Edward S. Baum

Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children's Cancer Group.

PURPOSE The specific aims of this study were to improve event-free survival (EFS) in patients with newly diagnosed nonmetastatic osteosarcoma of an extremity using the histologic response to neoadjuvant chemotherapy to determine postoperative chemotherapy; to evaluate a uniform histologic grading system that measures tumor response; and to identify patient characteristics that might influence EFS and survival. PATIENTS AND METHODS Two hundred sixty-eight patients with nonmetastatic osteosarcoma of the extremity were entered between August 1983 and October 1986. Preoperative chemotherapy consisted of four courses of high-dose methotrexate (MTX) and one course of bleomycin, cyclophosphamide, and dactinomycin (BCD). Histologic response to preoperative chemotherapy was determined by morphometric analysis. Good histologic responders (< 5% residual viable tumor) were treated postoperatively with MTX, BCD, and doxorubicin (DOX); poor histologic responders were treated with BCD, DOX, and cisplatin (CDDP). RESULTS The 8-year EFS and survival rates were 53% and 60%, respectively. Two hundred six patients had their tumors assessed for histologic response: 28% displayed a good histologic response to preoperative chemotherapy. Good histologic responders had an 8-year postoperative EFS rate of 81% and survival rate of 87%; those with a poor histologic response had an 8-year postoperative EFS rate of 46% and survival rate of 52%. A primary tumor site in the proximal humerus or proximal femur and an elevated serum alkaline phosphatase level were associated with an increased risk of an adverse event, whereas the type of surgical procedure was not. CONCLUSION EFS and survival appear to be directly related to histologic response to neoadjuvant chemotherapy.

A phase II study of cisplatin therapy in recurrent childhood brain tumors

Thirty-six children with brain tumors were treated with surgery, radiation and/or adjuvant chemotherapy. After tumor recurrence, cisplatin (60 mg/m2/day IV×2) was given every three to four weeks. CT scans were used to measure drug response prior to the first, third and fifth courses. Complete and partial responses were demonstrated in nine of 31 evaluable patients. Dose limiting toxicities were renal and auditory. Seven patients developed the syndrome of inappropriate antidiuretic horm one secretion. This study confirms that cisplatin is active in a spectrum of brain tumors.

Bleomycin-induced pulmonary fibrosis mimicking recurrent metastatic disease in a patient with testicular carcinoma: case report of the CT scan appearance.

Pulmonary fibrosis is a well‐recognized complication of bleomycin therapy. Detection of bleomycin‐induced pulmonary fibrosis by computed axial tomographic scanning (CT) has not been reported. We report on a patient in whom the development of lesions on chest CT scan following cessation of chemotherapy (including bleomycin) was interpreted as representing recurrent metastatic disease. At bilateral thoracotomy, only pulmonary fibrosis was found. In this patient, the CT scan appearance of bleomycin‐induced pulmonary fibrosis mimicked recurrent disease.

Pulmonary resection and chemotherapy for metastatic alveolar soft‐part sarcoma

Alveolar soft‐part sarcoma (ASPS) is an unusual tumor of soft tissues; it has invariably ended in death from disseminated disease, and the lung has been the most common site of metastasis. We present a patient with ASPS with bilateral pulmonary metastases who achieved a complete response after bilateral thoracotomies with removal of all gross disease and after combination chemotherapy including vincristine, actinomycin D, cyclophosphamide, and doxorubicin. The patient has now been followed for five years since the appearance of the metastases and has been off therapy for the past 34 months. He shows no evidence of disease. We suggest that multimodality therapy is a reasonable approach in patients with ASPS and pulmonary metastases and that such therapy has the potential for improving survival.

Current trends in treatment of childhood rhabdomyosarcoma of lower genitourinary tract

Treatment of childhood embryonal rhabdomyosarcoma of the lower genitourinary tract is in the process of undergoing drastic changes. Extensive surgery with excision of the lesion and its contiguous structures leaving the patient with significant physical disability is being replaced by biopsy and aggressive combined chemotherapy along with radiation therapy. Although it would appear that survival may be improved by this approach, caution is recommended and extirpation advised should the tumor fail to respond rapidly to chemotherapy.

Continuous Infusion of 5-Azacytidine as Induction for Acute Nonlymphocytic Leukemia in Patients with Previous Exposure to 5-Azacytidine

5 children with acute nonlymphocytic leukemia in relapse who had received 5-azacytidine as a part of previous multiagent chemotherapy received continuous infusion of 5-azacytidine, 150-200 mg/m2/day, for 5-7 days every 2 weeks. 2 achieved remission marrows with good peripheral counts (duration 1 and 3 months). 1 achieved a transient remission marrow but remained pancytopenic and 1 achieved reduction from 91% blasts to 18% blasts in the marrow. Principal toxicities were severe myelosuppression, diarrhea, and phlebitis.

Microcomputer-assisted data management for multiinstitutional pediatric clinical cancer trials.

Microcomputer assisted data management techniques, utilized in the oversight of two multiinstitutional trials for children with previously untreated acute lymphoblastic leukemia and unfavorable prognostic features, are presented. In the first study, such oversight hastened identification of unexpectedly prolonged delays, so that treatment could be successfully modified. In the second study, inferiority of one therapy was rapidly demonstrated, and after careful review that therapy was halted. Performance monitoring is discussed in terms of consideration of the overall quality of a clinical trial, namely, how complete are the data submitted and how precisely was protocol therapy administered; measurement of the quality of institutional participation, and identification of deficiencies in reporting or performance in the records of individual patients.