Leonard A. Parker

Induction chemoradiotherapy followed by esophagectomy in patients with carcinoma of the esophagus.

BACKGROUND Induction chemoradiotherapy followed by esophagectomy may provide results superior to those of single-modality treatment in patients with esophageal cancer. The purpose of this study was to review our experience with this approach for esophageal cancer. METHODS From 1988 to 1996, 166 consecutive patients with esophageal cancer were evaluated; 66 entered a protocol of chemotherapy (5-fluorouracil, cisplatin) concurrent with radiation (45 Gy) followed by esophagectomy. Fifty-four patients completed the protocol. RESULTS Toxicity associated with induction chemoradiotherapy was minimal. The actuarial survival at 12, 24, and 36 months was 59%, 42%, and 32%, respectively. The pathologic complete response (pCR) rate was 41%, with 12-, 24-, and 36-month survivals of 77%, 50%, and 45%, whereas non-pCR patients had survivals of 46%, 35%, and 23%. The difference in survival between pCR and non-pCR patients was not significant (p = 0.13), but the difference in recurrence-free survival was significant (p = 0.007). CONCLUSIONS This well-tolerated protocol resulted in a high pCR. Trimodality treatment for esophageal cancer may provide long-term survival in some patients regardless of their pCR status.

Amyloidosis : CT appearance of calcified, enlarged periaortic lymph nodes

The radiographic demonstration of lymph node involvement in amyloidosis is rare. We report a case of calcified, enlarged perioartic and mediastinal lymph nodes detected by CT.

Fulminant systemic necrotizing arteritis: CT findings.

Fulminant necrotizing arteritis can be a rapidly fatal disease with protean manifestations often suggesting other diagnoses. We present two cases with angiographic and CT correlation and discuss CT findings that are suggestive of the diagnosis.

Evaluation of T1N0M0 lung cancer with CT

Medical records and radiologic studies of 238 patients with non-small cell lung cancer who had preoperative evaluation by chest radiography and CT were reviewed. Thirty-six patients were staged as T1N0M0 by chest radiograph. Of this group, 18 (50%) had abnormalities on CT requiring additional evaluation. Confirmation of abnormalities was by tissue sampling or clinical follow-up. Evidence for unresectable spread of disease was obtained in 12 (33%). We conclude that routine preoperative staging of T1N0M0 lung cancer with CT has a positive impact on patient management.

Computed tomography in the evaluation of clinical stage IB carcinoma of the cervix

A retrospective analysis of 47 cases of clinical stage IB cervical carcinoma radiologically staged with computed tomography (CT) was undertaken. There were no cases where CT provided information which altered staging. In 5 cases, CT suggested extension of disease beyond the cervix which was not confirmed surgically or with other staging procedures. In 3 cases, one or more normal-sized obturator or internal iliac nodes with metastatic disease were discovered at surgery, but the high common iliac and periaortic nodes were disease free. We conclude that routine use of CT in patients with clinical stage IB cervical carcinoma is not warranted unless the patients body habitus precludes accurate physical examination.

Chronic posttraumatic aortic pseudoaneurysm: Recognition before rupture

Few patients survive transection of the aorta caused by blunt trauma. However, among those who do are a small number who go on to live with an unrecognized pseudoaneurysm that may rupture at any time. Because these aneurysms may be mistaken for more common disease processes, such as hilar adenopathy, atherosclerotic aneurysm, or neoplasia, the authors describe radiographic findings that suggest the correct diagnosis.

Chronic arsenic poisoning as a cause of increased hepatic density with CT.

Increased hepatic density on CT has been described in several clinical entities. We present a case of arsenic poisoning demonstrating both increased hepatic and splenic attenuation.

CT demonstration of central pulmonary venous and arterial occlusive diseases

Computed tomography was used to evaluate three patients with complicated pulmonary vascular patterns. The physiologic and anatomic changes seen on chest radiography were well defined by CT and in each case CT suggested the correct diagnosis.