Henry A. Briele

Soft tissue sarcomas of the adult head and neck

From 1969 to 1983, 53 adult patients with head and neck soft tissue sarcomas were evaluated and treated by the Division of Surgical Oncology at the University of Illinois. The most common anatomic location was the neck (36%), and these patients had the highest 5‐year disease‐free survival rate (67%). Fibrosarcoma was the most common histologic type (26%); patients with aggressive fibromatosis had the longest mean survival time (93 months). The mean overall survival time was 58.7 months, and the disease‐free 2‐year, 5‐year, and 10‐year survival rates were 68%, 54%, and 28%, respectively. Wide excision was the treatment of choice, with adjuvant radiotherapy or chemotherapy, or both, used in selected patients. In all of the long‐term survivors, the tumors were either well‐differentiated or ≤5.0 cm in diameter. It is apparent that aggressive therapy of such tumors can provide good long‐term results.

Soft tissue sarcomas of the adult thoracic wall

Forty‐nine adult patients with soft tissue sarcomas of the thoracic wall have been treated by the Division of Surgical Oncology at the University of Illinois. Fibrosarcoma was the most common histologic type (20%). Patients with dermatofibrosarcoma protuberans had the longest mean overall survival time (150.8 months). The mean overall survival time for all patients was 98.2 months, and the disease‐free 2‐, 5‐, and 10‐year survival rates were 68%, 51%, and 34%, respectively. Wide excision was the treatment of choice; selected patients also received adjuvant radiotherapy, chemotherapy, or both. In all 10‐year survivors, the sarcomas were low grade and well differentiated, or were ≤5.0 cm in diameter. Aggressive treatment afforded these patients good long‐term results. Cancer 59:370–373, 1987.

Malignant melanoma of the female genitalia

Fifteen women with genital malignant melanoma were studied. Their ages ranged from 19 to 66 years (mean 49.1 years); 12 were white, and three were black. The sites of involvement were the mons pubis (one patient), perineal body (one), labium majus (three), labium minus (three), and vagina (seven). Ten patients (66.6%) died of their disease, one is alive with disease, and four are alive without evidence of disease. For the living patients the duration of follow-up was 20 to 118 months (mean 63.6 months). Of those who died, survival ranged from 3 to 76 months (mean 25.1 months). The predominant type of malignancy was superficial spreading melanoma 50%. Nodular melanoma represented 22%, and the nodular polypoidal variant 14%. Melanoma of the squamous mucosa, also referred to as lentiginous melanoma, constituted 14%. By using Chungs method of determining levels of invasion, we found that no lesion was in situ (level I), two were level II (less than 1.0 mm thick), one was level III (between 1.0 and 2.0 mm) and the remaining 11 patients had lesions that were greater than 2.0 mm (levels IV and V). Because the subcutaneous fat is not consistently present in all sites of the female genitalia, all tumors thicker than 2.0 mm were included in level IV, and no level V tumors were classified in our study. Using Breslows microstaging method, we found the thickness to range from 0.65 to 9.5 mm (mean 4.75 mm). When we correlated survival with level and thickness of tumor in nine patients who died, one tumor was level III and eight were level IV; thickness ranged from 1.65 to 9.0 mm (mean 5.64 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Results of treatment of stage I-III breast cancer in black Americans: the Cook County Hospital experience, 1973-1987

Whether the prognosis for black women with breast cancer differs from that of nonblack women remains controversial. The treatment results of 526 black women who received definitive therapy for Stage I‐III breast cancer at Cook County Hospital, 1973 through 1987 are presented. The 5‐year and 10‐year projected survival rates for 272 node‐negative patients (83.9% and 76.6%, respectively) and for 72 node‐positive nonadjuvant treated patients (58.1% and 35.2%, respectively) are similar to those reported in the literature for nonblack patients. Adjuvant therapy improved the projected relapse‐free (P = 0.0744) and overall survival curves (P = 0.0448) for 182 node‐positive patients compared with nonadjuvant patients. The greatest benefit was seen for patients > 50 years of age with one to three positive nodes. The incidence of estrogen and progesterone receptors was found to be similar to those reported for nonblack patients. Once breast cancer has been diagnosed and appropriately treated, there appear to be few differences in the natural history of breast cancer between black and nonblack patients.

Natural history of cutaneous malignant melanoma.

The rising incidence of cutaneous malignant melanoma with the consequent increase in mortality from melanoma has intensified efforts to understand the factors that initiate the malignant transformation of melanocytes and to define those tumor-host interactions that play a relevant role in the clinical course of this disease. Increased exposure to solar radiation has been proposed as an explanation for the rising incidence of melanoma observed in light-skinned races. Because of the low incidence of melanoma in darkly pigmented races and its tendency in these individuals to develop in relatively nonpigmented areas, such as the sole of the foot, it is postulated that melanin, in addition to its well-known photoprotective effects, may protect against certain intrinsic carcinogenic agents. Developing cutaneous malignant melanomas progress through several cell types that have varying potentials for invasion and metastasis. This developmental process can be appreciated by examination of the various histologic types of melanomas. Early superficial spreading melanoma and lentigo maligna melanoma are characterized by cells that exhibit a prolonged intraepidermal growth phase, and most of these lesions can be diagnosed while they are still curable by simple surgical therapy. Subpopulations of more aggressive cells eventually develop, however. These cells also may characterize the initial stages of nodular melanoma in which the intraepidermal growth phase is absent and early invasion is common. Prognosis for survival depends on the depth of invasion of the primary tumor. Microstaging of the depth of invasion together with information as to mitotic index, sex, site, age, and histologic type will usually predict the natural history of the disease. With present-day management, the overall long-term, disease-free survival rate of patients with cutaneous melanoma is 60–70% and compares favorably with that of the more common cancers.RésuméLa fréquence croissante des mélanomes malins et laugmentation de la mortalité ont stimulé les recherches qui étudient les facteurs de transformation maligne des mélanocytes et les interactions hôtetumeur qui jouent un rôle important dans lévolution de cette maladie. On a suggéré que lexposition aux rayons solaires expliquait laugmentation de fréquence du mélanome dans les races à peau claire. Comme le mélanome est rare dans les races à peau foncée et quil apparait, chez ces individus, de préférence dans les zones non pigmentées, telles que la plante du pied, on pense que la mélanine, outre ses effets photoprotecteurs, pourrait également protéger contre certains agents carcinogènes intrinsèques. Au cours de leur développement, les mélanomes malins cutanés passent par divers types cellulaires dont les potentialités invasives et métastatiques varient. Ce mode de développement peut être démontré par létude des divers types histologiques de mélanomes. Le mélanome à extension superficielle au stade précoce et le mélanome malin à aspect de lentigine sont caractérisés par des cellules qui ont une longue phase de croissance intra-épidermique: la plupart de ces lésions peuvent être diagnostiquées à un stade où elles sont encore curables par la seule chirurgie. Plus tard peuvent se développer des sous-populations de cellules plus agressives. Ces cellules peuvent être également caractéristiques des stades initiaux du mélanome nodulaire, pour lequel la phase de croissance intra-épidermique est absente et linvasion souvent précoce. Le pronostic dépend de la profondeur de lenvahissement par la tumeur primitive. Lhistoire naturelle de la maladie peut en général être prédite par la définition microscopique du degré denvahissement et de lindex mitotique, ainsi que par le sexe, lâge et la localisation. Avec les possibilités thérapeutiques actuelles, la survie à long terme sans récidive est de 60–70%; elle est donc comparable à celle dautres cancers plus fréquents.