locations: supraglottis versus glottis; tongue, tip, and lateral border versus tongue, other sites; floor of the mouth versus buccal mucosa. Some of the results might be particular to elements of the French life-style (e.g., consumption of brown tobacco, high consumption of wine).

Giant cell tumor of the tendon sheath (nodular tenosynovitis). A study of 207 cases to compare the large joint group with the common digit group.

Abstract: Clinicopathologic, enzyme histochemical, and electron microscopic findings in 207 cases (208 lesions) of giant cell tumor of tendon sheath (GCTTS) are presented. The GCTTS could be divided into two groups according to the anatomic location, the first occurring in the digits (digit group, 182 cases) and the second, in the larger joints (large joint group, 25 cases). In the majority of cases of the digit group, the tumor occurred in one of the fingers (158 cases), whereas in the large joint group, the tumor was common in the ankle (10 cases) and knee joints (8 cases). The lesion was more common in women (67%) than in men (33%). Microscopically, the GCTTS in both groups consisted of a mixture of abundant histiocyte-like, foam, and multinucleated giant cells of the osteoclast type. However, worthy of special mention were the large clefts or wide pseudoglandular spaces lined by synovial cells and that were more striking in the large joint group than in the conventional digit group. The component cells had functional properties of macrophages, as determined in the enzyme histochemical study. Electron microscopically, the tumors consisted essentially of histiocyte-like, fibroblast-like, and intermediate cells, together with myofibroblasts.

Lung cancer detection. Results of a randomized prospective study in Czechoslovakia.

Abstract: A randomized prospective study of lung cancer detection was begun in 1976 to evaluate semiannual screening by radiologic and sputum cytologic study in comparison to screening at a 3-year interval, and to no screening. In a high-risk population of 6364 men (aged 40 to 64 years), the initial prevalence of lung cancer was 0.28% (18 cases), the annual incidence was 0.35% per year (66 cases during 3 years), the proportion of Stage I cases was 31% (26/84), and Stage II was 17% (14/84), "curative" resections were 27% (23/84), and 5-year survival was 23% (19/84). The study confirmed the ability of radiologic screening to detect lung cancer at an earlier stage when treatment by resection can be accomplished. The fate of a high-risk population submitted to screening was better than that of a population with no screening where lung cancer was discovered by symptoms, accidental x-rays, or at autopsy. A matter of lesser importance was the frequency of screening. The absolute numbers of 5-year survivors detected by screening were practically the same for either compared screening frequency.

Psychosocial benefits of a cancer support group.

Abstract: Many clinicians use group support to reduce the psychosocial difficulties of persons with cancer. This study compared the long-term benefits of a thematic counseling model used both as a structure for group support and for counseling patients individually. The thematic model included eight counseling sessions focused on information about cancer and positive health strategies such as progressive relaxation, diet, and exercise. The psychosocial status of women newly diagnosed with gynecologic cancer was assessed before the counseling, immediately after counseling, and again 6 months later. The women who participated in thematic counseling were significantly less depressed and less anxious and had more knowledge of their illness, better relationships with care givers, fewer sexual difficulties, and more participation in leisure activities. Data confirmed the model to be equally helpful whether it was used as a structure for individual counseling or more cost-effective group counseling. This model is easily adaptable to the needs of persons with other forms of cancer.

A randomized trial of cyclophosphamide and doxorubicin with or without cisplatin in advanced ovarian carcinoma. A Gynecologic Oncology Group Study.

Abstract: A randomized clinical trial was conducted in women with bulky (suboptimal) Stage III and Stage IV ovarian carcinoma, using doxorubicin (Adriamycin) and cyclophosphamide with or without cisplatin. There were 440 evaluable cases, of which 227 had measurable disease. One hundred twenty of these latter patients were treated with cyclophosphamide and doxorubicin (CA), while 107 received cyclophosphamide, doxorubicin and cisplatin (CAP). The clinical complete response (CR) rate for CA was 26% (31/120) compared with 51% (55/107) for CAP (P = less than 0.0001). Of 23 CRs receiving CA who had a second-look laparotomy, only four were negative; of 39 CRs receiving CAP and a second-look, 13 were negative (not statistically significant). The response duration for patients with measurable disease (median 14.6 versus 8.8 months), progression-free interval for all patients (13.1 versus 7.7 months), and survival for patients with measurable disease (19.7 versus 15.7 months) showed a statistically significant advantage for CAP; however, there was no difference in survival of patients with nonmeasurable disease. Toxicity was more severe with CAP but was tolerable. Thus, the addition of cisplatin improves the chemotherapy of advanced ovarian carcinoma.

Hepatoid adenocarcinomas of the stomach. An analysis of seven cases.

Abstract: Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. They usually produce large amounts of alpha-fetoprotein (AFP) with a Concanavalin A-binding property of hepatic type. In this study, these carcinomas occurred in older persons, with the antrum being a common site. Observed grossly, growth of the tumors was nodular and massive. Prognosis was poor because of frequent liver metastases. In the cytoplasms of tumor cells, various serum proteins were identified, including AFP, alpha-1 antitrypsin (AAT), alpha-1 antichymotrypsin (ACT), albumin, and prealbumin. Localizations of ferritin, prothrombin, and transferrin were demonstrated with less frequency. Adenocarcinomatous foci were composed of well-differentiated, intestinal-type epithelial cells and often contained carcinoembryonic antigen. These adenocarcinomatous and hepatoid areas were often intermingled with each other. There were extensive venous involvements by tumor cells. The poor prognosis of the tumors may be attributed to these involvements as well as to production of AFP and presence of AAT/ACT, which have immunosuppressive and protease-inhibitory properties, respectively.

High‐grade soft tissue sarcomas of the extremities

Abstract: From July 1975 to December 1982, 358 patients were referred to the Surgery Branch of the National Cancer Institute (NCI) with the diagnosis of soft tissue sarcoma of the extremities. Two hundred eleven of these patients presented with resectable, localized high-grade soft-tissue sarcomas and have been included in the present analysis of the management and outcome of patients with high-grade soft tissue sarcomas of the extremity treated at the NCI. One hundred forty-seven of these 211 patients have been included in randomized prospective trials. The remaining 64 patients in this analysis have been followed at the NCI, but were not included in randomized trials because of patient refusal or ineligibility. Tumor size was identified as a highly significant prognostic variable for disease-free and overall survival (P2 = 0.00001 and 0.0081, respectively). Tumor site, histologic type, and microscopic margins of resection were not significant prognostic variables. There was no difference between patients undergoing amputation compared to those undergoing limb-sparing procedures plus postoperative radiotherapy in disease-free or overall survival for all 211 patients in this study (P2 = 0.068 and 0.131, respectively). A significantly greater frequency of local failure among patients treated by local excision was noted compared to patients undergoing amputation (12/128 versus 0/83, P2 = 0.004), but this did not result in decreased overall survival in patients undergoing combined modality limb-sparing procedures. Adjuvant chemotherapy significantly prolonged disease-free survival (P2 = 0.005) for the 124/211 patients treated with adjuvant chemotherapy, although analysis of overall survival did not reveal a significant increase (P2 = 0.10). In a subset of 65 patients included in a prospective randomized trial evaluating the efficacy of adjuvant chemotherapy, a significant improvement in both disease-free (P2 = 0.033) and overall (P2 = 0.055) survival was seen in patients receiving chemotherapy. Sixty-five patients developed recurrent disease (65/211, 31%) and 42 of these patients were rendered disease-free surgically. Survival from the time of first recurrence was significantly prolonged among the 42 patients who were rendered disease-free (median survival, 31 months) compared to those who were not (median survival, 9 months, P2 less than 0.001).

Ewing's sarcoma of bone. Experience with 140 patients.

Abstract: The records of 140 patients with histologically verified Ewing's sarcoma of bone treated between 1969 and 1982 were studied retrospectively. Various factors thought to be relevant to prognosis were analyzed. Three statistically significant factors were found: presence of metastatic disease, elevation of the sedimentation rate, and location of the tumor in the pelvis. In addition, patients who underwent complete surgical excision of the primary lesion had a better survival rate (74% at 5 years) than those who did not (34% at 5 years). It is concluded that patients with surgically accessible lesions should undergo treatment consisting of surgery, chemotherapy, and, in selected cases, radiation.

Chemotherapy induces regression of brain metastases in breast carcinoma

Abstract: This study improves treatment options and ultimately survival by using systemic chemotherapy in brain metastases from breast carcinoma, since most of these patients have disseminated disease and a dismal prognosis when treated by conventional brain irradiation alone. One hundred consecutive patients with symptomatic brain metastases documented by radionuclide and/or computerized tomography scan were treated with systemic chemotherapy. Fifty of 100 patients demonstrated an objective response of brain metastases which was similar for extracranial metastases. There were 10 complete responders (CR), 40 partial responders (PR), 9 stable, and 41 nonresponders. Median duration of remission was 10+ months for CR and 7 months for PR (range, 2-72 months). Primary chemotherapy of brain metastases yielded responses in 27 of 52 patients (52%) treated with Cytoxan (cyclophosphamide) (C), 5-fluorouracil (F) and prednisone (P); 19 of 35 (54%) receiving CFP-methotrexate (M) and vincristine (V); 3 of 7 (43%) treated with MVP, and 1 of 6 (17%) receiving Cytoxan plus Adriamycin (doxorubicin) (CA). Thirteen of 35 patients (37%) who subsequently had relapse of brain metastases were retreated successfully with secondary chemotherapy. The median survival for CR and PR was 39.5 months and 10.5 months, respectively, in contrast with nonresponder patients who had a median survival of 1.5 months. Thirty-one percent of all treated patients survived more than 12 months. These findings suggest that the chemotherapeutic agents used penetrate the blood-brain barrier inducing regression of brain metastases. This approach offers a significant benefit by simultaneously controlling extracranial disease, improving the response and prolonging survival.

Adenoid cystic carcinoma of salivary glands. A study of 61 cases with clinicopathologic correlation.

Abstract: Sixty-one cases of adenoid cystic carcinoma of the head and neck region, excluding the ear canal, lacrimal glands, larynx, esophagus, and trachea, were studied, and their different clinicopathologic aspects were analyzed. Adenoid cystic carcinoma occurred more commonly in the minor salivary glands; the palate was affected in 31% of the cases. The fifth decade of life was the age at which patients were most commonly affected, and there was a slight predominance of white women. In most patients a mass was the main complaint; in 63% the duration of symptoms was 1 year or less. Forty-one patients had Stages 3 or 4 disease when first seen, and 51.7% of the patients died of disease, with a mean survival period of 35.4 months. Three basic patterns of growth, solid, cribriform, and tubular, were identified in the histopathologic examination of the cases. Other pathologic aspects analyzed were cellular pleomorphism, mitotic activity, necrosis, vascular invasion, and perineural infiltration. The study revealed a positive correlation between location of the tumor, clinical staging, duration of symptoms, and histologic pattern of growth with the prognosis of the lesion. Tumors located in the minor salivary glands, those in which the duration of symptoms was less than 1 year, and those that showed advanced clinical staging and a predominantly solid pattern of growth had an extremely poor prognosis. Surgery is the treatment of choice of adenoid cystic carcinoma, and microscopically free surgical lines of resection must be obtained. Radiation therapy, although not curative, plays an important role in prolonging survival.

Postoperative radiotherapy in Dukes' B and C carcinoma of the rectum and rectosigmoid: a randomized multicenter study

Abstract: Results obtained during the first 5 years of a randomized study of postoperative radiotherapy (50 Gy) are presented. Criteria for randomization were fulfilled in 494 of 861 patients with Dukes' B and C tumors, when the trial was closed. Severe complications from radiotherapy approximated 10%. Probability of survival without local failure within 24 months was significantly higher after radiotherapy in patients with Dukes' C tumors, and the time of local failure was delayed 1 year. Patients with Dukes' B tumors had no benefit from radiotherapy. Risks of distant metastases and death were not influenced by radiotherapy in the main groups. Plasma-CEA measurements were evaluated blindly, and radiotherapy changed the critical levels of CEA for detection of recurrent cancer. It was concluded that patients with Dukes' C tumors may benefit from radiotherapy and plasma-CEA levels are influenced by radiotherapy, which may be important, when these are used in screening for recurrent cancer.

Effects of vitamins C and E on N-nitroso compound formation, carcinogenesis, and cancer.

Abstract: The properties of N-nitroso compounds (NNC) and of vitamins C and E are briefly described. The author reviews the ability of vitamins C and E to inhibit NNC formation in chemical systems, in nitrite-preserved meat, in experimental animals and in humans. Dietary vitamins C and E both produced 30% to 60% inhibitions in most carcinogenesis experiments employing preformed carcinogens. Vitamin C reversed transformation in an in vitro system. Carcinogenicity tests of the vitamins are reviewed (vitamin C can promote bladder carcinogenesis). Intake of fresh fruits and vegetables (which contain vitamin C) is negatively correlated with cancer of the stomach, esophagus, larynx, mouth and cervix. For gastric and esophageal cancer, there is evidence that this association is due to an inhibition of in vivo NNC formation. Vitamin C is apparently not a useful treatment for cancer. The author supports the recommendation that fresh fruit and vegetable intake be increased to lower the risk of cancer.

Total parenteral nutrition and cancer clinical trials

Abstract: Twenty-eight prospective randomized controlled clinical trials evaluating the use of total parenteral nutrition (TPN) in cancer patients were identified through a search of major indexing sources. The data were pooled across studies to increase the ability to detect therapeutic effects. The impact of publication bias and the quality of reporting each trial were used to critically assess the conclusions drawn from the pooled analysis. The authors conclude that TPN may be useful when used preoperatively in patients with gastrointestinal tract cancer. It appears to be beneficial in reducing major surgical complications (pooled P = 0.01) and operative mortality (pooled P = 0.02). No statistically significant benefit from TPN could be demonstrated in survival, treatment tolerance, treatment toxicity, or tumor response in patients receiving chemotherapy or radiotherapy. An increase in the risk of developing an infection in chemotherapy patients given TPN (pooled P less than 0.0001) underscores the importance of demonstrating significant benefits in randomized trials before TPN is used routinely in these patients.

Essential thrombocythemias: clinical evolutionary and biological data

Abstract: This retrospective study reviewed 94 patients, aged 6 to 90 years, with thrombocythemia. The women/men ratio was 1.76. At onset or, less commonly, during the course of the disease, 45% of the patients presented hemorrhagic manifestations, 29% thrombotic complications, and only 14% the association of hemorrhage and thrombosis. The average platelet count was 1200 X 10(9)/1, with no difference according to sex or age. Platelet hypoaggregation was seen in practically all the cases (94%), although myelofibrosis was less frequent (54%). The frequency of hemorrhages increased when the platelet count was above 1000 X 10(9)/1 (P less than 0.01), but the occurrence of thrombosis was correlated neither with platelet count nor with thrombopathy. Survival time was lengthy: 80% of survival (standard error 6%) was observed at 100 months. Transformation to acute leukemia was observed in five patients. Because the disease course is most often prolonged, therapeutic measures must be conservative: anti-aggregating drugs in small doses, and chemotherapy beginning with nonalkylating agents.

Preoperative radiation and surgery for cancer of the rectum: Veterans administration surgical oncology group trial II

Abstract: In a prospective randomized trial, 361 male patients with histologically proven adenocarcinoma of the rectum, judged preoperatively to require abdominoperineal resection (APR), were treated by surgery alone or were given 3,150 rads of preoperative radiotherapy. Surgical resection was done on 320 patients, 262 having "curative" APR. Only moderate symptoms from radiotherapy were noted and postoperative complications and 30-day mortality were similar in both groups. Five-year survival for curative APR was the same in both groups (50% for both treated and control patients). The incidence of positive lymph nodes in the resected specimens was 35% in treated and 41% in controls. In the first preoperative radiotherapy trial conducted by the group, 5-year survival in patients undergoing "curative" APR was 47% in treated versus 34% in control groups. Additionally, the difference in positive lymph nodes in the resected specimens was substantially greater in the first trial (26% in treated versus 44% in controls).

The preoperative carcinoembryonic antigen test in the diagnosis, staging, and prognosis of colorectal cancer.

Abstract: A study of preoperative carcinoembryonic antigen (CEA) levels was conducted in 319 patients with surgically treated colorectal cancer, 272 of whom had disease resectable with curative intent. Only three patients could not be completely followed. All of the remaining 316 patients have been followed for a minimum of 5 years or until death. From the standpoint of diagnosis, the CEA test was more frequently positive (>5 mg/ml) in patients with advanced stage disease, with larger primary tumors, and with more differentiated histopathologic characteristics. It was grossly insensitive in diagnosis of resectable cancer (26%) and was only reasonably reliable (72%) in patients with unresectable and metastatic disease. In relationship to surgical pathology of colorectal cancer, CEA levels were significantly correlated with stage of disease and with size of the primary tumor in Dukes' B lesions, but not with extent of nodal metastasis in Dukes' C lesions. In advanced stage lesions, CEA was inversely correlated with degree of anaplasia. In the overall patient group, and also among resectable patients, the preoperative CEA level was strongly associated with survival after adjustment for the effects of a number of other prognostic factors. Within stages of resectable disease, however, CEA was not significantly associated with survival among patients with Dukes' A and B lesions or Dukes' C lesions with one to three nodes involved. CEA was found to be a significant and independent prognostic determinant only in patients with Dukes' C lesions who had four or more metastatically involved lymph nodes. Under these circumstances, a preoperative CEA level could perhaps be of some value for stratification of Dukes' C patients in randomized colorectal cancer surgical adjuvant trials. The value of this test as a prognostic guide in clinical practice, however, would seem to be limited because of a lack of sensitivity in identifying individual poor prognosis patients. Cancer 58:603-610, 1986.

The role of fine-needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm.

Abstract: This report describes our 5-year experience with fine-needle aspiration (FNA) biopsy of the thyroid in a 560-bed teaching hospital. Three hundred nine FNA biopsies were performed primarily by one endocrinologist and interpreted by several pathologists. Analysis of the data reveals the sensitivity of the procedure is 93%, specificity is 95.1%, and the positive and negative predictive values are 88.9% and 96.5%, respectively. This data confirms the diagnostic accuracy of FNA biopsy. Complications were seen in 6 of 309 cases (1.9%) and were relatively mild. Nearly 75% of the cases in the series were cytologically diagnosed as nonneoplastic. Fine-needle aspiration biopsy identified 19.4% of the cases needing surgery, of which 72% had neoplastic nodules, confirming the selection role of the procedure. The management of thyroid nodules is discussed and a selective review of the FNA literature is presented. The authors believe that our experience rebuts the argument that special referral centers are needed to interpret the cytologic material. Several well trained surgical pathologists can become proficient in interpreting the FNA biopsies without significant loss in accuracy, and thereby render a definite diagnosis in the vast majority of the cases. Accordingly, the authors recommend FNA of the thyroid as the initial diagnostic test in the evaluation of thyroid nodules.

Intermittent endocrine therapy for advanced prostate cancer.

Abstract: Twenty patients with advanced prostate cancer have been treated with an intermittent endocrine therapy schedule. Hormone therapy (diethylstilbestrol in 19 patients and flutamide in 1 patient) was administered until a clinical response was clearly demonstrated and then it was withheld until symptoms recurred. Prior to treatment 17 of 20 patients had bone pain and positive radionuclide scans, two had asymptomatic pulmonary metastases, and one had symptomatic localized disease. Duration of endocrine therapy prior to withdrawal of all treatment ranged 2 to 70 months (median, 10 months). Disease progression occurred 1 to 24 months (median, 8 months) after interruption of therapy. All patients who relapsed had a rapid clinical response following resumption of endocrine therapy. Nine of ten patients rendered impotent by endocrine therapy resumed sexual activity within 3 months of stopping treatment. This data indicates that satisfactory palliation of advanced prostatic cancer can be achieved in selected patients using intermittent endocrine therapy.

Pulmonary complications occurring after allogeneic bone marrow transplantation. A study of 130 consecutive transplanted patients.

Abstract: This report deals with 81 pulmonary episodes occurring in 130 consecutive patients who underwent allogeneic bone marrow transplantation for hematologic malignancy in the same unit over a 5-year period. These episodes observed in 69/130 patients (53%) were mostly of infectious origin, and were investigated by bronchoalveolar lavage (BAL). The main causes of pneumonia were: cytomegalovirus (CMV) (n = 25), bacterial pneumonia (n = 17), invasive aspergillosis (n = 11) and pulmonary hemorrhage (n = 9). The overall mortality due to or associated with pneumonia was 26/130 (20%). Graft-versus-host disease clearly increased the incidence of infectious pneumonia and the mortality due to or associated with pneumonia. Granulocyte transfusions did not influence the incidence of CMV pneumonitis. The main causes and risk factors for pneumonia are discussed. The role of BAL as a noninvasive procedure is stressed. Cancer 58:1047-1054, 1986.