Prospective randomized evaluation of the role of limb-sparing surgery, radiation therapy, and adjuvant chemoimmunotherapy in the treatment of adult soft-tissue sarcomas.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to B Chabner.
Explore the source record for details and available documents.
One hundred consecutive untreated cases of non-Hodgkin's lymphomas were reviewed according to Rappaport's classification. There were 49 males and 51 females, almost evenly distributed between nodular (49) and diffuse (51) patterns. Only diffuse lymphomas were seen in patients under age 20 and they were twice as common as nodular lymphomas in patients over 60. Nodular lymphomas were predominantly lymphocytic (61%) or mixed (35%) while diffuse lymphomas were commonly histiocytic (43%). Standardized pathological staging was based upon the serial performance of bone marrow needle biopsy, percutaneous hepatic biopsy, peritoneoscopic hepatic biopsies and exploratory laparotomy. For all patients this sequence terminated with the first positive biopsy. Hepatic involvement was documented in 40 patients by either percutaneous biopsies,18 peritoneoscopic biopsies,9 or wedge biopsy at laparotomy.13 Thirty-seven of 49 patients who underwent laparotomy had biopsy-proven abdominal involvement. Overall incidence of biopsy-proven abdominal disease was 64%. Positive spleens varied widely in weight but all negative spleens weighed less than 270 g. Constancy of histologic type in multiple sites was observed in 90% of cases.
Twenty-seven patients with advanced diffuse histiocytic lymphoma (reticulum-cell sarcoma) were treated with combination chemotherapy utilising nitrogen mustard (or cyclophosphamide), procarbazine, vincristine, and prednisone. Elven (41%) achieved a complete remission and only one of these has had a recurrence of tumour. The remaining ten complete responders were free of all evidence of tumour when last seen 26-105 months from the end of treatment. In contrast, all non-responders or partial responders have died. An interpretation of published survival data suggests that this virulent disease evolves quickly and is usally rapidly fatal if treatment is unsuccessful. Survival free of disease beyond 2 years from the end of treatment may be considered tantamount to cure. This definition of cure, previously applied only to patients treated with radiotherapy, seems applicable to patients who acheive complete remissions with modern drug treatment.
Peritoneoscopy was done within 1 month of exploratory laparotomy in 30 consecutive patients, with ovarian carcinoma as part of their pretreatment evaluation. Six of the 7 patients who were thought to have ovarian carcinoma localized to the pelvis (stages I and II) were found to have advanced disease (stage III) at peritoneoscopy and thus required a change in therapy. Metastatic diaphragmatic involvement in ovarian carcinoma is common and was found in 77 percent of all patients studied. The routine shielding if the liver area ordinarily used with total abdominal radiotherapy would select these patients for therapeutic failure. Peritoneoscopy supplied reevaluable finding in 2 of 7 patients having normal physical, roentgenologic, and laboratory examinations, as well as in 93 percent of all patients stuided. "Second look" peritoneoscopy precluded the need the laparotomy in 5 to 13 patients achieving as apparent clinical remission.
Forty patients with ovarian adenocarcinoma had peritoneoscopy within 1 month of their exploratory laparotomy as part of their pretreatment evaluation. Of 12 patients (58%) believed to have disease localized to the pelvis (stage 1 or II) at laparotomy staging 7 were found to have more advanced disease (stage III) at peritoneoscopy and thus required a change in therapy. Involvement of the diaphragm with metastatic ovarian carcinoma was found in 63% of all patients. This finding again necessitated a change in therapy, since the right hemidiaphragm is shielded along with the liver when abdominal radiotherapy is used. Peritoneoscopy supplied the only followable findings with which to gauge response to therapy in 40% of the patients and also supplied followable findings in 78% of all patients studied. Second-look peritoneoscopy was performed in all patients achieving an apparent clinical remission with chemotherapy. Active disease was found in 43% of these patients, which thus precluded the need for laparotomy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.