Alternative management of cutaneous squamous cell carcinoma in an elderly man: report of a case and review of the literature.
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Antineoplastic Combined Chemotherapy Protocols↗
Biomedical subjects
L Balducci
Publications and source records attributed to L Balducci.
Acute myelogenous leukemia in the elderly.
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Aged↗
Primary brain tumors in the older patient: an annotated review.
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Aged↗
High proliferation of early hemopoietic progenitors in tumor-bearing mice.
During the progression of Lewis lung carcinoma (LLC) in C57Bl/6 mice, a neutrophilia with granulocytosis develops. This heightened myeloid response is further reflected in a progressively increasing concentration of precursors CFU-GM (colony-forming unit, granulocyte-macrophage) in the marrow. However, during the final days of tumor growth (day 19) the cycling fraction of CFU-GM declines in LLC mice, although their concentration remains high. It was of interest to explore in the present study whether this decline in proliferation of committed myeloid progenitors was due to exhaustion of the pool of early and late pluripotential stem cells CFU-S (colony-forming unit, spleen). The results indicate that early stem cells experience an initial proliferative burst (day 14) during tumor growth, but fail to replenish their own pool by day 19, suggesting that their self-replicative ability may become exhausted during growth of this cancer. The implications of these findings to conditions of chronic hemopoietic stress are discussed.
Anemia↗
Pharmacology and organ toxicity of chemotherapy in older patients.
Age-related changes in pharmacokinetics and pharmacodynamics of drugs, in functional reserve of target organs, and in tumor biology, may lessen the benefits and enhance the toxicity of cancer chemotherapy. These changes include progressive decline in glomerular filtration rate, enhanced risk and severity of mucositis and peripheral neuropathy, and increased incidence of refractory forms of acute myeloid leukemia. Myelotoxicity is also increased following aggressive combinations of cytotoxic drugs. While hormonal therapy is well tolerated, biological treatment with recombinant alpha interferon at doses higher than 5mU/daily may be associated with acute demential syndromes in persons over 65. Tolerance of treatment may be improved by selecting alternative, safer drugs, antidotes to drug toxicity, and adjusting schedule and route of drug administration. A major advancement in supportive care has been the synthesis of hemopoietic growth factors, which are effective even in patients of advanced age.
Aged↗
Cancer control and the older person. Issues in treatment.
The Committee on Treatment acknowledged the paucity of information related to the management of cancer in older patients and identified short-term and long-term efforts to study these issues. Short-term efforts should focus on effects of cancer and cancer treatment on survival and quality of life, efficacy and toxicity of antineoplastic therapy, barriers to adequate treatment, alternative settings of cancer care, and special supportive care needs. Long-term efforts should focus on unique features of cancer in older patients, long-term effects of cancer and cancer treatment, and prevention and detection of new primary malignancies. The Committee recognized that our recent advances in cancer treatment including palliative surgery, limited surgery, radiosurgery, and antidotes to drug toxicity may improve the tolerance of antineoplastic therapy by older patients and be beneficial in terms of survival and quality of life.
Aged↗
Breast cancer of the older woman: an annotated review.
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Aged↗
Chronic treatment with a long-acting somatostatin analogue in a patient with intestinal carcinoid tumor: occurrence of cholelithiasis.
The long-acting somatostatin analogue SMS 201-995 has been used efficaciously in the therapy of metastatic carcinoid tumor, vasoactive intestinal peptide producing islet cell carcinoma, acromegaly, and TSH secreting pituitary tumors. We report the development of a gallstone in a patient treated for 23 months with a long acting somatostatin analogue for a metastatic carcinoid tumor. Symptomatic improvement and a reduction in the urinary excretion of 5-hydroxyindoleacetic acid occurred. There was no evidence of a gallstone on ultrasound and CT scan of the abdomen prior to somatostatin therapy. A progressively enlarging, asymptomatic gallstone developed during therapy.
Carcinoid Tumor↗
Burkitt's lymphoma of the testicle: report of 2 cases occurring in elderly patients.
Burkitt's lymphoma is rare in patients older than 50 years and almost never presents as a testicular tumor. We report 2 cases of primary Burkitt's lymphoma of the testicle in men 68 and 79 years old. In 1 man the extragonadal tumor had a rapid and lasting response to combination chemotherapy. The cases are of interest for the unusual presentation of the disease and for the possibility to control Burkitt's lymphoma in older patients without undue toxicity. The management of testicular lymphoma requires radical orchiectomy and prophylactic irradiation of the contralateral testis. Chemotherapy is indicated for advanced disease and may prevent relapses in patients with early disease. The role of central nervous system prophylaxis is controversial.
Aged↗
Systemic management of prostate cancer.
The objective of this review is to explore different therapeutic options for metastatic adenocarcinoma of the prostate. Orchiectomy, estrogen therapy, synthetic LHRH analogs and possibly antiandrogens are equally effective frontline treatment modalities. Ketoconazole is indicated in emergency situations, but chronic use is prevented by serious idiosyncratic toxicity and by long term complications. Combined androgen blockade (CAB), with leuprolide (or tryptorelin) and flutamide is more effective than single modality treatment in patients capable of strict treatment compliance. Estramustine phosphate may be as effective as CAB and may be the frontline treatment of choice in sexually active patients. Institution of single modality treatment may be delayed until cancer becomes symptomatic. Controversy lingers over whether the institution of CAB at an earlier time may improve progression free survival (PFS) and survival. Research projects of immediate clinical relevance include: comparison of CAB and estramustine; determination of the optimal time for CAB; study of other forms of CAB; and phase II trials of new cytotoxic agents.
Androgen Antagonists↗
Paraneoplastic eosinophilia. Report of a case with in vitro studies of hemopoiesis.
Eosinophilia is an unusual paraneoplastic manifestation. The authors describe for the first time the association of eosinophilia and metastatic medullary carcinoma of the thyroid. The eosinophil count normalized during remission after chemotherapy but increased at time of relapse. The patient's serum enhanced eosinophilic differentiation of human multipotential hemopoietic precursors but was inhibitory to in vitro growth of murine myelopoietic precursors. The number of multipotential colonies which could be cultured in vitro was lower in the patient's peripheral blood than in normal controls. The authors conclude that a tumor-related circulating factor caused eosinophilia by inducing eosinophilic differentiation and inhibiting myeloid differentiation. Such a mechanism of paraneoplastic eosinophilia has not been previously described.
Cells, Cultured↗
Prostate cancer: a model of cancer in the elderly.
Prostate cancer is the most common malignancy in men over 70. Chronic course of the disease and multiple therapeutic options allow a customized management of the patient's individual problems. Prognostic factors are stage, size of primary tumors, serum acid phosphatase levels, number of metastases, ureteral obstruction and patient's age. In localized disease, surgery and radiation therapy are equally effective for patients with a life expectancy less than or equal to 10 years. Surgery may be superior to radiation if longer survival is expected. In locally advanced disease radiation therapy is preferred to surgery, due to a lower rate of complications. Management of metastatic disease requires offsetting androgen effects by castration or by antiandrogens. Orchiectomy, the safest way to produce castration, is unacceptable to 50% of patients. LHRH analogs are safer than estrogens, but more expensive; the risk of tumor flare up controindicates these compounds in life-threatening situations. The use of ketoconazole is limited by long-term toxicity, but may be life-saving in life-threatening situations, due to a rapid onset of action. Antiandrogens are as effective as castration, but are not commercially available in the USA. Alternative treatments include Estracyt, intermittent estrogentherapy, progesterone derivative and aminogluthetimide. Radical prostatectomy and radiation therapy to the prostate cause erectile impotence with persistence of orgasmic sensations. These patients are ideal candidates for erection-restoring interventions, such as intrapenile injections or penile implants.
Aged↗
Metastatic carcinoma of unknown primary: complete response to second-line treatment with plicamycin.
In selected groups of patients, metastatic carcinoma of unknown primary (MCUP) is highly responsive to cisplatin-based combination chemotherapy. These therapeutic responses usually are partial and shortlived. The authors report the case of a 41-year-old man whose MCUP relapsed after responding to cisplatin, bleomycin, and etoposide. Alternate-day treatment with plicamycin induced a second complete remission (CR) in this patient with minimal hematologic and metabolic toxicity. Plicamycin may prove effective in enhancing CR rate, prolonging CR duration, and salvaging cisplatin failures in MCUP.
Adult↗
[Unusual anatomo-clinical features of thyroid metastasis].
The authors report a case of metastatic tumor from clear cell carcinoma in the thyroid gland occurred in a patient who had his primary tumor previously treated with right nephrectomy. The time interval before the appearance of the metastasis was 6 years. The diagnosis was made preoperatively because of the peculiar biological behavior of the primary tumor. In fact, the metastasis and the primary presented with neoplastic invasion of the middle thyroid vein and the renal vein respectively. The ultrasound examination revealed the vein thrombus arising from the thyroid and reaching the internal jugular vein through the middle thyroid vein. Subsequent fine needle aspiration biopsy confirmed the diagnosis of metastasis from clear cell renal carcinoma. The low grade of malignancy of the primary from the clinical point of view and the absence of other metastatic locations influenced the therapeutic approach.
Carcinoma, Renal Cell↗
Pharmacology of antineoplastic agents in the elderly patient.
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Aged↗
Metastatic extramammary Paget's disease: dramatic response to combined modality treatment.
A case of extramammary Paget's disease is reported. The distinguishing features of the case are: (1) localization of the primary lesion to the scrotum, (2) development of metastases in the absence of a recognizable underlying carcinoma, and (3) response of the systemic disease to a combination of radiation therapy and chemotherapy. The histogenesis, clinical behavior, and treatment of extramammary Paget's disease are reviewed.
Antineoplastic Combined Chemotherapy Protocols↗
Systemic treatment of cancer in the elderly.
The goal of this review is to provide a readable and exhaustive reference in three major areas of geriatric oncology: complications of chemotherapy and radiotherapy, responsiveness of cancer to systemic treatment, social issues in the care of elderly patients with terminal illnesses. The conclusions of this study are: 1. Progressive deterioration of renal function is the most consistent change of aging. Adjustment of doses of renally excreted drugs to individual creatinine clearance may prevent life-threatening myelotoxicity in the elderly. 2. Intensive chemotherapy regimens (acute leukemia, non Hodgkin's lymphoma) cause more serious and prolonged myelotoxicity in the elderly. Elderly are more susceptible than younger patients to cardiotoxicity and central and peripheral neurotoxicity. Age is a poor predictor of complications in other organs or systems. 3. The prognosis of patients with Hodgkin's disease worsens with aging, possibly due to increased prevalence of mixed cellularity histology. It is controversial whether the prognosis of other neoplasias is poorer. Prognosis is not age-related in multiple myeloma. In general, elderly in good performance status may benefit from systemic cancer treatment to the same extent as younger patients, except for Hodgkin's disease. 4. The Informal Support Network, epitomized by the family, appears the most suitable environment to care for the elderly with cancer.
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Preoperative evaluation with radionuclide brain scanning and computerized axial tomography of the brain in patients with breast cancer.
To determine the roles of radionuclide brain scanning and computerized tomography of brain in the pretreatment evaluation of patients with primary and locoregional recurrence of breast cancer, we reviewed the clinical and radiologic findings in 226 patients with breast cancer who underwent one of these scans either preoperatively or within 6 weeks of operation and in 34 patients presenting with locoregional recurrence. Four of 131 radionuclide brain scans in primary breast cancer suggested calvarial metastasis, and the findings were confirmed with bone scans and skull radiographs. One of 95 computerized tomographic scans of the brain showed brain metastasis, and this patient had profound neurologic deficits. With respect to locoregional recurrence, the results of 2 of 23 radionuclide scans and 1 of 11 computerized tomographic scans were positive. All three patients had clinical evidence for brain metastasis. We conclude that in the absence of signs and symptoms, routine evaluation for brain metastasis is not justified in primary and locoregional recurrence of breast cancer.
Brain Neoplasms↗