David T. Carr

Pleural effusion in lymphoma.

Pleural effusion in lymphoma is usually, but not invariably, a poor prognostic sign. The presence of underlying parenchymal lung involvement or a chylous type of effusion does not further alter the prognosis, but the presence of malignant cells in the fluid probably shortens survival. Obstruction of lymphatic drainage of the lung and pleura by enlarged mediastinal nodes, with resulting lymphedema of the pleural space, is probably the most common cause of nonchylous pleural effusion. In contrast to patients with metastatic carcinoma, pleural involvement by lymphoma is uncommonly the major factor in fluid formation. Radiation therapy to the mediastinum or to the affected hemithorax is more likely to relieve lymphomatous effusions than is intrapleural therapy or systemic chemotherapy alone.

Combination chemotherapy of advanced lung cancer. A randomized trial

A controlled clinical trial comparing two‐drug and three‐drug combination chemotherapy was performed in 206 patients with advanced bronchogenic carcinoma, comprised of 26.2% with epidermoid carcinoma, 30.1% with small cell anaplastic carcinoma, 27.2% with adenocarcinoma, and 15.6% with large cell carcinoma. Each drug combination consisted of agents with different modes of action and included a cell‐cycle‐stage nonsensitive and a cell‐cycle‐stage‐sensitive agent. The overall response rate was highest for small cell carcinoma (48.2%) and adenocarcinoma (23.6%); it was less than 10% in epidermoid and large cell carcinoma. Similarly, the overall median survival was twice as long for the first two cell types (7 months) as compared with that recorded for the other two cell types (3 1/2 months). The combination of 1 (2‐chloroethyl)‐3‐cyclohexyl‐1‐nitrosourea (CCNU), cyclophosphamide, and methotrexate was shown to be statistically superior to cyclophosphamide and methotrexate with regard to objective response rate, duration of response, and median survival for adenocarcinoma. Responders lived significantly longer than nonresponders (254 versus 90 days for small cell anaplastic carcinoma patients and 244 versus 184 days for adenocarcinoma patients). No difference in survival or objective response rate was observed between the different treatments for the other two cell types of lung cancer.

Radiotherapy plus 5-Fu compared to radiotherapy alone for inoperable and unresectable bronchogenic carcinoma

One hundred and eighty‐eight patients with inoperable or unresectable bronthogenic carcinoma, classified by cell type and extent of disease, were randomly allocated to radiotherapy alone or to radiotherapy plus 5‐FU. Results of therapy, evaluated primarily by survival rates, revealed no significant improvement by the addition of 5‐FU. For example, the survival rates at 12 months for patients with squamous cell carcinoma were 32% after radiotherapy alone and 36% after radiotherapy plus 5‐FU. Comparable survival rates for patients with adenocarcinoma were 42% and 60%; for patients with small cell carcinoma, 19% and 23%; and for patients with large cell undifferentiated carcinoma, 31% and 28%. Our data reveal that the regimen of 5‐FU and radiotherapy is not significantly more effective than radiotherapy alone in the treatment of inoperable or unresectable bronchogenic carcinoma.

Hexamethylmelamine (NSC‐13875) in the treatment of primary cancer of the lung with metastasis

Seventy patients with primary pulmonary cancer with metastasis received a micronized form of hexamethylmelamine (HXM) (NSC‐13875) at dosages of 8 to 12 mg/kg/day given orally. Most patients had some nausea or vomiting but were able to continue the treatment. Aluminum hydroxide and prochlorperazine alleviated the gastrointestinal reactions. At 12 mg/kg/day, one fourth of the patients had leukopenia or thrombocytopenia or both. These were much less frequent with the smaller doses. The counts always increased to normal when treatment was discontinued temporarily. There were no fatal reactions. In one patient with small‐cell cancer, all evidence of the cancer completely disappeared. In 12 other patients the tumor decreased 50% or more in size. In 16 additional patients there was less than 50% decrease or no change in the objective evidence of cancer. Response to therapy could not be correlated with sex of the patients or cell type of the pulmonary cancer.

The 30-year trend of bronchogenic carcinoma in Olmsted County, Minnesota, 1935–1964

Abstract The results of trend studies of bronchogenic carcinoma in the Olmsted County population are similar to those derived from mortality statistics and tumor registries assembled elsewhere, although the trends for other diseases in Olmsted County have not always conformed to the results from those other sources. Having available a unique data resource, centered about the records of the Mayo Clinic, which made it possible to avoid many of the methodologic shortcomings of retrospective population studies and permitted the identification of practically all cases of malignancy in the population of Olmsted County, we investigated the incidence and mortality of primary lung cancer in the population of Olmsted County, Minnesota, over the three decades 1935–1964, inclusive. Thus identified were 137 cases of bronchogenic carcinoma (112 male patients, 25 female) diagnosed among Olmsted residents during the years 1935–1964. Tissue specimens were located in 131 (95 per cent) of the cases, and 127 of these could be classified by specific cell type: 40 (31 per cent) adenocarcinoma and 37 (28 per cent) squamous-cell, 26 (20 per cent) small-cell, and 23 (18 per cent) large-cell carcinoma. There was a single case of adenocystic type. The average annual incidence per 100,000 population for males increased rapidly from 3 in the first decade to about 25 in the third, but for females the rate remained about 3 over the three decades. Since the same medical facilities and the same methods of record-keeping, indexing, and retrieval are available for females in the community as for males, the observed upward trend of bronchogenic carcinoma in males presumably is valid and not related to diagnostic procedures nor to any systematic artifact. The upward trend was more marked among urban males than among rural males; the reason for the difference is unknown. As of 1 January 1970, 130 (95 per cent) of the patients had died. The death certificates recorded bronchogenic carcinoma as the underlying cause of death in 116 (90 per cent) of these 130. This study reveals a marked increase over the last 30 years in the incidence rates for primary cancer of the lung and tends to refute the argument that proficiency in diagnosis has accounted for the rise. Such a dramatic upward trend through the same period has not been noted in Olmsted County for other diseases studied in a similar manner.

The Staging of Cancer

Excerpt The classification of human illnesses into categories called diagnoses and the estimation of the severity of the disease have always been important functions in the work of the physician. T...

Adriamycin and Radiation Reaction

Excerpt To the editor: We read with interest the report by Greco and associates (1) on the enhanced skin and esophageal radiation reaction in small-cell lung cancer patients being treated with a th...

Fundamentals of Oncology

Many physicians in practice today in the United States attended medical school before the discovery of much of the present knowledge about cancer. Although Pitot did not write this book for them, they would find it to be a reliable source of information about the fundamentals of oncology. The book grew out of course notes for graduate classes in oncology. The first edition was so successful that it has been updated twice, the current book being the third edition. While it is not an encyclopedia of oncology, it thoroughly covers the fundamental aspects of the etiology of cancer, its natural history, the immunobiology of cancer, and the relationships between the host and the tumor. The principles of chemotherapy of cancer are presented in a chapter on chemotherapy, along with a brief history of the development of chemotherapeutic agents and a discussion of the complex program of drug development from screening

Handbook of Cancer Diagnosis and Staging: A Clinical Atlas

Learning all about the diagnosis and staging of the many varieties of cancer is a great challenge to medical students and residents. Learning to do it in a cost-effective manner is even more difficult. No book could make this task simple, but this handbook gives the student an outline that will introduce the subject. The text is based on the tumor, node, metastasis (TNM) system of the American Joint Committee on Cancer. The flow charts for each primary site of cancer present a simplified concept of how to approach each problem and solve it. The illustrations of roentgenograms are well chosen and show the abnormalities clearly. The diagrams of the various manifestations of cancer give a simple and easily comprehended concept of the pathology of these diseases. This is not an adequate substitute for one of the comprehensive texts on oncology but it is a good introduction to the subject

Mind and Cancer Prognosis

Host factors have been receiving more attention by many students of the cancer problem in recent years. The immunocompetence of the host has received the greatest attention, but the psychosomatic aspects of cancer have not been ignored. Stoll and his numerous coauthors, from the United States, Canada, and Great Britain, who have produced this collection of 15 essays on various aspects of the relationship between the mind and the prognosis in cancer, are to be congratulated. They have called attention to the evidence that a patients attitude toward his cancer may have some influence on his prognosis. In the opening chapter, Stoll poses the two questions that the book attempts to answer: Can psychological factors affect prognosis in the cancer patient? Can psychological support improve cancer prognosis? In answer to the first question, the authors point out that variation in the emotional status of the patient might explain the periods