E. Omer Burgert

Isolation of Swine Influenza Virus from Autopsy Lung Tissue of Man

Swine influenza virus, or an antigenically closely related virus, has been considered to be the etiologic agent of the 1918 influenza pandemic.1 2 3 4 Influenza in swine has continued to occur in t...

Intergroup Ewing's Sarcoma Study Local Control Related to Radiation Dose, Volume, and Site of Primary Lesion in Ewing's Sarcoma

One hundred ninety‐three patients with localized Ewings sarcoma treated at participating institutions of the Intergroup Ewings Sarcoma Study form the basis for this report. All patients received radiation therapy to the primary lesion and were randomized to receive vincristine, actinomycin‐D, and cyclophosphamide (VAC) plus adriamycin (Regimen I); VAC alone (Regimen II); or VAC and bilateral pulmonary irradiation (Regimen III). Local control was achieved in 96% of the patients in Regimen I, and 86% of the patients in both Regimens II and III. The median duration of follow up was 83 weeks and median survival time was 172 weeks. Incremental doses of irradiation did not result in significant changes in the rate of local control of primary lesions. The local control rate was the same (92%) for tumors treated by means of whole‐bone irradiation or with at least 5 cm of free margin around the lesion. The local control rate decreased to 79% for lesions treated with less than a 5‐cm margin. Excellent control was obtained for lesions involving the skull or spine (100%), and distal bones (fibula, 96% and tibia, 91%). Less favorable control rates were noted for pelvic and humeral lesions (84% and 79%, respectively). Bilateral pulmonary irradiation for subclinical disease played a role in lowering the incidence of lung metastases from 38% to 20% for patients treated with VAC. Lung metastases were similarly decreased (10%) when adriamycin was added to VAC chemotherapy. Cancer 46:516–521, 1980.

Familial erythrophagocytic lymphohistiocytosis. report of two cases and clinicopathologic review

An unusual syndrome of hepatosplenomegaly and fever followed by rapid deterioration and death has been described in 38 children from 21 families Pancytopenia, liver dysfunction, and bleeding developed prior to death from hemorrhage, sepsis, or lymphocytic meningitis. This report reviews the literature and adds a set of twins to the reported cases.

The role of radiation therapy in the management of non-metastatic Ewing's Sarcoma of bone. Report of the intergroup Ewing's Sarcoma Study

Abstract The role of radiation therapy in local tumor control and decreased incidence of pulmonary metastasis is reported in 271 patients who were entered into the Intergroup Ewings Sarcoma Study with more than one year follow-up and on whom all radiotherapy records were reviewed. The majority of the patients were irradiated to the primary tumor with doses of 4500 to 6500 rad in five to six weeks in combination with systemic administration of three drugs (vincristine, actinomycin-D and cyclophosphamide) or four drugs (vincristine, actinomycin-D, cyclophosphamide and adriamycin). One of the groups of patients was treated with three drugs and bilateral pulmonary irradiation (1500 rad, uncorrected dose, in two weeks). Preliminary analysis shows an overall local primary tumor control of 89 %. Patients with lesions in the pelvis had a local failure rate of 17% (9 of 52) and in the humerus 23% (7 of 31). Factors affecting local recurrences are analyzed in detail. Distant metastases have been noted in 40% of all patients; the highest proportion was noted in the pelvis (49%). There was a significant difference in the appearance of pulmonary metastases in the patients who were treated with four drugs (9.7%) and in the group who received three drugs and pulmonary irradiation (23.5%) when compared with the patients treated with three drugs only (37%). Intensive chemotherapy and radiotherapy significantly improve local tumor control and survival of patients with localized Ewings sarcoma. However, the high incidence of metastasis suggests the need for more effective systemic chemotherapy to further improve treatment results. It is very important to determine the optimal dose of irradiation and minimal volume to be treated in order to achieve optimal survival and primary tumor control with the least sequela.

Primary Ewing's sarcoma of the ribs: A report from the intergroup Ewing's sarcoma study

Thirty‐six patients with primary Ewings sarcoma of the ribs have been reviewed. Of these, 21 had clinically localized disease at diagnosis and were entered on protocol IESS 7299, eight had regional and seven metastatic disease at diagnosis and were entered on protocol 7450. The 21 with localized disease were treated with surgical excisio or biopsy, followed by local radiotherapy (in all but one patient) and randomization to one of three chemotherapy regimens. Eleven patients (52%) remain disease‐free for periods ranging from 18 to 64 months, respectively. Seven of eight patients who underwent complete surgical excisio of the primary lesion remain disease‐free after partial excision or biopsy. However, analysis of sixe of tumor at diagtnosis revelas thjat smaller primary tumors have a better prognosis irrespective of extent of surgery. Protocol IESS 7450, consisted of radiotherapy to all areas of known disease and four drug chemotherapy. Four (50%) with regional disease but none with metastatic disease have remained alive and continuously disease‐free. It is concluded that an aggressive approach to Ewings sarcoma of the ribs is justified by the results, as even regional disease may be curable. The apparent prognostic advantgage for those patients undergoing surgical excision may be explained by patient selection.

Radiotherapy and combination chemotherapy in advanced Ewing's sarcoma–Intergroup study

Forty‐four patients with metastatic (36 patients) and advanced regional (eight patients) Ewings sarcoma were treated on a protocol employing intensive combination chemotherapy and radiotherapy to all sites of overt disease (primary site and metastatic sites). Thirty‐one patients achieved a complete remission, eight achieved a partial remission, and five patients did not respond to treatment. Of the 31 patients who achieved a complete remission (12 had metastases and six had regional spread), 18 remained disease‐free with a median follow‐up of 34 months, while recurrences occurred in nine patients. Four patients died of complications of treatment.

Analysis of local tumor control in ewing's sarcoma. Preliminary results of a cooperative intergroup study

This report is a preliminary analysis of the local tumor control in 187 patients treated with multi‐agent chemotherapy and local radiation therapy for non‐metastatic Ewings sarcoma. Patients were treated according to three different regimens, all of which included irradiation of the primary tumor and involved bone (5000‐6000 rads in 5‐6 weeks). The first group was treated with a combination of cyclophosphamide, vincristine, adriamycin and actinomycin‐D. The second group received cyclophosphamide, vincristine and actinomycin‐D. The third group was treated with cyclophosphamide, vincristine and actinomycin‐D in addition to bilateral pulmonary irradiation. The present results, after a median follow‐up of 24‐30 months in the various groups combined, indicate that the local control is 87%. Twenty‐two of 25 local failures appeared within 24 months (88% of recurrences). No difference in time of appearance of local recurrence was noted in the three treatment regimens. The highest incidence of local recurrence has been noted in the humerus (22%), the pelvis (19%), the tibia (14%) and the femur (11%). Sixty‐seven of the 187 patients (35.8%) have developed distant metastases, mostly to the lungs and to other skeletal sites. Of the patients with pelvic primaries, 62% have developed distant metastases followed by the humerus (41%), the femur (36%) and the tibia (24%). A detailed analysis of radiation therapy technical factors was done in 110 patients with complete dosimetry data at the time of this report. There is a trend indicating that patients who received doses over 6000 rads (20/20) or with lower doses combined with chemotherapy containing adriamycin (9/9) have a higher local control. However, the difference with the other groups (67/81‐83%) was not statistically significant. Radiation therapy in combination with multiple chemotherapy is an effective treatment method to control Ewings sarcoma locally. The late effects of this intensive combined therapy must be assessed in long term survivals. Future studies in Ewings sarcoma should attempt to elucidate crucial issues such as the optimal volume of bone that should be irradiated, the potential value of limited surgical resection of gross tumor and the determination of optimal multi‐agent regimens which will enhance local tumor control and diminish distant metastases. Because of the rarity of this tumor, the need for cooperative controlled clinical trials is emphasized. Cancer 40:2864‐2873, 1977.

Cardiopulmonary Function in Long-Term Survivors of Childhood Hodgkin's Lymphoma: A Pilot Study

Twelve patients who had received mantle radiotherapy for Hodgkins lymphoma during childhood underwent cardiopulmonary testing 7 years or more after the initial diagnosis and treatment. All but one patient had been asymptomatic. Results of echocardiography, pulmonary function tests, or exercise studies were abnormal in 9 of the 12 patients. Long-term follow-up of cardiopulmonary function will be important to determine the ultimate significance of these abnormalities. These potential complications must be considered in planning prospective therapeutic studies in children with Hodgkins disease.

Acute Megakaryocytic Leukemia (M7) in Children

We analyzed the clinical and laboratory features of eight children (median age, 20 months; range, 13 months to 11 years) with acute megakaryocytic leukemia (M7) and compared the findings with those reported in the literature. The diagnosis was supported by ultrastructural examination for platelet peroxidase or immunophenotyping for glycoprotein IIb/IIIa or the von Willebrand factor protein. Two patients had Downs syndrome. Initial findings included anemia (in all patients), thrombocytopenia (in six), myelofibrosis (in three), lytic bone lesions (in two), and pronounced leukocytosis (in one). Stem cell culture studies of peripheral blood specimens revealed an aberrant phenotype of the megakaryocytes in one patient and reversal to a normal pattern after successful therapy. Remission was achieved in seven of the eight patients after aggressive chemotherapy, and four patients remained in remission 27 to 57 months after diagnosis. Three of these four patients underwent allogeneic bone marrow transplantation. M7 leukemia is not infrequent in children younger than 3 years of age, especially in those with Downs syndrome. The availability of monoclonal antibodies specific to restricted antigens of the megakaryocytic lineage has made the diagnosis of M7 leukemia both possible and practical.

Local control and survival related to radiation dose and volume and to chemotherapy in non-metastatic Ewing's sarcoma of pelvic bones.

Abstract This manuscript reviews 25 patients with non-metastatic Ewings sarcoma of the pelvis. In 4/25 (16%) the disease recurred locally and then metastasized. In addition, 15/25 patients have shown widespread metastases without local recurrence. Thus, only 10/25 (40%) remain with no evidence of disease at this writing. Patients who received VAC