Biomedical subjects
Publications and source records attributed to G M Mead.
We report two patients with multiple cavitating lung lesions caused by large cell non-Hodgkin's lymphoma. This pattern of disease has rarely been reported in non-Hodgkin's lymphoma and is more commonly described in Hodgkin's disease. The patterns of pulmonary parenchymal involvement in non-Hodgkin's lymphoma are reviewed with particular reference to cavitary lesions.
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We report a patient with intraperitoneal metastases following treatment for seminoma. This is an unusual site of spread and was accompanied by transformation of tumour morphology.
27 patients with relapsed/refractory non-Hodgkin lymphoma (NHL) received combination chemotherapy with prednisolone, cytosine arabinoside, lomustine (CCNU), etoposide and thioguanine (PACET). 25 patients are evaluable for response. 7 (26%) obtained a complete response and one (4%) a partial response. The median survival for the entire group was 6 months. 2 patients are currently alive without disease, 1 of whom has received further therapy. The regimen was intensely myelosuppressive, but was well tolerated. The complete response rate and median survival figures are comparable to previous studies of salvage therapy confirming the poor prognosis for relapsed NHL and emphasising the need for prospective randomised studies.
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BACKGROUND: Patients with advanced Hodgkin's disease failing to achieve complete remission with chemotherapy or developing disease progression within 1 year have a poor prognosis with salvage chemotherapy. PATIENTS AND METHODS: Twenty-five patients fulfilling the above criteria after failing treatment with ChlVPP (chlorambucil, vinblastine, procarbazine and prednisolone) or its variant were treated with a new salvage regimen CAPE/PALE (cyclophosphamide, adriamycin, prednisolone, etoposide and lomustine), given for 6 courses at three weekly intervals. RESULTS: Thirteen of the 25 patients (52%) achieved complete remission. After a minimum follow-up period of 38 months five of these patients remained free from disease progression. This regimen was very well tolerated. CONCLUSIONS: CAPE/PALE produces results comparable to other salvage regimens in Hodgkin's disease. New strategies are however required for this patient group.
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The Medical Research Council (MRC) has conducted two retrospective studies of prognostic factors in metastatic non-seminomatous germ cell tumours among patients treated in its participating institutions. In the first study, of 458 patients treated between 1976 and 1982, adverse features identified were (1) increasing tumour volume and (2) alpha fetoprotein (AFP) > 500 kU/l, or human chorionic gonadotrophin (HCG) > 1,000 IU/l. In the second study of 795 patients treated between 1982 and 1986, four adverse features were identified. These were (1) liver, bone or brain metastases, (2) AFP > or = 1000 kU/l or HCG > or = 10,000 IU/l, (3) mediastinal mass > 5 cm in diameter and (4) > or = 20 lung metastases. Using this data, two prognostic groups were identified and formed the basis of current multicentre randomised trials.
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Between May 1986 and September 1990 a total of 43 patients with metastatic transitional cell carcinoma (TCC) of the urinary tract have been treated at our institution with combination chemotherapy (CMV) consisting of cisplatin 100 mg m-2 i.v. day 2; methotrexate 30 mg m-2 i.v. days 1.8; and vinblastine 4 mg m-2 i.v. days 1.8. Chemotherapy was recycled on day 22 and continued for a maximum of six cycles in responding patients. Of 33 patients with measurable disease 8 (24%) achieved a complete remission (CR). The median survival for patients achieving a CR was 13 months (range 5-29+) whilst the median survival for all 43 patients was 7 months (range 1-29+). Only three patients are still alive--two are disease free. More effective and/or less toxic chemotherapy regimens are needed for the treatment of patients with metastatic TCC.
The testis and central nervous system (CNS) may act as sanctuary sites for testicular germ cell tumours, as cytotoxic drugs penetrate these areas less well than systemic sites. We describe three patients who relapsed in the testis (one patient) or CNS (two patients) after receiving chemotherapy for responsive systemic disease. All three were asymptomatic at relapse, which was first manifest by rising tumour marker levels. These sanctuary site relapses were managed locally with surgery +/- radiotherapy. Two patients were rendered disease-free; one died of progression of his local disease only. Sanctuary site tumour should be considered when relapse occurs in the setting of otherwise chemosensitive disease; local therapy may be curative.
Twelve adult patients with non-leukaemic lymphoblastic lymphoma were treated with combination chemotherapy and central nervous system prophylaxis according to the protocol developed at Stanford University. Despite strict adherence to the Stanford protocol, 4 of 12 patients relapsed in the CNS, all with meningeal disease. Only four of the 12 patients are in continuing complete remission 6 to 88 months from the completion of induction therapy. These results are inferior to those previously reported for this regimen, and fail to confirm the high rate of control of CNS disease.
PURPOSE: To assess prognostic factors in a large population of patients with metastatic nonseminomatous germ cell tumors (NSGCT) arising in gonadal or extragonadal sites. PATIENTS AND METHODS: Data from 795 patients treated with chemotherapy between 1982 and 1986 in 13 centers were analyzed. Particular emphasis was placed on exact tumor measurements (eg, size of nodal masses, number of lung metastases), and the diagnostic pathology was also reviewed. Cox regression analysis was performed on these data. The patients were treated with a variety of cisplatin-containing chemotherapy regimens, 86% of which included etoposide. RESULTS: With median follow-up of 45 months, overall 3-year survival is 85%. The independently adverse features proved to be (1) the presence of liver, bone, or brain metastases; (2) raised marker levels (alpha-fetoprotein [AFP] level greater than 1,000 kU/L or beta subunit of human chorionic gonadotropin [HCG] greater than 10,000 IU/L [corrected]); (3) the presence of a mediastinal mass greater than 5 cm in diameter; (4) the presence of 20 or more lung metastases; (5) increasing age; and (6) absence of undifferentiated teratoma (embryonal carcinoma) or fibrous tissue from the primary tumor. CONCLUSIONS: The first four factors were used to define a simple prognostic classification. A good-prognosis group having none of these features comprised 67% of our patient population and had a 3-year survival of 93%. The remaining 33% of patients having at least one of these features had a 3-year survival rate of 68%. These patient groups are currently the subjects of international randomized clinical trials.
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Enteropathy-associated T-cell lymphoma commonly presents with malabsorption, and debate continues as to whether adult-onset coeliac disease (CD) is itself a form of low-grade lymphoma. A 59-year-old man with adult-onset CD required resection of a segment of oedematous jejunum. Histological examination of this tissue revealed an intense intraepithelial lymphocytosis. Immunophenotypic (CD3-, CD4-, CD8-, CD34-, and CD45 RO-) and cytogenetic (deletion of the Y chromosome and chromosome 9) abnormalities were found, together with monoclonal T-cell-receptor gene rearrangements. Some patients with adult-onset CD may have low-grade lymphoma from the outset of their illness.
Most patients with disseminated nonseminomatous germ cell tumor (NSGCT) have an excellent prognosis with modern chemotherapy, although certain subgroups with a worse prognosis have been described. One such subgroup includes patients with high serum levels of the tumor marker, human chorionic gonadotropin (HCG). Sixteen patients of 104 treated for NSGCT at the CRC Wessex Medical Oncology Unit (Southampton, UK) presented with serum HCG greater than 25,000. Most of these patients exhibited features of the "choriocarcinoma syndrome" with bulky, rapidly progressive disease; frequent pulmonary, hepatic, and central nervous system complications; and a generally poorer response to standard NSGCT chemotherapy. Histologic identification of trophoblastic tumor was not made in all patients and is not essential for the diagnosis of the syndrome; indeed, closed biopsy may be contradicted in some circumstances because of the risk of hemorrhage. The NSGCT patients with poor prognosis, including patients with the choriocarcinoma syndrome, must be clearly identified in order to improve management and, eventually, cure rates.
Mediastinal involvement from Hodgkin's disease is common. Significant symptoms resulting from disease at this site are less common and only rarely does severe airway obstruction occur. The authors report six cases of Hodgkin's disease in which life-threatening airway obstruction was a major feature of the clinical presentation and early clinical course. The literature describing this complication is reviewed. General anesthesia with endobronchial intubation should be avoided if at all possible in patients with airway obstruction and alternative methods of diagnosis and management are discussed.