MENINGEAL TUMOURS WITH EXTRACRANIAL METASTASES: REPORT OF A CASE.
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Brain Neoplasms↗
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RHABDOMYOSARCOMA; CASE REPORT OF LONG TERM PALLIATION BY IRRADIATION.
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Bone Neoplasms↗
[Meaningful possibilities of palliative therapy of incurable mouth and pharyngeal neoplasms and their recurrence].
In incurable cancer of the mouth and oropharynx, reasonable palliative therapy should render the patient's remaining life-span worth living. The following problems impair tumor patient's well-being: 1. pain, 2. ingestive and respiratory difficulties, 3. aspect, 4. odor, 5. psychic trauma resulting from 3 and 4. Pain, either caused by the tumor itself or as a reaction to irradiation or inflammatory response, is of primary importance. Impairment of ingestion, respiration, and speech diminishes the quality of life. Disfigurement of the face or a penetrating odor may sometimes cause additional psychic stress. Besides palliative radio- and chemotherapy, in certain cases palliation can be obtained by surgery, which may reduce the size of a cosmetically disturbing tumor mass or create a clean wound surface easier to care for than a necrotic surface. Furthermore, painful neuralgic nerve branches may be severed. Severe lymphedema of the face and neck may be improved by lumbo-peritoneal shunt operation. Most recently, cryosurgery has won an established place in the management of these problems, although certain restrictions must be observed. Superficial recurrences can be treated without further mutilation of the patient. Painful areas of the tumor can be eradicated. Recurrences in the hypopharynx, which are accessible with difficulty only, can be treated with a cryosonde with little harm to an already impaired patient. Multiple tumor lesions can be iced at the same time. Among the reasonable palliative methods of treatment, synchronized irradiation and chemotherapy as well as implantation of solid radioactive substances must be mentioned.
Analgesia↗
Amplification and expression of the epidermal growth factor receptor gene during the progression of neuroepithelial tumours in vivo.
The epidermal growth factor receptor (EGFR) gene is homologous to the oncogene c-erbB. The occurrence of amplification and rearrangements at the EGFR gene locus is associated with malignancy in neuroepithelial tumours. Sixteen neuroepithelial tumours from eight patients with recurrence of their neoplasms were analysed for changes at the EGFR gene locus and for expression of EGFR. Ten tumours from five patients lacked changes at the EGFR gene locus. Three of eight individuals showed EGFR gene amplifications in both tumours with a higher grade of amplification in the second tumour. In addition to amplification, a rearrangement was found in both tumours of the first patient. In the second case an amplification of chromosome-7-specific c-met sequences was found in the regrown tumour, suggesting that a polysomy 7 was at least partly responsible for the higher copy number of the EGFR sequences. In both tumours of the third patient with EGFR gene amplification different alleles were amplified. In contrast to the findings at the DNA level the EGFR expression, analysed by immunohistochemical techniques, showed a more heterogeneous pattern after tumour progression.
Adult↗
Prostatic adenocarcinoma in a cat.
Prostatic adenocarcinoma was diagnosed in an 11-year-old neutered cat. Clinical signs of the disease included hematuria and a mass in the caudal portion of the abdomen. Prostatectomy was performed. Doxorubicin was administered IV at a dosage of 30 mg/m2 of body surface, followed by cyclophosphamide (300 mg/m2, IV). After 4 treatments, low urine specific gravity and proteinuria developed, and treatment was discontinued. The cat was euthanatized 10 months after surgery because of recurrence of the neoplasm. Necropsy revealed metastasis to the lungs and pancreas.
Adenocarcinoma↗
[Simultaneous radiochemotherapy in recurrent and metastatic breast neoplasm. Clinical experience].
BACKGROUND: To improve the quality of life for patients with recurrent and metastatic breast cancer, palliation of pain, skin and soft tissue metastases and complicating lymph node relapses are mandatory. Toxicity and efficacy of 2 simultaneous radiochemotherapy regimens was tested in this study. PATIENTS AND METHODS: From October 1989 to March 1993, 48 patients with locoregional relapse of breast carcinoma after primary mastectomy and no option for curative resection were entered in the study. Seventeen patients had additional distant metastases. Two different radiochemotherapy regimens were applied: Group A (28 patients) received a "split course" radiotherapy within 10 weeks (1.8 to 2 Gy single dose) on day 1 to 12, 29 to 40 and 57 to 68 up to a total dose of 54 Gy. Chemotherapy with 5-FU, methotrexate and cyclophosphamide was applied simultaneously with radiation. After the second and fourth week the treatment was interrupted for 2 weeks. Group B (20 patients) received "conventional" radiotherapy over 6 weeks with 1.8 to 2 Gy single and 54 Gy total dose. 5-FU and mitomycin C was applied in the first and fifth week of radiotherapy. Treatment toxicity was analyzed in 48 patients, while treatment efficacy was assessed in 44 patients with a minimum follow-up of at least 1 year. RESULTS: Overall treatment response (CR+PR) was 82% in group A (CR 21%). Five of 28 patients developed toxicities of grade 3 to 4 (EORTC/RTOG/WHO). The overall response rate in group B was 87% (CR 19%). In this group 6 of 20 patients experienced toxicities of grade 3 to 4. In both groups, the local response rate was remarkably reduced in patients with additional visceral metastases. CONCLUSIONS: Both treatment concepts achieved similar response rates. Group B patients experienced a higher toxicity rate, but treatment duration was considerably shorter. The local response rate correlated well with the extent of systemic metastatic disease.
Antibiotics, Antineoplastic↗
Giant desmoid tumor of the abdominal wall masquerading as recurrent testicular cancer.
A huge abdominal mass developed 4 years after successful chemotherapy and laparotomy for stage III embryonal testicular cancer. Complete surgical extirpation proved that this lesion was a desmoid tumor of the abdominal wall and not a recurrent germ cell neoplasm. Fortunately, this mass was excised and not treated by aggressive chemotherapy.
Abdominal Neoplasms↗
[Pelvic and perineal recurrence after amputation of the rectum for a neoplasm].
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Humans↗
Percutaneous endoureterotomy of uretero-ileal stenosis in the Camey-Le Duc substitution bladder. Our experience in two cases.
Two patients with a Camey-Le Duc substitution bladder who presented monolateral uretero-ileal stenosis were treated by percutaneous endoureteral incision using electrocautery and moulding stents. The results were encouraging in one patient after 12 months follow-up. In the other case, however, endourological manipulation had solely symptomatic purpose since the stenosis was caused by local recurrence of primitive neoplasm.
Carcinoma, Transitional Cell↗
CT and MR appearance of recurrent malignant head and neck neoplasms after resection and flap reconstruction.
PURPOSE: To describe the appearance of recurrent malignant neoplasms in patients who have undergone resection of primary head and neck tumors with flap reconstruction. METHODS: Thirty-two examinations, 26 CT and 6 MR scans, were retrospectively reviewed in 25 patients with documented recurrent malignant neoplasms. Confirmation of disease was by biopsy or disease progression. The flaps included 15 myocutaneous, 6 free composite, 2 jejunal free grafts, and 2 combined jejunal and myocutaneous flaps. RESULTS: The most common location of recurrence was in the primary tumor bed involving the undersurface or suture line of the reconstruction flaps, 14 of 32 scans; both nodal and flap recurrence was seen in 12 of 32 scans. CONCLUSIONS: When examining patients who may have recurrent disease after flap reconstruction, the radiologist should be aware of the type of flap used and the expected appearance. Tumor recurrence in this patient population is manifest either as a focal recurrent mass at or near the suture line of the reconstruction flap, or nodal disease, usually in the contralateral neck.
Adult↗
Decreased interstitial cells of Cajal in the neorectum after anterior resection of the rectum.
BACKGROUND/AIMS: Patients who have undergone anterior resection for rectal carcinoma often complain of anorectal and defecatory dysfunction postoperatively. The aim of this study was to examine the expression of interstitial cells of Cajal (ICCs) in the sigmoid colon used for constructing the neorectum after anterior resection of the rectum. METHODOLOGY: As the neorectum group, we assessed 12 patients with local and anastomotic recurrence or new neoplasm in the neorectum after anterior resection of the rectum. The control group consisted of 16 patients who underwent sigmoid colon resection for sigmoid colon carcinoma. All resected specimens were investigated with immunohistochemical staining, using c-kit antibody for ICCs. The correlation between the number of ICCs and defecatory symptoms was assessed for the neorectum. RESULTS: The total number of ICCs significantly decreased in the neorectum group as compared to the control group. In particular, a significant difference was noted between the two groups as to the number of ICCs found between the layers of the myenteric plexus in histological studies, as well as in the circular and longitudinal muscles. There was no correlation between the number of ICCs and the time interval from the initial anterior resection to the resection of the neorectum, nor was there any relationship between the number of ICCs and defecatory symptoms. CONCLUSIONS: The expression of ICCs in the neorectum was reduced in the early stages after anterior resection of the rectum. Expression of ICCs in the neorectum did not recover to preoperative levels over time.
Adult↗
ON THE QUESTION OF RECURRENCE OF OSTEOCHONDROMA.
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Bone Neoplasms↗
Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin.
The clinical and pathologic features of 22 examples of pure ductal squamous cell carcinoma (SqCC) of the breast are reported. All patients were women with a mean age of 53 years. Only two of the 19 women with axillary dissection had metastases, but one woman had a positive supraclavicular lymph node in the presence of negative axillary nodes. All metastases were squamous carcinoma. All patients were eligible for a minimum of 5 years' follow-up; the cumulative 5-year disease-specific survival rate was 63%. Eight women developed metastases and one also developed local recurrence, all within 2 years, and all eight died from tumor within 4 years of initial therapy (mean, 2 years). Prophylactic postoperative radiation therapy and radiation for lymph node metastases at initial surgery did not prolong survival as four of the five recipients died from tumor. Although there were no statistically significant gross or histologic differences between recurrent and nonrecurrent neoplasms, larger neoplasms tended to metastasize. Immunohistochemical study for S-100 protein identified an immunoreactive cell component in five of seven neoplasms tested. This and light microscopic findings suggest myoepithelial proliferation, differentiation, or origin.
Adult↗
Tamoxifen for relapse of ovarian cancer.
BACKGROUND: Tamoxifen is an important drug for treating breast cancer. Ovarian cancer cells are known to possess receptors for hormones and may thus also respond to tamoxifen. OBJECTIVES: Tamoxifen is used to treat breast cancer in women whose tumours have oestrogen receptors. Since ovarian cancers also commonly have oestrogen receptors, it has been suggested that tamoxifen may be of some benefit. The objective of this review was to assess the effects of tamoxifen in women with relapsed ovarian cancer. SEARCH STRATEGY: We searched the Cochrane Gynaecological Cancer Group trials register and references from relevant articles. We also contacted researchers and drug companies. SELECTION CRITERIA: Randomised and non-randomised studies of tamoxifen in women with ovarian cancer who have not responded to conventional chemotherapy. Only trials involving 10 or more patients were included. DATA COLLECTION AND ANALYSIS: One reviewer assessed eligibility and extracted data from non-randomised studies. Two reviewers were to have independently assessed the quality and extracted data from any randomised trials found. MAIN RESULTS: Eleven non-randomised series, one non-randomised phase two study and one randomised trial were included. Only observational data from women treated with tamoxifen are reported. Fifty-nine of 568 women (10.4%) treated with tamoxifen achieved an objective response to treatment. However this varied from 0% to 56% in different studies. Stable disease, for variable periods of four weeks or more, was observed in 109 of 356 (30.6%) women from eight studies. There were not enough data to assess duration of response, survival, or the palliative effect of tamoxifen on symptom control or quality of life. REVIEWER'S CONCLUSIONS: There is some evidence from observational studies that tamoxifen may produce a response in a modest proportion of women with relapsed ovarian cancer. However, there are no reliable data from randomised controlled trials.
Antineoplastic Agents, Hormonal↗
Recurrence of brain tumours in patients treated with growth hormone: analysis of KIGS (Pfizer International Growth Database).
BACKGROUND: Growth hormone (GH) has been used successfully in the treatment of short stature secondary to GH deficiency in survivors of childhood brain tumours. There has been concern that GH might increase the risk of recurrence. AIM: To analyse KIGS (Pfizer International Growth Database) with respect to tumour recurrence in patients with brain tumours. METHODS: Data for tumour recurrence were analysed retrospectively in 1038 patients with craniopharyngiomas, 655 with medulloblastomas, 113 with ependymomas, 297 with germinomas, and 400 with astrocytomas or gliomas. All patients had received recombinant human GH (Genotropin, Pfizer Inc.). RESULTS: Recurrence-free survival rates were 63% at a follow-up of 10.3 y in craniopharyngioma, 69% in 9.1 y in the glial tumours, 71% in 7.4 y in germinomas, 92% in 4.6 y in medulloblastomas and 89% in 2.5 y in ependymomas. Dose of GH and treatment modalities did not differ significantly between patients with and without recurrence. CONCLUSION: Tumour recurrence rates in surviving patients with brain tumours receiving GH treatment do not appear to be increased compared with published reports. However, longer follow-up regarding recurrences and secondary neoplasms remains essential.
Adolescent↗
Myeloablative chemotherapy for recurrent aggressive oligodendroglioma.
The objective of this study was to ascertain the duration of tumor control and the toxicities of dose-intense myeloablative chemotherapy for patients with recurrent oligodendrogliomas. Patients with previously irradiated oligodendrogliomas, either pure or mixed, that were contrast enhancing, measurable, and behaving aggressively at recurrence were eligible for this study. Only complete responders or major partial responders (75 % reduction in tumor size) to induction chemotherapy--either intensive-dose procarbazine, lomustine, and vincristine or cisplatin plus etoposide-could receive high-dose thiotepa (300 mg/m2/day for 3 days) followed by hematopoietic reconstitution using either bone marrow or peripheral blood stem cells. Thirty-eight patients began induction chemotherapy and 20 (10 men, 10 women; median age 46 years; median Karnofsky score 80) received high-dose thiotepa. For the high-dose group, the median event-free, progression-free, and overall survival times from recurrence were 17, 20, and 49 months, respectively. Tumor control in excess of 2 years was observed in 6 patients (30%). Four patients (20%) are alive and tumor free 27 to 77 months (median, 42 months) from the start of induction therapy; however, fatal treatment-related toxicities also occurred in 4 patients (20%). Three patients died as a result of a progressive encephalopathy which, in 2 instances, was accompanied by a wasting syndrome; 1 patient died as a consequence of an intracerebral (intratumoral) hemorrhage. Fatal toxicities occurred in patients with pretreatment Karnofsky scores of 60 or 70. High-dose thiotepa to consolidate response was a disappointing treatment strategy for patients with recurrent aggressive oligodendroglial neoplasms, although several patients had durable responses. Moreover, as prescribed, high-dose thiotepa had significant toxic effects in previously irradiated patients, especially those with poorer performance status.
Adult↗
Canine orbital meningiomas: a review of 22 cases.
Clinical and pathologic features of primary orbital meningiomas in the dog were reviewed. Twenty-two meningiomas, confined to the orbit, were identified from the Comparative Ophthalmic Pathology Laboratory of Wisconsin from 1981 to 1997. The dogs ranged in age from 3 to 17 years (mean = 9.2 years). The clinical presentation, reported in 20 cases, was indicative of a retrobulbar mass and included exophthalmos and orbital swelling (18/20), and papilledema or abnormalities of the posterior segment (7/20). Visual acuity was reported in 15 cases; of those, 12 dogs were blind in the affected eye. Follow-up information was obtained on 17 cases; six dogs developed local recurrence of the neoplasm. Two dogs with recurrent neoplasms simultaneously developed blindness in the opposite eye. Extension along the optic nerve to the optic chiasm was suspected. No metastasis was found at the time of the study. Enucleation with excisional biopsy was effective therapy to date in 11 cases (0.2-4.5 years follow-up time). All neoplasms were located within the vicinity of the optic nerve and, when sectioned through the optic nerve head, appeared to completely envelope the nerve. The neoplastic cells were arranged in tight whorls and bundles characteristic of meningiomas. Most tumors had islands of chondroid and osseous metaplasia (17/22). Ocular invasion was limited to small foci in the posterior choroid or optic nerve head of six dogs. Immunoperoxidase stains on 10 cases were positive for vimentin and S-100, but negative for cytokeratin. Electron microscopy revealed complex interdigitations between cell membranes and few desmosomal intercellular attachments. Primary orbital meningiomas have a characteristic histologic appearance and may recur locally after surgical excision.
Journal Article↗
Perspectives in the treatment of breast cancer: 1976.
Breast cancer is the major cancer killer of women in the United States. Recent advances in therapy promise more effective control of this illness. The development of hormone receptor analysis permits us to better understand the mechanisms of action of steroid and peptide hormones and increases the likelihood of using there hormonal agents effectively. Prospective surgical and surgical adjuvant trials offer the opportunity to define accurately the appropriate surgical procedure and most effective postoperative therapy after initial surgery. The development of chemotherapy, first singly and now in combination, has led to improved treatment of patients with advanced disease and defined better chemotherapy for use in adjuvant settings. The investigation of a matrix of marker substances in breast cancer may uncover new methods to assess residual disease and to monitor disease recurrence.
Breast Neoplasms↗