Search PubMed⌕ Search

Biomedical subjects

R Musumeci

Publications and source records attributed to R Musumeci.

At least 55 records · Page 3Linked to original sources
PubMed1987

Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy.

In an attempt to reduce some of the delayed sequelae associated with combined modality therapy in Hodgkin's disease, we randomly tested stages IIB, IIIA, and IIIB MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) v ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine). In 232 previously untreated patients, three cycles of either combination preceded and followed extensive irradiation. The complete remission rate was 80.7% following MOPP and 92.4% following ABVD (P less than .02). The 7-year results indicated that ABVD was superior to MOPP in terms of freedom from progression (80.8% v 62.8%; P less than .002), relapse-free survival (87.7% v 77.2%; P = .06), and overall survival (77.4% v 67.9%; P = .03). Moreover, the comparative iatrogenic morbidity showed that irreversible gonadal dysfunction as well as acute leukemia occurred only in patients subjected to MOPP, while cardiopulmonary studies failed to document significant laboratory differences between the two treatment groups. Present findings indicate that ABVD followed by extensive irradiation represents a valid therapeutic alternative to the widely used alkylating agent-containing regimens plus radiotherapy.

Adult↗
PubMed1987

Reliability of diagnostic imaging after orchiectomy alone in follow-up of clinical stage I testicular carcinoma: excessive cost with potential risk.

From 1981 to 1984, 86 consecutive patients with previously untreated nonseminomatous testicular carcinoma were classified as clinical radiological stage I and treated with orchiectomy alone. The follow-up program included chest x-ray and lymphangiography (LAG) every month and abdominal computed tomography (CT) bimonthly. All patients were followed for 15 to 63 months after orchiectomy (median 32 mo.). Metastases developed in 23 patients (26.7%) and in 13/23 there was retroperitoneal lymphadenopathy. Time of relapse after orchiectomy ranged from 2 to 36 months (median 7 mo.) with a shorter interval for chest (4 mo.) compared with retroperitoneal metastases (7 mo.). Lung metastases were readily identified at an early stage (less than 2 cm) whereas more than one-third of retroperitoneal nodal metastases were greater than 5 cm at time of diagnosis. LAG detected metastases in 8/11 patients (72.7%), abdominal CT in 8/10 (80%), and both together (LAG and CT) 7/8 (87.5%). In clinical stage I nonseminomatous testicular carcinoma, the high incidence of concomitant but often asymptomatic regional and distant metastases and the relatively high cost and inconvenience of follow-up using abdominal CT imaging, LAG and chest x-ray suggest that orchiectomy is best combined with retroperitoneal node dissection at time of initial presentation to insure more accurate and safe staging of tumor dissemination.

Follow-Up Studies↗
PubMed1986

Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.

Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.

Adolescent↗
PubMed1986

[Study of adenopathies: what is the current role of magnetic resonance?].

The actual role that MR imaging can play in detection of adenopathies in different body sites has been evaluated in 54 oncologic patients with pathologic nodes already seen with other methods. Enlarged lymph-nodes seen by CT or ultrasound were all visible by MR as well. Relaxation times of pathologic tissue (T1-T2) were calculated at a 0,5 magnetic field: it's our opinion that at present it's not already possible to state the capability of MR to distinguish different pathologic tissues.

Evaluation Studies as Topic↗
PubMed1985

Lymphangiography and computerized tomography in testicular carcinoma: how accurate in early stage disease?

The usefulness of lymphangiography and computerized tomography was evaluated in 167 consecutive patients with pathological stages I and II testicular carcinoma and metastases of less than 5 cm. Lymphangiography demonstrated 74.4 per cent sensitivity, 77.6 per cent specificity and 76.0 per cent over-all accuracy. Computerized tomography revealed comparable results, with 74.3 per cent over-all accuracy, 73.7 per cent sensitivity and 75.0 per cent specificity. The combination of lymphangiography and computerized tomography performed in 35 patients consistently improved the diagnostic possibilities of either technique alone in patients with positive nodes, reducing the false negative rate from 27 to 10 per cent. On the other hand, this combination increased the false positive rate from 25 to 37 per cent in patients with negative nodes. In patients with clinical stage I disease for whom a wait-and-see policy after orchiectomy is adopted at our institute both methods must be considered mandatory. In all other situations computerized tomography alone should be the preferred procedure in the diagnosis of retroperitoneal lymph node metastases from testicular carcinoma.

Carcinoma↗
PubMed1984

Indirect lymphography of the breast with iotasul: a vanishing hope?

Using a new aqueous nonionic contrast medium (Iotasul, Schering) we attempted visualization of axillary lymph nodes in patients with breast carcinoma. Intradermal infusion into the areola consistently opacified the subareolar plexus and latero-cranial lymphatic trunk. Axillary nodes were visualized in 78.6% of patients, but only 5.7% of surgically excised nodes were partially or totally opacified. Eleven patients underwent axillary lymph node dissection and histology confirmed metastases in 4, of which only two were detected by lymphography. Breast lymphography is inadequate for routine clinical application, and radical axillary dissection remains the mainstay for documentation of nodal metastases.

Breast Neoplasms↗
PubMed1983

[Histiocytosis X: radiologic evaluation of 52 patients].

Fifty-two patients with histologically proven histiocytosis X and intrathoracic and/or bone lesions have been evaluated. In the group, bone lesions appear clearly prevalent (51/52 patients) mainly as localized monostotic disease (31/51). Flat bones were more frequently involved, with special evidence for skull and ribs. Short as well as long bones were only seldom compromised, almost only in polyostotic and generalized disease. On the basis of our experience the most suggestive radiological findings in bone to diagnose an histiocytosis X were the following: preferential involvement of a flat bone, osteolytic pattern, sharp borders (72.9%), rare evidence of pathological fracture (20%) and periostitis (10%). On the contrary, the involvement of the neighbouring soft tissues (38.8%) appears to be significant.

Adolescent↗
PubMed1982

Natural history of dysgerminoma.

Data on 56 patients with pure dysgerminoma are discussed. Forty-nine patients were classified as having new disease or were to have reassessment of disease, and seven cases were to be restaged (one with and six without clinical evidence of disease). Of new and reassessment cases, 44 patients underwent lymphography, 16 underwent peritoneoscopy with diaphragmatic inspection and 30 had peritoneal cytologic testing performed. Positive lymphography resulted in restaging in 31.6% of patients. Diaphragmatic inspection was always negative. Peritoneal cytologic testing was positive for malignant cells in three patients and worsened the stage in one. Pathologic staging of disease was as follows: Stage IA, 24; Stage IB, one Stage IC, one; Stage III peritoneal disease, two. Stage III retroperitoneal disease, 12; Stage III peritoneal and retroperitoneal disease; four. The 5-year relapse-free survival rates were 91% in patients with pathologic Stages IA, IB, and IC; 74% in those with Stage III retroperitoneal disease, and 24% in patients with Stage III peritoneal disease or peritoneal plus retroperitoneal disease. The results indicate that the prognosis is excellent for patients with Stage I and Stage III retroperitoneal disease whereas peritoneal involvement is associated with a poor prognosis.

Adolescent↗
PubMed1982

Endometrial carcinoma: stage I. A retrospective analysis of 262 patients.

From 1969 to 1977, 420 patients with endometrial carcinoma were observed and treated at the National Tumor Institute of Milan. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed in 351. After careful clinical and pathologic review, 262 patients were classified as having stage I disease. Further treatment included post-operative radium therapy to the vaginal vault. There were 247 cases with adenocarcinoma, 10 with adenoacanthoma, and 5 with adenosquamous or clear cell carcinoma. Of 257 cases with adenocarcinoma or adenoacanthoma, 63 were grade 1, 161 grade 2, and 33 grade 3. Of the total series, only 41 cases had disease limited to the mucosal surface. The 5-year actuarial survival was 91.4% and the recurrence-free survival was 93.4%. The case material was evaluated according to the risk factors, and results were 1) premenopausal patients had a better prognosis (100% recurrence-free survival versus 92.8% for postmenopausal women, P = .003); 2) length of the uterine cavity was not a significant prognostic factor; 3) myometrial invasion alone was not prognostic but correlated with grade of tumor; 4) the grade of the tumor was an important determinant of recurrence (grade 1 98% recurrence-free survival, grade 2 95%, grade 3 79%). With the described therapy, vaginal recurrences were absent. The recurrences were distant in 20% and local with or without distant metastases in 80%.

Adenocarcinoma↗
PubMed1981

Staging and surgery in testicular cancer.

Both staging and surgery in testicular cancer are thoroughly analysed. Extensive experiences from various authors are reported and compared. The essentials for staging are suggested and a new detailed stage grouping is proposed. The role of surgery in diagnosis, staging and therapy is examined. It is stressed that in non-seminomas, retroperitoneal lymph node dissection is not only a staging procedure, but it may be also a curative operation in several cases of patients with lymph node metastases and a prospective randomized clinical trial is advocated in order to clarify the usefulness of adjunctive chemotherapy in these cases. Surgery is also useful as adjuvant to chemotherapy in several patients with advanced non-seminomas and it is underlined that it should be undertaken early, after only 2 or 3 cycles of chemotherapy, in order to avoid the strong fibrosis that often occurs after long-term chemotherapy and which makes surgical dissection very difficult or even impossible. Lastly, even if extensive, surgery seems to be a safe procedure in these young patients.

Antineoplastic Agents↗
PubMed1981

A clinical and pathologic study of 34 sarcomas of the uterus.

The clinical and pathologic features of 34 uterine sarcomas were studied to determine the natural history of the disease. Sixteen patients had leiomyosarcoma, five mixed mesodermal sarcoma, ten endometrial stromal sarcoma, two carcinosarcoma and one endolymphatic stromal myosis. The patients were treated without an unique protocol. At 3 years the actuarial relapse-free survival was 53.6%: 68.4% in stage I-II patients and 22.2% in stage III-IV patients. As regards the histologic subtype mixed mesodermal sarcomas had the best prognosis; endometrial stromal sarcomas the worst. The necessity of a uniform clinical and histologic classification as well as the importance of controlled clinical trials are pointed out.

Adult↗
PubMed1981

Restaging of patients with ovarian carcinoma.

Sixty-four patients, 34 with no clinical evidence of disease (NED) and 30 with clinical evidence of disease (ED), were submitted to restaging with peritoneoscopy plus diaphragmatic inspection, peritoneal cytology, and lymphography. Eleven patients (32.2%) in the NED group and 25 (83.3%) in the ED group had positive restaging findings. The 3 diagnostic procedures, in combination, are important in establishing occult disease and therefore in the planning of further treatment.

Female↗
PubMed1980

Lymphography in bone and soft tissue sarcomas. Experiences from three institutions.

The case material was collected from 3 Institutions with a total of 441 patients: 217 with primary bone tumor and 224 with soft tissue sarcomas. In the majority of patients lymphography was performed during the initial diagnostic workup. The lymphograms were interpreted as negative or positive for metastases. In bone tumors, the incidence of metastases was 21%, ranging from 28% for osteosarcoma to 18% for Ewing's sarcoma and 13% for chondrosarcoma. In tumors of the soft tissue, the frequency was somewhat higher (28%), with special regard to rhabdomyosarcoma (53%), anaplastic sarcoma (67%), neurogenic sarcoma (42%) and synovial sarcoma (35%). In the group of bone sarcomas, primary hematogenous spread was 3 times more frequent than lymphogenous spread, while in soft tissue sarcomas, with a higher incidence of lymphatic spread, this finding was inverted. In the more consistent tumor groups, the occurrence of lymphatic metastases indicated a significant worsening of the prognosis. In 96 patients, lymph node biopsies were performed and the radiologic histologic correlation gave evidence of a 97.7% overall diagnostic accuracy.

Bone Neoplasms↗
PubMed1980

Are retroperitoneal lymph node metastases a major problem in endometrial adenocarcinoma? Diagnostic and prognostic assessment with lymphography.

The results of foot lymphography in 295 patients with endometrial carcinoma observed from 1968 to 1978 at two institutions are reported. One hundred and eighty-two were new cases, 61 were recurrences, and 52 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The incidence of lymphatic spread was correlated with the clinical stage, the pathologic stage, and the extent of recurrent disease. In fact, in the 182 new cases, at clinical stage, the pathologic stage, lymphography was positive in 8.9% of patients at Stage I, 28.6% at Stage II, 57.1% at Stage III, and 66.6% at Stage IV disease; at pathological stage, lymphography was positive in 8% of patients at Stage I, 14.8% at Stage II, 39.3% at Stage II, and 53.3% at Stage IV disease. There was lymph node involvement in 47.5% of the 61 pretreated patients. Finally, in 52 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7.7%. In new cases, metastases were found only in the pelvic nodes in 56.2% of the patients and only in the para-aortic nodes in 9.5%; in 34.3%, both chains were simultaneously involved. The five-year survival rate for patients at Stage I, II, and III disease with positive lymphography was 35% as compared with 73% for negative cases. In patients at Stage I and II, the difference of survival was equal to 24%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-pathologic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct plan of treatment.

Adenocarcinoma↗