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PubMed1978

Indications for radical neck dissection following radiation therapy.

The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.

Evaluation Studies as Topic↗
PubMed1976

Second malignant neoplasms associated with immunosuppressive medications.

Previous studies have shown that immunosuppressive therapy permits the growth and spread of inadvertently transplanted malignant cells in man, and, in addition, is associated with a 5 to 6% incidence of de novo cancers in organ homograft recipients who were apparently free of cancer before and at the time of transplantation. In the present report two further groups of patients were studied. There was a 4% incidence of new tumors in 101 organ homograft recipient- who had had pre-existing cancers. The immunosuppressive effects of cancer chemotherapeutic agents may have been responsible for the development of 166 new malignancies in 160 patients who received treatment for 161 neoplasms. This does not contraindicate the use of chemotherapy in patients with advanced or widespread neoplasms, as the occasional development of new malignancies is far outweighed by the many months or years of control of the original tumors.

Humans↗
PubMed1976

Feasibility study of active immunotherapy in patients with solid tumors.

Forty-five immunocompetent patients with solid tumors were immunized with BCG, PPD, and tumor cells. The methods were practical, but the morbidity was significant, including painful draining ulcerations at vaccine sites, possible enhancement of tumor growth in three patients, and the discovery at autopsy of systemic tuberculosis in one patient. Various facets of cellular immunity were altered, namely: 1) a majority of the patients developed enhanced cutaneous reactions to the microbial skin-test antigens (particularly tuberculin) and tumor cells; 2) nine patients developed the equivalent of delayed hypersensitivity reactions or flares at all previous PPD and BCG inoculation sites following subsequent injection of these agents, which supports the concept of immunologic memory for these target antigens; 3) lesions resembling those of "spontaneous" regressed moles (halo-nevi) were observed at previous vaccine sites in 20 patients and generalized depigmentation occurred in three patients; 4) foreign body giant cells in tumor metastasis remote from BCG-PPD-tumor vaccine sites may indicate a cross-reactivity of microbial and tumor antigens; and 5) intralesional inoculation of the nonspecific agents (BCG, PPD, Varidase, and Mumps) resulted in dense mononuclear cell infiltration and complete regression of most of the injected lesions. Destruction of single or multiple lesions by local injections of antigens did not provide either significant regression of uninjected lesions or clinical benefit.

Abscess↗
PubMed1977

Malignant mixed tumor of salivary origin: a clinicopathologic study of 146 cases.

A 30-year Memorial Hospital experience with 146 patients with malignant mixed tumor is reviewed. These comprised 5% of 2,743 patients who were treated for salivary neoplasms from 1939 through 1968. The tumors arose in the parotid gland in 108 patients, submaxillary gland in 23 patients, mucus or so-called minor salivary glands in 16 patients, and sublingual gland in one. In terms of our total experience, 11% of all submaxillary tumors proved to be of the malignant mixed variety as compared to 6% of parotid tumors and 3% of minor salivary tumors, respectively. Seventy-one patients (48%) had previously received therapy elsewhere. Results of treatment are presented and the factors which influenced the results are discussed.

Adenocarcinoma↗
PubMed1977

Malignant tumors of the testis: analysis of treatment results and sites and causes of failure.

A total of 150 patients with germinal testicular neoplasms treated at the University of California, San Francisco, were reviewed. The 5-year actuarial survival rate was 95% for 57 patients with seminoma and 56% for 75 patients with carcinoma. Treatment modalities were compared with respect to sites and causes of failure and complications. The most common sites of failure in the carcinoma patients were lung, and supraclavicular or mediastinal lymph nodes. Scrotal orchiectomy, elevated gonadotropins, elements of choriocarcinoma, and bulky abdominal disease were all correlated with high treatment failure rate.

Carcinoma↗
PubMed1977

Naked megakaryocyte nuclei: a clue to malignancy.

Bone marrow smears from 63 patients with various malignancies and a series of 51 controls were examined for the presence and percentage of naked megakaryocyte nuclei (NMN). Patients with malignancy had more than 15% NMN, which, when compared with the incidence in controls, was statistically significant. The etiology of this artifact is unknown. It is a clue to the presence of malignancy, and might be useful in following treated cases of malignancy for evidence of relapse. NMN should not be confused with metastatic malignant cells.

Cell Nucleus↗
PubMed1978

Carcinoma of the pyriform sinus. An analysis of treatment results and patterns of failure.

A retrospective review of 169 patients with carcinoma of the pyriform sinus was accomplished for a ten-year-period from 1964 to 1974. Of the 169, 80 (47%) were treated with low dose preoperative radiation and partial laryngopharyngectomy (PLP), 57 (34%) were treated with radiation and total laryngectomy-partial pharyngectomy (TLP), and 32 (19%) were treated with palliative radiation, surgery or chemotherapy. Act,arial five-year-survival was 31% for all cases, 59% for the PLP group, 21% for the TLP group and 4% for the palliation group. Eighty to 90% of the relapses occurred within two years. The primary and/or nodal failure rates were 23, 37 and 78%, respectively for the PLP, TLP and palliation groups while the distant metastasis rates were 15, 37 and 34% for the three groups. Sites of failure differed for the three groups with a relatively high rate of contralateral neck metastases (23%) in the TLP group and an overwhelming number of primary and ipsilateral failures (78%) in the palliation group. Retreatment of failures resulted in few salvages (15%) and a significant number of fatal complications (26%). The cause of death was tumor related in most cases.

Carcinoma, Squamous Cell↗
PubMed1978

Synchronous malignant glandular schwannomas in congenital neurofibromatosis.

An eight-year-old child with congenital neurofibromatosis developed rapidly growing synchronous malignant schwannomas in the neck and mediastinum. These tumors, displaying a biphasic pattern of spindle cell sarcoma admixed with mucinous epithelium, represent the eighth and ninth known examples of glandular schwannoma. The clinical and pathological features of this case are detailed and the histogenesis of the tumors discussed.

Child↗
PubMed1979

Radiation management of carcinoma of the cervical stump.

In spite of a low incidence of carcinoma of the cervical stump at the present time, the management of this interesting disease deserves special attention because of the success which can be obtained with proper treatment. We have reviewed our cervical stump cases treated at the University of Maryland Hospital, Department of Radiation Therapy, from 1962 to 1973. Of 107 cases treated, only 100 cases were "true cases" of carcinoma of the stump and were eligible for this study. 7 cases were excluded from the study because they were probably coincidental carcinomas and were treated soon after subtotal hysterectomy. The lesions were staged according to the FIGO system. 93 cases (93%) were invasive squamous cell carcinoma, 6 cases (6%) adenocarcinoma and 1 case (1%) transitional cell carcinoma. Of 100 cases with a minimum 5 year follow-up, the absolute 5-year cure rate for various clinical stages is as follows: Stage I 83.3% (20/24); Stage IIA 75.0% (9/12); Stage IIB 62.5% (20/32); Stage IIIA 50% (1/2); Stage IIIB 48% (12/25); Stage IV 20% (1/5). The overall absolute 5-year cure rate for all stages combined is 63% (63/100) compatible with a series reported by M.D. Anderson. A better result in Stage IIIB as compared to several previous reports is thought to be due to extensive and aggressive interstitial radium therapy properly combined with external supervoltage irradiation. Techniques of treatment stage by stage including computerized dosimetry will be discussed along with complications and failures.

Adult↗
PubMed1978

Radical mastectomy: a 27-year survey.

Records of 736 cases of breast cancer presenting to one of the authors (J. D. Y.) have been kept over 27 years. The principles of treatment have remained the same throughout the survey. A radical mastectomy was carried out for stage I and early stage II cases, and when axillary nodes were histologically involved, immediate radiotherapy was given. The 5-, 10- and 15-year survival figures are reported.

Adult↗
PubMed1979

Modulation of the immune response and control of tumour spread by a new synthetic compound.

A small molecular weight biofunctional polymer, NED 137, has been investigated for its anti-neoplastic effect. Through its effect on the immune system, particularly the induction of B cell differentiation to antibody producing cells, this synthetic compound can retard tumour growth and prevent the development of distant metastases. Reactivity to tumour developed following administration of the NED 137. No toxicity has been observed. The polymer NED 137 is now being tested in phase I and phase II clinical trials.

Adjuvants, Immunologic↗
PubMed1979

Cancer progression and monocyte inflammatory dysfunction: relationship to tumour excision and metastasis.

In a longitudinal study performed before and after surgical resection of a chemically-induced, transplanted rat tumour we found that a monocytosis- and tumour-induced anti-inflammatory effect directed against macrophages was promptly corrected by tumour excision but recurred with metastasis. These observations indicate that the monocyte abnormalities are acquired and related to cancer progression. The anti-inflammatory effect required relatively large primary or metastatic tumour burdens. Our findings support the clinical impression that monocyte abnormalities are associated with a poor prognosis.

Animals↗
PubMed1978

Cis-diamminedichloroplatinum (NSC-119875) in childhood malignancies: a Southwest Oncology Group study.

Children with malignancies resistant to conventional therapy were treated with cis-diamminedichloroplatinum (PDD), 15 to 20 mg/m2, given daily by rapid intravenous infusion for 5 days at 3-wk intervals. Eleven of 24 children with acute lymphocytic leukemia (ALL) received two or more courses; among these no remissions occurred. Fifty-four children with solid tumors were treated: 25 neuroblastoma, 9 rhabdomyosarcoma, 4 Ewing sarcoma, 2 testicular embryonal carcinoma, 2 retinoblastoma, and 12 miscellaneous tumors. One complete remission, 3 partial remissions, and 2 improvements were observed in children with neuroblastoma. One girl with metastatic osteogenic sarcoma achieved a partial remission. One child with metastatic testicular embryonal carcinoma showed improvement. The side effects were vomiting controlled by antiemetics in 26 children and transient elevations of serum creatinine and BUN in 14 children. Nineteen of 39 children with solid tumors, who received more than one course of PDD, had moderately severe myelosuppression caused by PDD. In summary, PDD is a promising agent in neuroblastoma, osteogenic sarcoma, and testicular embryonal carcinoma, and an ineffective agent in ALL. The effect of PDD on other types of solid tumors should be evaluated in the future.

Adolescent↗
PubMed1978

Relapse of Hodgkin disease after extended-field radiotherapy.

Thirteen relapses occurred among 51 consecutive surgically staged patients with I, IIA, and IIIA Hodgkin disease who achieved complete remission following extended-field radiotherapy. The median disease-free interval was 14 months, but three disseminated relapses occurred at 36, 36, and 39 months. In 6 of the 13 cases, relapses occurred within treated fields. Relapse frequency was greater with advancing stage, but was not related to histology. In 9 of 12 evaluable cases the patients achieved complete remission with MOPP combination chemotherapy. All responders continue in complete remission a median time of 23 months after completing MOPP. This report emphasizes the need for sustained, close follow-up after radical radiotherapy and the excellent response rate of relapsed patients to MOPP combination chemotherapy.

Adolescent↗
PubMed1979

Ewing sarcoma: treatment with high dose radiation and adjuvant chemotherapy.

Twenty-one patients with pathologically proven Ewing sarcoma without overt metastases at diagnosis were treated with a protocol designed by the Royal Marsden/St. Bartholomew's Hospitals Children's Solid Tumour Group (CSTG). They received megavoltage radiotherapy to the involved bone and adjuvant chemotherapy with a combination of four cytotoxic drugs. Seven patients have so far relapsed, four at the original site and three in other bones. The other 14 are clinically free of disease a median of 36 months from diagnosis. Comparison with a historical control group of 19 patients treated with surgery or radiotherapy, but without initial chemotherapy, shows a significant improvement in survival for the study group (P = 0.03). Seventeen of the controls have died. The treatment regime was moderately toxic, but there were no treatment-related deaths. These results confirm that an improved survival time and hopefully cure rate can be expected from treating Ewing tumour with high doses of megavoltage radiation and combination chemotherapy. Future goals must be the better control of large primary lesions and the eradication of micrometastases in other bones. The place of surgery should be re-evaluated in the treatment of the primary tumour, and better adjuvant chemotherapy regimes are needed.

Adolescent↗