Q. Scott Ringenberg

Bone marrow involvement in small cell lung cancer. Clinical significance and correlation with routine laboratory variables.

Of 129 patients with small cell lung cancer (SCLC) who underwent bone marrow examination for staging, 39 (30%) had bone marrow involvement. Only three of 129 patients (2.3%) had bone marrow involvement as the only site of metastatic disease. When patients with bone marrow metastasis were compared with patients whose bone marrow was normal, there were significant differences in serum levels of lactate dehydrogenase (LDH), glutamic oxalacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), alkaline phosphatase (AP), albumin, and sodium (Na). We found no clinically significant difference in survival between patients with extensive disease with or without bone marrow involvement. Serum Na, albumin, SGOT, and uric acid were important prognostic determinants of survival. Based on the results of this study, we do not recommend routine bone marrow examinations in the staging of SCLC.

Malignant ascites of unknown origin

To determine the clinical characteristics of patients presenting with malignant ascites, as well as means of evaluating the outcome of patients with the disease, a retrospective review was conducted of all cases of malignant peritoneal effusions diagnosed from 1978 to 1987 at a University Hospital and a Veterans Administration Hospital. Of 65 patients with malignant ascites (40 women; 25 men), the primary site was known in 51 cases (80%). Common sites in women were the ovaries, endometrium, and cervix; in men, common sites were the colon, rectum, and stomach. For five women and nine men the primary site was unknown. Median survival from diagnosis was 7.5 days (mean, 43 days; range, 1–256 days). Chest radiograph and abdominal computed tomography (CT) scan did not disclose the occult primary. An occult primary was detected while the patient was alive in only two cases and at autopsy in two other patients. Due to the poor prognosis for this disease, we do not recommend an aggressive approach to malignant ascites of unknown origin, except perhaps in women, in whom ovarian cancer should be suspected.

Chronic Calcium Antagonist Use in Carcinoma of the Lung and Colon: A Retrospective Cohort Observational Study

Detailed records were maintained prospectively of all medications taken by 719 patients with advanced carcinoma of the lung or colon. Of this total, a cohort of 19 patients was identified who had ingested incidentally either nifedipine, diltiazem, verapamil, or trifluoperazine in standard therapeutic doses for a minimum of one month and a mean of 5.8 months and median of three months. Treatment with these calcium antagonists was well tolerated and, upon comparison with otherwise comparable patients who did not ingest a calcium antagonist, appeared to be associated with certain favorable outcomes, including delayed tumor progression and prolonged survival. These preliminary findings suggest that beneficial effects of such drugs observed with chronic treatment in experimental animal tumor models may occur in human disease and that definitive prospective, randomized, clinical trials of calcium antagonists administered continuously in ordinary therapeutic doses are both feasible and justified.

A randomized trial to compare intravenous and oral etoposide in combination with cisplatin for the treatment of small cell lung cancer

In a randomized multi‐center study, 83 patients with small cell lung cancer were randomly assigned to treatment with cisplatin 100 mg/m2 intravenously (IV) day 1 and etoposide 120 mg/m2 IV days 1, 2, and 3 or cisplatin 100 mg/m2 IV day 1 and etoposide 120 mg/m2 IV day 1 and 240 mg/m2 orally days 2 and 3. Both regimens were repeated every 4 weeks. Prior to randomization, patients were stratified by extent of disease, performance status, and gender. A total of 41 patients were randomly assigned to the parenteral treatment only regimen, and 42 patients received cisplatin and IV/oral etoposide therapy. Both treatment arms were comparable regarding patient characteristics. Limited disease (LD) patients constituted 52% and 49% of the patient population for the oral and IV etoposide regimens, respectively. The overall complete response (CR) and partial response (PR) rate was 50% (95% confidence interval [CI] 35% to 65%) for the oral etoposide regimen and 59% (95% CI 44% to 74%) for the IV etoposide regimen (P = 0.438). For both regimens, 55% of the LD patients achieved either CR or PR. Time to progression and survival were comparable for both treatment arms. Hematologic toxicity was comparable in both treatment arms, with 80% of patients experiencing grade 3 or 4 neutropenia or thrombocytopenia. Moderate to severe anemia and weight loss were more predominant with the IV than with the oral regimen.

Interferons in the Treatment of Skin Disease

Interferons are naturally occurring antiviral agents that combat infection and enhance immune surveillance. Interferons produced from natural sources and, more recently, by recombinant DNA technology bave been used to treat a variety of skin infections, cutaneous neoplasms, and skin diseases often in recalcitrant forms, when all other tberapy bas failed. Although successful in treating several neoplasms, the use of interferons in clinical trials in combating viral infections has been somewhat less dramatic and the progress slower. Tbis expanding area of clinical research bas many implications to dermatology. In this review, our current understanding of the toxicity, clinical uses, and mechanism of action of interferons will be discussed. In the areas where current investigations provide conflicting conclusions or demonstrate a lack of progress, explanations and questions for further investigation will be sougbt.

Postmastectomy educational needs and social support.

Due to shorter hospitalization periods and changes in surgical procedures, breast cancer patients have less inpatient contact with rehabilitation resources. A questionnaire related to educational needs and social support was mailed statewide to 2,000 postmastectomy women who had received a Reach to Recovery visit. The findings are based on quantitative data reported by 933 women and from 27 women in follow-up interviews. Respondents ranked their educational needs in six categories from greatest to least importance as follows: (1) information about breast cancer, (2/3) personal hygiene/exercise and nutrition/weight control (both ranked of equal importance), (4) prosthesis/clothing information, (5) social support, and (6) sexual issues. Performance on the knowledge assessment correlated directly with the amount of educational experience and inversely with age. Respondents who lived in communities of less than 2,500 were less informed than those from other locations. Participation in formalized support groups was infrequent (11%). The major source of information was the media, with 88% indicating they would watch television programs about breast cancer. Thirty-three percent of the respondents indicated they owned a video cassette recorder (VCR); about 93% said VCRs were available for rent in their community. Work associates were identified as a group that encouraged information seeking; health care professionals were the most successful in motivating women to participate in support groups.

Clinical cardiotoxicity of esorubicin (4′-deoxydoxorubicin,DxDx): Prospective studies with serial gated heart scans and reports of selected cases - A Cancer and Leukemia Group B report

SummaryEsorubicin (4′-deoxydoxorubicin, DxDx) has undergone extensive Phase II investigation for the treatment of cancer. Based on in vitro and animal data, esorubicin may possess less myocardial toxicity when compared to doxorubicin. One hundred thirty-six patients with histologically or cytologically documented non-small cell lung cancer or advanced breast cancer were enrolled in two concurrent CALGB clinical trials using esorubicin at a dose of 30 mg/m2 administered intravenously every 21 days. No patient had previously received an anthracycline agent or had evidence of severe cardiovascular disease. Cardiotoxicity was observed in eleven patients. Four patients developed symptoms of congestive heart failure and three asymptomatic patients had a significant fall in left ventricular ejection fraction (LVEF) as measured by gated pool heart scan. Four patients had cardiac signs or symptoms of indeterminate relationship to esorubicin therapy. Of 44 patients receiving more than four cycles of therapy, 36 patients (82%) had serial gated pool heart scans permitting assessment of subclinical myocardial toxicity. A 5% drop in LVEF was observed following approximately 240 mg/m2 esorubicin; a 10% drop was observed after approximately 480 mg/m2. If further clinical studies are undertaken with esorubicin, investigators are advised to monitor cardiac function frequently once the cumulative esorubicin dose exceeds 240 mg/m2. If congestive failure appears during therapy, prompt cessation of esorubicin and institution of inotropic agents may provide effective palliation. Normal myocardial function may be restored within several months.

Collecting cancer registry data with a cancer patient questionnaire

Tumor registries provide a valuable source of treatment, survival, and epidemiologic data but have been faulted for incomplete and insufficient collection of data. An eight page, 38-item Cancer Patient Questionnaire (CPQ) was developed to collect more extensive information for the tumor registry. The CPQ identified significantly more patients with a family history of cancer than had previously been detected by chart review by the tumor registrar. The CPQ agreed with data collected by the tumor registry in 96% of cases for place of birth, 84% of cases for occupational history, 91% of cases for tobacco use, and 88% of cases for number of pregnancies or live births. The Cancer Patient Questionnaire is complete and easy to use and may replace the chart review in the collection of these data.

Lymphomas associated with HIV infection

INCE the initial reports of non-Hodgkin’s lymphoma (NHL) in patients with acquired immunodeficiency syndrome (AIDS) in 1982,‘,* it has become increasingly apparent that individuals with human immunodeficiency virus (HIV) infection are at an increased risk of developing aggressive malignant lymphomas.3-5 indeed, a diagnosis of high-grade B-cell lymphoma or primary cranial lymphoma in an HIV-infected patient is now recognized as an indicator disease of AIDS.6 These lymphomas mostly affect young males and are predominantly high- and intermediate-grade histologic type, according to the working formulation.7 Patients often present with advanced disease in extranodal sites, particularly the central nervous system (CNS), bone marrow, and gastrointestinal (GI) tract. 3-5 Response to chemotherapy is poor and the prognosis is dismal, with a median survival of less than 1 year.4 Although Hodgkin’s disease has also been described in association with HIV infection,*-‘* it is currently not included among the diagnostic criteria of AIDS. We review herein the incidence, clinical features, pathology, treatment, prognosis, and pathogenesis of lymphomas associated with HIV infection. [Nursing management of many of the problems associated with lymphomas is discussed by McMahon and Coyne elsewhere in this issue.]