Harvey Brodovsky

Non‐hodgkin's lymphomas: A clinicopathologic study of 293 cases

Retrospective clinicopathologic study of 293 cases of non‐Hodgkins lymphomas was performed. Nodularity was quantitatively graded 0 through +4. Higher degrees of nodularity were associated with improved survival. Comparing nodular and diffuse groups, nodularity was associated with improved survival for each cell type except mixed lymphoma. Within nodular and diffuse groups survival advantage was shown to be related to cell type. In NLPD and NM, male sex and systemic symptoms adversely affected survival. In DLPD and DM, advanced clinical stage, old age, and systemic symptoms were associated with poor outlook, sex having no significant effect. In DH, only the absence of systemic symptoms was beneficial; clinical stage, sex, and age showed no effect on the poor outcome. No survival advantage was observed for cases with histologic evidence of nodular fibrosis. Vascular invasion was demonstrated in 18% of nodular and 27% of diffuse lymphomas and was most common in mixed and histiocytic types. However, survival was adversely affected only in histiocytic lymphomas. No direct association between vascular invasion and wide‐spread dissemination was observed. The results suggest that only cases with well developed histologic nodularity have improved survival over diffuse lymphoma, and affirm the prognostic value of the pathologic classification of Rappaport.

Cooperative groups and community hospitals. Measurement of impact in the community hospitals

The Eastern Cooperative Oncology Group, composed of major cancer treatment centers, has an outreach program which involves community hospitals in ongoing cancer clinical trials. A prevalence survey was carried out in February 1981 among 104 community hospitals and 21 member institutions to determine the characteristics of patients being treated, their staffing, and reasons why patients were not on protocol studies. The survey sampled 25 (50) consecutive patients from community hospitals (member institutions). The purpose of the study was to assess the impact of a community cancer control program. The results of the study demonstrated that 16% of patients surveyed in the affiliated community hospitals were being treated on a research protocol. In addition, a further 35% had their treatment plan influenced by a protocol. Consequently protocols have impacted directly or indirectly on 51% of the patients. The corresponding figures in member institutions were 23% and 38% for a total of 61%. In studying protocol availability, it was found that 66% of all patients were ineligible for any protocol. Of patients eligible for a protocol but not registered on one, 52% were not registered because of physician preference for a specific treatment. The affiliates surveyed were shown to be on average half as large as member institutions in terms of number of beds and staff size. Also, staff/patient ratios are generally smaller in the community hospitals. The median age of patients was considerably lower than SEER incidence data. Also, elderly patients were slightly more prevalent in community hospitals than in member institutions. A clear relationship between disease stage and age in breast cancer patients was noted with the representation of early‐stage disease much higher in young women.

Association of subacute motor neuronopathy with thymoma

A case of subacute motor neuronopathy in association with thymoma is described. Subacute motor neuronopathy is marked by a painless, progressive, and asymmetric muscle weakness that usually affects the lower extremities. It is a rare paraneoplastic effect of tumors that has been described with both Hodgkins and non‐Hodgkins lymphoma. This is the first case report of its association with thymoma.

Comparison of melphalan with cyclophosphamide, methotrexate, and 5-fluorouracil in patients with ovarian cancer.

Melphalan (L‐PAM) was compared to (C) cyclophosphamide, (M) methotrexate, and (F) 5‐fluorouracil (CMF) in 413 patients with advanced ovarian carcinoma. L‐PAM was given 3.5 mg/m2 twice daily for 5 days every 5 weeks. CMF doses were: C, 400 mg/m2; M, 15 mg/m2; and F, 400 mg/m2 IV on days 1 and 8 every 28 days. Three hundred seventy‐five patients have been analyzed (L‐PAM, 190; CMF, 185). One hundred fifty‐three patients (41%) had measurable disease, 109 (29%) had evaluable disease, and 113 (30%) had nonmeasurable, nonevaluable disease. Response rates for patients with measurable and evaluable disease combined were similar: L‐PAM, 32/130 (24%) (15% complete response); CMF, 47/132 (35%) (18% complete response). Patients with Stage IV measurable disease had a greater response rate to CMF, 22/52 (42%) versus L‐PAM, 6/39 (15%). Survival and time to treatment failure were similar for both treatment regimens. Survival was improved in responders. Medians are: complete response, 28.1 months; partial response, 12.3 months; and no response, 6.7 months. Disease stage, performance status and age were identified as important prognostic variables for both survival and time to treatment failure.

A randomized multicenter trial of cyclophosphamide, Novantrone and 5-fluorouracil (CNF) versus cyclophosphamide, Adriamycin and 5-fluorouracil (CAF) in patients with metastatic breast cancer

SummaryAs of August 1984, 115 women with advanced breast cancer have been randomized to receive a combination of either cyclophosphamide, Novantrone (mitoxantrone) and 5-fluorouracil (CNF) or cyclophosphamide, Adriamycin (doxorubicin) and 5-fluorouracil (CAF). Seventy-one percent of all patients were postmenopausal and 44% of CNF patients and 57% of CAF patients were estrogen receptor (ER) negative. Slightly over 30% of all patients had received hormonal therapy or chemotherapy in an adjuvant setting.Hematologic toxicity was similar in regard to platelet counts but slightly lower nadirs were experienced with CNF therapy than with CAF. However, there were fewer dosage decreases with CNF. Significantly less nausea and vomiting were observed with the CNF regimen compared to CAF. Moreover, alopecia was reduced appreciably in patients who received CNF.The response rate to CNF for the first 38 eligible and evaluable patients was 42%, and for 53 eligible and evaluable patients who received CAF the response rate was 45%, a non-significant difference. Median response durations were similar also, 140 days for CNF and 168 days for the CAF regimen. Time to treatment failure was similar for both regimens.CNF is an effective regimen for patients with advanced breast cancer, with less toxicity than CAF.

Renal carcinoma in mother and daughter

The histories of a mother and daughter with renal cell carcinoma are presented. To our knowledge, this is the first such occurrence to be reported. The tumor occurred in the daughter at age 26, and in the mother 14 years later at 60 years of age. Other instances of familial renal tumors are cited and discussed.