Charles M. McBride

Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy

One hundred seventy‐four evaluable patients with noninflammatory Stage III (both operable and inoperable) breast cancer were treated with a combined modality strategy between 1974 and 1985. All patients received combination chemotherapy with 5‐fluorouracil, Adriamycin (doxorubicin), and cyclophosphamide (FAC) as their initial form of therapy. After three cycles of chemotherapy, local treatment in the form of a total mastectomy with axillary dissection, or radiotherapy, or both, was completed. Subsequently, adjuvant chemotherapy was continued. There were 48 patients with Stage IIIA, and 126 patients with Stage IIIB disease. A complete remission was achieved in 16.7% of the patients, and 70.7% achieved a partial remission after the initial three cycles of FAC. The complete response rate was higher for patients with Stage IIIA, than for patients with Stage IIIB disease. All but six of the 174 patients treated were rendered disease‐free after induction chemotherapy and local treatment. The median follow‐up of this group of patients is 59 months. The 5‐year disease‐free survival rates were 84% for patients with Stage IIIA, and 33% for patients with Stage IIIB disease. The 5‐year survival rate for, patients with Stage IIIA was 84%, and for patients with Stage IIIB 44%. At 10 years, 56% of patients with Stage IIIA and 26% of patients with Stage IIIB disease are projected to be alive. Younger patients, and those with estrogen receptor‐positive tumors, had a trend for better survival than older patients and those with estrogen receptor‐negative tumors. The quality of response to induction chemotherapy correlated prominently with prognosis, as did compliance with treatment. Twenty‐six patients (15.3%) had locoregional recurrence. This multidisciplinary approach to locally advanced breast cancer rendered most patients disease‐free and produced an excellent local control rate. Modifications of this treatment strategy may result in further improvement of survival rates.

Resectable gastric carcinoma. An evaluation of preoperative and postoperative chemotherapy

Patients with locoregional gastric carcinoma often die because of the low rates of curative resection and frequent appearance of distant metastases (mainly peritoneal and hepatic). To evaluate the feasibility of preoperative and postoperative chemotherapy, 25 consecutive previously untreated patients with potentially resectable locoregional gastric carcinoma received two preoperative and three postoperative courses of etoposide, 5‐fluorouracil, and cisplatin (EFP). Ninety‐eight courses (median, five courses; range, two to five courses) were administered. Six patients had major responses to EFP. Eighteen patients (72%) had curative resections, and three specimens (12%) contained only microscopic carcinoma. At a median follow‐up of 25 months, the median survival of 25 patients was 15 months (range, 4 to 32+ months). Peritoneal carcinomatosis was the most common indication of failure. One patient died of postoperative complications, but there were no deaths due to chemotherapy. EFP‐induced toxic reactions were moderate. Preoperative and postoperative chemotherapy for locoregional gastric carcinoma is feasible, and additional studies to develop regimens that could result in 5% to 10% complete pathologic responses may be warranted.

Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis.

The histologic presence of axillary lymph node metastasis is the most commonly used indicator of prognosis for patients with operable breast cancer. The record of 385 patients treated by 390 radical mastectomies between the years 1944 and 1972 were reviewed to clarify this. The axillary nodes recovered were evenly distributed. The median number of positive lymph nodes at each level was two; 50% had involvement of only one level. The number of lymph nodes identified increased with the number of positive nodes. When compared with similar patients, survival curves for those having a single involved node and also those having multiple metastatic nodes were similar whether the node were in the proximal, middle, or distal levels. The 10‐year determinate survival for patients with fewer than five positive nodes was just under 50%. High positive nodal counts, or involvement of more than one level, were associated with local recurrence of disease.

Prognostic factors in patients with regional cervical nodal metastases from cutaneous malignant melanoma

A retrospective analysis with a minimum 10 year follow-up was performed on 287 patients who underwent radical or modified neck dissections with histologically involved regional nodal metastases from cutaneous malignant melanoma. The cumulative 5 year and 10 year survival rates calculated from the time of node dissection were 33 percent and 28 percent, respectively. Age and sex of the patient, site of known primary tumor, clinical stage at presentation, and time interval from the treatment of the primary tumor to node dissection did not independently affect survival. However, an unknown site of primary disease, the presence of only one histologically involved node, and the absence of extranodal tumor invasion at the time of node dissection were statistically significant individual prognostic factors for an improved survival rate.

Improving the efficiency of wound drainage catheters

We have modified the most commonly utilized wound drainage system to further reduce the incidence of postoperative accumulation of fluid under the skin flaps. This modification allows more efficient removal of debris, loose tissue fragments, and clots from the wound catheters and insures a constant negative pressure in the system. These maneuvers lengthen the usefulness and improve the efficiency of the catheters and have reduced the incidence of fluid accumulation.

Hepatic hyperthermia by total isolation and regional perfusion in vivo

Abstract A pump-oxygenator and isolation-perfusion circuit were used to selectively elevate hepatic temperature in 33 dogs to either 37, 41, or 43°C. Temperatures were maintained for 10–30 min. Survival was 75% in 8 dogs after 37°C × 30 min, 40% in 10 dogs after 41°C × 30 min (not significant), 40% in 5 dogs after 43°C × 10 min (not significant), and 0% in 10 dogs after 43°C × 30 min ( P ⩽ 0.01). Animals subjected to 43°C × 30 min hepatic perfusion exhibited an increase in fatal intraoperative arrhythmias despite maintenance of relatively normal blood pressure, systemic temperature, blood gases, and electrolytes. Six animals (2 after 43°C × 10-min perfusion, 4 after 43°C × 30-min perfusion) developed a postoperative symptom complex of progressive obtundation, fever, oliguria, hypotension, and death. Blood cultures were negative. Laboratory values in some animals suggested hepatic necrosis and early hepatic and renal failure but did not completely explain the clinical picture observed. The most striking finding in hyperthermically perfused animals was a diffuse hepatocyte vacuolopathy which on serial liver biopsies in surviving animals progressed to ballooning degeneration then complete resolution. This study demonstrates that temperatures suitable for thermotherapy of hepatic malignancies have hepatotoxic effects which are both temperature and time dependent. Present studies attempt to modulate the toxicity of hepatic hyperthermia by use of perfusate additives.

Hematoma of the liver discovered one year after injury

Abstract An unusual case of blunt trauma to the abdomen resulting in a huge hematoma of the left lobe of the liver one year after injury is reported. This condition was treated by left hepatic lobectomy, and the patient is well one year after operation.