Calvin T. Klopp

Lobular carcinoma in situ: Incidence and treatment

It has been our impression that in‐situ lobular carcinoma is diagnosed less frequently than the true incidence of the disease. To confirm this, all breast biopsies at George Washington University Hospital, from 1953 to 1971, were reviewed and the incidence of in‐situ lobular carcinoma was determined to be 2.5 per/100 breast biopsies. Four hospitals were contacted and asked to review their records to ascertain the incidence of the disease at these institutions. Two hospitals reported never diagnosing the lesion and two hospitals diagnosed it at a much lower rate. Reasons for the difference are discussed. One hundred twenty‐four cases of in‐situ lobular carcinoma were diagnosed, and 105 cases received a simple mastectomy. Nineteen patients refused operation and instead were followed carefully. The good results in the latter group and reports by other authors suggest to us that a program of careful follow‐up visits is a valid alternative to simple mastectomy in selected patients with in‐situ lobular carcinoma.

Use of intra-arterial nitrogen mustard therapy in the treatment of cervical and vaginal cancer

Abstract The local administration of nitrogen mustard (methyl-bis [B-chloroethyl amine] hydrochloride) has resulted in partial regression of malignant tumors which are not amenable to intravenously administered drug. 1, 2. 3 This therapeutic effect has usually been obtained by repeated injections of the chemotherapeutic agent over a prolonged period of time, through a cannula inserted directly into the artery which supplies the tumor region. This is a study of the immediate effects of HN 2 given by intra-arterial injection in cases of carcinoma of the cervix and vagina.

Palliation achieved in carcinoma of the head and neck with intra-arterial chemotherapy

1. 1. Palliation of nonresectable carcinoma of the head and neck is presently most easily achieved with fractionated dosages of intraarterial HN2. 2. 2. The technic of isolation perfusion in carcinoma of this region is neither indicated nor justifiable with the technics and chemotherapeutic agents presently in use except as an experimental tool. 3. 3. Methotrexate infusion has been inferior to fractionated HN2 in our experience as regards both duration and extent of tumor regression and the duration of pain relief.

Some aspects of the clinical use of nitrogen mustards.

Publisher Summary This chapter discusses the action of methyl-bis-(β-chloroethyl)amine (HN 2 ) on humans. The effects produced by the administration of HN 2 are discussed in terms of organ, system, or general metabolic effects. Like sulfur mustard, HN 2 when applied directly, has a vesicant necrotizing action on the skin. The severity is roughly dependent on the concentration of the applied drug and the duration of contact with the skin. Following intravascular injection, the compound undergoes intramolecular cyclization in the polar solvent, plasma, to form a cyclic ethylenimonium compound. During the intravenous administration of HN 2 , the capillary bed of the lung is the first to be traversed by the drug. Standard courses of HN 2 have no demonstrable effect on normal kidney structures and renal function as determined by routine studies and tests. The intravenous administration of usual amounts of HN 2 has no apparent effect on either the peripheral or central nervous system. The therapeutic application of HN 2 has been limited by the poisonous effect of this agent on the host as well as on the tumor.

Present status of isolation perfusion and intra-arterial infusion technics.

The success of regional chemotherapy in malignancy depends chiefly on the sensitivity of the tumor to the particular agent that is used.Isolation perfusion of chemotherapeutic agents has apparently proved effective as an adjunctive measure in certain malignancies of the extremities; in other areas, leakage of the agent into the systemic circulation is such that no value is obtained from this procedure.Continuous intra-arterial administration of alkylating agents may prove effective in malignancies of the extremities, head and neck and pelvic regions.All forms of isolation perfusion and intra-arterial infusion have been equally impressive in relieving pain in far-advanced malignancies.