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Biomedical subjects

R C Marcove

Publications and source records attributed to R C Marcove.

At least 55 records · Page 3Linked to original sources
PubMed1981

Malignant retrorectal tumors: 28 years' experience at Memorial Sloan-Kettering Cancer Center.

From 1949 to 1977, 39 patients with localized malignant retrorectal tumors were treated at Memorial Sloan-Kettering Cancer Center. Chordomas were the most frequent histologic type (38 per cent of patients) followed by neurogenic tumors (15 per cent) chondrosarcomas, hemangiopericytomas, and embryonal adenocarcinomas (8 per cent each). Treatment consisted of surgical excision in 28 patients (18 of whom received adjuvant radiotherapy and/or chemotherapy). Ten patients were treated nonsurgically, receiving radiation and/or chemotherapy alone. Large tumors were most successfully managed by a combined surgical approach consisting of exploratory celiotomy, rectal mobilization, and bilateral hypogastric artery (with middle sacral artery and vein) ligation, followed by transsacral tumor excision with incontinuity sacrectomy. For all treated patients, survival at 5, 10, 15 and 20 years was 69 per cent, 50 per cent, 37 per cent and 20 per cent, respectively. Long-term disease-free survival (17 to 25 years post treatment) was noted in six patients. [Key words: Tumor(s), retrorectal, malignant; Tumor(s), treatment].

Adolescent↗
PubMed1981

Abdominal sacral resection of locally recurrent rectal cancer.

Local recurrence of rectal cancer develops in the posterior bony pelvis as an isolated event in about half of the patients with recurrence. Although radiation can palliate sacral root pain, the disease is usually progressive and is rarely amenable to conventional resection. We have adapted a surgical technique usually used for primary sacral tumors, which permits a complete en bloc excision of recurrent rectal cancer in most instances. This approach consists of a laparotomy with pelvic dissection and mobilization of structures to be resected. The patient is repositioned prone and the posterior pelvis (sacrum and side walls) is then resected with preservation of appropriate nerve roots of the posterior pelvis and the sciatic nerve. Reconstruction is done with muscle and skin flaps. We have done 21 such procedures, of which, 11 were for pelvic recurrence of rectal adenocarcinoma. Seven patients had resections for cure and four had palliative resections of fungating or infected tumors. All but one patient was postabdominal perineal resection and nine patients had been irradiated (3000-9000 rads). Two patients had received up to 9000 rads in separate courses (external beam in one and interstitial radiation in the other). The posterior extent of resection was S1-2 to 5 in six patients; S3 to 5 in three patients, and S4-5 in two patients. Anterior exenteration was performed in three patients and three patients had additional resection of other organs. In the curative resection group, three patients are living free of disease at six, ten, and 52 months, and one patient was NED at 60 months, but has again had tumor recurrance and is living with disease at 65 months. One patient died of disease at 13 months and one patient died of a pulmonary embolus following resection for ureteral obstruction at five months. One postoperative death occurred from a cerebrovascular accident at 52 days. In the palliative resection group, three patients survived with relief of local tumor symptoms four, eight, and 12 months. One patient who had received a total of 9000 rads developed flap necrosis, small bowel fistula and died 60 days after resection. Although this is a small series, it suggests that abdominal sacral resection of locally advanced pelvic cancer is feasible and may provide good palliation in most and possible cure in some patients who develop recurrence after primary resection of adenocarcinoma of the rectum.

Abdomen↗
PubMed1981

En bloc resections for osteogenic sarcoma.

This paper is a preliminary report on 58 patients who underwent en bloc resection for osteogenic sarcoma of the femur (30), tibia (12), shoulder girdle (15), and fibula (1). We undertook this study to determine whether en bloc resection in association with intensive chemotherapy is a realistic alternative to radical amputation and chemotherapy. Average survival for this group of patients was 38.4 months; 41 are alive with no evidence of disease, 7 are living but with disease, and 10 have died.

Adolescent↗
PubMed1981

Osteogenic sarcoma: eight-percent, three-year, disease-free survival with combination chemotherapy (T-7).

Sixty-one patients were treated with combination chemotherapy (T-7) for biopsy-proved, fully malignant, osteogenic sarcoma (OS) of the extremity. Chemotherapy consisted of the combination of bleomycin, cyclophosphamide, and dactinomycin, followed in 2 weeks by vincristine and high-dose methotrexate (HDMTX) given in doses of 8 g/m2 for adolescents and 12 g/m2 for children 12 years old or younger with citrovorum factor rescue. The HDMTX was administered weekly for 4 weeks. One week following the 4 HDMTX treatments, adriamycin (ADR) was given at a dose of 90 mg/m2 for 2 days. Two weeks after the ADR, 2 additional doses of HDMTX were given before surgery. Thirty-eight of the 61 patients were referred before amputation and underwent preoperative chemotherapy for approximately 3 months. After surgery, chemotherapy was resumed. Of the 61 consecutive patients with primary OS entered in the T-7 protocol, 54 (88%) remained free of disease for more than 8 to over 35 months (median 18+ mo), with a projected 3-year disease-free survival in excess of 80%. Of the 38 receiving T-7 chemotherapy before surgery, 28 demonstrated a near complete or complete lack of viable tumor cells on examination of the resected primary tumors. All 28 are surviving free of disease. Nine of the 10 patients less than 12 years of age remain free of disease from over 12 to more than 35 months (median 24+ mo). A significant increase in disease-free survival in the younger patients could presumably be attributed to the use of 12 g HDMTX/m2 in that age group. The prognostic value of the effect of preoperative chemotherapy on the primary tumor is statistically highly significant. These data indicated that preoperative chemotherapy with the proper dose of HDMTX would be valuable in all patients with OS.

Antineoplastic Agents↗
PubMed1981

Combination chemotherapy (T-6) in the multidisciplinary treatment of Ewing's sarcoma.

Twenty-eight patients with primary Ewing's sarcoma (ES) and 10 with primary and metastatic ES were treated with intensive induction (T-6) and maintenance sequential chemotherapy (T-2). Local treatment for the primary tumor was surgery and/or radiation therapy (RT), and the choice depended on the patient's age and the location and size of the tumor. Patients with pulmonary metastases received bilateral pulmonary RT with 1,400 rad before T-2 maintenance chemotherapy. Most patients who were given T-65 induction chemotherapy before local therapy had healing of pathologically destroyed, tumor-bearing bones before the initiation of RT. None who had RT after T-6 chemotherapy developed pathologic fractures. Of the 28 with primary ES, 23 (82%) remained free of disease for more than 12 to over 46 months (median 22+ mo). Six of 10 with primary and metastatic disease are free of disease from more than 14 to over 34 months (median, 22+ mo). In addition to producing higher survival rates in the patients with poor prognoses, T-6 chemotherapy also improved the treatment of the primary tumor and achieved better function and, it is hoped, a lower local recurrence rate following RT. We found that the timing of T-6 chemotherapy and RT was crucial to obtaining a maximal response of the primary tumor and to maintaining patient tolerance for this aggressive treatment. The long rest required after patients were given 1,3-bis (2-chloroethyl)-1-nitrosourea makes its use in future protocols undesirable.

Adolescent↗
PubMed1980

En bloc resections for osteogenic sarcoma.

This paper presents a preliminary report of 66 patients who underwent en bloc resection for osteogenic sarcoma of the femur (34 patients), tibia (12 patients), shoulder girdle (19 patients), and fibula (1 patient). Presentation of a limb, without sacrificing the principles of cancer surgery, is a desirable goal in people with osteogenic sarcoma. Up to the present time, amputation has been regarded by most authorities as the only well-established typical curative treatment for this malignancy. Usually when a tumor is close to a joint, amputation includes excision of a part of the adjacent joint as well as a wide removal of the involved bone to encompass both area of potential capsular-joint local skip and possible intraosseous skip areas of tumor. The former has been observed more than the latter. In an effort to improve survival rates, the distal femur lesion (having the lowest extremity cure rate in our opinion) requires removal of the whole bone. The following study was undertaken to determine whether en bloc resection in association with intensive chemotherapy is a realistic alternative to radical amputation and chemotherapy. We believe our definition of osteogenic sarcoma, unlike some, excludes the good prognostic medullary invading juxtacortical osteogenics, chondrosarcomas (making bone), and includes telangiectatic osteogenic sarcomas. Therefore, our cure rate, with amputation under the age of 21 was 17% with no evidence of disease. Any paper not analyzing the age of the patient (under 21 years old) cannot in itself be comparable. Cure rates of older patients can be as high as 35% according to Dr. Andrew Huvos at our hospital.

Adolescent↗
PubMed1980

Primary leiomyosarcoma of bone.

We describe a primary leiomyosarcoma arising in the proximal part of the right tibia of a 65-year-old man. The diagnosis was confirmed by both histochemical and electron microscopical studies. Ultrastructural examination revealed two different neoplastic cell populations. One, the type 1 cell, resembled typical mature smooth muscle cells, whereas the type 2 cells were smaller, more pleomorphic, and contained thick myofilaments in addition to the characteristic thin actin-like filaments. The tumor most likely arose from vascular smooth muscle cells, although origin from perivascular, multipotential, mesenchymal cells cannot be ruled out. Prognosis of reported cases appears to be poor if they are treated by inadequate surgical excision and irradiation but is more promising if wide excision or major amputation is performed.

Aged↗
PubMed1979

Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery.

From 1973--1975, 31 patients with biopsied primary osteogenic sarcoma were treated with preoperative chemotherapy followed by surgical ablation of the primary tumor. Surgery was delayed in order to obtain a custom-fitted prosthetic bone implant in an attempt to avoid amputation. Preoperative chemotherapy included high dose methotrexate (HDMTX) with citrovorum factor rescue (CFR) and adriamycin (T-5 protocol) and was administered for 3 months preoperatively and continued with the inclusion of cyclophosphamide for approximately 5 months postoperatively. At a follow-up period of 30--52 months, 23 of 31 patients (75%) are surviving (21 of 23 with no evidence of disease). Histologic examination of primary tumor removed at surgery revealed varying degrees of tumor destruction (from very little effect to no evidence of viable tumor) attributable to the effect of chemotherapy. The 21 patients that are disease-free survivors had a more complete effect of preoperative chemotherapy on the primary tumor. Some patients achieving favorable effects upon the primary tumor did so only after the dose of HDMTX was escalated to greater than the starting dose of 8 g/m2. Preoperative chemotherapy for all patients with osteogenic sarcoma would seem to offer the following advantages: 1) Evaluation of the effect of HDMTX with CFR on the primary tumor with escalation of the dose of HDMTX until a clinical response is observed, thus defining the dose of HDMTX effective in that patient, to be continued postoperatively as adjuvant therapy; 2) The early use of systemic therapy to eradicate distant microfoci of disease that will eventually kill the patient if not adequately treated by effective chemotherapy; 3) Allow more time for postoperative healing without the need to start adjuvant chemotherapy immediately; and 4) Provide the surgeon time to plan resection surgery. To date, 20 additional patients with biopsy proven osteogenic sarcoma have been treated with more aggressive preoperative chemotherapy (T-7) for approximately 2 1/2 months prior to definitive surgery (resection or amputation). Doses of HDMTX were escalated where necessary and good clinical responses were obtained in 19 of 20 patients. In the majority of patients, no evidence of viable tumor was found on histologic examination of the surgically removed primary tumor. All 20 patients are surviving free of active disease at this brief follow-up period of 4--20 months.

Adolescent↗
PubMed1979

Primary malignant giant cell tumor of bone: a study of eight cases and review of the literature.

Eight cases of primary malignant giant cell tumor of bone were reviewed. There was a wide range in age from 17 to 76 years, with the sixth decade of life being the most common. The tumor was more frequent among females (male to female ratio--3:5). The most common sites of occurrence were in the region of the knee, with the distal end of femur and the proximal end of tibia affected in three and two cases, respectively. Pain and swelling of the involved regions were the most common complaints. The roentgenographic and pathologic features and the treatment were analyzed in detail. Although these cases were considered malignant, the follow-up periods varying from 4 to 15 years were available in six of the eight cases; only one patient died of tumor, 8 months after the surgical procedure. One patient died of unrelated cause, but the others were all alive with no evidence of disease. The pertinent literature was analyzed and examples of secondary malignant giant cell tumors of bone were compared to those of this present series to delineate differences in natural history and clinicopathologic features. It was clearly established that primary malignant giant cell tumor of bone is a separate entity with a more favorable clinical behavior, particularly if the disease process is eradicated early on either by cryosurgery, en bloc radical resection, or amputation.

Adolescent↗
PubMed1979

Preservation of the functional above knee stump following hip disarticulation by means of an Austin-Moore prosthesis.

Patients can be provided with a functional above-knee amputation stump when the tumor is not resectable. In order to do this and still remove the entire upper end of the femur a small Austin-Moore prosthesis with drill holes is inserted and enclosed in long anterior and posterior flaps. Muscle attachments are sutured into the distal stem to obtain the balance between abduction and extension of a functional stump.

Adolescent↗
PubMed1978

Curability of Ewing's sarcoma and considerations for future therapeutic trials.

Twenty previously untreated children with primary Ewing's sarcoma and 8 children with primary tumor and metastatic disease were treated with surgery or radiation therapy (6,000-7,000 rads) for their primary tumor and T-2 chemotherapy. Of the 20 children with primary Ewing's sarcoma treated with T-2 "adjuvant" chemotherapy, 15 had no evidence of recurrent disease for from 31+-82+ months (median 46+ months) from the start of treatment. The actuarial 5-year disease-free survival rate for this group of patients was 75%. Eight patients presenting with metastatic disease had complete responses to T-2 chemotherapy, but 7/8 with metastatic disease eventually had tumor recurrence. Examination of the treatment failures, both those patients relapsing after adjuvant chemotherapy for primary Ewing's sarcoma (5), and those relapsing after having a complete response of metastatic disease (7) to T-2 chemotherapy, revealed that all relapses occurred at the end of the second year of T-2 chemotherapy or after chemotherapy was stopped. In addition, of 23 patients receiving "curative" radiation therapy to their primary tumor, 5 had local recurrence (22%) and 6 (26%) had severe functional debility secondary to combined radiation therapy and T-2 chemotherapy. The conclusions drawn from this experience have led us to consider a new approach to the treatment of Ewing's sarcoma, namely: 1) more aggressive initial or "induction" chemotherapy with subsequent T-2 "maintenance" chemotherapy to eradicate more completely all metastatic microfoci of disease presumed to be present in patients with primary tumor at the time of diagnosis, and ostensively present in patients with metastatic disease; 2) the use of surgery alone or in combination with moderate doses of radiation therapy in those patients in whom we can predict a high frequency of local recurrence (pelvic lesions) or a high percentage of "functional failures" (young children with lower extremity lesions). Preliminary results with this latter approach are encouraging with 11/13 patients with primary Ewing's sarcoma free of disease at 12+-26+ months. A longer follow-up of this more aggressive treatment is needed to determine the superiority of this approach for both increased survival and improved late physical rehabilitation.

Child↗
PubMed1978

Cryosurgery in the treatment of giant cell tumors of bone. A report of 52 consecutive cases.

Cryosurgery combined with routine "second look" biopsy has been previously reported in our initial series of 25 cases and has been demonstrated to be a promising modality in the treatment of giant cell tumors of bone. Further refinement of this surgical technique by more careful preliminary curettage has now significantly improved the rate of local tumor control and has markedly reduced the incidence of associated complications. While the problems of infection, fracture, delayed bone healing and local tumor recurrence have not been completely eliminated, our experience with 27 additional cases shows that it has been possible to develop a highly reliable procedure for the eradication of tumor while usually preserving joint motion and avoiding arthrodesis or amputation. The 1.9% malignancy rate is much lower than the previously reported papers by Hutter and Jaffe.

Adolescent↗
PubMed1978

Epithelioid sarcoma: an analysis of 22 cases indicating the prognostic significance of vascular invasion and regional lymph node metastasis.

Twenty-two cases of epithelioid sarcoma seen and/or treated at Memorial Hospital are presented. With the exception of one tumor which occurred in the neck, all the sarcomas arose in the upper (15 cases) or lower extremities (6 cases). Ten originated in the hand. At the time of initial treatment, 14/22 patients were between 20 and 40 years of age. The tumor most commonly presented as a nodular lesion and involved dermis, subcutaneous tissue, fascia and tendons, and when it recurred (13 cases) it tended to grow proximally along tendons and fascial planes. Of special interest was the finding of vascular invasion in surgical specimens removed from 5 patients. Four of these represented recurrent tumor, and in two cases the vascular invasion was massive. Two of these patients also demonstrated tumor emboli in pulmonary vessels and cardiac involvement at autopsy. Metastasis to regional lymph nodes occurred in eight cases (42%). Follow-up ranging from 2 to 34 years (average of 8 years) was obtained for 19 cases (86%). Eleven patients are alive with disease or died as a result of their sarcoma (58% of the follow-up group). Adverse prognostic factors included recurrence after initial local excision, vascular invasion and lymph node metastasis. All of the patients with intravenous extension of tumor and 6 of 8 patients with lymph node involvement died with pulmonary metastases. Our data suggest that cure may best be achieved by amputation or by an exceptionally wide en bloc excision as early as possible, depending upon the location and extent of the original tumor.

Adolescent↗
PubMed1978

Chondrosarcoma of the spine.

Involvement of the spine by chondrosarcoma is rare. Three recent cases involving the cervical with or without extension to the thoracic spine are reported. Detailed radiologic investigations to evaluate the extent of the disease are essential to management. Computerized axial tomography and angiography were performed in 1 case and were extremely helpful. Surgical resection of the lesion is the only currently effective method of treatment, but long-term survival figures are not good.

Adolescent↗