Cerebral metastases. From adenocarcinoma of the colon and rectum.
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Adenocarcinoma↗
Biomedical subjects
A Mittelman
Publications and source records attributed to A Mittelman.
Phase I study of high-dose methotrexate with thymidine and low-dose leucovorin.
A total of 15 patients with advanced neoplastic disease, 13 with different solid tumors, one with lymphoma, and one with acute lymphocytic leukemia, underwent treatment consisting of continuous infusion of methotrexate (2 g/sq m/day) with concomitant thymidine (8 g/sq m/day) and leucovorin (1 mg/sq m/day). The dose of methotrexate was increased progressively by lengthening the methotrexate infusion from 2 to 7 days. After cessation of methotrexate infusion, thymidine and leucovorin were continued until the plasma level of methotrexate decreased to 2 X 10(-8) M. Toxicity was mucositis (23 of 27 evaluable courses), leukopenia (15 of 26 evaluable courses), thrombocytopenia (10 of 26 evaluable courses), renal and hepatic toxicity and diarrhea. Plateau levels of plasma methotrexate or methotrexate plasma half-life did not correlate with toxicity.
Adult↗
Phase I trial and pharmacokinetics of a daily x 5 schedule of 3-deazauridine.
The uridine analog 3-deazauridine has been given to 19 patients in a phase I and pharmacokinetic study. Only mild toxicity was seen at doses less than 1200 mg/m2/day for 5 days. At a dose of 1200 mg/m2/day x 5, leukopenia (mean wbc count nadir of 2650/mm3) was seen in nine of 12 patients and thrombocytopenia (mean platelet count nadir of 47,000/mm3) in five of 12 patients. Nausea and vomiting and oral toxicity were each seen in two patients, and diarrhea and skin toxicity occurred in one patient each. Pharmacokinetic studies indicate a biphasic plasma decay with a beta-half-life of 6.9 hours and urinary excretion, mostly of unchanged drug, as the most important route for drug elimination. A dose of 1200 mg/m2/day x 5 is recommended for phase II studies and great caution is advised in administering the drug in the presence of renal impairment.
3-Deazauridine↗
Metachronous ovarian metastases from adenocarcinoma of the colon and rectum.
Our observations indicate that the menopausal status of a patient, the anatomic location or the histologic differentiation of a primary adenocarcinoma of the colorectal area does not seem to affect the incidence of ovarian metastases. Tumors initially classified as Dukes' B2 and, later, associated with ovarian metastases have consistently poorer prognosis. The reason that ovarian metastases attain a relatively large size, while other metastatic foci remain small, is unknown. Regardless of the surgical findings, patients with ovarian metastases from a primary adenocarcinoma of the colorectal area tend to have short survival with widespread distribution of the tumors at death. This would suggest that these metastases occur primarily by the hematogenous route rather than by an orderly invasion to contiguous structures and draining lymph nodes. Patients with resectable solitary ovarian metastases and prospectives of cure must be a rare event in carcinoma of the colon and rectum.
Adenocarcinoma↗
Phase II study of 3-deazauridine in advanced colorectal adenocarcinoma.
A phase II study of 3-deazauridine (DAUR) showed poor activity in previously treated patients with advanced colorectal adenocarcinoma. There were no responses among 15 patients treated on a dose schedule of 1200 mg/m2/day for 5 days repeated at 3-week intervals. Toxicity included mild nausea and vomiting, occasional mucositis, diarrhea, and dizziness. A minimal degree of myelosuppression was observed.
3-Deazauridine↗
Extensive resections of isolated metastasis from carcinoma of the colon and rectum.
The results of this study show that hepatic resection for metastatic carcinoma of the colon and rectum is an effective treatment modality. The duration and quality of survival are better than those achieved by an other treatment modalities. The results of this study also show that hepatic resection is a safe procedure; however, a 50 per cent, two of four, mortality rate in patients undergoing a trisegmentectomy for metastatic disease points toward a need for better selection of patients. Adjuvant chemotherapy following hepatic resection has not been shown to be of any benefit in this series.
Adenocarcinoma↗
Malignant epithelial tumors of the anal canal.
A simplified staging for malignant epithelial tumors of the anal canal is presented. The pattern of recurrence in males is pelvic and perineum, in females pelvis and posterior vaginal wall. Concomitant posterior vaginectomy is advocated. The disease is more common in females than males (4:1). There is little difference between histologic types, i.e. cloacagenic or squamous cell type. Recurrence and survival depend upon depth of invasion and extent of spread rather than histologic cell type. The tumors respond to well-designed surgery, radiotherapy and probably chemotherapy.
Adenocarcinoma↗
A statistical evaluation of baseline and follow-up carcinoembryonic antigen in patients with resectable colorectal carcinoma.
A long-term CEA follow-up was evaluated statistically for a series of 74 patients with primary colorectal carcinoma who underwent resections for cure. Thirty-three recurrences and 29 deaths were reported among this population after a median follow-up interval of 55 months. Preoperative CEA levels correlated with the Dukes' classification. However, the preoperative level adds significant information to Dukes' classification in the prediction of recurrence. Postoperative CEA assays taken later in the clinical evaluation process carry the most prognostic information for subsequent recurrence. Using matched-pairs techniques, the authors noted that CEA often rose in anticipation of recurrence, sometimes as early as one year before recurrence. The following four follow-up CEA events were evaluated: 1) three consecutive rising CEA's 2) CEA rises 5.0 ng/ml; 3) CEA exceeds 5.0 ng/ml; 4) CEA exceeds 5.0 ng/ml two consecutive times. The follow-up CEA events examined were characterized by false positive rates ranging from 17% to 66% and true positive rates ranging from 43% to 56% in the prediction of recurrence. From follow-up CEA evaluations, further clinical investigation appeared most warranted when CEA exceeds 5.0 ng/ml at two consecutive follow-up evaluations, but the chances of finding any subsequent recurrent disease was near 50%. Among patients experiencing recurrences, although forewarned by CEA elevations, there was no subsequent time when patients were most likely to have recurrence of disease.
Carcinoembryonic Antigen↗
Angled low anterior resection scissors.
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Surgical Instruments↗
Interstitial pneumonitis associated with mitomycin C and DTIC: a case report.
A case of interstitial pneumonitis secondary to mitomycin C and DTIC combination therapy in a 58-year-old male with metastatic adenocarcinoma of the rectum is reported. Dry cough and dyspnea, especially on exertion, were presenting symptoms. Arterial blood gas analysis was compatible with severe impairment in pulmonary diffusion capacity. Chest x-ray showed a diffuse increase in interstitial markings in both lung fields consistent with interstitial pneumonia. Histologically, prominence of type I pneumocytes, focal proliferation of type II pneumocytes, and varying degree of fibroblastic proliferation and collagenization within the alveolar septae were observed. The obliteration of alveolar septal vessels due to endothelial edema and/or proliferation of fibroblast-like mesenchymal cells were also noted. Withdrawal of drugs and institution of high dose corticosteroid therapy were followed in rapid improvement in dyspnea and arterial blood gas findings. If diagnosed early, this potentially life threatening complication may respond to such therapy.
Adenocarcinoma↗
Biologic markers in cancer diagnosis and treatment.
We have reviewed several tumor markers that our advocates feel are now clinically useful, involve current assay technology, and are based on already available information. These include, in selected instances, estrogen receptors for breast cancer, thyrocalcitonin for medullary cancer of the thyroid, prostatic acid phosphatase for cancer of the prostate, alpha-fetoprotein for hepatocellular cancer, and carcinoembryonic antigen for monitoring colon cancer. We have considered the potential use of measurement of serum proteases and protein degradation products due to their activity as possible future areas of development, and we have explored measurement of tissue aryl hydrocarbon hydroxylase to identify populations at risk of cancer resulting from chemical carcinogenesis. It is clear that the study of tumor markers is already improving patient care in some specific areas and offers exciting potential for the future.
Acid Phosphatase↗
Total pelvic exenteration in colorectal disease: A 20-year experience.
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Adenocarcinoma↗
Indications for cholecystectomy in ligation of the hepatic artery.
Ligation of the hepatic artery has been successfully used in the management of massive bleeding, secondary to hepatic trauma, and in the treatment of metastatic neoplastic disease. The indications for a concomitant cholecystectomy are less well defined. It is generally accepted that cholecystectomy should be performed when ligation is used to control bleeding. In our study, ligation of the hepatic artery was performed, leaving the gallbladder in situ. At autopsy, no pathologic process could be detected in the gallbladder. Microscopic analysis showed fibrosis in the mucosal surface, mild chronic inflammation and nonspecific mononuclear infiltration. We conclude that the changes are insufficient to warrant the removal of a normal gallbladder when ligation of the hepatic artery is performed as treatment for neoplastic disease.
Adult↗
New agents for prostatic carcinoma.
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Adamantane↗
Treatment of recurrence of adenocarcinoma of the colon and rectum at the anastomotic site.
Resection of recurrent adenocarcinoma of the colon and rectum at the anastomotic site was performed in 30 patients. In the majority of the patients, the recurrence was apparent within two years of the initial operation. In 27 patients, the recurrence was diagnosed based upon persistent signs and symptoms or if the tumor was clinically palpable. In 15 patients, complete resection of the recurrent tumor was feasible, and the median survival time was 59 months, with a five year survival rate of 49 per cent. In ten other patients, minimal tumor was left behind. The median survival time was 17 months and 12 per cent survived five years.
Adenocarcinoma↗
Effects of 1,2-symmetrical dimethylhydrazine on jejunocolic transposition in Sprague-Dawley rats.
In this experiment, a segment of the left colon including the upper part of the rectum was transposed to the upper jejunum, and a segment of upper jejunum was transposed to the left colon of the same animal. In another group, the same colon and jejunum segments were transsected and reanastomosed in place. A third group served as a normal control. After a recovery period, weekly s.c. 1,2-symmetrical dimethylhydrazine injections were begun. Each animal received a total of 20 injections at a dose of 20 mg/kg. Five weeks after the last 1,2-symmetrical dimethylhydrazine injection, 15 of 19 (79%) of the animals had one or more tumor(s) in the transposed colon segment, while none had tumor in the transposed jejunal segment. Transsected and reanastomosed animals showed the same distribution of tumors as did the normal control animals. All three groups had tumors at other sites in the colon and rectum. In addition, about 20% had tumors of the duodenojejunal area. These data indicate that the colonic mucosa is the primary target for the carcinogenic effect of 1,2-symmetrical dimethylhydrazine, independent of other variables such as the fecal stream.
1,2-Dimethylhydrazine↗
Trends in the United States for the management of adenocarcinoma of the rectum.
Data from surveys conducted by the Commission on Cancer of the American College of Surgeons were examined to identify recent trends in the treatment of carcinoma of the rectum. Between 1973 and 1978, the stage of disease at diagnosis for the total series changed little, but significant upgrading in the stage of disease at diagnosis for the black patients was observed. There was increasing use of a multimodality approach to treatment combining operation with radiotherapy. The use of chemotherapy alone or in combination with other therapies, while never widely used, declined during the interval observed. Significant changes occurred in the type of operations performed for carcinoma in the upper two-thirds of the rectum. During this interval, abdominoperineal resection was increasingly being displaced by low anterior resection. The trend toward multimodality treatment and the use of effective sphincter preserving procedures represent significant changes noted in this survey in the therapy of carcinoma of the rectum.
Adenocarcinoma↗
The importance of the stable category for chemotherapy treated patients with advanced and relapsing prostate cancer.
Categories of objective response to chemotherapy for 460 advanced relapsing prostate cancer patients evaluated in the initial first four randomized clinical trials of the National Prostatic Cancer Project were compared by survival and other patient and disease characteristics. The response criteria for stable were shown to delineate patients with markedly improved survival and other disease conditions relative to those designated as progression. Survival was similar for stable and partial regression patients despite more frequent reduction of primary tumor and subjective improvement in performance status, pain, and body weight in the partial regression patients. Consequently, we feel that in these studies the stable category is valid and useful for determining efficacy of treatment in patients with advancing prostate cancer.
Acid Phosphatase↗