Johnny B. Craig

Prospective evaluation of changes in computed cranial tomography in patients with small cell lung carcinoma treated with chemotherapy and prophylactic cranial irradiation.

Computed cranial tomographic scans were performed as part of the pretreatment evaluation and at six- to nine-month intervals posttreatment in 13 patients with small cell lung carcinoma. All patients received 3,000 rad of prophylactic cranial irradiation delivered over two weeks in ten treatment fractions in conjunction with multiagent chemotherapy. Posttreatment scans documented an extraordinarily high frequency of abnormalities including cerebral atrophy (100%), ventricular dilatation (70%), and decreased coefficient of absorption in the white matter (15%). Unexplained neurologic abnormalities developed in four of six patients living at least 15 months after institution of therapy. As the number of long-term survivors of this type of lung cancer increases, the need for prospective comprehensive neuropsychologic assessment to determine the clinical significance of these changes is needed.

Secondary malignancies of the penis and epididymis: A case report and review of the literature

A patient with carcinoma of the colon developed metastases to the penis and right epididymis. These two organs are rare locations for metastases and the concurrent involvement of both sites has not been previously described. Our patient and the results of a literature review are presented. Two hundred eighteen cases of penile and 37 separate cases of epididymal metastases were identified. The genitourinary and gastrointestinal tracts were the predominant sites of the primary malignancies. Presenting symptoms, the interval between diagnoses of the primary and metastatic lesions, and the therapy of the penile/epididymal deposits varied greatly. Surgical excision is the major mode of therapy; radiotherapy, chemotherapy, or hormonal therapy may be beneficial in selected cases. Survival among these patients is poor due to the presence in most patients of widespread metastases in addition to their genital lesions. However, instances of prolonged survival are noted in both groups. Patient characteristics and possible mechanisms of metastatic spread to the genitals are discussed.

Second primary bronchogenic carcinomas after small cell carcinoma: Report of two cases and review of the literature

Second primary carcinomas of the lung are well described. However, their occurrence following initial diagnosis of small cell lung carcinoma is rare. The development and antemortem diagnosis of metachronous second primary bronchogenic carcinomas in two long-term (more than four years) survivors of small cell lung cancer is described. The histologic types of the second carcinomas were mucoepidermoid and bronchoalveolar. On the basis of a review of the literature, only eight similar cases have been reported; none of the second primaries was mucoepidermoid or bronchoalveolar. The question of whether second primaries after small cell lung cancer represent true metachronous carcinomas, different degrees of differentiation of the same tumor, or the emergence of a previously unrecognized synchronous tumor is discussed. The need for awareness of this complication and the necessity for life-long follow-up in long-term survivors of small cell lung cancer is emphasized.

A phase II trial of high-dose cytarabine and cisplatin in previously untreated non-small cell carcinoma of the lung: a piedmont oncology association study

Thirty‐seven chemotherapy‐naive patients with advanced non‐small cell lung cancer (NSCLC) were treated with cytarabine (3 g/m2 intravenously [IV] during 3 hours) after IV bolus cisplatin (100 mg/m2 repeated every 3 weeks). Aside from nausea and vomiting, the principal toxicity was hematologic, with Grade IV myelosuppression in 32% and Grade III in 14%. Four patients died while on study. One complete and four partial responses were observed for an overall response rate of 14%. Responses were limited to lymph node and lung metastases and occurred in two of 17 adenocarcinomas, two of 12 squamous cell carcinomas, and one of eight large cell carcinomas. At this dose, the plasma level of cisplatin is only 3 μg/ml and the plasma level of cytarabine is 10 to 50 μg/ml, compared with the levels of 10 μg/ml and 1000 μg/ml, respectively, required for in vitro synergy. The severity of myelotoxicity observed indicates that, even at these levels, cisplatin enhances cytarabine activity. The combination may prove useful in malignancies that are sensitive to cytarabine, but is not of benefit in cytarabine‐resistant malignancies such as NSCLC.

Sequential hemibody irradiation integrated into a chemotherapy-local radiotherapy program for limited disease small cell lung cancer

Twenty-four patients with limited disease small cell lung cancer (SCLC) were treated with sequential hemibody irradiation (SHB) integrated into a conventional chemotherapy-local radiotherapy (LRT) program. Among 23 evaluable patients, 12 (52%) attained a complete response (CR) and 8 (35%) attained a partial response for an overall major response rate of 87%. The median time since study entry is 29 months. Durations of response are 9.9 months for all patients and 16.5 months for patients who achieved a CR. The primary site was the predominant area of recurrence. The median survival is 13.2 months for all patients and 23.2 months for the 12 patients who attained a CR. Myelosuppression, especially thrombocytopenia, was the major toxicity. Acute radiation toxicities and subacute pneumonitis previously associated with hemibody radiotherapy were well controlled or prevented using the current dose, premedication, and shielding techniques. This integrated program of systemic therapies with SHB and combination chemotherapy plus LRT is feasible for limited disease SCLC; it may prolong survival in patients who attain a CR but compared to similar programs without hemibody irradiation, there was no improvement in overall response rate, response duration, or survival.

Phase II trial of high-dose cytosine arabinoside and cisplatin in recurrent squamous carcinoma of the head and neck: a piedmont oncology association study

Fifteen patients with recurrent squamous carcinoma of the head and neck received high-dose cytosine arabinoside (araC) (3 g/m2) and cisplatin (100 mg/m2) every 3 weeks in an attempt to explore the dose-dependent synergy between these two agents. A partial response was attained in one patient; there were no complete responses. The major toxicity was myelosuppression. With the current schedule, high-dose ara-C failed to improve the response rate achieved with cisplatin alone.

The Prevention and Treatment of Immediate Hypersensitivity Reactions From Cancer Chemotherapy

I N THE PRESENT-DAY PRACTICE of medical oncology, administration of chemotherapeutic drugs is one of the primary responsibilities of oncology nurses. These specialists are welleducated in the appropriate management of the common adverse side effects of chemotherapeutic agents, including nausea, vomiting, and bone marrow suppression. However, until recently, the importance of hypersensitivity reactions, an often serious complication of chemotherapy administration, has received little attention. Since these potentially life-threatening reactions occur immediately after drug administration-a time when frequently only nursing personnel are available-oncology nurses should be well-informed in the recognition and treatment of immediate hypersensitivity reactions resulting from cancer chemotherapy. Hypersensitivity reactions to drugs are the result of a reaction between antibodies and a foreign antigen, in this case, the chemotherapy drug. These reactions are divided into four classes-types I, II, III, and IV-based upon the mechanism by which the drug results in tissue damage (Table l).’ Type I, immediate hypersensitivity reactions (anaphylactic, anaphylactoid), will be the focus of this article. Anaphyluxis is a generic term used to describe the clinical manifestations of any type I reaction.

Treatment of advanced colorectal carcinoma with actinomycin D, vincristine, methyl-CCNU, and methotrexate.

Twenty patients with advanced colorectal carcinoma were treated with combination chemotherapy consisting of acti-nomycin D, vincristine, methyl-CCNU, and methotrexate. Fourteen patients had received prior chemotherapy with 5-fluorouracil (5-FU). No complete responses and only one partial response were observed for an overall response rate of 5%. The combination of actinomycin D, vincristine, methyl-CCNU, and methotrexate at the doses and schedule used was of no value in the treatment of patients with metastatic colorectal carcinoma.