Cancer

Haslam, John Battle; Cavanaugh, Patrick J.; Stroup, Steven L.

doi: 10.1002/1097-0142(197312)32:6<1341::AID-CNCR2820320609>3.0.CO;2-Apmid: 4127980

Twenty‐nine patients with irresectable adenocarcinoma of the pancreas were treated with radiotherapy between 1961 and 1971. In 6 patients the tumor was widespread. Twenty‐three patients had regional malignancy, and were treated with curative intent. Some patients received adjunctive chemotherapy, usually with 5‐fluorouracil. The radiotherapeutic technique used when cure was thought possible consisted of 6000 R calculated at the frontal midplane (anterior‐posterior diameter) of the pancreas region, using Cobalt 60, in 10 weeks elapsed time. Three series of 2000 R in 10 fractions (2 weeks) were given, spaced by intervals (2 weeks) The crude survival figure was 21% at 2 ½ years following diagnosis for all 29 patients. The morbidity of treatment was low; palliative results were encouraging.

Fuks, Zvi Y.; Bagshaw, Malcolm A.; Farber, Eugene M.

doi: 10.1002/1097-0142(197312)32:6<1385::AID-CNCR2820320617>3.0.CO;2-#pmid: 4202190

A total of 132 patients with biopsy‐proven mycosis fungoides were treated by total skin irradiation with 2.5 MeV electrons. In 58% a complete remission of cutaneous manifestations was observed. The rate of complete remission was dose‐dependent and was inversely dependent on the extent of disease. Fourteen patients had disease‐free survivals of 3–14 years following a single course of treatment, and may be considered as cured. Fifty‐six patients died, 52% of whom succumbed to extracutaneous involvement with disease. Extracutaneous involvement correlated with the extent of skin involvement, and with the presence of initial lymphadenopathy, and was associated with poor prognosis. A new staging classification is proposed which provides a rational basis for the introduction of new treatment modalities for the management of mycosis fungoides patients.

Yates, Jerome W.; Holland, James F.

doi: 10.1002/1097-0142(197312)32:6<1490::AID-CNCR2820320628>3.0.CO;2-6pmid: 4202191

A prospective study of infectious morbidity in patients with acute myelocytic leukemia receiving chemotherapy was undertaken to test the effects of a reduction of ambient and/or endogenous microorganisms. Patients were randomly allocated to receive: (1) neither barrier isolation nor antimicrobial suppression; (2) antimicrobial suppression (gentamicin, vancomycin, and nystatin) in conventional ward reverse isolation; (3) barrier isolation and filtered air; or (4) barrier isolation, filtered air, and antimicrobial suppression. The presence of infection at the time of randomization was a significant factor (p < 0.02) accounting for an increased death rate. Individuals housed in the isolator who were initially uninfected demonstrated a decrease in the acquisition of severe infections after 23 study days, and fewer respiratory infections throughout the study period. Pseudomonas infections were decreased in isolator patients. Fewer fatalities from infection, but more from hemorrhage, were noted in patients who received endogenous antimicrobial suppression. An increased remission rate was seen in isolated patients not receiving antibiotics for gut flora suppression (not statistically significant). Significant improvement of leukemic remission rate or survival by these environmental manipulations was not found.

Nishiyama, Hiroshi; Anderson, Robert E.; Ishimaru, Toranosuke; Ishida, Kenzo; Ii, Yohei; Okabe, Nobukazu

doi: 10.1002/1097-0142(197312)32:6<1301::AID-CNCR2820320602>3.0.CO;2-Zpmid: 4757920

The present study demonstrates an increased prevalence of malignant lymphoma and multiple myeloma in survivors of the atomic bomb in Hiroshima exposed to 100 rad or more; a similar relationship is not evident in Nagasaki. This apparent discrepancy is tentatively attributed to known physical differences in the radiation spectrum emitted by the 2 bombs and/or biological differences between the inhabitants of Hiroshima and Nagasaki. Other observations of interest include the following: the risk of developing lymphoma or multiple myeloma appears to be greater in persons exposed at less than 25 years of age than in people who were 25 or more years old at the time of the bomb; the appearance time is shorter in the younger age group exposed to 100 rad or more in comparison with less heavily exposed persons, and also in comparison with heavily exposed persons in the older age groups.

Talerman, A.; Magyar, E.

doi: 10.1002/1097-0142(197312)32:6<1477::AID-CNCR2820320626>3.0.CO;2-Upmid: 4357079

Two cases of hepatocellular carcinoma presenting with pathologic fracture due to bone metastases are reported. The patients did not exhibit clinical evidence of liver disease on presentation, and there was no previous history of liver disease. Liver function tests were normal in 1 case, while in the other the only abnormality was a slightly raised alkaline phosphatase. In 1 case the diagnosis was made by needle biopsy of a metastatic bone lesion, and in the other only at autopsy. The literature concerning this mode of presentation of hepatocellular carcinoma, and of liver cell carcinoma with skeletal metastases is reviewed. It is considered that hepatocellular carcinoma should be included in the differential diagnosis of carcinoma metastatic to bone.

Milder, Michael S.; Frankel, Robert S.; Bulkley, Gregory B.; Ketcham, Alfred S.; Johnston, Gerald S.

doi: 10.1002/1097-0142(197312)32:6<1350::AID-CNCR2820320611>3.0.CO;2-Zpmid: 4757925

Gallium‐67 whole body scintigraphy was included in the diagnostic workup of 44 consecutive patients with biopsy proven malignant melanoma in order to study the uptake of this nuclide by known melanoma tissue and to objectively assess its value in the detection of known and unknown meta‐static disease.

Mashberg, Arthur; Morrissey, John B.; Garfinkel, Lawrence

doi: 10.1002/1097-0142(197312)32:6<1436::AID-CNCR2820320622>3.0.CO;2-Cpmid: 4757933

This is a study of the appearance of asymptomatic early squamous cell carcinoma documenting location, color, size, surface (texture, elevation, ulceration), presence of bleeding, induration, lymphadenopathy, and distant metastasis. Of 158 lesions, 143 (90.5%) had an erythroplastic (red) component, whereas only 98 (62%) had white components. Only 4 lesions were solely white. There was essentially no color distinction between invasive carcinoma vs. in situ carcinoma. One hundred forty‐two (89.8%) lesions were located in the floor of the mouth, ventral or lateral tongue, or soft palate anterior pillar complex. One hundred twelve (70.9%) of the lesions in the study were invasive. Only 11 lesions were indurated, and these were all invasive. One hundred nine (69%) of all lesions were approximately 2 cm or less, and 37 (23.4%) were less than 1 cm. An erythroplastic (red velvety) lesion appears to be the earliest visible sign of asymptomatic oral squamous cell carcinoma—invasive or in situ. The presence of a white component did not appear to be significant unless it was accompanied by erythroplasia (redness). Minimal size (less than 1 cm) does not preclude the existence of an invasive carcinoma. The persistence of erythroplastic lesions for more than 14 days without obvious etiology requires biopsy.

McGovern, Vincent J.; Mihm, Martin C.; Bailly, Christiane; Booth, Joan C.; Clark, Wallace H.; Cochran, Alistair J.; Hardy, E. G.; Hicks, J. D.; Levene, Arnold; Lewis, Martin G.; Little, J. H.; Milton, G. W.

doi: 10.1002/1097-0142(197312)32:6<1446::AID-CNCR2820320623>3.0.CO;2-8

doi: 10.1002/1097-0142(197312)32:6<1541::AID-CNCR2820320633>3.0.CO;2-Jpmid: N/A

Kay, Neil E.; Gottlieb, Arlan J.

doi: 10.1002/1097-0142(197312)32:6<1508::AID-CNCR2820320630>3.0.CO;2-Bpmid: 4757936

A case of disseminated Hodgkin's disease and hypouricemia is reported. Serum uric acid values prior to chemotherapy ranged from 0.7 to 1.7 mg% in association with a markedly elevated uric acid clearance. The etiology of the defect in renal handling of uric acid in this syndrome remains to be elucidated.