Joseph Levin

Significance of serum concentrations of carcinoembryonic antigen, ferritin, and calcitonin in breast cancer

Serum concentrations of carcinoembryonic antigen (CEA), ferritin, and calcitonin were measured in 107 patients with breast cancer, 80 of whom had overt or occult metastatic disease. CEA and ferritin values were statistically higher in those patients with metastases. In contrast, there was no correlation between calcitonin concentrations and the stage of the disease. All 27 subjects with CEA concentrations greater than 80 μg/liter and 32 of 40 with values between 41–80 μg/liter had metastatic disease. Ferritin was a definite but less sensitive discriminator, with metastatic disease present in all nine patients having concentrations greater than 400 μg/liter. Such metastases were invariably hepatic. When the two measurements were used as a combined discriminant, the diagnostic accuracy increased somewhat. All 32 patients with a CEA concentration greater than μg/liter and/or a ferritin concentration greater than 400 μg/liter had metastatic disease; the same was true for 32 of the 42 subjects with CEA concentration between 41–80 μg/liter and/or a ferritin concentration between 200–400 μg/liter. The measurements had prognostic value, both when assessed alone and together, with a median survival from the time of study significantly shorter in those with the highest values.

Treatment of metastatic breast cancer in estrogen receptor positive patients a randomized trial comparing tamoxifen alone versus tamoxifen plus CMF

In a controlled clinical trial, 52 patients with ER positive metastatic breast cancer were randomly assigned to receive initial treatment with either tamoxifen alone followed by sequential cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) after tumor progression or concurrent tamoxifen plus CMF. All 52 patients entered are eligible and 50 patients were currently assessable. Response rates (CR + PR) were similar for the two treatment groups (15/24 tamoxifen alone, 17/26 tamoxifen + CMF). The median durations of survival for the two treatment groups 17.7 months and 17.1 months were also not significantly different. Significant correlations were found between level of ER and response rate and also between level of ER and response duration. From the result of this investigation it would appear that there is no advantage to the addition of chemotherapy prior to an adequate trial of hormone therapy in patients with metastatic ER positive breast cancer.

Radiation Therapy in Breast Cancer: Optimal Combination of Technical Factors; Analysis of Five-Year Results

Although both mastectomy and radiation have been used in the treatment of breast cancer for over half a century, there is still no unanimity among surgeons or radiotherapists as to the value of such treatment in general, much less as to the relative merits of the two modalities and the various technical differences in the application. According to some authorities (49, 58), it is doubtful whether the average survival of patients with breast cancer can be improved by any form of therapy currently available, be it radical surgery or radiation therapy, although the palliative value of treatment for the locally advanced or metastatic stages of the disease is generally accepted. Whether a combined procedure can achieve more than either modality alone or, more specifically, the extent to which radiation can improve upon the overall salvage rate with surgery alone, remains obscure. Before any form of therapy can be assessed, therefore, it is necessary to define its objectives and limitations. There is some evide...

Cyclic nucleotides in biological fluids in hepatocellular carcinoma

To investigate the prediction that urinary cGMP (UcGMP) and cAMP (UcAMP) excretion is altered in a manner consistent with unregulated cell growth in hepatocellular carcinoma (HCC), we studied 31 patients with this disease, 25 without apparent disease, 16 with various hepatic diseases, and 16 with nonhepatic neoplasms. Results were expressed as UcGMP excretion per 100 ml glomerular filtration because reduced creatinine excretion in patients with muscle wasting or renal dysfunction may spuriously elevate UcGMP. UcGMP excretion was elevated in 80% of patients with HCC, 75% of patients with hepatic disease and 68% of patients with other neoplasms. Mean values for UcAMP excretion did not differ significantly from normal values. Plasma and ascitic fluid cGMP concentrations in HCC and hepatic diseases were raised. These results support the hypothesis of a shift in cyclic nucleotide metabolism toward cGMP in malignant diseases. However, UcGMP measurement does not detect progression of cirrhosis to HCC.

Scintigraphy in the Diagnosis of Hepatocellular Carcinoma

The introduction of hepatic scintigraphy in the late 1950s represented a major advance in the diagnosis of focal hepatic lesions because it became possible for the first time to obtain images of the liver with a noninvasive procedure. Several years were to elapse before alternative and perhaps better hepatic imaging modalities became available, and during this time radio-tracer scanning proved to be invaluable, both in the recognition of hepatocellular carcinoma and in the evaluation of patients with this tumor. Scintigraphy was used to confirm (or in some patients to establish) the presence of a “space-occupying lesion” in the liver, to provide a reasonably accurate assessment of the size, position, the extent of the tumor when resectability was being considered, and to determine the optimal site for percutaneous biopsy of the lesion.

57-Cobalt-bleomycin as a tumor scanning agent in primary hepatocellular cancer

Abstract57Co-bleomycin and 99mTc-sulfur colloid scans were performed in 13 southern African black patients with primary hepatocellular cancer (PHC) and 3 patients with other space-occupying hepatic lesions. Selective concentration of 57Co-bleomycin in the defect or defects seen on the 99mTc-sulfur colloid scan occurred in only 4 of the 13 (31%) patients with PHC. In the remaining PHC patients, as well as in the 2 patients with metastatic liver disease and the 1 patient with an amebic liver abscess, the 57Co-bleomycin and 99mTc-sulfur colloid scans were identical. 57Co-bleomycin appears to have only a limited place as a tumor-seeking agent in the diagnosis of PHC in southern African blacks.

Technetium-99m glucoheptonate as a scanning agent in hepatocellular carcinoma

Technetium-99m glucoheptonate (Tc-99m GH) is concentrated in pulmonary and cerebral tumors. The purpose of this study was to assess the uptake of this radionuclide by hepatocellular carcinoma. Its concentration by the primary tumor was compared with that in the non-neoplastic hepatic tissue in 31 patients who showed obvious defects on a colloid scan, and its uptake by pulmonary metastases was examined in six patients with x-ray evidence of this complication. In two patients, the uptake by the tumor was greater than, in six it was equal to, and in ten it was less than that in the non-neoplastic hepatic tissue. In the remaining 13 patients, there was no concentration at all in the tumor. In none of the six patients with multiple pulmonary metastases could uptake of Tc-99m GH by the metastases be demonstrated. It is concluded that Tc-99m GH is of limited value in the diagnosis of primary or metastatic hepatocellular carcinoma.

The clinical value of scintigraphic brain scanning. Experience at the Hillbrow Hospital, Johannesburg, South Africa.

Patients were referred to the Department of Nuclear Medicine for brain scintigraphy to be screened for possible intracranial pathology. These referrals were made in order to reduce the heavy load on the transmission computerized tomography (TCT) facilities. Great clinical importance, therefore, has been attached to scintigraphic findings; this emphasizes the need for an accurate assessment of the predictive value of this procedure.