Erica Rakowsky

Carcinoma of the nasopharynx: An analysis of 91 cases and a comparison of differing treatment approaches

Ninety‐one patients with malignant epithelial tumors of the nasopharynx seen in our department from 1970 to 1982 were evaluated. The 5‐ and 10‐year actuarial survival rates were 62.0% and 42.0%, respectively. Patients Seen from 1970 to 1979 were treated by radiotherapy to the primary site and upper neck, the lower neck being irradiated only in instances of massive disease. Those treated from 1980 to 1982 received elective irradiation of the whole neck, as well as adjuvant chemotherapy (consisting of cyclophosphamide, methotrexate, and either 5‐fluorouracil or bleomycin) for 6 to 12 months after completion of radiotherapy. Comparison of 3‐year actuarial survival (61.4% versus 83.3%) and disease‐free survival (49.7 versus 77.0%) rates show significantly improved results (P < 0.05) for those receiving combined therapy. In addition, significantly fewer (P < 0.05) distant metastases appeared in the combined therapy group at 18 months. A retrospective analysis comparing those patients who received full‐neck irradiation and adjuvant chemotherapy with those who received full‐neck irradiation alone showed a significantly improved survival (P < 0.02) and disease‐free survival (P < 0.05) for those patients with undifferentiated carcinomas, including lymphoepitheliomas, who received adjuvant chemotherapy.

Activity of porphobilinogen deaminase in peripheral blood mononuclear cells of patients with metastatic cancer

Porphobilinogen deaminase (PBGD), one of the enzymes in the pathway of heme synthesis, was found to be elevated in peripheral mononuclear cells of 60% of patients with epithelial tumors and metastatic spread, but only in 14% of patients with tumor and no evidence of metastases. The combination of both high lactic dehydrogenase and high PBGD afforded a sensitivity of 40%, but a specificity of 96% in diagnosing metastatic spread.

Classic Kaposi sarcoma: Experience at Rabin Medical Center in Israel

Classic Kaposi sarcoma is an indolent cutaneous proliferative disease affecting mainly elderly people of Mediterranean and Jewish origin. The authors review the epidemiologic and clinical findings in Israeli patients with classic Kaposi sarcoma treated at the Institute of Oncology, Rabin Medical Center. A total of 123 patients were identified. The average age at diagnosis was 68 years (range, 20-90 years) and, as expected, there was a strong predominance of men (2.4:1). All but two patients were Jewish. The distribution of Ashkenazic Jews and Sephardic Jews was almost equal. Twenty-three patients (19%) had secondary malignancies that were mostly solid tumors. The clinical course was indolent and rarely fatal (4% disease-related mortality). Multivariate analysis revealed that non-Ashkenazic origin, age over 70 years, multiple lesions (>10), and immunocompromised conditions adversely affected survival. Radiotherapy for localized skin lesions yielded an 88% objective response, with symptomatic relief in 95% of patients. Chemotherapy was similarly effective (76% response rate) in patients with disseminated disease. These data demonstrate the indolent nature of classic Kaposi sarcoma which usually requires a less aggressive therapeutic approach than in the African and AIDS-related types of Kaposi sarcoma.

Advanced non-small cell lung cancer: induction chemotherapy and chemoradiation before operation

BACKGROUND Induction chemotherapy before operation is beneficial for patients with advanced locoregional non-small cell lung cancer. However, no optimal regimen has been established. This study assesses feasibility, response, resectability, and survival of chemotherapy followed by chemoradiation before operation in patients with non-small cell lung cancer. METHODS Fifty-seven stage IIIA and selected IIIB patients with non-small cell lung cancer received 2/3 cycles of cisplatin and oral etoposide, followed in 3/4 weeks by chemoradiation with daily cisplatin before each radiation fraction. Patients achieving a resectable status underwent operation. RESULTS Response to induction treatment was documented in 73%; 69% achieved a resectable status and 53% underwent operation. Median survival was 16 months. The 1-, 2-, and 3-year survival rates were 65%, 35% and 22%, respectively. There was no difference in survival between stage IIIA and IIIB disease. Myelotoxicity was moderate to severe (grade III/IV in 61% of patients). Three patients died of late complications of pneumonectomy. CONCLUSIONS Our presurgery chemotherapy and chemoradiation protocol yields high response and resectability rates, with moderate to severe myelotoxicity. Pneumonectomy is associated with a relatively high rate of late complications.

Methotrexate-Induced Leukoencephalopathy is Treatable with High-Dose Folinic Acid: A Case Report and Analysis of the Literature

An episode of leukoencephalopathy is reported in a 13-year-old girl who, after standard radiotherapy for a posterior fossa medulloblastoma, received 8 treatments with a protocol containing a 4-hour infusion of 500 mg/m2 methotrexate and 12 mg intrathecal methotrexate. The leukoencephalopathy, documented clinically and by CT and EEG, cleared after 2350 mg of leucovorin (citrovorum factor, folinic acid) was given in addition to the 135 mg given as part of the therapy. A review of the literature suggests that leukoencephalopathy may be prevented by high doses of leucovorin and can be treated by high doses, if lower doses were used initially. When high dose leucovorin was not used, residual neurological damage is not unusual.

Leiomyosarcoma of kidney.

The case of a seventy-one-year-old woman with leiomyosarcoma of the kidney capsule is presented. Despite lack of invasion into surrounding tissues and few mitoses, the tumor recurred thirteen months after nephrectomy. A full subjective response and an almost complete objective regression lasting eight months were achieved using a short course of combination chemotherapy. The literature on leiomyosarcoma of the kidney is reviewed.

Is the delay in starting postoperative radiotherapy a key factor in the outcome of advanced (T3 and T4) laryngeal cancer

OBJECTIVE: To identify factors influencing the outcome of postoperative radiotherapy in patients with advanced laryngeal cancer. DESIGN: The files of 44 patients with advanced laryngeal cancer who were treated by surgery followed by radiotherapy (24 with pT3 and 20 with pT4) were reviewed. Median delay in starting radiotherapy was 50 days (range, 19–150 days). Treatment variables, in addition to certain patient and tumor characteristics, were analyzed in terms of locoregional control and survival. SETTING: Major referral tertiary center in central Israel. RESULTS: Locoregional control rates were 86% and 81% at 2 and 5 years, respectively, and corresponding survival rates were 82% for both. Only nodal involvement retained statistical significance for both locoregional control as well as survival on multivariate analysis (P = 0.0009 and P = 0.0004, respectively). CONCLUSIONS: This is the first study showing that delay in postoperative radiotherapy in advanced laryngeal cancer is not a significant predictor of locoregional control or survival in advanced laryngeal cancer. Only lymphatic spread was found to have a significant influence on treatment outcome.

Current developments in breast cancer

Interest in the prevention and early detection of breast cancer (BC) is increasing. Prevention studies are under way, and new data from mass screening trials are being evaluated. Improvement of the quality of mammography films and their proper interpretation are regarded as essential for effective early detection. With screening encompassing an increasing number of women, the rising proportion of suspicious breast findings has led to renewed efforts to improve the accuracy of cytologic diagnosis. Basic research continues to contribute to a better understanding of BC biology. Improved discrimination between subsets of patients with different prognosis is expected to optimize results of therapy in operable BC. Reports on taxol and suramin, new types of antitumoral drugs, as well as progress in monoclonal antibody therapy, may constitute preliminary steps towards novel therapeutic strategies.

Primary liposarcoma of the heart.

A rare form of primary heart tumour, a liposarcoma, is reported. A discussion of diagnosis and modalities of treatment of primary heart sarcomas is presented.