Arthur J. Weiss

Low‐dose chemotherapy of desmoid tumors

Eight patients with desmoid tumors, symptomatic, and none a candidate for conservative surgery, were treated with weekly vinblastine, maximum dose 10 mg/week, and methotrexate, maximum dose 50 mg/week. Symptomatic relief was obtained in all patients. Using Eastern Cooperative Oncology Group (ECOG) criteria, two patients had a complete remission, one of which has lasted for 30 months, four patients have had partial remissions, one patient has had a mixed response, and one patient who has been treated for only 4 weeks, a minimal response. Toxicity has been minor and transient. Chemotherapy appears to be an acceptable alternative to radical surgery in selected patients with desmoid tumors.

Lymphangiograms: Their Diagnostic and Therapeutic Potential1

Lymphangiography, the radiographic demonstration of the lymphatic system by intralymphatic injection of contrast material, has opened a new field of investigation. Earlier attempts at indirect lymphography were made by injection of radiopaque material into the subcutaneous tissue with uptake in the adjacent nodes (1). Direct injection into large palpable nodes, lymphadenography, was introduced by Carvalho in 1931 (6, 26, 31). Kinmonth in 1955 developed lymphangiography as a method of study of lymphedema of the lower extremities (20). Hreshchyshyn and Sheehan recently modified this approach (13). We have utilized the procedure with only minor variations to study the dynamics of the lymphatic system and the abnormalities in the nodes in various disease states. We have correlated our findings in man with those of animal investigations as summarized by Drinker, Yoffey, and Courtice (8, 29). Our investigation was initiated at Jefferson Medical College Hospital and later extended to include the group at Philade...

Experience with the use of adriamycin in combination with other anticancer agents using a weekly schedule, with particular reference to lack of cardiac toxicity

Two hundred and seven patients have been treated using a weekly regimen of Adriamycin in combination with various other anticancer agents. Thirty‐six of these patients have received between 600 and 1000 mg/m2 of Adriamycin and 27 have received more than 1000 mg/m2 of the agent. While electrocardiographic abnormalities were relatively common in this group of patients, no patient developed evidence of a cardiomyopathy. Significant remission rates were seen with patients having malignant lymphomas, carcinoma of the breast, various soft tissue sarcomas, and carcinoma of the ovary. We now have data on 149 patients given Adriamycin weekly who have received over 600 mg/m2 of the drug. Sixty‐four of these patients have received over 1000 mg/m2 of Adriamycin. Eight patients were suspected of having an Adriamycin‐induced cardiomyopathy and this was believed to be likely in only four of these patients. One patient died of a cardiomyopathy apparently induced by Adriamycin. It is our opinion that Adriamycin can be given with only a slight risk of developing a severe cardiomyopathy, in doses greater than 600 mg/m2, either as a single agent or in combination with methotrexate, Cytoxan, vincristine, or 5‐fluorouracil, if the Adriamycin is given weekly.

Therapy of desmoid tumors and fibromatosis using vinorelbine.

In patients with either desmoids or fibromatosis who do not tolerate vinblastine and methotrexate because of neurotoxicity, the combination of vinorelbine and methotrexate can be substituted in most. Patients with the same condition who had not been previously treated with a combination of vinblastine and methotrexate responded well to the combination of vinorelbine and methotrexate, with significantly less neurotoxicity and a similar objective and subjective response rate. Sixty percent of patients had either a substantial partial remission or a complete remission. In no patients did the disease progress while they were receiving this therapy. Symptomatic relief, primarily of pain, occurred in 80% of patients. While minimal neurotoxicity was seen in 16% of these patients, it did not interfere with the completion of therapy. The combination of vinorelbine and methotrexate appears to be active in the treatment of both desmoid tumors and fibromatosis and is associated with significantly less neurotoxicity then that seen with the combination of vinblastine and methotrexate. No long-term toxicity was seen in any patient in this series.

An evaluation of 5-fluorouracil in malignant disease.

Excerpt Until recently, it was believed that preformed pyrimidines, unlike preformed purines, were not utilized by mammalian tissues, either normal or neoplastic. In 1954, Rutman, Cantarow, and Pas...

Preoperative embolization of retroperitoneal hemangiopericytomas as an aid in their removal

The first reported cases of preoperatively embolized hemangiopericytomas are presented. Both lesions presented in the retroperitoneum where most lesions are now considered to be malignant. In the past, the highly vascular nature of these tumors has made resection in these areas difficult. Since the angiographic picture of hemangiopericytomas is now thought to be specific, it became feasible to add preoperative embolization to the overall management of these cases. In the first case, the diagnosis had been established 15 years previously. When first seen at Thomas Jefferson University Hospital, extensive bone destruction of the sacrum and lumbar vertebrae were present. Preoperative Gelfoam embolization aided in the palliative debulking of the tumor at operation. With this experience, preoperative embolization became part of the management in the second case and aided in the complete surgical removal of the tumor. Radiation therapy in the dosage of 5000 rad was given postoperatively in this case and should also be part of the treatment plan for these lesions. Cancer 50:1870‐1875, 1982.

Cytosine Arabinoside (NSC 63878) Toxicity and Antitumor Activity in Human Solid Tumors

Cytosine arabinoside was administered to 449 patients with a variety of solid tumors. The phase I study included doses of 0.8–3.5 mg/kg × 10 days, and a small number received 5 mg/kg daily for the fir

The diagnostic value of lymphangiography.

Excerpt Lymphangiography, the radiographic demonstration of the lymphatic system by intralymphatic injection of contrast material, has, in our experience, proved to be a new and useful diagnostic t...

Intraarterial Chemotherapy with Limb-sparing Resection of Large Soft-Tissue Sarcomas of the Extremities

Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.

Dimethylacetamide: a hitherto unrecognized hallucinogenic agent.

Dimethylacetamide in large doses was found to be a potent hallucinogenic drug in the human. Characteristic electroencephalographic changes accompanied the clinical abnormalities.